"programme_id","programme_title","programme_language","programme_type","other_program","iso3code","country_name","program_location","area","status","start_date","end_date","brief_description","references","related_policy","new_policy","partner_gov","partner_government_details","partner_un","partner_un_details","partner_ngo","partner_ngo_details","partner_donors","partner_donors_details","partner_intergov","partner_intgov_details","partner_national_ngo","partner_nat_ngo_details","partner_research","partner_research_details","partner_private","partner_private_details","partner_other","partner_other_details","cost","fsector_0","fpartner_0","fdetails_0","fsector_1","fpartner_1","fdetails_1","fsector_2","fpartner_2","fdetails_2","fsector_3","fpartner_3","fdetails_3","fsector_4","fpartner_4","fdetails_4","fsector_5","fpartner_5","fdetails_5","fsector_6","fpartner_6","fdetails_6","fsector_7","fpartner_7","fdetails_7","fsector_8","fpartner_8","fdetails_8","fsector_9","fpartner_9","fdetails_9","fsector_10","fpartner_10","fdetails_10","fsector_11","fpartner_11","fdetails_11","fsector_12","fpartner_12","fdetails_12","fsector_13","fpartner_13","fdetails_13","fsector_14","fpartner_14","fdetails_14","fsector_15","fpartner_15","fdetails_15","fsector_16","fpartner_16","fdetails_16","fsector_17","fpartner_17","fdetails_17","fsector_18","fpartner_18","fdetails_18","fsector_19","fpartner_19","fdetails_19","fsector_20","fpartner_20","fdetails_20","fsector_21","fpartner_21","fdetails_21","fsector_22","fpartner_22","fdetails_22","fsector_23","fpartner_23","fdetails_23","fsector_24","fpartner_24","fdetails_24","fsector_25","fpartner_25","fdetails_25","fsector_26","fpartner_26","fdetails_26","fsector_27","fpartner_27","fdetails_27","fsector_28","fpartner_28","fdetails_28","fsector_29","fpartner_29","fdetails_29","fsector_30","fpartner_30","fdetails_30","fsector_31","fpartner_31","fdetails_31","fsector_32","fpartner_32","fdetails_32","fsector_33","fpartner_33","fdetails_33","fsector_34","fpartner_34","fdetails_34","fsector_35","fpartner_35","fdetails_35","fsector_36","fpartner_36","fdetails_36","fsector_37","fpartner_37","fdetails_37","fsector_38","fpartner_38","fdetails_38","fsector_39","fpartner_39","fdetails_39","fsector_40","fpartner_40","fdetails_40","fsector_41","fpartner_41","fdetails_41","fsector_42","fpartner_42","fdetails_42","fsector_43","fpartner_43","fdetails_43","fsector_44","fpartner_44","fdetails_44","fsector_45","fpartner_45","fdetails_45","fsector_46","fpartner_46","fdetails_46","fsector_47","fpartner_47","fdetails_47","fsector_48","fpartner_48","fdetails_48","fsector_49","fpartner_49","fdetails_49","action_id","theme","topic","new_topic","micronutrient","micronutrient_compound","target_group","age_group","place","delivery","other_delivery","dose_frequency","impact_indicators","me_system","target_pop","coverage_percent","coverage_type","baseline","post_intervention","social_det","social_other","elena_link","problem_0","solution_0","problem_1","solution_1","problem_2","solution_2","problem_3","solution_3","problem_4","solution_4","problem_5","solution_5","problem_6","solution_6","problem_7","solution_7","problem_8","solution_8","problem_9","solution_9","other_problems","other_lessons","personal_story","language" "8818","Improving nutrition of women and children: the MICAH program ","English","Multi-national","","ETH|GHA|MWI","Ethiopia|Ghana|Malawi","Ethiopia|Ghana|Malawi","Peri-urban","completed","01-1995","01-2005","
The MICronutrient and Health (MICAH) Program contributed to improved quality of life of women and children in five African nations (Ethiopia, Ghana, Malawi, Sénégal and Tanzania) over a 10-year period between 1996 and 2005. The problem of micronutrient deficiencies (vitamin A, iron and iodine) was addressed through integrated strategies and direct interventions that resulted in measurable positive effects. Quantitative and qualitative program results affirm the contribution of MICAH’s achievements towards the Millennium Development Goals, and global nutrition and health targets.
","http://www.wvnutrition.net/home/resources/better-practices/micah-final-d...
","8329|8270|8112|8488|8111|8013|8657|8369|7979|7917","","","","","","World Vision International","","","","","","","","","","","","","","Ethiopia • $4.4 million budget (USD, 2002-2005)Ghana • $745,000 budget (USD, 2002-2005)Malawi • $3.8 million budget (USD, 2002-2005)","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","Working in close cooperation with government, non-government organizations (NGOs), and communities, MICAH built on existing delivery systems within ministries of health, education and agriculture, equipping them to strengthen the coverage and quality of their mandated activities. The foundation for a self-sustaining nutrition and health infrastructure was laid, by empowering communities to take ownership for program activities within their grasp: exclusive breastfeeding, capacity building of community health workers in nutrition and health, establishment of household gardens and revolving funds, and latrine construction.
MICAH also provided education to local populations about the importance of health and nutrition. Thousands of community health workers and volunteers were trained while program staff were equipped with skills to monitor and evaluate the program, gathering valuable information to assess its impact.
","Ethiopia
Ghana
Malawi
ETHIOPIA
Supervision/monitoring visits were routinely made at all levels of Ethiopia’s MICAH projects.The program coordinating office and program partners conducted 86 visits to assess the implementation and progress of various initiatives.Throughout the year, activity reports and evaluation documents were reviewed, site visits made, and ongoing discussions held between MICAH staff and stakeholders. After every visit, copies of feedback reports were sent to the relevant ADPs and NGOs. At the project level, MICAH facilitators conducted joint field visits and reviews with frontline personnel such as government health workers, community health workers, volunteers and school teachers to ensure implementation of activities was proceeding according to plan.
GHANA
Monitoring of MICAH Ghana improved in several ways in Phase 2 as the program team worked closely with Ghana Health Service and community health volunteers. Increased effectiveness was best illustrated by the heightened accuracy of data for iodized salt consumption after changing the method from school-based to houseto-house surveys.The team reinforced this effort by testing the quality of salt in markets as well. To improve monitoring of compliance with iron supplementation, MICAH facilitators worked closely with community health volunteers to assess whether women and children were taking the supplements as prescribed.Throughout the program, monitoring information was shared with all stakeholders at quarterly district and sub-district meetings in an effort to improve implementation and build ownership.
MALAWI
Regular meetings were conducted with government ministry and partner staff to share feedback and resolve issues.Training was provided and follow-up maintained to improve the capacity of field agents and staff. Regular community visits, including meetings with women and local leaders, provided management staff an opportunity to ensure quality implementation. Specific issues were dealt with using results-based management. For example, to obtain a more accurate estimate of deworming coverage in Phase 2, the household listing register was introduced and utilized, to supplement data regarding the de-wormed child. As a result of this new system, household monitoring revealed the extent of infection and enabled appropriate follow-up.To monitor the quality of the flour fortification project, the Malawi Bureau of Standards (MBS) and Chancellor College labs analyzed premix produced at the Domasi Fortification Unit. Each test found the Domasi premix to meet all MBS requirements; recommended levels of iron were found in the flour, and flour samples were free from contaminants.
","Ethiopia (1.8 million beneficiaries); Ghana (150,000 beneficiaries); Malawi (272,391 direct beneficiaries, with indirect benefit extending to 4.7 million people)","x","","","","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","“The MICAH approach is a good and successful model for the Ministry of Agriculture. Given right training people are ready to follow new habits and change traditional attitudes – for example, by eating rabbits and drinking goat milk. MICAH has provided a learning area for agriculture to reduce hunger.” – Mr. Bbvumbwe, Malawi
""""""""The positive impact of MICAH on the
health of children is a motivation to
continue. With improved knowledge,
good health and nutrition practices will
be sustained with support from chiefs
and elders.""""""""
– Qualitative survey, Ghana
Aa a result of the MICAH program… our children are healthy, alert and active; they look
attractive and beautiful; children are not falling sick with malaria as frequently as they did in the
past; the frequency of diarrhea and intestinal worms has decreased; eye diseases have decreased
because of improved hygiene; the harmful health practices have now been dropped because of
the intensive education given by health workers; and severe malnutrition, blindness, measles and polio have decreased.”
– Focus group discussion, qualitative survey, Ethiopia
","English" "8930","Assistance to Ghanaian Food-Insecure Households in Northern Ghana","English","Community/sub-national","","GHA","Ghana","Tongo, Bolgatanga Municipal, Upper East, Ghana|Danko, Wa Municipal, Upper West, Ghana|Zuorugu, Tamale, Ghana","Rural","on-going","01-2010","01-2014","
The project supports the Government of Ghana in its efforts to improve the protection of vulnerable populations in northern Ghana from the devastating impacts of floods and droughts, and also to ensure that the immediate food needs of the most severely food-insecure households are met. The project aims to improve agriculture, water and land resources; create strategic reserves to protect the nutritional status of at-risk groups (including children under five, pregnant and lactating women and people living with HIV/AIDS); and support the rehabilitation and recovery of agricultural livelihoods. This project contributes to alleviating chronic food security amongst vulnerable groups, targeting and assisting poverty reduction in the most susceptible areas of northern Ghana.
","http://www.acdi-cida.gc.ca/CIDAWEB/cpo.nsf/vWebCSAZEn/503DAC11D7D8F3AD85...
","8488","","","","World Food Programme (WFP)","","","","","","","","","","","","","","","","CA$ 20,000,000","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8929","","Food distribution/supplementation for prevention of acute malnutrition","","","","HIV cases|Infants and young children|Lactating women (LW)|Pregnant women (PW)","","The 3 Northern regions (Upper East, Upper West, Northern region)","Community-based","","Results as of May 2012 include: the World Food Program (WFP) has distributed food to 327,982 beneficiaries out of the 423,250 planned. In particular, the targets for supplementary feeding of malnourished children under five and pregnant and lactating women are close to being achieved, and will likely be exceeded by the end of the project. The project has already exceeded the targets for the number of beneficiaries on its components Food for Assets (FFA) and Food for Training (FFT), and has reforested some 7,357 ha of land and rehabilitated 250 dams/dugouts.
","It is anticipated that all expected outcomes of increasing equitable access to food aid and prevention of malnutrition, particularly among children under five, pregnant and lactating women, including refugees; as well as to improving food consumption over the assistance period for targeted households, and people living with HIV/AIDS and their families; and increasing the targeted communities equitable access to livelihood assets, including assets for environmental conservation will be achieved.
","","423,250","327,982 beneficiaries (for distributed food); ","","","","Vulnerable groups","","Micronutrient supplementation in children with severe acute malnutrition>>>Micronutrient supplementation in children with severe acute malnutrition>>http://www.who.int/elena/titles/micronutrients_sam","","","","","","","","","","","","","","","","","","","","","","","","English" "8933","The Leyaata (“Rescue Us”) Project to Reduce Maternal, Infant and Child Mortality","English","Community/sub-national","","GHA","Ghana","Kintamp, Ghana|Bole, Ghana","Rural","on-going","01-2011","01-2015","The project aims to reduce maternal, infant and child mortality in 50 marginalized villages in the north Kintampo and south Bole districts of Ghana by directly addressing key health issues. Reaching approximately 10,000 beneficiaries, the project addresses care during pregnancy and childbirth, neonatal care, and malaria control as critical health concerns in these communities. Key project components include establishing a prenatal and neonatal home visit system for pregnant women and infants, and launching a malaria control program that prioritizes mothers and infants.
Specific activities include: distributing neonatal care kits; training community-based volunteers and local health professionals; providing mosquito nets for all village residents; conducting malaria control workshops; and supplying local clinics with rapid malaria test kits. Ghana Rural Integrated Development is working in partnership with the Northern Empowerment Association to implement this project.
","http://www.acdi-cida.gc.ca/CIDAWEB/cpo.nsf/vWebCSAZen/index.html7E4DFE9C...
","8111","","","","","","","","","","","","National NGOs","Ghana Rural Integrated Development, Northern Empowerment Association","","","","","","","CA$ 643,464.00","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8932","","Distribution of insecticide-treated bednets","","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)","","North Kintampo & South Bole Districts","Community-based","","Specific activities include: distributing neonatal care kits; training community-based volunteers and local health professionals; providing mosquito nets for all village residents; conducting malaria control workshops; and supplying local clinics with rapid malaria test kits.
","Maternal, infant and child mortality
","","10,000 beneficiaries","50 marginalized villages in the north Kintampo and south Bole districts of Ghana","","","","Vulnerable groups","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010The FMOH has developed a four-pronged national strategy for PMTCT: primary prevention of HIV infection; prevention of unintended pregnancies among HIV-positive women; prevention of HIV transmission from infected women to their infants; and treatment, care, and support of HIVpositive women and their infants and families. All health centers have a system of identifying infants born to HIV-positive mothers as part of their PMTCT program. 11The following is a brief description of the flow of PMTCT services, commencing from a woman’s first visit for ANC:All women coming for ANC are routinely informed—individually or in a group—about the benefits of HIV testing for mothers and babies. During this process—known as providerinitiated HIV counseling and testing—mothers reserve the right to say “NO.” Those who say “YES” will be tested.Women with positive results are referred to MSG mentors, and ANC follow-up continues. Their partners will also be tested.MSG mentors counsel an HIV-positive woman and transfer her to the ART nurse for antiretroviral drugs.The ART nurse takes a CD4 count. If not eligible for treatment based on her count, the woman will commence treatment and ANC follow-up continues. If she is eligible for treatment based on her count, she will be put on complete antiretroviral prophylaxis that starts at 27 weeks of gestation.Follow-up continues and the mother is advised to deliver at a health facility.At delivery, the infant will be started on prophylaxis as an HIV-exposed infant.A dried blood sample will be taken from the infant for polymerase chain reaction (PCR) testing after 45 days.Follow-up continues until cessation of breastfeeding, with re-screening done six weeks later.
","CD4 countsPCR test for HIV status of iinfant
","","x","Highly HIV prevalent regions","","","","Vulnerable groups","","Infant feeding for the prevention of mother-to-child transmission of HIV>>>Infant feeding for the prevention of mother-to-child transmission of HIV>>http://www.who.int/elena/titles/hiv_infant_feeding","","","","","","","","","","","","","","","","","","","","","","","Aberash, a 33-year-old woman, was in the 36th week of her pregnancy at the time of this assessment. She was not married and had tested HIV positive. Since the time she had learned her HIV status, Aberash had been visiting the health center in Shashemene at least once every week—and sometimes more often. Her primary concern was transmitting HIV to her unborn baby. Sr Terunesh*, the nurse responsible for ANC services at the health center, had been counseling Aberash on a number of issues related to her well-being and that of the baby. These discussions usually included nutrition-related issues, specifically breastfeeding and its potential hazards. In addition to these counseling sessions, Sr Terunesh had connected Aberash with the MSG for continued support, counseling, and encouragement, both from the mentors and from other mothers in the group.* Not her real name.
","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Behaviour change communication and/or counselling for improved complementary feeding was reported to the Global Nutrition Policy Review (GNPR) 2009-2010Trials for Improved Practices (TIPs) is a relatively new and innovative methodology for Ethiopia, especially its use in shaping critical strategies to improve IYCF behaviors. The standard approach to TIPs implementation involves three household visits. The purpose of the first visit is to learn about current household feeding practices. The second visit is a ―counseling visit,‖ which includes the negotiating of a new practice with the mother or caregiver for her to try. The third visit is a follow-up visit to check on the mother’s experience in implementing the recommended/negotiated new practice. This ―negotiation TIPs‖ is mainly used in maternal and infant feeding, and identifies the best choices among a number of different actions that could yield IYCF nutrition benefits.
","Urban garden household participationFoods most frequently consumedHouseholds consuming at least four different food groups on a daily basis
","","x","Two similar, poor, urban populations from two districts (Adama and Debra Zeit)","","","","Socio-economic status","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","The results point to some specific areas that appear to be the most promising for improving complementary child feeding practices across the different age groups from 6 to 24 months:Improving the porridge/special food given to the child by adding different foods to enhance the quality and increase the energy density;Adding different mixtures to the porridge or giving different food combinations such as egg and potato;Adding fruits to the child’s diet, bearing in mind economic constraints that limit availability of fruit on a daily basis;Trying to introduce vegetables earlier, starting after six months and continuing (when mothers tried adding vegetables they found that their fears of ―doing harm‖ to the child were not justified); Increasing the amount of food provided in part by adding additional foods (fruits and vegetables); andUsing a separate bowl/plate for the child to facilitate monitoring the amount of food the child consumes.
","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","","","","","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Promotion of handwashing or hygiene interventions was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","","","","","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Promoting and implementation of delayed cord clamping was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Cord clamping for the prevention of iron deficiency anaemia in infants: optimal timing>>>Cord clamping for the prevention of iron deficiency anaemia in infants: optimal timing>>http://www.who.int/elena/titles/cord_clamping","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","","","","","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","Urban|Rural","completed","01-2010","01-2011","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Management of MAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: Emergency Nutrition Intervention Guideline, August 2004
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9119","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ETH","Ethiopia","Ethiopia","","","","","From January 2010 to December 2011, the Infant and Young Child Nutrition (IYCN) Project supported the Federal Ministry of Health (FMOH) and US President’s Emergency Plan for AIDS Relief (PEPFAR) partners in Ethiopia to improve maternal and child nutrition practices and increase HIV-free survival of children. Although Ethiopia has successfully integrated services for prevention of mother-to-child transmission (PMTCT) of HIV with antenatal care (ANC) services, many facility-based providers lack nutrition counseling skills and access to tools and materials to help them offer adequate support to mothers and children. The project worked with the Ethiopian government and partners to improve the quality of nutrition assessment, counseling, and support services in several communities in Addis, Oromia, and Amhara regions where the HIV prevalence rate is disproportionately high. This included developing behavior change communication tools and materials for health workers, health extension workers, and mothers’ support groups; updating the skills of agricultural extension workers to integrate nutrition education; and training health workers to better counsel mothers, particularly those who are HIV-positive, about optimal maternal, infant, and young child nutrition practices.
","Management of SAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: Protocol for The Management of Severe Acute Malnutrition, FMOH, March 2009
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Behaviour change communication and/or counselling for improved complementary feeding was reported to the Global Nutrition Policy Review (GNPR) 2009-2010SamplingStudy participants were drawn from 45 communities in the nine project districts. The communities were selected based on the presence of mother support groups and church-based groups. In each district, purposeful sampling was used to select the female caregivers.1 The criterion used for selecting female respondents was that they were caregivers of children 6-24 months. Fathers2 of children 6-24 months, health workers, and community group leaders were selected using convenience sampling. Data collection methodsBoth qualitative and quantitative methods were used to conduct this study. Data were collected using a structured survey, in-depth interviews, and focus group discussions (FGDs) (see Appendix 2 for the study tools). Findings from all three sources were triangulated for the purpose of validation.Structured surveyEach study community was divided into six sub-areas, and one caregiver was selected from each sampled household within each sub-area, for a total of six participants per community.3Households in the cluster were numbered, and one was randomly selected. In a sampled household where there was more than one caregiver for the child aged 6-24 months, data collectors purposefully sampled for the interview one mother or caregiver who regularly fed the index child. In a situation where the selected caregiver had more than one child aged 6-24 months, the older one was selected as the index child. In-depth interviewsBased on the classification of health facilities in Brong Ahafo Region, we identified and selected four categories to use in the data collection exercise: district hospitals, clinics, health centers, and Community-Based Health Planning and Services compounds. In each district, five health workers were interviewed, including two health workers from the district hospital responsible for child welfare clinics (growth monitoring sessions) and one from each of the other three facility categories. Leaders of mother support groups and church-based groups at the community level whose activities could impact infant and young child feeding practices were also interviewed. In each district, five of these groups were randomly selected from a list of such groups within the district. Identification and sampling of the groups was done with the help of district-level health staff.
","From October 2010 to December 2011, the project:•Aired 855 radio spots with key messages on complementary feeding on Radio BAR, Omega FM, Success FM, Jerryson FM, Chris FM, Adarz FM, Star FM, and Royals FM. An additional 340 spots are scheduled to air in January 2012.Distributed 5,860 posters with key messages.Distributed 19,428 flyers with key messages.Trained 196 health workers and 137 community group leaders in appropriate complementary feeding practices and the use of BCC materials. Reached around 2,500 community group members with appropriate complementary feeding messages through trained group leaders.
","","45 communities in 9 selected districts in Brong- Ahafo region","45 communities in 9 selected districts in Brong- Ahafo region (","","Initiation of complementary feeding; Frequency of feeding; Feeding a variety of foods to children 6-24 months; Knowledge of three food groups; Caregivers who followed the World Health Organization’s (WHO) recommended practice of starting complementary foods at 6 months; Caregivers who gave fortified complementary foods to their children aged 6 to 9 months two or more times per day; Caregivers who gave their children aged 6 to 9 months porridge thick enough to stay on a spoon.","","Socio-economic status","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","Engaging District Health Management Teams is integral to success. IYCN and partners engaged district heads early in the process. As a result, they demonstrated strong support for the activities and they are poised to monitor the community-level activities to ensure effective rollout, dissemination, and distribution of BCC materials.Partnerships can help to expand reach. By collaborating with the BCS Project and leveraging a national behavior change communication campaign, the project was able to expand reach of the complementary feeding messages. Although the social marketing strategy targets the Brong Ahafo region, radio spots and BCC materials will be spread across the country as part of the Healthy Eating for Good Life campaign. Local partners at the district level, such as World Vision Ghana, also carried messages into districts outside of the project’s target area.Job-aids are necessary in communicating behavior change messages. Health workers in the target districts welcomed posters and leaflets that contained key messages and were grateful for them. It certainly made work easier for them. Since the orientations, community workers have displayed posters on walls in vantage points in all the communities and caregivers discussed the contents of the leaflets at community meetings.
","In addition to breastmilk, we give local dishes like palm nut soup with soya beans, banku and groundnut soup, fufu with soup, kontomire [cocoyam leaf] with soya beans, and fish soup. We also give them oranges and pineapple — FGD with women Sunyani West District.At weighing, we are taught how to dress the child, breastfeeding, cleanliness, sleeping under mosquito nets, and family planning, how to feed the child. — FGDs with women Jaman South and Sunyani West Districts“I learned a lot of things here. You see my son likes the breastmilk and the only other thing he will eat is porridge; so I am going to read this leaflet so that it will guide me on what to feed him. You see he is my firstborn so his health is important to me.” —Nursing mother“This project is a good start of what we want to see in the community; that the caregiver is empowered to be in charge of the health and good development of their children. What I would also like to see is strengthening the skills and competencies of the health providers so that [they] would be able to help caregivers do appropriate feeding especially for the children under two years.” —Mrs. Wilhelmina Okwabi, Deputy Director of Health Services (Nutrition)“I was part of the data collection process and listening to the preliminary results gives me a sense of ownership; also the results show what is happening in the district and it shows us the work we are doing in the districts. We’ve learnt a lot here. We are going back to educate the mothers on what they are not doing well and encourage them to continue the good feeding practices.” —Technical officer, Vivian Dapaah District“We are thinking of ending malnutrition in children in line with Millennium Development Goal 4. If we don’t feed them well we cannot achieve this. That is why this [IYCN] project is very important and timely for the Regional Health Directorate.” —WS Supiimeh, Regional Health Promoter
","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","","","","","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9144","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","GHA","Ghana","Ghana","Urban|Rural","completed","01-2010","01-2011","In 2010 and 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project provided technical assistance to the Global Alliance for Improved Nutrition (GAIN) to promote appropriate complementary feeding practices and encourage increased use of high-quality, fortified complementary foods to curb malnutrition among children 6-23 months of age.
Working in nine districts of Ghana’s Brong Ahafo Region, the project used a social marketing approach to engage households and communities through radio spots, radio discussions with community health workers and community leaders, and use of social and behavior change communication materials. These behavior change techniques aimed to increase knowledge and application of appropriate complementary feeding practices among low-income households caring for young children.
","Distribution of complementary foods was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","Urban|Rural","completed","01-2006","01-2011","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010Study preparation and data collectionDue to the post-election violence that occurred in Kenya in January and February 2008, initiation of this study was postponed from its original start date of January 2008 to May 2008 to ensure the safety of the field team. The study team for Western Province included one field supervisor and four research assistants who were fluent in the local Luhya and Swahili languages. The study team for Eastern Province included one field supervisor and four research assistants who were fluent in Kamba, Swahili, and Kikuyu. A data analyst was also hired to enter and clean data in real time, as well as to assist with data analysis. Study procedural training was held with the entire study team, led by Dr. Kiersten Israel-Ballard and Ms. Margaret Waithaka, May 19–23, 2008. This included pretesting the data collection tools, revising all translations as needed, and piloting them in multiple languages at a local clinic. The study launch was on May 26 for Eastern Province, with field support from Dr. Israel-Ballard, and June 2 for Western Province, with field support from Ms. Waithaka. The data collection tools utilized in this study are available upon request.Study populations and proceduresThis cross-sectional study was designed to collect formative research data in a descriptive manner. This study took place at APHIA II (AIDS, Population and Health Integrated Assistance [USAID-funded program]) affiliated sites in the Kakamega, Vihiga, Hamisi, and Bungoma Districts of Western Province and in the Kitui, Makueni, Kibwezi, Machakos, Mwala, Yatta, Mwingi, and Mbooni Districts of Eastern Province. These regions were selected to include food-secure areas of Western Province and food-insecure areas of Eastern Province. Data collection occurred between May and September 2008. According to the 2007 Kenya AIDS Indicator Survey, Eastern Province had an HIV prevalence of 4.7 and Western Province of 5.1.This study was composed of a convenience sample of quantitative in-depth interviews, brief post-counseling exit interviews, and counseling session observations. A total of 386 women older than 18 years of age were recruited. In-depth interviews were conducted with 285 women (137 in Eastern Province, 148 in Western Province). Women known to be HIV positive were recruited from PMTCT clinics, comprehensive care centers, and postnatal wards at local clinics and referral hospitals, as well as from support groups affiliated with the health centers. Inclusion criteria included being HIV infected, having an infant <18 months of age, and having stopped breastfeeding between 1 week to 6 months prior to participation. Survey questions focused on the period over which breastfeeding cessation took place, including the age of the infant, liquids and foods fed during this period and their associated costs and availability, infant illness, breast health, general challenges, as well as a 24-hour dietary recall to capture current infant feeding practices and challenges. Infant weight and mid-upper arm circumference (MUAC) were measured to capture current nutritional status.Post-counseling exit interviews were conducted with 80 women (50 in Eastern Province, 30 in Western Province) who had not participated in the cross-sectional survey. The difference in sample size between provinces was due to clinic staffing shortages, resulting in the lack Kenya Infant Feeding Assessment 5 of individual postnatal counseling in Western Province; group PMTCT counseling was more commonly practised Women known to be HIV positive were recruited upon leaving an antenatal or postnatal PMTCT counseling session at a health facility. Inclusion criteria included being HIV positive, being pregnant, or having an infant <12 months of age. Counseling session observations occurred 22 times with different women and in various clinics (9 in Eastern Province, 13 in Western Province). Inclusion criteria included being HIV positive, being pregnant, or having an infant <12 months of age. In Eastern Province, four of these observations were antenatal and five were postnatal; in Western Province nine were antenatal and four were postnatal. Antenatal mothers were recruited in the antenatal care (ANC) clinic in the PMTCT section. Postnatal mothers were recruited in the comprehensive care center or in the maternal and child health (MCH) ward. Three observations were of ANC group counseling sessions rather than individual sessions; two in Western, one in Eastern. The observer used a check list to indicate whether a specified topic had been covered during the session. Although recruitment criteria were inclusive of both antenatal and postnatal mothers with infants under 12 months of age, most (n = 8) of the mothers interviewed postnatally had infants of only 1 month of age, while one mother had a 3-month-old and another had a 9-month-old infant, thus limiting the infant age ranges. All clients who met the recruitment criteria and consented to join the study during the recruitment period were recruited. To ensure eligibility and guardianship of the infant we required identification documents prior to enrollment. Additionally, 11 local stakeholders, including district and provincial nutritionists and nursing officers from Nairobi and Eastern and Western Provinces, were informally interviewed to gather their perceptions and attitudes toward infant feeding in the context of HIV in their communities.
","Weightfor-age (WFA) z-score,Upper-arm-circumference-for-age z-scoreMUACcount of the number of morbidities (0 to 5) the infant experienced during or subsequent to weaning, chosen from a list of five morbidities (respiratory symptoms, diarrhea, dehydration symptoms, fever, and refusal to eat)
","To monitor the progress of infant feeding and HIV activities, IYCN provided reporting tools which included a form to help APHIA II Western-supported PMTCT counselors accurately report on their facility-based activities in a standardized way, and to provide an opportunity to share successes and challenges; an observation checklist to provide structured feedback to facility-based counselors to improve their counseling and facilitation skills; and a reporting form for community-based workers to report on infant feeding activities. Subsequently, several PMTCT and HIV partners adopted the tools for use in their programs.
","*","Western and Eastern Province","","","","Vulnerable groups","","Infant feeding for the prevention of mother-to-child transmission of HIV>>>Infant feeding for the prevention of mother-to-child transmission of HIV>>http://www.who.int/elena/titles/hiv_infant_feeding","","","","","","","","","","","","","","","","","","","","","","Confirming our post-counseling exit interview findings, we observed that few counselors discussed safe water as part of their AFASS assessment. Yet, this is a crucial factor for decision-making in this study population given that the most common water sources cited among mothers interviewed were rivers, dams, or open ponds. We also noted that the costs of replacement feeding were rarely mentioned. Interestingly, we observed more emphasis placed on risks from replacement feeding than on those from breastfeeding during ANC, but the opposite emphasis during postnatal visits, perhaps due to the perceived fear of infecting an otherwise healthy-looking infant. Regardless of when the counseling takes place, an accurate representation of risks and benefits associated with all infant feeding options needs to be conveyed to mothers. It was reassuring to note that most counseling sessions included discussion around how to stop breastfeeding, including mentioning that cessation should not occur until 6 months and that AFASS criteria should be in place, and providing an explanation of how a mother should physically stop breastfeeding (i.e., reduce number of breastfeeds per day) and how long the transition should take. However, as with the exit interviews, few mentioned manual expression to prevent breast pathologies. Although complementary foods were often discussed, mothers needed more detailed information on Kenya Infant Feeding Assessment 28 timing, frequency, quantity, diversity, and appropriate local foods to be able to optimally feed their infants. Although infants were often weighed, their growth progress was rarely discussed with the mother. Effective growth monitoring should also include growth promotion, which includes dialogue with the mother in order to identify and address problem areas before they lead to growth faltering or malnutrition.
","“I feel that those who fully understand/grasp the counseling are most likely to exclusively breastfeed.” - District Nursing Officer Western Province“If you take a mother through one-on-one counseling, most will then exclusively breastfeed successfully.” - District Nursing OfficerWestern Province
","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","Urban|Rural","completed","01-2006","01-2011","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Management of MAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: IMAM
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9241","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","KEN","Kenya","Kenya","","","","","The US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project built support within communities and households for improving the way mothers in Kenya feed their infants, young children, and themselves. The IYCN Project collaborated with the government of Kenya and USAID-funded partners to conduct an assessment of infant feeding practices in Kenya’s Western and Eastern Provinces, which informed several national strategies and programs. The project also completed a literature review and a formative assessment on engaging fathers and grandmothers in infant and young child nutrition. Findings informed the design of an evaluation to test the effectiveness of interventions that engage fathers and grandmothers to improve and support mothers’ dietary and infant and young child feeding practices. To complement these efforts, IYCN partnered with the USAID-supported AIDS, Population and Health Integrated Assistance (APHIA) II and APHIAplus Projects to increase support for optimal infant feeding practices at the facility level and in the community
","Management of SAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010. Protocol used: intergrated management of acute Malnutrition
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","Urban|Rural|Peri-urban","completed","01-2009","01-2011","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010In Eastern Cape Province, IYCN supported PATH’s efforts to improve the quality, availability, and uptake of PMTCT services by strengthening under-resourced PMTCT sites and mobilizing communities to increase the uptake of those services. To prevent malnutrition and ensure HIVfree survival of children, IYCN contributed to integrating infant and young child feeding activities into PMTCT interventions. Specifically, the project helped develop atraining package for lay counselors and community health workers and supported the training of 100 community health workers on infant and young child feeding. In addition, the project assisted the provincial health department to develop tools for surveying facility-based nutritionservices.By adapting a regional, community-based planning tool for use locally, IYCN worked with private-sector partner, J & J Trust, South Africa’s Ekurhuleni Municipality, and Ward 86 within the municipality’s Nigel District to conduct a pilot program that integrated nutrition interventions into economic and community development planning. This model approach can be scaled up throughout the district and beyond to enhance awareness of the nutritional status of young children and dietary and feeding practices that can improve their health. Through this approach, IYCN trained community volunteers to engage the community in nutrition activities. The community response was overwhelming, and community leaders included nutrition activities in development plans. These new activities included establishing a support group for pregnant and lactating mothers and their parents and initiating an awareness campaign on available structures to support lactation.
","x
","","x","x","","","","Vulnerable groups","","Infant feeding for the prevention of mother-to-child transmission of HIV>>>Infant feeding for the prevention of mother-to-child transmission of HIV>>http://www.who.int/elena/titles/hiv_infant_feeding","","","","","","","","","","","","","","","","","","","","","","The use of existing structures and processes made planning community nutrition activities and allocating resources feasible. The community in Ward 86 continues to implement nutrition activities based on their community development plans. Although the project did not fund the implementation of these activities, community leaders were able to leverage existing structures and resources.Engagement with communities revealed that people are aware of nutrition and related issues, but that technical support is needed to develop creative behavior change interventions. It is possible to build better linkages between the community and health services by engaging the municipal planning system.
","“I have seen the level of interest in nutrition in the community increase, and now ward members are empowered to influence the development plans of the municipality and the district to prioritize support for nutrition.”— Benny Sikhakhane, IYCN Project consultant
","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","Urban|Rural|Peri-urban","completed","01-2009","01-2011","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Distribution of complementary foods was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","Urban|Rural|Peri-urban","completed","01-2009","01-2011","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","Urban|Rural|Peri-urban","completed","01-2009","01-2011","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Management of MAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","","","","","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Management of SAM was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","","","","","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","","","","","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Providing maternal supplements of balanced energy and protein was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9691","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZAF","South Africa","South Africa","","","","","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","South Africa’s HIV burden is the greatest in the world. From 2009 to 2011, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition Project worked to prevent HIV from reaching the next generation and to improve the nutritional status of mothers and children. The project informed a new set of national guidelines on infant and young child feeding in the context of HIV, and with national and international partners, identified opportunities for integrating nutrition assessment, counseling, and support services into programs focusing on prevention of mother-to-child transmission (PMTCT) of HIV. The project also worked in one district to mobilize communities and local government to integrate nutrition activities into community development plans. All of the project’s efforts have contributed to strengthening programs that seek to improve the nutrition of infants and young children, pregnant and lactating women, and orphans and vulnerable children (OVC), particularly populations at risk of contracting HIV.
","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","Urban|Rural","completed","01-2008","01-2011","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Nutritional care and support for people living with HIV/AIDS was reported to the Global Nutrition Policy Review (GNPR) 2009-2010IYCN took a comprehensive approach to addressing nutrition assessment, counseling, and support in Zambia by working with stakeholders at the national, district, provincial, and community levels to assess needs, enhance national policies, build the capacity of health providers, implement behavior change communication strategies, strengthen monitoring and evaluation systems, and identify and share good practices. Here is a snapshot of the project’s key activities and accomplishments.
