DIRECTORES REGIONALES DE LAS NACIONES UNIDAS . Propuesta Alianza Panamericana por la Nutrición y el Desarrollo para la Consecución de los Objetivos de Desarrollo del Milenio . TALLER DE DIRECTORES REGIONALES DE LAS NACIONES UNIDAS WASHINGTON, D.C. 24 y 25 de julio del 2008

Estado de la Salud de los Niños hacia el ODM 4 400,000 niños menores de 5 años mueren cada año en la Región 70% (280,000) de las muertes ocurre en menores de 1 año 70% (190,000) de ellas ocurre en el primer mes de vida En los últimos 15 años hubo una reducción del 48% en la tasa de Mortalidad Infantil, pero la Mortalidad Neonatal ha quedado casi inalterable Marco Estratégico “Estrategia y Plan de Acción Regional para la Salud Neonatal en el Marco del Continuo de la Atención Materna, Recién Nacido y Niñez, 2008-2015” Development and dissemination of macro policies targeting critical nutrition-related issues. It is important to consider in relevant international agendas and trade agreements issues that can influenced young child health and nutrition develop. To revitalize policies and programs, it is recommended that countries form an inter-sectoral high-level committee to convene and coordinate different sectors at both national and local levels to implement a national strategy and plan of action to improve young child nutrition. Examples of such inter-sectoral high-level committees include the committee for Zero Malnutrition in Bolivia and Brazil and “CRECER” in Peru. Lastly, a strategy is needed to ensure the universal application of highly effective nutrition interventions in primary health care and to guarantee universal access to vulnerable groups and populations. Strengthening resource capacity in the health and non health sectors. Investing in capacity in public health nutrition is needed to ensure that countries have updated knowledge in technical advances, effective policies and programs and monitoring and evaluation strategies in child nutrition. There are examples in the Region developed in Chile, Costa Rica, Mexico, and other countries that serve as regional resources for academic degrees, scholarships and training in maternal and child nutrition and health. Investing in information, knowledge management and evaluation systems. Public health decisions should be data-driven and guided by operation’s research that provides answers on whether programs work; why they work and how much they cost. Funds for monitoring and evaluation should be included in every program budget and sufficient to ensure useful results for decision making. Many countries make large investments in feeding programs that have never been evaluated and, therefore, lack information on whether these investments are achieving their stated goals. Evaluations are needed to provide a rational basis for defending and expanding--and when necessary--changing programs to improve young child nutrition. They also serve to hold all stakeholders, including program beneficiaries, accountable. Development and dissemination of guidelines, tools and effective models. Guidelines, tools and models for how to improve young child nutrition must be continuously updated with respect to scientific changes in our understanding of the causes and consequences of young child nutrition and empirical knowledge from program evaluations. Most importantly, this information must be integrated into medical, nursing and health policy curricula. To reach political and non technical audiences, advocacy materials based on sound science is needed and a communication strategy to reach these audiences developed. Mobilizing partnerships, networks and a Regional Forum in Food and Nutrition. There is a need to harness and coordinate the actions of all stakeholders, including a strategic alliance among the UN Agencies to optimize technical cooperation on young child health and nutrition and a coordinating mechanism among many stakeholders, including bi-lateral agencies, non governmental organizations (NGOs), faith-based organization, foundations and public-private partnerships. The private sector has an important role to play in the marketing of high-quality, low-cost fortified complementary foods and/or micronutrient sachets to improve access to such foods by the poor and in adhering in letter and spirit to the International Code of Marketing of Breast-milk Substitutes.[20] The UN Sub-Committee on Nutrition (SCN) coordinates the global efforts of UN Agencies, bi-lateral organizations and NGOs. A Regional SCN in Latin America, coordinated by PAHO/WHO Peru country office, was a key recommendation of the Latin American Working Group in the 2008 SCN Meeting. Fostering of South-South Cooperation. Several countries in Latin America have been successful in virtually eliminating young child malnutrition. Others have made great strides. These countries can provide cooperation, sharing lessons learned, strategic directions and evaluation strategies. Examples of such cooperation include Brazil’s founding of the Latin American Network of Human Milk Banks; Mexico’s sharing of expertise in implementing and evaluating a successful inter-sectoral poverty alleviation program (Opportunities) with a strong nutrition component; Chile’s example of iron and folic acid fortification of wheat flour; and Costa Rica’s experience in integrating actions to improve young child nutrition in primary health care. Mecanismos de Coordinación Alianza Regional Neonatal para América Latina y el Caribe Miembros: OPS/OMS, UNICEF, USAID, CORE Group, URC/CHS, Save the Children/SNL, ACCESS, BASICS, ALAPE, FLASOG

