Final report -- USAID/IMPACT micronutrient field support to the Government of Honduras, 1994-97 : achievements, results and lessons learned

Among the project"s major accomplishments are the establishment of a policy dialogue process with the government at different levels; the training of 1,447 Ministry of Health (MOH) staff members, primary school teachers, community volunteers, and staff from sugar and salt production plants; and provision of TA for policy and program development, food fortification, quality assurance and quality control (QA/QC) and monitoring systems for fortified foods, micronutrient surveillance, supplementation protocols, and information, education, and communication (IEC). The maternal/child health technical norms on vitamin A and iron supplementation were revised, vitamin A supplements were incorporated into the list of essential medicines, the MOH began making budgetary allocations for supplements in 1996, a distribution system was developed and partially put in place, and vitamin A supplementation was linked to the Expanded Program of Immunization and registered on immunization cards. Routine postpartum supplementation of women was established in some hospitals. Other significant accomplishments include operational studies for the adaptation of fortification technology, technical manuals for premix preparation and addition to sugar at production plants, simplification of legal procedures for fortificant imports, and provision of TA in fortification technology, premix preparation, and quality control. A functional QA/QC and monitoring system for sugar fortification and salt iodization was established. A consensus building process between the government and private food producers was consolidated and a firm public/private sector partnership established. Finally, an IEC plan focusing on vitamin A and iodine was implemented in priority regions. Attempts to incorporate supplementation monitoring information and a micronutrient surveillance component within the MOH information system and to implement a sentinel site based system only partially succeeded. Baseline anemia, goiter, and urinary iodine studies in sentinel communities and schools in the priority regions, conducted independently rather than as integral part of a surveillance system, provided key surveillance information. In terms of impact, the prevalence of vitamin A deficiency (VAD) in preschool age children dramatically dropped from 39.5% in 1965 to 13.6% in 1996. This is mostly attributed to sugar fortification, given substantial improvement in coverage and quality over the last 3 years. In 1996, iron deficiency anemia continued to be a significant problem affecting one third of the preschool-aged children and one fourth of the women of childbearing age (at least one third of the pregnant women); there was no evidence of improvement over time, which, on the other hand, would not be expected in the absence of specific interventions. In 1996, a decline in goiter prevalence to less than 5% in children from sentinel schools in endemic areas was observed, and the median urinary iodine excretion ranged from 13 to 50 ug/dL, above the 10 ug/dL cut-off proposed by WHO as an indication that iodine deficiency disorder (IDD) is under control. This is certainly the result of increased coverage and quality of salt ionization. Includes lessons learned on generating political commitment, policy development, developing public/private sector partnerships, program integration, project structure/management, interagency coordination, and sustainability.