","x
","","x","National coverage","","","","Vulnerable groups","","Infant feeding for the prevention of mother-to-child transmission of HIV>>>Infant feeding for the prevention of mother-to-child transmission of HIV>>http://www.who.int/elena/titles/hiv_infant_feeding","","","","","","","","","","","","","","","","","","","","","","Taking a comprehensive approach to addressing nutrition assessment, counseling, and support will help ensure a continuum of care and prevent nutritionally vulnerable mothers and children from falling through the cracks.Building the capacity of provincial teams as trainers is an efficient and cost-effective way to increase the number of trained infant feeding counselors.Community health volunteers can fill a key role in counseling and supporting mothers at health facilities, where health workers are often overwhelmed. When trained, volunteers can provide high-quality infantand young child feeding counseling for mothers.Building upon existing resources available in health facilities and communities can ensure government support and sustainability.
","“With IYCN’s support, we have been able to meet our objective of conducting high-quality training workshops for more health workers in our own province.” —Sydney Kambobe, Eastern Province Nutrition Specialist“Now I conduct cooking demonstrations to teach mothers to mix some of the nutritious local foods to give to the child. We pound meat and add it to the porridge.” —Lucy, Community health volunteer“I didn’t know that I could use the foods from my garden to make more nutritious meals for my child.” —Mother in Kabwe
","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","Urban|Rural","completed","01-2008","01-2011","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Providing maternal supplements of balanced energy and protein was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","Urban|Rural","completed","01-2008","01-2011","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Distribution of complementary foods was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","Urban|Rural","completed","01-2008","01-2011","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Distribution of insecticide-treated bednets was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","","","","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Maternal deworming in pregnancy was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","","","","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Preventive treatment of malaria in women was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "9703","Infant and Young Child Nutrition (IYCN) Project ","English","Multi-national","","ZMB","Zambia","Zambia","","","","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","For the past three years, the US Agency for International Development’s (USAID) Infant & Young Child Nutrition (IYCN) Project has supported the Ministry of Health and the National Food and Nutrition Commission to strengthen policies, programs, and health systems to improve the nutrition—and thereby prolong the lives— of mothers and their children younger than 2 years of age, including those affected by HIV. IYCN has collaborated with a wide range of partners to support mothers in adopting healthy feeding practices and to ensure a better future for Zambian communities and families.
The project focused on strengthening nutrition interventions within prevention of mother-to-child transmission of HIV programs and child health services and conducting supportive community-based activities. Since 2008, when the project began, health workers and community health volunteers in several districts have developed the skills and knowledge to help mothers improve nutrition for themselves and their babies. Formative research on maternal nutrition and child feeding practices has enabled stakeholders to understand beliefs and behaviors that contribute to poor nutrition. Structures are now in place for assessing the quality and consistency of health worker counseling. Additionally, messages to encourage changes in the way mothers feed their children have been disseminated through mass media.
","","8152","","","","","","","","","","","","","","Research/academia","University Research Co., LL C.","Private sector","The Manoff Group","","","","Bilateral and donor agencies and lenders","","Deworming of children 0-2 years was reported to the Global Nutrition Policy Review (GNPR) 2009-2010
","","","","National coverage","","","","","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "11454","Maternal, Infant and Young Child Nutrition Project","English","Multi-national","","MWI","Malawi","Salima District, Central Region, Malawi","Urban|Rural|Peri-urban","completed","01-2010","01-2011","From 2010 through 2011, the Infant & Young Child Nutrition (IYCN) Project supported Malawi’s Office of the President and Cabinet (OPC) to develop community-based nutrition services targeting mothers, infants, and young children, including HIV-positive populations. The project increased understanding of feeding behaviors, supported enhanced national policies, played a key role in shaping the country’s Scaling Up Nutrition (SUN) strategy, developed a package of training materials for a new cadre of community nutrition workers, and increased the capacity of community-based workers to improve infant and young child nutrition. We piloted capacity-building activities in Salima District, which will be scaled up nationally to improve the growth, nutritional status, health, and HIV-free survival of infants and young children.
","Examined caregivers’ feeding practices
IYCN conducted a joint research project with Bunda College of Agriculture and the World Bank to generate information that can be used to improve infant and young child nutrition activities within Malawi’s existing programs. The study was conducted in two phases: phase one was exploratory, and gathered information about feeding practices from 60 mothers with children 6 through 23 months of age and 18 key informants. In phase two, or the Trials of Improved Practices phase, counselors offered 100 mothers of children 0 through 23 months of age one to three improved feeding practices that they could try for about one week and gathered results from trying those practices.
","In a joint study with the World Bank, IYCN identified key infant feeding problems and tested practical solutions to inform new behavior change communication materials for community nutrition workers. Findings revealed that mothers could adopt new, improved practices, such as:
Formative research findings can help motivate stakeholders to take action.
The project’s formative research demonstrated that it is feasible for mothers in Malawi to make small changes in feeding practices that go a long way toward preventing malnutrition. These powerful findings influenced several national strategies and contributed to the country’s focus on prevention of stunting.
Training materials should meet the needs of community-based workers.
Because community-based workers selected for IYCN’s trainings lacked knowledge about the basic principles of nutrition, adapting the training materials to include this basic information, along with building counseling skills, led to the development of more effective tools for counseling caregivers. Mentoring and supportive supervision are a great way to reinforce concepts learned during a training session. We found that community workers were motivated to do the work when they received regular supervision and mentoring.
","“Indeed biscuits are expensive…and with the same amount of money, I can buy eight bananas.”
—Mother, Salima
Royce’s story: Small changes, big growth
When Gladys, a community health worker trained by IYCN, first met Linnes during a home visit, the young mother was concerned that her nine-month-old baby, Royce, had remained the same weight for the past three months. Sitting in the shade outside of Linnes’ mudbrick home in Nthiwatiwa village, Gladys asked her how she had been feeding her baby and used a set of illustrated counseling cards to suggest feeding changes. She advised that increasing the frequency of breastfeeding, making thicker porridge, and diversifying Royce’s meals could improve her growth and health. During several more home visits, Gladys found that Linnes was able to make these small feeding improvements; and after just two months, the baby’s growth improved significantly. Now, Linnes proudly shares her story with other mothers in the village.
","English" "11470","Integrated Family Health Program (IFHP)","English","National","","ETH","Ethiopia","Addis Ababa, Ethiopia|Amhara, Ethiopia|Benishangul-Gumuz, Ethiopia|Oromia, Ethiopia|Southern Nations, Nationalities, and People's Region, Ethiopia|Tigray, Ethiopia","Rural|Peri-urban","on-going","01-2008","01-2013","The Integrated Family Health Program (IFHP) supports the Government of Ethiopia’s Health Extension Program (HEP) and reaches over 32 million people—40% of the Ethiopian population—in 300 districts. Through assistance to over 13,000 health extension workers (HEWs) and thousands of community volunteers, USAID supports the delivery of key maternal, neonatal and child health services at the community level. These services include:
Goal:
Improve family health, especially for mothers, newborns, and children.
Project Objectives:
IFHP emphasizes a continuum of care approach at household/family, community and health facility levels through the provision of selected evidence-based and high-impact packages of services. This project plays an integral role in assisting the Ministry of Health to develop and change national policies, such as the use of antibiotics at the community level. The project supports the Government of Ethiopia in its Health Sector Development Plan and enhancing the Government’s management capacity as decentralization continues, leaving behind a well-functioning health system. By increasing the quality of health workers at the primary health care level and increasing demand for quality services, IFHP improves health behaviors and utilization of services. Additionally, IFHP also strengthens the promotion of essential nutrition actions with a strong focus on behavior change at both the community and facility level.
","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Twice a year, at designated times, the three programs distribute capsules to children aged six months to five years. Each program follows a campaign model based upon intensified social mobilization and service delivery over two to seven days. The twice-yearly events have created a cadre of field-tested personnel in the three countries, who are skilled at working with the local communities and at promoting their support and active participation. All three programs have been associated with National Immunization Days (NIDs), a WHO global program to eradicate polio. Since NIDs were held annually, however, they provided an opportunity for only one dose of vitamin A each year. Because children with vitamin A deficiency should receive a supplement at least twice a year (every four to six months), another mechanism was needed for the second dose. Relying exclusively upon facility-based distribution to deliver the second dose was not a viable option for several reasons, but in particular because healthfacility attendance for older children was not high enough to ensure adequate coverage in the one-to-five-year age group.
In Zambia, the first non-NIDs vitamin A supplementation program was launched in August 1999, and later renamed Child Health Week (CHW) to make the focus on the child more explicit. It was also felt that, instead of limiting activities to a vertical vitamin A supplementation program, the opportunity should be seized to deliver an integrated service that included not only vitamin A capsules but also other health services such as de-worming, health education, immunization, family planning, prenatal care, and growth monitoring. Districts were encouraged to provide an integrated package of services commensurate with their local capacity and need — as long as vitamin A supplementation remained the core activity during that week. In Zambia, the first NIDs campaign took place in 1997, and was a nationwide undertaking. The program was scaled down to about half the districts in recent years. Since 1999, the focus has shifted to priority districts, where communities have been at a constant risk of cross-border polio infections due to civil-war-related migrations from neighboring countries. This narrower focus is referred to in Zambia as sub-NIDS.
The first round of vitamin A supplementation in Ghana was integrated into NIDs in 1996. By 1999, a detailed plan was developed to implement a nationwide stand-alone supplementation program for the second round. In 2000, the Ministry of Health (MOH) carried out the first vitamin A standalone capsule distribution in the country’s ten regions. Since that date, the program has become a two- to three-day stand-alone event used to deliver a second dose of vitamin A to all children 6 to 59 months of age. Volunteers from the Ghana Education Service, along with personnel from other decentralized departments, assist with the supervision and capsule-distribution effort. Community-based volunteers are in direct contact with caregivers and children and also work very closely with health workers, assemblymen, chiefs, opinion leaders, gong-gong beaters, and other community leaders to mobilize beneficiaries, administer vitamin A, and maintain distribution records.
In contrast to Zambia and Ghana, Nepal followed a phased approach to program implementation. Integration of vitamin A into NIDs in Nepal was initiated in 1997,
four years after a supplementation program was established in 8 of the country’s 75 districts. The second distribution campaign has since been phased in at a rate of eight to ten districts per year. By 2001, the program covered all but three politically unstable districts. Under the program, high-dose vitamin A capsules are distributed to all children aged 6 to 59 months during a twoday event.
","
Ghana
A monitoring team consisting of national, regional, and district supervisors carries out organized and random spot checks. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. Capsule-distribution teams use all means of transportation available within the region and district, whether these be 4x4 vehicles, 2x4 pickups, motorcycles, or bicycles. MOH, district assemblies, decentralized departments, and local and international NGOs provide fuel and contribute to vehicle maintenance. At the end of each day, tally sheets are counted and summary sheets completed. Data are compiled by sub-district and district health management teams. After all figures are checked for accuracy, district coverage is calculated. District coverage data are sent to the regional nutrition officers and senior medical officers of public health, who compile regional coverage figures before sending them to the Nutrition Unit in Accra. Using regional figures, the Nutrition Unit estimates national coverage.
Zambia
Monitoring teams consisting of national, provincial, and district staff carry out systematic or random observations, depending on what they are monitoring. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. At the end of each day, tally sheets are counted, summary sheets completed, and data compiled. District figures are then checked for accuracy, after which district coverage is calculated and the results forwarded to NFNC.
","Ghana: 3.5 million children ","Ghana: Exceeded target in May 2001; Zambia: 28 percent in 1999, 88 in Febraury 2002","","serum retinol levels of &lt;20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","serum retinol levels of <20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Insufficient staff","In Zambia and Ghana, it has been somewhat more difficult to generate a consistent cadre of volunteers for the vitamin A distribution. In each country, districts mobilize health post and sub-health post staff, identify extended outreach sites (including clinics, schools, and community centers),and then recruit community members to assist them with their activities. In Ghana, this has been relatively successful since there have been adequate clinic staff and a manageable number of outreach sites. In spite of this, many districts have continued to do some house-to-house visits to ensure high coverage. In Zambia, it has been more difficult to recruit community volunteers, and the clinic staff have been stretched to cover outreach sites.","","","","","","","","","","","","","","","","","","","","","Robin Houston (2003). Why They Work: An analysis of three successful public health interventions - Vitamin A supplementation programs in Ghana, Nepal, and Zambia
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Five data collection methods were used:
During the fieldwork, the enumerators worked in pairs. The enumerators were not allowed to use the instruments in the facilities where they worked. Each pair spent a full day at a health facility. Field supervisors supported the enumerators during the data collection and checked the questionnaires for consistency and completeness. This was to ensure that the data collected was accurate as possible.
","""""Many pregnant mothers do not come to ANC because they had several normal pregnancies and think all will continue to go on well always.”
- Health worker, Apac
“ The health worker at the health centre is very rude, she has no time for us; so we fear even asking questions or discussing any issue about our health. So I go all the way to Naguru health clinic and only here if I have no money for transport.”
- A pregnant woman, Kojja, Mukono
“ I think these tablets for blood should be given only to pregnant women who have no blood. It may cause a high blood level and lead to high blood pressure.”
- TBAs, Kyampisi
“ Women with increased blood should not take these tablets (iron and folic acids) because their heartbeats will increase and they will sweat very much.”
- TBAs, Seeta Nazigo
“ Some mothers say it smells and they throw away the tablets soon after the clinic.”
- Pregnant mothers, Kojja
“ Some mothers do not like taking tablets when they are pregnant.”
- Pregnant mothers, Seeta Nazigo
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Ethiopia
MOST is providing technical and implementation support to the Ministry of Health in the development of a national micronutrient program. The program is a cooperative effort between the MOH, USAID/Ethiopia, MOST, and UNICEF. Program components include strengthening of the newly formed nutrition division at the MOH and the micronutrient committee; development of a locally designed vitamin A supplementation strategy and its pilot test; support for initial trials of vitamin A sugar fortification in one of the country's four sugar factories; and support for information, education, and communication activities.
South Africa
MOST is working with counterparts at the University of the Western Cape (UWC) to support and strengthen a new vitamin A supplementation program being started by the Department of Health in Eastern Cape province. MOST is also supporting a pilot initiative by UWC that aims to incorporate micronutrient interventions into the Eastern Cape Integrated Nutrition Program.
.
","","","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","","","","","","","","","","","","","","","","","","","","","","","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Government agencies encouraged the initial development of fortification: NFNC promoted initial research, sponsored meetings, and coordinated activities related to fortification; MOH researched the legal framework; the National Institute for Scientific and Industrial Research (NISIR) provided technical guidance; the Food and Drug Control Laboratory (FDCL) conducted monitoring and evaluation; and the Zambian Revenue Authority (ZRA) examined the tax structure. Industry acceptance allowed planning to begin, but donor support was critical to the development of the program: the U.S. Agency for International Development (USAID) was the lead financer of the project and provided technical assistance, UNICEF provided spare parts, and the Japanese International Cooperation Agency (JICA) provided spectrophotometers for Zambia Sugar and the FDCL.
While legislation was still being developed, Zambia Sugar went ahead with the launch of fortified Whitespoon Sugar on May 15, 1998. Zambia Sugar began its fortification program at 15 mg/kg, but cost considerations led the company to reduce the level to 10 mg/kg within three months. In May 1997, one year before fortification began, a consultant estimated the cost of fortifying 100,000 metric tons of sugar at 16 mg/kg to be around $1 million U.S., while fortifying at 20 mg/kg would cost almost $1.25 million.24 Reducing the level from 16 to 10 mg/kg could thus have reduced costs by approximately $375,000 a year.
","Modified Relative Dose Response Test (MRDR) in children
","The first outside tests of fortificant levels in sugar were controversial. Four months after the launch of fortified sugar, a team consisting of representatives from the MOH, the NFNC, and NISIR visited the Zambia Sugar mill. The team tested samples from the mill at the FDCL; these tests showed far lower levels of vitamin A than those shown in tests by Zambia Sugar. The government’s tests indicated a range of 0–13.6 mg/kg, while Zambia Sugar’s tests indicated a range of 9–21 mg/kg for the same samples. Zambia Sugar believes that the samples suffered sedimentation in the transport to the government laboratory and that this explains the different results.
MOST, the USAID micronutrient program, sponsored the creation of training manuals for health inspectors and Food and Drug enforcement officers, as well as a national training workshop from September 24 to October 7, 2000. The workshop focused on inspection procedures and methods, provided laboratory training where appropriate, and included a trip to the Zambia Sugar plant. Since the implementation of that program, Zambia Sugar has expressed satisfaction with law enforcement efforts. UNICEF subsequently funded workshops at the district level, using reproductions of the training manuals that had been produced with MOST funding.
","nationwide","..","","","","Vulnerable groups","","","Financial resources","","Communication","","Financial resources","","Adherence","","","","","","","","","","","","","","","","","English" "11536","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","TZA","United Republic of Tanzania"," Tanzania |Morogoro, Tanzania|Zanzibar, Tanzania|Dodoma, Tanzania|Manyara, Tanzania|Arusha, Tanzania|Kilimanjaro, Tanzania|Tanga, Tanzania|Coast, Tanzania|Dodoma, Tanzani|Iringa, Tanzania|Mbeya, Tanzani","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Tanzania, Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 430,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Feed the Future Tanzania also aims to:
To help meet its objectives Feed the Future Tanzania is making core investments in four key areas:
CORE INVESTMENT AREA 1A: SYSTEMS TRANSFORMATION THROUGH AGRICULTURAL PRODUCTION AND PROCESSING
The first set of core investments contribute to IRs 1-3, 5, 6, 7, and 8. These core investments play a role in systems transformation, with a primary focus on rice and targeted interventions in maize and horticulture as secondary value chains. The main objective is inclusive agriculture sector growth, which will be accomplished through increased agricultural productivity, expanded markets and trade, increased private sector investment in agriculture- and nutrition-related activities, and increased agricultural value chain on- and off-farm jobs. Investment in these value chains will improve availability and access to staple foods and improve nutrition. USG investments will facilitate the competitiveness of smallholders in rice, maize and horticulture.
NAFAKA – Staples Value Chain Development (Rice and Maize)
Description: This program will facilitate the competitiveness of the smallholder-based rice value chain, and balance these impacts on growth with broader efforts to reduce poverty through investments aimed at improving the competitiveness and productivity of the maize value chain. This includes support to the Morogoro and Arusha-based Agricultural Research Station and National Seed Laboratory. Specific activities will:
Market-Based Solutions to Reduce Poverty and Improve Nutrition
The purpose of this project is to strengthen the capabilities of the agro-processors operating in the FTF targeted geographic areas for the staple grains of rice and maize and a range of horticultural products to build sustainable enterprises and expand and diversify the production and marketing of nutritious processed foods. This will include an array of support to processors of different scales of operations, farmers, public sector institutions involved in food technology and safety, agribusinesses, and traders.
Sustainable Horticulture for Income and Food Security in Tanzania (SHIFT)
This sustainable agriculture program aims to increase demand by expanding market opportunities for smallholder horticultural producers and processors in domestic, regional and international markets, and will work with farmers to build supply by introducing sustainable agricultural practices, increasing productivity, and reducing postharvest losses. Activities will include farmer association capacity building, nutrition education, and developing market hubs. The geographic focus is in the southern regions, and falls within the SAGCOT.
Tanzania Agriculture Productivity Program (TAPP)
This program aims to increase smallholder farmer incomes through enhanced productivity and improved domestic and export marketing of agricultural products. This program provides business services to farmers and associations in six target zones in the northern regions (Arusha, Moshi/Hai, Lushoto, Morogoro, Coast and Zanzibar). The activities include management training, marketing tools, business lobbying skills, and technical assistance for developing and marketing policy reforms. In implementing these activities, the program focuses on strengthening producer associations and preparing them to graduate from TAPP support and sustain their activities. The program strengthens market linkages by expanding domestic and export market outgrower schemes.
NAFAKA – Staples Value Chain Development (Rice and Maize)
Market-Based Solutions to Reduce Poverty and Improve Nutrition
Sustainable Horticulture for Income and Food Security in Tanzania (SHIFT)
Tanzania Agriculture Productivity Program (TAPP)
Overview
A participatory approach, which calls for active participation of all stakeholders, will be used to monitor and evaluate (M&E) FTF Tanzania. The design of the M&E system will be based on the usefulness of the data and information which is collected and processed at the different levels and intervals of program implementation and operationalization. M&E for FTF will involve on-going monitoring of program activities in the participating districts, annual evaluations, annual review workshops, beneficiary assessments, mid-term review and terminal evaluation.
Evaluations will be carried out using an independent entity to assess annual program performance. In addition, FTF Tanzania will organize annual review workshops for the duration of the program to enable implementing partners to share information on program implementation performance. FTF will also draw lessons and experiences from these workshops that can be taken into account when planning activities for subsequent years of implementation.
A matrix for the selected FTF indicators is attached as Annex A. FTF Tanzania has received assistance from USAID‘s Bureau for Food Security to provide M&E technical assistance. A preliminary M&E plan has been developed for FTF Tanzania which will be completed in September 2011 once the FTF M&E implementing partner, The Mitchell Group (TMG), has arrived in Tanzania and is fully operational.
Performance Evaluations
Performance evaluations will be carried out for selected FTF Tanzania projects to ascertain the trends in achieving project results of the FTF interventions, to document the overall progress toward objectives, and to assess what is working and what is not and why. One evaluation will be done in project year one (PY 1), another in PY 3 and the last one in PY 5. A mid-term review is planned for the end of PY 2 to assess overall progress and impact of FTF implementation, to provide for corrective actions to enhance performance of FTF, and to provide recommendations for future program designs. These recommendations will be confirmed in the terminal evaluation to be carried out in PY 5.
Qualitative and participatory methods will be utilized for the performance evaluations. Evaluators will utilize methods such as observation, focus groups, key informant interviews, stakeholder interviews and rapid survey techniques to assess progress. These techniques often provide critical insights into beneficiaries‘ perspectives on the value of programs to them, the processes that may have affected outcomes, and a deeper interpretation of results observed. Specific targets for the indicators at the outcome and output levels will be developed once FTF Tanzania has carried out the baseline survey in the FTF target areas along with the preparation of Performance Monitoring Plans.
Impact Evaluation
In addition to performance evaluations, FTF Tanzania will design an impact evaluation to test a selected development hypothesis for FTF. Ideally the impact evaluation will utilize Experimental Methodology to design and conduct the impact evaluation. This methodology will incorporate a rigorously defined counterfactual and will utilize experimental design to test the development hypothesis. At a minimum, quasi-experimental methods will be utilized to test the selected hypothesis and to determine the attribution of FTF project impacts. The Impact Evaluation will be carried out under the guidance of TMG.
Program Monitoring
All programs receiving resources under FTF Tanzania will be expected to use rigorous M&E systems that will feed into the broader FTF and GOT M&E frameworks. To the extent possible, examples of participatory methodologies built into program implementation to engage program beneficiaries in knowledge sharing, learning, and potential behavior change opportunities will be encouraged. In addition to the standard reporting requirements, the M&E program will develop and undertake baseline and other survey/assessment work (e.g. household, facility, market) to contribute to the larger M&E framework under FTF. Selected programs will designate a full-time M&E Specialist to appropriately monitor progress and engage in reporting systems for FTF as they are developed. These M&E Specialists will work to ensure that program results are jointly monitored with the ASDP and contribute to their reporting systems. The M&E Specialists will participate in annual meetings that include all implementing partners for FTF Tanzania, the FTF working group, and GOT representatives from relevant ministries.
Baselines
Baseline surveys will be required for several of the indicators listed in the annex. During 2011, a comprehensive baseline survey will be carried out by the Tanzania National Bureau of Statistics under the guidance of TMG. This baseline data will assist FTF Tanzania to set targets, monitor progress toward those targets and to initiate mid-course corrections for its programs and activities. The baseline will inform FTF Tanzania with data to determine whether or not selected activities are likely to achieve their targets.
Links to Government Monitoring Systems
The GOT will conduct rigorous M&E of their CAADP plan and supporting strategies such as the ASDP. To the extent possible, the FTF M&E framework is intended to utilize information that GOT already collects, especially at the national level. The M&E program will provide direct support to the GOT‘s National Bureau of Statistics. FTF investments in M&E will also be linked with the GOT monitoring mechanisms to build host country capacity and ability to analyze and report on results. A monitoring conceptual framework will set the stage for ensuring progress against targets, provide opportunities for learning, and employ participatory methods. Monitoring activities will support GOT analytical capacity building.
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Tanzania, Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 430,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Feed the Future Tanzania also aims to:
To help meet its objectives Feed the Future Tanzania is making core investments in four key areas:
CORE INVESTMENT AREA 2: IMPROVING NUTRITION
Contributes to IR 4: Increased resilience of vulnerable communities and households, IR 5: Improved access to diverse and quality foods, IR 6: Improved nutrition-related behaviors and IR 7: Improved utilization of maternal and child health and nutrition services.
The second set of core investments will focus on scaling up the delivery of a comprehensive package of nutrition interventions in regions of the country with the highest rates of chronic undernutrition among children under five (also referred to as stunting) and maternal anemia. It will also focus on raising the problem of undernutrition as a key development challenge and policy issue for Tanzania to address in order to meet the objectives set forth in the CAADP and the MKUKUTA II/ MKUZA II.
Another key priority area for nutrition under FTF Tanzania will be to maximize opportunities for ―smart integration‖ with other USG investments under the Global Health Initiative. This will mean strengthening and building nutrition components into new and existing safety net, maternal and child health, HIV/AIDS, malaria and water/sanitation/hygiene programs in order to maximize synergies and leverages additional nutrition results in programs that may or may not have nutrition of children or pregnant women as a main focus of their work.
Flagship Nutrition Program
The USG has developed a new program under FTF and the Global Health Initiative designed to reduce rates of chronic undernutrition (stunting) among children under-five and maternal anemia among women of reproductive age. The program will cover the following:
Overview
A participatory approach, which calls for active participation of all stakeholders, will be used to monitor and evaluate (M&E) FTF Tanzania. The design of the M&E system will be based on the usefulness of the data and information which is collected and processed at the different levels and intervals of program implementation and operationalization. M&E for FTF will involve on-going monitoring of program activities in the participating districts, annual evaluations, annual review workshops, beneficiary assessments, mid-term review and terminal evaluation.
Evaluations will be carried out using an independent entity to assess annual program performance. In addition, FTF Tanzania will organize annual review workshops for the duration of the program to enable implementing partners to share information on program implementation performance. FTF will also draw lessons and experiences from these workshops that can be taken into account when planning activities for subsequent years of implementation.
A matrix for the selected FTF indicators is attached as Annex A. FTF Tanzania has received assistance from USAID‘s Bureau for Food Security to provide M&E technical assistance. A preliminary M&E plan has been developed for FTF Tanzania which will be completed in September 2011 once the FTF M&E implementing partner, The Mitchell Group (TMG), has arrived in Tanzania and is fully operational.
Performance Evaluations
Performance evaluations will be carried out for selected FTF Tanzania projects to ascertain the trends in achieving project results of the FTF interventions, to document the overall progress toward objectives, and to assess what is working and what is not and why. One evaluation will be done in project year one (PY 1), another in PY 3 and the last one in PY 5. A mid-term review is planned for the end of PY 2 to assess overall progress and impact of FTF implementation, to provide for corrective actions to enhance performance of FTF, and to provide recommendations for future program designs. These recommendations will be confirmed in the terminal evaluation to be carried out in PY 5.
Qualitative and participatory methods will be utilized for the performance evaluations. Evaluators will utilize methods such as observation, focus groups, key informant interviews, stakeholder interviews and rapid survey techniques to assess progress. These techniques often provide critical insights into beneficiaries‘ perspectives on the value of programs to them, the processes that may have affected outcomes, and a deeper interpretation of results observed. Specific targets for the indicators at the outcome and output levels will be developed once FTF Tanzania has carried out the baseline survey in the FTF target areas along with the preparation of Performance Monitoring Plans.
Impact Evaluation
In addition to performance evaluations, FTF Tanzania will design an impact evaluation to test a selected development hypothesis for FTF. Ideally the impact evaluation will utilize Experimental Methodology to design and conduct the impact evaluation. This methodology will incorporate a rigorously defined counterfactual and will utilize experimental design to test the development hypothesis. At a minimum, quasi-experimental methods will be utilized to test the selected hypothesis and to determine the attribution of FTF project impacts. The Impact Evaluation will be carried out under the guidance of TMG.
Program Monitoring
All programs receiving resources under FTF Tanzania will be expected to use rigorous M&E systems that will feed into the broader FTF and GOT M&E frameworks. To the extent possible, examples of participatory methodologies built into program implementation to engage program beneficiaries in knowledge sharing, learning, and potential behavior change opportunities will be encouraged. In addition to the standard reporting requirements, the M&E program will develop and undertake baseline and other survey/assessment work (e.g. household, facility, market) to contribute to the larger M&E framework under FTF. Selected programs will designate a full-time M&E Specialist to appropriately monitor progress and engage in reporting systems for FTF as they are developed. These M&E Specialists will work to ensure that program results are jointly monitored with the ASDP and contribute to their reporting systems. The M&E Specialists will participate in annual meetings that include all implementing partners for FTF Tanzania, the FTF working group, and GOT representatives from relevant ministries.
Baselines
Baseline surveys will be required for several of the indicators listed in the annex. During 2011, a comprehensive baseline survey will be carried out by the Tanzania National Bureau of Statistics under the guidance of TMG. This baseline data will assist FTF Tanzania to set targets, monitor progress toward those targets and to initiate mid-course corrections for its programs and activities. The baseline will inform FTF Tanzania with data to determine whether or not selected activities are likely to achieve their targets.
Links to Government Monitoring Systems
The GOT will conduct rigorous M&E of their CAADP plan and supporting strategies such as the ASDP. To the extent possible, the FTF M&E framework is intended to utilize information that GOT already collects, especially at the national level. The M&E program will provide direct support to the GOT‘s National Bureau of Statistics. FTF investments in M&E will also be linked with the GOT monitoring mechanisms to build host country capacity and ability to analyze and report on results. A monitoring conceptual framework will set the stage for ensuring progress against targets, provide opportunities for learning, and employ participatory methods. Monitoring activities will support GOT analytical capacity building.
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Tanzania, Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 430,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Feed the Future Tanzania also aims to:
To help meet its objectives Feed the Future Tanzania is making core investments in four key areas:
Overview
A participatory approach, which calls for active participation of all stakeholders, will be used to monitor and evaluate (M&E) FTF Tanzania. The design of the M&E system will be based on the usefulness of the data and information which is collected and processed at the different levels and intervals of program implementation and operationalization. M&E for FTF will involve on-going monitoring of program activities in the participating districts, annual evaluations, annual review workshops, beneficiary assessments, mid-term review and terminal evaluation.
Evaluations will be carried out using an independent entity to assess annual program performance. In addition, FTF Tanzania will organize annual review workshops for the duration of the program to enable implementing partners to share information on program implementation performance. FTF will also draw lessons and experiences from these workshops that can be taken into account when planning activities for subsequent years of implementation.
A matrix for the selected FTF indicators is attached as Annex A. FTF Tanzania has received assistance from USAID‘s Bureau for Food Security to provide M&E technical assistance. A preliminary M&E plan has been developed for FTF Tanzania which will be completed in September 2011 once the FTF M&E implementing partner, The Mitchell Group (TMG), has arrived in Tanzania and is fully operational.
Performance Evaluations
Performance evaluations will be carried out for selected FTF Tanzania projects to ascertain the trends in achieving project results of the FTF interventions, to document the overall progress toward objectives, and to assess what is working and what is not and why. One evaluation will be done in project year one (PY 1), another in PY 3 and the last one in PY 5. A mid-term review is planned for the end of PY 2 to assess overall progress and impact of FTF implementation, to provide for corrective actions to enhance performance of FTF, and to provide recommendations for future program designs. These recommendations will be confirmed in the terminal evaluation to be carried out in PY 5.
Qualitative and participatory methods will be utilized for the performance evaluations. Evaluators will utilize methods such as observation, focus groups, key informant interviews, stakeholder interviews and rapid survey techniques to assess progress. These techniques often provide critical insights into beneficiaries‘ perspectives on the value of programs to them, the processes that may have affected outcomes, and a deeper interpretation of results observed. Specific targets for the indicators at the outcome and output levels will be developed once FTF Tanzania has carried out the baseline survey in the FTF target areas along with the preparation of Performance Monitoring Plans.
Impact Evaluation
In addition to performance evaluations, FTF Tanzania will design an impact evaluation to test a selected development hypothesis for FTF. Ideally the impact evaluation will utilize Experimental Methodology to design and conduct the impact evaluation. This methodology will incorporate a rigorously defined counterfactual and will utilize experimental design to test the development hypothesis. At a minimum, quasi-experimental methods will be utilized to test the selected hypothesis and to determine the attribution of FTF project impacts. The Impact Evaluation will be carried out under the guidance of TMG.
Program Monitoring
All programs receiving resources under FTF Tanzania will be expected to use rigorous M&E systems that will feed into the broader FTF and GOT M&E frameworks. To the extent possible, examples of participatory methodologies built into program implementation to engage program beneficiaries in knowledge sharing, learning, and potential behavior change opportunities will be encouraged. In addition to the standard reporting requirements, the M&E program will develop and undertake baseline and other survey/assessment work (e.g. household, facility, market) to contribute to the larger M&E framework under FTF. Selected programs will designate a full-time M&E Specialist to appropriately monitor progress and engage in reporting systems for FTF as they are developed. These M&E Specialists will work to ensure that program results are jointly monitored with the ASDP and contribute to their reporting systems. The M&E Specialists will participate in annual meetings that include all implementing partners for FTF Tanzania, the FTF working group, and GOT representatives from relevant ministries.
Baselines
Baseline surveys will be required for several of the indicators listed in the annex. During 2011, a comprehensive baseline survey will be carried out by the Tanzania National Bureau of Statistics under the guidance of TMG. This baseline data will assist FTF Tanzania to set targets, monitor progress toward those targets and to initiate mid-course corrections for its programs and activities. The baseline will inform FTF Tanzania with data to determine whether or not selected activities are likely to achieve their targets.
Links to Government Monitoring Systems
The GOT will conduct rigorous M&E of their CAADP plan and supporting strategies such as the ASDP. To the extent possible, the FTF M&E framework is intended to utilize information that GOT already collects, especially at the national level. The M&E program will provide direct support to the GOT‘s National Bureau of Statistics. FTF investments in M&E will also be linked with the GOT monitoring mechanisms to build host country capacity and ability to analyze and report on results. A monitoring conceptual framework will set the stage for ensuring progress against targets, provide opportunities for learning, and employ participatory methods. Monitoring activities will support GOT analytical capacity building.
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Tanzania, Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 430,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Feed the Future Tanzania also aims to:
To help meet its objectives Feed the Future Tanzania is making core investments in four key areas:
CORE INVESTMENT AREA 3: CAPACITY BUILDING AND SUPPORT SERVICES
Contributes to IR 1: Improved agricultural productivity, IR 2: Expanding markets and trade, IR 3: Increased private investment in agriculture- and nutrition-related activities, IR 4: Increased resilience of vulnerable communities and households, IR 5: Improved access to diverse and quality foods, IR 6: Improved nutrition-related behaviors, IR 7: Improved utilization of maternal and child health and nutrition services, and IR 8: Improved enabling policy environment for both agriculture and nutrition.
Tanzania‘s food security and overall agricultural performance into the medium-term will be predicated upon the CAADP process and the accompanying Country Investment Plan (CIP). FTF investments will help support the drafting of the CAADP investment plan and also assist with its successful implementation in collaboration with all partners. FTF Tanzania will invest in building government capacity for policy-making, analysis, and interpretation and delivering on Tanzania‘s CAADP investment plan.
The investments will support host-country leadership and strategy planning to develop sustainability through a new generation of leadership. The USG will provide short- and long-term high-level policymaking support to GOT to develop and deliver on a robust, comprehensive CAADP investment plan and to build a formal mechanism for public-private sector dialogue. Investments will increase the capacity of Tanzanians to act as change agents for transforming the sector.
In addition, FTF will invest in research and development to build Tanzania‘s capacity to respond to challenges through innovations. FTF supports collaborative research to enhance Tanzania‘s ability to improve productivity, especially in light of climate change impacts and other constraints, both agronomic and economic.
Finally, one of the important parts of strengthening the capacity of Tanzanian agriculture is through supporting market-based financial services, including through a variety of loan programs. FTF Tanzania is utilizing innovative methods to increasing rural financing opportunities, especially through microfinance.