Estado de la salud de la mujer hacia el ODM 5. 21,000 muertes maternas equivale a RMM 130 por cien mil NV Riesgo de MM de una mujer en LAC es 14 veces superior que en Canadá 10 países con RMM por encima del promedio regional 89% de mujeres con al menos una consulta prenatal 87% de partos atendidos por personal calificado Baja prevalencia promedio de uso de anticonceptivos (65 %) Aborto inseguro persiste como causa importante de muerte materna Marco Estratégico Estrategia y plan de acción regional para la reducción de la mortalidad materna. Consenso interagencial para la reducción de la mortalidad materna Mecanismos de Coordinación Grupo de Trabajo Interagencial Regional para la Reducción de la Mortalidad y Morbilidad Maternas. ( UNICEF, UNFPA, OPS, USAID, WB, BID, PC, FCI, FLASOG, FEPPEN, ICM). Development and dissemination of macro policies targeting critical nutrition-related issues. It is important to consider in relevant international agendas and trade agreements issues that can influenced young child health and nutrition develop. To revitalize policies and programs, it is recommended that countries form an inter-sectoral high-level committee to convene and coordinate different sectors at both national and local levels to implement a national strategy and plan of action to improve young child nutrition. Examples of such inter-sectoral high-level committees include the committee for Zero Malnutrition in Bolivia and Brazil and “CRECER” in Peru. Lastly, a strategy is needed to ensure the universal application of highly effective nutrition interventions in primary health care and to guarantee universal access to vulnerable groups and populations. Strengthening resource capacity in the health and non health sectors. Investing in capacity in public health nutrition is needed to ensure that countries have updated knowledge in technical advances, effective policies and programs and monitoring and evaluation strategies in child nutrition. There are examples in the Region developed in Chile, Costa Rica, Mexico, and other countries that serve as regional resources for academic degrees, scholarships and training in maternal and child nutrition and health. Investing in information, knowledge management and evaluation systems. Public health decisions should be data-driven and guided by operation’s research that provides answers on whether programs work; why they work and how much they cost. Funds for monitoring and evaluation should be included in every program budget and sufficient to ensure useful results for decision making. Many countries make large investments in feeding programs that have never been evaluated and, therefore, lack information on whether these investments are achieving their stated goals. Evaluations are needed to provide a rational basis for defending and expanding--and when necessary--changing programs to improve young child nutrition. They also serve to hold all stakeholders, including program beneficiaries, accountable. Development and dissemination of guidelines, tools and effective models. Guidelines, tools and models for how to improve young child nutrition must be continuously updated with respect to scientific changes in our understanding of the causes and consequences of young child nutrition and empirical knowledge from program evaluations. Most importantly, this information must be integrated into medical, nursing and health policy curricula. To reach political and non technical audiences, advocacy materials based on sound science is needed and a communication strategy to reach these audiences developed. Mobilizing partnerships, networks and a Regional Forum in Food and Nutrition. There is a need to harness and coordinate the actions of all stakeholders, including a strategic alliance among the UN Agencies to optimize technical cooperation on young child health and nutrition and a coordinating mechanism among many stakeholders, including bi-lateral agencies, non governmental organizations (NGOs), faith-based organization, foundations and public-private partnerships. The private sector has an important role to play in the marketing of high-quality, low-cost fortified complementary foods and/or micronutrient sachets to improve access to such foods by the poor and in adhering in letter and spirit to the International Code of Marketing of Breast-milk Substitutes.[20] The UN Sub-Committee on Nutrition (SCN) coordinates the global efforts of UN Agencies, bi-lateral organizations and NGOs. A Regional SCN in Latin America, coordinated by PAHO/WHO Peru country office, was a key recommendation of the Latin American Working Group in the 2008 SCN Meeting. Fostering of South-South Cooperation. Several countries in Latin America have been successful in virtually eliminating young child malnutrition. Others have made great strides. These countries can provide cooperation, sharing lessons learned, strategic directions and evaluation strategies. Examples of such cooperation include Brazil’s founding of the Latin American Network of Human Milk Banks; Mexico’s sharing of expertise in implementing and evaluating a successful inter-sectoral poverty alleviation program (Opportunities) with a strong nutrition component; Chile’s example of iron and folic acid fortification of wheat flour; and Costa Rica’s experience in integrating actions to improve young child nutrition in primary health care.

