Scaling-up Nutrition: Developments, achievements & challenges.

Perspectives from MQSUN support

April 2014

Outline

Objectives:• Introduce MQSUN Support Phases

• Highlight Progress in preparing for Scale-up

• Introduce key points from Planning and Costing Paper

• Share current MQSUN activities

• Outline current challenges for MQSUN support

PATH Consortium – Call Down 3

OutlinePhase I

Policy reviewAnalytical framework (ACT): Programme classification, target groups, costsMethodology for country visits

Phase IIRemote support to countries and SUN Movement Secretariat (SMS) 21Country visits (stakeholder engagement, situational analysis, cost map)Support SMS at International events

Phase IIIPolicy, legislation, and plan reviews and summariesSupport effective nutrition-sensitive implementation around a Common

Results FrameworkSupport financial tracking and resource mobilization

Outline

Applied Classification of Interventions in the Country Plans

Nutrition-sensitive Approaches

• Food Security and Agriculture

• Care Environment

• Public Health and Water and Sanitation

Specific Nutrition Actions

• Good Nutrition Practices

• Vitamin and Mineral Intake

• Acute Malnutrition Management

• Enrichment of diet nutrient density for pregnant and lactating women and children 6-23 months

Governance• Coordination and Information Management• Policy and Legislation Development• Advocacy and Communication• System Capacity Building

Outline

OutlineNUTRITION SPECIFIC ACTION COSTS

TOTAL COST: US$ 4.0 billion (timeframe 2011-2015)US$ 2.4 billion for good nutrition practices (61%)US$ 650 million for acute malnutrition management (21%)US$ 717 million for vitamin and mineral intake (18%)US$ 198 million for nutrient dense diet for PLW and young children (5%).*

*Peru, Mozambique and Madagascar

Outline

NUTRITION SENSITIVE ACTION COSTS

TOTAL COST: US$ 28.9 billion (timeframe 2011-2015)

US$ 19.6 billion for nutrition-sensitive food systems. Note: Bangladesh alone is US$ 8.5 billion

US$ 89.5 million for interventions enhancing caring environments

US$ 9.2 billion for interventions in public health services, including reproductive health and WASH

OutlineNutrition sensitive – Food Systems

OutlineNutrition sensitive – Public Health

OutlineGOVERNANCE TOTAL COST: US$ 2.3 billion (timeframe 2011-2015)

US$ 1.5 billion for system-wide capacity building (66%)US$ 629 million for coordination and information management (28%)US$ 143 million for policy development, advocacy and communication

(6%)

OutlinePlan differences (caveats for comparison)

Inclusions/exclusionsExisting government inputs (labor, infrastructure)New versus existing interventionsStakeholder and sector involvement

Assumptions for scale-upPercentage increaseDistrict rolloutNational coverage

Cost methodologiesTotal intervention costs (ingredients)Marginal budgetingProgram unit costs

Cost estimationsProgram planningCountry budgetsExternal budgets

Outline

Highlight Progress in preparing for Scale-up

Paper 1 Details of Progress in SUN Countries

OutlineProgress with Preparing for Scaling-up Nutrition

Process Indicator I – Bringing people into a shared space for action (the multi-sector, multi-stakeholder platform):

Process Indicator II – Ensuring a coherent policy and legal framework:

Process Indicator III – Aligning around a single set of Expected Results [Common Results Framework CRF]:

Process Indicator IV - Financial Tracking and Resource Mobilisation:

Paper 1 Details of Progress in SUN Countries

OutlineProgress with Preparing for Scaling-up Nutrition

The impact of high-level political commitment:

Tanzania, Uganda, Benin and Namibia have placed nutrition directly under the supervision of the Head of Government or State.

The President of Guatemala and the President of Peru have linked their presidency mandate to the reduction of stunting.

Other countries including Zimbabwe, Sierra Leone and The Gambia have their Vice-Presidents as national Champions for Scaling Up Nutrition.

Many are focusing on the gender dimensions of under-nutrition and the importance of empowering women for scaling up nutrition.

OutlineProgress with Preparing for Scaling-up Nutrition

National policies, legislation and strategies that impact on nutritional outcomes :

Nutrition policies and strategies have been updated and endorsed

In Nepal, Mozambique, Madagascar, Benin, Tanzania, Zambia and Uganda the approved national policies and strategies reflect a multi-sector approach

At least one third received legislative approval for a coherent multi-sector framework (Niger, Mauritania, Indonesia, Burkina Faso and Peru)

The Gambia, Madagascar and Uganda have specific gender policies that will contribute to nutritional outcomes.

OutlineProgress with Preparing for Scaling-up Nutrition

Aligning around a single set of expected results (Common Results Framework) :

A priority for strategic focus on the most effective interventions

Aligning different programs to contribute to one set of expected results.

