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National Multi-Sector Nutrition Policy 2018–2022 April 2018

Malawi National Multi-Sector Nutrition Policy 2018-2022

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Page 1: Malawi National Multi-Sector Nutrition Policy 2018-2022

National Multi-Sector Nutrition Policy

2018ndash2022

April 2018

copy 2018 Department of Nutrition HIV and AIDS

$amp$( The Government of Malawi recognises that adequate nutrition is a prerequisite for human growth and development as it plays an important role in onersquos physical and intellectual development and consequentially work productivity Nutrition is fundamental for the socio-economic growth and development of this country thus Government has placed nutrition high on the national development agenda

In 2007 Malawi developed the first edition of National Nutrition Policy and Strategic Plan that guided the implementation of a multi-sectoral nutrition response The goal of the Policy and Strategic Plan was to facilitate the improvement of the nutrition status of all Malawians with emphasis on children under five years pregnant and lactating women school aged children and other vulnerable groups such as people living with HIV and people affected by emergencies

The Government of Malawi has renewed its commitment and strategic response to nutrition-related issues by reviewing the National Nutrition Policy which is multi-sectoral and covers both nutrition-specific and nutrition-sensitive interventions The National Multi-Sector Nutrition Policy 2018ndash2022 serves to redirect the national focus on nutrition programming and to realign the national nutrition priorities with the national development agenda

National Multi-Sector Nutrition Policy 2018-2022 i

ii

The Government of Malawi understands that the causes of malnutrition are multi-faceted which require multi-sectoral approach coordination and implementation platforms with clear terms of reference at all levels In this regard the Government established the Department of Nutrition HIV and AIDS in 2004 to provide oversight and coordination of the national nutrition response Understanding that operationalisation of this Policy falls in the hands of a number of sectors each sector is expected to commit itself to fulfil its mandate

The Government is committed to continue placing nutrition high on the national development agenda I therefore call upon all line ministries and other stakeholders to join hands in the successful implementation of this Policy

Honourable Atupele Austin Muluzi MP

MINISTER OF HEALTH AND POPULATION

National Multi-Sector Nutrition Policy 2018-2022 ii

$+-( The National Multi-Sector Nutrition Policy 2018ndash2022 has been developed following the review of the National Nutrition Policy and Strategic Plan 2007ndash2012 The Policy was reviewed through a consultative process that involved a range of stakeholders including the local leaders and communities line ministries civil society development partners and the private sectors The process has taken into consideration the lessons learnt gaps identified and emerging issues

This new Policy aims at ensuring that evidence-based high-impact nutrition interventions are developed and implemented at scale The Policy will be implemented in line with the overarching National Development Strategy which considers nutrition as one of the priority area under the social development thematic area

The Policy is aligned with the Scaling Up Nutrition movement global declarations and commitments which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy Special appreciation goes to the World Bank Canadian International Development Agency United States Agency for International Development ndash through the Food and Nutrition Technical Assistance III Project and the United Nations organisations for their financial and technical support

Dr Dan Namarika SECRETARY RESPONSIBLE FOR NUTRITION HIV AND AIDS

National Multi-Sector Nutrition Policy 2018-2022 iii

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466 A$amp89-(B$C(DC-(E--gtamp(F-1(0$$-(amp(A-9$$amp 7

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66( 0$1(0$$1(N-(O(T-K-amp(amp(ltamp(I(N-( )amp$$amp 20

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6G6 0$1(0$$1(N-(GO($$amp(Q$ampS($(( )L$$$ampS(amp(0$$gt-(7-Cgt$(ltCamp9- 24

National Multi-Sector Nutrition Policy 2018-2022 iv

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

6W6( 0$1(0$$1(N-(WO(lt-$amp9(amp(QampL$amp9(Qampgt$ampK-amp(((((((((((((( I($$amp 28

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646(=amp$$amp(Namp9-K-amp 32

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39=$(ltltF(G0$E((H)8=0(8(222222222222222222222222222222(CI(

National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

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KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

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ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

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5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 2: Malawi National Multi-Sector Nutrition Policy 2018-2022

copy 2018 Department of Nutrition HIV and AIDS

$amp$( The Government of Malawi recognises that adequate nutrition is a prerequisite for human growth and development as it plays an important role in onersquos physical and intellectual development and consequentially work productivity Nutrition is fundamental for the socio-economic growth and development of this country thus Government has placed nutrition high on the national development agenda

In 2007 Malawi developed the first edition of National Nutrition Policy and Strategic Plan that guided the implementation of a multi-sectoral nutrition response The goal of the Policy and Strategic Plan was to facilitate the improvement of the nutrition status of all Malawians with emphasis on children under five years pregnant and lactating women school aged children and other vulnerable groups such as people living with HIV and people affected by emergencies

The Government of Malawi has renewed its commitment and strategic response to nutrition-related issues by reviewing the National Nutrition Policy which is multi-sectoral and covers both nutrition-specific and nutrition-sensitive interventions The National Multi-Sector Nutrition Policy 2018ndash2022 serves to redirect the national focus on nutrition programming and to realign the national nutrition priorities with the national development agenda

National Multi-Sector Nutrition Policy 2018-2022 i

ii

The Government of Malawi understands that the causes of malnutrition are multi-faceted which require multi-sectoral approach coordination and implementation platforms with clear terms of reference at all levels In this regard the Government established the Department of Nutrition HIV and AIDS in 2004 to provide oversight and coordination of the national nutrition response Understanding that operationalisation of this Policy falls in the hands of a number of sectors each sector is expected to commit itself to fulfil its mandate

The Government is committed to continue placing nutrition high on the national development agenda I therefore call upon all line ministries and other stakeholders to join hands in the successful implementation of this Policy

Honourable Atupele Austin Muluzi MP

MINISTER OF HEALTH AND POPULATION

National Multi-Sector Nutrition Policy 2018-2022 ii

$+-( The National Multi-Sector Nutrition Policy 2018ndash2022 has been developed following the review of the National Nutrition Policy and Strategic Plan 2007ndash2012 The Policy was reviewed through a consultative process that involved a range of stakeholders including the local leaders and communities line ministries civil society development partners and the private sectors The process has taken into consideration the lessons learnt gaps identified and emerging issues

This new Policy aims at ensuring that evidence-based high-impact nutrition interventions are developed and implemented at scale The Policy will be implemented in line with the overarching National Development Strategy which considers nutrition as one of the priority area under the social development thematic area

The Policy is aligned with the Scaling Up Nutrition movement global declarations and commitments which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy Special appreciation goes to the World Bank Canadian International Development Agency United States Agency for International Development ndash through the Food and Nutrition Technical Assistance III Project and the United Nations organisations for their financial and technical support

Dr Dan Namarika SECRETARY RESPONSIBLE FOR NUTRITION HIV AND AIDS

National Multi-Sector Nutrition Policy 2018-2022 iii

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National Multi-Sector Nutrition Policy 2018-2022 iv

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National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

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Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

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321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

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L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

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ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

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Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

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$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

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G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

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9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

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G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

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8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

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RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

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C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

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K K K K K ltXBB $E$3

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XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

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9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

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lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

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GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

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National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 3: Malawi National Multi-Sector Nutrition Policy 2018-2022

$amp$( The Government of Malawi recognises that adequate nutrition is a prerequisite for human growth and development as it plays an important role in onersquos physical and intellectual development and consequentially work productivity Nutrition is fundamental for the socio-economic growth and development of this country thus Government has placed nutrition high on the national development agenda

In 2007 Malawi developed the first edition of National Nutrition Policy and Strategic Plan that guided the implementation of a multi-sectoral nutrition response The goal of the Policy and Strategic Plan was to facilitate the improvement of the nutrition status of all Malawians with emphasis on children under five years pregnant and lactating women school aged children and other vulnerable groups such as people living with HIV and people affected by emergencies

The Government of Malawi has renewed its commitment and strategic response to nutrition-related issues by reviewing the National Nutrition Policy which is multi-sectoral and covers both nutrition-specific and nutrition-sensitive interventions The National Multi-Sector Nutrition Policy 2018ndash2022 serves to redirect the national focus on nutrition programming and to realign the national nutrition priorities with the national development agenda

National Multi-Sector Nutrition Policy 2018-2022 i

ii

The Government of Malawi understands that the causes of malnutrition are multi-faceted which require multi-sectoral approach coordination and implementation platforms with clear terms of reference at all levels In this regard the Government established the Department of Nutrition HIV and AIDS in 2004 to provide oversight and coordination of the national nutrition response Understanding that operationalisation of this Policy falls in the hands of a number of sectors each sector is expected to commit itself to fulfil its mandate

The Government is committed to continue placing nutrition high on the national development agenda I therefore call upon all line ministries and other stakeholders to join hands in the successful implementation of this Policy

Honourable Atupele Austin Muluzi MP

MINISTER OF HEALTH AND POPULATION

National Multi-Sector Nutrition Policy 2018-2022 ii

$+-( The National Multi-Sector Nutrition Policy 2018ndash2022 has been developed following the review of the National Nutrition Policy and Strategic Plan 2007ndash2012 The Policy was reviewed through a consultative process that involved a range of stakeholders including the local leaders and communities line ministries civil society development partners and the private sectors The process has taken into consideration the lessons learnt gaps identified and emerging issues

This new Policy aims at ensuring that evidence-based high-impact nutrition interventions are developed and implemented at scale The Policy will be implemented in line with the overarching National Development Strategy which considers nutrition as one of the priority area under the social development thematic area

The Policy is aligned with the Scaling Up Nutrition movement global declarations and commitments which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy Special appreciation goes to the World Bank Canadian International Development Agency United States Agency for International Development ndash through the Food and Nutrition Technical Assistance III Project and the United Nations organisations for their financial and technical support

Dr Dan Namarika SECRETARY RESPONSIBLE FOR NUTRITION HIV AND AIDS

National Multi-Sector Nutrition Policy 2018-2022 iii

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646( 0$1(0$$1(N-(4O(0-gt-amp$amp(I(Pamp-amp$$amp 16

626( 0$1(0$$1(N-(2O(J-amp-(QR$1S(QR$1S(0-$ampS( 0$$H$amp(amp(QKHB-K-amp(I($KHgt-($$amp 18

66( 0$1(0$$1(N-(O(T-K-amp(amp(ltamp(I(N-( )amp$$amp 20

66( 0$1(0$$1(N-(O(0-gt-amp$amp(amp()amp9-K-amp(I( Dgt-B-$9C(amp($$amp+--(ltU 22

6G6 0$1(0$$1(N-(GO($$amp(Q$ampS($(( )L$$$ampS(amp(0$$gt-(7-Cgt$(ltCamp9- 24

National Multi-Sector Nutrition Policy 2018-2022 iv

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

6W6( 0$1(0$$1(N-(WO(lt-$amp9(amp(QampL$amp9(Qampgt$ampK-amp(((((((((((((( I($$amp 28

656(0$1(0$$1(N-(5O($$amp()amp$$amp9S(Qgt$ampS( E--CS(amp(gt-$amp- 30

C22(lt6D8600(3$$E601(222222222222222222222222222222222222222222222(Agt(

646(=amp$$amp(Namp9-K-amp 32

626(=KH-K-amp$amp(0amp 38

66()amp$$amp9(amp(Qgt$amp 39

39=$(ltF(lt6D8600(8(222222222222222222222222222222222222222222222222(C(

39=$(ltltF(G0$E((H)8=0(8(222222222222222222222222222222(CI(

National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

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9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

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K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 4: Malawi National Multi-Sector Nutrition Policy 2018-2022

ii

The Government of Malawi understands that the causes of malnutrition are multi-faceted which require multi-sectoral approach coordination and implementation platforms with clear terms of reference at all levels In this regard the Government established the Department of Nutrition HIV and AIDS in 2004 to provide oversight and coordination of the national nutrition response Understanding that operationalisation of this Policy falls in the hands of a number of sectors each sector is expected to commit itself to fulfil its mandate