FTF staff and partners involved in this component will ensure that gender equitable policies are included in the TAFSIP and in its implementation, that women participate in leadership and training programs, and that women are involved in program activities with Sokoine University of Agriculture and the National Agricultural Research System.
Sokoine University of Agriculture Capacity Building
This program will expand and improve the quality of training in agricultural fields and research in support of FTF Tanzania. By supporting Sokoine University of Agriculture through a direct mechanism, FTF Tanzania will build the capacity of this Tanzanian institution to respond to agricultural issues.
This program will strengthen the training and research capacities of Sokoine University of Agriculture and the Tanzanian National Agricultural Research System. The program will support collaborative research, foster leadership in training and research through long-term training in agriculture, strengthen the capacity of Sokoine University of Agriculture, and promote tripartite Sokoine University if Agriculture - U.S. University - South-South University Cooperation.
","Overview
A participatory approach, which calls for active participation of all stakeholders, will be used to monitor and evaluate (M&E) FTF Tanzania. The design of the M&E system will be based on the usefulness of the data and information which is collected and processed at the different levels and intervals of program implementation and operationalization. M&E for FTF will involve on-going monitoring of program activities in the participating districts, annual evaluations, annual review workshops, beneficiary assessments, mid-term review and terminal evaluation.
Evaluations will be carried out using an independent entity to assess annual program performance. In addition, FTF Tanzania will organize annual review workshops for the duration of the program to enable implementing partners to share information on program implementation performance. FTF will also draw lessons and experiences from these workshops that can be taken into account when planning activities for subsequent years of implementation.
A matrix for the selected FTF indicators is attached as Annex A. FTF Tanzania has received assistance from USAID‘s Bureau for Food Security to provide M&E technical assistance. A preliminary M&E plan has been developed for FTF Tanzania which will be completed in September 2011 once the FTF M&E implementing partner, The Mitchell Group (TMG), has arrived in Tanzania and is fully operational.
Performance Evaluations
Performance evaluations will be carried out for selected FTF Tanzania projects to ascertain the trends in achieving project results of the FTF interventions, to document the overall progress toward objectives, and to assess what is working and what is not and why. One evaluation will be done in project year one (PY 1), another in PY 3 and the last one in PY 5. A mid-term review is planned for the end of PY 2 to assess overall progress and impact of FTF implementation, to provide for corrective actions to enhance performance of FTF, and to provide recommendations for future program designs. These recommendations will be confirmed in the terminal evaluation to be carried out in PY 5.
Qualitative and participatory methods will be utilized for the performance evaluations. Evaluators will utilize methods such as observation, focus groups, key informant interviews, stakeholder interviews and rapid survey techniques to assess progress. These techniques often provide critical insights into beneficiaries‘ perspectives on the value of programs to them, the processes that may have affected outcomes, and a deeper interpretation of results observed. Specific targets for the indicators at the outcome and output levels will be developed once FTF Tanzania has carried out the baseline survey in the FTF target areas along with the preparation of Performance Monitoring Plans.
Impact Evaluation
In addition to performance evaluations, FTF Tanzania will design an impact evaluation to test a selected development hypothesis for FTF. Ideally the impact evaluation will utilize Experimental Methodology to design and conduct the impact evaluation. This methodology will incorporate a rigorously defined counterfactual and will utilize experimental design to test the development hypothesis. At a minimum, quasi-experimental methods will be utilized to test the selected hypothesis and to determine the attribution of FTF project impacts. The Impact Evaluation will be carried out under the guidance of TMG.
Program Monitoring
All programs receiving resources under FTF Tanzania will be expected to use rigorous M&E systems that will feed into the broader FTF and GOT M&E frameworks. To the extent possible, examples of participatory methodologies built into program implementation to engage program beneficiaries in knowledge sharing, learning, and potential behavior change opportunities will be encouraged. In addition to the standard reporting requirements, the M&E program will develop and undertake baseline and other survey/assessment work (e.g. household, facility, market) to contribute to the larger M&E framework under FTF. Selected programs will designate a full-time M&E Specialist to appropriately monitor progress and engage in reporting systems for FTF as they are developed. These M&E Specialists will work to ensure that program results are jointly monitored with the ASDP and contribute to their reporting systems. The M&E Specialists will participate in annual meetings that include all implementing partners for FTF Tanzania, the FTF working group, and GOT representatives from relevant ministries.
Baselines
Baseline surveys will be required for several of the indicators listed in the annex. During 2011, a comprehensive baseline survey will be carried out by the Tanzania National Bureau of Statistics under the guidance of TMG. This baseline data will assist FTF Tanzania to set targets, monitor progress toward those targets and to initiate mid-course corrections for its programs and activities. The baseline will inform FTF Tanzania with data to determine whether or not selected activities are likely to achieve their targets.
Links to Government Monitoring Systems
The GOT will conduct rigorous M&E of their CAADP plan and supporting strategies such as the ASDP. To the extent possible, the FTF M&E framework is intended to utilize information that GOT already collects, especially at the national level. The M&E program will provide direct support to the GOT‘s National Bureau of Statistics. FTF investments in M&E will also be linked with the GOT monitoring mechanisms to build host country capacity and ability to analyze and report on results. A monitoring conceptual framework will set the stage for ensuring progress against targets, provide opportunities for learning, and employ participatory methods. Monitoring activities will support GOT analytical capacity building.
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Tanzania, Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 430,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Feed the Future Tanzania also aims to:
To help meet its objectives Feed the Future Tanzania is making core investments in four key areas:
CORE INVESTMENT AREA 4: ENABLING POLICY ENVIRONMENT
Contributes to IR 8: Improved enabling policy environment and good governance for both agriculture and nutrition
FTF Tanzania will support policy reform and address major agricultural policy and governance issues by building the capacity of the government and private sector to conduct analyses and take action to identify and address the binding constraints to agricultural development. The USG will promote policies that provide an enabling environment for private sector investment in agriculture, create more certain and consistent trade policies, develop and assist in the implementation of more gender equitable policies and focus on policies that enable the implementation of key nutritional interventions. These will include policies and legal issues related to agricultural inputs, credit, markets, and land and trade policy. In order for any of the investments in food security to have the intended impact, a supportive policy environment is foundational.
Tanzania has overarching policy challenges that can seriously impact its performance with food security and its possible role as a regional provider into the future. The recent AgCLIR assessment for Tanzania identified several key policy issues that currently inhibit transformational agricultural growth, including: policy instability, multiplicity of local taxes, and a weak legal framework to protect property rights.
FTF will actively work to develop the GOT‘s capacity to analyze and implement policy instruments that address both short and long-term food security needs. Possible interventions include:
To ensure that policies that cause market distortion are avoided, FTF will create a robust monitoring system for policy reforms and will promote mutual accountability based on a consultative process rather than imposing conditionality.
One of the main challenges to promoting good governance in Tanzania is access to information by the public and by pressure groups, which is necessary for holding the government accountable in use of resources for provision of public services such as rural roads or extension. FTF will establish a communications strategy that will enhance access to information on food security and agriculture so as to foster public awareness on the program, and on state and private sector performance in the sector. The program will build upon the existing processes for ―Agricultural Sector Review‖ and ―Public Expenditure Review‖ which are held annually.
The participation of civil society, media and NGOs in shaping an agricultural development program is essential to ensuring that a program articulates the needs of the majority, including vulnerable segments of the population such as women and children. Civil society and NGOs can also assist in holding the government accountable for its performance. FTF Tanzania will support some local NGOs and civil society organizations to champion policy reforms. USG has started, and will continue, to engage civil society in the shaping of FTF, and encourage them to participate in the implementation process. The U.S. Government advocated for more engagement of civil society in the CAADP process, resulting in the engagement of the Agriculture Non-State Actors Forum (ANSAF) in the CAADP Task Force and the Drafting Team for TAFSIP. As the U.S. Government assumes the leadership of the donors‘ group for agriculture in July 2011, it will engage more NGOs and civil society organizations in the Agricultural Sector and Public Expenditure Reviews.
FTF Tanzania will advocate for policies that will address gender disparities in access to resources. For instance, the ―Secured Transactions Reforms‖ would create a legal framework to support the use of movable assets as collateral for accessing credit by small and medium enterprises. Such a system would enhance equitable access to credit, as the current system relies on the use of fixed assets such as land, and thereby often excludes women, who under traditional cultural practices have limited opportunity to land titling.
Enabling Policy Environment for Agricultural Sector Growth
The project‘s primary goal is to advance policy reform efforts in key areas identified as the critical barriers to transformation of the agriculture sector. The purpose of this project is to develop a policy partnership between government, private sector organizations, and research institutions to achieve key policy reforms in the agriculture sector and related business environment that will ensure successful implementation of the GOT‘s agriculture investment plan and FTF. The project will: strengthen the capacities of GOT institutions, the private sector, and other stakeholders for policy research and implementation of policy change that informs the CAADP process and FTF on constraints to growth; promotes dialogue among all stakeholders and partners; identifies and develops consensus on specific policies that need to be analyzed and changed; and monitors the implementation and impact of reforms intended to enable increased private investments in agriculture and trade.
Overview
A participatory approach, which calls for active participation of all stakeholders, will be used to monitor and evaluate (M&E) FTF Tanzania. The design of the M&E system will be based on the usefulness of the data and information which is collected and processed at the different levels and intervals of program implementation and operationalization. M&E for FTF will involve on-going monitoring of program activities in the participating districts, annual evaluations, annual review workshops, beneficiary assessments, mid-term review and terminal evaluation.
Evaluations will be carried out using an independent entity to assess annual program performance. In addition, FTF Tanzania will organize annual review workshops for the duration of the program to enable implementing partners to share information on program implementation performance. FTF will also draw lessons and experiences from these workshops that can be taken into account when planning activities for subsequent years of implementation.
A matrix for the selected FTF indicators is attached as Annex A. FTF Tanzania has received assistance from USAID‘s Bureau for Food Security to provide M&E technical assistance. A preliminary M&E plan has been developed for FTF Tanzania which will be completed in September 2011 once the FTF M&E implementing partner, The Mitchell Group (TMG), has arrived in Tanzania and is fully operational.
Performance Evaluations
Performance evaluations will be carried out for selected FTF Tanzania projects to ascertain the trends in achieving project results of the FTF interventions, to document the overall progress toward objectives, and to assess what is working and what is not and why. One evaluation will be done in project year one (PY 1), another in PY 3 and the last one in PY 5. A mid-term review is planned for the end of PY 2 to assess overall progress and impact of FTF implementation, to provide for corrective actions to enhance performance of FTF, and to provide recommendations for future program designs. These recommendations will be confirmed in the terminal evaluation to be carried out in PY 5.
Qualitative and participatory methods will be utilized for the performance evaluations. Evaluators will utilize methods such as observation, focus groups, key informant interviews, stakeholder interviews and rapid survey techniques to assess progress. These techniques often provide critical insights into beneficiaries‘ perspectives on the value of programs to them, the processes that may have affected outcomes, and a deeper interpretation of results observed. Specific targets for the indicators at the outcome and output levels will be developed once FTF Tanzania has carried out the baseline survey in the FTF target areas along with the preparation of Performance Monitoring Plans.
Impact Evaluation
In addition to performance evaluations, FTF Tanzania will design an impact evaluation to test a selected development hypothesis for FTF. Ideally the impact evaluation will utilize Experimental Methodology to design and conduct the impact evaluation. This methodology will incorporate a rigorously defined counterfactual and will utilize experimental design to test the development hypothesis. At a minimum, quasi-experimental methods will be utilized to test the selected hypothesis and to determine the attribution of FTF project impacts. The Impact Evaluation will be carried out under the guidance of TMG.
Program Monitoring
All programs receiving resources under FTF Tanzania will be expected to use rigorous M&E systems that will feed into the broader FTF and GOT M&E frameworks. To the extent possible, examples of participatory methodologies built into program implementation to engage program beneficiaries in knowledge sharing, learning, and potential behavior change opportunities will be encouraged. In addition to the standard reporting requirements, the M&E program will develop and undertake baseline and other survey/assessment work (e.g. household, facility, market) to contribute to the larger M&E framework under FTF. Selected programs will designate a full-time M&E Specialist to appropriately monitor progress and engage in reporting systems for FTF as they are developed. These M&E Specialists will work to ensure that program results are jointly monitored with the ASDP and contribute to their reporting systems. The M&E Specialists will participate in annual meetings that include all implementing partners for FTF Tanzania, the FTF working group, and GOT representatives from relevant ministries.
Baselines
Baseline surveys will be required for several of the indicators listed in the annex. During 2011, a comprehensive baseline survey will be carried out by the Tanzania National Bureau of Statistics under the guidance of TMG. This baseline data will assist FTF Tanzania to set targets, monitor progress toward those targets and to initiate mid-course corrections for its programs and activities. The baseline will inform FTF Tanzania with data to determine whether or not selected activities are likely to achieve their targets.
Links to Government Monitoring Systems
The GOT will conduct rigorous M&E of their CAADP plan and supporting strategies such as the ASDP. To the extent possible, the FTF M&E framework is intended to utilize information that GOT already collects, especially at the national level. The M&E program will provide direct support to the GOT‘s National Bureau of Statistics. FTF investments in M&E will also be linked with the GOT monitoring mechanisms to build host country capacity and ability to analyze and report on results. A monitoring conceptual framework will set the stage for ensuring progress against targets, provide opportunities for learning, and employ participatory methods. Monitoring activities will support GOT analytical capacity building.
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 1: DIVERSIFICATION OF PRODUCTION AND INCOME – UPGRADE VALUE CHAINS
The first set of core investments in the Zambia FTF strategy contributes to systems transformation, with a primary focus on oilseeds and legumes and targeted interventions in the maize value chain, and a secondary focus on horticulture.
Feed the Future Value Chain Investments
USAID/Zambia will have several programs that contribute significantly to upgrading the oilseeds, legumes and maize value chains. This will be accomplished through several planned mechanisms, including: 1) the Production, Finance and Improved Technology Plus program, which is designed to increase food security and decrease hunger through agriculture-led growth and inclusive market access by smallholder farmers; and 2) public-private partnerships including Global Development Alliances (GDAs) to leverage private sector activity and promote market sustainability through private sector models. These efforts will stimulate agricultural growth and significantly contribute to the Millennium Development Goal 1 of halving the proportion of people living in extreme poverty and suffering from hunger by 2015. The programs will build on previous USAID-funded activities by closely linking efforts to enhance input supply with output markets, promoting value-added rural enterprises linked to selected value chains, and ensuring that women fully benefit from value chain development. One of the challenges of the previous program, given its focus on private sector sustainability, was to ensure female participation. Lessons learned from the successful Production, Finance and Improved Technologies (PROFIT) program, which closes in 2011, will be incorporated into new programs.
Programs will focus specifically on maize and oilseed/legume (particularly, groundnut, soya and sunflower) value chains in Eastern province and horticulture value chains in peri-urban Lusaka. Through this geographic focus, USAID-funded FTF activities will reach up to 25 percent of Zambian men and women smallholder farmers. Maize value chain work will focus on increasing productivity in order to meet food security. Smallholders will be benefit from an integrated approach that provides for maize food security and enables smallholders to diversify into commercial crops.
Illustrative Examples of Value Chain Activities
In-depth analysis of selected value chains. The program will conduct in-depth economic value chain analysis including market (both domestic and export) assessments, competition/profitability analyses, gender analyses, and strategies for Zambian value chains to improve competitiveness in light of market opportunities and constraints.
Value chain finance. Both the demand and supply side of value chain finance will be addressed to increase the competitiveness of selected value chains. Options to increase access to production and processing credit may include insurance, operating leases and expansion of e-banking. Activities to expand access to credit and financial services to both men and women will be assessed and implemented through a variety of mechanisms, partners and tools, including intermediary businesses, credit guarantees, microfinance and commercial banking products oriented to benefit smallholder farmers.
Provide local trade information and services. Local provider(s) of trade information and services will be supported to aid producers’ entry into local, regional and international markets, including sanitary and phytosanitary protocols, import requirements, customs and borders procedures, and contact points. The program will take extra effort to ensure equal access to information for women. The Zambia Agricultural Commodity Exchange (ZAMACE) will require support that will be gradually phased out, with the goal of achieving sustainability through self-sufficient funding of operations within three years.
Target regional export markets. The program will develop a strategy for targeting profitable export markets for Zambian products initially in the maize, legume and horticulture sectors. USAID/Zambia’s experience thus far has shown that in many cases regional markets provide more opportunities for exporters (particularly smallholders) than more distant international markets. Efforts will be made to ensure both men and women producers can access export markets.
Promote rural enterprise and cooperative development, particularly in value-added processing of selected value chains. Activities will also address marketing constraints faced by smallholder farmers, in particular women. The project will identify key agents that can create rural employment and opportunities for value addition, including cooperatives, traders, processors and agribusinesses that warehouse commodities. Governance, operations and capacity of Zambian organizations and firms that link farmers to value-added markets, including animal feed, high protein products, cooking oil and canned vegetables, will be strengthened. In particular, women-based producer and marketing associations will be organized around selected value chains.
",".
","USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components: 1) project-level reporting; 2) performance management/monitoring and evaluation; and, 3) external impact assessment to capture the aggregate impact of all investments and the relative contribution of different interventions to the extent feasible.
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives: (1) engage in """"rigorous"""" impact evaluations; and (2) build local capacity for monitoring and evaluation. The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Overall, an estimated 263,000 vulnerable Zambian women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty","","","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product); Number of farmers, processors, and others who have applied new technologies or management practices as a result of USG assistance (disaggregated by sex); Value of incremental sales (collected at farm/firm level) attributed to FTF implementation (disaggregated by targeted commodity) (disaggregated by sex of household head); Value of new private sector investment in the agriculture sector or food chain leveraged by FTF implementation (Change in value – investments local and international); Increase in employment in value-added processing enterprises linked to selected commodities.","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product); Number of farmers, processors, and others who have applied new technologies or management practices as a result of USG assistance (disaggregated by sex); Value of incremental sales (collected at farm/firm level) attributed to FTF implementation (disaggregated by targeted commodity) (disaggregated by sex of household head); Value of new private sector investment in the agriculture sector or food chain leveraged by FTF implementation (Change in value – investments local and international); Increase in employment in value-added processing enterprises linked to selected commodities.","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
Feed the Future Value Chain Research & Development Program
Research features prominently in the Feed the Future Initiative. The FTF research strategy has three objectives: advancing the productivity frontier, transforming production systems and enhancing dietary quality and food safety. The sustainable use of natural resources and adaptation to global climate changes are additional objectives. R&D investments will include several sub-components, through collaboration between international agriculture research centers, GRZ research institutes and public universities, private sector and other partners. The project will also incorporate a competitive grants program to promote public-private research and technology adoption. A key objective of the program is to enable these entities to directly implement activities within the life of the program. All programs will outline the steps, process and timeline to enable Zambian Government, NGO and other entities to be able to directly implement selected project activities within two years after the project has begun field implementation. Finally, to be effective, the programs must also actively involve both men and women in research design and trials to ensure appropriateness to their relative needs.
Some of the key issues that the agricultural research program in Zambia will address are outlined below.
The approach should include preliminary analysis to identify high pay-off interventions with the greatest potential to increase incomes and improve nutrition for a large number of smallholder maize-based farm households, with particular attention to gender-based constraints. These interventions may include varieties, management, alternative farm resource allocation and post-harvest approaches.
Possible components of a program include:
Low Productivity and Limited Production of Groundnuts--Limiting Their Contribution to Household Nutrition, Incomes and Women’s Empowerment
Illustrative activities include:
Widespread Aflatoxin Contamination--Reducing Food Quality and Limiting Exports
Responses to the aflatoxin problem in Zambia may include:
Role of Zambian Women in Science
The FTF strategy will also invest in the development of Zambian women scientists. The African Women in Research and Development (AWARD) program has successfully supported the career of up to nine Zambian women scientists in private and public research organizations as well as civil society organizations. The AWARD Fellows are paired with a leading scientist mentor in their field who supports the development of professional skills. Training in leadership and other professional skills such as writing and communication is provided. A current AWARD Fellow recently conducted a workshop on gender in the aquaculture sector, highlighting the importance of considering gender constraints in this sector. The AWARD Fellows also become mentors to younger women, thus extending the benefits of the program. The FTF strategy will continue this investment throughout the program and work with these scientists in order to strengthen the participation of women in agricultural research.
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.
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USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Data quality assessments will be conducted regularly to ensure consistency and completeness. Data collected through monitoring will be used for periodic reports to stakeholders. Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty","","","","","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 2: ENABLING ENVIRONMENT AND POLICY DEVELOPMENT
As an additional key strategy component, FTF Zambia will support the development of favorable agriculture policy through policy research and advocacy for reform. For example, continued policy reform is needed for maize to be competitive in regional markets, including a consistent and open border policy; small government strategic reserve; price-band management; and, use of the e-voucher system in input provision. Another critical investment is support to the GRZ to advance and complete the CAADP process, i.e., by helping the government develop a realistic but ambitious Country Investment Plan.
Several important policy objectives will be supported by the USG toward creating an enabling environment to achieve FTF objectives. These include:
USAID/Zambia has awarded a five-year project (2010-2015) that will assist stakeholders through a program of research, policy analysis, outreach, and training. Assistance provided will also support key agricultural policy stakeholders throughout the development and implementation of the Comprehensive African Agriculture Development Program (CAADP). The project, the Food Security Research Project (FSRP), will work closely with the Agricultural Consultative Forum (ACF), a Zambian NGO that provides a forum for policy dialogue, Ministry of Agriculture and Cooperatives (MACO), the Ministry of Livestock and Fisheries Development (MLFD), the Central Statistical Office (CSO), and other selected Zambian organizations.
The FSRP and ACF will take center stage in carrying out independent research to form the basis for developing and promoting supportive agricultural policy in Zambia. The ACF will also remain flexible to build capacity of other Zambian institutions that support the goal of improving fact-based agricultural and economic policy formulation in Zambia to nurture local capacity and local dissemination of knowledge to the public through commissioning and mentoring of local groups to undertake policy analysis. ACF and FSRP efforts in the past have addressed sound market-based principles through institutional capacity building and empirically-based policy research. Those efforts will be intensified to better support the GRZ’s implementation of its CAADP Investment Plan, which is a critical component of the FTF.
New USG funding in the project will be directed to three general activities – capacity building, more active outreach within and beyond the agricultural sector, and improvements in the quality of basic agricultural data emerging from CSO and MACO. This work will be undertaken in collaboration with other efforts to improvements overall data collection management of the CSO, particularly that being spearheaded by the U.K. Department for International Development (DFID). FTF will also fund training to support public and civil society leaders engaged in the CAADP process, as well as training of women scientists.
Key Enabling Environment Program Areas
Analytical Capacity for Improved Agricultural Policy in Zambia. Weak human and institutional capacity to analyze agricultural policy contributes to the politicization of agriculture in Zambia and a weak business climate for agricultural investment. FTF assistance will improve the analytical capacity of Zambian stakeholders. Stronger ―home-grown‖ analytical capacity and greater public outreach will lead to a greater understanding of key issues affecting agriculture by both the public at large and policy makers within the government. Informed technocrats within the government, backed by a supportive public opinion, should be able to convince political leaders to make sound decisions in agricultural policy.
New Project Directions. Emphasis will be on ―Zambianizing‖ the research capacity, which previously was not deep enough, due to limited finances and limited scope of local institutions. Increased high-level USG attention to food security issues demands a more thorough understanding of GRZ priorities and donor commitments in the sector. FSRP and ACF activities will provide the analytical basis for future US and other donor investments in the agricultural sector to combat hunger and poverty, which are aligned with the GRZ’s CAADP Compact.
Thematic And Operational Support of the CAADP Agenda. FSRP has supported the CAADP Compact process, ensuring that critical agricultural policy issues are, and will be, reflected in future policy planning and programming. FSRP support has ensured Zambian ownership of the CAADP framework, including its policies, programs, and targets. FSRP will work with policy makers and stakeholders as before, but with the added mandate of contributing to the peer review process that is part of the CAADP framework, focusing specifically on public resource allocation, investments and the implementation of policies that are the backbone of the CAADP process. FSRP will advocate that the CAADP process include a wide range of stakeholders with broad food security objectives across all four CAADP Pillars, and not result in a concentrated focus on agricultural productivity.
Political Will and Technical Capacity Building. For civil society, the press, government technocrats, and other groups to effectively influence policy, they need fact-based positions and up-to-date information from credible entities. It is therefore important, and an explicit objective of FSRP, to put fact-based information in front of the body politic. Political will shifts when confronted by an aware and informed electorate.
On-going Research Areas
New Potential Research Areas
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USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
The USAID/Zambia Mission has committed to implementing the operational research, managing for results, evaluation and local capacity-building model in its CDCS, and this will apply as well to FTF.
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","","","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
CORE INVESTMENT AREA 3: ECONOMIC RESILIENCE
FTF investments in agricultural value chains will increase agricultural productivity and incomes. FTF investments in health and nutrition infrastructure will improve access to health and nutrition services and information at the district and community level. However, not all households will be able to benefit in the medium term from these investments. In addition, intra-household resource management, even in better-off agricultural households, can be a barrier to the translation of systemic investments in the agricultural and health infrastructure into improvements in benefits for women and children. The Zambia FTF strategy proposes a set of investments to address these two challenges. The investments will target households that are more vulnerable to food insecurity due to composition, illness, or other factors.
Economic Resilience Programming
FTF investments will focus on an integrated approach to building assets and risk reduction, and call for innovative models to link vulnerable households to value chain interventions and investments in community, district and provincial health systems. These programs will engage new partners and will be structured to ensure both small businesses and local partners have the capacity to participate. The program will enhance coping skills, build assets and increase rural incomes for vulnerable households in targeted areas, thereby significantly contributing to Millennium Development Goal 1 of halving the proportion of Zambians living in extreme poverty and suffering from hunger by 2015.
The vulnerable and very poor have some minimum set of assets but have been unable to move towards longer-term economic well-being and health. Frequently donor and government assistance to these households has been in the form of humanitarian relief, economic transfers or subsidies (e.g., of staple foods). USAID/Zambia seeks to support innovative ideas, concepts and programs to increase the economic resilience of the very vulnerable Zambian rural population in targeted areas.
Investments under this core investment area aim to increase the food security of vulnerable and very poor rural households in targeted areas through interventions that reduce the number of hunger months, improve nutrition and health practices, and increase the value of household assets and the ability of households to productively use those assets. These achievements are expected to contribute significantly to reducing stunting and underweight levels in the targeted households over a five-year period.
Activities will target vulnerable groups in rural areas with a minimum set of assets (land and/or labor) and fall below the poverty line of $1.25/day. These attributes characterize a majority of smallholder agricultural producers in Eastern province. To identify more vulnerable households it will be necessary to include households according to additional characteristics such as: female-headed - widowed or divorced; household with person living with AIDS (PLWA) or other chronic and debilitating diseases; household caring for or headed by orphan or vulnerable child (OVC); or disabled household head or member.
Potential Activities
Investments will build upon USAID-funded activities that work in agricultural growth, nutrition and economic resilience efforts, such as the Title II program, the Consortium for Food Security, Agriculture and Nutrition, AIDS, Resiliency and Markets (C-FAARM), closing out in 2011. The programs will implement innovative strategies and approaches to enable vulnerable rural households, including those affected by HIV/AIDS and other diseases, orphan and vulnerable child-headed households, and female-headed households, by improving food security through strengthened economic resilience. Special attention will be given to enabling very poor women to participate in expanding opportunities as producers, service providers and entrepreneurs.
Programs will take an integrated approach to improved food security – addressing availability, access and utilization components, as well as linkages to nutrition and health, and gender relations. Programs as diverse as micro-savings and lending, conditional cash transfers, ―farming as a family business‖ have all shown some potential to reduce vulnerability of poor households under specific conditions. Proposals will be expected to demonstrate scalability.
Recent evidence of preventive approaches to undernutrition in other countries provides direction for successful components of nutrition interventions. The promotion of Essential Nutrition Actions will be a fundamental component of all interventions. Other approaches will be considered. For example, a positive deviance model demonstrated that three-quarters of children under age five treated for undernutrition made significant weight gains when their diets included legumes and other high protein supplements, combined with improved health and sanitary practices, and access to clean water.18 Some microfinance schemes follow a positive deviance model in which seed capital is not injected into communities, but revolving loan funds are created based on the capital available within communities, and members increase their ability to borrow based on the amount of shares they are able (and willing) to invest in the loan fund. Savings-led financial services have been demonstrated to serve an important role in consumption smoothing. Small livestock may actually serve as savings accounts, easily converted into cash when needed. Approaches that target all farm household members, both men and women, have been shown to be effective in improving the use of resources and changing household food security. A recent gender assessment of the SIDA-funded agricultural support program reported that better internal management of household resources was a significant factor contributing to greater household food security for project participants, as measured by months of household food security19. Given strong evidence of the significance of women’s income to child nutrition, approaches that build better household management of resources and strengthen women’s effective control may have a high payoff.
Lessons learned from GCC/SL pilots on community and household use of forest resources will be incorporated into the FTF economic resilience activities. Many vulnerable households are dependent on communal resources for sources of wild foods and medicinal crops that supplement nutritional and income needs. Household use of agriculture and non-agricultural land, such as forests, for additional income will be examined to determine strategies that build resilience and improve land use, without increasing the pressure on non-agricultural lands.
","
It is envisaged that these activities will result in tangible benefits to households such as increased food availability, better management, and improved intra-household food allocation, with improved child food intake and greater diet diversity for vulnerable members. Some expected achievements leading to household level benefits include increased access of poor and very poor farming households to commercial sources of inputs and non-financial supporting services, including extension and agronomic services; increased productivity by poor and very poor farming households; application by very poor farming households of improved crop production and post-harvest practices; and increased access of poor and very poor farming households to financial services.
","
USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components:
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of:
Data collected through monitoring will be used for periodic reports to stakeholders.
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the Future aims to help an estimated 834,000 vulnerable Tanzanian women, children and family members—mostly smallholder farmers—escape hunger and poverty","","","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product) (disaggregated by sex); Increased expenditures (proxy for income) of rural households, including female-headed households; Prevalence of households with moderate or severe hunger (disaggregated by sex of household head); Per cent of children 6-23 months that receive a Minimum Acceptable Diet (disaggregated by sex); Number of vulnerable households benefiting from program activities through increased economic resilience (disaggregated by sex of household head); Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age; Prevalence of exclusive breastfeeding of children under 6 months; Number of people with a savings account or insurance policy as a result of USG assistance (disaggregated by sex).","Increased productivity and income from selected value chains (gross margin per unit of land or animal of selected product) (disaggregated by sex); Increased expenditures (proxy for income) of rural households, including female-headed households; Prevalence of households with moderate or severe hunger (disaggregated by sex of household head); Per cent of children 6-23 months that receive a Minimum Acceptable Diet (disaggregated by sex); Number of vulnerable households benefiting from program activities through increased economic resilience (disaggregated by sex of household head); Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age; Prevalence of exclusive breastfeeding of children under 6 months; Number of people with a savings account or insurance policy as a result of USG assistance (disaggregated by sex).","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11545","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","ZMB","Zambia"," Eastern Province, Zambia|Lusaka-Eastern Province, Zambia|Lusaka-Central Province, Zambia","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a foundation for lasting progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with governments, donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Zambia, Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Zambia is making core investments in four key areas:
1. Oilseeds, legumes, maize and horticulture value chains
2. Enabling Environment
3. Economic Resilience
4. Nutrition
Target Regions
Feed the Future is focusing its efforts in two areas: the Eastern Province, with a value chain focus on oilseeds, legumes and maize; and selected peri-urban districts near Lusaka, connecting to Eastern Province, with a particular focus on horticulture.
Highlights
Comprehensive Africa Agriculture Development Programme (CAADP) process. Zambia’s CAADP Compact was signed in January 2011, and development of the Zambia CAADP Country Investment Plan has begun. Through this Compact the Government of the Republic of Zambia is committed to the following:
Diversification of staple crop production. Diversification of selected staple value chains will:
Gender. The Zambia strategy strives to maximize the positive impact on female farmers and ensure equitable benefits for men and women by:
FTF Zambia is investing in capacity-building and training of health workers to improve nutrition services and nutrition education. The nutrition program will include a national mass media campaign around the Essential Nutrition Actions that will be linked to community-level behavioral and social change communications. Additionally, the program will build strong linkages to rural health services and nutrition interventions. The nutrition program is largely managed by USAID/Zambia’s Health and HIV Offices, but activities by the USAID Economic Growth Team and Centers for Disease Control will also contribute.
The Government of Zambia has recently refocused on the poor national nutrition levels by developing a National Nutrition Strategy and holding a National Nutrition Consultative Forum to discuss the strategy. Zambia has also been selected as an Early Riser under the Scaling Up Nutrition (SUN) Initiative promoted by the U.S. and a wide range of other donors. The USG participates in a recently formed Nutrition Donor Convener Group, chaired by DFID and UNICEF, under the Health Sector Working Group. The USG can play an important role in raising concern over nutrition levels within the country, coordinating USG and other donor investments, and supporting government efforts to intensify efforts to address undernutrition.
Nutrition Programming
FTF Agriculture and Food-based Nutrition Programming. FTF agriculture investments will contribute to improved nutritional outcomes through several approaches. Improved incomes for poor households as a result of improved agricultural practices and better market access can translate into improved household food availability, although this is usually not sufficient for changes in child nutritional status. FTF agricultural investments will also improve the quantity and quality of staple foods in Eastern province, resulting in reduced prices for poor households, most of which purchase food for several months of the year. In addition, FTF food-based strategies will result in more nutritious foods through strategies such as bio-fortification and breeding, particularly through increasing dissemination and production of beta-carotene-rich ―orange‖ maize and orange-fleshed sweet potatoes. Household-based approaches through the Economic Resilience programs, described in greater detail in Section 4.3 above, will focus on more equitable food distribution/income control and on communicating behavioral change messages on essential nutrition actions at the household level. These programs will also ensure that all nutrition-related activities are consistent with and support other nutrition programming, for example in nutrition training of agricultural workers and extension staff, or capacity-building of community workers other than community-based health workers. Other potential food based strategies include school feeding linkages with organizations such as the World Food Program, with the introduction of nutritious products such as soy-based products or orange-fleshed sweet potatoes.
FTF Nutrition-related Programming through the Health Sector. USG investments in the health sector are extensive and broad and make a major contribution to the status of Zambians’ health. Many of these programs have components that directly address nutrition through improving health outcomes, reducing incidence of diseases such as malaria, vaccine preventable diseases, intestinal worm infestation, etc., providing food to PLWA, and supporting orphans and vulnerable children, among others.
The USAID Health Office invests in four programs supporting systemic change in health services. These programs include support for:
The logistics program focuses on improvements in commodities and supply chains for a wide array of critical inputs such as antiretroviral drugs, family planning inputs, and bed nets. Social marketing is conducted for all important areas, including family planning, HIV prevention and inputs, and malaria. Broad spectrum media campaigns are conducted under the integrated behavior change communication investments. These campaigns are conducted at national, provincial and community levels to elicit change in a wide range of health-related behaviors.
The following national-level interventions will be considered:
Recommendations for rural areas include the following:
In addition to interventions that strengthen the health system and refocus efforts on nutrition behavior change, the FTF strategy proposes to link health, nutrition, economic resilience, and economic growth activities at the household-level, to the extent this is feasible and cost-effective. Two approaches will be adopted:
FTF Nutrition-related Investments through HIV/AIDS Programming. Another significant contributor to child malnutrition is the high rate of pediatric HIV/AIDS. Based on a 2010 technical update on WHO guidelines, for infants and young children known to be HIV-infected, mothers are strongly encouraged to breastfeed exclusively for the first 6 months and to continue breastfeeding, with adequate supplementary feeding, up to 2 years and beyond. Therefore all infants 6 months of age and older need additional, developmentally and nutritionally appropriate food sources, as breast milk is no longer sufficient. Hence, nutrition-related HIV/AIDS interventions are also under development by the USG in Zambia, and these investments will have an impact on the reduction of undernutrition in children below age 2.