Estado de la epidemia del VIH en LAC hacia el ODM 6 128.796 nuevas infecciones VIH estimadas en LAC 2007 vs. 123.547 en 2001 21.300 nuevos casos con TB/VIH en 2006 Brecha importante Prevención transmisión materno infantil (PTMI): (52% con test de VIH realizado; 36% de las mujeres embarazadas que califican recibieron tratamiento antirretroviral (TAR) Cobertura estimada TAR 2007: 43% en Caribe, 63% en América Latina, 62% en LAC Atención a los grupos vulnerables (HSH, TS, UDI, clientes de TS, parejas de UDI, jóvenes, poblaciones móviles, etnias) Sólo 2 países con incidencia de sífilis congénita < 0.5 casos/1000 nacimientos vivos. Marco Estratégico “Plan Regional de VIH/ITS para el Sector Salud 2006-2015” y planes desarrollados a nivel subregional para el Caribe y la Región Andina Development and dissemination of macro policies targeting critical nutrition-related issues. It is important to consider in relevant international agendas and trade agreements issues that can influenced young child health and nutrition develop. To revitalize policies and programs, it is recommended that countries form an inter-sectoral high-level committee to convene and coordinate different sectors at both national and local levels to implement a national strategy and plan of action to improve young child nutrition. Examples of such inter-sectoral high-level committees include the committee for Zero Malnutrition in Bolivia and Brazil and “CRECER” in Peru. Lastly, a strategy is needed to ensure the universal application of highly effective nutrition interventions in primary health care and to guarantee universal access to vulnerable groups and populations. Strengthening resource capacity in the health and non health sectors. Investing in capacity in public health nutrition is needed to ensure that countries have updated knowledge in technical advances, effective policies and programs and monitoring and evaluation strategies in child nutrition. There are examples in the Region developed in Chile, Costa Rica, Mexico, and other countries that serve as regional resources for academic degrees, scholarships and training in maternal and child nutrition and health. Investing in information, knowledge management and evaluation systems. Public health decisions should be data-driven and guided by operation’s research that provides answers on whether programs work; why they work and how much they cost. Funds for monitoring and evaluation should be included in every program budget and sufficient to ensure useful results for decision making. Many countries make large investments in feeding programs that have never been evaluated and, therefore, lack information on whether these investments are achieving their stated goals. Evaluations are needed to provide a rational basis for defending and expanding--and when necessary--changing programs to improve young child nutrition. They also serve to hold all stakeholders, including program beneficiaries, accountable. Development and dissemination of guidelines, tools and effective models. Guidelines, tools and models for how to improve young child nutrition must be continuously updated with respect to scientific changes in our understanding of the causes and consequences of young child nutrition and empirical knowledge from program evaluations. Most importantly, this information must be integrated into medical, nursing and health policy curricula. To reach political and non technical audiences, advocacy materials based on sound science is needed and a communication strategy to reach these audiences developed. Mobilizing partnerships, networks and a Regional Forum in Food and Nutrition. There is a need to harness and coordinate the actions of all stakeholders, including a strategic alliance among the UN Agencies to optimize technical cooperation on young child health and nutrition and a coordinating mechanism among many stakeholders, including bi-lateral agencies, non governmental organizations (NGOs), faith-based organization, foundations and public-private partnerships. The private sector has an important role to play in the marketing of high-quality, low-cost fortified complementary foods and/or micronutrient sachets to improve access to such foods by the poor and in adhering in letter and spirit to the International Code of Marketing of Breast-milk Substitutes.[20] The UN Sub-Committee on Nutrition (SCN) coordinates the global efforts of UN Agencies, bi-lateral organizations and NGOs. A Regional SCN in Latin America, coordinated by PAHO/WHO Peru country office, was a key recommendation of the Latin American Working Group in the 2008 SCN Meeting. Fostering of South-South Cooperation. Several countries in Latin America have been successful in virtually eliminating young child malnutrition. Others have made great strides. These countries can provide cooperation, sharing lessons learned, strategic directions and evaluation strategies. Examples of such cooperation include Brazil’s founding of the Latin American Network of Human Milk Banks; Mexico’s sharing of expertise in implementing and evaluating a successful inter-sectoral poverty alleviation program (Opportunities) with a strong nutrition component; Chile’s example of iron and folic acid fortification of wheat flour; and Costa Rica’s experience in integrating actions to improve young child nutrition in primary health care. Mecanismo de Coordinación Grupo de los Directores Regionales (RDG) Miembros: representantes de los 10 co-patrocinadores de ONUSIDA a nivel regional (Banco Mundial, OIT, OPS/OMS, PNUD, UNHCR, UNODC, UNESCO, UNFPA, UNICEF, PAM)

