"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" "6034","Desnutrición Cero","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","06-2007","","
The Multi-sectoral Zero Malnutrition Programme focuses on children under the age of five, with a particular emphasis on children under two years of age, and, in its activities, it assigns priority to working with municipalities with a high degree of vulnerability to food insecurity. The program is a multi-sectoral effort and one of the most important challenges facing the current administration.
Bolivia has a population of 10 million people.
","http://www.imtf.org/blog/2008/06/12/bolivia-zero-malnutrition; http://webapps01.un.org/nvp/indpolicy.action?id=1262 http://www.sns.gob.bo/aplicacionesweb/pmdc1/index.php
","","","","","","","","","Australian Agency for International Development (AUSAID)","","","","","","","","","","","","65.157.257(2007-2011)","Bilateral and donor agencies and lenders","Other","Belgium| Canada| France","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6033","","Complementary feeding promotion and/or counselling","promoting better nutritional and health habits in women and children under age 5","","","Infants and young children","adults and children under age of 5","La Paz","Community-based","","Strengthened local participation through social networks promoting better nutritional and health habits in women and children under age 5, with an inter-cultural approach
","Infants under age 1 receive exclusive breastfeeding until at least 6 months old.- Children between 6 and 9 months have started complementary nourishment once 6 months old.- Families with infants between 6 and 23 months can properly identify at least 4 dangerous symptoms in order to seek help- Municipalities implementing the PDC with social organizations’ participation under a shared management (with the involvement of local and regional authorities)
","In process
","missing","missing","","chronic malnutrition prevalence in 3-48 months old children and anemia prevalence in 6 -48 months old children","","None","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","","","","","","","","","","","","","","","","","","","","","","There was created a software to register all the children, in order to have a better follow up and data-collection. (soaps)
","","English" "6034","Desnutrición Cero","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","06-2007","","The Multi-sectoral Zero Malnutrition Programme focuses on children under the age of five, with a particular emphasis on children under two years of age, and, in its activities, it assigns priority to working with municipalities with a high degree of vulnerability to food insecurity. The program is a multi-sectoral effort and one of the most important challenges facing the current administration.
Bolivia has a population of 10 million people.
","http://www.imtf.org/blog/2008/06/12/bolivia-zero-malnutrition; http://webapps01.un.org/nvp/indpolicy.action?id=1262 http://www.sns.gob.bo/aplicacionesweb/pmdc1/index.php
","","","","","","","","","Australian Agency for International Development (AUSAID)","","","","","","","","","","","","65.157.257(2007-2011)","Bilateral and donor agencies and lenders","Other","Belgium| Canada| France","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6035","Acute malnutrition","Food distribution/supplementation for prevention of acute malnutrition","","","","","Children under 5 years old and pregnant woman","La Paz","Primary health care center","","Reduced micro nutrient deficiency in target population after applying supplementation strategies, fortification and complementary food.
","- Children under age 5 maintaining levels ofserum retinol (Vit A) above 20 mg/dl.- Children under age 5 maintaining normal levels of Haemoglobin (Hb)- Dairy products selected by the Program arefortified pursuant to the national regulation.- Women with malnutrition
","in process for the report of this year.
","","","","nutritional practices, complementary nourishment and micronutrient supplementation","","None","","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","Staff retention","A solution to the staff retention were a lot of Vacancies at different levels.","Supplies","To get more supply support in the municipalities, they got support in their management by law (f.e. decreto supremo).","Financial resources","To get more financial support in the municipalities, they got support in their management by law (f.e. decreto supremo)","","","","","","","","","","","","","","","","","","English" "6034","Desnutrición Cero","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","06-2007","","The Multi-sectoral Zero Malnutrition Programme focuses on children under the age of five, with a particular emphasis on children under two years of age, and, in its activities, it assigns priority to working with municipalities with a high degree of vulnerability to food insecurity. The program is a multi-sectoral effort and one of the most important challenges facing the current administration.
Bolivia has a population of 10 million people.
","http://www.imtf.org/blog/2008/06/12/bolivia-zero-malnutrition; http://webapps01.un.org/nvp/indpolicy.action?id=1262 http://www.sns.gob.bo/aplicacionesweb/pmdc1/index.php
","","","","","","","","","Australian Agency for International Development (AUSAID)","","","","","","","","","","","","65.157.257(2007-2011)","Bilateral and donor agencies and lenders","Other","Belgium| Canada| France","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6036","Maternal, infant and young child nutrition","Baby-friendly Hospital Initiative (BFHI)","Strengthened management capacity at the national and departmental health services network","","","Adult men and women","all","La Paz","Primary health care center|Other","structural level - departemental and municipal governments","Strengthened management capacity at the national and departmental health services network to provide comprehensive nutritional care including prevention of prevalent illnesses in women, newborns, and children under 5
","Prioritized municipalities have Comprehensive Nutrition Units (CNU/UNI) and comply with quality standards.- First-level health facilities provide comprehensive care to children under age 5 according to IMCI-Nut standard.- Children under age 2 with diagnosis of low tall receive Zinc.- Mother-Child hospitals complying with the Mother and Child Friend Hospitals Initiative 11 steps.- Lethality in Children under age 5 with severe acute malnutrition attended in reference hospitals.