The Government is committed to continue placing nutrition high on the national development agenda I therefore call upon all line ministries and other stakeholders to join hands in the successful implementation of this Policy

Honourable Atupele Austin Muluzi MP

MINISTER OF HEALTH AND POPULATION

National Multi-Sector Nutrition Policy 2018-2022 ii

$+-( The National Multi-Sector Nutrition Policy 2018ndash2022 has been developed following the review of the National Nutrition Policy and Strategic Plan 2007ndash2012 The Policy was reviewed through a consultative process that involved a range of stakeholders including the local leaders and communities line ministries civil society development partners and the private sectors The process has taken into consideration the lessons learnt gaps identified and emerging issues

This new Policy aims at ensuring that evidence-based high-impact nutrition interventions are developed and implemented at scale The Policy will be implemented in line with the overarching National Development Strategy which considers nutrition as one of the priority area under the social development thematic area

The Policy is aligned with the Scaling Up Nutrition movement global declarations and commitments which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy Special appreciation goes to the World Bank Canadian International Development Agency United States Agency for International Development ndash through the Food and Nutrition Technical Assistance III Project and the United Nations organisations for their financial and technical support

Dr Dan Namarika SECRETARY RESPONSIBLE FOR NUTRITION HIV AND AIDS

National Multi-Sector Nutrition Policy 2018-2022 iii

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National Multi-Sector Nutrition Policy 2018-2022 iv

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

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National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 5: Malawi National Multi-Sector Nutrition Policy 2018-2022

$+-( The National Multi-Sector Nutrition Policy 2018ndash2022 has been developed following the review of the National Nutrition Policy and Strategic Plan 2007ndash2012 The Policy was reviewed through a consultative process that involved a range of stakeholders including the local leaders and communities line ministries civil society development partners and the private sectors The process has taken into consideration the lessons learnt gaps identified and emerging issues

This new Policy aims at ensuring that evidence-based high-impact nutrition interventions are developed and implemented at scale The Policy will be implemented in line with the overarching National Development Strategy which considers nutrition as one of the priority area under the social development thematic area

The Policy is aligned with the Scaling Up Nutrition movement global declarations and commitments which Malawi is signatory such as the Sustainable Development Goals and the World Health Assembly targets The Government of Malawi is indebted to all the people and institutions that were involved in reviewing the Policy Special appreciation goes to the World Bank Canadian International Development Agency United States Agency for International Development ndash through the Food and Nutrition Technical Assistance III Project and the United Nations organisations for their financial and technical support

Dr Dan Namarika SECRETARY RESPONSIBLE FOR NUTRITION HIV AND AIDS

National Multi-Sector Nutrition Policy 2018-2022 iii

$amp$ ()amp)+---------------------------------------------------------------------------------------(

)amp012amp-----------------------------------------------------------------------------------------(

344)amp1$1$+32)$56-------------------------------------------------------(

781)5---------------------------------------------------------------------------------------9(

22(lt0$=-0(222222222222222222222222222222222222222222222222222222222222222222222222222(((

4646 789amp 2

4626 $$amp($$amp 4

466 lt-amp($$amp(=amp-gt-amp$amp(amp(-9$- 6

466 A$amp89-(B$C(DC-(E--gtamp(F-1(0$$-(amp(A-9$$amp 7

46G6 0H-(I(C-(0$1 11

gt22($(8-5($-0(2222222222222222222222222222222222222222222222222222222222(gt(

2646(0$1(J 12

2626(0$1(DK- 12

266(0$1(DLM-$gt- 13

266(J$$amp9(0$amp$H- 14

A22(8-5($$05(3$1(22222222222222222222222222222222222222222222222222222222222222(B(

646( 0$1(0$$1(N-(4O(0-gt-amp$amp(I(Pamp-amp$$amp 16

626( 0$1(0$$1(N-(2O(J-amp-(QR$1S(QR$1S(0-$ampS( 0$$H$amp(amp(QKHB-K-amp(I($KHgt-($$amp 18

66( 0$1(0$$1(N-(O(T-K-amp(amp(ltamp(I(N-( )amp$$amp 20

66( 0$1(0$$1(N-(O(0-gt-amp$amp(amp()amp9-K-amp(I( Dgt-B-$9C(amp($$amp+--(ltU 22

6G6 0$1(0$$1(N-(GO($$amp(Q$ampS($(( )L$$$ampS(amp(0$$gt-(7-Cgt$(ltCamp9- 24

National Multi-Sector Nutrition Policy 2018-2022 iv

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

6W6( 0$1(0$$1(N-(WO(lt-$amp9(amp(QampL$amp9(Qampgt$ampK-amp(((((((((((((( I($$amp 28

656(0$1(0$$1(N-(5O($$amp()amp$$amp9S(Qgt$ampS( E--CS(amp(gt-$amp- 30

C22(lt6D8600(3$$E601(222222222222222222222222222222222222222222222(Agt(

646(=amp$$amp(Namp9-K-amp 32

626(=KH-K-amp$amp(0amp 38

66()amp$$amp9(amp(Qgt$amp 39

39=$(ltF(lt6D8600(8(222222222222222222222222222222222222222222222222(C(

39=$(ltltF(G0$E((H)8=0(8(222222222222222222222222222222(CI(

National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

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9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 6: Malawi National Multi-Sector Nutrition Policy 2018-2022

$amp$ ()amp)+---------------------------------------------------------------------------------------(

)amp012amp-----------------------------------------------------------------------------------------(

344)amp1$1$+32)$56-------------------------------------------------------(

781)5---------------------------------------------------------------------------------------9(

22(lt0$=-0(222222222222222222222222222222222222222222222222222222222222222222222222222(((

4646 789amp 2

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466 lt-amp($$amp(=amp-gt-amp$amp(amp(-9$- 6

466 A$amp89-(B$C(DC-(E--gtamp(F-1(0$$-(amp(A-9$$amp 7

46G6 0H-(I(C-(0$1 11

gt22($(8-5($-0(2222222222222222222222222222222222222222222222222222222222(gt(

2646(0$1(J 12

2626(0$1(DK- 12

266(0$1(DLM-$gt- 13

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A22(8-5($$05(3$1(22222222222222222222222222222222222222222222222222222222222222(B(

646( 0$1(0$$1(N-(4O(0-gt-amp$amp(I(Pamp-amp$$amp 16

626( 0$1(0$$1(N-(2O(J-amp-(QR$1S(QR$1S(0-$ampS( 0$$H$amp(amp(QKHB-K-amp(I($KHgt-($$amp 18

66( 0$1(0$$1(N-(O(T-K-amp(amp(ltamp(I(N-( )amp$$amp 20

66( 0$1(0$$1(N-(O(0-gt-amp$amp(amp()amp9-K-amp(I( Dgt-B-$9C(amp($$amp+--(ltU 22

6G6 0$1(0$$1(N-(GO($$amp(Q$ampS($(( )L$$$ampS(amp(0$$gt-(7-Cgt$(ltCamp9- 24

National Multi-Sector Nutrition Policy 2018-2022 iv

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

6W6( 0$1(0$$1(N-(WO(lt-$amp9(amp(QampL$amp9(Qampgt$ampK-amp(((((((((((((( I($$amp 28

656(0$1(0$$1(N-(5O($$amp()amp$$amp9S(Qgt$ampS( E--CS(amp(gt-$amp- 30

C22(lt6D8600(3$$E601(222222222222222222222222222222222222222222222(Agt(

646(=amp$$amp(Namp9-K-amp 32

626(=KH-K-amp$amp(0amp 38

66()amp$$amp9(amp(Qgt$amp 39

39=$(ltF(lt6D8600(8(222222222222222222222222222222222222222222222222(C(

39=$(ltltF(G0$E((H)8=0(8(222222222222222222222222222222(CI(

National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 7: Malawi National Multi-Sector Nutrition Policy 2018-2022

6V6((0$1(0$$1(N-(VO($$amp($amp9(QK-9-amp1(((((((((((((((( $$amp 26

6W6( 0$1(0$$1(N-(WO(lt-$amp9(amp(QampL$amp9(Qampgt$ampK-amp(((((((((((((( I($$amp 28

656(0$1(0$$1(N-(5O($$amp()amp$$amp9S(Qgt$ampS( E--CS(amp(gt-$amp- 30

C22(lt6D8600(3$$E601(222222222222222222222222222222222222222222222(Agt(

646(=amp$$amp(Namp9-K-amp 32

626(=KH-K-amp$amp(0amp 38

66()amp$$amp9(amp(Qgt$amp 39

39=$(ltF(lt6D8600(8(222222222222222222222222222222222222222222222222(C(

39=$(ltltF(G0$E((H)8=0(8(222222222222222222222222222222(CI(

National Multi-Sector Nutrition Policy 2018-2022 v

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

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Kamp- LML6

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$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

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897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 8: Malawi National Multi-Sector Nutrition Policy 2018-2022

344$)01((3-$561( AIDS Acquired Immunodeficiency Syndrome

ADC Area Development Committee

AEC Area Executive Committee

ANCC Area Nutrition Coordination Committees

BFHI Baby Friendly Hospital Initiative

CHD Child Health Day

CMAM Community-based Management of Acute Malnutrition

CBO Community Based Organisations

CSO Civil Society Organisations

DAES District Agriculture Extension Services

DC District Commissioner

DMECC District MampE Coordination Committees

DNCC District Nutrition Coordination Committees

DNHA Department of Nutrition HIV and AIDS

DHS Demographic and Health Survey

HSA Health Surveillance Assistant

HIV Human Immunodeficiency Virus

HMIS Health Management Information Systems

IPs Implementing Partners

IYCF Infant and Young Child Feeding

MAM Moderate Acute Malnutrition

National Multi-Sector Nutrition Policy 2018-2022 vi

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

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lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

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K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

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KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 9: Malawi National Multi-Sector Nutrition Policy 2018-2022

i

MampE Monitoring and Evaluation

MGDS Malawi Growth and Development Strategy

MICS Multi Indicator Cluster Survey

MNS Micronutrient Survey

MoAIWD Ministry of Agriculture Irrigation and Water Development

MoEST Ministry of Education Science and Technology

MoFEPD Ministry of Finance Economic Planning and Development

MoH Ministry of Health

MoIT Ministry of Industry and Trade

MoJCA Ministry of Justice and Constitutional Affairs

MoLGRD Ministry of Local Government and Rural Development

MUAC Mid-Upper Arm Circumference

MVAC Malawi Vulnerability Assessment Committee

NCDs Non-Communicable Diseases

NCST Nutrition Care Support and Treatment

NMNP National Multi-Sector Nutrition Policy

NRU Nutrition Rehabilitation Unit ORS Oral Rehydration Salts OTP Outpatient Therapeutic Programme PLHIV People Living with HIV PPP Public ndashPrivate Partnership

National Multi-Sector Nutrition Policy 2018-2022 vii

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 10: Malawi National Multi-Sector Nutrition Policy 2018-2022

SAM Severe Acute Malnutrition

SFP Supplementary Feeding Program

SUN Scaling Up Nutrition

TB Tuberculosis

VNCC Village Nutrition Coordination Committees

WASH Water Sanitation and Hygiene

WHO World Health Organisation

National Multi-Sector Nutrition Policy 2018-2022 viii

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 11: Malawi National Multi-Sector Nutrition Policy 2018-2022

7811$5( Acute Malnutrition is caused by a decrease in food consumption andor illness resulting in bilateral pitting oedema or sudden weight loss They are two forms of acute malnutrition Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)

bull SAM is very low weight-for-height below -3 z-scores of the median WHO growth standards visible severe wasting MUAC less than 115 cm in children 6ndash60 months old or presence of bilateral pitting oedema

bull MAM is defined as a weight-for-height between -3 and -2 z-scores of the median World Health Organisation (WHO) child growth standards wasting and mid-upper arm circumference (MUAC) between 115 and 125 cm in children 6ndash60 months old

Adequate Nutrition refers to the availability of food in a quantity and quality sufficient to satisfy the dietary needs of individuals free from adverse substances combined with regular physical activity