High prevalence of Vitamin A deficiency in rural Zambia. Vitamin A deficiency is a long-standing public health problem in Zambia due to inadequate dietary intake. The Ministry of Health distributes vitamin A supplements during the twice-yearly child health weeks and sugar is fortified with Vitamin A. Nonetheless, according to the 2007 Zambia Demographic and Health Survey vitamin A deficiency (VAD) continues to affect 54 percent of Zambian children under 5 and women of reproductive age. These high levels of VAD may be attributed to the high prevalence of asymptomatic infections in the Zambian population. Increasing the intake of Vitamin A through a wider range of sources, combined with health interventions, including those to prevent and treat infectious disease, will decrease defiency in many vulnerable groups. Biofortified crops have a high potential to increase Vitamin A content in diets, particularly of rural households that produce their own food and have limited consumption of fortified products.
Potential agriculture activities include:
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USAID/Zambia will monitor and evaluate programs and activities throughout the strategy period to ensure that those investments are achieving objectives and maximizing returns to investments. Though many of the investments will be managed and monitored primarily by USAID, some investments will originate from other USG agencies and by government, donors, or the private sector. The Zambia CAADP Country Investment Plan will provide a framework for the development of a more comprehensive national effort in agriculture and poverty reduction that will be supported through the USG FTF effort. CAADP monitoring is addressed below. The M&E framework for the USG FTF strategy outlined in this section will be inclusive and involve all government agencies investing in FTF areas, particularly in the FTF priority geographic area, Eastern province.
The geographic focus, co-location of investments, and the timing of the initiation of new investments provide the opportunity to establish a solid impact assessment framework as well. USAID/Zambia’s approach to monitoring and evaluation will be comprised of three components: 1) project-level reporting; 2) performance management/monitoring and evaluation; and, 3) external impact assessment to capture the aggregate impact of all investments and the relative contribution of different interventions to the extent feasible.
The FTF strategy will be implemented primarily through two of the USAID/Zambia CDCS Development Objectives (DO) and will meet the requirements of CDCS Development Objectives:
PERFORMANCE MANAGEMENT
The FTF Performance Monitoring Plan will include indicators measuring progress towards achieving results at all levels. For each indicator, the data source and methodology, baseline, targets, and a calendar of performance management tasks, including a schedule for data collection, will be included. The selection of indicators to include in the PMP will be driven by ongoing and planned activities, the availability of baseline, and provisions made to ensure availability of data for the reference reporting period.
To monitor performance, the Mission will establish baselines and collect data for standard and customized indicators to track whether desired results are occurring and whether performance is on target. All programs receiving FTF resources will be expected to develop monitoring and evaluation strategies that are consistent with the USG Zambia’s FTF framework.
Initial stakeholder workshops will be held for the purposes of:
Given that FTF has the intention to work with a broader range of partners, including local organizations, it is expected that some partners will have more limited reporting capacity. These organizations will need greater assistance, and it may be necessary to delegate the responsibility for some monitoring and reporting to external entities.
For higher level objectives, tracking performance will be beyond the manageable interest of individual projects. In particular, changes in incomes, nutritional status, and some community-level variables among others will be more appropriately measured across the program areas. The FTF Team is developing a consortium of stakeholders to assess existing data sources, and intends to identify an external entity to coordinate baseline and periodic data collection for specific indicators.
An FTF M&E plan will be finalized by the end of Fiscal Year 2011, outlining all indicators and the reporting responsibilities by all USAID/Zambia’s partners. Key FTF required indicators to be tracked and reported are listed in Annex B. Additional project-specific and other relevant indicators not included in the FTF required indicators will be added. It is important to note that all appropriate indicators will be sex-disaggregated.
EVALUATION
In line with the new evaluation policy, the FTF program intends to conduct a number of performance evaluations and impact evaluations. Evaluations of two programs closing in 2011, PROFIT and C-FAARM, will be useful for the FTF learning agenda. The USG FTF has a unique opportunity with a defined geographic focus and the initiation of new activities to establish an impact assessment framework to assess high level impact, as well as to identify the relative contribution of different intervention, such as value chain upgrading versus household level management skills. USAID/Zambia will work with partners and other agencies to develop an impact assessment methodology that is consistent with and contributes to the project performance monitoring framework, but will also test several development hypotheses.
An initial baseline survey will be conducted in Eastern province to establish current levels of key variables including incomes, nutritional status, household production and asset patterns, and agriculture technology levels. This baseline will draw from the latest survey methodologies, particularly recent work on gender and asset control24. An appropriate sampling framework will be established to assess impact, most likely on a biannual basis. A randomized approach will be considered for a sub-sample to maintain the integrity of the impact assessment; however, flexibility will be needed to consider mid-term correction in order to ensure the greatest impact over the period of the strategy.
In the context of the development challenges and opportunities identified in Zambia and outlined in Section 1.1, several development hypotheses are of interest for the impact assessment. In particular, the relative contribution will be assessed of community-level versus household-level interventions to reducing poverty and undernutrition, as well as the additional value of the co-location of interventions. Another hypothesis of interest to be tested is: By increasing productivity, improving household food security and linking smallholders to markets for agriculture commodities, FTF interventions will reduce the incentives for exploiting the natural resource base.
Performance Evaluation
The FTF program will schedule performance evaluations to focus on descriptive and normative questions including: project or program achievements (either at an intermediate point in execution or at the conclusion of an implementation period); program implementation; program perception and value; and other questions pertinent to program design, management and operational decision-making. These performance evaluations will incorporate before-after comparisons whenever feasible.
Impact Evaluation
The FTF program will conduct impact evaluations to measure the change in development outcomes attributable to FTF interventions. Impact evaluations will be based on cause-effect models and will require a credible and rigorously-defined counterfactual control. Impact evaluations with treatment and control groups help provide the strongest evidence of a relationship between interventions and measured outcomes. One hypothesis to be explored includes identifying increased benefits from combined interventions, particularly income-augmenting and nutrition-related activities. In the nutrition portfolio, the differential effect of geographically co-locating health programs active in nutrition with agriculture programs working on the productivity and diversity side of the nutrition equation can be tested.
LINK TO GOVERNMENT MONITORING SYSTEMS
USAID/Zambia has provided extensive support to the Government of Zambia in monitoring the agricultural sector, and in analyzing government data through the Food Security Research Project (FSRP). This support will continue and can be drawn upon to monitor agricultural trends. In addition, FSRP has expertise in analyzing surveys such as the biannual Living Conditions Monitoring Survey (LCMS) which tracks poverty levels, and the Supplemental Surveys, which provide quality agricultural data. This expertise can be leveraged for improved performance monitoring by the GRZ, as well as for FTF performance.
The CAADP framework focuses largely on performance in the agricultural sector. For national performance toward other MDGs, particularly those related to nutrition and gender impacts, the FTF team will work with additional partners to identify appropriate data sources and performance monitoring modalities. For example, the Nutrition Cooperating Partners sub-group may be instrumental in the creation of a data monitoring platform according to the SUN Movement principles. However, the Zambia FTF framework will focus its efforts largely on performance for the targeted FTF areas and the contribution of these changes to national levels.
","Feed the future aims to help an estimated 263,000 vulnerable Zambian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 173,000 children will be reached with services to improve their nutrition and prevent s","","","Number of people trained in child health and nutrition through USG-supported programs; Anemia among women of reproductive age (%); Number of health facilities with established capacity to manage acute undernutrition; Prevalence of anemia among children 6-59 months; Number of children under five years of age who received Vitamin A from USG-supported programs; Number of children under five reached by USG-supported nutrition programs.","Number of people trained in child health and nutrition through USG-supported programs; Anemia among women of reproductive age (%); Number of health facilities with established capacity to manage acute undernutrition; Prevalence of anemia among children 6-59 months; Number of children under five years of age who received Vitamin A from USG-supported programs; Number of children under five reached by USG-supported nutrition programs.","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","
Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","The USG will make investments in nutrition across three critical sectors; agriculture, health, and social protection, with nutrition as the lynchpin between these sectors. As such, the USG will implement a comprehensive approach that maximizes all three sectors and strengthens and links the nutrition components of each. These investments will be underpinned by a core set of nutrition indicators that are common across all programs, and will be supported by policy investments that mirror the comprehensive nature of nutrition programming by working with the Office of the President’s Cabinet (OPC) and the Ministries of Agriculture and Food Security, Health, and Gender.
Building on lessons and experiences from current programs implementing preventive nutrition activities (e.g., the WALA and BASICS projects), USG resources will scale up prevention of undernutrition and resiliency of communities, while maintaining critical investments in treatment and nutrition service delivery. The rationale for this shift is due to the overall high prevalence of chronic undernutrition (47 percent) and the low prevalence of acute undernutrition (4 percent), the latter of which has been achieved by sustained commitment to scaling up CMAM. As a result, the USG will aim to drive a decrease in stunting as the highest level objective in FTF. The USG plans to focus on cost-effective preventive nutrition interventions targeting the 1,000 days window of development (pregnancy through two years), including maternal nutrition; early and exclusive breastfeeding through six months; use of appropriate, diverse foods beginning at six months of age; targeted micronutrient supplementation; and improved hygiene and sanitation. Activities will be integrated into health, HIV, and agriculture platforms, taking full advantage of the resources that these programs have. These investments leverage funding from health (Global Health and Child Survival), agriculture (Development Assistance), and Title II to advance nutrition objectives. The Care Group model encompasses a combined FTF and GHI approach to reduce poverty, hunger, and undernutrition by joining two complementary lines of investment at an operational level:
The objectives of the Care Groups complement value chain development activities by building capacity of:
Community-Level Organizations and Integration with Government of Malawi Systems for Health and Agricultural Extension
The Care Group in the context of this model is notable in that it supports a sustainable and simultaneous approach to agriculture, nutrition, and microfinance. Cross-fertilization of nutrition and agricultural messaging and skill building, as well as the opportunity to create cross-sector targets and results frameworks allows for a uniquely comprehensive approach.
Volunteers are trained and facilitated to conduct community outreach and follow-up in both agricultural- and health-focused nutrition interventions, thus supporting an operational link between nutrition and agriculture programming. Each volunteer takes on responsibility for conducting outreach and follow-up to some 10-12 nearby households. Care Group volunteers also have access to agricultural inputs to start and maintain community gardens, as well as engage in income-diversification through activities such as establishing voluntary savings and loan activities. Access to these inputs provides motivation and support for implementing targeted nutrition-focused interventions focused on behavior change, including:
Linking the agriculture and value chain components of the project with health and nutrition promotion at the community level is especially advantageous in that it provides opportunities to address two key crosscutting areas:
Prevention Linked with Health Service Delivery
The USG’s approach to service delivery covers community level action, improvement of quality at all levels of facilities, and strengthening the central and district level systems of management. This provides a common platform for multi-thematic messages and programs, ensuring that there are ―no missed opportunities‖. It also ensures a focused yet comprehensive basic package accessible to the Malawian population that stretches across the continuum of care from community to facility and from facility to community. At the community level, the Health Surveillance Assistants (HSAs) and health volunteers will continue to focus on interpersonal counseling, limited preventive and curative care through village clinics and drug boxes, and to create demand for services at the health facilities across family planning, maternal and neonatal health, child health, nutrition, malaria and HIV areas. At the facility level, the USG will support improved quality of care for existing interventions that target integrated and comprehensive primary health care provision and performance based incentives. At the national, zonal and district levels, USG programs will continue to strengthen the financial, management and leadership capabilities of the Ministry of Health staff. Also, programs will work closely with the technical staff to provide technical assistance and work toward meaningful policy changes. At all levels, USG resources will focus on integration of social and behavior change communication efforts through community and facility level entry points.
An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","Although the main focus will be on preventing childhood undernutrition, USAID/Malawi will continue to support CMAM, building on past investments. Since 2005, USAID has supported the integration of CMAM in existing health care services. Partners are working at both the policy and community levels to ensure this integration. As of December 2009, 24 out of 28 districts are implementing CMAM in over 240 health facilities. The USG will support one additional year of the MoH’s CMAM Advisory Service to finalize the transition of complete CMAM scale-up to the GoM. An evaluation in 2012 will help inform the USG on the areas needing further investment.
Through two GDAs with Project Peanut Butter, a local producer of ready-to use therapeutic food (RUTF), USAID/Malawi’s support has resulted in an annual production capacity of over 1,200 MT of RUTF, which, when combined with production from a second local producer of RUTF, more than meets the total requirements of RUTF for Malawi, with capacity to export to neighboring countries. The USG will take advantage of this existing capacity to explore the development and promotion of ready to use supplementary and complementary foods.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","The USG will support GoM's efforts towards fortification of prioritized centrally processed foods, namely: sugar, oil, wheat and maize flour, and complementary baby foods. Data from the National Micronutrient Survey shows that the consumption of these foods has increased over the last ten years. USAID health funding will continue to support the universal salt iodization program in order to sustain the gains made with previous investments. Although not sufficient to forestall stunting in children under five, one necessary input is a high quality, low-cost complementary food. The legume and dairy value chains present a unique opportunity for the development of such a product. Malawi will take advantage and work with existing food processors (e.g., Rab processors, Project Peanut Butter and Valid Nutrition) to develop a suitable product.
Prevention and control of micronutrient malnutrition will require a concerted effort by all USAID/Malawi’s health programs, namely, malaria, family planning, maternal, neonatal and child health, HIV/AIDS and nutrition. Possible USG support to SUN for specific activities with deliverables in FY11 include the following:
An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Prevalence of stunted children under five years of age; Prevalence of wasted children under five years of age; Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Prevalence of households with moderate or severe hunger","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","USG investments in legume and dairy value chains are designed to boost competitiveness and promote diversification into higher-return value chains that will also spawn non-farm employment opportunities. While these investments in economic growth will be necessary to reduce poverty and hunger, they will be insufficient by themselves. Beyond growth, poverty reduction will require targeted interventions that address the needs of smallholder farmers (the rural poor) as well as more vulnerable populations. A significant smallholder need is to produce more from a very limited resource base. Conservation farming practices offer promise in this regard, by increasing yields, soil fertility and soil moisture content per unit area. Importantly CF offers a window of opportunity to increase yield from a fixed unit area, freeing up land for diversification of both other cereals and legumes. Improving market and input access and the affordability of business development and financial services tailored to the needs of smallholders is critical in order to ―pull‖ rural households into income-raising activities.
Integrating Nutrition with Value Chains (INVC)
INVC is designed to combine the livelihood benefits of an agricultural value chain approach with the nutrition benefits of increased dietary diversification. This centerpiece of Malawi’s FTF strategy will invest in the competitiveness of food staple value chains in which large numbers of smallholders, over 56 percent of whom are below the poverty line, participate, and link increased household production of nutritious crops to household consumption and improved nutritional status. INVC will link value chain development and increased household income to improved nutrition through diet diversification, and improvements in food storage, preparation, and consumption practices at the household level.
INVC’s value chain approach will focus on legumes (groundnuts and soy) and dairy, and is designed to facilitate change in both the individual value chains and the broader market and household-farming systems, looking for synergies across value chains such as common constraints and/or actors. A strong emphasis will be placed on improving the demand side of the value chain, by working to improve market linkages between input and output dealers through improved and more reliable services, including financial, business development, agronomic and livestock-related services. While most of INVC’s efforts will further develop and strengthen Malawi’s existing input and output markets serving the legumes and dairy value chains, the program will also include strengthening the capacity of processors and agribusinesses to meet export market demands, as well as building the capacity of smallholder suppliers to meet buyer demands. At the same time, INVC will work to mitigate the risks for rural households to diversify their income and food sources beyond maize through an option of conducting a vulnerability assessment for its target population and to access nutritional education that will help them translate a more diverse basket of food into improved nutrition. INVC will place a particular emphasis on women’s economic empowerment across all of its activities, including additional support and guidance to women owned businesses and women producers.
INVC will spur investment and innovation in the legume and dairy value chains through an Innovation and Investment Facility meant to provide INVC a tool to identify and support specific opportunities that can further strengthen the selected value chains and market systems within which they operate. An important use of the facility will be to buy down risk for a firm, farmer, or other value chain actor in order to encourage early adoption of new technologies, such as CF by smallholders, and spur sector-wide innovation. Facility partners may include private firms, GoM agencies, research institutes, NGOs or other local organizations, as well as other donors best placed to identify new solutions to key value chain and systemic43 constraints. This Innovation and Investment Facility will be a key instrument for developing the capacity of the private sector and will also have targets and incentives for the participation of women-owned enterprises or individuals.
A core principle of INVC will also be to build the capacity of the key value chain actors to address the competitiveness of their value chain through their own projects and interventions. As such, INVC will place a strong emphasis on building local capacity to contribute to and invest in agricultural transformation. While Malawi has numerous small businesses, local NGOs and private sector and civil society organizations, few, if any, have both the technical and administrative capacity to implement USAID projects without support. As such, INVC’s approach to capacity building will be to invest resources in local partners while leveraging their local knowledge and capacity to generate results. The project will have a target for graduating local partners to independent status that would allow them to receive USAID funds directly. As partners reach this independent status, they would take on current functions of INVC.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Percent change in agricultural GDP (monitor national trend); Per Capita expenditures of rural households (proxy for income) of USG targeted beneficiaries; Gender index; Gross margin per unit of land or animal of selected product; Value of incremental sales (collected at farm- level) attributed to FTF; Percent change in diversity of agricultural commodities produced by households; Number of newly created jobs attributed to FTF Value of new private sector investment in the agriculture sector or food chain leveraged by FTF","Percent change in agricultural GDP (monitor national trend); Per Capita expenditures of rural households (proxy for income) of USG targeted beneficiaries; Gender index; Gross margin per unit of land or animal of selected product; Value of incremental sales (collected at farm- level) attributed to FTF; Percent change in diversity of agricultural commodities produced by households; Number of newly created jobs attributed to FTF Value of new private sector investment in the agriculture sector or food chain leveraged by FTF","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","Supplies","A significant constraint to the development of competitive groundnut and soybean value chains is the inadequate production of breeder seed. Ten years ago, USAID/Malawi established a $250,000 revolving fund to support ICRISAT in contracting out groundnut breeder seed production, but the FISP addition of legume seed packs the significant gross margins of legumes has driven demand far beyond local seed production capacity. Given the importance of reliable input supplies to Malawi’s FTF strategy, USAID and Irish Aid will partner to expand local capacity for production of quality, certified legume seed. USAID will invest in expanding the existing revolving fund and link in the International Institute of Tropical Agriculture to enable the expansion of their efforts in soy breeder seed production. Irish AID will expand its assistance to small and medium sized enterprises to develop their capacity of to multiply groundnut seed – currently only one company (Seed Co.) is involved in soybean seed production using privately developed germplasm.","Infrastructure","Malawi also lacks an International Organization for Standardization (ISO) certified laboratory for testing and certifying groundnuts and soybeans, which limits access by exporters to broader export markets. Currently, companies that export groundnuts send samples to South Africa for testing, which is costly and limits export capacity. With Irish Aid support, ICRISAT and NASFAM are developing a low cost, rapid testing technology; however, achieving ISO certification will be costly. The EU and UNDP will also begin work next year on a project designed to support the processing and exports side of legume value chains, a major component of which will focus on bringing the Malawi Bureau of Standards up to ISO certification. USG resources will support GoM efforts to establish a national sanitary/phyto-sanitary (SPS) strategy and achieve COMESA SPS compliance, as well as to build the capacity of Bunda College and the MoAFS research stations to conduction aflatoxin mitigation research.","Financial resources","Access to finance remains a major constraint to smallholders investing in productivity enhancing technologies due to weak financial sector infrastructure, inadequate financial services options, and GoM regulatory capacity. USAID will jointly develop a Financial Sector Technical Assistance Project with the World Bank and DfID.","","","","","","","","","","","","","","","","","","English" "11605","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MWI","Malawi","Dedza|Mchinji|Lilongwe|Ntcheu|Mangochi|Balaka|Machinga","Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Malawi, Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
","In view of the capacity challenges that exist, USAID will strengthen the capacity of the GoM to plan, implement, monitor and evaluate nutrition programs. With substantial funding increases anticipated through the FTF, USAID/Malawi will ensure that GoM institutions have adequate capacity to implement the various programs that will be designed under the initiative. This activity is in line with Strategic Objective Three of the NNPSP, which clearly outlines the capacity gaps and needs for the nutrition sector in Malawi. The USG will strengthen capacity of its partners, both government and non- governmental, as well as the private sector. USG support will be at three levels: community, institutional and tertiary. Irish Aid, the World Bank, CIDA, and the EU are all key donors in capacity building.
Strategic Analysis and Knowledge Support System (SAKSS)
Since 2008, USAID/Malawi has supported a SAKSS unit implemented through the International Food Policy Research Institute (IFPRI) at the MoAFS. The objectives of this activity are threefold: 1) generate demand-driven diagnostic and strategic research to fill key knowledge gaps, 2) establish an information and knowledge support system, in cooperation with the Southern Africa Regional Strategic Analysis and Knowledge Support System that has been set up to help promote peer and progress review of the CAADP, and 3) strengthen the capacity of national institutions, such as the MoAFS, in policy and strategy research. The Malawi Mission plans to extend the work of the SAKSS unit as part of capacity building support under FTF.
Malawi Agriculture Policy Strengthening (MAPS)
Strong civil society and private sector networks are critical to implementing the ASWAp in a way that responds to the evolving needs of its stakeholders. In recent decades, weak capacity and declining GoM interest in inclusive policy making is leading Malawi’s CAADP process towards a Government-owned rather than Country-owned process. Grounded in the CAADP principles of increasing stakeholder participation in the policy making process,44 the Malawi Agriculture Policy Strengthening (MAPS) program is designed to increase the participation of private sector and civil society stakeholders in agriculture policy dialogue.
MAPS will increase the profile, capacity and engagement of civil society and private sector stakeholders in agriculture policy development and implementation through a combination of capacity building interventions and establishing linkages between producers and consumers, including state and non-state actors, of high quality policy research. Though not exclusively, MAPS will focus on key stakeholders along the proposed FTF value chains.
MAPS capacity building activities will focus on improving organizational ability to meet its goals and objectives by strengthening administrative and financial management, organizational structure and strategic planning. The second focus of the project will strengthen policy analysis and advocacy capacity through building linkages between Malawian farmers and private sector associations and regional networks and research institutions, such as local and regional universities among civil society groups. MAPS will similarly link GoM counterparts to those research institutions to improve their ability to become informed consumers of stakeholder policy advocacy. These two components will account for the varying levels of development and readiness of organizations and associations in Malawi to take on advocacy activities. MAPS will also focus on elevating the voices of women in policy dialogue by targeting women-led civil-society/public service organizations for organizational capacity building and providing additional women-focused leadership training and gender equity sensitization to facilitate women taking on leadership roles within larger organizations.
","An important element of the multi-year FTF Strategy is monitoring and evaluation, which is an iterative learning process that will put into place the principle of a sustained and accountable delivery approach. Program activities must be monitored through periodic field visits by Mission staff and ongoing monitoring and learning by implementing partners. Mission staff has a key role to play in monitoring and learning from partners both through oversight and input to design of project level M&E plans and systems and also through follow-up on quarterly reports and other communication with partners.
The integration of agricultural, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Also, the Malawi FTF Strategy will foster linkages among existing programs, which will harmonize key agriculture and nutrition and indicators across relevant areas of focus.
Building on this collaboration, both the Health and Sustainable Economic Growth (SEG) teams at USAID/Malawi will work together to integrate M&E systems and processes in order to track synergies and multiplier effects between the two sectors not captured through the agriculture/nutrition overlap. There is currently significant USG investment on the part of USAID through PEPFAR and GHI in health systems strengthening, family planning, and malaria and tuberculosis reduction among others in the geographic areas targeted through FTF. We believe it is critical to capture at the highest level the combined impact of FTF and GHI/PEPFAR in order to reduce duplication, increase the applicability of data across interventions and most importantly, learn across programs in order to improve and increase efficiency and impact of all USAID investments in Malawi. This integration of M&E function may take the form of harmonized M&E plans at the implementer level combined with joint monitoring visits by SEG and Health team members.
Reliable and well-defined monitoring, reporting and evaluation methods, roles and communication channels result in improved project and program management, promote ongoing learning and testing of development hypotheses and ensure accountability. A fully functioning M&E team and system further help to illustrate the Mission’s value added to overall development not only to key stakeholders in the USG, but also to the GoM and other development partners.
USAID/Malawi is currently refining Mission processes in line with the requirements and recommendations of the newly announced USAID Evaluation Policy. To that end, and in preparation for the Country Development Cooperation Strategy (CDCS), SEG will identify further impact evaluation questions and set aside funds for impact evaluation in 2011. This will serve as solid preparation for FTF-focused evaluation activities in subsequent years.
","Feed the Future aims to help an estimated 281,000 vulnerable Malawian women, children, and family members—mostly smallholder farmers—escape hunger and poverty. More than 293,000 children will be reached with services to improve their nutrition","Central and southern regions","","Number of institutions/organizations undergoing capacity /competency assessments as a result of USG assistance; Number of institutions/organizations mature/viable in the competency areas strengthened as a result of USG assistance Frequency of GoM consultation with civil society/private sector on relevant policies; Comparison of programmatic objectives Pre and post FtF funding distribution; Number of new funding mechanisms","Number of institutions/organizations undergoing capacity /competency assessments as a result of USG assistance; Number of institutions/organizations mature/viable in the competency areas strengthened as a result of USG assistance Frequency of GoM consultation with civil society/private sector on relevant policies; Comparison of programmatic objectives Pre and post FtF funding distribution; Number of new funding mechanisms","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
The first set of core investments in USG/Mozambique‘s FTF strategy provides smallholders with links to input and output markets in selected value chains. The focus of this set of investments will be on oilseeds (sesame, groundnuts, and soybeans), cashews, and fruit (e.g., pineapple, mango and bananas). The main objective is inclusive agriculture sector growth, which FTF/Mozambique will achieve through increased and sustained agricultural productivity, expanded markets and trade, and increased private sector investment in agriculture and nutrition-related activities. Investment in these value chains will improve income opportunities for smallholders, increase access to nutritious foods, and facilitate competitiveness of small scale farmers in these value chains.
Oilseeds
This program will facilitate the development of long-term linkages between smallholders that produce groundnuts, sesame, and/or soybeans and input and output markets. This will include efforts to bring better farming practices and inputs to the farm level, as well as linking production to markets through aggregation and farmer organizations. Specific activities include:
Technical assistance and grants to farmer associations/ cooperatives and agro-service centers, to enable them to provide
Support to build mentoring business relationships between commercial and emerging farmers, which are farmers that overcame size and productivity constraints and farm sizes between10 and 50 hectares. These commercial farmers provide some or all of the following to the emerging farmers:
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","Estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty.","Zambesia and Nampula Provinces","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
The first set of core investments in USG/Mozambique‘s FTF strategy provides smallholders with links to input and output markets in selected value chains. The focus of this set of investments will be on oilseeds (sesame, groundnuts, and soybeans), cashews, and fruit (e.g., pineapple, mango and bananas). The main objective is inclusive agriculture sector growth, which FTF/Mozambique will achieve through increased and sustained agricultural productivity, expanded markets and trade, and increased private sector investment in agriculture and nutrition-related activities. Investment in these value chains will improve income opportunities for smallholders, increase access to nutritious foods, and facilitate competitiveness of small scale farmers in these value chains.
Cashews
This investment builds on USAID/Mozambique‘s history of successful cashew sector development. This experience includes USAID Title II support to nurseries in seedling production and distribution and DA support to the local cashew processing industry – the latter resulting in one of the most vibrant cashew processing sectors in Africa. Building on this track record, FTF will now invest in a major supply-side constraint: renewing the existing stock of cashew plants. Mozambique has the oldest population of cashew trees in Africa (some trees are more than 80 years old) and overall productivity is decreasing rapidly. Thus, our FTF investment in cashews focuses on the expansion of cashew nurseries to supply new cashew seedlings and to extend pruning and crafting practices for existing trees.
Specific activities include:
Technical assistance and grants to existing nurseries or other investors (e.g., cashew processors, entrepreneurs) to incentivize establishing nurseries and supply seedlings and extension (nurseries to offer a package of seedlings, and training in seedling maintenance, crafting, and pruning; farmers to pay for this service).
Technical assistance and support to farmer and community organizations for them to support smallholders in grafting, pruning, and seedling care monitoring, and pass on processor-financed incentive payments for tree care.
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","Estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty.",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
The first set of core investments in USG/Mozambique‘s FTF strategy provides smallholders with links to input and output markets in selected value chains. The focus of this set of investments will be on oilseeds (sesame, groundnuts, and soybeans), cashews, and fruit (e.g., pineapple, mango and bananas). The main objective is inclusive agriculture sector growth, which FTF/Mozambique will achieve through increased and sustained agricultural productivity, expanded markets and trade, and increased private sector investment in agriculture and nutrition-related activities. Investment in these value chains will improve income opportunities for smallholders, increase access to nutritious foods, and facilitate competitiveness of small scale farmers in these value chains.
Fruit
Fruit is farmed by more than a million households in the focus regions, but currently provides very limited income opportunities. FTF will primarily focus on improving the income potential of domestic fruit, by supporting the development of a domestic processing sector. The underlying hypothesis is that upon successful development of the domestic fruit sector, smallholders can play an increasing role in a viable export market (e.g. through outgrower schemes). Nutrition activities will be co-located to ensure improved consumption of fruits on a household level.
Specific activities include:
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","Estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty.",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
The second set of core investments will focus on scaling up the delivery of key nutrition interventions in the focus regions, acting on both the demand and supply side. On the demand side, FTF will invest in documenting and reinforcing improved nutrition behaviors through district and community based nutrition activities including growth monitoring and promotion (building on USAID Title II support in Zambezia and Nampula) and the promotion of optimal nutrition-related behaviors (building on PEPFAR infrastructure in Sofala and Manica). On the supply side, FTF will encourage the availability of nutritious foods through a Nutrition Challenge Fund.
Community-Based Nutrition Activities
FTF/Mozambique will address Mozambique‘s high undernutrition rates through a comprehensive, standard program of activities at the community level that includes growth monitoring, promotion of optimal infant and young child feeding practices, and dietary diversity and quality for pregnant and lactating women. Specific activities include:
","
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2012","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
The second set of core investments will focus on scaling up the delivery of key nutrition interventions in the focus regions, acting on both the demand and supply side. On the demand side, FTF will invest in documenting and reinforcing improved nutrition behaviors through district and community based nutrition activities including growth monitoring and promotion (building on USAID Title II support in Zambezia and Nampula) and the promotion of optimal nutrition-related behaviors (building on PEPFAR infrastructure in Sofala and Manica). On the supply side, FTF will encourage the availability of nutritious foods through a Nutrition Challenge Fund.
Nutrition Challenge Fund
FTF Mozambique will also stimulate the supply of nutritious, diverse, and quality foods. FTF/Mozambique will do this through a Nutrition Challenge Fund: a competitive grant scheme that encourages innovations in agro-processing (e.g. fortification, food processing) that reach a large share of the vulnerable population to improve nutrition. The competitive grant will be available to the private sector or community organizations, who will be selected based primarily on impact, innovation, and sustainability of the business model. Other potential criteria for selection include financial leverage, number of suppliers and consumers reached, and synergies with USG programs. FTF/Mozambique plans to leverage at least as much funding as will be contributed, although the aspiration is to leverage double our funding. The grants will provide up-front financing and technical assistance to ensure a successful venture.
","Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality..",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Urban|Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
USG/Mozambique will support FTF objectives and program activities through cross-cutting investments in policy analysis and advocacy, as well as research and technology transfer.
Policy
Policy analysis and advocacy is targeted to support an accelerated CAADP process, business and trade policy reform (particularly in the fruit sector), an integrated policy agenda for agriculture and nutrition, and policy supporting growth monitoring and nutrition. Specific initiatives include:
","
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Urban|Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
USG/Mozambique will support FTF objectives and program activities through cross-cutting investments in policy analysis and advocacy, as well as research and technology transfer.
Research and Technology Transfer
USG/Mozambique will leverage its comparative advantage in research and technology transfer, focusing support on the introduction and dissemination of new technologies. FTF/Mozambique will achieve this through support to the Mozambique Platform for Agricultural Research and Technology Innovation, which engages International Agricultural Research Centers (IARCs) and Brazil‘s national agricultural research enterprise (EMBRAPA). Main initiatives include:
Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11612","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","MOZ","Mozambique","Zambezia Province|Nampula Province|Sofala Province|Manica Province","Rural","on-going","01-2011","12-2015","Feed the Future, the U.S. Government’s global hunger and food security initiative, is establishing a lasting foundation for progress against global hunger. With a focus on smallholder farmers, particularly women, Feed the Future supports partner countries in developing their agriculture sectors to spur economic growth that increases incomes and reduces hunger, poverty, and undernutrition. Feed the Future efforts are driven by country-led priorities and rooted in partnership with donor organizations, the private sector, and civil society to enable long-term success. Feed the Future aims to assist millions of vulnerable women, children, and family members to escape hunger and poverty, while also reaching significant numbers of children with highly effective nutrition interventions to prevent stunting and child mortality.
Over the next five years in Mozambique, Feed the Future aims to help an estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 346,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
Supporting women in agriculture and household nutrition is essential to the success of this strategy. Agriculture employs 90 percent of Mozambique‘s female labor force, and a quarter of all farming households are women-headed. Women are also the leaders on nutrition in the household. USG/Mozambique‘s FTF strategy supports women by:
Training women as trainers of other women in nutrition benefits and improved household processing of soybeans, orange fleshed sweet potato and cowpeas.
",".
","Using guidance from the January 2011, USAID Evaluation Policy, USAID/Mozambique will employ monitoring and evaluation (M & E) personnel to gather evidence of how FTF Mozambique projects are sustainably reducing poverty and hunger. USAID/Mozambique‘s Agriculture, Trade and Business Office (ATB) staff will be responsible for supervising M & E work. USG/Mozambique will monitor and evaluate overall FTF investments to ensure that they are achieving objectives and maximizing returns. Program activities must be tracked through periodic field visits by Mission staff and through ongoing monitoring and learning by implementing partners. USG/Mozambique‘s approach to M&E will consist of three components:
The integration of agriculture, nutrition, and health elements into a joint strategic plan provides a unique opportunity to innovate, document, and demonstrate best practices associated with a concurrent multi-sector investment model. Because the Mozambique FTF strategy will be supporting linkages among existing programs, USAID/Mozambique is well positioned to develop a model for harmonizing key agricultural and nutrition indicators relevant across areas of focus. Building on this collaboration, both the Health and Economic Growth teams will work together to integrate M & E systems and processes to track synergies and multiplier effects between the two sectors. The integration of the M & E function may take the form of harmonized M & E plans at the implementer level combined with joint monitoring by Mission, Economic Growth and Health team members.
Reliable and well-defined monitoring, reporting, and evaluation methods, roles, and communication channels result in:
A fully functioning M & E team and system further help to illustrate the Mission‘s value added to overall development not only to key stakeholders in the USG, but also to the Government of Mozambique and other development partners.
","estimated 207,000 vulnerable Mozambican women, children and family members—mostly smallholder farmers—escape hunger and poverty",".","","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","FTF/Mozambique will use the following lead indicators to track progress in implementing this strategy.Reduction in the poverty prevalence rate in Zambezia and Nampula, disaggregated by sex; Reduction in the underweight prevalence rate of children under five years of age in Zambezia and Nampula.Further indicators will be chosen as appropriate, but are expected to include:Value of incremental sales (collected at farm-level) attributed to FTF implementation, disaggregated by sex of household; Prevalence of stunted children under five years of age.","Sex","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11627","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","RWA","Rwanda","Rwanda","Urban|Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support countrydriven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, children, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Rwanda, Feed the Future aims to help an estimated 713,000 vulnerable Rwandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Rwanda is making core investments in three key areas:
1. Systems Transformation
Sustainable Market Linkages
Infrastructure
Nutrition
2. Innovation. Research Capacity Building Program
3. Policy
Concerted U.S. Government engagement at the policy level through the provision of SPA will ensure the FTF initiative in Rwanda has nation-wide impact. The policy dialogue with the GOR will seek to encourage more robust dialogue between the GOR and private sector and focus on key issues that are critical to raising productivity of staple crops and constitute core elements of the FTF strategy: privatization of the fertilizer market, post-harvest management, and land tenure security. The SPA will thus enhance the effectiveness of the technical support provided under the FTF initiative in these areas, and, similarly, the technical support will enhance the effectiveness of the SPA.