Alignment: the best means for translating commitments made by governments / partners into synergized implementation. Roadmaps Shared.

Examples include: 3N initiative in Niger, Hambre Zero in Guatemala, CRECER para Incluir in Peru and Aba Grangou in Haiti. The Focal Points in Mozambique, Tanzania, Madagascar and Indonesia have shared their experiences of prioritisation at the sub-national level.

OutlineProgress with Preparing for Scaling-up Nutrition

Estimation of the cost for scaling-up and analysis of shortfalls :

Information within SUN Country Templates about estimated costs, domestic and external contributions, and financing gaps, is incomplete.

Most SUN countries provided an indication of the costs of nutrition-specific interventions, mostly those provided through the health sector.

National authorities & donor agencies struggling to establish consistent methods for tracking expenditures on nutrition outcomes across sectors.

Nevertheless country focal points from Bangladesh, Niger, Indonesia, Sierra Leone, Peru, Guatemala, Ethiopia, Mozambique, The Gambia and Nepal have reported on efforts to estimate overall financial investments for nutrition.

Outline

Planning and costing for the acceleration of actions for nutrition: experiences of countries

in the Movement for Scaling Up Nutrition

April 2014

Outline

Brief History of SUN – Costing Processes

• 2010 – Movement Led by Governments – NOW 45 countries• Provided context for existing support groups to align behind national

policies• National plans need core elements as well as investors language• Framework for Scaling-up Nutrition (What will it cost – Susan Horton) –

Stunting as an indicator• 2013 Refinements in costs of specific interventions / WHO Costing• June 2013 G8 – costs pulled together from national plans to show

elements, costs and gaps where plausible

OutlineG8 Commitments – 2013

• Global Nutrition for Growth Compact endorsed by a total of 94 stakeholders

• 15 Governments committed to increase the domestic resources

12 Governments announced national stunting-reduction targets.

• Donors today have secured new commitments of up to GBP £2.7 billion (USD $4.15 billion) to tackle undernutrition up to 2020, GBP £1.9 billion (USD $2.9 billion) of which is core funding with the remainder secured through matched funding.

• An estimated GBP £12.5 billion (USD $19 billion) committed for improved nutrition outcomes from nutrition-sensitive investments between 2013 and 2020.

Outline

G8 Commitments – 2013

• New partnerships between business and science

• Commitment to develop a new catalytic financing facility for nutrition.

• Launch an annual Global Report on Nutrition from 2014,.

• Hold annual global nutrition meeting in margins of UN General Assembly, from September 2013.

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Contribution of National Nutrition Plans to Stewardship of Multiple Actors and Synergised, Effective Actions

The process through which a plan is developed has a critical influence on the utility of the plan for stewardship of multiple actors.

The development of a national nutrition plan is a “directed negotiation”.

A national nutrition plan is often an amalgam of multiple sector plans.

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Contribution of Nutrition Plans to Effective Implementation of Interventions to Scale Up Nutrition

Local level plans informed by national recommendations

Plans are especially useful if then basis for monitoring progress

Most likely to yield synergised and effective efforts if attention paid to nutritionally vulnerable individuals and communities.

Most plans currently focus on enabling pregnant women and young children to access specific nutrition interventions in the 1,000 day window

Outline

Cost Calculations in National Plans Should be Based on Explicit Principals and Assumptions

Increasing need for costing to be undertaken in an inclusive way.

The assumptions that underlie costings are made explicit and can be examined by all:

Intervention directly relates to nationally agreed targets for implementation rather than to general objectives for improvement,

…and if expected expenditure is spelt out year by year.

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Strategy for Increase the Potential Utility of Costed National Plans for Scaling Up Nutrition

Emphasis on the processes for planning, implementation and monitoring rather than on the plan itself.

The systematic engagement of domestic and international decision makers in planning and costing work.

The evolution of principles that should be reflected in different stages of the planning cycle (from design to costing, managing implementation and monitoring).

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National Nutrition Planning Processes are Likely to be most Useful if Based in the Following Principals

Agreement around a national Common Results Framework (CRF) helps to shape multi--‐stakeholder working.

The role of government is to convene all stakeholders, coordinate their engagement, lead strategy, maintain shared ownership (national and sub)

Tracking the use of resources involves the development of systems for gathering data on expenditure.

National plans should incorporate the investments of the NGOs contributing to national targets and Common Results Frameworks.

The design of a financial tracking system should at all times reflect the interests of decision –makers. Type / regularity and level of info needed?

Outline

Next Steps – Strengthening the capacity of SUN countries for planning, costing, managing implementation, tracking expenditure and monitoring progress.