Food Security is defined as including both physical and economic access to food that meets peoples dietary needs and food preferences for a productive and healthy life Food security has four components food availability food access food utilisation and stability of the first three components

National Multi-Sector Nutrition Policy 2018-2022 ix

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

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HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

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967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 12: Malawi National Multi-Sector Nutrition Policy 2018-2022

Nutrition is the intake of food considered in relation to the bodyrsquos dietary needs It is the science that interprets the interaction of nutrients and other substances in food in relation to maintenance growth reproduction health and disease of an organism

Nutrition Security is achieved when secure access to an appropriately nutritious diet is coupled with a sanitary environment adequate health services and care to ensure a healthy and active life for all household members

Nutrition Sensitive Interventions address the underlying causes of foetal and child nutrition and developmentmdash food security adequate caregiving resources at the maternal household and community levels and access to health services and a safe and hygienic environment

Nutrition Specific Interventions address the immediate causes of foetal and child nutrition and developmentmdashadequate food and nutrient intake feeding caregiving and parenting practices and low burden of infectious diseases

Nutrition Surveillance refers to monitoring the state of health nutrition eating behaviour and nutrition knowledge of the population for the purpose of planning and evaluating nutrition policy Especially in low-income countries monitoring may include factors that may give early warning of nutritional emergencies

Overnutrition is a result of excessive intake of energy leading to overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 x

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

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321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 13: Malawi National Multi-Sector Nutrition Policy 2018-2022

Overweight and Obesity is defined as abnormal or excessive fat accumulation that may impair health Overweight and obesity is measured by a body mass index greater than 25

Stunting reflects retarded growth defined as height-for-age below -2 z-scores of the median WHO growth standards

Undernutrition is a lack of nutrients caused by inadequate dietary intake It encompasses a range of conditions including acute undernutrition chronic undernutrition and micronutrient deficiency

Underweight is weight-for-age below -2 z-scores of the median WHO growth standards

National Multi-Sector Nutrition Policy 2018-2022 xi

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 14: Malawi National Multi-Sector Nutrition Policy 2018-2022

22(lt0$=-0( Nutrition is a pre-requisite for human growth and development and an integral element for the social and economic development of a country Adequate nutrition is critical for physical and intellectual development of an individual and is a major determinant of onersquos intellectual performance academic and professional achievement and overall work productivity at later stages in life This directly and indirectly influence potential future gains and economic contribution of the individual to the nation

The National Multi-Sector Nutrition Policy (NMNP) 2018ndash2022 is intended to provide a guiding framework for the successful implementation of the national nutrition response address the existing and emerging national and global issues and consequently uphold the Governmentrsquos commitment towards eliminating all forms of malnutrition The Policy shall be operationalised through the National Nutrition Strategic Plan 2018ndash2022 Additional supporting operational strategies and guidelines shall be developed to further translate the aspiration into tangible actions These shall include the following strategies and guidelines National Nutrition Education and Communication infant and young child feeding (IYCF) Micronutrient Adolescent Nutrition School Health and Nutrition Early Childhood Development Community-based Management of Acute Malnutrition (CMAM) Nutrition Care Support and Treatment (NCST) and prevention and treatment of nutrition-related Non-Communicable Diseases (NCDs)

National Multi-Sector Nutrition Policy 2018-2022 1

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

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444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

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22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

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)6(D6A()-$( 2345E2322(

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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()$amp$lt1(=( Bamp=9$amp( 2345E2322(

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 15: Malawi National Multi-Sector Nutrition Policy 2018-2022

The Policy has identified eight priority areas which include i) Prevention of undernutrition ii) Gender equality equity protection participation and empowerment for improved nutrition iii) Treatment and control of acute malnutrition iv) Prevention and management of overweight and nutrition-related NCDs v) Nutrition education social mobilisation and positive behaviour change vi) Nutrition during emergency situations vii) Creating an enabling environment for nutrition and viii) Nutrition monitoring evaluation research and surveillance The Policy also contains an implementation plan monitoring and evaluation framework presented in annexure I and II respectively

22 -JE$=( The Government of Malawi developed the first National Nutrition Policy in 2007 whose overall goal was to have a well-nourished nation with sound human resource that effectively contributes to the economic growth and prosperity The first Policy recognized malnutrition as a disorder with social cultural economic development political and biomedical dimensions The Policy was expected to facilitate achievement of the following objectives

i Prevention and control of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

ii Increased access to timely and effective management of the most common nutrition disorders among women men boys and girls in Malawi by 2011 with emphasis on vulnerable groups

National Multi-Sector Nutrition Policy 2018-2022 2

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 16: Malawi National Multi-Sector Nutrition Policy 2018-2022

iii Creation of an enabling environment for the effective implementation of nutrition services and programmes between 2007 and 2011

The first edition of the Policy was implemented for a period of five years 2007 to 2011 and operationalized through the National Strategic Plan The Policy was aligned to the Malawi Growth and Development Strategy (MGDS) I and the Millennium Development Goal

Malawi has registered significant progress in the prevention treatment care and support of malnutrition which include

i Strengthened Government stewardship championship and multi-sector coordination of nutrition interventions and programmes through the National Nutrition Committee Nutrition Technical Working Groups and District Nutrition Coordination Committees (DNCC)

ii Development of the Food and Nutrition Security Bill strategic documents and guidelines

iii Improved nutritional status of the Malawian population This has been marked by a reduction in the following nutrition indicators bull Percentage of children under five years of age who are

stunted from 471 in 2010 to 371 in 2015-16 (Demographic Health Survey [DHS])

bull Percentage of children under five years of age who are underweight from 128 in 2010 to 117 in 2015-16 (DHS)

bull Percentage of children under five years of age who are wasted from 40 in 2010 to 27 in 2015-16 (DHS)

National Multi-Sector Nutrition Policy 2018-2022 3

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 17: Malawi National Multi-Sector Nutrition Policy 2018-2022

Despite the improvement in the nutrition indicators the prevalence of malnutrition remains high according to global standards This calls for a re-definition of the strategies based on emerging issues lessons learnt and best practices

2gt2 K=0$0(L0=0(

M$=0$0( Over the past two decades Malawi has experienced a decline in the rates of undernutrition an indication that investments in nutrition are paying off The percentage of children under five years of age who are stunted has decreased from 471 to 371 underweight from 128 to 117 and wasting from 40 to 27 (DHS 2010 and DHS 2015-16 respectively) Similarly the prevalence of micronutrient deficiencies decreased anaemia decreased from 55 percent to 28 percent and Vitamin A from 59 percent to 4 percent (MNS 2009 and MNS 2015 ndash 16 respectively) Even with the noted decline in undernutrition continued efforts are needed to address micronutrient deficiencies and the high rates of stunting Additionally Zinc deficiency is an emerging public health concern affecting over 60 percent of the population including children under the age of five and women of reproductive age group (MNS 2015)

The prevalence of undernutrition is high among adolescent girls (156 percent) similarly the IYCF practices need to be improved as the proportion of infants 0ndash6 months old who are exclusively breastfed declined from 714 percent in 2010 to 612 percent in 2015-16 and only 78 percent of children aged 6ndash23 months consumed foods that met the minimum acceptable diet

National Multi-Sector Nutrition Policy 2018-2022 4

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

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Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

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K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

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9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

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GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

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National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 18: Malawi National Multi-Sector Nutrition Policy 2018-2022

The causes of undernutrition are manifold repeated infections including acute respiratory infections diarrhoea and malaria suboptimal breastfeeding and infant feeding practices resulting in inadequate dietary intake are the immediate causes of malnutrition The underlying causes include food insecurity gender inequality poor hygiene practices and lack of safe water and sanitation As such malnutrition is a complex problem that persists due to multiple causes rooted in various sectors In addition to nutrition-specific interventions nutrition-sensitive interventions that are multi-sectoral are essential in reducing and eradicating malnutrition in Malawi

N)$=0$0( In addition to a high prevalence of undernutrition the WHO in 2014 estimated that nine percent of children under five are overweight In Malawi adults between 15 and 49 years of age 21 percent are overweight while five percent are obese The prevalence of overweight and obesity is higher in women (24 percent are overweight and 6 percent are obese) than men (17 percent are overweight and 3 percent are obese)

The prevalence of cardiovascular diseases (eg heart disease and stroke) cancer respiratory diseases and diabetes mellitus are increasingly becoming significant causes of morbidity and mortality in Malawi As overweight and more so obesity increase the risk of nutrition-related NCDs also increases These statistics demonstrate the need to address all forms of malnutrition including overweight and obesity

National Multi-Sector Nutrition Policy 2018-2022 5

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

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Kamp- LML6

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$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

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897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 19: Malawi National Multi-Sector Nutrition Policy 2018-2022

2A2 =$$0(K=0$0(lt0$)01((L0$0E1(

Through the implementation of the National Nutrition Policy and Strategic Plan 2007ndash2011 significant progress was made in addressing some of the aforementioned nutrition challenges Notable positive achievements include establishment of a multi-sectoral coordinating institution increasing access to services by expanding coverage of evidence-based high-impact interventions providing a framework for standardisation and improvement of nutrition service delivery and positioning nutrition high on the National Development Agenda

The National Nutrition Response was and is partially consistent with the conceptual framework on actions to achieve optimum foetal and child nutrition and development A comprehensive multi-sectoral nutrition programme therefore needs to build an enabling environment for nutrition while also implementing high-impact nutrition-specific and nutrition-sensitive interventions

National Multi-Sector Nutrition Policy 2018-2022 6

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 20: Malawi National Multi-Sector Nutrition Policy 2018-2022

2C2 OJE1(amp0P(N0P$(Q8)0(R5(8-1((OE180(

The Policy will operate in line with the existing legal and policy frameworks at national and global levels as indicated in the following section

SP(100=0( The NMNP 2018-2022 is aligned with the Constitution under Chapters III and IV which provide for the Principles of National Policy and Human Rights respectively In section 13 (b) the Constitution provides that lsquoThe State shall actively promote the welfare and development of the people of Malawi by progressively adopting and implementing policies and legislation aimed at achieving the following goals (b) Nutrition ndash To achieve adequate nutrition for all in order to promote good health and self-sufficiencyrsquo

G8amp(7$amp0P(()8D60(L0$0E5(( The MGDS as an overarching policy document identifies Nutrition as one of the national priorities The NMNP shall thrive to uphold the vision to have lsquoa well-nourished Malawian population that effectively contributes to the social and economic growth and prosperity of the countryrsquo

National Multi-Sector Nutrition Policy 2018-2022 7

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

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4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

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000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

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321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

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$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

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9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

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8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

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RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

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R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 21: Malawi National Multi-Sector Nutrition Policy 2018-2022

OJE1(amp0P(OE1801(( The Policy shall operate in an environment which has other legislation that touches on nutrition-related issues such as The Consumer Protection Act The Pharmacy Medicines and Poisons Act The Malawi Bureau of Standards Act The Public Health Act Health and Welfare Act The Prevention of Domestic Violence Act The Child Care Justice and Protection Act The Persons with Disabilities Act and The Local Government Act

K08(3E$-=80=$(8-5(( The Agriculture Policy promotes nutrition-sensitive food and agriculture-based approaches including production of diversified foods and dietary diversification It also promotes integrated homestead farming production and consumption of high nutritive-value foods more capital-intensive forms of agriculture (cash crops livestock and aquaculture) market access and ensuring sustainable food and nutrition security for all Malawians

K08(T80P(8-5( The Health Policy promotes several nutrition-specific interventions at the health facility and community level These interventions include promoting dietary diversity optimal IYCF and caring practices treatment of acute malnutrition nutrition care support and treatment for people living with HIV (PLHIV) and tuberculosis (TB) patients and micronutrient supplementation In addition the Health Policy also promotes growth monitoring and promotion provision of insecticide-treated bed nets and de-worming

National Multi-Sector Nutrition Policy 2018-2022 8

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 22: Malawi National Multi-Sector Nutrition Policy 2018-2022