While the SPA will focus specifically on a few key measures to raise agricultural productivity, it can be expected to help strengthen the GOR-donor policy dialogue in the agriculture sector more generally and even to provide a platform for discussing other issues, such as food safety standards and climate change policy.62 According to the FAO, the core elements of a strengthened dialogue include: more detailed annual planning and budgeting, strengthening existing monitoring arrangements such as the JSRs, and a strengthened M&E system so that discussions are grounded in reliable performance information.63 Complementary technical support will therefore be provided to strengthen M&E capacity, including through the (re-)establishment of the Famine Early Warning System (FEWS) in Rwanda to strengthen data collection and analytical capacity on a number of issues that affect food security, such as climate change.
Because SPA resources will be channeled through GOR systems, it is important to have a full understanding of the risks the systems present so they can be mitigated. As previously mentioned, the general environment for making use of host-country systems in Rwanda is quite sound, with low levels of corruption and high levels of performance on various measures of the quality of public administration. The recent PEFA assessment found that substantial progress was made in the area of public financial management over the past three years, findings that were confirmed in the first phase application of USAID’s fiduciary risk assessment tool. The second phase application of the tool, performed with the support the internationally recognized accounting firm, Deloitte, involved a detailed analysis of agriculture sector institutions’ financial management systems and found that all identified risks can be mitigated through a targeted public financial management capacity building program within MINAGRI.64 Such a program will complement planned support to strengthen the human and institutional capacity of selected GOR institutions and civil society organizations that have a role in providing oversight of public expenditure and program performance.
",".
","PERFORMANCE MONITORING
USAID’s existing Performance Management Plan (PMP) for its Economic Growth SO already includes several FTF indicators or indicators closely related to them. Efforts to strengthen the PMP’s alignment with the initiative are underway while FTF nutrition indicators will be incorporated into the GHI/BEST PMP. USAID has developed a web-based performance monitoring tool that facilitates reporting from its implementing partners as a key element of its M&E system. This same system will be utilized to collect activity-level data on FTF indicators.
For many of the high-level FTF indicators, baselines will be established through two national surveys currently underway. Results from the Demographic and Health Survey (DHS), for which the U.S. Government is providing focused technical support to the National Institute of Statistics (NISR), will be available in late 2011 while results from a household survey, providing data on poverty levels, are scheduled to be released in early 2012. Consideration is being given to the regular application of an adapted version of USAID’s Poverty Assessment Tool in order to obtain some indication of poverty trends between household surveys, which typically only take place every five years, while an interim DHS planned for 2013/14 and a Knowledge, Attitudes, and Practices survey will document changes in nutritional status and feeding practices. Efforts will also be made to utilize the Ministry of Health database to which community health workers report cases of malnutrition via mobile phone.
As previously noted, given identified gaps in data collection and performance monitoring in MINAGRI, the U.S. Government will seek to strengthen its M&E capacity through the establishment of a FEWS field presence and additional M&E technical support. Other donors, including DFID, the EC, and the World Bank, are helping to strengthen the NISR, including its collection and analysis of agricultural data. Improvement of agricultural statistics is a core element of the GOR’s PSI program with the IMF, as data collection procedures that systematically over-estimated agricultural production were thought to compromise the reliability of the GOR’s national income accounts data.
Given Rwanda’s limited size and population, as well as planned U.S. Government engagement on several key policy issues that will have broad, national impact on agricultural development and nutrition, FTF assistance can be expected to substantively contribute to reductions in Rwanda’s rural poverty and malnutrition rates. Through FTF in Rwanda more than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. An estimated 713,000 vulnerable Rwandan women, children and family members will receive targeted assistance to escape hunger and poverty.
IMPACT EVALUATION
Periodic impact evaluations conducted over the course of the strategy period will help identify the contributions of FTF investments to progress observed through regular performance monitoring, as well as programmatic adjustments that may be required. As an example, a recent impact evaluation of the U.S. Government’s investments in the coffee sector over the past decade was used to inform a decision about whether continued support to the sector was warranted under the FTF initiative.66 An evaluation of USAID’s dairy competiveness program, undertaken in early 2011, likewise informed a decision to re-compete the program.
In addition, the Integrated Improved Livelihoods Program was selected for inclusion in USAID’s FY 2012 Evaluation Initiative, requiring a rigorous impact evaluation of the program’s central hypothesis that integrating microfinance with non-financial services, such as health and education, has the potential to address the multiple needs of the poor with greater efficiency and impact. The evaluation’s design will commence with program start-up to ensure the necessary baseline data is collected from treatment and control groups. The evaluation itself is planned to take place during the program’s third year of implementation so that lessons learned can be applied during its remaining two years.
","estimated 713,000 vulnerable Rwandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality.",".","","","","Socio-economic status","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11627","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","RWA","Rwanda","Rwanda","Urban","on-going","01-2011","12-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support countrydriven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, children, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Rwanda, Feed the Future aims to help an estimated 713,000 vulnerable Rwandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Rwanda is making core investments in three key areas:
1. Systems Transformation
Sustainable Market Linkages
Infrastructure
Nutrition
2. Innovation. Research Capacity Building Program
3. Policy
It is well known that research generates some of the highest average returns to public investment in agriculture.60 In Rwanda, where research capacity is extremely limited – it is estimated there are only about 30 people actively engaged in agriculture-related research with PhDs61 – the returns are likely to be even higher. As a result, the country is not adequately prepared to meet the demands of producers for improved agricultural inputs and respond to emerging threats to agricultural productivity and food security, such as crop disease and climate change. Developing such capacity is all the more important in light of the GOR’s policy to encourage land use consolidation. FTF assistance will therefore invest in strengthening Rwandan research capacity, with priority given to actionable, demand-driven research in support of priority value chains and nutrition objectives, such as maize and bean varieties that are more resistant to extreme weather events and post-harvest technologies that can be commercialized.
The program will aim to strengthen the capacity of the Rwandan Agriculture Research Institute (ISAR) to produce relevant research and develop systems, in cooperation with Belgian assistance, to ensure research results are disseminated to the field through an improved extension network. Drawing on USAID’s extensive experience with higher education partnerships in Africa, the program will also provide cost-effective, long-term degree training by forging partnerships between U.S. and Rwandan universities so that the country begins to produce a steady stream of qualified agricultural researchers and extension agents. Consistent with the recommendations of the gender strategy for the agriculture sector, special efforts will be made to encourage female enrollment in agricultural universities as a means of ensuring the different needs of women are considered in the country’s agricultural research and extension agendas.
","Improved agricultural productivity
","PERFORMANCE MONITORING
USAID’s existing Performance Management Plan (PMP) for its Economic Growth SO already includes several FTF indicators or indicators closely related to them. Efforts to strengthen the PMP’s alignment with the initiative are underway while FTF nutrition indicators will be incorporated into the GHI/BEST PMP. USAID has developed a web-based performance monitoring tool that facilitates reporting from its implementing partners as a key element of its M&E system. This same system will be utilized to collect activity-level data on FTF indicators.
For many of the high-level FTF indicators, baselines will be established through two national surveys currently underway. Results from the Demographic and Health Survey (DHS), for which the U.S. Government is providing focused technical support to the National Institute of Statistics (NISR), will be available in late 2011 while results from a household survey, providing data on poverty levels, are scheduled to be released in early 2012. Consideration is being given to the regular application of an adapted version of USAID’s Poverty Assessment Tool in order to obtain some indication of poverty trends between household surveys, which typically only take place every five years, while an interim DHS planned for 2013/14 and a Knowledge, Attitudes, and Practices survey will document changes in nutritional status and feeding practices. Efforts will also be made to utilize the Ministry of Health database to which community health workers report cases of malnutrition via mobile phone.
As previously noted, given identified gaps in data collection and performance monitoring in MINAGRI, the U.S. Government will seek to strengthen its M&E capacity through the establishment of a FEWS field presence and additional M&E technical support. Other donors, including DFID, the EC, and the World Bank, are helping to strengthen the NISR, including its collection and analysis of agricultural data. Improvement of agricultural statistics is a core element of the GOR’s PSI program with the IMF, as data collection procedures that systematically over-estimated agricultural production were thought to compromise the reliability of the GOR’s national income accounts data.
Given Rwanda’s limited size and population, as well as planned U.S. Government engagement on several key policy issues that will have broad, national impact on agricultural development and nutrition, FTF assistance can be expected to substantively contribute to reductions in Rwanda’s rural poverty and malnutrition rates. Through FTF in Rwanda more than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. An estimated 713,000 vulnerable Rwandan women, children and family members will receive targeted assistance to escape hunger and poverty.
IMPACT EVALUATION
Periodic impact evaluations conducted over the course of the strategy period will help identify the contributions of FTF investments to progress observed through regular performance monitoring, as well as programmatic adjustments that may be required. As an example, a recent impact evaluation of the U.S. Government’s investments in the coffee sector over the past decade was used to inform a decision about whether continued support to the sector was warranted under the FTF initiative.66 An evaluation of USAID’s dairy competiveness program, undertaken in early 2011, likewise informed a decision to re-compete the program.
In addition, the Integrated Improved Livelihoods Program was selected for inclusion in USAID’s FY 2012 Evaluation Initiative, requiring a rigorous impact evaluation of the program’s central hypothesis that integrating microfinance with non-financial services, such as health and education, has the potential to address the multiple needs of the poor with greater efficiency and impact. The evaluation’s design will commence with program start-up to ensure the necessary baseline data is collected from treatment and control groups. The evaluation itself is planned to take place during the program’s third year of implementation so that lessons learned can be applied during its remaining two years.
",".",".","","","","Sex","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11627","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","RWA","Rwanda","Rwanda","Urban|Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support countrydriven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, children, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Rwanda, Feed the Future aims to help an estimated 713,000 vulnerable Rwandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Rwanda is making core investments in three key areas:
1. Systems Transformation
Sustainable Market Linkages
Infrastructure
Nutrition
2. Innovation. Research Capacity Building Program
3. Policy
While nutritional value was a key criteria in selecting priority value chains, planned value chain investments will be designed to ensure their nutritional benefits are maximized. Increasing the focus of post-harvest investments on the household level, as noted above, and targeting women with the Integrated Improved Livelihoods Program are expected to contribute to the FTF nutrition objective and are part of the NSEM’s plan to strengthen and scale-up CBNP.
Interestingly, recent evaluative evidence suggests access to microfinance may contribute more to maintaining basic food security and nutrition than raising incomes due to its consumption-smoothing effects and the flexibility it offers in dealing with unexpected health emergencies.58 Research also suggests that integrating microfinance with nonfinancial services, such as education on improved feeding and consumption practices, as is planned in the Integrated Improved Livelihoods Program, offers great potential to address the multiple needs of the poor in a more efficient manner.
It is important to note that achieving the FTF nutrition objective in Rwanda will require investments beyond those which can be integrated into investments in priority value chains. Illustrative activities and expected results in each of these areas are as follows:
FTF assistance will support improvements in the quality of routine reporting to monitor mild, moderate, and acute malnutrition among young children and pregnant and lactating women. For example, the Ministry of Health has introduced a system for providing community health workers with health and nutrition information and promptly reporting cases of malnutrition via mobile phone.
PERFORMANCE MONITORING
USAID’s existing Performance Management Plan (PMP) for its Economic Growth SO already includes several FTF indicators or indicators closely related to them. Efforts to strengthen the PMP’s alignment with the initiative are underway while FTF nutrition indicators will be incorporated into the GHI/BEST PMP. USAID has developed a web-based performance monitoring tool that facilitates reporting from its implementing partners as a key element of its M&E system. This same system will be utilized to collect activity-level data on FTF indicators.
For many of the high-level FTF indicators, baselines will be established through two national surveys currently underway. Results from the Demographic and Health Survey (DHS), for which the U.S. Government is providing focused technical support to the National Institute of Statistics (NISR), will be available in late 2011 while results from a household survey, providing data on poverty levels, are scheduled to be released in early 2012. Consideration is being given to the regular application of an adapted version of USAID’s Poverty Assessment Tool in order to obtain some indication of poverty trends between household surveys, which typically only take place every five years, while an interim DHS planned for 2013/14 and a Knowledge, Attitudes, and Practices survey will document changes in nutritional status and feeding practices. Efforts will also be made to utilize the Ministry of Health database to which community health workers report cases of malnutrition via mobile phone.
As previously noted, given identified gaps in data collection and performance monitoring in MINAGRI, the U.S. Government will seek to strengthen its M&E capacity through the establishment of a FEWS field presence and additional M&E technical support. Other donors, including DFID, the EC, and the World Bank, are helping to strengthen the NISR, including its collection and analysis of agricultural data. Improvement of agricultural statistics is a core element of the GOR’s PSI program with the IMF, as data collection procedures that systematically over-estimated agricultural production were thought to compromise the reliability of the GOR’s national income accounts data.
Given Rwanda’s limited size and population, as well as planned U.S. Government engagement on several key policy issues that will have broad, national impact on agricultural development and nutrition, FTF assistance can be expected to substantively contribute to reductions in Rwanda’s rural poverty and malnutrition rates. Through FTF in Rwanda more than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. An estimated 713,000 vulnerable Rwandan women, children and family members will receive targeted assistance to escape hunger and poverty.
IMPACT EVALUATION
Periodic impact evaluations conducted over the course of the strategy period will help identify the contributions of FTF investments to progress observed through regular performance monitoring, as well as programmatic adjustments that may be required. As an example, a recent impact evaluation of the U.S. Government’s investments in the coffee sector over the past decade was used to inform a decision about whether continued support to the sector was warranted under the FTF initiative.66 An evaluation of USAID’s dairy competiveness program, undertaken in early 2011, likewise informed a decision to re-compete the program.
In addition, the Integrated Improved Livelihoods Program was selected for inclusion in USAID’s FY 2012 Evaluation Initiative, requiring a rigorous impact evaluation of the program’s central hypothesis that integrating microfinance with non-financial services, such as health and education, has the potential to address the multiple needs of the poor with greater efficiency and impact. The evaluation’s design will commence with program start-up to ensure the necessary baseline data is collected from treatment and control groups. The evaluation itself is planned to take place during the program’s third year of implementation so that lessons learned can be applied during its remaining two years.
","estimated 713,000 vulnerable Rwandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 174,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality.",".","","","","Vulnerable groups","","Multiple micronutrient powders for home fortification of foods consumed by children 6–23 months of age>>>Multiple micronutrient powders for home fortification of foods consumed by children 6–23 months of age>>http://www.who.int/elena/titles/micronutrientpowder_infants","","","","","","","","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","12-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
USAID will build on previous strategic investments in nutrition and take them to scale in the areas and populations of greatest need to support the GOU and private sector to reduce chronic undernutrition in the country with a primary focus on prevention. Through these interventions an estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. The core investments in nutrition will focus on community and facility based prevention and treatment, targeted nutrition service delivery, the enabling environment for nutrition and capacity building.
Community and Facility-Base Prevention and Treatment
By emphasizing prevention, FTF programs will help to reduce not only chronic undernutrition, but should also reduce the number of severely/acutely malnourished children as well, resulting in fewer children outside HIV and emergency situations needing treatment for severe acute malnutrition. For the treatment of acute malnutrition, Uganda has adopted a national protocol for the Integrated Management of Acute Malnutrition (IMAM). Through a ommunity and facility based approach to treating under nutrition, therapeutic and/or supplementary food is provided to severe or moderately malnourished children, with medical support, nutrition education, and at-home follow up through community based volunteers. FTF and PEPFAR’s partnership on the production, distribution, and management of RUTF support the larger national IMAM protocols.
Capacity Building
Capacity building at the national and district level is critical. Nutrition has only recently become a priority in the health sector, and without strong nutrition champions and policies centrally, nutrition priorities will not be realized. USAID will continue to train health workers in new IMAM guidelines for use in health facilities and will expand technical assistance and capacity building at the national level beyond the health sector to include Agriculture and other ministries who can contribute to a national action plan on nutrition.
","Some key outputs of nutrition activities are: nutrition officers placed in a majority of districts; active Food and Nutrition Councils organized in districts; mandatory fortification of major manufactured foods; therapeutic food reconstituted from locally available foods developed and distributed to district and regional hospitals; and community behavior changes to prevent undernutrition.
","PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition","This component will reach children in 47 districts in the Southwest and North of Uganda","","","Prevalence of households with moderate or severe hunger;Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Number of health facilities with established capacity to manage acute under nutrition; Prevalence of anemia among children 6-59 months; Prevalence of Poverty: Percent of people living on less than $1.25/day; Expenditures of rural households;Prevalence of stunted children under five; Change in average score on Household Hunger index; Percent of children 6-23 months who received a Minimum Acceptable Diet.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
USAID will build on previous strategic investments in nutrition and take them to scale in the areas and populations of greatest need to support the GOU and private sector to reduce chronic undernutrition in the country with a primary focus on prevention. Through these interventions an estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. The core investments in nutrition will focus on community and facility based prevention and treatment, targeted nutrition service delivery, the enabling environment for nutrition and capacity building.
Targeted Nutrition Service Delivery – Fortification and Supplementation
Targeted nutrition service delivery is focused primarily on approaches to reduce specific micronutrient
deficiencies in Uganda. FTF will continue to support vitamin A supplementation and de-worming for
children and iron folic acid supplementation and de-worming for pregnant women at the facility level,
through district-level health programs in target geographical areas. In addition, food fortification
activities will be supported to improve the necessary vitamin and mineral content of staple foods that
will reach a larger target audience, primarily in urban and peri-urban areas where fortified foods are
more accessible. This will build on previous work supported by the USG that has resulted in cooking
oil fortification with vitamin A that now covers more than 85 percent of the country’s market and the
fortification of maize and wheat flour with vitamin A, iron, zinc, folic acid and vitamin B12 and. New food fortification vehicles will be added that include sugar fortification with vitamin A.
The agriculture team is also looking at improved seed varieties to increase micronutrient content such as the orange-fleshed sweet potato, which has increased levels of beta-carotene (Vitamin A). The introduction of fortification of foods will be combined with educational activities that promote dietary diversity through the community and facility based programs.
As previously mentioned, a key component to treatment of undernutrition in Uganda is the production of therapeutic and complementary foods. USG’s Feed the Future will expand on previous investments in local ready-to-use therapeutic food production to increase availability and distribution in health facilities across the country to treat acute undernutrition.
Enabling Environment
Our program will work to leverage other sectors (e.g., agriculture, water, public/private, etc) to create demand for fortified foods, adopt good nutrition behaviors, and activities like exclusive breastfeeding and integrated nutrition/WASH/food hygiene. Advocacy efforts will continue to emphasize the importance of nutrition among key stakeholders. Uganda is one of the countries that is taking on the Scaling Up Nutrition (SUN) initiative spear headed globally by the Irish Government, U.S. Government and the UN. SUN focuses on integration of relevant sectors with a view to addressing the window of opportunity within the 1,000 days (from minus 9 months to 24 months). We will work to harmonize FTF and SUN activities to maximize efficiency and national coverage in close consultation with MOH, MAAIF and other stakeholders. Through the existing micronutrient fortification program that has successfully enriched common staples such as oil and flour, FTF will continue to advocate for mandatory fortification of manufactured foods.
","Some key outputs of nutrition activities are: nutrition officers placed in a majority of districts; active Food and Nutrition Councils organized in districts; mandatory fortification of major manufactured foods; therapeutic food reconstituted from locally available foods developed and distributed to district and regional hospitals; and community behavior changes to prevent undernutrition.
","PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition","This component will reach children in 47 districts in the Southwest and North of Uganda.","","","Prevalence of households with moderate or severe hunger;Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Number of health facilities with established capacity to manage acute under nutrition; Prevalence of anemia among children 6-59 months; Prevalence of Poverty: Percent of people living on less than $1.25/day; Expenditures of rural households;Prevalence of stunted children under five; Change in average score on Household Hunger index; Percent of children 6-23 months who received a Minimum Acceptable Diet.","Vulnerable groups","","Multiple micronutrient powders for home fortification of foods consumed by pregnant women>>>Multiple micronutrient powders for home fortification of foods consumed by pregnant women>>http://www.who.int/elena/titles/micronutrients_pregnancy","","","","","","","","","","","","","","","","","","","","","","","","English" "11629","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","UGA","Uganda","Northern Uganda |central “Maize Belt|Southwest Uganda","Rural|Peri-urban","on-going","01-2011","01-2015","Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.
Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.
To meet its objectives, Feed the Future Uganda is making core investments in three key areas:
1. Nutrition
2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.
3. Connecting Nutrition to Agriculture
Priority Value Chains
Our investments will focus on value chains with the greatest market potential, the highest number of farmers, and the greatest income potential for farmers. Impact on nutrition and role of gender were also critical considerations in our value chain focus, as was the potential for sector-wide impact and maximum return on investment. Many of the value chain components have integrated nutrition and agriculture dimensions. The starting point for this strategy is the Government of Uganda’s Agriculture Sector Development Strategy and Investment Plan (DSIP) where ten priority value chains were selected. In looking at each commodity, maize and coffee stood out as key drivers for conomic growth in terms of number of farmers, market demand, and income potential. Most of the Ugandan staple diet is built around other staples like beans, cassava, and banana – leaving maize to function more as a cash crop that responds to regional food security and trade demands, rather than as a household staple. Fish, dairy and livestock were also considered. However all three present a number of challenges that would require substantially higher levels of investment to address and would deliver a much lower rate of return for dollar invested.
Value-chain Investments
Policy - The USG FTF strategy will support a five-year policy reform initiative in agriculture, trade, health and gender equity. Some examples of policy priorities include the passage of Uganda’s Biotechnology and Bio-safely bill, effective implementation of the Agricultural Chemicals Control Act (1989, amended in 2006) which establishes a licensing regime for insecticides, herbicides, fungicides and fertilizers, and controls and regulates the manufacture, storage, distribution, trade, import, and export of agricultural chemicals, effective implementation of the Agriculture Seeds and Plant Act (1994) which regulates seed companies operating or importing plant material into Uganda, and passage of the Food and Nutrition Bill and related Health, Nutrition and Sanitation policies for a proposed National Food and Drug Authority. Review of Uganda’s marriage and family act lays out the ownership and control of assets for women. It is critical to address key gender components of legislation.
Capacity Building - Support to strengthen key public and private sector institutions at the national and district levels is essential to the overall success of our Feed the Future activities. This five-year set of activities will focus on building capacity within the Uganda Bureau of Statistics, and Ministries of Health and Agriculture to collect and analyze data, and to monitor and evaluate the effectiveness of their programs. There will also be a short, medium, and long-term training and education component to develop the next generation of Uganda decision makers.
Agriculture Research – Feed the Future will support continued research in three areas:Biotechnology to protect food security crops from serious disease threat – specifically cassava (Cassava MOSAIC) and banana (Banana Wilt (BXW) and Black Sigatoka Disease); breeding to increase stress tolerance and disease resistance for Feed the Future focus crops (maize, coffee and beans); and partnership with Harvest Plus to scale-up the production and mainstream marketing of bio-fortified/nutritionally enhanced crop varieties - specifically Orange-fleshed Sweet Potato and high zinc/iron beans.
Increased Quality and Production – USG will contribute to a $50 million partnership with DANIDA, the EU, Belgium, and Sweden to address farm-level constraints to quality and production in maize, beans and coffee. The program will also focus on increasing farmer access to financial services and supporting trade-related sanitary and phytosanitary standards and quality management systems. Agro-Input Supply - A five-year program to increase the quality, availability, and use of inputs. This program will build the capacity of the Uganda National Agriculture Input Dealers Association (UNADA) and private sector retailers.
Farm-level Aggregation and Market Linkages - This program will work to build the capacity of farmer organizations to enter into agreements with major buyers, access finance, purchase inputs, bulk, clean, and process their commodities. The program will work in conjunction with the Abi-Trust Partnership (DANIDA) and emphasize linkages to the WFP's Purchase for Progress efforts and the Uganda Commodity Exchange.
Market-Information System - This program will work with local partners to utilize the latest in information and communications technology to address market information gaps for smallholder farmers.
","Some key outputs include:
PERFORMANCE MONITORING
Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.
IMPACT EVALUATION
To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding
CAPACITY BUILDING/SUPPORT TO DATA COLLECTION
A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.
NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP)
We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.
","estimated 709,000 vulnerable Ugandan women, children and family members—mostly smallholder farmers—escape hunger and poverty. ","This component will reach farmers in 62 districts in the maize, coffee, and beans belt in Southwest and Central Uganda.","","Uganda National Household Survey, 2009/2010; Demographic Health Survey, 2006; The 2008 Uganda Food Consumption Survey; 2007 Uganda Service Provision Survey; The Uganda National Household Survey 2008/2009","Percent growth in agricultural GDP of maize and coffee; Percent change in value of intra-regional exports of targeted agricultural commodities as a result of USG assistance; Post-harvest losses as a percentage of overall harvest, for selected commodities; Value of new private sector investment in the agriculture sector or food chain leveraged by FTF.implementationCapacity of relevant national statistical office to collect high-quality agricultural data","Socio-economic status","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","","","","","","","","","","","","","","","","","","","","","","","","English" "17804","Community-based Management of Acute Malnutrition (CMAM) Programme in Niger ","English","National","","NER","Niger","Zinder, Niger|Maradi, Niger|Niamey, Niger|Tillabéry, Niger|Tahoua, Niger","Urban|Rural","on-going","07-2005","","The Community-Based Management of Acute Malnutrition (CMAM) is one of World Vision’s core project models in nutrition. The CMAM approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with severe acute malnutrition (SAM) in the home using Ready-to-Use-Therapeutic Foods (RUTF) and receiving routine medical care at a local health facility. When necessary, severely malnourished children who have medical complications or lack an appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other longer-term interventions such as Nutrition Education, Infant and Young Child Feeding and Food Security. These interventions are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.
There are four key components to the CMAM approach: Community Mobilisation, Supplementary Feeding Program (SFP), Outpatient Therapeutic Program (OTP), and Stabilisation Centre/In-patient Care (SC). On the most part, World Vision does not set up Stabilisation Centres but instead works closely with existing local health institutions or medical NGOs to provide these services.
World Vision has been operational in Niger for almost two decades – implementing a wide range of long-term development activities across the country. Their work is structured alongside the model of comprehensive area development programs (known internally as ADPs). Each ADP has a Health & Nutrition component which seeks to deliver support through (while simultaneously strengthening) local health structures. In July 2005 and as a result of the 2005 food crisis in Niger that year, World Vision launched a community-based management of acute malnutrition (CMAM) program based on the National Protocol for the Management of Acute Malnutrition. At that time, contacts were made with Valid International – aimed at establishing a partnership for an effective and quality delivery of the CMAM program. An institutional agreement between World Vision and Valid International was reached in July 2006, thus paving the way for the provision of technical support to the Niger CTC (now called CMAM) program.
As a part of the national nutrition strategy, WV is currently implementing CMAM in many decentralized government health centers throughout the country, with the support of partner NGOs (ex. Medecins Sans Frontieres). From the onset of CMAM program implementation, It has been integrated within the Ministry of Health structures such as the CSIs (Integrated Health Centers) with regular trainings of MOH health staff at national, regional and CSI levels based on the most revised version of the National Protocol, ultimately leading to the final version (i.e. Protocole Nationale de prise en Charge de la Malnutrition. MOH Publique/UNICEF/OMS. Juin 2009).
","Evaluation of World Vision Niger Emergency Nutrition Programme, Tillaberi and Niamey Regions (Jul 2010 - Jul 2011), Bernadette Feeney, Technical Advisor, Valid International.
Evaluation Semi-Quantitative de l’Accessibilité et de la Couverture (SQUEAC) CSI appuyés par World Vision ADP de Kornaka West, Gobir Yamma, Chadakori et Goulbi Kaba Région de Maradi, République du Niger, (22 mars au 15 avril, 2011), Allie Norris, Consultante Mobilisation, Valid International.
Rapport De La Mobilisation Sociale Dans Le Cadre Du Redémarrage des Activités Du Programme De World Vision de Prise en charge Communautaire de la Malnutrition Aiguë Régions de Zinder, Maradi et Tillabéri, Niger (13 Juin au 8 Juillet, 2010), Allie Norris et Gabriele Walz Techniciennes de Mobilisation Sociale, Valid International.
Formation sur la “Prise en charge Communautaire de la Malnutrition Aiguë” (PCMA) ADP de Zinder & de Tillabéri (20 juin au 19 juillet, 2010); ADP de Maradi (20 Juin au 8 Juillet, 2010), Lionella Fieschi, Consultante PCMA et Bernadette Feeneey, Valid International.
Evaluation Finale Du Programme CTC Dans La Région De Zinder World Vision, Niger (06 au 18 Juin, 2008), El Hadji Issakha Diop, CTC Advisor, Valid International.
Rapport De L’enquête De Couverture Du Projet CTC Exécuté Par World Vision ADPs De Kassama, DTk Et Gamou Région De Zinder Niger (Avril- Mai, 2007), Lionella Fieschi, Consultante CTC, Valid International.
Programme CTC de World Vision dans la région de Zinder, Niger : Evaluation à mi- parcours (11- 18 Mai, 2007), El Hadji Issakha Diop, Consultant CTC, Valid International.
Visite au programme CTC Région de Zinder (WV Niger), (13 – 24 Février, 2007) Montse Saboya, Valid International.
Mobilisation Communautaire Visite Technique au Programme de CTC Zinder, Niger, (20 février – 2 mars, 2007), Saul Guerrero & Nyauma Nyasani, Consultants de développement communautaire et social, Valid International.
Community Mobilisation aspects of the World Vision CTC Programme, Zinder Region, Niger (Aug 4 - 18, 2006), Saul Guerrero, Valid International.
Assessment for CTC World Vision in Niger (Jul - Aug, 2006), Valid International.
Community-based Management of Acute Malnutrition Model: http://www.wvi.org/nutrition/project-models/cmam
","","","Health","Gouvernement du Niger et la Direction Departementale de la Sante Publique et la Direction de la Nutrition (DN/MSP)","","","","","","","","","","","","","","","","","Currency: US Dollars (USD)Purposes: Salaries & Benefits; Supplies & Materials; Travel & Transportation; Training & Consulting; Monitoring & Evaluation; Occupancy; Communications; Equipment.Action: Covers all actions","International NGOs","World Vision International","World Vision is a global Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice. http://www.wvi.org (WV Canada, WV US, WV Taiwan, WV UK, WV New Zealand, WV Germany, and WV Switzerland are support offices)","Bilateral and donor agencies and lenders","","The Disasters Emergency Committee (DEC) brings 14 leading UK aid charities together in times of crisis: Action Aid, Age International, British Red Cross, CAFOD, Care International, Christian Aid, Concern Worldwide, Islamic Relief, Merlin, Oxfam, Plan UK, Save the Children, Tearfund and World Vision; all collectively raising money to reach those in need quickly. http://www.dec.org.uk/about-dec","UN","World Food Programme (WFP)","The World Food Programme (WFP) is the United Nations' frontline agency in the fight against hunger. It responds to emergencies, saving lives by getting food to the hungry fast, and it also works to help prevent hunger in the future. http://www.wfp.org (The WFP provides WVN direct supply of food for SFP in different CSI).","UN","United Nations Children's Fund (UNICEF)","The United Nations Children's Fund (UNICEF) is the main UN organization defending, promoting and protecting children's rights. UNICEF works to improve the social and economic conditions of children by increasing children's access to health care, safe drinking water, food, and education; protecting children from violence and abuse; and providing emergency relief after disasters. http://www.unicef.org","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","The Canadian International Development Agency (CIDA) is Canada's lead agency for development assistance. http://www.acdi-cida.gc.ca/home","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","The United States Agency for International Development (USAID) is the United States federal government agency primarily responsible for administering civilian foreign aid. http://www.usaid.gov (The fund is provided through the Office of U.S. Foreign Disaster Assistance (OFDA))","Bilateral and donor agencies and lenders","Australian Agency for International Development (AUSAID)","The Australian Agency for International Development (AusAID) is the Australian Government agency responsible for managing Australia's overseas aid programme. http://www.ausaid.gov.au/Pages/home.aspx","Bilateral and donor agencies and lenders","Swedish International Development Cooperation Agency (SIDA)","The Swedish International Development Cooperation Agency (Sida) is a government organization under the Swedish Foreign Ministry responsible for administering approximately half of Sweden's budget for development aid. http://www.sida.se/English/","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","17803","","Management of severe acute malnutrition","","","","Preschool-age children (Pre-SAC)|SAM child","6-59 months","5 regions (Zinder, Maradi, Niamey, Tillabéri, Tahoua)","Community-based","","World Vision works with communities through Area Development Programs (ADPs) that have been identified and implemented based on a series of development criteria. The ADPs serve as the basic intervention unit of the WV's multi-sectoral programs/projects (e.g. in education, water and sanitation, health, income-generating activities and sponsorship of children etc.), but the geographical areas of the ADPs do not necessarily align with administrative boundaries of the country. The whole ADP and program management structure is geared toward long-term development programming, into which the nutritional activities/programs such as Community-based Management of Acute Malnutrition (CMAM) are integrated.
Since July/August 2005, WV Niger has been implementing and supporting the following four components of a CMAM program:
All programmatic activities are implemented through the local health structures and systems and their respective catchment areas. The majority of the OTP and SFP activities are implemented in the Integrated Health Centers (CSI) but in order to achieve greater coverage and to bring supplementary facilities closer to communities, WV has also implemented the programs in Health Posts (CS) which are satellites of CSI. Most OTP take place together with SFP in CSI but few are located in CS as well. The OTP activities, including the provision of Ready-to-Use Therapeutic Food (Plumpy Nut) and the systematic treatments are conducted on a weekly basis, whereas the SFP activities, including the distribution of Fortified Blended Food (Premix with CSB (Corn Soya Based), oil, sugar) for MAM children and moderately malnourished PLWs are carried out bi-monthly basis. The numbers of OTP and SFP sites and staff per ADP differ depending on the target population size and needs.
The technical (nutrition related) and managerial structure of WV in Niger (WVN) includes two nutrition coordinators (East and West) and six regional nutrition supervisor mangers (one per region) who coordinate and harmonize nutritional activities through the different locations. All of them are supported by a relief-nutrition country manager based in Niamey. In each ADP, there is also a health-nutrition manager who is responsible for overseeing ADP related health and nutrition programs and staff. As the national health system is WV's principle partner, WVN staff always work in partnership/collaboration with Ministry of Health (MOH) staff. Currently, WVN staff mainly act as technical facilitators and help with the general management of the program activities such as site organization, training of the community volunteers who help during distributions, channeling food and medical supplies coming from UNICEF and WFP, and program monitoring. Depending on the ADP, there is also either one or two nurses who provides support to the MOH staff in the field.