Mecanismos de Coordinación Malaria ODM # 6 1 millón de casos de malaria anualmente al 2000 Reducción de 31.4% del número de casos y 37% de la mortalidad relacionada 2000-2007 De 21 países endémicos, 10 con reducciones > 50% de casos Marco Estratégico Plan Estratégico Regional Contra la Malaria en las Américas, 2006 - 2010 Resolución CSP27/9; Conferencia Sanitaria Panamericana de la OPS; 59 Sesión del Comité Regional de OMS para las Américas, 2007 Día de la malaria en la Región 6 de noviembre Mecanismos de Coordinación Iniciativa Amazónica de Malaria / Red Amazónica para Vigilancia Resistencia de Drogas Antimaláricas. Miembros: OPS/OMS, USAID, CDC, MSH, USP. 5

“Plan Regional de Tuberculosis 2006-2015” Tuberculosis ODM # 6 331.000 nuevos casos de TB; 21.300 con TB/VIH (2006) 41.000 murieron de TB , el 9.5% por TB/VIH (2006) 93% de la población vivía en áreas DOTS (2006) 69% de casos de TBP BK+ fueron detectados bajo DOTS (2006) 78% de casos de TBP BK+ fueron tratados exitosamente DOTS (2005) Incidencia notificada de TB desde los 80s continuamente en descenso Marco Estratégico “Plan Regional de Tuberculosis 2006-2015” Basado en atención integral de TB (sensible, resistente a drogas, co-infectado TB/VIH…) y “Estrategia Alto al TB” Development and dissemination of macro policies targeting critical nutrition-related issues. It is important to consider in relevant international agendas and trade agreements issues that can influenced young child health and nutrition develop. To revitalize policies and programs, it is recommended that countries form an inter-sectoral high-level committee to convene and coordinate different sectors at both national and local levels to implement a national strategy and plan of action to improve young child nutrition. Examples of such inter-sectoral high-level committees include the committee for Zero Malnutrition in Bolivia and Brazil and “CRECER” in Peru. Lastly, a strategy is needed to ensure the universal application of highly effective nutrition interventions in primary health care and to guarantee universal access to vulnerable groups and populations. Strengthening resource capacity in the health and non health sectors. Investing in capacity in public health nutrition is needed to ensure that countries have updated knowledge in technical advances, effective policies and programs and monitoring and evaluation strategies in child nutrition. There are examples in the Region developed in Chile, Costa Rica, Mexico, and other countries that serve as regional resources for academic degrees, scholarships and training in maternal and child nutrition and health. Investing in information, knowledge management and evaluation systems. Public health decisions should be data-driven and guided by operation’s research that provides answers on whether programs work; why they work and how much they cost. Funds for monitoring and evaluation should be included in every program budget and sufficient to ensure useful results for decision making. Many countries make large investments in feeding programs that have never been evaluated and, therefore, lack information on whether these investments are achieving their stated goals. Evaluations are needed to provide a rational basis for defending and expanding--and when necessary--changing programs to improve young child nutrition. They also serve to hold all stakeholders, including program beneficiaries, accountable. Development and dissemination of guidelines, tools and effective models. Guidelines, tools and models for how to improve young child nutrition must be continuously updated with respect to scientific changes in our understanding of the causes and consequences of young child nutrition and empirical knowledge from program evaluations. Most importantly, this information must be integrated into medical, nursing and health policy curricula. To reach political and non technical audiences, advocacy materials based on sound science is needed and a communication strategy to reach these audiences developed. Mobilizing partnerships, networks and a Regional Forum in Food and Nutrition. There is a need to harness and coordinate the actions of all stakeholders, including a strategic alliance among the UN Agencies to optimize technical cooperation on young child health and nutrition and a coordinating mechanism among many stakeholders, including bi-lateral agencies, non governmental organizations (NGOs), faith-based organization, foundations and public-private partnerships. The private sector has an important role to play in the marketing of high-quality, low-cost fortified complementary foods and/or micronutrient sachets to improve access to such foods by the poor and in adhering in letter and spirit to the International Code of Marketing of Breast-milk Substitutes.[20] The UN Sub-Committee on Nutrition (SCN) coordinates the global efforts of UN Agencies, bi-lateral organizations and NGOs. A Regional SCN in Latin America, coordinated by PAHO/WHO Peru country office, was a key recommendation of the Latin American Working Group in the 2008 SCN Meeting. Fostering of South-South Cooperation. Several countries in Latin America have been successful in virtually eliminating young child malnutrition. Others have made great strides. These countries can provide cooperation, sharing lessons learned, strategic directions and evaluation strategies. Examples of such cooperation include Brazil’s founding of the Latin American Network of Human Milk Banks; Mexico’s sharing of expertise in implementing and evaluating a successful inter-sectoral poverty alleviation program (Opportunities) with a strong nutrition component; Chile’s example of iron and folic acid fortification of wheat flour; and Costa Rica’s experience in integrating actions to improve young child nutrition in primary health care. Mecanismos de Coordinación Alianza Regional Alto a la Tuberculosis Miembros: OPS/OMS, CDC, USAID, MSH, La Unión, KNCV, DHAWN, U. MacGill, Fondo Mundial (MCP/países), PEPFAR, Fundación Damian, U. Gainesville, ATS, INEI.

A nivel global, se estima que la malnutrición del niño y la lactancia materna sub-óptima son responsables del 35% de las muertes de menores de 5 años y si se suman las muertes maternas relacionadas con la anemia durante el embarazo, son responsables del 11% de la carga global de enfermedad.

