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Program Design, Implementation & Scale-Up NTAG designs and implements programs to achieve targeted results and provides technical support in this area to the Government of Nepal and a number of international and national organizations to create programs that improve the health of Nepali families. Since its establishment, NTAG has been providing technical support to the MoHP in the design and implementation of one of Nepal’s most successful health programs, the National Vitamin A Program (NVAP). In the last 15 years, NVAP has been continuously achieving over 85% coverage of biannual vitamin A supplementation for children and women. An analysis of 2001 data in Nepal found that vitamin A supplementation combined with the FCHVs’ other health-related activities accounted for a reduction of over a half in under-five mortality in Nepal.(Thapa S, Choe MK, Retherford RD. Effects of vitamin A supplementation on child mortality: evidence from Nepal’s 2001 Demographic and Health survey. Trop Med Int Health. 2005;10(8):782-789). In 2000, NVAP further incorporated postpartum vitamin A supplementation and routine de-worming medication. A recent DHS survey found greater reductions in under-five mortality in Nepal, decreasing from 118 to 91 to 61, over the span of 1996, 2001, and 2006, respectively, showing Nepal on the path of achieving the fourth Millennium Development Goal of reducing child mortality by two-thirds by 2015. (Ministry of Health and Population (MOHP), New ERA, and Macro International Inc. 2007. Nepal Demographic and Health Survey 2006. Kathmandu, Nepal: MOHP, New ERA, and Macro International Inc.). NTAG has been instrumental in the success, maintenance and scaling up of this program, acting as the primary provider of technical and logistical support to the MoHP. NVAP and other national government programs technically supported by NTAG, such as the Iron Intensification Program and the Community-Based Integrated Management of Childhood Illness (CB-IMCI) Program began as limited-district programs that were later scaled up nationally. NTAG’s consistent method in assuring sustainable expansion of projects to the national level has been the phase-wise scale-up approach. Increasing programmatic areas one-by-one allows NTAG to closely analyze the best practices suitable for specific geographic areas and expand its programs in a locally appropriate manner, resulting in programs highly accepted by local populations across the country and much more sustainable than programs scaled-up directly from pilot projects into national programs. Similarly, the phase-wise approach has been used repeatedly by NTAG when giving technical assistance to the MoHP in national policy implementation. Alongside its extensive work in rural health and development programming, NTAG has also been working to improve health service provision in Nepal's municipalities and urban areas, with special emphasis on the disadvantaged populations. NTAG builds the capacity of municipal health departments and their cadres to improve provision of family health services and facilitates the coordination between Nepal's urban and rural health systems.
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