","
OTP Outcome
Cured % (#)
> 75%
Died % (#)
< 10%
Defaulted % (#)
< 15%
Non-recovered % (#)
Regions
Reporting Period: 2010
Maradi (June-Dec)
74.5 (1540)
0.7 (14)
6.9 (143)
17.9 (371)
Niamey (Aug-Dec)
83.3 (445)
0.4 (2)
3.6 (19)
12.7 (68)
Tahoua (Aug-Dec)
86.6 (453)
1.0 (5)
10.3 (54)
2.1 (11)
Tillaberi (Jan-Dec)
86.4 (912)
1.5 (16)
11.0 (116)
1.1 (12)
Zinder (Jan-Dec)
83.6 (799)
4.3 (41)
10.0 (96)
2.1 (20)
Reporting Period: Jan - Dec, 2011
Maradi
93.5 (4510)
0.3 (16)
4.9 (235)
1.3 (62)
Niamey
NA
NA
NA
NA
Tahoua
84.2 (1054)
0.8 (10)
5.8 (72)
9.3 (116)
Tillaberi
85.5 (1484)
1.6 (27)
10.8 (187)
2.1 (37)
Zinder
94.8 (1803)
0.5 (9)
3.2 (61)
1.5 (29)
Reporting Period: Jan - Dec, 2012
Maradi
97.7 (2651)
0.1 (3)
1.5 (41)
0.7 (18)
Niamey
86.9 (839)
0.3 (3)
5.4 (52)
7.5 (72)
Tahoua
84.7 (762)
1.6 (14)
10.4 (94)
3.3 (30)
Tillaberi
89.1 (886)
1.7 (17)
8.4 (83)
0.8 (8)
Zinder
98.8 (4200)
0.3 (12)
0.1 (6)
0.8 (32)
Reporting Period: 2013
Maradi (Jan-Apr)
94.6 (546)
0.5 (3)
3.3 (19)
1.6 (9)
Niamey (Jan-May)
70.1 (129)
0.0 (0)
18.5 (34)
11.4 (21)
Tahoua (Jan-May)
92.7 (281)
0.0 (0)
4.6 (14)
2.6 (8)
Tillaberi (Jan-Mar)
95.8 (46)
0.0 (0)
4.2 (2)
0.0 (0)
Zinder (Jan-May)
99.6 (1254)
0.2 (3)
0.1 (1)
0.1 (1)
","
Ongoing monitoring and evaluation of CMAM programs is essential for ensuring program targets are being reached. As of Spring 2010, WV is using a consolidated online database management system for CMAM programs. The system is a positive transformation from the existing Excel spreadsheets (template provided by Valid International) that were used during the first few years of WV CMAM programming by National Offices. A simple and systematic data management system allows multi-level program managers to easily retrieve CMAM data and make quick and accurate decisions based on the data that is available to them. In the early days of WV CMAM implementation, prompt access the Excel database was limited to the field staff throughout the year. However, WV’s online CMAM system aims to facilitate this overall data recovery process for WV Staff located in the National, Regional and Support Offices, and Global Health Centre, as well. The online system is carefully designed to be user friendly and applicable for WV staffs across partnership. Staff members are provided with password protected login identification and can access the different online pages that are relevant to their job responsibilities. In this way, they are able to input their monthly tally sheets, generate clear reports, predict future trends (including resources), provide timely input to all internal/external requests and access raw data sheets for further analysis. Furthermore, the quantitative indicators and data collection tools closely align themselves with what has been developed and used by different MOH, facilitating a simple integrating with existing administrative systems and standards in a particular country. All WV CMAM indicators and data collection tools have been standardized to complement the existing myriad of MOH and National Office requirements, as well as the International benchmarks (e.g. SPHERE). In addition to these standard indicators, the CMAM database also includes WV contextual data (e.g. # Registered Children, # Orphans & Vulnerable Children) that is mandatory with the Partnership’s Integrated Program Management.
","ADP Name Total Population; 6-59 months Kornaka West 68,165; 15,261 Gobir Yamma 56,032; 12,934 Ouallam 572,377; 188,745 Simiri 186,528; 76,805 ","Zinder: April-May 2007, point coverage = 21.4% and period coverage = 36.1%. ","","Sept - Oct, 2005: National GAM 15.3%, SAM 1.8%; Zinder GAM 16.1%, SAM 1.2%.Sept, 2006: Maradi GAM 8.2%, SAM 0.8%, U5M 1.3/10,000. Oct - Nov, 2006: National GAM 10.3%, SAM 1.4%, U5M 1.08/10,000, Exclusive breastfeeding 2.2%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 9.7%, SAM 1.7%; Maradi GAM 6.8%, SAM 0.6%; Tahoua GAM 12.5%, SAM 1.1%; Tillaberi GAM 11.2%, SAM 1.9%; Niamey GAM 9.2%; SAM 0.5%. June, 2007: National GAM 11.2%, SAM 1%, U5M 0.71/10,000; Tillaberi GAM 11.2%Oct - Nov, 2007: National GAM 11.0%, SAM 0.8%, U5M 1.81/10,000, Exclusive breastfeeding 9.0%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 11.7%, SAM 1.0%, U5M 3.55/10,000, EB 9.7%, CF 68.2%; Maradi GAM 10.7%, SAM 0.8%, U5M 0.83/10,000, EB 7.6%, CF 73.9%; Tahoua GAM 13.1%, SAM 0.4%, U5M 1.62/10,000, EB 15.7%, CF 89.7%; Tillaberi GAM 7.9%, SAM 1.0%, U5M 3.14/10,000, EB 1.6%, CF 63.5%; Niamey GAM 9.9%, SAM 0.9%, U5M 1.57/10,000, EB 17.1%, CF 40.6%. June-July, 2008: National GAM 10.7%, SAM 0.8%, U5M 1.53/10,000; Zinder GAM 15.7%, SAM 1.9%, U5M 2.13/10,000; Maradi GAM 9.9%, SAM 1.0%, U5M 1.79/10,000; Tahoua GAM 8.4%, SAM 0.6%, U5M 1.67/10,000; Tillaberi GAM 10.1%, SAM 0.1%, U5M 1.11/10,000; Niamey GAM 6.8%, SAM 0.9%, U5M 0.34/10,000. May-June, 2010: National GAM 16.7%, SAM 3.2%; Maradi GAM 19.7%, SAM 3.9%; Zinder GAM 17.8%, SAM 3.6%; Tillaberi GAM 14.8%, SAM 2.7%. June, 2009: National GAM 12.3%, SAM 2.3%.Oct, 2010: Maradi GAM 15.5%, SAM 4.3% MAY, 2013:TILLABERRI GAM 13.3%, SAM 3.1%ZINDER GAM 11.7%, SAM 2.3%MARADI GAM 16.3%, SAM 3.0%TAHOUA GAM 13.1%, SAM 2.3%NIAMEY GAM 11.0%, 1.6%","See above","Vulnerable groups","","Treatment of dehydration in children with severe acute malnutrition>>>Treatment of dehydration in children with severe acute malnutrition>>http://www.who.int/elena/titles/dehydration_sam","Supplies","Problem: There had been some difficulties in ensuring a consistent supply of RUTF. The nutritional commodities for the treatment of SAM are supplied via UNICEF through the MOH supply structure. But there were some challenges due to logistical and organisational issues, including the local/global availability of RUTF. Solution: WV established a buffer stock to resolve the issue. ","Supplies","Problem: A lack of consistent supply of medicines to the CSIs risks the increase in morbidity and mortality from illnesses such as pneumonia and malaria which are major causes of mortality in malnourished children. The care of children under the age of five are free in Niger. However, there are frequent shortage in medicinal supply. Because of the exemption of the fee and the system of cost recovery are in place, in principle UNICEF does not provide for the medicines for activities related to CMAM program although some spot supplies are available they are often inadequate. Solution: WVN is, already involved in the provision of medicines through the activities of ADP and, in case of need, the support will be intensified during this period of crisis. In addition to the routine medicines used for the treatment of the children admitted in the OTP, it would be important that WVN also considers to provide, in the event of rupture, the medicines needed to treat the pathologies associated with malnutrition.","Staff skills/training","Problem: When CTC/CMAM was launched in Niger in 2005/2006, the national/international capacity available for CTC/CMAM implementation was very limited, resulting in a low quality program.Solution: WV developed an Instituational Agreement with Valid International to build their capacity in the overall management of acute malnutrition.","Staff retention","Problem: Due to the erratic funding cycles associated with CMAM programming, it was very difficult to retain staff (Community Mobilization volunteers, MOH staff and WV Staff) when funding cycles terminate. Furthermore, there are difficulties retaining volunteers and keeping them motivated to continue their activities.Solution: WVN established permanent positions, embedded within their ADP and National management structures, for ongoing CMAM program support, including during funding disruptions. Furthermore, WVN can help improve sustainability of the self governing of CSIs and management of volunteers by building capacity of the village health committees (COGES) as an ongoing development commitment. ","Insufficient staff"," Problem: In order to respond to the increased case load of SAM, the capacity of MOH (e.g. staff at CSIs) had to be increased. Solution: Rather than placing WV staff to manage the increased caseload, WV provided training and on-going support to strengthen volunteer capacity to manage SFP which will reduce workload of the health staff in the CSI thereby enabling them to address the more severe cases of malnutrition. This strategy appeared to be very effective in helping the MOH to cope with the case load. For Example: In three of the four CSIs sampled, it was found that the volunteers managed SFP completely thus relieving the existing CSI staff to manage SAM cases. ","","","","","","","","","","","","","Zeinaba Abdoulahi lost her second child five years ago at the age of 4; his death is still a source of grief for this young Nigerien mother. Earlier this year, her fourth child, Tinoumoune, was close to death. The eight-month old girl was dehydrated and losing weight. After treating her with traditional herbal remedies, Tinoumoune continued to become physically weaker and weaker and had a fever for eight days. Zeinaba says “My child was between life and death. She was fading away. I had not a droplet of hope.” Zeinaba bundled her daughter on her back and left early in the morning to walk the seven kilometres from her village to the closest health centre, which runs a community-based management of acute malnutrition (CMAM) programme supported by World Vision. Tinoumoune was diagnosed with severe acute malnutrition and admitted to the nutrition programme, where she was treated with ready-to-use therapeutic food. “In two weeks, she regained weight and became stronger and healthier. I’m very happy.” explains Zeinaba. The family has been spared the grief of a second lost child.
©2010 Ann Birch/World Vision ©2010 Gebregziabher Hadera/World
Mma Halima is a CMAM community volunteer in Niger. She started in this role after caring for her own malnourished son until he graduated from World Vision's CMAM programme. Mma Halima screens and refers malnourished children in her nomadic community and provides health and nutrition education. She describes the ripple effect of her son's rehabilitation through CMAM: ""Now in my community all the mothers are using mosquito nets and our children are not getting sick as before. Now I have only two malnourished children in my community. It is impressive.""
","English" "17804","Community-based Management of Acute Malnutrition (CMAM) Programme in Niger ","English","National","","NER","Niger","Zinder, Niger|Maradi, Niger|Niamey, Niger|Tillabéry, Niger|Tahoua, Niger","Urban|Rural","on-going","07-2005","","The Community-Based Management of Acute Malnutrition (CMAM) is one of World Vision’s core project models in nutrition. The CMAM approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with severe acute malnutrition (SAM) in the home using Ready-to-Use-Therapeutic Foods (RUTF) and receiving routine medical care at a local health facility. When necessary, severely malnourished children who have medical complications or lack an appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other longer-term interventions such as Nutrition Education, Infant and Young Child Feeding and Food Security. These interventions are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.
There are four key components to the CMAM approach: Community Mobilisation, Supplementary Feeding Program (SFP), Outpatient Therapeutic Program (OTP), and Stabilisation Centre/In-patient Care (SC). On the most part, World Vision does not set up Stabilisation Centres but instead works closely with existing local health institutions or medical NGOs to provide these services.
World Vision has been operational in Niger for almost two decades – implementing a wide range of long-term development activities across the country. Their work is structured alongside the model of comprehensive area development programs (known internally as ADPs). Each ADP has a Health & Nutrition component which seeks to deliver support through (while simultaneously strengthening) local health structures. In July 2005 and as a result of the 2005 food crisis in Niger that year, World Vision launched a community-based management of acute malnutrition (CMAM) program based on the National Protocol for the Management of Acute Malnutrition. At that time, contacts were made with Valid International – aimed at establishing a partnership for an effective and quality delivery of the CMAM program. An institutional agreement between World Vision and Valid International was reached in July 2006, thus paving the way for the provision of technical support to the Niger CTC (now called CMAM) program.
As a part of the national nutrition strategy, WV is currently implementing CMAM in many decentralized government health centers throughout the country, with the support of partner NGOs (ex. Medecins Sans Frontieres). From the onset of CMAM program implementation, It has been integrated within the Ministry of Health structures such as the CSIs (Integrated Health Centers) with regular trainings of MOH health staff at national, regional and CSI levels based on the most revised version of the National Protocol, ultimately leading to the final version (i.e. Protocole Nationale de prise en Charge de la Malnutrition. MOH Publique/UNICEF/OMS. Juin 2009).
","Evaluation of World Vision Niger Emergency Nutrition Programme, Tillaberi and Niamey Regions (Jul 2010 - Jul 2011), Bernadette Feeney, Technical Advisor, Valid International.
Evaluation Semi-Quantitative de l’Accessibilité et de la Couverture (SQUEAC) CSI appuyés par World Vision ADP de Kornaka West, Gobir Yamma, Chadakori et Goulbi Kaba Région de Maradi, République du Niger, (22 mars au 15 avril, 2011), Allie Norris, Consultante Mobilisation, Valid International.
Rapport De La Mobilisation Sociale Dans Le Cadre Du Redémarrage des Activités Du Programme De World Vision de Prise en charge Communautaire de la Malnutrition Aiguë Régions de Zinder, Maradi et Tillabéri, Niger (13 Juin au 8 Juillet, 2010), Allie Norris et Gabriele Walz Techniciennes de Mobilisation Sociale, Valid International.
Formation sur la “Prise en charge Communautaire de la Malnutrition Aiguë” (PCMA) ADP de Zinder & de Tillabéri (20 juin au 19 juillet, 2010); ADP de Maradi (20 Juin au 8 Juillet, 2010), Lionella Fieschi, Consultante PCMA et Bernadette Feeneey, Valid International.
Evaluation Finale Du Programme CTC Dans La Région De Zinder World Vision, Niger (06 au 18 Juin, 2008), El Hadji Issakha Diop, CTC Advisor, Valid International.
Rapport De L’enquête De Couverture Du Projet CTC Exécuté Par World Vision ADPs De Kassama, DTk Et Gamou Région De Zinder Niger (Avril- Mai, 2007), Lionella Fieschi, Consultante CTC, Valid International.
Programme CTC de World Vision dans la région de Zinder, Niger : Evaluation à mi- parcours (11- 18 Mai, 2007), El Hadji Issakha Diop, Consultant CTC, Valid International.
Visite au programme CTC Région de Zinder (WV Niger), (13 – 24 Février, 2007) Montse Saboya, Valid International.
Mobilisation Communautaire Visite Technique au Programme de CTC Zinder, Niger, (20 février – 2 mars, 2007), Saul Guerrero & Nyauma Nyasani, Consultants de développement communautaire et social, Valid International.
Community Mobilisation aspects of the World Vision CTC Programme, Zinder Region, Niger (Aug 4 - 18, 2006), Saul Guerrero, Valid International.
Assessment for CTC World Vision in Niger (Jul - Aug, 2006), Valid International.
Community-based Management of Acute Malnutrition Model: http://www.wvi.org/nutrition/project-models/cmam
","","","Health","Gouvernement du Niger et la Direction Departementale de la Sante Publique et la Direction de la Nutrition (DN/MSP)","","","","","","","","","","","","","","","","","Currency: US Dollars (USD)Purposes: Salaries & Benefits; Supplies & Materials; Travel & Transportation; Training & Consulting; Monitoring & Evaluation; Occupancy; Communications; Equipment.Action: Covers all actions","International NGOs","World Vision International","World Vision is a global Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice. http://www.wvi.org (WV Canada, WV US, WV Taiwan, WV UK, WV New Zealand, WV Germany, and WV Switzerland are support offices)","Bilateral and donor agencies and lenders","","The Disasters Emergency Committee (DEC) brings 14 leading UK aid charities together in times of crisis: Action Aid, Age International, British Red Cross, CAFOD, Care International, Christian Aid, Concern Worldwide, Islamic Relief, Merlin, Oxfam, Plan UK, Save the Children, Tearfund and World Vision; all collectively raising money to reach those in need quickly. http://www.dec.org.uk/about-dec","UN","World Food Programme (WFP)","The World Food Programme (WFP) is the United Nations' frontline agency in the fight against hunger. It responds to emergencies, saving lives by getting food to the hungry fast, and it also works to help prevent hunger in the future. http://www.wfp.org (The WFP provides WVN direct supply of food for SFP in different CSI).","UN","United Nations Children's Fund (UNICEF)","The United Nations Children's Fund (UNICEF) is the main UN organization defending, promoting and protecting children's rights. UNICEF works to improve the social and economic conditions of children by increasing children's access to health care, safe drinking water, food, and education; protecting children from violence and abuse; and providing emergency relief after disasters. http://www.unicef.org","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","The Canadian International Development Agency (CIDA) is Canada's lead agency for development assistance. http://www.acdi-cida.gc.ca/home","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","The United States Agency for International Development (USAID) is the United States federal government agency primarily responsible for administering civilian foreign aid. http://www.usaid.gov (The fund is provided through the Office of U.S. Foreign Disaster Assistance (OFDA))","Bilateral and donor agencies and lenders","Australian Agency for International Development (AUSAID)","The Australian Agency for International Development (AusAID) is the Australian Government agency responsible for managing Australia's overseas aid programme. http://www.ausaid.gov.au/Pages/home.aspx","Bilateral and donor agencies and lenders","Swedish International Development Cooperation Agency (SIDA)","The Swedish International Development Cooperation Agency (Sida) is a government organization under the Swedish Foreign Ministry responsible for administering approximately half of Sweden's budget for development aid. http://www.sida.se/English/","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","17821","","Management of moderate malnutrition","","","","MAM child|Preschool-age children (Pre-SAC)","6 - 59 months","5 regions (Zinder, Maradi, Niamey, Tillabéri, Tahoua)","Community-based","","World Vision works with communities through Area Development Programs (ADPs) that have been identified and implemented based on a series of development criteria. The ADPs serve as the basic intervention unit of the WV's multi-sectoral programs/projects (e.g. in education, water and sanitation, health, income-generating activities and sponsorship of children etc.), but the geographical areas of the ADPs do not necessarily align with administrative boundaries of the country. The whole ADP and program management structure is geared toward long-term development programming, into which the nutritional activities/programs such as Community-based Management of Acute Malnutrition (CMAM) are integrated.
Since July/August 2005, WV Niger has been implementing and supporting the following four components of a CMAM program:
All programmatic activities are implemented through the local health structures and systems and their respective catchment areas. The majority of the OTP and SFP activities are implemented in the Integrated Health Centers (CSI) but in order to achieve greater coverage and to bring supplementary facilities closer to communities, WV has also implemented the programs in Health Posts (CS) which are satellites of CSI. Most OTP take place together with SFP in CSI but few are located in CS as well. The OTP activities, including the provision of Ready-to-Use Therapeutic Food (Plumpy Nut) and the systematic treatments are conducted on a weekly basis, whereas the SFP activities, including the distribution of Fortified Blended Food (CSB (Corn Soya Based), oil, sugar) for MAM children and moderately malnourished PLWs are carried out bi-monthly basis. The numbers of OTP and SFP sites and staff per ADP differ depending on the target population size and needs.
The technical (nutrition related) and managerial structure of WV in Niger (WVN) includes two nutrition coordinators (East and West) and six regional nutrition supervisor mangers (one per region) who coordinate and harmonize nutritional activities through the different locations. All of them are supported by a relief-nutrition country manager based in Niamey. In each ADP, there is also a health-nutrition manager who is responsible for overseeing ADP related health and nutrition programs and staff. As the national health system is WV's principle partner, WVN staff always work in partnership/collaboration with Ministry of Health (MOH) staff. Currently, WVN staff mainly act as technical facilitators and help with the general management of the program activities such as site organization, training of the community volunteers who help during distributions, channeling food and medical supplies coming from UNICEF and WFP, and program monitoring. Depending on the ADP, there is also either one or two nurses who provides support to the MOH staff in the field.
","SFP Outcome
Cured % (#)
> 75%
Died % (#)
< 3%
Defaulted % (#)
< 15%
Non-recovered % (#)
Regions
Reporting Period: 2010
Maradi (Sept-Dec)
88.5 (491)
0.4 (2)
8.6 (48)
2.5 (14)
Niamey (Jan-Dec)
88.6 (194)
0.0 (0)
1.4 (3)
10.0 (22)
Tahoua (Aug-Dec)
86.4 (248)
0.0 (0)
13.6 (39)
0.0 (0)
Tillaberi (June-Dec)
88.4 (501)
0.7 (4)
10.2 (58)
0.7 (4)
Zinder (Jan-Dec)
90.8 (640)
2.6 (18)
5.4 (38)
1.3 (9)
Reporting Period: Jan - Dec, 2011
Maradi
97.0 (7069)
0.0 (3)
2.2 (162)
0.7 (51)
Niamey
85.8 (1949)
0.2 (5)
7.7 (175)
6.3 (143)
Tahoua
92.1 (1413)
0.0 (0)
6.3 (96)
1.6 (25)
Tillaberi
93.7 (4413)
0.2 (9)
5.1 (242)
0.9 (44)
Zinder
95.6 (4825)
0.4 (18)
2.4 (119)
1.7 (84)
Reporting Period: Jan - Dec, 2012
Maradi
99.0 (9559)
0.0 (0)
0.4 (38)
0.6 (54)
Niamey
81.3 (1886)
0.0 (0)
10.0 (233)
8.7 (201)
Tahoua
90.1 (984)
0.2 (2)
7.7 (84)
2.0 (22)
Tillaberi
88.7 (2065)
0.2 (4)
9.7 (226)
1.4 (33)
Zinder
94.9 (5508)
0.1 (3)
2.6 (148)
2.5 (143)
Reporting Period: 2013
Maradi (Jan-Apr)
97.1 (1501)
0.1 (1)
2.7 (42)
0.1 (2)
Niamey (Jan-Apr)
73.9 (241)
0.0 (0)
18.7 (61)
7.4 (24)
Tahoua (Jan-May)
88.7 (344)
0.0 (0)
9.0 (35)
2.3 (9)
Tillaberi
NA
NA
NA
NA
Zinder (Jan-May)
99.7 (2910)
0.0 (0)
0.2 (6)
0.1 (2)
","Ongoing monitoring and evaluation of CMAM programs is essential for ensuring program targets are being reached. As of Spring 2010, WV is using a consolidated online database management system for CMAM programs. The system is a positive transformation from the existing Excel spreadsheets (template provided by Valid International) that were used during the first few years of WV CMAM programming by National Offices. A simple and systematic data management system allows multi-level program managers to easily retrieve CMAM data and make quick and accurate decisions based on the data that is available to them. In the early days of WV CMAM implementation, prompt access the Excel database was limited to the field staff throughout the year. However, WV’s online CMAM system aims to facilitate this overall data recovery process for WV Staff located in the National, Regional and Support Offices, and Global Health Centre, as well. The online system is carefully designed to be user friendly and applicable for WV staffs across partnership. Staff members are provided with password protected login identification and can access the different online pages that are relevant to their job responsibilities. In this way, they are able to input their monthly tally sheets, generate clear reports, predict future trends (including resources), provide timely input to all internal/external requests and access raw data sheets for further analysis. Furthermore, the quantitative indicators and data collection tools closely align themselves with what has been developed and used by different MOH, facilitating a simple integrating with existing administrative systems and standards in a particular country. All WV CMAM indicators and data collection tools have been standardized to complement the existing myriad of MOH and National Office requirements, as well as the International benchmarks (e.g. SPHERE). In addition to these standard indicators, the CMAM database also includes WV contextual data (e.g. # Registered Children, # Orphans & Vulnerable Children) that is mandatory with the Partnership’s Integrated Program Management.
","ADP Name Total Population; 6-59 months Kornaka West 68,165; 15,261 Gobir Yamma 56,032; 12,934 Ouallam 572,377; 188,745 Simiri 186,528; 76,805","Zinder: April-May 2007, point coverage = 28.5% and period coverage = 49.0%.","","Sept - Oct, 2005: National GAM 15.3%, SAM 1.8%; Zinder GAM 16.1%, SAM 1.2%.Sept, 2006: Maradi GAM 8.2%, SAM 0.8%, U5M 1.3/10,000. Oct - Nov, 2006: National GAM 10.3%, SAM 1.4%, U5M 1.08/10,000, Exclusive breastfeeding 2.2%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 9.7%, SAM 1.7%; Maradi GAM 6.8%, SAM 0.6%; Tahoua GAM 12.5%, SAM 1.1%; Tillaberi GAM 11.2%, SAM 1.9%; Niamey GAM 9.2%; SAM 0.5%. June, 2007: National GAM 11.2%, SAM 1%, U5M 0.71/10,000; Tillaberi GAM 11.2%Oct - Nov, 2007: National GAM 11.0%, SAM 0.8%, U5M 1.81/10,000, Exclusive breastfeeding 9.0%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 11.7%, SAM 1.0%, U5M 3.55/10,000, EB 9.7%, CF 68.2%; Maradi GAM 10.7%, SAM 0.8%, U5M 0.83/10,000, EB 7.6%, CF 73.9%; Tahoua GAM 13.1%, SAM 0.4%, U5M 1.62/10,000, EB 15.7%, CF 89.7%; Tillaberi GAM 7.9%, SAM 1.0%, U5M 3.14/10,000, EB 1.6%, CF 63.5%; Niamey GAM 9.9%, SAM 0.9%, U5M 1.57/10,000, EB 17.1%, CF 40.6%. June-July, 2008: National GAM 10.7%, SAM 0.8%, U5M 1.53/10,000; Zinder GAM 15.7%, SAM 1.9%, U5M 2.13/10,000; Maradi GAM 9.9%, SAM 1.0%, U5M 1.79/10,000; Tahoua GAM 8.4%, SAM 0.6%, U5M 1.67/10,000; Tillaberi GAM 10.1%, SAM 0.1%, U5M 1.11/10,000; Niamey GAM 6.8%, SAM 0.9%, U5M 0.34/10,000. May-June, 2010: National GAM 16.7%, SAM 3.2%; Maradi GAM 19.7%, SAM 3.9%; Zinder GAM 17.8%, SAM 3.6%; Tillaberi GAM 14.8%, SAM 2.7%. June, 2009: National GAM 12.3%, SAM 2.3%.Oct, 2010: Maradi GAM 15.5%, SAM 4.3% ","See above","Vulnerable groups","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","Supplies","Problem: The lack of a consistent supply of nutritional commodities for SFP has put children suffering from MAM at an increased risk for relapse, non-response, deterioration in status (into SAM) and defaulting. This lack of consistency has also negatively affected the credibility of the SFP program within the community. In turn, this has reduced the overall number of caregivers accessing the SFP services and thus has become a barrier to access.Solution: Contingency planning by the Food Commodity Department and logistics within WV to avoid stock shortage. For example add an extra percentage onto projected estimations each month in order to always have stock in place. ","Communication","Problem: The lack of clarity over the use of RUSF (Ready-to-Use Supplementary Food) and the target group has introduced increased risks for MAM cases in more vulnerable age groups. These cases were not being treated properly, thereby reducing effectiveness of the SFP program. Solution: Clarification with written protocols on the use of RUSF and other nutritional commodities for MAM and the target groups should be made available in the CSIs. It is also essential that there is community sensitization/awareness in the CSI catchment communities on the MAM aspect of CMAM.","External factors","Problem - Conflicting admission criteria: Community Volunteers (Femmes Relais) screen children for MAM in the communities using MUAC. However, upon arrival to the CSI/CS, the same children are admitted into the program on the basis of W/H criteria (outlined in National Protocol). Due to the discrepancies between W/H and MUAC screening, children are rejected from the program. This can reduce the effectiveness of community mobilization because of the problem of rejection.Solution: In order to increase coverage of the program a mass screening was carried out in the 5 regions covered by WV. Over 40,000 children were screened which resulted in a subsequent increase in the SFP admission. ","External factors","Problem: Distance as a barrier to access. Some of the CSI are located very far from the communities that they are serving. Solution: Expand MAM treatment (i.e. SFP) to Health Posts (CS) in order to reduce distance travelled for beneficiaries thus helping to improve the program accessibility as well as reducing the work load in CSIs (however the program capacity must be assured before decentralising these services to health posts).","Staff skills/training","Problem: When CTC/CMAM was launched in Niger in 2005/2006, the national/international capacity available for CTC/CMAM implementation was very limited, resulting in a low quality program. Solution: WV developed an Institutional Agreement with Valid International to build their capacity in the overall management of acute malnutrition.","Staff retention","Problem: Due to the erratic funding cycles associated with CMAM programming, it was very difficult to retain staff (Community Mobilization volunteers, MOH staff and WV Staff) when funding cycles terminate. Furthermore, there are difficulties retaining volunteers and keeping them motivated to continue their activities. Solution: WVN established permanent positions, embedded within their ADP and National management structures, for ongoing CMAM program support, including during funding disruptions. Furthermore, WVN can help improve sustainability of the self governing of CSIs and management of volunteers by building capacity of the village health committees (COGES) as an ongoing development commitment. ","Insufficient staff","Problem: In order to respond to the increased case load of SAM, the capacity of MOH (e.g. staff at CSIs) had to be increased. Solution: Rather than placing WV staff to manage the increased caseload, WV provided training and on-going support to strengthen volunteer capacity to manage SFP which will reduce workload of the health staff in the CSI thereby enabling them to address the more severe cases of malnutrition. This strategy appeared to be very effective in helping the MOH to cope with the case load. For Example: In three of the four CSIs sampled, it was found that the volunteers managed SFP completely thus relieving the existing CSI staff to manage SAM cases. ","","","","","","","","","","English" "17804","Community-based Management of Acute Malnutrition (CMAM) Programme in Niger ","English","National","","NER","Niger","Zinder, Niger|Maradi, Niger|Niamey, Niger|Tillabéry, Niger|Tahoua, Niger","Urban|Rural","on-going","01-2005","","The Community-Based Management of Acute Malnutrition (CMAM) is one of World Vision’s core project models in nutrition. The CMAM approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with severe acute malnutrition (SAM) in the home using Ready-to-Use-Therapeutic Foods (RUTF) and receiving routine medical care at a local health facility. When necessary, severely malnourished children who have medical complications or lack an appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other longer-term interventions such as Nutrition Education, Infant and Young Child Feeding and Food Security. These interventions are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.
There are four key components to the CMAM approach: Community Mobilisation, Supplementary Feeding Program (SFP), Outpatient Therapeutic Program (OTP), and Stabilisation Centre/In-patient Care (SC). On the most part, World Vision does not set up Stabilisation Centres but instead works closely with existing local health institutions or medical NGOs to provide these services.
World Vision has been operational in Niger for almost two decades – implementing a wide range of long-term development activities across the country. Their work is structured alongside the model of comprehensive area development programs (known internally as ADPs). Each ADP has a Health & Nutrition component which seeks to deliver support through (while simultaneously strengthening) local health structures. In July 2005 and as a result of the 2005 food crisis in Niger that year, World Vision launched a community-based management of acute malnutrition (CMAM) program based on the National Protocol for the Management of Acute Malnutrition. At that time, contacts were made with Valid International – aimed at establishing a partnership for an effective and quality delivery of the CMAM program. An institutional agreement between World Vision and Valid International was reached in July 2006, thus paving the way for the provision of technical support to the Niger CTC (now called CMAM) program.
As a part of the national nutrition strategy, WV is currently implementing CMAM in many decentralized government health centers throughout the country, with the support of partner NGOs (ex. Medecins Sans Frontieres). From the onset of CMAM program implementation, It has been integrated within the Ministry of Health structures such as the CSIs (Integrated Health Centers) with regular trainings of MOH health staff at national, regional and CSI levels based on the most revised version of the National Protocol, ultimately leading to the final version (i.e. Protocole Nationale de prise en Charge de la Malnutrition. MOH Publique/UNICEF/OMS. Juin 2009).
","Evaluation of World Vision Niger Emergency Nutrition Programme, Tillaberi and Niamey Regions (Jul 2010 - Jul 2011), Bernadette Feeney, Technical Advisor, Valid International.
Evaluation Semi-Quantitative de l’Accessibilité et de la Couverture (SQUEAC) CSI appuyés par World Vision ADP de Kornaka West, Gobir Yamma, Chadakori et Goulbi Kaba Région de Maradi, République du Niger, (22 mars au 15 avril, 2011), Allie Norris, Consultante Mobilisation, Valid International.
Rapport De La Mobilisation Sociale Dans Le Cadre Du Redémarrage des Activités Du Programme De World Vision de Prise en charge Communautaire de la Malnutrition Aiguë Régions de Zinder, Maradi et Tillabéri, Niger (13 Juin au 8 Juillet, 2010), Allie Norris et Gabriele Walz Techniciennes de Mobilisation Sociale, Valid International.
Formation sur la “Prise en charge Communautaire de la Malnutrition Aiguë” (PCMA) ADP de Zinder & de Tillabéri (20 juin au 19 juillet, 2010); ADP de Maradi (20 Juin au 8 Juillet, 2010), Lionella Fieschi, Consultante PCMA et Bernadette Feeneey, Valid International.
Evaluation Finale Du Programme CTC Dans La Région De Zinder World Vision, Niger (06 au 18 Juin, 2008), El Hadji Issakha Diop, CTC Advisor, Valid International.
Rapport De L’enquête De Couverture Du Projet CTC Exécuté Par World Vision ADPs De Kassama, DTk Et Gamou Région De Zinder Niger (Avril- Mai, 2007), Lionella Fieschi, Consultante CTC, Valid International.
Programme CTC de World Vision dans la région de Zinder, Niger : Evaluation à mi- parcours (11- 18 Mai, 2007), El Hadji Issakha Diop, Consultant CTC, Valid International.
Visite au programme CTC Région de Zinder (WV Niger), (13 – 24 Février, 2007) Montse Saboya, Valid International.
Mobilisation Communautaire Visite Technique au Programme de CTC Zinder, Niger, (20 février – 2 mars, 2007), Saul Guerrero & Nyauma Nyasani, Consultants de développement communautaire et social, Valid International.
Community Mobilisation aspects of the World Vision CTC Programme, Zinder Region, Niger (Aug 4 - 18, 2006), Saul Guerrero, Valid International.
Assessment for CTC World Vision in Niger (Jul - Aug, 2006), Valid International.
Community-based Management of Acute Malnutrition Model: http://www.wvi.org/nutrition/project-models/cmam
","","","Health","Gouvernement du Niger et la Direction Departementale de la Sante Publique et la Direction de la Nutrition (DN/MSP)","","","","","","","","","","","","","","","","","Currency: US Dollars (USD)Purposes: Salaries & Benefits; Supplies & Materials; Travel & Transportation; Training & Consulting; Monitoring & Evaluation; Occupancy; Communications; Equipment.Action: Covers all actions","International NGOs","World Vision International","World Vision is a global Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice. http://www.wvi.org (WV Canada, WV US, WV Taiwan, WV UK, WV New Zealand, WV Germany, and WV Switzerland are support offices)","Bilateral and donor agencies and lenders","","The Disasters Emergency Committee (DEC) brings 14 leading UK aid charities together in times of crisis: Action Aid, Age International, British Red Cross, CAFOD, Care International, Christian Aid, Concern Worldwide, Islamic Relief, Merlin, Oxfam, Plan UK, Save the Children, Tearfund and World Vision; all collectively raising money to reach those in need quickly. http://www.dec.org.uk/about-dec","UN","World Food Programme (WFP)","The World Food Programme (WFP) is the United Nations' frontline agency in the fight against hunger. It responds to emergencies, saving lives by getting food to the hungry fast, and it also works to help prevent hunger in the future. http://www.wfp.org (The WFP provides WVN direct supply of food for SFP in different CSI).","UN","United Nations Children's Fund (UNICEF)","The United Nations Children's Fund (UNICEF) is the main UN organization defending, promoting and protecting children's rights. UNICEF works to improve the social and economic conditions of children by increasing children's access to health care, safe drinking water, food, and education; protecting children from violence and abuse; and providing emergency relief after disasters. http://www.unicef.org","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","The Canadian International Development Agency (CIDA) is Canada's lead agency for development assistance. http://www.acdi-cida.gc.ca/home","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","The United States Agency for International Development (USAID) is the United States federal government agency primarily responsible for administering civilian foreign aid. http://www.usaid.gov (The fund is provided through the Office of U.S. Foreign Disaster Assistance (OFDA))","Bilateral and donor agencies and lenders","Australian Agency for International Development (AUSAID)","The Australian Agency for International Development (AusAID) is the Australian Government agency responsible for managing Australia's overseas aid programme. http://www.ausaid.gov.au/Pages/home.aspx","Bilateral and donor agencies and lenders","Swedish International Development Cooperation Agency (SIDA)","The Swedish International Development Cooperation Agency (Sida) is a government organization under the Swedish Foreign Ministry responsible for administering approximately half of Sweden's budget for development aid. http://www.sida.se/English/","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","17823","","Food distribution/supplementation for prevention of acute malnutrition","","","","Lactating women (LW)|Pregnant women (PW)|Pregnant/lactating women with HIV/AIDS","","Zinder, Maradi, Niamey, Tahoua","Community-based","","World Vision works with communities through Area Development Programs (ADPs) that have been identified and implemented based on a series of development criteria. The ADPs serve as the basic intervention unit of the WV's multi-sectoral programs/projects (e.g. in education, water and sanitation, health, income-generating activities and sponsorship of children etc.), but the geographical areas of the ADPs do not necessarily align with administrative boundaries of the country. The whole ADP and program management structure is geared toward long-term development programming, into which the nutritional activities/programs such as Community-based Management of Acute Malnutrition (CMAM) are integrated.