K08(H=-0(8-5( The National Education Policy advocates for the promotion of the school feeding programme school health and water sanitation and hygiene (WASH) HIV and AIDS gender and education interventions The Policy is also mainstreaming nutrition within the school curricula and implementing nutrition-sensitive interventions that improve classroom education and keeping adolescent girls and young women in schools

K08(7$(8-5( The Gender Policy seeks to mainstream gender in the national development process in order to enhance participation of women and men girls and boys at individual household and community levels for sustainable and equitable development It also promotes a holistic approach to gender equality and social protection poverty reduction through microfinance and sustaining livelihoods of ultra-poor households using cash transfers

-0$8U0(8-5( The Decentralization Policy seeks to create a democratic environment and institutions for governance and development at the local level that facilitate grassroots participation in decision making It supports the roll out of nutrition interventions and promotes district- and community-level operationalisation of nutrition policies and strategic plans

Nutrition has also strong linkages with other social and sectoral policies as a cross-cutting issue as follows National Social Support Policy National Population Policy National Youth Policy and National HIV and AIDS Policy

National Multi-Sector Nutrition Policy 2018-2022 9

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

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National Multi-Sector Nutrition Policy 2018-2022 41

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

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KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

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ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

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National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 23: Malawi National Multi-Sector Nutrition Policy 2018-2022

OJE1(amp0P(lt0$08(lt10$=601( The Policy is guided by international human rights and other instruments which Malawi is party to at the regional and global levels such as the Convention on Human Rights the International Covenant on Economic Social and Cultural Rights the Convention on the Elimination of all Forms of Discrimination Against Women the Convention on the Rights of the Child the African Charter on Human and Peoplersquos Rights and its relevant protocols the Southern African Development Community Protocol on Gender and Development the Declaration of Commitment on HIV and AIDS Action the Maputo Declaration on Tuberculosis HIV and AIDS Malaria and other related infections the World Health Assembly Targets the Sustainable Development Goals and Scaling up Nutrition (SUN) movement

The instruments collectively enshrine the respect protection and fulfilment of the rights of all individuals especially those with nutrition disorders and other vulnerable populations The Policy will also be guided by the lsquoMalawi Commitments on Nutritionrsquo espoused in 2013 in the London Compact lsquoNutrition for Growth Beating Hunger through Business and Sciencersquo

National Multi-Sector Nutrition Policy 2018-2022 10

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

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321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

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321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

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$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

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Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

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9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

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97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

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67 J7 J7 JK7 J87 87 B($)$0E $)-3$

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National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

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7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

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G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

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$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

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Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

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K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 24: Malawi National Multi-Sector Nutrition Policy 2018-2022

2B2 =$D1(+(0P(8-5( This NMNP 2018ndash2022 serves as a guiding document for national nutrition stakeholders including government civil society faith-based organisations academia the private sector and development partners to promote

bull Evidence-based programming and strengthening of the national nutrition response

bull Scale up of evidence-based innovative interventions

bull Re-alignment of nutrition interventions to the current national development strategy the SUN movement World Health Assembly targets the Sustainable Development Goals and other new global declarations which the government has signed

The Policy provides the framework and context within which sectoral and other strategic plans and budgets should be coordinated formulated implemented and monitored

National Multi-Sector Nutrition Policy 2018-2022 11

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

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7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

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9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

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967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

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C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

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C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

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(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

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K K K K K ltXBB $E$3

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Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

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National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

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National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

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National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 25: Malawi National Multi-Sector Nutrition Policy 2018-2022

gt22($(8-5($-0( gt22(8-5(78(

A well-nourished Malawian population that effectively contributes to the economic growth and prosperity of the country

gt2gt2(8-5(N=0-61( The expected outcomes of this Policy are

i Improved adolescent maternal and child nutrition and health

ii Reduced prevalence of overweight and nutrition-related NCDs among the general population

iii Reduced nutrition-related mortality among children under the age of five years and the general population

iv Improved enabling environment for effective coordination and implementation of nutrition-sensitive and specific interventions

National Multi-Sector Nutrition Policy 2018-2022 12

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

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2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

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321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

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Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

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$E$-amp+033amp30D-amp) (Q0(2--33(

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$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

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$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

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$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

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C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

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6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

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$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

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Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

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R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

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C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

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Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

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9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

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National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

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lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

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K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 26: Malawi National Multi-Sector Nutrition Policy 2018-2022

gt2A2(8-5(N4V-0)1(

The objectives of the policy are to

i Prevent undernutrition with emphasis on children under five adolescent girls school-going children pregnant and lactating women PLHIV and other vulnerable groups

ii Enhance gender equality equity protection participation and empowerment of adolescent women and children for improved nutrition

iii Treat and control acute malnutrition among children under five adolescents pregnant and lactating women PLHIV and other vulnerable groups

iv Prevent and manage overweight and nutrition related NCDs

v Enhance nutrition education social mobilisation and positive behaviour change

vi Improve delivery of nutrition interventions during emergencies

vii Create an enabling environment for effective implementation of nutrition interventions

viii Enhance evidence-based programming through nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 13

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

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4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

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22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

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HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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)6(D6A()-$( 2345E2322(

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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()$amp$lt1(=( Bamp=9$amp( 2345E2322(

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

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National Multi-Sector Nutrition Policy 2018-2022 60

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National Multi-Sector Nutrition Policy 2018-2022 61

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Page 27: Malawi National Multi-Sector Nutrition Policy 2018-2022

gt2C2(7=E($-D81(

The successful implementation of the Policy will be guided by the following principles

Right to optimum nutrition Every Malawian has a right to access safe and nutritious food at all times even during emergency situations

Multi-sectoral approach Nutrition issues are multi-faceted in nature and implemented by different sectors that need effective partnerships and coordination

Gender Equality and Equity Eliminating gender and other inequalities will help address some of the underlying causes of malnutrition and accelerate nutrition improvement for all

Decentralization Effective implementation of nutrition activities through a well-governed decentralized system will yield greater beneficial outcomes for households and communities

Community empowerment and participation Partnering with and empowering communities in the delivery of nutritional knowledge skills and resources is likely to yield better outcomes and engender community acceptance and ownership

Evidenced-based interventions Evidence-based proven strategies and best practices have potential for greater impact on improving nutrition The NMNP will promote evaluation and learning documentation of implementation successes best practices and application of lessons learnt in programming

National Multi-Sector Nutrition Policy 2018-2022 14

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

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$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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$amp()+($ )$0E3+0amp-amp-amp)

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X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

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K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

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897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 28: Malawi National Multi-Sector Nutrition Policy 2018-2022

A22(8-5($$05(3$1( The Policy has identified eight priority areas that consolidate aspirations contained in the goal and the policy objectives

The priority areas are

i Prevention of undernutrition

ii Gender equality equity protection participation and empowerment for improved nutrition

iii Treatment and control of acute malnutrition

iv Prevention and management of overweight and nutrition-related NCDs

v Nutrition education social mobilisation and positive behaviour change

vi Nutrition during emergency situations

vii Creating an enabling environment for nutrition

viii Nutrition monitoring evaluation research and surveillance

National Multi-Sector Nutrition Policy 2018-2022 15

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 29: Malawi National Multi-Sector Nutrition Policy 2018-2022

A22((8-5($$05(3$(F($)0(+(M$=0$0(

Prevention of undernutrition involves adequate dietary intake and control of acute diseases throughout the life cycle of human growth and development In Malawi prevention of undernutrition has been a challenge due to inadequate availability and access to diverse nutritious foods poor health-seeking behaviours WASH weak access to quality health care low education levels among caregivers and insufficient household incomes In this regard prevention of undernutrition therefore requires a multi-sectoral approach in delivering nutrition interventions to reach sustainable change

8-5(L00601( The Policy will ensure that

I High-impact cost-effective nutrition interventions are scaled up to all communities

L0$0E1F( bull Promote optimal nutrition in the general population

bull Promote womenrsquos nutrition before during and after pregnancy

bull Intensify prevention and control of micronutrient malnutrition

bull Promote optimal breast feeding practices for children 0-6 months at facility community and household levels

National Multi-Sector Nutrition Policy 2018-2022 16

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

$$amp()+)-$012$)30$) 3(12(14)(0)5+)3(6$12$)27)8$9($(112$) lt=16+)3(6$)$9($(112$)gt1)-01)2$)=19($)$9()AB)092=$B)=22CD21$D)=19($B)-(D$0$) 0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)6$78+$9(lt+-==-$gt-(amp$$amp($amp-gt-amp$amplt(-(lt-((((99amp$$-lt)

(44(09-($9(amp$$amp($amp(8-(7-amp-($amp( )ABCD()6(( 2345E2322(

(42(09-(F9-amp(amp$$amp(G-=-($amp7(amp(=-(-7ampamp1(( )ABCD()6( 2345E2322(

4H(Bamp-amplt$=1(-gt-amp$amp(amp(amp(=(9$amp$-amp(9amp$$amp( )ABCD()6( 2345E2322(

4I(09-($9(G-lt(=--$amp7($-lt(=(8$-amp(3JK(9amp8lt((=$$1( 99amp$1(amp(8lt-8(-gt-( )ABCD()6( 2345E2322(

4L(09-(amp$amp-(G-lt=--$amp7(amp($-(9-9-amp1(=--$amp7(=(8$-amp( 7-(KJ2I(9amp8lt(amp(G-1amp( )6( 2345E2322(

4K(-amp78-amp($9(=--$amp7(=(8$-amp($amp7(amp(=-($amp-ltlt( )6()ABCD(( 2345E2322(

4M(09-($9gt-(CA6($lt-lt((99amp$1(amp(8lt-8(-gt-lt( )ABCD()6( )NOC(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

321=4)H0$)K+)6$78+$9(amp$$amp+lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt($amp(8-(--gtamp(-(lt-( $$-lt(lt-7$-lt($9-9-amp$amp(amplt(amp(G7-lt(-($amp-7-) 45(09-($9-9-amp$amp(=(amp$$amp(lt-amplt$$gt-(amp(amp$$amp+lt-$=$($amp-gt-amp$amplt( $amp(8-(--gtamp(-(lt-lt(

)ABCD()6( )NOC(( 2345E2322(

4P(09-(lt8(=--$amp7(amp(lt8(8-8(amp(amp$$amp(799-lt(( )QR()ABCD( )6()NOC( 2345E2322(

321=4)H0$)L+(0$gt-(lt-(-amp77-9-amp($amp(8-($amp(-ltlt$amp7(amp(amplt9$amp(=(8$78+S$1( amp$$amp(=lt( 443(09-(0G$+0$gt-(0amp-lt8$lt($amp(=($amp(-ltlt$amp7(=$=$$amp( amp(amplt9$amp(

000(99$ltlt$amp( D6A(

2345E2322(

444(09-(=$=$$amp(amp(ltamp$lt$amp(=(-amp1(-ltlt-(=(=( $9gt-(amp$$amp( )BR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)09-($99(amp$$amp(lt-gt$-(-$gt-1((-lt-amplt) 24(09-($9gt-(amp$$amp(=(-lt-amp( )NOC(D6A( 2345E2322(

22(09-($amp+=-(lt-9-amp$amp(=(F9-amp(=(-$gt-(7-(( )QR()6( )NOC( 2345+2322(

321=4)H0$)K+)Aamp($amp-lt-($amp(9-ampTlt(lt8-(-ltamplt$G$$1(=(8$(-(amp(8lt-8($-lt((-ampG-(F9-amp( $$$amp($amp(lt$(amp(-amp9$($gt$$-lt)

2H(09-(9-($ampgtgt-9-amp($amp(9-amp(amp$$amp(8$(-(amp(8lt-8($-lt( )NOC(D6A( 2345E2322(

321=4)H0$)L+)Bamp-7$amp(amp(-gt-7-(8-lt(($9gt-(F9-ampTlt(-$lt$amp+9U$amp7(F-(=(-ltlt(( $9gt-(amp$$amp) 2I(A-ltlt(7-amp-(amp(lt$+($ltlt-lt(8(==-(-lt-amp(9-amp($amp=amp( amp(1amp7(8$(amp$$amp( )NOC( 2345E2322(