Desnutrición hacia los ODMs 52 millones de habitantes de America Latina y el Caribe sub-nutridos 11 países han mostrado poco avance e incluso retroceso en el número de desnutridos 9 millones de niños menores de 5 años con desnutrición crónica 22.3 millones de niños preescolares, 33 millones de mujeres en edad fértil y 3.6 millones de embarazadas con anemia Marco Estratégico Estrategia y Plan de Acción Regional sobre la Nutrición en la salud y el desarrollo. Development and dissemination of macro policies targeting critical nutrition-related issues. It is important to consider in relevant international agendas and trade agreements issues that can influenced young child health and nutrition develop. To revitalize policies and programs, it is recommended that countries form an inter-sectoral high-level committee to convene and coordinate different sectors at both national and local levels to implement a national strategy and plan of action to improve young child nutrition. Examples of such inter-sectoral high-level committees include the committee for Zero Malnutrition in Bolivia and Brazil and “CRECER” in Peru. Lastly, a strategy is needed to ensure the universal application of highly effective nutrition interventions in primary health care and to guarantee universal access to vulnerable groups and populations. Strengthening resource capacity in the health and non health sectors. Investing in capacity in public health nutrition is needed to ensure that countries have updated knowledge in technical advances, effective policies and programs and monitoring and evaluation strategies in child nutrition. There are examples in the Region developed in Chile, Costa Rica, Mexico, and other countries that serve as regional resources for academic degrees, scholarships and training in maternal and child nutrition and health. Investing in information, knowledge management and evaluation systems. Public health decisions should be data-driven and guided by operation’s research that provides answers on whether programs work; why they work and how much they cost. Funds for monitoring and evaluation should be included in every program budget and sufficient to ensure useful results for decision making. Many countries make large investments in feeding programs that have never been evaluated and, therefore, lack information on whether these investments are achieving their stated goals. Evaluations are needed to provide a rational basis for defending and expanding--and when necessary--changing programs to improve young child nutrition. They also serve to hold all stakeholders, including program beneficiaries, accountable. Development and dissemination of guidelines, tools and effective models. Guidelines, tools and models for how to improve young child nutrition must be continuously updated with respect to scientific changes in our understanding of the causes and consequences of young child nutrition and empirical knowledge from program evaluations. Most importantly, this information must be integrated into medical, nursing and health policy curricula. To reach political and non technical audiences, advocacy materials based on sound science is needed and a communication strategy to reach these audiences developed. Mobilizing partnerships, networks and a Regional Forum in Food and Nutrition. There is a need to harness and coordinate the actions of all stakeholders, including a strategic alliance among