Since July/August 2005, WV Niger has been implementing and supporting the following four components of a CMAM program:
All programmatic activities are implemented through the local health structures and systems and their respective catchment areas. The majority of the OTP and SFP activities are implemented in the Integrated Health Centers (CSI) but in order to achieve greater coverage and to bring supplementary facilities closer to communities, WV has also implemented the programs in Health Posts (CS) which are satellites of CSI. Most OTP take place together with SFP in CSI but few are located in CS as well. The OTP activities, including the provision of Ready-to-Use Therapeutic Food (Plumpy Nut) and the systematic treatments are conducted on a weekly basis, whereas the SFP activities, including the distribution of Fortified Blended Food (Premix with CSB (Corn Soya Based), oil, sugar) for MAM children and moderately malnourished PLWs are carried out bi-monthly basis. The numbers of OTP and SFP sites and staff per ADP differ depending on the target population size and needs.
The technical (nutrition related) and managerial structure of WV in Niger (WVN) includes two nutrition coordinators (East and West) and six regional nutrition supervisor mangers (one per region) who coordinate and harmonize nutritional activities through the different locations. All of them are supported by a relief-nutrition country manager based in Niamey. In each ADP, there is also a health-nutrition manager who is responsible for overseeing ADP related health and nutrition programs and staff. As the national health system is WV's principle partner, WVN staff always work in partnership/collaboration with Ministry of Health (MOH) staff. Currently, WVN staff mainly act as technical facilitators and help with the general management of the program activities such as site organization, training of the community volunteers who help during distributions, channeling food and medical supplies coming from UNICEF and WFP, and program monitoring. Depending on the ADP, there is also either one or two nurses who provides support to the MOH staff in the field.
","
The Community-Based Management of Acute Malnutrition (CMAM) is one of World Vision’s core project models in nutrition. The CMAM approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with severe acute malnutrition (SAM) in the home using Ready-to-Use-Therapeutic Foods (RUTF) and receiving routine medical care at a local health facility. When necessary, severely malnourished children who have medical complications or lack an appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other longer-term interventions such as Nutrition Education, Infant and Young Child Feeding and Food Security. These interventions are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.
There are four key components to the CMAM approach: Community Mobilisation, Supplementary Feeding Program (SFP), Outpatient Therapeutic Program (OTP), and Stabilisation Centre/In-patient Care (SC). On the most part, World Vision does not set up Stabilisation Centres but instead works closely with existing local health institutions or medical NGOs to provide these services.
World Vision has been operational in Niger for almost two decades – implementing a wide range of long-term development activities across the country. Their work is structured alongside the model of comprehensive area development programs (known internally as ADPs). Each ADP has a Health & Nutrition component which seeks to deliver support through (while simultaneously strengthening) local health structures. In July 2005 and as a result of the 2005 food crisis in Niger that year, World Vision launched a community-based management of acute malnutrition (CMAM) program based on the National Protocol for the Management of Acute Malnutrition. At that time, contacts were made with Valid International – aimed at establishing a partnership for an effective and quality delivery of the CMAM program. An institutional agreement between World Vision and Valid International was reached in July 2006, thus paving the way for the provision of technical support to the Niger CTC (now called CMAM) program.
As a part of the national nutrition strategy, WV is currently implementing CMAM in many decentralized government health centers throughout the country, with the support of partner NGOs (ex. Medecins Sans Frontieres). From the onset of CMAM program implementation, It has been integrated within the Ministry of Health structures such as the CSIs (Integrated Health Centers) with regular trainings of MOH health staff at national, regional and CSI levels based on the most revised version of the National Protocol, ultimately leading to the final version (i.e. Protocole Nationale de prise en Charge de la Malnutrition. MOH Publique/UNICEF/OMS. Juin 2009).
","Evaluation of World Vision Niger Emergency Nutrition Programme, Tillaberi and Niamey Regions (Jul 2010 - Jul 2011), Bernadette Feeney, Technical Advisor, Valid International.
Evaluation Semi-Quantitative de l’Accessibilité et de la Couverture (SQUEAC) CSI appuyés par World Vision ADP de Kornaka West, Gobir Yamma, Chadakori et Goulbi Kaba Région de Maradi, République du Niger, (22 mars au 15 avril, 2011), Allie Norris, Consultante Mobilisation, Valid International.
Rapport De La Mobilisation Sociale Dans Le Cadre Du Redémarrage des Activités Du Programme De World Vision de Prise en charge Communautaire de la Malnutrition Aiguë Régions de Zinder, Maradi et Tillabéri, Niger (13 Juin au 8 Juillet, 2010), Allie Norris et Gabriele Walz Techniciennes de Mobilisation Sociale, Valid International.
Formation sur la “Prise en charge Communautaire de la Malnutrition Aiguë” (PCMA) ADP de Zinder & de Tillabéri (20 juin au 19 juillet, 2010); ADP de Maradi (20 Juin au 8 Juillet, 2010), Lionella Fieschi, Consultante PCMA et Bernadette Feeneey, Valid International.
Evaluation Finale Du Programme CTC Dans La Région De Zinder World Vision, Niger (06 au 18 Juin, 2008), El Hadji Issakha Diop, CTC Advisor, Valid International.
Rapport De L’enquête De Couverture Du Projet CTC Exécuté Par World Vision ADPs De Kassama, DTk Et Gamou Région De Zinder Niger (Avril- Mai, 2007), Lionella Fieschi, Consultante CTC, Valid International.
Programme CTC de World Vision dans la région de Zinder, Niger : Evaluation à mi- parcours (11- 18 Mai, 2007), El Hadji Issakha Diop, Consultant CTC, Valid International.
Visite au programme CTC Région de Zinder (WV Niger), (13 – 24 Février, 2007) Montse Saboya, Valid International.
Mobilisation Communautaire Visite Technique au Programme de CTC Zinder, Niger, (20 février – 2 mars, 2007), Saul Guerrero & Nyauma Nyasani, Consultants de développement communautaire et social, Valid International.
Community Mobilisation aspects of the World Vision CTC Programme, Zinder Region, Niger (Aug 4 - 18, 2006), Saul Guerrero, Valid International.
Assessment for CTC World Vision in Niger (Jul - Aug, 2006), Valid International.
Community-based Management of Acute Malnutrition Model: http://www.wvi.org/nutrition/project-models/cmam
","","","Health","Gouvernement du Niger et la Direction Departementale de la Sante Publique et la Direction de la Nutrition (DN/MSP)","","","","","","","","","","","","","","","","","Currency: US Dollars (USD)Purposes: Salaries & Benefits; Supplies & Materials; Travel & Transportation; Training & Consulting; Monitoring & Evaluation; Occupancy; Communications; Equipment.Action: Covers all actions","International NGOs","World Vision International","World Vision is a global Christian relief, development and advocacy organisation dedicated to working with children, families and communities to overcome poverty and injustice. http://www.wvi.org (WV Canada, WV US, WV Taiwan, WV UK, WV New Zealand, WV Germany, and WV Switzerland are support offices)","Bilateral and donor agencies and lenders","","The Disasters Emergency Committee (DEC) brings 14 leading UK aid charities together in times of crisis: Action Aid, Age International, British Red Cross, CAFOD, Care International, Christian Aid, Concern Worldwide, Islamic Relief, Merlin, Oxfam, Plan UK, Save the Children, Tearfund and World Vision; all collectively raising money to reach those in need quickly. http://www.dec.org.uk/about-dec","UN","World Food Programme (WFP)","The World Food Programme (WFP) is the United Nations' frontline agency in the fight against hunger. It responds to emergencies, saving lives by getting food to the hungry fast, and it also works to help prevent hunger in the future. http://www.wfp.org (The WFP provides WVN direct supply of food for SFP in different CSI).","UN","United Nations Children's Fund (UNICEF)","The United Nations Children's Fund (UNICEF) is the main UN organization defending, promoting and protecting children's rights. UNICEF works to improve the social and economic conditions of children by increasing children's access to health care, safe drinking water, food, and education; protecting children from violence and abuse; and providing emergency relief after disasters. http://www.unicef.org","Bilateral and donor agencies and lenders","Canadian International Development Agency (CIDA)","The Canadian International Development Agency (CIDA) is Canada's lead agency for development assistance. http://www.acdi-cida.gc.ca/home","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","The United States Agency for International Development (USAID) is the United States federal government agency primarily responsible for administering civilian foreign aid. http://www.usaid.gov (The fund is provided through the Office of U.S. Foreign Disaster Assistance (OFDA))","Bilateral and donor agencies and lenders","Australian Agency for International Development (AUSAID)","The Australian Agency for International Development (AusAID) is the Australian Government agency responsible for managing Australia's overseas aid programme. http://www.ausaid.gov.au/Pages/home.aspx","Bilateral and donor agencies and lenders","Swedish International Development Cooperation Agency (SIDA)","The Swedish International Development Cooperation Agency (Sida) is a government organization under the Swedish Foreign Ministry responsible for administering approximately half of Sweden's budget for development aid. http://www.sida.se/English/","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","17824","","Nutrition education and counselling","","","","Adolescents|Adult men and women|Elderly|Family ( living in same household)|Females|Lactating women (LW)|Males|Non-pregnant women (NPW)|Non-pregnant, non-lactating women (NPNLW)|Pregnant women (PW)|Pregnant/lactating women with HIV/AIDS|Women of reproductive age (WRA)","","5 regions (Zinder, Maradi, Niamey, Tillabéri, Tahoua)","Community-based","","Once the main components of the CMAM programme (e.g. OTP and SFP) have been well implemented in the existing MOH and community structures, a focus was given to address the negative behavioural and adaptive issues around IYCF in order to prevent further malnutrition. Depending on the priorities and funding availability, some ADPs were able to integrate IYCF activities in the CMAM. These included carrying out weekly health and nutrition session on CMAM days at the CSIs (Health Centers) and reactivating PD Hearth approach to develop menus using new types of locally available foods for complementary feeding promotion. Additional objectives of IYCF included strengthening existing nutrition systems and capacity building through training of health workers and community volunteers on IYCF and carrying out a baseline survey on IYCF and quarterly monitoring of changes in behaviour (e.g. EBF rates, diversity of food groups in complementary feeding). However, apart from the weekly nutrition education sessions at the CSIs, some of the activities did not translate into action at the community level. For example, the training of national WV staff on IYCF did not cascade down to the community level with community volunteers and also did not translated into activities or development of monitoring tools at community level. Additionally, no baseline IYCF information was available and quarterly monitoring data had not been collected or was unavailable at community level.
NB: This program was funded for a year therefore continuation of the activities beyond the funding period is likely be sporadic as it will depend on various factors including staff and volunteer capacity and motivation.
","For Tillaberi and Niamey regions in July 2010-July 2011:
Nutrition education (incl. IYCF): Target 24,700; Achieved (by the 3rd quarter) 14,234
Number and percentage of infants 0-6 mos who are exclusively breastfed: Target 310 (10%); Achieved N/A
Number and percentage of children aged 6-24 mos who receive foods daily from 4 or more food groups: Target 3045 (40%); Achieved N/A
","Due to a lack of monitoring and reporting it was not possible to report on Infant and Young Child Feeding activities apart from nutrition education sessions at the health centers even if these activities had been occurring in an informal manner in the communities. But it appears that these activities had been strengthened and expanded towards the end of the programme cycle.
","See outcome indicator section","NA","","Sept - Oct, 2005: National GAM 15.3%, SAM 1.8%; Zinder GAM 16.1%, SAM 1.2%.Sept, 2006: Maradi GAM 8.2%, SAM 0.8%, U5M 1.3/10,000. Oct - Nov, 2006: National GAM 10.3%, SAM 1.4%, U5M 1.08/10,000, Exclusive breastfeeding 2.2%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 9.7%, SAM 1.7%; Maradi GAM 6.8%, SAM 0.6%; Tahoua GAM 12.5%, SAM 1.1%; Tillaberi GAM 11.2%, SAM 1.9%; Niamey GAM 9.2%; SAM 0.5%. June, 2007: National GAM 11.2%, SAM 1%, U5M 0.71/10,000; Tillaberi GAM 11.2%Oct - Nov, 2007: National GAM 11.0%, SAM 0.8%, U5M 1.81/10,000, Exclusive breastfeeding 9.0%, Complementary feeding (6-9mos) 78.4%; Zinder GAM 11.7%, SAM 1.0%, U5M 3.55/10,000, EB 9.7%, CF 68.2%; Maradi GAM 10.7%, SAM 0.8%, U5M 0.83/10,000, EB 7.6%, CF 73.9%; Tahoua GAM 13.1%, SAM 0.4%, U5M 1.62/10,000, EB 15.7%, CF 89.7%; Tillaberi GAM 7.9%, SAM 1.0%, U5M 3.14/10,000, EB 1.6%, CF 63.5%; Niamey GAM 9.9%, SAM 0.9%, U5M 1.57/10,000, EB 17.1%, CF 40.6%. June-July, 2008: National GAM 10.7%, SAM 0.8%, U5M 1.53/10,000; Zinder GAM 15.7%, SAM 1.9%, U5M 2.13/10,000; Maradi GAM 9.9%, SAM 1.0%, U5M 1.79/10,000; Tahoua GAM 8.4%, SAM 0.6%, U5M 1.67/10,000; Tillaberi GAM 10.1%, SAM 0.1%, U5M 1.11/10,000; Niamey GAM 6.8%, SAM 0.9%, U5M 0.34/10,000. May-June, 2010: National GAM 16.7%, SAM 3.2%; Maradi GAM 19.7%, SAM 3.9%; Zinder GAM 17.8%, SAM 3.6%; Tillaberi GAM 14.8%, SAM 2.7%. June, 2009: National GAM 12.3%, SAM 2.3%.Oct, 2010: Maradi GAM 15.5%, SAM 4.3% ","Same as above","Vulnerable groups","","","Management","","","","","","","","","","","","","","","","","","","","","WV Niger’s implementation of IYCF activities into the ongoing CMAM program started late in the program period. Due to the high resource (human & financial) intensity of implementing a CMAM program, it was not feasible to introduce IYCF activities until the latter program stages. At the beginning of the program, the MOH staff were trained in providing nutrition education sessions at CSIs on OTP/SFP days which included IYCF messages. Later on, national WV staff were trained on IYCF with the aim that they would cascade this training to the ADP level and then to the community level. However, the training did not continue to the community level (with community volunteers) until near end of the program period.
To strengthen IYCF component of CMAM including monitoring activities, the following activities are recommended:
1. Recruit community mobilisers at ADP level who will work with district Community Focal Points, WV ADP and National Community Mobiliser. The lack of WV community mobilisers at ADP level to work alongside the Nutrition Coordinators has risked a delay in training community volunteers and may have also prevented the implementation of community mobilization activities including IYCF activities and monitoring of these activities.
2. Ensure women are represented in nutrition programs. During the IYCF investigation the 50/50 presence of women as interviewers for the IYCF investigation ensured better access to women and thus the provision of more rigorous information regarding IYCF practices.
3. Develop monitoring tools for IYCF. E.g. How many IYCF sessions held and how many participated?
4. Carry out a representative and statistically significant baseline and final IYCF survey – for EBF rates and diversity of food groups.
","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","01-1978","01-1989","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Internal provision supplementary feeding
","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year). ","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","01-1978","01-1989","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year). ","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","01-1978","01-1989","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year). ","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","01-1978","01-1989","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Internal provision supplementary feeding
","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Weight-for-age z-score (WAZ)
","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","There was a reduction in underweight from 28.3% (1983) to 18.7% (1985) (3.2 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23111","Barangay Integrated Development Approach for Nutrition Improvement (BIDANI)","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The Barangay Integrated Development Approach for Nutrition Improvement (BIDANI) programme ran in the Philippines from 1978 to 1989
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BIDANI is retrieved from the ENA Part II where BIDANI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 2/child per year","UN","United Nations Children's Fund (UNICEF)","Although the programme showed positive impact on weight for age, implementation was found to be a consistent restraint
","","70 % coverage of children under 5 years","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23147","Third Community Health and Nutrition Project (CHN 3)","English","Large scale programmes","","IDN","Indonesia","","Urban|Rural|Peri-urban","completed","","2001","CHN 3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. Additionally, there is a section describing findings from cash transfer programmes. This summary of CHN 3 is retrieved from the ENA Part II where CHN 3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million by the Government of Indonesia.","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23144","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Preschool-age children (Pre-SAC)","","Five provinces in Indonesia","Community-based","","Internal provision supplementary feeding
","Weight-for-age z-score (WAZ)
","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birth-rate in the lowest quintile of the population.
","Five provinces in Indonesia","Five provinces in Indonesia","","","","None","","","","","","","","","","","","","","","","","","","","","","","","Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define.
","","English" "23147","Third Community Health and Nutrition Project (CHN 3)","English","Large scale programmes","","IDN","Indonesia","","Urban|Rural|Peri-urban","completed","","2001","CHN 3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. Additionally, there is a section describing findings from cash transfer programmes. This summary of CHN 3 is retrieved from the ENA Part II where CHN 3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million by the Government of Indonesia.","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23145","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)","","Five provinces in Indonesia","Community-based","","","Weight-for-age z-score (WAZ)
","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birth-rate in the lowest quintile of the population
","Five provinces in Indonesia","Five provinces in Indonesia","","","","None","","","","","","","","","","","","","","","","","","","","","","","","Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define.
","","English" "23147","Third Community Health and Nutrition Project (CHN 3)","English","Large scale programmes","","IDN","Indonesia","","Urban|Rural|Peri-urban","completed","","2001","CHN 3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. Additionally, there is a section describing findings from cash transfer programmes. This summary of CHN 3 is retrieved from the ENA Part II where CHN 3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million by the Government of Indonesia.","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23146","","Nutrition education and counselling","","","","Lactating women (LW)|Pregnant women (PW)","","Five provinces in Indonesia","Community-based","","","Weight-for-age z-score (WAZ)
","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birth-rate in the lowest quintile of the population.
","Five provinces in Indonesia","Five provinces in Indonesia","","","","None","","","","","","","","","","","","","","","","","","","","","","","","Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define.
","","English" "23299","Bolsa Alimentacão (BA)","English","Large scale programmes","","BRA","Brazil","","","completed","","01-1970","Bolsa Alimentacão (BA) was a conditional cash transfer programme that ran from 2001 - 03. Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly, for up to 3 children. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. In 2003 BA merged with several programmes to form the current Bolsa Familia Programme (BFP).
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Bolsa Alimentacão is retrieved from the ENA Part II where Bolsa Alimentacão is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","Health","Ministry of Health ","","","","","","","","","","","","","","","","","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly. Resource intensity: US$ 84/hd/year","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23298","","Conditional cash transfer","","","","Family ( living in same household)","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42","","Community-based","","Families who met the inclusion criteria received US$ 7 per child monthly, for up to 3 children.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Initial evaluation data from Bolsa Alimentacão showed worsening height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for beneficiaries compared to non-beneficiaries, though results were not statistically significant. This result was despite a reported increase in food consumption, which may have been due to beneficiary mothers assuming they would be ineligible for benefits if children were healthy.
","","1.5 million persons (about 1% of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23299","Bolsa Alimentacão (BA)","English","Large scale programmes","","BRA","Brazil","","","completed","","01-1970","Bolsa Alimentacão (BA) was a conditional cash transfer programme that ran from 2001 - 03. Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly, for up to 3 children. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. In 2003 BA merged with several programmes to form the current Bolsa Familia Programme (BFP).
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Bolsa Alimentacão is retrieved from the ENA Part II where Bolsa Alimentacão is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","Health","Ministry of Health ","","","","","","","","","","","","","","","","","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly. Resource intensity: US$ 84/hd/year","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23300","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","Children below 7 years of age","","Community-based","","Regular growth monitoring
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Initial evaluation data from Bolsa Alimentacão showed worsening height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for beneficiaries compared to non-beneficiaries, though results were not statistically significant. This result was despite a reported increase in food consumption, which may have been due to beneficiary mothers assuming they would be ineligible for benefits if children were healthy.
","","1.5 million persons (about 1% of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23299","Bolsa Alimentacão (BA)","English","Large scale programmes","","BRA","Brazil","","","completed","","01-1970","Bolsa Alimentacão (BA) was a conditional cash transfer programme that ran from 2001 - 03. Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly, for up to 3 children. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. In 2003 BA merged with several programmes to form the current Bolsa Familia Programme (BFP).
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Bolsa Alimentacão is retrieved from the ENA Part II where Bolsa Alimentacão is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","Health","Ministry of Health ","","","","","","","","","","","","","","","","","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly. Resource intensity: US$ 84/hd/year","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23301","","Nutrition education and counselling","","","","Family ( living in same household)|Lactating women (LW)|Pregnant women (PW)","amilies with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42","","Community-based","","Regular participation in nutritio-education seminars
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Initial evaluation data from Bolsa Alimentacão showed worsening height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for beneficiaries compared to non-beneficiaries, though results were not statistically significant. This result was despite a reported increase in food consumption, which may have been due to beneficiary mothers assuming they would be ineligible for benefits if children were healthy.
","","1.5 million persons (about 1% of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23299","Bolsa Alimentacão (BA)","English","Large scale programmes","","BRA","Brazil","","","completed","","01-1970","Bolsa Alimentacão (BA) was a conditional cash transfer programme that ran from 2001 - 03. Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly, for up to 3 children. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. In 2003 BA merged with several programmes to form the current Bolsa Familia Programme (BFP).
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Bolsa Alimentacão is retrieved from the ENA Part II where Bolsa Alimentacão is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","Health","Ministry of Health ","","","","","","","","","","","","","","","","","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42 received US$ 7 per child monthly. Resource intensity: US$ 84/hd/year","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23302","","Vaccination","","","","Family ( living in same household)","Families with pregnant or lactating women and/or children less than 7 years of age with a monthly per capita income below US$ 42","","Community-based","","","","","","1.5 million persons (about 1% of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23304","Bolsa Familia Programme (BFP)","English","Large scale programmes","","BRA","Brazil","","","on-going","","","Bolsa Familia Programme (BFP) is an ongoing conditional cash programme where families with pregnant and lactating mothers and/or children less than 7 years of age, with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor), receive monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. BFP coverag in 2006 was approximately 100% of the poor and 25% of the total Brazilian population.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BFP is retrieved from the ENA Part II where BFP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","US$ 84-540/hd/year.Public expenditure for the BFP in 2005 was US$ 3.2 billion, equivalent to 0.36% of GDP. World Bank support for the programme was about US$ 562 million from 2003–2009, or approximately US$ 93.7 million/year(Monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income)","Bilateral and donor agencies and lenders","The World Bank","","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23303","","Conditional cash transfer","","","","Family ( living in same household)","Families with pregnant and lactating mothers and children less than 7 years of age with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor).","","Community-based","","Monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor).
","Height-for-age z-score (HAZ)
","Evaluation data from the BFP is limited, but a positive impact has been reported; stunting among beneficiary children aged 6–11 months was 3.3 ppt lower (2 versus 5.3) than nonbeneficiary children. However, the results are questionable due to selection bias. Study results may also be limited (especially for children aged 12–36 months) by supply-side constraints restricting health services, irregular growth monitoring despite the conditionality, and lack of information on timing of enrollment.
","","in 2006 was 11.1 million families (46 million persons), approximately 100% of the poor and 25% of the total Brazilian population.","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23304","Bolsa Familia Programme (BFP)","English","Large scale programmes","","BRA","Brazil","","","on-going","","","Bolsa Familia Programme (BFP) is an ongoing conditional cash programme where families with pregnant and lactating mothers and/or children less than 7 years of age, with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor), receive monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. BFP coverag in 2006 was approximately 100% of the poor and 25% of the total Brazilian population.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BFP is retrieved from the ENA Part II where BFP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","US$ 84-540/hd/year.Public expenditure for the BFP in 2005 was US$ 3.2 billion, equivalent to 0.36% of GDP. World Bank support for the programme was about US$ 562 million from 2003–2009, or approximately US$ 93.7 million/year(Monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income)","Bilateral and donor agencies and lenders","The World Bank","","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23305","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","Children below 7 years of age","","Community-based","","Regular growth monitoring in order to receive cash transfer
","Height-for-age z-score (HAZ)
","Evaluation data from the BFP is limited, but a positive impact has been reported; stunting among beneficiary children aged 6–11 months was 3.3 ppt lower (2 versus 5.3) than nonbeneficiary children. However, the results are questionable due to selection bias. Study results may also be limited (especially for children aged 12–36 months) by supply-side constraints restricting health services, irregular growth monitoring despite the conditionality, and lack of information on timing of enrollment.
","","11.1 million families (46 million persons), approximately 100% of the poor and 25% of the total Brazilian population","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23304","Bolsa Familia Programme (BFP)","English","Large scale programmes","","BRA","Brazil","","","on-going","","","Bolsa Familia Programme (BFP) is an ongoing conditional cash programme where families with pregnant and lactating mothers and/or children less than 7 years of age, with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor), receive monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. BFP coverag in 2006 was approximately 100% of the poor and 25% of the total Brazilian population.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BFP is retrieved from the ENA Part II where BFP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","US$ 84-540/hd/year.Public expenditure for the BFP in 2005 was US$ 3.2 billion, equivalent to 0.36% of GDP. World Bank support for the programme was about US$ 562 million from 2003–2009, or approximately US$ 93.7 million/year(Monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income)","Bilateral and donor agencies and lenders","The World Bank","","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23306","","Nutrition education and counselling","","","","Lactating women (LW)|Pregnant women (PW)","Caretakers of children below the age of 7","","Community-based","","Regular participation in nutrition education seminars
","Height-for-age z-score (HAZ)
","Evaluation data from the BFP is limited, but a positive impact has been reported; stunting among beneficiary children aged 6–11 months was 3.3 ppt lower (2 versus 5.3) than nonbeneficiary children. However, the results are questionable due to selection bias. Study results may also be limited (especially for children aged 12–36 months) by supply-side constraints restricting health services, irregular growth monitoring despite the conditionality, and lack of information on timing of enrollment.
","","11.1 million families (46 million persons), approximately 100% of the poor and 25% of the total Brazilian population","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23304","Bolsa Familia Programme (BFP)","English","Large scale programmes","","BRA","Brazil","","","on-going","","","Bolsa Familia Programme (BFP) is an ongoing conditional cash programme where families with pregnant and lactating mothers and/or children less than 7 years of age, with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor), receive monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income. Conditions for receipt of the transfer included regular pre- and postnatal care, growth monitoring, immunization, and participation in nutrition education seminars. BFP coverag in 2006 was approximately 100% of the poor and 25% of the total Brazilian population.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BFP is retrieved from the ENA Part II where BFP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","US$ 84-540/hd/year.Public expenditure for the BFP in 2005 was US$ 3.2 billion, equivalent to 0.36% of GDP. World Bank support for the programme was about US$ 562 million from 2003–2009, or approximately US$ 93.7 million/year(Monthly cash transfers range from US$ 7–US$ 45 per family depending upon eligibility as determined by monthly per capita income)","Bilateral and donor agencies and lenders","The World Bank","","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23307","","Vaccination","","","","Family ( living in same household)","Families with pregnant and lactating mothers and children less than 7 years of age with monthly per capita income ceilings of US$ 57 (moderately poor) and US$ 29 (extremely poor).","","Community-based","","","","","","11.1 million families (46 million persons), approximately 100% of the poor and 25% of the total Brazilian population","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23330","National Nutrition Program (NNP)","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The NNP was a follow-up of the The Bangladesh Integrated Nutrition Programme ((BINP) - which was completed in 2002). The implementation of the NNP started in 2004.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP is retrieved from the ENA Part II where NNP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23329","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)|School age children (SAC)","Children below 6 years","","Community-based","","","","The NNP had implementation problems; the baseline survey was delayed and the end survey never conducted. Thus, no estimate of effect is available.
","Intended coverage: 105/464 thanas","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23330","National Nutrition Program (NNP)","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The NNP was a follow-up of the The Bangladesh Integrated Nutrition Programme ((BINP) - which was completed in 2002). The implementation of the NNP started in 2004.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP is retrieved from the ENA Part II where NNP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23331","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)|School age children (SAC)","Children below 6 years","","Community-based","","Internal provision supplementary feeding
","","NNP had implementation problems; the baseline survey was delayed and the end survey never conducted. Thus, no estimate of effect is available.
","Intended coverage: 105/464 thanas","","","","","Other","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23330","National Nutrition Program (NNP)","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The NNP was a follow-up of the The Bangladesh Integrated Nutrition Programme ((BINP) - which was completed in 2002). The implementation of the NNP started in 2004.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of NNP is retrieved from the ENA Part II where NNP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23332","","Nutrition education and counselling","","","","Lactating women (LW)|Pregnant women (PW)","","","Community-based","","","","NNP had implementation problems; the baseline survey was delayed and the end survey never conducted. Thus, no estimate of effect is available.
","Intended coverage: 105/464 thanas","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23334","The Bangladesh Integrated Nutrition Programme (BINP) ","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The Bangladesh Integrated Nutrition Project (BINP) represented the first large-scale government intervention in nutrition. The BINP operated from 1995 to 2002. By targeting pragnent and lactating women, as well as children under two years, the project's components included growth monitoring, internal provision of sepplementary feeding and nutrition education/councelling.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, whichprovides a compact of WHO guidance on nutrition interventions targeting the first 1,000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BINP is retrieved from Part II where BINP is one of 32 community-based large-scale programmes that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","National NGOs","","","","","","","","Intensity of community health and nutrition worker (CHNW) was reported as 1:200 children, i.e. about 5:100 households. Resource intensity was estimated at approximately US$ 18/household per year, including supplementary feeding.","Bilateral and donor agencies and lenders","The World Bank","Monthly growth monitoring and promotion (GMP) for children under two years of age and pregnant and lactating women (PLW)
","Height-for-age z score (HAZ), weight-for-age z score (WAZ), weight-for-height z score (WHZ)
","Various evaluations of BINP’s nutritional impact were conducted by both internal and external reviewers.
","","15% coverage by area",""," ","Participants' initial rate: 14,5 ppt/year change in underweight. Participants' sustained rate: 0,3 ppt/year change in underweight.
","","","","","","","","","","","","","","","","","","","","","","","","","Reasons for low effectiveness may include:
BINP itself was of low effectiveness and did not lead to a sustainable set of actions. In part this was due to the project design and inadequate intensity, and in part to complexities in implementation (institutional and otherwise)
","","English" "23334","The Bangladesh Integrated Nutrition Programme (BINP) ","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The Bangladesh Integrated Nutrition Project (BINP) represented the first large-scale government intervention in nutrition. The BINP operated from 1995 to 2002. By targeting pragnent and lactating women, as well as children under two years, the project's components included growth monitoring, internal provision of sepplementary feeding and nutrition education/councelling.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, whichprovides a compact of WHO guidance on nutrition interventions targeting the first 1,000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BINP is retrieved from Part II where BINP is one of 32 community-based large-scale programmes that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","National NGOs","","","","","","","","Intensity of community health and nutrition worker (CHNW) was reported as 1:200 children, i.e. about 5:100 households. Resource intensity was estimated at approximately US$ 18/household per year, including supplementary feeding.","Bilateral and donor agencies and lenders","The World Bank","Supplementary feeding (SF) of malnourished PLW and malnourished and growth-faltered children under 2 years of age.
","Height-for-age z score (HAZ), weight-for-age z score (WAZ), weight-for-height z score (WHZ).
","Various evaluations of BINP’s nutritional impact were conducted by both internal and external reviewers.
","","15% by area","","","Participants' initial reduction rate: 14.5 ppt/year change in underweight. Participants' sustained rate: 0.3 ppt/year change in underweight.
","","","","","","","","","","","","","","","","","","","","","","","","","Reasons for low effectiveness may include:
BINP itself was of low effectiveness and did not lead to a sustainable set of actions. In part this was due to the project design and inadequate intensity, and in part to complexities in implementation (institutional and otherwise).
","","English" "23334","The Bangladesh Integrated Nutrition Programme (BINP) ","English","Large scale programmes","","BGD","Bangladesh","","","completed","","01-1970","The Bangladesh Integrated Nutrition Project (BINP) represented the first large-scale government intervention in nutrition. The BINP operated from 1995 to 2002. By targeting pragnent and lactating women, as well as children under two years, the project's components included growth monitoring, internal provision of sepplementary feeding and nutrition education/councelling.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, whichprovides a compact of WHO guidance on nutrition interventions targeting the first 1,000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of BINP is retrieved from Part II where BINP is one of 32 community-based large-scale programmes that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","Health","","","","","","","","","","National NGOs","","","","","","","","Intensity of community health and nutrition worker (CHNW) was reported as 1:200 children, i.e. about 5:100 households. Resource intensity was estimated at approximately US$ 18/household per year, including supplementary feeding.","Bilateral and donor agencies and lenders","The World Bank","Nutrition education for pregnant women, mothers of children under two, and adolescent girls
","Height-for-age z score (HAZ), weight-for-age z score (WAZ), weight-for-height z score (WHZ)
","Various evaluations of BINP’s nutritional impact were conducted by both internal and external reviewers.
","","15% by area","","","Participants' initial rate: 14,5 ppt/year change in underweight. Participants' sustained rate: 0,3 ppt/year change in underweight.
","","","","","","","","","","","","","","","","","","","","","","","","","Reasons for low effectiveness may include:
BINP itself was of low effectiveness and did not lead to a sustainable set of actions. In part this was due to the project design and inadequate intensity, and in part to complexities in implementation (institutional and otherwise).
","","English" "23363","Family Nutrition Improvement programme (UPGK)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","The Family Nutrition Improvement programme (UPGK), also known as the Posyandu (weighing post) programme, started around 1979 and expanded to national coverage, continuing until constrained by an economic crisis in the late 1990s. The UPGK (centred on Posyandus) projects were based on the strategy of consistent monthly weight gain in healthy children targeting children under five and their mothers. The activities included weighing, education, micronutrient supplementation and supplementary feeding in combination with other health interventions through weighing posts managed by community leaders and volunteers
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of UPGK is retrieved from the ENA Part II where UPGK is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
","","","","","","","","","","","","","","","","","","","","","The cost per beneficiary was US$ 2 for weighing-screening and US$ 11 per beneficiary for weighing-feeding. Recurrent costs, which may be seen as those needed for sustained activities, were estimated at approximately US$ 1/household per year, but may not include all local costs. The number of children per posyandu (weighing post) was about 60. 4 community health and nutrition workers (CHNWs) per posyandu, this gives 66 CHNWs/1000.","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23362","","Growth monitoring and promotion","","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","","Protein-energy malnutrition
Underweight
","Both process and impact evaluations were performed on UPGK.
","","Approximately 90% by area. (58000/65000 villages). Coverage reached 80 % of the population under 5 years ","","","The level of severe protein-energy malnutrition declined from 3%–5% to 1%. The reduction in underweight ascribed to UPGK activities based on previous research was approximately 1.0 ppt/year","","","","","","","","","","","","","","","","","","","","","","","","","Inclusion of too many other health issues may have diluted the nutrition interventions). Other evaluation results indicate high programme access and initial coverage above 80% but reduced active participation over time. A lack of baseline data makes impact difficult to assess.
CHNWs had limited training (3 days) and high turnover, and on evaluation only a small percentage was able to provide meaningful counselling.