","in process for the report of this year.
","","","","","","None","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6034","Desnutrición Cero","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","06-2007","","The Multi-sectoral Zero Malnutrition Programme focuses on children under the age of five, with a particular emphasis on children under two years of age, and, in its activities, it assigns priority to working with municipalities with a high degree of vulnerability to food insecurity. The program is a multi-sectoral effort and one of the most important challenges facing the current administration.
Bolivia has a population of 10 million people.
","http://www.imtf.org/blog/2008/06/12/bolivia-zero-malnutrition; http://webapps01.un.org/nvp/indpolicy.action?id=1262 http://www.sns.gob.bo/aplicacionesweb/pmdc1/index.php
","","","","","","","","","Australian Agency for International Development (AUSAID)","","","","","","","","","","","","65.157.257(2007-2011)","Bilateral and donor agencies and lenders","Other","Belgium| Canada| France","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6037","","Nutritional surveillance system","","","","All population groups","","","Community-based","","Strengthened nutritional surveillance capacity at national, departmental, health facilities network and community level","Sentinel municipalities submit information regarding acute and chronic malnutrition to the National Health Information System.- (Municipalities providing acute and chronic malnutrition information according to Program regulations.- Prioritized municipalities submit community nutritional surveillance information to the NHIS/SNIS.","in process for the report of this year.","","","","","","None","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6039","Chispitas program","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","01-2006","","Ferrous sulfate syrup has been the major source of iron supplementation until 2006 for the Bolivian children. Although not documented in a systematic fashion, it was generally accepted in the country that acceptance of the syrup was low due to taste and frequently reported side effects. This and the persistently high prevalence of anemia provided the case for seeking alternative approaches to micronutrient supplementation. Stressing the importance of anemia prevention and control among children 6-59 months of age in Bolivia, the Pan American Health Organization (PAHO) and the Micronutrient Initiative (MI) proposed to the Ministry of Health and Sports (MSD) to replace syrup with Micronutrient powder (MNP) at the national level. The free distribution of MNP in Bolivia was integrated into the Desnutricion Cero (Zero Malnutrition) program, an integrated strategy to combat malnutrition in Bolivia, launched by the Morales government in 2006. The Centro de Abastecimiento de Suministros de Salud (CEASS), a national procurement agency for the MSD managed the distribution of the sachets to all 9 departments on behalf of the MSD.
","","","","Health","Ministry of Health and Sport/ Nutrition unit","","","","","","","","","","","","","","","","","Municipalities purchase directly from the manufacturers at prices ranging from 14.50Bs (US$2.07) to 15Bs (US$ 2.15) for a box of 60 sachets.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6038","Iron and/or folic acid","Iron supplementation","","","","Infants and young children","6-23 months","N/A","Commercial|Primary health care center","Free distribution through the government’s universal health care program, Seguro Universal Materno Infantil (SUMI).","Each child is provided with 60 Chispitas sachets every year. Caregivers are recommended to provide one sachet everyday for 60 days to their children.
","Anemia prevalence
","Both qualitative and quantitative information were collected from three different sources to evaluate diverse aspects of the implementation of the Chispitas program with an objective to:1. Asses efficiency of logistics systems management across different departments and health districts,2. Assess the acceptability of Chispitas by the caregivers across urban and rural areas, and 3. Know the adequacy of Chispitas preparation by caregivers. An external evaluation was done by the Asociacion de Instituciones de Promocion y Educacion (AIPE), a private firm, to achieve the first three objectives using the program monitoring data and external survey data in 2008. In addition, a workshop was conducted in September 2009 by researchers from Cornell University, MI and MSD to review the Chispitas program and provide feedback to further strengthen it. Later in 2010, a study was conducted provide data to develop a communications strategy by a private firm (TICs Communications) contracted by MI, and allow a comparison post-implementation (focus groups were also conducted). All studies/reviews only looked at the program from the public health system distribution point of view. The 2010 TICs study collected data from households and public health centers in both rural and urban municipalities in Bolivia, in each of the 9 departments of the country. The sample sizes are not large enough however to be nationally representative.