the UN Agencies to optimize technical cooperation on young child health and nutrition and a coordinating mechanism among many stakeholders, including bi-lateral agencies, non governmental organizations (NGOs), faith-based organization, foundations and public-private partnerships. The private sector has an important role to play in the marketing of high-quality, low-cost fortified complementary foods and/or micronutrient sachets to improve access to such foods by the poor and in adhering in letter and spirit to the International Code of Marketing of Breast-milk Substitutes.[20] The UN Sub-Committee on Nutrition (SCN) coordinates the global efforts of UN Agencies, bi-lateral organizations and NGOs. A Regional SCN in Latin America, coordinated by PAHO/WHO Peru country office, was a key recommendation of the Latin American Working Group in the 2008 SCN Meeting. Fostering of South-South Cooperation. Several countries in Latin America have been successful in virtually eliminating young child malnutrition. Others have made great strides. These countries can provide cooperation, sharing lessons learned, strategic directions and evaluation strategies. Examples of such cooperation include Brazil’s founding of the Latin American Network of Human Milk Banks; Mexico’s sharing of expertise in implementing and evaluating a successful inter-sectoral poverty alleviation program (Opportunities) with a strong nutrition component; Chile’s example of iron and folic acid fortification of wheat flour; and Costa Rica’s experience in integrating actions to improve young child nutrition in primary health care.

¿Por qué desnutrición crónica? Baja Talla Disminuye la: Capacidad Funcional Capacidad de trabajo Desarrollo mental e intelectual Crecimiento y desarrollo La productividad individual y social Mayor riesgo de: Muerte Infecciones Enfermedades no transmisibles Vulnerabilidad a desastres Restricción del crecimiento intrauterino Transmisión Intergeneracional de daños y riesgos

La nutrición un tema en agenda política Un tema de urgencia regional

La nutrición un tema en agenda política Un tema de urgencia regional

¿Por qué desnutrición crónica (baja talla)? Es un indicador de fácil medición Refleja sensiblemente los desequilibrios de las determinantes sociales Su multicausalidad exige un análisis multifactorial y un abordaje en toda la Región Es “políticamente atractivo” Está asociado e involucra a los ODMs

La pobreza: determinantes y efectos Analfabetismo y pobre instrucción Discriminación Mayor riesgo de enfermar Ambiente físico inadecuado Muerte prematura Pobreza, deprivación social y falta de bienestar Falta de acceso a agua segura y Saneamiento básico Desnutrición Reducción de la capacidad funcional Deficiente acceso a Servicios de Salud Afectación del desarrollo intelectual Desempleo y subempleo Baja productividad laboral Inseguridad alimentaria

Pobreza y desnutrición crónica en menores de 5 años de edad, Perú 2000 % de niños con desnutrición crónica Coeficiente de Correlación: 0.76 % de población pobre Fuente: INEI. Encuesta Demográfica y de Salud Familiar 2000. ENAHO 2001

Servicio de alcantarillado y desnutrición crónica en menores de 5 años, Perú 2000 % de niños con desnutrición crónica Coeficiente de Correlación: 0.82 % of población con servicio de alcantarillado Fuente: INEI. Encuesta Demográfica y de Salud Familiar 2000 Condiciones de vida en los departamentos del Perú – ENAHO 2003-4