","","English" "23363","Family Nutrition Improvement programme (UPGK)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","The Family Nutrition Improvement programme (UPGK), also known as the Posyandu (weighing post) programme, started around 1979 and expanded to national coverage, continuing until constrained by an economic crisis in the late 1990s. The UPGK (centred on Posyandus) projects were based on the strategy of consistent monthly weight gain in healthy children targeting children under five and their mothers. The activities included weighing, education, micronutrient supplementation and supplementary feeding in combination with other health interventions through weighing posts managed by community leaders and volunteers
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of UPGK is retrieved from the ENA Part II where UPGK is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
","","","","","","","","","","","","","","","","","","","","","The cost per beneficiary was US$ 2 for weighing-screening and US$ 11 per beneficiary for weighing-feeding. Recurrent costs, which may be seen as those needed for sustained activities, were estimated at approximately US$ 1/household per year, but may not include all local costs. The number of children per posyandu (weighing post) was about 60. 4 community health and nutrition workers (CHNWs) per posyandu, this gives 66 CHNWs/1000.","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23364","","Nutrition education and counselling","","","","Lactating women (LW)|Pregnant women (PW)","","","Community-based","","","Protein-energy malnutrition
Underweight
","Both process and impact evaluations were performed on UPGK
","","Approximately 90% by area. (58000/65000 villages). Coverage reached 80 % of the population under 5 years ","","","The level of severe protein-energy malnutrition declined from 3%–5% to 1%. The reduction in underweight ascribed to UPGK activities based on previous research was approximately 1.0 ppt/year","","","","","","","","","","","","","","","","","","","","","","","","","Inclusion of too many other health issues may have diluted the nutrition interventions). Other evaluation results indicate high programme access and initial coverage above 80% but reduced active participation over time. A lack of baseline data makes impact difficult to assess.
CHNWs had limited training (3 days) and high turnover, and on evaluation only a small percentage was able to provide meaningful counselling
","","English" "23363","Family Nutrition Improvement programme (UPGK)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","The Family Nutrition Improvement programme (UPGK), also known as the Posyandu (weighing post) programme, started around 1979 and expanded to national coverage, continuing until constrained by an economic crisis in the late 1990s. The UPGK (centred on Posyandus) projects were based on the strategy of consistent monthly weight gain in healthy children targeting children under five and their mothers. The activities included weighing, education, micronutrient supplementation and supplementary feeding in combination with other health interventions through weighing posts managed by community leaders and volunteers
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of UPGK is retrieved from the ENA Part II where UPGK is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
","","","","","","","","","","","","","","","","","","","","","The cost per beneficiary was US$ 2 for weighing-screening and US$ 11 per beneficiary for weighing-feeding. Recurrent costs, which may be seen as those needed for sustained activities, were estimated at approximately US$ 1/household per year, but may not include all local costs. The number of children per posyandu (weighing post) was about 60. 4 community health and nutrition workers (CHNWs) per posyandu, this gives 66 CHNWs/1000.","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23365","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","Internal provision supplementary feeding
","Protein-energy malnutrition
Underweight
","Both process and impact evaluations were performed on UPGK.
","","Approximately 90% by area. (58000/65000 villages). Coverage reached 80 % of the population under 5 years ","","","The level of severe protein-energy malnutrition declined from 3%–5% to 1%. The reduction in underweight ascribed to UPGK activities based on previous research was approximately 1.0 ppt/year","","","","","","","","","","","","","","","","","","","","","","","","","Inclusion of too many other health issues may have diluted the nutrition interventions). Other evaluation results indicate high programme access and initial coverage above 80% but reduced active participation over time. A lack of baseline data makes impact difficult to assess.
CHNWs had limited training (3 days) and high turnover, and on evaluation only a small percentage was able to provide meaningful counselling.
","","English" "23368","Third Community Health and Nutrition Project (CHN3)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","CHN3 picked up where UPGK left off. CHN3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CHN3 is retrieved from the ENA Part II where CHN3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million investment by the Government of Indonesia","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23367","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","","
Weight-for-age z-score (WAZ)
","A World Bank evaluation of the project determined that design made the project difficult to supervise and that poor monitoring and evaluation of performance made assessment of project effectiveness difficult to determine
","","Focus on five provinces","","","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birthrate in the lowest quintile of the population.","","","","","","","","","","","","","","","","","","","","","","","","","
Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define.
","","English" "23368","Third Community Health and Nutrition Project (CHN3)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","CHN3 picked up where UPGK left off. CHN3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CHN3 is retrieved from the ENA Part II where CHN3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million investment by the Government of Indonesia","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23369","","Nutrition education and counselling","","","","Lactating women (LW)|Pregnant women (PW)","","","Community-based","","","
Weight-for-age z-score (WAZ)
","A World Bank evaluation of the project determined that design made the project difficult to supervise and that poor monitoring and evaluation of performance made assessment of project effectiveness difficult to determine
","","Focus on five provinces","","","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birthrate in the lowest quintile of the population.","","","","","","","","","","","","","","","","","","","","","","","","","Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define.
","","English" "23368","Third Community Health and Nutrition Project (CHN3)","English","Large scale programmes","","IDN","Indonesia","","","completed","","01-1970","CHN3 picked up where UPGK left off. CHN3 focused on capacity building, health information systems, education and service delivery in a province-based model in five provinces.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CHN3 is retrieved from the ENA Part II where CHN3 is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","US$ 3.6 million investment by the World Bank. US$ 0.6 million investment by the Government of Indonesia","Bilateral and donor agencies and lenders","The World Bank","Government of Indonesia","Government","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23370","","Food distribution/supplementation for prevention of acute malnutrition","","","","Infants and young children|Lactating women (LW)|Pregnant women (PW)|Preschool-age children (Pre-SAC)|School age children (SAC)","","","Community-based","","
Internal provision supplemetary feeding
","Weight-for-age z-score (WAZ)
","A World Bank evaluation of the project determined that design made the project difficult to supervise and that poor monitoring and evaluation of performance made assessment of project effectiveness difficult to determine
","","Focus on five provinces","","","From 1989 to 2003 underweight (<-2 SD WAZ) decreased from 37.5% to 27.5% (0.71 ppt/year) despite the financial crisis of the early 1990s. This decrease may be partially attributed to a reduction in birthrate in the lowest quintile of the population.","","","","","","","","","","","","","","","","","","","","","","","","","Attempts to decentralize health interventions to the provincial level with CHN3 faced challenges of implementation and monitoring. Lack of baseline and surveillance data made effectiveness of these projects difficult to define
","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
The health and nutrition transfer component of Oportunidades is US$ 15/household per month, about 20% of average monthly household expenditures. Receipt of transfer is conditional upon regular health visits for all children in which growth monitoring is included, pre- and postnatal care for women, and adult (greater than 15 years of age) participation in health and nutrition education sessions.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group. In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Regular health visits for all children in which growth monitoring is included
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Adult (greater than 15 years of age) participation in health and nutrition education sessions
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","Increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group (35). In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
The nutrition supplement is intended to provide 20% of daily caloric and 100% of daily micronutrient requirements.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","An increase in height in children 0–6 months of 1.1 cm (26.4 cm versus 25.3 cm) in programme beneficiaries compared to a control group. In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic.","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23382","Oportunidades","English","Large scale programmes","","MEX","Mexico","","Urban|Rural","on-going","","","Oportunidades (known as Progresa from 1997–2002) is a conditional cash transfer (CCT) programme in operation at the time of writing. It was initiated in rural areas and expanded to include urban areas beginning in 2002, although approximately 70% of programme participants reside in rural areas. Targeting for Oportunidades is based on both geography, through identification of localities with high marginality indices, and socioeconomic status, through proxy means testing. Approximately 60 % of households in the bottom decile of per capita expenditures are participants, suggesting effective targeting of the poorest.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of Oportunidades is retrieved from the ENA Part II where Oportunidades is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
Mean haemoglobin
Anemia prevalence
","Multiple evaluations of Oportunidades have been conducted with data demonstrating significant improvements in nutritional outcomes.
","","5 million families, approximately 20 % of the population","","","In rural children ages 12–24 months, a significant increase in mean hemoglobin of 0.37 g/dl was found after 12 months in the programme; 11.12 g/dl in the treatment group compared to 10.75 g/dl in the controls. Corresponding anaemia prevalence among beneficiary children was 44.3% compared to 54.9% among control children, a significant 10.6 ppt decrease. Even with improvement, nearly half of beneficiary children were still anaemic","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23388","","Conditional cash transfer","","","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","RPS participants received a nutrition/food security transfer equivalent to US$ 18/month upon confirmation that conditions were met. The transfer was equivalent to approximately 18% average monthly household expenditure. Conditions for receipt of the transfer included: monthly growth monitoring for children less than 24 months (every other month for children ages 2–5 years), participation in nutrition and health education sessions on topics such as breastfeeding, hygiene and feeding practices, regular vaccinations for children, and routine care for pregnant women. Antiparasitic medications and iron supplements were also provided.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23390","","Growth monitoring and promotion","","","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","Monthly growth monitoring for children less than 24 months (every other month for children ages 2–5 years)
","","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%).","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23391","","Breastfeeding promotion and/or counselling","","","","Lactating women (LW)|Pregnant women (PW)","Mothers of children under two","","Community-based","","Participation in nutrition and health education on breastfeeding in order to receive ransfer
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%).","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23392","","Complementary feeding promotion and/or counselling","","","","Infants and young children","Mothers of children under two years of age","","Community-based","","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23393","","Promotion of improved hygiene practices including handwashing","","","","Women of reproductive age (WRA)","","","Community-based","","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23394","","Iron supplementation","","Iron","","Infants and young children|Preschool-age children (Pre-SAC)","Children below 5 years","","Community-based","","","","","","165 000 persons (approximately 3 % of the population)","","","","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23389","Red de Proteccion Social Program (RPS)","English","Community/sub-national","","NIC","Nicaragua","nicaragua","","completed","","01-1970","The Red de Protección Social Programme (RPS) ran from 2000–2005. It was a small-scale CCT programme. Both geographical and household targeting was used for implementation in departments and municipalities with high rates of extreme poverty.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of RPS is retrieved from the ENA Part II where RPS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Total funding was US$ 38 million.RPS participants received a nutrition/food security transfer equivalent to US$ 18/month","Bilateral and donor agencies and lenders","Inter American Development Bank","Government of Nicaragua ","Government","","","Bilateral and donor agencies and lenders","The World Bank","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23395","","Nutrition education and counselling","","","","Women of reproductive age (WRA)","Mothers of children under five years of age","","Community-based","","Participation in nutrition and health education sessions in order to receive conditional cash transfer
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","","","165 000 persons (approximately 3 % of the population)","","","An increase in HAZ of 0.17 was reported for beneficiary children and stunting decreased in RPS versus control groups by 5.5 ppt. A significant change in underweight was also reported; it decreased in RPS areas (13.7% to 9.8%) while it increased in control areas (14.3% to 16.6%). ","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "11445","Iodin deficiency disorders control programme","English","National","","GHA","Ghana","Accra, Greater Accra, Ghana|Kumasi, Ashanti, Ghana|Takoradi, Western, Ghana|Sunyani, Brong Ahafo, Ghana|Cape Coast, Central, Ghana|Wa, Ghana|Tamale, Ghana|Bolgatanga, Ghana|Koforidua, Eastern, Ghana|Ho, Volta, Ghana","Urban|Rural|Peri-urban","on-going","01-1996","","The programme focuses on the promotion of iodised salt consumption to elimate IDDs which are highly prevalent in Ghana. This done through sensitization of the public, training of salt producers and law enforcement agencies.
","Total goitre rates, household iodised salt consumption, market coverage of iodised salt, urinary and salt iodine concentrations
","Vulnerable groups","","Iodization of salt>>>Iodization of salt>>http://www.who.int/elena/titles/salt_iodization","Financial resources","Awareness creation of policy makers on the need to make funds available for IDD programms","Stakeholder","Ineffective collaboration is also dealt with by creating awareness of the importance of the programme to get them to include IDD in their work plan","Supplies","Removal of tax exemption on the import of potassium iodate to reduce the cost salt iodisation in the factories and cottage salt producers","","","","","","","","","","","","","","","","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Internal provision supplementary feeding
","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change omponents. The programme might have been more successful with better coordination of the CHWs.
","","86 % national coverage. Area coverage for feeding programmes reached 25/36 municipalities","","","From 2001 to 2003 in programme areas, underweight decreased 1.33 ppt/year and wasting decreased 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23116","Early Childhood Development (ECD) Project","English","Large scale programmes","","PHL","Philippines","","","completed","01-1998","01-2005","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change omponents. The programme might have been more successful with better coordination of the CHWs.
","","86 % national coverage. ","","","From 2001 to 2003 in programme areas, underweight for age decreased 1.33 ppt/year and wasting decreased. 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23116","Early Childhood Development (ECD) Project","English","Large scale programmes","","PHL","Philippines","","","completed","01-1998","01-2005","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change components. The programme might have been more successful with better coordination of the CHWs.
","","86% national coverage. Area coverage for nutrition education reached 36/36 municipalities","","","From 2001 to 2003 in programme areas, underweight for age decreased 1.33 ppt/year and wasting decreased. 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23116","Early Childhood Development (ECD) Project","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Internal provision supplementary feeding
","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change omponents. The programme might have been more successful with better coordination of the CHWs.
","","86 % national coverage. Area coverage for feeding programmes reached 25/36 municipalities","","","From 2001 to 2003 in programme areas, underweight decreased 1.33 ppt/year and wasting decreased 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23116","Early Childhood Development (ECD) Project","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change omponents. The programme might have been more successful with better coordination of the CHWs.
","","86 % national coverage. ","","","From 2001 to 2003 in programme areas, underweight for age decreased 1.33 ppt/year and wasting decreased. 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23116","Early Childhood Development (ECD) Project","English","Large scale programmes","","PHL","Philippines","","","completed","","01-1970","The intervention used Community health workers (CHWs) based in health centres and schools, as well as home visits.
The programme also included micronutrient supplementation and fortification
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ECD is retrieved from the ENA Part II where ECD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Weight-for-age z-score (WAZ)
Weight-for-height z-score (WHZ)
Height-for-age z-score (HAZ)
","An evaluation concluded that there were positive results on acute malnutrition due to the feeding programme but negative impact on chronic malnutrition as addressed by the nutrition education and behaviour change components. The programme might have been more successful with better coordination of the CHWs.
","","86% national coverage. Area coverage for nutrition education reached 36/36 municipalities","","","From 2001 to 2003 in programme areas, underweight for age decreased 1.33 ppt/year and wasting decreased. 1.56 ppt/year. No positive impact was found on stunting. From 1993 to 2003, prevalence of underweight for age declined from 28.3% to 20.7% (1.52 ppt/year).
","","","","","","","","","","","","","","","","","","","","","","","","","The ECD programme has had some significant effectiveness and could have potentially had even better results with improved implementation. The ECD programme showed positive evidence for the influence of community-based programmes on improved nutrition status with solid results in reducing prevalence of weight-for-height and wasting through feeding programmes. Long-term behaviour change was less effective due to poor coordination of CHWs.
","","English" "23287","The Child Pastorate Programme (CPP) ","English","Large scale programmes","","BRA","Brazil","","","on-going","","","The Child Pastorate Programme (CPP) is an ongoing large-scale programme in Brazil. In 2001 CPP coverage by area was about 63% (5140/8159 parishes), providing services to 32 265 communities. Coverage by population for the same year was about 1.6 million children less than 6 years of age (9.8% of total population for age group), in addition to more than 77 000 pregnant women.
The programme also included micronutrient supplementation to lactating women and children below 6 years of age, and referral through at home visits by community worker.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CCP is retrieved from the ENA Part II where CCP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","Other","Catholic Church of Brazil","Resource intensity for the CPP is US$ 4/person per year and personnel intensity is 1 community worker: 37 children less than 6 years of age. Total funding for the programme for 1999-2000 was US$ 6.9 million.","Government","Health","Ministry of Health","Government","Education and research","Ministry of Education","Private sector","Private sector","GLOBO TV Network","UN","United Nations Children's Fund (UNICEF)","At home visits by community worker
","Exclusive breastfeeding
Weight
Increased weight
Malnoursihment
","Internal evaluation were conducted from 1988 - 2001 reported an increase in EBF during the first 4 months (from 60% to 80%), decreases in malnourished children (from 18% to 4%) and pregnant women (from 20% to 4%). External evaluation data are unavalable.
","","In 2001: 77000 pregnant women ","","","Participants' sustained rate of underweight reduction: 1.1 ppt/year
","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23287","The Child Pastorate Programme (CPP) ","English","Large scale programmes","","BRA","Brazil","","","on-going","","","The Child Pastorate Programme (CPP) is an ongoing large-scale programme in Brazil. In 2001 CPP coverage by area was about 63% (5140/8159 parishes), providing services to 32 265 communities. Coverage by population for the same year was about 1.6 million children less than 6 years of age (9.8% of total population for age group), in addition to more than 77 000 pregnant women.
The programme also included micronutrient supplementation to lactating women and children below 6 years of age, and referral through at home visits by community worker.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CCP is retrieved from the ENA Part II where CCP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","Other","Catholic Church of Brazil","Resource intensity for the CPP is US$ 4/person per year and personnel intensity is 1 community worker: 37 children less than 6 years of age. Total funding for the programme for 1999-2000 was US$ 6.9 million.","Government","Health","Ministry of Health","Government","Education and research","Ministry of Education","Private sector","Private sector","GLOBO TV Network","UN","United Nations Children's Fund (UNICEF)","At home visits by community worker
","Weight
Increased Weight
Malnourishment
","Internal evaluations from 1988 - 2001 reported decreases in malnourished children (from 18% to 4%) and low birth weight (from 14% to 6%). External evaluations are not available.
","","1.6 million children less than 6 years of age (9.8% of total population for age group)","","","Participants' sustained rate of underweight reduction: 1.1 ppt/year
","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23287","The Child Pastorate Programme (CPP) ","English","Large scale programmes","","BRA","Brazil","","","on-going","","","The Child Pastorate Programme (CPP) is an ongoing large-scale programme in Brazil. In 2001 CPP coverage by area was about 63% (5140/8159 parishes), providing services to 32 265 communities. Coverage by population for the same year was about 1.6 million children less than 6 years of age (9.8% of total population for age group), in addition to more than 77 000 pregnant women.
The programme also included micronutrient supplementation to lactating women and children below 6 years of age, and referral through at home visits by community worker.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CCP is retrieved from the ENA Part II where CCP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","Other","Catholic Church of Brazil","Resource intensity for the CPP is US$ 4/person per year and personnel intensity is 1 community worker: 37 children less than 6 years of age. Total funding for the programme for 1999-2000 was US$ 6.9 million.","Government","Health","Ministry of Health","Government","Education and research","Ministry of Education","Private sector","Private sector","GLOBO TV Network","UN","United Nations Children's Fund (UNICEF)","At home visits by community worker
","Weight
Increased weight
Malnourishment
","Internal evaluations were conducted from 1988–2001 with reported decreases in malnourished children (from 18% to 4%) and pregnant women (from 20% to 4%), as well
as low birth weight (from 14% to 6%). External evaluation data are unavailable.
","","1.6 million children less than 6 years of age (9.8% of total population for age group). More than 77 000 pregnant women.","","","Participants' sustained rate of underweight reduction: 1.1 ppt/year
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23287","The Child Pastorate Programme (CPP) ","English","Large scale programmes","","BRA","Brazil","","","on-going","","","The Child Pastorate Programme (CPP) is an ongoing large-scale programme in Brazil. In 2001 CPP coverage by area was about 63% (5140/8159 parishes), providing services to 32 265 communities. Coverage by population for the same year was about 1.6 million children less than 6 years of age (9.8% of total population for age group), in addition to more than 77 000 pregnant women.
The programme also included micronutrient supplementation to lactating women and children below 6 years of age, and referral through at home visits by community worker.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CCP is retrieved from the ENA Part II where CCP is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","Other","Catholic Church of Brazil","Resource intensity for the CPP is US$ 4/person per year and personnel intensity is 1 community worker: 37 children less than 6 years of age. Total funding for the programme for 1999-2000 was US$ 6.9 million.","Government","Health","Ministry of Health","Government","Education and research","Ministry of Education","Private sector","Private sector","GLOBO TV Network","UN","United Nations Children's Fund (UNICEF)","At home vists by community worker
","Weight
Increased weight
Malnourishement
","Internal evaluations were conducted from 1988–2001 with reported decreases in malnourished children (from 18% to 4%) and pregnant women (from 20% to 4%), as well as low birth weight (from 14% to 6%). An increase in EBF during the first 4 months was also reported (from 60% to 80%). External evaluation data are unavailable.
","","More than 77 000 pregnant women","","","Participants' sustained rate of underweight reduction: 1.1 ppt/year
","Vulnerable groups","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23294","Integrated Management Childhood Illness (IMCI)","English","Large scale programmes","","BRA","Brazil","brazil","","on-going","","","The Integrated Management of Childhood Illness (IMCI) was implemented in Brazil in 1997 and by 2002 had begun in all states, within the context of the Family Health Programme. Coverage reported for the Family Health Programme is variable since municipalities must apply to the federal government and make a financial contribution to join the programme.
The programme also included referral by the community nutrition centre.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of IMCI is retrieved from the ENA Part II where IMCI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","Intensity of community health workers is reported as 1 per 100–200 families","Bilateral and donor agencies and lenders","The World Bank","Ministry of health","Government","Health","The impact of IMCI on nutritional status in Brazil has not been reported.
","","N/A","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23294","Integrated Management Childhood Illness (IMCI)","English","Large scale programmes","","BRA","Brazil","brazil","","on-going","","","The Integrated Management of Childhood Illness (IMCI) was implemented in Brazil in 1997 and by 2002 had begun in all states, within the context of the Family Health Programme. Coverage reported for the Family Health Programme is variable since municipalities must apply to the federal government and make a financial contribution to join the programme.
The programme also included referral by the community nutrition centre.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of IMCI is retrieved from the ENA Part II where IMCI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","Intensity of community health workers is reported as 1 per 100–200 families","Bilateral and donor agencies and lenders","The World Bank","Ministry of health","Government","Health","The impact of IMCI on nutritional status in Brazil has not been reported.
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23294","Integrated Management Childhood Illness (IMCI)","English","Large scale programmes","","BRA","Brazil","brazil","","on-going","","","The Integrated Management of Childhood Illness (IMCI) was implemented in Brazil in 1997 and by 2002 had begun in all states, within the context of the Family Health Programme. Coverage reported for the Family Health Programme is variable since municipalities must apply to the federal government and make a financial contribution to join the programme.
The programme also included referral by the community nutrition centre.
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of IMCI is retrieved from the ENA Part II where IMCI is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrit...
","","","","","","","","","","","","","","","","","","","","","Intensity of community health workers is reported as 1 per 100–200 families","Bilateral and donor agencies and lenders","The World Bank","Ministry of health","Government","Health","The impact of IMCI on nutritional status in Brazil has not been reported.
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Monthly growth monitoring of children less than 24 months of age and sick children 24–60 months of age at the community centre, although home visits are provided for children who do not attend.
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C. participants to non-participants.
Mean height-for-age was lower in the AIN-C group as compared to non-participants at less than six months of age. At 6–11 months and 12–23 months of age, there was no difference between AIN-C children and nonparticipants, suggesting a protective effect of AIN-C against growth faltering. Since a pre-/post- comparison was not possible, this conclusion cannot be certain. Intensity of participation in the programme was based on percentage of possible weighings attended by the child; after controlling for household assets and age of child, for every 1% increase in participation intensity, weight-for-age increased 0.005 z-score.
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Nutrition counselling for EBF less than 6 months of age
","Exclusive breastfeeding (EBF) rates
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C participants to non-participants. Improved caring practices were reported among AIN-C mothers. A 15.8 ppt difference in EBF at 6 months was found (55.8% AIN-C, 40% non- AIN-C).
","","24 of 42 health areas (>50%) in 2006 (18), and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Micronutrient distribution for children (iron and vitamin A)
","","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C participants to non-participants. With regard to receiving iron and vitamin A supplementation, differences of 36.1 ppt (65.6% AIN-C, 29.5% non-AIN-C) and 6.8 ppt (94.3% AIN-C, 87.5% non-AIN-C) respectively, were reported for children.
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23338","Atención Integral a la Niñez en la Comunidad (AIN-C)","English","Large scale programmes","","HND","Honduras","","","on-going","","","The national Atención Integral a la Niñez en la Comunidad (AIN-C) began in the mid- 1990s and remains in operation at the time of writing as a community-based expansion from the original AIN programme.
Referral to the health facility as needed
","
WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of AIN-C is retrieved from the ENA Part II where AIN-C is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity as measured by Community Health and Nutrition Workers (CHNWs):children is 3:25, where CHNWs work part-time for 3.5 hours weekly. Financial resource intensity is US$ 6.43/child per year","Government","Health","Ministry of Health","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","Nutrition counselling for complementary feeding less than 24 months of age
","Height-for-age z-score (HAZ)
Weight-for-age z-score (WAZ)
","Evaluation of the AIN-C was planned as a pre- and post-intervention, project and control comparison study, but the design was altered due to extensive contamination of control communities, non-equivalent groups, and reduced intensity of programme implementation due to changes in funding. A cross-sectional study using baseline data compared AIN-C. participants to non-participants. Mean height-for-age was lower in the AIN-C group as compared to non-participants at less than six months of age. At 6–11 months and 12–23 months of age, there was no difference between AIN-C children and nonparticipants, suggesting a protective effect of AIN-C against growth faltering. Since a pre-/ post- comparison was not possible, this conclusion cannot be certain. Intensity of participation in the programme was based on percentage of possible weighings attended by the child; after controlling for household assets and age of child, for every 1% increase in participation intensity, weight-for-age increased 0.005 z-score
","","Coverage of the programme by area was 24 of 42 health areas (>50%) in 2006 and by population was 90% of children less than 24 months of age.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23355","Integrated Child Development Services Project I (ICDS I)","English","Large scale programmes","","IND","India","Andhra Pradesh|Orissa","","completed","","01-1970","ICDS activities carried out in Andhra Pradesh and Orissa between 1990 and 1997.
Referral of infants and young children and pregnant women as needed
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ICDS I is retrieved from the ENA Part II where ICDS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","The intensity of community health and nutrition workers (CHNWs) , known as Anganwadi workers (ANWs) (estimated at 20 % of full-time equivalents) was 1:1000 persons, i.e. approximately 1:200 children or 10:1000 households.","Bilateral and donor agencies and lenders","The World Bank","Internal provision supplementary feeding
","Underweight
","While there are no definitive evaluations, most reports on ICDS 1 estimate that the change in underweight attributable to the programme was slight; the rate is plotted as 0,2 ppt/year.
","","Population coverage of approximately 2,5 %","","","","","","","","","","","","","","","","","","","","","","","","","","","","According to the World Bank, definitive judgments on the effectiveness of ICDS I cannot be made due to a lack of high-quality data. Measham & Chatterjee attribute the ineffectiveness of the project, particularly in Orissa, to issues related to proper implementation of programme activities:
1. inadequate coverage of children < 3 years
2. irregular food supply
3. poor nutrition education
4. inadequate health worker training
5. anganwadi work “overload”
6. poor linkages between ICDS and the health system.
","","English" "23355","Integrated Child Development Services Project I (ICDS I)","English","Large scale programmes","","IND","India","Andhra Pradesh|Orissa","","completed","","01-1970","ICDS activities carried out in Andhra Pradesh and Orissa between 1990 and 1997.
Referral of infants and young children and pregnant women as needed
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ICDS I is retrieved from the ENA Part II where ICDS I is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","The intensity of community health and nutrition workers (CHNWs) , known as Anganwadi workers (ANWs) (estimated at 20 % of full-time equivalents) was 1:1000 persons, i.e. approximately 1:200 children or 10:1000 households.","Bilateral and donor agencies and lenders","The World Bank","Underweight
","While there are no definitive evaluations, most reports on ICDS 1 estimate that the change in underweight attributable to the programme was slight; the rate is plotted as 0,2 ppt/year.
","","Population coverage of approximately 2,5 %","","","","","","","","","","","","","","","","","","","","","","","","","","","","According to the World Bank, definitive judgments on the effectiveness of ICDS I cannot be made due to a lack of high-quality data. Measham & Chatterjee attribute the ineffectiveness of the project, particularly in Orissa, to issues related to proper implementation of programme activities:
1. inadequate coverage of children < 3 years
2. irregular food supply
3. poor nutrition education
4. inadequate health worker training
5. anganwadi work “overload”
6. poor linkages between ICDS and the health system.
","","English" "23359","Integrated Child Development Services Project II (ICDS II)","English","Large scale programmes","","IND","India","Madhya Pradesh|Bihar","","completed","","01-1970","ICDS II activities were carried out in Madhya Pradesh and Bihar between 1993 - 2001. Components of the programme were identical to those in ICDS I.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ICDS II is retrieved from the ENA Part II where ICDS II is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Underweight
","ICDS II was found to be unsuccessful in improving the nutritional status of children in Madhya Pradesh and Bihar. In Madhya Pradesh, there was found to be a 0.62 ppt/year increase in severe underweight prevalence and a 0.18 ppt/year increase in moderate underweight prevalence. In Bihar, a 0.93 ppt/year decrease in severe underweight prevalence and a 1.37 ppt/year decrease in moderate underweight prevalence were found.
","","","","","Participants' initial rate of underweight reduction: 3,2 ppt/year. Population sustained rate of underweight reduction: 0,05 ppt/year.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23359","Integrated Child Development Services Project II (ICDS II)","English","Large scale programmes","","IND","India","Madhya Pradesh|Bihar","","completed","","01-1970","ICDS II activities were carried out in Madhya Pradesh and Bihar between 1993 - 2001. Components of the programme were identical to those in ICDS I.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of ICDS II is retrieved from the ENA Part II where ICDS II is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","The World Bank","Underweight
","ICDS II was found to be unsuccessful in improving the nutritional status of children in Madhya Pradesh and Bihar. In Madhya Pradesh, there was found to be a 0.62 ppt/year increase in severe underweight prevalence and a 0.18 ppt/year increase in moderate underweight prevalence. In Bihar, a 0.93 ppt/year decrease in severe underweight prevalence and a 1.37 ppt/year decrease in moderate underweight prevalence were found.
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23377","Second Surveillance and Education for Schools and Communities on Food and General Nutrition (SEECALINE)","English","Large scale programmes","","MDG","Madagascar","","","completed","","01-1970","The SEECALINE (Second Surveillance and Education for Schools and Communities on Food and General Nutrition) programme began in 1999 and was gradually scaled-up until 2002. Upon completion of scale-up activities, there were 3600 project sites in half the districts in Madagascar. SEECALINE targeted communities with poorer nutritional status as sites for implementation. Thus, communities with the programme had higher baseline levels of malnutrition than communities that did not have the programme. A key feature is that services are contracted out and provided by local NGOs in the target area. The programme objective was to improve the nutritional status of children under three, PLW, and school-aged children.
The programme also included referral of children under 3 years of age.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of SEECALINE is retrieved from the ENA Part II where SEECALINE is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity of Community health workers(CHWs) was estimated at 1:125 households to 1:225 households, or 60:1000 households.Resource intensity was estimated at US$ 10/household per year.","Bilateral and donor agencies and lenders","The World Bank","Underweight
","Evaluated by the World Bank in two different ways, using both monitoring data to investigate improvements in nutritional status of child participants, and by using two nationally representative surveys to calculate the improvements in child nutritional status in programme areas rather than among programme participants.
","","Coverage rate of approximately 50 % of the population under 3 years in the target areas","","","The rate of underweight reduction was reported as 0,86-1,25 ppt/year, or approximately 1,1 ppt/year for the population sustained rate
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23377","Second Surveillance and Education for Schools and Communities on Food and General Nutrition (SEECALINE)","English","Large scale programmes","","MDG","Madagascar","","","completed","","01-1970","The SEECALINE (Second Surveillance and Education for Schools and Communities on Food and General Nutrition) programme began in 1999 and was gradually scaled-up until 2002. Upon completion of scale-up activities, there were 3600 project sites in half the districts in Madagascar. SEECALINE targeted communities with poorer nutritional status as sites for implementation. Thus, communities with the programme had higher baseline levels of malnutrition than communities that did not have the programme. A key feature is that services are contracted out and provided by local NGOs in the target area. The programme objective was to improve the nutritional status of children under three, PLW, and school-aged children.
The programme also included referral of children under 3 years of age.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of SEECALINE is retrieved from the ENA Part II where SEECALINE is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity of Community health workers(CHWs) was estimated at 1:125 households to 1:225 households, or 60:1000 households.Resource intensity was estimated at US$ 10/household per year.","Bilateral and donor agencies and lenders","The World Bank","Underweight
","Evaluated by the World Bank in two different ways, using both monitoring data to investigate improvements in nutritional status of child participants, and by using two nationally representative surveys to calculate the improvements in child nutritional status in programme areas rather than among programme participants.
","","Coverage rate of approximately 50 % of the population under 3 years in the target areas","","","The rate of underweight reduction was reported as 0,86-1,25 ppt/year, or approximately 1,1 ppt/year for the population sustained rate
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23377","Second Surveillance and Education for Schools and Communities on Food and General Nutrition (SEECALINE)","English","Large scale programmes","","MDG","Madagascar","","","completed","","01-1970","The SEECALINE (Second Surveillance and Education for Schools and Communities on Food and General Nutrition) programme began in 1999 and was gradually scaled-up until 2002. Upon completion of scale-up activities, there were 3600 project sites in half the districts in Madagascar. SEECALINE targeted communities with poorer nutritional status as sites for implementation. Thus, communities with the programme had higher baseline levels of malnutrition than communities that did not have the programme. A key feature is that services are contracted out and provided by local NGOs in the target area. The programme objective was to improve the nutritional status of children under three, PLW, and school-aged children.
The programme also included referral of children under 3 years of age.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of SEECALINE is retrieved from the ENA Part II where SEECALINE is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Intensity of Community health workers(CHWs) was estimated at 1:125 households to 1:225 households, or 60:1000 households.Resource intensity was estimated at US$ 10/household per year.","Bilateral and donor agencies and lenders","The World Bank","Internal provision supplementary feeding
","Underweight
","Evaluated by the World Bank in two different ways, using both monitoring data to investigate improvements in nutritional status of child participants, and by using two nationally representative surveys to calculate the improvements in child nutritional status in programme areas rather than among programme participants.
","","Coverage rate of approximately 50 % of the population under 3 years in the target areas","","","The rate of underweight reduction was reported as 0,86-1,25 ppt/year, or approximately 1,1 ppt/year for the population sustained rate
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23424","Child Survival and Development (CSD) Programme","English","Large scale programmes","","TZA","United Republic of Tanzania","tanzania","","completed","","01-1970","The Child Survival and Development (CSD) Programme was initiated in 1985 and ran until 1995.
The programme also included micronutrient supplementation.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CSD is retrieved from the ENA Part II where CSD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Resource intensity of the CSD programme was US$ 2–US$ 3/child per year.","Bilateral and donor agencies and lenders","The World Bank","Underweight
","","The programme aimed for complete coverage","45% (9/20 regions), with approximately 12 million beneficiaries, 2 million of whom were children.","","","An initial reduction in malnutrition of about 8 ppt/year for 1–2 years, then a continued decrease of 1–2 ppt/year following the initial rapid decline.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "23424","Child Survival and Development (CSD) Programme","English","Large scale programmes","","TZA","United Republic of Tanzania","tanzania","","completed","","01-1970","The Child Survival and Development (CSD) Programme was initiated in 1985 and ran until 1995.
The programme also included micronutrient supplementation.
","WHO (2013) Essential Nutrition Actions – Improving maternal, newborn, infant and young child health and nutrition, which provides a compact of WHO guidance on nutrition interventions targeting the first 1000 days of life. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions require to implement them. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the essential nutrition actions described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. This summary of CSD is retrieved from the ENA Part II where CSD is one of 32 large-scale community-based programs that has been reviewed in detail and evaluated.
http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
","","","","","","","","","","","","","","","","","","","","","Resource intensity of the CSD programme was US$ 2–US$ 3/child per year.","Bilateral and donor agencies and lenders","The World Bank","Underweight
","","The programme aimed for complete coverage","45% (9/20 regions), with approximately 12 million beneficiaries, 2 million of whom were children.","","","An initial reduction in malnutrition of about 8 ppt/year for 1–2 years, then a continued decrease of 1–2 ppt/year following the initial rapid decline.
","","","","","","","","","","","","","","","","","","","","","","","","","","","English"