321=4)H0$)+)lt$amp-($gt-$8lt(=(F9-amp(amp(8$(8--(8lt-8lt(($amp-lt-(-ltlt(amp(amp(=( -lt-lt(=($9gt-(amp$$amp(ltlt) 2L(09-(ltlt$ampG-($gt-$8lt($amp-gt-amp$amplt(=(F9-amp(amp(8$(8--( 8lt-8lt( )NOC( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Ngt-amp9-amp(Famp-lt8$(amp(=$ampamp$amp7(=($amp-gt-amp$amplt(amp(8-(9amp7-9-amp(=(-(9amp$$amp()

H4(-amp78-amp(8-($9-9-amp$amp(=(O)A)(amp(OR(878($=-1-(8( 7-$amp7(-lt-amplt(lt(amp(8$-amp( )6( 2345E2322(

321=4)H0$)K+)-((=(amp$$amp(ltlt-ltlt9-amp(amplt-$amp7(amp(lt(lt-gt$-lt(amp($ampU7-(F$8($gt-$8( $amp-gt-amp$amplt(7-$amp7(-lt-amplt(lt(amp(8$-amp(-gt-$amp7(=9(gt$lt(=9lt(=($9-amplt($amp$amp7(6BV(amp(ABD( amp(RW((-amplt-((amp$amp9(=(-) H2(09-(lt$amp7((=(amp$$amp(-9-amp(-(amp(lt(=(RW($-amplt(0X6BV(amp( 8-(8amp$1($(-ltamplt($amp((G$(amp($gt-(8-8(=$$$-lt( )6( 2345E2322(

321=4)H0$)L+)-amp78-amp(-ampG$amp7(-ampgt$amp9-amp(=(O)A)(amp(OR(lt-gt$-(-$gt-1(amp()YQ(1lt-9(((-gt-lt)

HH(09-(7gt-ampamp-($amp$amp(9amp$$amp7(amp(-gt$amp(=(O)A)(amp(OR( lt-gt$-(-$gt-1(( )6(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+(Q1(--$amp(amp(9amp7-9-amp(=(gt-F-$78(amp(amp$$amp+--(ODlt(G1((amp$$amp(lt-gt$-( gt$-lt( I4(Bamp-lt-(-ltlt((lt-gt$-lt(=(-gt-amp$amp(-1(--$amp(amp(9amp7-9-amp(=( amp$$amp(--(ODlt(

)6(D6A()-$( 2345E2322(

321=4)H0$)K+(Qamp8amp-9-amp(=(lt-gt$-(gt$-ltT($1((gt$-(amp$$amp(amp($=-lt1-(amplt-$amp7(lt-gt$-lt(=( 8lt-(F8(-(gt-F-$78(amp(G-lt-( (I2(-amp78-amp($1(=(lt-gt$-(gt$-ltT((gt$-(amp$$amp(amp($=-lt1-( amplt-$amp7(lt-gt$-lt((8-(=$$1(amp(99amp$1(-gt-lt(

)6(D6A()-$( 2345E2322(

321=4)H0$)L+(0-gt-amp$amp(=(amp$$amp+--(ODlt(878(G-8gt$(8amp7-(99amp$$amp(=lt-(amp( amplt9$amp(=($-($-lt(9$amp(=(8-81($=-lt1-lt(amp(81lt$($gt$1( IH(09-(F-amp-ltlt(9$7amplt(amp(G-8gt$(8amp7-(99amp$$amp(amp( -gt-amp$amp(=(amp$$amp+--(ODlt(

)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-((=(amp$$amp(-$amp(G-8gt$(8amp7-(99amp$$amp(amp(lt$(9G$$lt$amp( $amp-gt-amp$amplt() L4(09-(G-8gt$(8amp7-(=(-$gt-($amp(99amp$1(Famp-lt8$(amp( $9gt-(amp$$amp(UampF-7-($-lt(amp($-lt( )QR( 2345E2322(

L2(Agt-(=(ltU-8-lt($$$amp($amp(amp$$amp(-$amp(799$amp7((( -gt-lt( D6A()XNZD( 2345E2322(

LH(09-(lt$(9G$$lt$amp(878(9ltlt(9-$(amp(8-(99amp$$amp( 8ampamp-lt(

()$amp$lt1(=( Bamp=9$amp( 2345E2322(

321=4)H0$)K+)Qamp8amp-($1(=(8-(-(lt-lt((=9-(amp($9-9-amp(amp$$amp(lt$(9G$$lt$amp(amp( G-8gt$(8amp7-(99amp$$amp($amp-gt-amp$amplt) LI(-amp78-amp(8-($1(=((lt-lt((amp$amp(amp($lt$(-gt-((-gt$-F(amp( $9-9-amp(amp$$amp(-$amp(amp(99amp$$amp(lt-71( )QR(D6A( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)R$9-1(amp(-==-$gt-(=(amp(amp$$amp(-ltamplt-((8-(==--($amp($amp$amp7(gtamp-G-( 7lt($amp7(-9-7-amp1(lt$$amplt)

K4(09-($9-1(--$amp(9amp7-9-amp(amp(-9-amp(=(9amp$$amp( )6(D6A( 2345E2322(

K2(09-(amp$$amp(-$amp(amp(9-amp(amp(8$(amp$$amp( )QR(D6A( 2345E2322(

KH(09-(-lt$$-amp(799-lt($9-(($9gt$amp7(9-amp(amp(8$(amp$$amp( )6(D6A( 2345E2322(

KI(-amp78-amp($amp$amp(9-lt-lt(=(amp$$amp(-9-7-amp1(-ltamplt-(((-gt-lt( D6A( )XNZD(

2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

321=4)H0$) I-2$1114) J17(0) 321=4)H0$)5+)Qamp8amp-(9$+lt-(amp($amp+lt-($amp$amp(=(amp$$amp($amp-gt-amp$amplt((amp$amp($lt$(amp( 99amp$1(-gt-lt()

M4(-amp78-amp(amp$$amp($amp$amp(((-gt-lt( (D6A()XNZD( )[Q0D( 2345E2322(

321=4)H0$)K+)$$amp(gt1(9-lt-lt(($amp-lt-(-lt-lt(lt$(amp($$(99$9-amp() M2(Agt-(=($amp-lt-(=$ampamp$(-lt-($amplt(=(amp$$amp(799$amp7( G1(7gt-amp9-amp(amp(-gt-9-amp(amp-lt( )6(D6A( 2345E2322(

321=4)H0$)L+)Bamp-lt-($amp(=(89amp(-lt-lt(G1(7gt-amp9-amp(=(8-($9-9-amp$amp(=(amp$$amp( $amp-gt-amp$amplt) MH(-amp78-amp(89amp($1(=(-==-$gt-(799$amp7(amp(-$gt-1(=(amp$$amp( lt-gt$-lt(((-gt-lt( D6A()XNZD( 2345E2322(

321=4)H0$)+)D-gt-9-amp(=(-7(9-8amp$lt9lt(8(-ltG$lt8(=(lt=-1(ltamplt(amp(-(amplt9-lt) MI(Qamp=-(-7($amplt9-amplt((7$-($9-9-amp$amp(=(amp$$amp(lt-gt$-lt(amp( 799-lt( D6A()OA( 2345E2322(

321=4)H0$)A+)Bamp-lt-($ampgt-lt9-amp($amp(-$gt-1(=(8$78+$9(amp$$amp($amp-gt-amp$amplt(ltlt(8-(lt-lt()

ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

321=4)H0$)5+)-amp78-amp-(G$amp(amp($amp$amp(=(amp$$amp(-lt-8($gt$$-lt()

54(09-($amp$amp(amp(G$amp(=(amp$$amp(-lt-8-lt($amp($amp-(F$8(8-( amp$$amp(-lt-8(lt-71(amp(8-(-]$lt$amp7($amplt($amp(8-(-lt-8($amplt$$amplt( D6A(A-9$( 2345E2322(

321=4)H0$)K+)Z$amp-($amp=9$amp($ltlt-9$amp$amp($$^$amp(amp(=--GU((amp$amp(amp($lt$(-gt-lt(=( -gt$-amp-+Glt-(-$lt$amp(9U$amp7) 52(09-(-lt-8(amp(lt-(=($amp=9$amp(=(-gt$-amp-+Glt-(-$lt$amp(9U$amp7((( -gt-lt( D6A(A-9$( 2345E2322(

5H(-amp78-amp(9amp$$amp7(-gt$amp(amp(ltgt-$amp-(lt1lt-9lt(=($amp-( $amp=9$amp(lt8$amp7(amp(($$^$amp(((-gt-lt(( D6A(A-9$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3 $-11-(D-ampI30EEDamp33

JJ7 H7 HK7 H87 H67 J67 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$E$-amp+-$amp6FGHDamp3 $-14$D-amp)D-(-amp

97 57 G7 7 H7 6H7 B=lt $E$3

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

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Kamp- LMLM

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8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

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X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

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K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

Page 30: Malawi National Multi-Sector Nutrition Policy 2018-2022

bull Promote continued breastfeeding and appropriate complementary feeding of children aged 6ndash24 months and beyond

bull Strengthen optimal feeding of children during and after illness

bull Promote improved WASH practices at community and household level

II High-impact nutrition-specific and nutrition-sensitiveinterventions in the relevant core sector policies strategies implementation plans and budgets are integrated

L0$0E1F( bull Promote implementation of nutrition-sensitive and

nutrition-specific interventions in the core relevant sectors

bull Promote school feeding and school health and nutrition programmes

III Private sector engagement in the production processingand consumption of high-quality nutritious foods is enhanced

L0$0E1F( bull Promote Public-Private Partnerships in food production

processing fortification and consumption

bull Promote fortification and standardisation of centrally-processed food for improved nutrition

National Multi-Sector Nutrition Policy 2018-2022 17

A2gt2(( 8-5($$05(3$(gtF(7$(HW=805X(HW=05X($0-0X($0-D0X((H6Damp$60(+$(lt6D$)(K=0$0((

Gender equality and equity is a fundamental human right Advancing gender equality and equity is critical in promoting healthy and prosperous nation Gender equality and equity are achieved when women men boys and girls enjoy the same rights and opportunities in economic empowerment participation in socio-economic activities and decision making across all sectors Gender inequality is high in Malawi and adversely impacts nutrition status of women children and other vulnerable groups

As girls move into adolescence gender disparities widen Early marriages and teenage pregnancies affect girls far more than boys with higher risk for nutrition and health disorders Womenrsquos participation particularly those of child bearing age in decision-making at household level is low

Therefore it is necessary for male involvement at household and community level to achieve gender equality equity protection and empowerment

8-5(L00601( The Policy will ensure that

I Optimum nutrition service delivery to adolescents is promoted

L0$0E5F( bull Promote improved nutrition for adolescents

National Multi-Sector Nutrition Policy 2018-2022 18

bull Promote iron-folate supplementation for women of reproductive age

II Menrsquos shared responsibility for child care and household duties to enable women participation in social and economic activities is increased

L0$0E5F( bull Promote male involvement in maternal nutrition child

care and household duties

III Approaches to improve womenrsquos decision-making power for access to optimum nutrition are integrated and leveraged

L0$0E5F( bull Address gender and socio-cultural issues that affect

adolescent maternal infant and young child nutrition

IV Livelihood for women- and child-headed households to increase access and control of resources for improved nutrition status is sustained

L0$0E5F( bull Promote sustainable livelihoods interventions for

women- and child-headed households

National Multi-Sector Nutrition Policy 2018-2022 19

A2A2(( 8-5($$05(3$(AF(S$060((0$8(+(3-=0(G8=0$0(

Treatment and control of acute malnutrition focuses primarily on timely identification treatment and follow-up of acutely malnourished children through a community- and facility-based approach In addition the Government established nutrition care support and treatment (NCST) interventions which aims at addressing malnutrition among adolescent and adults with chronic illness such as TB HIV and AIDS