Estimación de la contribución de los factores determinantes de la reducción en la malnutrición infantil entre 1970-1995 Salud Alimentación 26.1% 19.3% Status de la mujer 11.6% Educación de la mujer 43.0% Fuente: Smith L. and Haddad L. Overcoming child malnutrition in developing countries, past achievements and future choices. International Food Policy Research Institute. Washington DC 2000. (Peso edad)

Prevalencia estimada de desnutrición crónica, desnutrición aguda y sobrepeso según los nuevos estándares de OMS

Desnutrición crónica en menores de 5 años, según niveles de pobreza, 1996-2000 Incremento de la desnutrición crónica Entre 1996 y el año 2000 apenas hubo una ligera reducción de la desnutrición infantil, pero… … 7 de los 9 departamentos con más del 70% de población en situación de pobreza, aumentaron el porcentaje de niños con desnutrición. Variación porcentual de la desnutrición crónica Huánuco Puno Amazonas Cajamarca Ucayali Huancavelica Mayor pobreza Cusco Callao y Lima Tacna Porcentaje de población en pobreza Fuente: INEI. Encuesta Demográfica y de Salud Familiar 1996 y 2000 Encuesta Nacional de hogares 2001

Desnutrición crónica en menores de 5 años por Departamentos, Perú 2000 NCHS OMS Fuente: INEI. Encuesta Demográfica y de Salud Familiar 2000

Desnutrición crónica en niños de 6 a 9 años de edad – Huancavelica 2006 Tasa del departamento 52.8 % Fuente: Ministerio de Educación. Censo de talla de escolares 2006

Nutrición, pobreza y bienestar Intervenciones nutricionales Malnutrición Necesarias pero no suficientes Reduce la capacidad de aprendizaje y desarrollo Baja productividad Analfabetismo y pobre instrucción Ambiente físico inadecuado Pobreza y falta de bienestar individual y social Falta de acceso a agua segura y Saneamiento básico Deficiente acceso a Servicios de Salud Desempleo y subempleo Inseguridad alimentaria

Nutrición, pobreza y bienestar Reducción de la desnutrición Mayor capacidad de aprendizaje Mejor nivel educativo Mayor productividad Mejoramiento del Ambiente Físico Disminución de la Pobreza y falta de bienestar individual y social Mayor acceso agua y s. básicos Mayor cobertura de los Servicios de Salud Mejoramiento del empleo digno Necesarias y suficientes Intervenciones integrales basadas en determinantes Mayor seguridad alimentaria

Objetivos de Desarrollo del Milenio ODM 1: Erradicar la pobreza extrema y el hambre ODM 2: Lograr la enseñanza primaria universal ODM 3: Promover la igualdad entre los sexos y la autonomía de la mujer ODM 4: Reducir la mortalidad infantil ODM 5: Mejorar la salud materna ODM 6: Combatir el VIH/SIDA, el paludismo y otras enfermedades ODM 7: Garantizar la sostenibilidad del medio ambiente ODM 8: Fomentar una asociación mundial para el desarrollo

Intervenciones Básicas Niños/as Escolares Intervenciones Básicas Niños/as 6 a 24 m Niños/as de 2 a 5 años Parto atendido por personal capacitado AIEPI Neonatal Visitas domiciliarias a RN de riesgo Niños/as 2 a 6 m Control de C y D y Vacunación Educación integral Fortificación de alimentos Promoción de actividad física Embarazadas Consejería en Lact. Materna Suplementación micronutr. Control de C y D Vacunación AIEPI Cuidado infantil Parto y recién nacidos Alimentación nutritiva Control de C y D y Vacunación Suplementación micronutrientes AIEPI Cuidado infantil Atención pre-natal adecuada Suplementación con hierro, iodo y vit A Vacunación antitetánica Hogares maternos para embarazadas de riesgo Prevención del consumo de alcohol y tabaco Prevención de transmisión materno infantil de sífilis y VIH Jóvenes OPS PMA UNFPA UNICEF Salud Sexual y Reproductiva Suplementación hierro y folato Prevención de embarazo adolescente

