For the purpose of improving nutrition and health conditions for infants in poverty-stricken areas, helping caregivers with scientific feeding, and reducing birth defects among newborns in poverty-stricken areas, Chongqing Municipality implemented the Child Nutrition Improvement and Newborn Disease Screening Programs in three poverty-stricken areas in 2013 and 2014 (the "two programs").

The two programs were expanded to other districts and prefectures in the city in 2014 and 2015, and to a total of 14 districts/prefectures by the end of 2018. The two programs have realized full coverage of the city's poverty-stricken districts/prefectures as well towns and counties in deep poverty.

The two programs require infants aged 6 to 24 months to be given food supplement packages, scientific feeding knowledge and skills to be promoted, regional rates of anemia and delayed growth among infants to be lowered, and child nutrition and health conditions to be enhanced. They also target early detection of newborn inherited metabolic disease phenylketonuria ("PKU"), congenital hypothyroidism ("CH") and newborn hearing impairment in the region, and will try to lower rates of child mental retardation and hearing disability, improve residents' health conditions, and establish and optimize a newborn disease screening service network.

Since the adoption of the two programs, under the leadership of the Municipal Health Commission ( "the Commission"), the Child Health Department of Chongqing Health Center for Women and Children ("the Department") has served as the municipal-level project management office ("PMO") to drive implementation of the programs. The Department improved the program plans and promoted implementation of relevant tasks.

Firstly, the Municipal Health Commission, together with the Municipal Women's Federation and Municipal Disabled People's Federation, issued the program plans in 2013 and 2014. Leadership teams and technical taskforces were set up. Since then the Department has assisted the Commission in updating program plans based on actual needs and identified ways to facilitate project implementation. Secondly, the Department promoted publicity among the general public for better program awareness. On the municipal level, each year promotional videos, leaflets, and lectures were delivered to promote knowledge of relevant policies and newborn healthcare and to mobilize society to support infant nutrition in poverty-stricken areas and raise public awareness of the importance of newborn disease screening. These publicity efforts were a sound basis for successful program implementation, which has significantly enhanced awareness and acceptability of supplement packages and disease screening practices within relevant groups.

As a third step the Department provided hierarchical training for better execution capacity. Since the beginning workshops and themed training sessions were hosted every year, including seven nutrition improvement sessions and five newborn disease screening sessions. Through class elaboration and hands-on training, the Department has cultivated frontline trainers capable of delivering better service. All project management and technical staff have now received training.

Fourthly, the Department enhanced operation instructions and improved work quality. Since year one, inspections and operation instructions were conducted in different districts/prefectures each year, with municipal-level experts being sent on selective onsite inspections and cross-inspections. The inspections were conducted by means of on-site documentation review, interviewing selective staff, and onsite equipment checks; their purpose was to assess program performance on organizational management, publicity, training, oversight, monitoring and screening within the year. Guidance was given based on program assessment results.

Fifth, the Department assisted the Commission in centralized bidding on supplement packages as part of government purchasing each year. Sixthly, the Department enhanced program information collection and reporting, and provided timely updates on issues/deficiencies identified. On a quarterly basis, data was summarized city-wide, reviewed and duly reported to the national PMO. In the meantime, when identifying data errors in district/prefecture-level reports, the Department provided timely feedback and urged remediation or correction from certain districts/prefectures.

Positive results have been obtained in the two programs after years of hard work led by the Commission and hospital senior management. In terms of supplement package delivery and child nutrition and health conditions, for the period 2013 to June 2019 ("the review period"), a total of 3,405,071 supplement packages were delivered to 3,390,942 heads in 14 projects in Chongqing districts/prefectures, meaning that national-level targets were met. Recipients of supplement packages numbered 550,075, of whom 365,080 were new child beneficiaries. The delivery rate rose to 91.96% as of the first half of 2019 from 72.43 % in 2013. Rates of key supplementation and scientific feeding knowledge among infant caregivers were all above 80% and on an upward trend for the review period. In 2018, the rate of anemia in infants aged 6 to 24 months in the project districts/prefectures was recorded at 18.53%, 64.19% lower than the benchmark rate of 51.74%; the delayed growth rate was 5.53%, 59.72% lower than the benchmark rate of 13.73%; the underweight rate was 3.86%, 19.75% lower than the benchmark rate of 4.81%. The above-mention rates all met national requirements.

In terms of newborn disease screening, for the period 2014 to June 2019, the live birth total in 14 districts/prefectures was 178,611. In total, 164,718 primary screenings on PKU were completed, as well as 158,208 hearing screenings. The PKU screening rates were above 90% but for two exceptions, 80.87% (2014) and 83.66% (2015), while the primary hearing screening rates were all above 70%. The awareness rates of newborn disease screening were above 88%.

The Child Health Department of Chongqing Health Center for Women and Children has been duly undertaking tasks under the two programs, in addition to death monitoring of children under five, newborn death review, disability screening for children aged 0-6 years, critical neonates treatment and management, premature infants care, kindergarten healthcare, neonatal resuscitation, neonatal genetic and metabolic disease screening, child nutrition and health monitoring, and eye care and visual acuity examination for children aged 0-6 years, among other procedures. The Department will continue to follow the nation’s requirements under the leadership of the Municipal Health Commission and hospital senior management, stay true to its original aspirations, and fulfill its mission to serve every child of the city.