However treatment and control of acute malnutrition has faced several challenges including inadequate coverage weak linkages between facilities and communities low capacity and participation of clinicians in the management of acute malnutrition insufficient community outreach and mobilisation weak supply chain management and overall low quality of service delivery

8-5(L00601(( The Policy will ensure that

I Interventions on the management of acute malnutritionare owned and financed by the Government

L0$0E5F( bull Strengthen the implementation of CMAM and NCST

through lifecycle approach targeting adolescents adults and children

National Multi-Sector Nutrition Policy 2018-2022 20

II Nutrition assessment counselling and support services and linkage with livelihood interventions targetingadolescents adults and children recovering from various forms of ailments including TB HIV and AIDS are scaled up to ensure a continuum of care

L0$0E5F( bull Promote scaling up of nutrition treatment care and

support for TB patients PLHIV and other chronically ill persons in all public and private health facilities

III Enabling environment for CMAM and NCST service delivery and MampE system at all levels is strengthened

L0$0E5F( bull Promote governance coordination monitoring and

evaluation of CMAM and NCST service delivery

National Multi-Sector Nutrition Policy 2018-2022 21

A2C2(( 8-5($$05(3$(CF($)0((GE60(+(N)$ampEP0((K=0$0Y$80(K1(

Prevention and management of overweight and nutrition-related NCDs focuses on prevention early identification and treatment of overweight obesity and nutrition-related NCDs such as cardiovascular diseases diabetes cancers and chronic respiratory (lung) conditions Overweight and obesity can be a result of overnutrition random genetic abnormalities heredity and lifestyle including environmental causes

Overweight and obesity are on the rise and contribute to nutrition-related NCDs which are significant causes of morbidity and mortality in the country In addition to that urbanisation changing lifestyles such as tobacco smoking excessive alcohol consumption physical inactivity and low fruit and vegetable intake are well known shared risk factors for development of nutrition-related NCDs However identification and management of nutrition-related NCDs are not regularly done and the preventive measures for overweight and obesity are also not adequately met at the community and facility level

8-5(L00601(( The Policy will ensure that

I Overweight and nutrition-related NCDs by all nutrition service providers is detected and managed early

L0$0E5F( bull Increase access to services for prevention early

detection and management of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 22

II Service providersrsquo capacity to provide nutrition and lifestyle counselling services for those who are overweight and obese is enhanced

L0$0E5F( bull Strengthen capacity of service providersrsquo to provide

nutrition and lifestyle counselling services at the facility and community level

III Nutrition-related NCDs are prevented through behaviour change communication focused on consumption of appropriate diet promotion of healthy lifestyles and physical activity

L0$0E5F( bull Promote awareness campaigns and behaviour change

communication on prevention of nutrition-related NCDs

National Multi-Sector Nutrition Policy 2018-2022 23

A2B2( 8-5($$05(3$(BF(K=0$0(H=-0X(L-8(G4810((10)(P)=$(PE(

Nutrition education focuses on increasing the nutrition knowledge and awareness to the public and promoting desirable behaviours and practices in food production processing storage and consumption for optimum nutrition It is a combination of education strategies that enhances multi-sectoral response by mobilising and building strong movement and commitment for improvement in nutritional status at the individual household and community levels

The key challenges in nutrition education social mobilisation and positive behaviour change are cultural beliefs practices and taboos that prevent access and utilisation to nutritious foods Such changes are often difficult and require more than providing correct information about prevention of undernutrition or overnutrition Therefore well-designed social and positive behaviour change interventions are critical for improvement in nutrition practices

National Multi-Sector Nutrition Policy 2018-2022 24

8-5(L00601(( The Policy will ensure that

I Nutrition education behaviour change communication and social mobilisation interventions are scaled up

L0$0E1F( bull Promote behavioural change for collective action

community ownership and improved nutrition knowledge attitudes and practices

bull Advocate for stakeholdersrsquo participation in nutrition education programming at all levels

bull Promote social mobilisation through mass media and other communication channels

II Capacity of the core sectors to formulate and implementnutrition social mobilisation and behaviour change communication interventions is enhanced

L0$0E5F( bull Strengthen the capacity of all sectors at national and

district level to review and implement nutrition education and communication strategy

National Multi-Sector Nutrition Policy 2018-2022 25

A2Z2(8-5($$05(3$(ZF(K=0$0(=$E(H6$E-5(L0=01(

Emergency situations occur when there is an exceptional and widespread threat to life health and basic subsistence that is beyond the coping capacity of individuals and communities Malawi is prone to disasters predominantly droughts and floods which are further exacerbated by climate change The affected population are sometimes displaced from their homes lose their livelihoods and have little access to resources or services and become vulnerable to infectious diseases and malnutrition The impact of these disasters on the population are particularly devastating due to the high dependence on subsistence farming over-reliance on rain-fed agriculture poverty limited crop diversity and a lack of disaster-risk management infrastructure and systems

The key challenges during emergency situations are food insecurity poor livelihoods inadequate coping mechanisms resulting in limited availability and access to food and nutrition that compromises the nutritional status of individuals especially vulnerable groups

8-5(L0060(( I The Policy will ensure that food and nutrition response to the affected population including vulnerable groups duringemergency situations is done timely and effectively

L0$0E1F( ( bull Promote timely detection management and treatment of

malnutrition

National Multi-Sector Nutrition Policy 2018-2022 26

bull Promote nutrition education on maternal and child nutrition

bull Promote resilient programmes aimed at improving maternal and child nutrition

bull Strengthen coordination measures of nutrition emergency response at all levels

National Multi-Sector Nutrition Policy 2018-2022 27

A2[2((8-5($$05(3$([F($0E((H48E(H)$60(+$(K=0$0(

An enabling environment is a set of interrelated conditions such as legal organisational fiscal informational political and cultural that impact the capacity of stakeholders to engage in nutrition interventions in a sustained and effective manner Creating enabling environment involves ensuring that there is effective coordination advocacy regulations governance accountability capacity building and resource mobilisation In 2004 the Government established the DNHA to provide policy guidance oversight and MampE for all sectors implementing nutrition interventions Through the DNHA several governance structures have been established at the national district and community levels

Challenges for the enabling environment include insufficient capacity (human and financial) unavailability of legal instruments for nutrition and weak coordination and governance of structures at all levels

8-5(L00601(( The policy will ensure that

I Multi-sector and intra-sector coordination of nutrition interventions at national district and community levels is enhanced

L0$0E5F( bull Strengthen nutrition coordination at all levels

National Multi-Sector Nutrition Policy 2018-2022 28

II Nutrition advocacy measures are well coordinated to increase resources and social and political commitment

L0$0E5F( bull Advocate for increased financial resource allocations for

nutrition programming by government and development partners

III Allocation of human resources by government for the implementation of nutrition interventions is increased

L0$0E5F( bull Strengthen human capacity for effective programming

and delivery of nutrition services at all levels

IV Legal mechanisms that establish food safety standards and protect consumers is developed

L0$0E5F( bull Enforce legal instruments to guide implementation of

nutrition services and programmes

V Investment in delivery of high-impact nutritioninterventions is increased across the sectors

L0$0E5F( ( bull Promote public-private partnership in implementation of

nutrition programmes

National Multi-Sector Nutrition Policy 2018-2022 29

A22(8-5($$05(3$(F(K=0$0(G0$EX(H)8=0X(Q1$-P((L=$)88-(

Nutrition monitoring evaluation research and surveillance aim to measure achievements progress and gaps and to trigger corrective actions for nutrition planning and programming Nutrition MampE is primarily designed to provide stakeholders with relevant information on the implementation progress of nutrition services It further helps in evidence-based decision making

Nutrition research generates new information and provides evidence on improving programming and practice Although research has been key in building some of the national programmes such as the CMAM and sugar fortification it has not been adequate in supporting evidence-based programming around national policy priorities The Nutrition Research Strategy was not adequately disseminated to partners including academia private sector and non-governmental institutions There are inadequate financial and human resources to support national nutrition research capacity

Surveillance provides routine information about the populationrsquos nutritional status identifies at-risk groups and enables timely interventions to address a problem While the intervention was successful it has limited coverage and focuses on limited nutrition interventions

National Multi-Sector Nutrition Policy 2018-2022 30

8-5(L00601(( The Policy will ensure that

I Collaboration and coordination of nutrition research activities is strengthened

L0$0E5F( bull Promote coordination and collaboration of nutrition

researchers in line with the national nutrition research strategy and other existing actions in the research institutions

II Nutrition Research routine information dissemination utilization and feedback at national and district levels to enhance evidence-based decision making

L0$0E1F( bull Promote research and use of information for evidence-

based decision making at all levels

bull Strengthen monitoring evaluation and surveillance systems for routine information sharing and data utilisation at all levels

National Multi-Sector Nutrition Policy 2018-2022 31

C22(lt6D8600(3$$E601( Outlined in this chapter is how the policy will be implemented including institutional arrangements resource mobilisation sustainable financing and monitoring and evaluation

C22(lt100=08(3$$E601(

The Government recognises the importance of stakeholders and partnership in implementation of this policy The stakeholders include ministries departments agencies development partners academic and research institutions the public sector the private sector civil society organisations (CSOs) non-governmental organisations faith-based organisations and the communities which are as follows

SP(D$060(+(K=0$0X(Tlt]((3ltL(^KT3_( The Department will be responsible for provision of oversight strategic leadership policy direction coordination resource mobilisation capacity building quality control and monitoring and evaluation of the national nutrition response The department will also be responsible for 1) high level advocacy 2) spearheading the mainstreaming and integration of nutrition in the national development agenda sectorial policies programs and outreach services 3) ensuring the implementation of the Policy by sectors and other stakeholders on the basis of the defined mandates 4) tracking sector performance and ensuring accountability and 5) resource tracking

32 National Multi-Sector Nutrition Policy 2018-2022

G10$5($1D148(+$(3E$-=80=$X(lt$$E0((`0$()8D60(^G3lt`_( The Ministry will be responsible for food and nutrition security and mainstreaming nutrition as a core priority area by focusing on improving food access and promoting diversified diets The Ministry will support production of diverse nutritious crops and livestock Ministry will promote consumption and utilization of diverse diet from the six food groups including bio-fortified foods and strengthen value chains to improve production availability distribution and access to high-quality and safe nutritious foods Ministry will also promote Water Sanitation and Hygiene (WASH) interventions

G10$5($1D148(+$(T80P( The Ministry will be responsible for provision of leadership and technical direction in programming and delivery of the quality and cost-effective clinical and biomedical nutrition services in partnerships with stakeholders

G10$5($1D148(+$(7$X(P8$X(14805((L-8(`8+$( The Ministry will be responsible for provision of leadership and technical direction in programming gender and mainstreaming nutrition interventions The Ministry will promote womenrsquos and adolescentrsquos empowerment integration of nutrition in income generating activities social protection and welfare programmes and community mobilisation in support of nutrition Ministry will also promote the early stimulation care protection and development amongst children

National Multi-Sector Nutrition Policy 2018-2022 33

G10$5($1D148(+$(H=-0X(L--((S-P8E5(^GHLS_( The Ministry will be responsible for implementation of the school health and nutrition programmes including school feeding It will also be responsible for inclusion of nutrition education in school curricula at all levels of the education system

G10$5($1D148(+$(O-8(7)$60((Q=$8()8D60(^GO7Q_( The Ministry will be responsible for implementation of nutrition interventions at the council and community levels It will ensure the replication of the multi-sectoral approach to nutrition at the district municipal and city council levels It will also establish district and community-level nutrition committees

G10$5($1D148(+$(-X(H-6-(8E(()8D60( The Ministry will be responsible for mobilisation of resources from government and development partners and private sectors for nutrition interventions

G10$5($1D148(+$(lt+$60(()-(H=-0( The Ministry will be responsible for dissemination of nutrition information and public awareness using different communication channels