Determinantes sociales, económicos y ambientales Determinantes de la desnutrición Jóvenes Embarazadas Lactantes 6 m a 2 a Pre-escolares Escolares < 6 m Parto y recién nacidos Analfabetismo Violencia Desempleo/Subempleo Determinantes sociales, económicos y ambientales Inseguridad alimentaria Vectores de enfermedades Vivienda inadecuada Contaminación ambiental No acceso a agua segura Inadecuado Saneamiento Básico

Intervenciones permanentes Jóvenes Embarazadas Lactantes 6 m a 2 a Pre-escolares Escolares < 6 m Parto y recién nacidos “QUE HACER …?” Alfabetización y educación Empoderamiento e Interculturalidad Acceso a empleo digno Seguridad alimentaria y nutricional Intervenciones permanentes Prevención y Control de enfermedades Vivienda saludable Cocinas mejoradas en hogares Agua segura intra-domiciliaria Sistemas de disposición de excretas y residuos domiciliarios Fortalecer la capacidad de gestión local

Intervenciones permanentes “QUIÉNES …?” UNESCO UNCT OIT FAO, PMA, IICA Alfabetización y educación OPS, UNFPA, UNICEF Empoderamiento e Interculturalidad Acceso a empleo digno Intervenciones permanentes UN-HABITAT, OPS, UNEP Seguridad alimentaria y nutricional Prevención y Control de enfermedades Vivienda saludable OPS , UN-HABITAT Cocinas mejoradas en hogares Agua segura intra-domiciliaria Sistemas de disposición de excretas y residuos domiciliarios PNUD Fortalecer la capacidad de gestión local

Hacia la Conformación de la Alianza Panamericana por la Nutrición y el Desarrollo para la Consecución de los Objetivos de Desarrollo del Milenio

Propuesta organizativa Plano Regional: los Directores de cada Agencia (RDT) que integra la Alianza coordinado a través de secretariado rotatorio (DR) Plana Trans-nacional: integración de los UNCT de varios países responsable de proponer e implementar intervenciones adecuadas a las necesidades de grupos de población con características comunes Plano Nacional: un secretariado técnico a cargo del UNCT responsable de la coordinación y entrega efectiva de la cooperación Plano Local: apoyo coordinado del UNCT a gobiernos locales de zonas priorizadas sobre la base de proyectos específicos que reflejan intersectorialidad, participación comunitaria y gestión local

(Secretariado rotatorio) Plano Regional: RDT (Secretariado rotatorio) Comité Asesor Externo Secretariado Ejecutivo Integrantes: capitulo Latinoamericano del Standing Committee on Nutrition Función: Asesoría técnica y evaluación externa Integrantes: puntos focales de c/ agencias Función: seguimiento de los acuerdo y compromisos del RDT Lineamiento de políticas Abogacía Movilización de recursos Monitoreo y evaluación Plano Transnacional: UNCTs involucrados Plano Nacional: UNCT Programa conjunto en áreas transnacionales identificadas Abogacía Movilización de recursos Programa conjunto a nivel nacional Abogacía Movilización de recursos Programa conjunto en distritos seleccionados Abogacía Movilización de recursos Plano Local

¿Qué lograremos con la Alianza? Asegurar un esfuerzo inter-agencial más amplio Identificar prioridades y fortalezas Integrar mandatos y planes de trabajo Identificar y acordar intervenciones multisectoriales e inter-programáticas efectivas Procurar un abordaje multi-sectorial que responde a los determinantes sociales y a la multi-causalidad de la malnutrición Establecer una colaboración estrecha e intercambio entre países y gobiernos particularmente a nivel de fronteras comunes. Planificar sobre las lecciones aprendidas y las experiencias vigentes en los países Reforzar y potencializar los marcos estratégicos vigentes Hacer uso eficiente de los recursos Responder al objetivo de la reforma de Naciones Unidas Aumentar la posibilidad de cerrar las brechas.

Organización de la Salud Panamericana El problema a enfrentar es más grande y complejo que los mandatos y que las posibilidades de las agencias aisladas.

Trabajar TODOS Juntos De manera coordinada Simultáneamente La propuesta es: Trabajar TODOS Juntos De manera coordinada Simultáneamente En todos los frentes Y de manera Permanente ...

¡Gracias!