东盟国家卫生系统儿童浪费管理最低标准区域指南-2024_59页_2mb

报告摘要

ASEAN Regional Guideline on Minimum Standards for the Management of Child Wasting in National Health Systems

Core Content

The ASEAN Regional Guideline on Minimum Standards for the Management of Child Wasting in National Health Systems is a collaborative effort between UNICEF, WHO, WFP, Hellen Keller International, and ASEAN Member States (AMS). It aims to support AMSs in accelerating progress toward the prevention, early detection, and management of child wasting through national health systems, particularly by integrating these services into routine primary health care (PHC) systems.

Main Objectives

Outline core principles for the management of child wasting.
Define minimum standards for the provision of services for the prevention, early detection, and treatment of child wasting.
Provide essential steps for integrating wasting treatment services into routine PHC services.

Key Principles for Managing Child Wasting

Prevention first – Increase access to services that prevent wasting.
Understand local drivers of wasting and address them.
Prioritize vulnerable children in service delivery.
Adopt evidence-based national guidelines.
Simplify protocols to facilitate scale-up and integration.
Decentralize services to improve access.
Engage communities in the process.
Increase supply of essential commodities and equipment.
Monitor service reach and quality.
Link to other support services.
Build capacity for rapid expansion during emergencies.

Structure of the Guideline

The guideline is organized into four main chapters:

Chapter 1: Introduction

Defines child wasting as a condition where a child is too thin for their height, resulting from recent weight loss or failure to gain weight.
Highlights the serious health consequences of wasting, including weakened immunity, developmental delays, and increased mortality risk.
Notes that children under 2 years are most vulnerable.
States that child wasting is preventable, but when prevention fails, treatment is critical.

Chapter 2: Core Principles

Details 11 core principles for the management of child wasting, emphasizing a comprehensive and integrated approach.
Includes guidelines for prevention, early detection, and treatment based on WHO and local standards.

Chapter 3: Providing Services through National Health Systems

Focuses on governance, financing, service delivery, health workforce, health information systems, and medical products.
Provides benchmarks for each of these areas to ensure effective and equitable service delivery.

Chapter 4: Planning for Integration

Outlines key considerations and guiding principles for integrating wasting treatment services into national health systems.
Describes a five-stage process for integration, covering assessment, planning, implementation, monitoring, and evaluation.

Context and Rationale

Child wasting is a significant public health issue in the ASEAN region, with an estimated 4.5 million children affected.
The prevalence is medium in most ASEAN countries, except Brunei Darussalam and Singapore, which have low prevalence (<5%).
80% of affected children are under 2 years of age, highlighting the critical window for intervention.
The ASEAN Leaders' Declaration on Ending All Forms of Malnutrition (2017) established a commitment to end malnutrition by 2030, including reducing wasting to <5% by 2025 and <3% by 2030.
The ASEAN Strategic Framework and Action Plan on Nutrition (2018-2030) includes the development of minimum standards for wasting management as a strategic activity.

Global and Regional Context

Child wasting is one of six global nutrition indicators endorsed by WHO Member States in 2012.
The Sustainable Development Goals (SDGs), particularly Goal 2, aim to eliminate all forms of malnutrition by 2030.
The Global Action Plan (GAP) on Child Wasting was launched in 2020 to accelerate progress toward these targets.
Three ASEAN countries (Cambodia, Indonesia, and the Philippines) are part of the GAP.
Despite progress, only 2% of children with wasting in the region accessed treatment in 2021, indicating a need for stronger action.

Regional Progress and Challenges

All AMSs have endorsed the 2025 global nutrition targets and SDG 2.
Wasting is still prevalent, with 4.5 million children affected.
Policy development is advanced, but implementation and service availability remain low.
RUTF availability is limited, though Cambodia and Vietnam have initiated domestic production of RUTF using fish powder.

Key Supporting Elements

WHO guidelines (2023) have been updated for infants under 6 months and moderate wasting.
UNICEF has issued alerts highlighting child wasting as a child survival emergency.
The guideline is intended for policymakers and health/nutrition experts in AMSs.
It does not cover clinical protocols, which are outlined in national guidelines and WHO standards.

Key Figures and Tables

Figure 1: Prevalence of wasting in ASEAN countries.
Figure 2: Model package of essential maternal and child actions for wasting prevention.
Figure 3: UNICEF conceptual framework on maternal and child nutrition.
Figure 4: Interventions for the management of child wasting.
Figure 5: Roles of micro, meso, and macro levels of the health system.
Figure 6: A five-stage process for the integration of wasting into the health system.
Table 1: Model package of essential nutrition actions for wasting prevention, early detection, and treatment.
Table 2: Sample routine wasting indicators for integration into the national HMIS.
Table 3: Minimum preparedness actions for scaling up wasting services during emergencies.
Table 4-9: Benchmarks for governance, financing, service delivery, health workforce, HMIS, and medical products.
Table 10-11: Strategic objectives and mapping of factors influencing integration across health building blocks.

Acknowledgments

The guideline was developed with contributions from:

ASEAN Member States: Lead by Cambodia and co-led by Philippines and Lao PDR.
UNICEF, WHO, WFP, and Hellen Keller International.
Technical experts from various countries and organizations.

Conclusion

The ASEAN Regional Guideline serves as a comprehensive framework to strengthen national health systems in the prevention, early detection, and treatment of child wasting. It emphasizes the need for integration into PHC services, community engagement, and capacity building. Despite some progress, the region faces challenges in service availability and access, requiring urgent action to meet global targets.

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