National Multi-Sector Nutrition Policy 2018-2022 34

G10$5($1D148(+$(lt=10$5((S$( The Ministry will be responsible for enforcement of trade-related sections of legislation that have impact on food nutrition counterfeit law Salt Iodisation Act food standards as defined and protected by the Malawi Bureau of Standards and the National Code of Marketing of Breast Milk Substitutes

G10$5($1D148(+$(a=0P()8D60( The Ministry will be responsible for provision of leadership and coordination in the delivery of high quality culturally appropriate and contextually relevant nutrition information and services to the youth

G10$5($1D148(+$(b=10-((100=08(3++$1( The Ministry will be responsible for drafting and interpreting legislations that support food nutrition and the wellbeing of Malawians

G10$5($1D148(+$(860(PE( The Ministry will be responsible for coordinating integration and mainstreaming of nutrition in environmental and social impact assessment and management plans in view of challenges due to climate change

3-6-((Q1$-P(lt100=01(( Academic and research institutions will be responsible for conducting nutrition research and disseminating findings to inform policy and programming The academic institutions will also play an important role in ensuring that pre-service education addresses up-to-date nutrition policy interventions and standards that are relevant to the Malawi context

National Multi-Sector Nutrition Policy 2018-2022 35

)8D60($0$1( Development partners will align their nutrition interventions programmes and financial support with the Policy and nutrition strategy The development partners will continue to undertake high-level advocacy for nutrition among policy and decision makers provide technical support including policy analysis and implementation and assist Government sectors in mobilizing resources for implementation of nutrition programs

$)0(L-0$(3E-1( Private sector agencies will ensure that the standards in the production and marketing of high nutritive-value foods are upheld follow mandatory fortification requirements and adhere to recommended fortification standards in all the centrally-processed foods ensure that the provisions of the Nutrition and the Right to Food and Food Safety Acts are adhered to meet their social corporate obligation in promoting good nutrition for their employees and the nation

)8(L-05(N$E101( At the national level the Civil Society Organizations (CSOs) will collaborate with the government to advocate for and implement nutrition-specific and nutrition-sensitive interventions ensuring mutual accountability CSOs in Malawi will play a crucial role to ensuring that the concerns of various stakeholders in nutrition are heard and that government is held accountable to its commitments to the citizens of Malawi on matters of nutrition security

National Multi-Sector Nutrition Policy 2018-2022 36

$-D8(L-$0$1c(6600((K=0$0X(Tlt]X((3ltL( The Principal Secretariesrsquo Committee on Nutrition HIV and AIDS will be responsible for ensuring that nutrition interventions are implemented according to each sectorrsquos mandate roles and responsibilities As controlling officers at the sector level the Principal Secretaries through this committee will be accountable for operationalisation of the strategic interventions assigned to their sectors This responsibility includes ensuring that their respective sectors have been assigned adequate financial and human resources for nutrition develop action plans for implementation establish clear objectives and targets and adhere to reporting and review mechanisms for nutrition interventions

G=80YL-0$8(S-P-8(K=0$0(6600( The Multi-Sectoral Technical Nutrition Committee will provide technical oversight in the implementation of the policy within each sector receive reports from technical working groups and provide technical advise to TWGs

10$-0(K=0$0($0(66001(( District Committees will work closely with all the district level structures including the Area and Village Development Committees The Committees will be responsible for providing nutrition technical guidance to stakeholders coordinating monitoring and evaluation of interventions at the district and community levels

National Multi-Sector Nutrition Policy 2018-2022 37

E=$(F(KGK(gt(Y(gtgtgt(lt100=08(3$$E601((

Cabinet Committee on Social Development

Parliamentary Committee on NutritionHIV and AIDS

Principal Secretariesrsquo Committee on Nutrition HIV and AIDS

Development Partners

(Bilateral and Multilateral Donors)

Multisectoral Technical Nutrition Committee

Department of Nutrition HIV and AIDS

Private Sector

Sectors (Local GovernmentHealth AgicultureGender Education)

Civil SocietyOrganisations

Academic and Research Institutions

District Councils (District Executive Committee and Full Council)

District Nutrition Coordinating Committees

Area Development Committee Area Nutrition Coordinating Committees

VillageDevelopment Committee Village Nutrition

Coordinating Committees

Care Group

Households

National Multi-Sector Nutrition Policy 2018-2022 38

C2gt2(lt6D8600(8( This Policy will guide implementation of nutrition interventions and programmes by the defined line-ministries and sectors under the coordination of DNHA guided by the strategic focus and interventions contained in Annexure I

C2A2(G0$E((H)8=0(

The monitoring and evaluation will be guided by the National Monitoring and Evaluation Framework as presented in Annexure II

This Policy will be reviewed after five years

National Multi-Sector Nutrition Policy 2018-2022 39

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 40

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National Multi-Sector Nutrition Policy 2018-2022 41

321=4)3(12(14)(0)K+)M$9()NO014B)NO14B)3(2=12$B)30(1=1-012$)0$9)N-2gt($) lt=16+)N$0$=)D$9()O014B)-(2=12$B)-0(1=1-012$B)0$9)-2gt($)27)092=$)D1(B)gt2$B)0$9)=19($)72()1-(269)$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 42

321=4)3(12(14)(0)L+)J(0$)0$9)P2$(2)27)=)Q0$(112$) lt=16+)J(0)0$9)=2$(2)0=)0$(112$)02$D)=19($)$9()AB)-(D$0$)0$9)0=01$D)gt2$B)3EFGB)0$9)2()6$(0)D(2-)

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National Multi-Sector Nutrition Policy 2018-2022 43

321=4)3(12(14)(0)R)3(6$12$)0$9)Q0$0D$)27)6(gt1D)0$9)S(112$C(09)SPT)

lt=16+)3(6$)0$9)0$0D)26(gt1D)0$9)$(112$C(09)SPT)

321=4)H0$) I-2$1114) J17(0)

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)6(D6A()-$( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 44

321=4)3(12(14)(0)A+)S(112$)N9=012$B)H2=10)Q211012$)0$9)32116)U0612()P0$D)

lt=16+)N$0$=)2=10)211012$)V)-2116)0612()=0$D)=2$1=012$)72()$(112$)

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National Multi-Sector Nutrition Policy 2018-2022 45

321=4)3(12(14)(0)W+)S(112$)9(1$D)N(D$=4)H1012$)

lt=16+)N$0$=)916(4)27)$(112$)1$(6$12$)9(1$D)(D$=1)

321=4)H0$) I-2$1114) J17(0)

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2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 46

321=4)3(12(14)(0)X+)P(01$D)0$)N$01$D)N$61(2$$)72()S(112$) lt=16+)P(0)0$)$01$D)$61(2$$)72()77=16)1-$012$)27)$(112$)1$(6$12$)

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ML(09-(G$($gt-(amp-lt8$($amp($9-9-amp$amp(=(amp$$amp(799-lt( D6A(000O( 2345E2322(

National Multi-Sector Nutrition Policy 2018-2022 47

321=4)3(12(14)(0)Y+)S(112$)Q2$12(1$DB)N60012$B)I0(=)0$9)H(610$=)

lt=16+)N$0$=)619$=C09)-(2D(01$D)(2D)$(112$)(0(=)0$9)(610$=)

321=4)H0$) I-2$1114) J17(0)

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National Multi-Sector Nutrition Policy 2018-2022 48

$amp(()+-+amp0123-+43 4amp+amp-5amp6)4amp2-++780amp-amp-+ 9-+)(ltamp+20-amp-+=--=+7gt30amp0ampAB++7ampltamp+0-2amp+lt0+-amp23ampC3amp+lt= 9CD-2)4amp2-0ampE-amp-+B-lt==+30amp0ampA0+3=-amp3=Altamp-03--B+Alt+lt332 B-F(GH4IF(GJA0+-amp23ampC3amp+lt= 9-lt-6)(ltamp+20-amp-+=--=+730amp0amp

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-1 2($3+()4($30amp

567 587 557 597 57 57 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

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-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+-$amp()KFK5 Damp34$-1L$(3D-M 0$-amp)E$1-03(2

7 H7 J97 J57 JG7 G7 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 +()4$-1(D-amp-D0D (E(L-

957 9J7 KK7 K7 5K7 J7 lt=gt gt0$1-(amp

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp6FK5Damp3 +()4amp30D-$ampN$-+3 0$-amp)E$1-03(2

87 8H7 G97 G57 GG7 8G7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 49

$amp()+4L-$4-)L(L-3 9K7 997 97 H7 J7 957 lt=gtABgt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp0amp$+-1 2($3+()4($0amp$4-)

997 97 H7 7 67 9K7 =Agtlt=gt ABgt

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FK5Damp3 $-1D-$amp0$-ampE4$35 3(3

OPlt OPlt OPlt OPlt OPlt OPlt B($)$0E $)-3$

-$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+amp4NL$amp3L$(3+ 4--amp5D-amp03+L-$

J7 J7 JK7 J87 J67 67 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp()6FK5 Damp34$-1+3+$D8$ D$+)$0E30$-amp)E$1-03 (2

57 5G7 87 8G7 G7 KG7 B($)$0E $)-3$ lt=gtABgt

Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6NK5 Damp34$-1D-amp-D0DD( +$Q0amp2

587 5H7 887 8H7 G87 KH7 lt=gt Aamp$(3$E(amp-($2-1$3-2

$amp()+-$amp()6FGH Damp34-(amp(D-(

697 GH7 G7 GG7 G57 657 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

50

9-lt-L)(ltamp+20-amp-+=--=+7B++7ampltamp+0-2amp+lt

4amp7+amp(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()4Damp+$E$0-1 ()9GF8H2($34($-amp

67 G7 87 57 K7 7 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()4Damp+$E$0-1 ()9GF8H2($3amp30D-amp)8$D$ +)$0E3

KH7 597 557 5G7 57 K7 gt0$1-(amp Aamp$(3$E(amp-($2-1$3-2

$E$-amp+033amp30D-amp) (Q0(2--33(

RH7 RH7 RH7 RH7 RH7 H7 lt=gtABgt -$amp0$-amp330EEDamp(-amp E$)$(DD4-L3(0EL2A3

$amp()+E$)amp(amp4Damp $-19KS-$amp+(TUUV (L3

KJ7 557 5J7 857 8J7 K57 =Agt I1(-(L--2+-$amp+( 30EEDamp3

$amp()+E$)amp(amp4Damp() 9GF8H2($34-(amp(D-(

5K7 597 57 KJ7 K7 557 lt=gt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-amp3$-1 amp0$--amp(3333Damp

9G7 KG7 5G7 8G7 GG7 G7 =Agt C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 51

4+354amp+amp-5ampL)U0amp1V3-5A1V-5A4amp+--+A4amp-lt-+01lt+Bamp- 9-+)(ltamp+200ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp--+=+300+-5323 9CD-2)10ampV3-5Altamp+--+Altamp-lt-+A0lt+Bamp-+70+3=-amp3=AB+A030amp7+amp ltamp+20-amp-+ 9-lt-6)(ltamp+20==-+30ampA5+-0B+7+amp0ampV3-5Altamp+--+Altamp-lt-+0lt+Bamp-

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+WBlt amp$3E$1--amp) amp0$--amp30EE$

5G7 87 8G7 G7 GG7 57 gt-(4+($ $E$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

$amp()+ =033Lamp+--amp) +$D3-((3 $(amp3+$3

6K7 687 667 6J7 7 67 gt-(4+($ CE$3

C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)(amp=0==-+=++33-0-amp-+ $amp()+E$-D($2 33E$(-amp) 3D(3

8J7 G7 GK7 G87 G67 867 gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

$amp()+E$-D($2 33-DEDamp-amp) DEgt=X E(M()