Optimising the use of communications and advocacy to maintain political commitment and support institutional change,

Establishing guidance for countries on nutrition-sensitive investments, planning, costing and managing the implementation of actions and establishing robust systems

Mobilising additional external and domestic resources for nutrition, and tracking the effectiveness and efficiency of these funds.

Outline

Share current MQSUN activities

1. Policy, legislation and plan reviews and summaries

2. Support effective nutrition-sensitive implementation around a Common Results Framework (CRF) to maximise impact

3. Support financial tracking and resource mobilization

4. Aggregate and document the lessons learned from the work with countries

Outline

Yemen – Contextual analysis and prioritisation of nutrition-sensitive intervention within the national plan.

Malawi – Monitoring and Evaluation support / financial tracking, especially in the area of nutrition sensitive

Ghana – Support the review process of the National Nutrition Policy, provide training on costing processes and identify features of financial tracking

Benin – Support development of the multi-sector M&E framework

Chad - Costing of the National Action Plan (scoping exercise)

El Salvador – Review and considering alignment of the Capacity Building Strategy to the Nutrition and Food Security Strategy

Synthesis

Other ToR (Haiti and Indonesia)

Outline

Challenges

Ensuring capacity of the movement within national settingsEfficient use of MQSUN resources – country selcection and ToR DevelopmentUnderstanding and enhancing service provision capacityAssessing the exponential growth for coverageHow to correctly select nutrition-sensitive interventions within a ‘nutrition framework’Assessing impact of nutrition-sensitive (Columbia and List)Promotion of learning between national platformsUnderstanding the links between existing budgetsDesigning and installing pooled or ‘top-up’ mechanismsLinks with private industriesNational level resource development (CS )

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ADDITIONAL SLIDES

OutlineGlobal Targets for Nutrition

Outline

Average Annual Rate

of Reduction (AARR)

Multi-sectoral Nutrition Intervention Framework

Child growthfailure/ death

Low Birthweightbaby

Low weight & height in teenagers

Early pregnancy

Small adultwoman

Small adult man

The intergenerational transmission of growth failure: When to intervene in the life cycle

SO 2. Ministry of Health and Population

Community 14 High Impact

Interventions

ANC, Malaria, LBWWater & Sanitation LinksEducation (Health curriculum)

SO 4. Ministry of Education• Specific girls education • School nutrition

relevance recognized

Incentives:• CCT• Take home food rations• Free school materials

SO 5. Ministry of Agriculture

• Support home gardening for poor families in rural areas (2m) (women)

• Bee keeping & livestock support

• Support food processing in rural areas (3m)

• Introduction of improved crop varieties of cereals, pulses, fruit and vegetables (2m)(challenge qat)

• Support production and marketing of fresh dairy products in rural areas (6m)(women involvement)

• Awareness programme for dietary diversification etc (1m)

SO 6. Ministry of Fisheries

• Project to feed the targeted population sardines (5M)

• Awareness programme to promote the consumption of fatty fish (1m)

• Conservation and fish drying (including women) (2m)

• Support Storage facilities for fresh fish for small enterprises – makes available at village level (2m)

Strategic Objective (SO) 1. MOPIC (Suggested Results)

• Multi-sectoral commitment and resources for nutrition are increased

• Nutritional information management and data analysis strengthened

• Nutrition capacity of implementing agencies is strengthened

SO 3. Ministry of Water & Sanitation• Potable water

supply and sanitation (20m)

• Distribution of water filters at household level (8m) (social fund for development)

• Social mobilization programme (10m)

• Regulate private sector in service delivery

• Treatment of sewage, grey water

Outline

OutlineIntroduction (Susan Horton)

Opportunity to attract even greater support

The food price crisis of 2007 helped reverse international complacency

We know more about “what works” – Lancet Interventions (direct)

MDG’s have helped to focus attention on investment not only social benefits, but also economic benefitsAmassing international funding for nutrition came from global costingExercises – World BankThe 2013 “Nutrition for Growth” – ambitious targetsIndividual country costing efforts are the essential next step.Costing a plan is key to the process of prioritisation – actions / sequence / then adaptation and decentralisation20 Countries have invested in this process

Outline

Overview David Nabarro

National plans for scaling-up nutrition include:

(a) Improvements in people’s access to nutrition specific interventions,(b) The adoption of nutrition - sensitive strategies in related sectors,(c) Explicit functions to enable stewardship & synergised working of stakeholders.

The costing of these plans is most valuable if it includes the followingelements:

• A well-defined population for enhanced access to nutrition interventions• Clarity of national targets well as up to date estimates of projected coverage• Definition of multi-stake holder platforms & performance monitoring

mechanisms• Reliable unit costs for interventions• Well justified costs for the stewardship of joint actions• Incorporating costs of existing plans including labour and fixed costs