OPlt OPlt OPlt OPlt OPlt OPlt gt=X$E$3 gt(3$)$(D 4-L3(0EL2 E($amp$3

National Multi-Sector Nutrition Policy 2018-2022 52

4+354amp+amp-5ampW)Kamp--0gt+-amp+3+7-3-amp-+ 9-+)S00ltamp23+7-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3 amp+lt= 9CD-2)Kamp-0+-amp+3-3-amp-++30amp0ampAltamp-03--B+A4IF(GA0+-amp23ampC3amp+lt= 9-lt-6)S00B=-+30amp0amp725amp=Altamp-03--B+A4IF(G0+-amp23ampC3amp+lt=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+-$amp0amp$+-12($3 +()4($4(3

KYG7 KYK7 KY7 9Y7 9YG7 KY7 lt=gtABgt gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 -3($)(3$1$-ampBI E$)$(DT9YXCZ3KY[O35YgtU3V

JG7 H7 JG7

J67 H97 J67

J7 HK7 J7

JJ7 H57 JJ7

JH7 H87 JH7

J87 JH7 J87

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp4(1 +(0-amp0$3+E$)$(DT9Y XCZ3KY[O35YgtU3V

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

]G7 ]G7 ]97

57 J7 957

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+-$amp6FGHDamp3+ ()(D-+$$(Damp-ampBI

57 5H7 897 857 8G7 5G7 BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp(amp(03-amp =A^(ampOP($(amp$(Damp4 $-1amp0$--amp(3333Damp

G7 67 G7 JG7 JG7 ]G7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$E$-amp+(3amp3(amp(03-amp =A^(ampOP($(amp$(Damp43 amp0$--amp(3(03-3(3333_(33-+- (3D$((amp31$0amp$amp0$--amp

]97 ]J7 ]G7 ]G7 ]G7 9K7 XBgtO $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)S00Camp+70-=+730amp0amp725amp=0-+B=- $E$-amp+-$amp4(1--amp 0$3+E$)$(DT9YXCZ3KY[O3 5YgtU3V

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

]G7 ]97 ]97

97 97 7

BI $E$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 53

4+354amp+amp-5ampXY4amp2-+0-+792ampB-0Z-amp-+Eamp3-0Zgt[= 9-+)S00ltamp23+7+2ampB-R+C=+30amp0amp0B++7ampltamp+0-2amp+lt

9CD-2)4amp2-0+2ampB-0-amp-+Eamp3-0Zgt[=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+730amp0ampB+amp+2ampB- $amp()+-$amp 0amp$+-12($3+() 4($1$4-)

8Y7 8Y87 8Y97 5YJ7 5YG7 G7 lt=gtABgt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

9-lt-L)S00Camp+7B+B+amp+2ampB-+amp+C= $amp()4Damp+ $E$0-1()9GF 8H2($34($ L3$1$4-)

K7 9H7 9J7 97 967 K97 lt=gt C1(amp3$3 amp-amp0 -DEDampE(ampamp amp0$--amp$( E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 54

4+354amp+amp-5amp)Z-amp-+10-+AQ+3+C3=-+04+=-2P2+ampgt

9-+)(ltamp+20lt+=-2C2+amp+-amp-0lt+lt3-+-+2+lt--amp-+

9CD-2)1=+3+C3=-+ lt+=-2C2+amp+-+7+amp-amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+20Camp=-70ltamp-= $E$-amp+-$ampFGDamp3+ ()4($`03-12L$(3+

657 6G7 67 6H7 97 697 lt=gt gt0$1-(amp

X0$--amp0(-amp E$)$(DD4-L3( 0EL2-DEDamp-amp) E($amp$3

9-lt-L)(ltamp+20amp=TC2+amp+-+-5 $amp()+-$amp0amp$+-12($3 +()+$D0334-AOX4 3E0amp$(ampAOX(3amp-)

97 57 G7 7 H7 6H7 lt=gt I1(-(L--2(amp (33-L--2+-amp3-- $(amp3

$amp()+-$amp0amp$()G4- -($$(-amp(3K4M34 $-1[CO(ampamp-amp0+-amp) 0$-amp)E-3+-($$(

G87 GH7 687 6H7 87 8H7 lt=gtABgt I1(-(L--2+[Cgt Mamp4)+D$3amp DD(+0-3+$ D(amp()Damp+-($$(

$amp()+-$amp0amp$G4- -($$(-amp(3K4M34 $-1a-amp

557 5J7 857 8J7 G57 KJ7 lt=gt I1(-(L--2+b-amp Mamp4)+D$3amp D(amp()Damp+-($$(

$amp()+E$)amp(amp4Damp$-1 (ampamp((($TIXBV-amp+-$3$-D3$

97 KK7 K7 5K7 57 9K7 lt=gtABgt I4($amp33(L0IXB (Damp)E$)amp(amp4Damp

National Multi-Sector Nutrition Policy 2018-2022

9-lt-W)(ltamp+20lt+=-2C2+amp-amp+amp3-amp-amp-+E==-2-amp2-+=7+amp+lt--amp-+

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

$amp()+($ )$0E33(L-3

6H7 97 57 G7 7 67 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3$(-amp

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+($ )$0E3+0amp-amp-amp)

JK7 J87 J67 JJ7 H7 J7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+L(M2($ )($amp33(L-3

K7 5K7 57 8K7 87 KK7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 E$(-3-amp)-amp)$( 03+($D-amp)T( (35V

897 857 8G7 87 8H7 5H7 ltIWgt Damp2 $E$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+4Damp $E$8$D$IXB 1-3-30$-amp)E$)amp(amp2 +$-$D3$amp L-$

G57 GG7 G7 GH7 697 G97 lt=gt X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

$amp()+033 4--$amp0amp$() 4Lamp+--amp)+$D Damp2($)$0E 3$1-3-amp-amp$1amp-amp -3$-3

67 J7 J7 JK7 J87 87 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 56

$amp()+03$ ($3amp0-amp)D 1-3-30amp3 ($)-1$3

67 6H7 97 57 G7 6G7 B($)$0E $)-3$

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-X)(ltamp+20C7amp=ltamp-lt-+amp+B-+-+amp===+= $amp()+-$ampKF G2($3E($--E(-amp)-amp )$4Damp-$-amp)(amp E$D-amp333-amp3

7 H7 J97 J57 JG7 G7 B($)$0E $)-3$

X0$--amp0(-ampE$)$(DD4-L 3(0EL2-DEDamp-amp)E($amp$3

9-lt-)(ltamp+20==-+=70ampTB-amp0ltamp+20=--+73-= $amp()+EE0(-amp 03-amp)-DE$130$3 +$-ampM-amp)4($

JH7 H97 H57 HG7 H7 J7 lt=gtABgt c1$ampDampDD-DampE$1- 3(+$-ampM-amp)4($

$amp()+EE0(-amp 03-amp)-DE$13(amp-(-amp +(---3

G67 G7 GJ7 GH7 67 GG7 lt=gtABgt gt(amp-(-amp4-L3(L2A3

National Multi-Sector Nutrition Policy 2018-2022 57

4+354amp+amp-5amp])Z-amp-+0amp1amp5Q--+= 9-+)(ltamp+207++00-amp-+amp=lt+=0ampamp5=--+=

9CD-2)1032amp5+7-amp-+-amp2-+=0ampamp=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)S00Camp+7ltamp=+=B+ampamp=T+77++0=amp-50323++0= $amp()+EE0(-amp( $-3M++(amp-1-3 -amp30$-2

967 9G7 987 957 9K7 97 ^IB gt0$1-(amp

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

9-lt-L)(ltamp+20+-5=amp0amp=lt+=7+amp-3-amp-+ $amp()+-$amp6FGH Damp33$amp+$(0 D(amp0$--amp

8H7 G97 G57 GG7 G7 87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3I

RK7 RK7 RK7 RK7 RK7 8Y87 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+-$amp6FGH Damp3-amp-+-(3gtI

R97 R97 R97 R97 R97 9Y67 X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

$amp()+0334- (0D(amp0$-3-$amp 1$0amp$^IB$3Eamp3

OPlt OPlt OPlt OPlt OPlt OPlt X0$--amp WD$)amp2 CE$3

C1(amp3$3amp-amp0 -DEDampE(ampampamp0$--amp $(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 58

4+354amp+amp-5amp^)gtamp-1C312amp+-7+ampZ-amp-+ 9-+)(ltamp+203-E=-+amp3ltamp+amp0++amp0-++7-amp-+-amp2-+=

9CD-2)gtamp-C32amp+-7+amp77-2lt3--++7-amp-+-amp2-+=

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(amp=0+-+amp2=-=7+ampV3-5==amp XY+Damp-$-amp)1-3-3amp0 +$ADEDamp(-amp+Aamp$amp(-amp( B+($M-amp)+P$(3ND-M gt0L3-03(-3$-1

K K K K K ltXBB $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

XY+Damp-$-amp)1-3-3amp0 +$+$-+-(-amp

8 8 8 8 8 8 U$-+-(-amp $E$3

C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-L)(ltamp+20ltamp7+amp+7FQ=7+ampgt $amp()+=gtI3$(-amp-amp BI

G7 GH7 697 657 6G7 GG7 =Agt C1(amp3$3amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

9-lt-W)(amp=0C0-amp533+-+7+amp-amp-+C5+2amp- $amp()+L0)($2((-amp +$amp0$--ampE$)$(D3

Y87 Y87 Y87 YG7 YG7 Y57 ltXBB $E$3

C1(amp3$3 amp-amp0-DEDamp E(ampampamp0$--amp$(E$)$(DD

National Multi-Sector Nutrition Policy 2018-2022 59

9-lt-X)(amp=0==-+CC57amp035+=lt-3= $amp()+-3$-DD0amp-2 3E-(3$-+-(3L(L2N+$-amp2

7 H7 997 957 9G7 G7 =Agt $(+(---3 (EP(L2U$-amp2 =(TPU=AV-amp--(-13

9-lt-)(ltamp+20++amp0-+-0=-amp-0+-5323 A3lt-3$-X0$--amp B$-amp(-ampBDD-TltXBBV +0amp-amp(-amp-3$-d

KJ KJ KJ KJ KJ K6 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

X0DL$+I$(X0$--amp B$-amp(-ampBDD-3TIXBBV +0amp-amp-amp)-amp-3$-

9K 95G 9G 9G 9H 9G ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

$amp()+^-()X0$--amp B$-amp(-ampBDD-3T^XBBV +0amp-amp-amp)-amp-3$-

GK7 G87 G67 GJ7 67 G7 ltXBB $E$3

lt-3$-3(M$3e DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 60

4+354amp+amp-5ampN)Z-amp-++-+ampA123-+AS=amp0Qamp233 9-+)gt$amp)amp$(-D-amp+$D(-amp323D+$1-ampL(3-3-ampD(M-amp)((13

9CD-2)120C=0ltamp+amp-amp+-amp-+amp=amp0=amp233

(0-+amp Kamp- LM6N

Kamp- LM6O

Kamp- LMLM

Kamp- LML6

Kamp- LMLL P=3 Q+amp+7

Gamp7-+ ==lt-+=RS=T=

9-lt-6)(ltamp+2020C=0-+ X0DL$+$1-4 D-amp)3amp0

8 8 8 8 8 K ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+-3$-3 03-amp)($Damp-a $E$-amp)323D

9 9G K KG KJ G ltX=ICE$3 Aamp)$(-amp+$D(-amp 323D4-L -DEDampL2 ltX=I

X0DL$+$3($ -33D-amp(-amp amp+$amp3 amp0

9 9 9 9 ltX=ICE$3 C3($Ofc(amp O(3M+$(-1

9-lt-L)(ltamp+20++amp0-+7+amp1-0=-amp-323 A3lt-3$-_W B$-amp(-amp BDD-TltWBBV +0amp-amp(-amp -3$-d

K KK K8 K6 KJ 9J ltXBB$E$3 lt-3$-3(M$3 DD-Damp(amp 4--amp)amp33

National Multi-Sector Nutrition Policy 2018-2022 61

$amp()+-amp)012)3415 6)7amp8+09 amplt=gt=A B1BCDEFG 69H F(9I7Jampamp8K3)LgtltL(H EM7IHHHL3)LgtltL(H

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