","400000 (50%)","N/A","","","","None","","Intermittent iron supplementation in preschool and school-age children>>>Intermittent iron supplementation in preschool and school-age children>>http://www.who.int/elena/titles/iron_infants","Staff skills/training","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Staff retention","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Adherence","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Supplies","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","","","","","","","","","","","","","","Inclusion of Chispitas in the Desnutricion Cero strategy strengthened nutrition policy and dialogue in Bolivia generally and the Chispitas distribution program took advantage of that for immediate national implementation. Smaller scale implementation initially with good quality monitoring may have facilitated the identification and timely resolution of problems related to supply, knowledge, acceptance and utilization. The decision to immediately implement at scale diverted financial and human resources from these necessary start-up activities and left little room for the in-depth monitoring required for the timely identification and resolution of problems with the program design and barriers to appropriate implementation. Because of the national scale of the program, implications and problems need to be identified and potential solutions explored at large scale, resulting in complexities and delays in the public health systematical ability to do so.The legal framework, i.e., change of the regulation and inclusion of Chispitas in the insurance commodity package was an important step towards national implementation of the program.
","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6042","Maternal, infant and young child nutrition","Breastfeeding promotion and/or counselling","","","","Women of reproductive age (WRA)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Train health 69 staff in lactation management, including HIV in relation to breastfeeding; 2. Support the formation of 95 mother-to-mother support groups and men’s groups; 3. Support assessment and designation of 6 facilities as Baby Friendly Health Institutions (BFHI); 4. Support follow up of HIV infected mothers through mother-to-support groups and CBSV to maintain exclusive breastfeeding and monitor nutritional status and growth of the infants; 5. Train HIV infected mothers on breastfeeding techniques to decrease risk of breat inflammation that may increase HIV transmission; 6. Intensify nutrition and health education at facility and community levels monthly
","% of children 0-6 exclusively breastfed in the previous 24 hours. % of infants fed mothers' milk within 1hour after birth % ofchildren(12-23mos) exclusively breastfed for 6 months
","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","79 communities with a total population of 77, 780 children under-five years of age and 19,445 pregnant women living in an area with a population of 388, 902 people and an estimated 64,817 households are benefiting from project interventions.","Missing","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","Staff skills/training","Project and GHS staffs have received training in lactation management. ","Insufficient staff","We have continued to advocate for increased numbers for the beneficiary districts. To meet this gap capacities of Mother-to-mother Supports Groups(MtMSGs),Traditional Birth Attendants(TBAs) and Community Based Surveillance Volunteers(CBSVs) been built to support the action. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this challenge. ","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","Adherence","The slow adoption of appropriate feeding practices by caregivers remains a challenge. Community level education has therefore, been intensified to address the situation.","Financial resources","Government's financial support to District Health Management Teams (DHMTs) is sometimes delayed and this affects the smooth implementation of project interventions.","","","","","","","","","","","","","I have observed that grandmothers' and men's involvement in the action implementation is critical. In some communties for instance, father-to-father support groups have been formed to support the action. Capacity building for groups such as CBSVs, MtMSGs, TBAs, women's and men's groups, faith-based organizations(FBOs) etc at the community could contribute immensely to project outcomes.
","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6044","","Complementary feeding promotion and/or counselling","","","","Women of reproductive age (WRA)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Train 105 GHS staff and CBSVs in Community Based Growth Promotion (CBGP) 2. Institute CBGP in 15 poor and hard to reach communities including visits to OVCs under 5 to make sure these children go for growth monitoring3. Train 60 GHS, World Vision staff in Infant and Young Child Nutrition counselling4. Provide equipment for growth monitoring and counseling5. Carry out quarterly food demonstration sessions including low-labour nutritious meals that can be prepared/managed by mothers who are ill in communities using nutrient and energy dense locally available foods 6. Intensify monthly nutrition and health education for mothers and other caregivers, including appropriate messages for HIV+ve mothers through CBSV, CCC and health staff","% of children< 2 years underweight % of children 12-23 months who are still breastfeeding % of sick children 6-59 month who received increased fluids and continues feeding during an illness in the last 2 weeks % of children 6-59 month attending growth promotion sessions at least once every 3 months % of children 6-59 months who ate solid or semi-solid food at least the minimum recommended no. of times 24hrs preceding survey","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","89447","","","Conducted","Midterm evaluation has been conducted and results are being analysed.","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","Staff skills/training","Project and GHS staffs have received training in lactation management. ","Insufficient staff","We have continued to advocate for increased numbers for the beneficiary districts. To meet this gap capacities of Mother-to-mother Supports Groups(MtMSGs),Traditional Birth Attendants(TBAs) and Community Based Surveillance Volunteers(CBSVs) been built to support the action. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this challenge. ","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","Adherence","The slow adoption of appropriate feeding practices by caregivers remains a challenge. Community level education has therefore, been intensified to address the situation.","Financial resources","Government's financial support to District Health Management Teams (DHMTs) is sometimes delayed and this affects the smooth implementation of project interventions.","","","","","","","","","","","","","Cultural barriers could impede the action as mothers/caregivers who have acquired knowledge and are willing to feed their children appropriately could be prevented from doing so.","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6045","","Management of moderate malnutrition","","","","Infants and young children","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based","","1. Purchase vegetable seeds and citrus seedlings2. Distribute vegetable seeds and seedlings to households and groups3. Purchase small animals 4. Distribute small animals to households and groups5. Train beneficiaries in the raising of small animals and crop production techniques6. Support the processing of vegetables materials)7. Produce/adapt & distribute IEC materials8. Carry out community education on animal husbandry and crop production","% of households producing fruits for their own consumption% of households producing vegetables for their own consumption% of households growing and using nutrient-dense drought-tolerant crops for their food sources e.g. cowpeas, green grams, groundnuts etc% of household rearing and using one or more type of high protein animal/poultry based foods sources eg. Chicken, fish etc.% of households practicing food preservation techniques% of women controlling some household resources e.g. animals, land etc","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","2400","","","Conducted","Midterm evaluation has been conducted and results are being analysed.","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","Financial resources","Government's financial support to District Agriculture Development Unit is sometimes delayed and this affects the smooth implementation of project interventions. We continue to advocate for timely disbursement of funds.","Adherence","","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","","","","","","","","","","","","","","","Although, households with children under-five in particular are targeted, the provision of inputs has been demand-driven. Consquently, the response by households has not been at the level expected.","Continuous community level education by Agriculture Extension Agents (AEAs) has, however, brought about improvement in the implmentation of the action. Land availability for home gardening activities is a challege in some communities. Group garden activities are therefore being considered. ","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6046","Acute malnutrition","Growth monitoring and promotion","","","","Infants and young children","0-59months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1.Support monthly growth monitoring2.Train 105 GHS staff and CBSVs in Community Based Growth Promotion (CBGP) 3.Institute CBGP in 15 poor and hard to reach communities including visits to OVCs under 5 to make sure these children go for growth monitoring","% of boys and girls underweight (WAZ<-2) % of children 6-59 month attending growth promotion sessions at least once every 3 months","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Supplies","","Stakeholder","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6047","Stunting","Vaccination","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Support GHS in increasing immunization coverage among children < 5 years2. Support GHS in carrying out follow-ups on IMNCI activities at health facility and community levels3.Produce/adapt and distribute IEC materials on vaccine preventable diseases4.Carry out education on vaccine preventable diseases in communities
","% of children12-23 months fully immunized
","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Supplies","","","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6048","Acute malnutrition","Oral rehydration solution promotion","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Purchase ORS2. Distribute ORS to CBSVs and health facilities 3. Support GHS in providing quality treatment to children with diarrhoea5.Train GHS and World Vision Staffs in IMNCI4. Support GHS in carrying out follow-ups on IMNCI activities at health facility and community levels5.Produce/adapt and distribute IEC materials on control of diarrhea6.Carry out education on environmental sanitation and personal hygiene in communities","1.% of children with diarrhoea in the previous 2 weeks(or last episode of diarrhoea) who received ORT 2. % of health facilities(or alternative access point) with no stock out for ORT in the previous three months","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Adherence","","Stakeholder","","","","","","","","","","","","","","","","","Mothers/caregivers have difficulties continuing feeding as well as increasing the amount of fluids given their children during illness.","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6049","Acute malnutrition","Distribution of insecticide-treated bednets","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Purchase LITNs2. Distribute LITNs to children under five years and pregnant women3. Support GHS in carrying out follow-ups on IMNCI activities at facility and community level4. Produce/adapt and distribute IEC materials on malaria5. Carry out education on malaria control in communities","% of children Under five sleeping under an LLITN the previous night% of pregnant women who slept under an LLITN the previous night","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","7,460 (children 0-59 months), 2615 PWs","","","Conducted","Midterm evaluation conducted and results are being analysed","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","Adherence","Community level education to encourage households to sleep under insecticide-treated bednets has been intensified.","","","","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6050","","Vitamin A supplementation","","","","Infants and young children","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1.Through monthly routine EPI2. Bi-annual spplementation
","% of children 6-59 months who received vitamin A capsules in previous 6 months
","1.Key performance indicator was baselined to establish coverage at the beginning of the project.2.Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders.3. Midterm and Endterm project evalutions will be conducted.
","","","","","","Vulnerable groups","","Vitamin A supplementation in infants and children 6–59 months of age>>>Vitamin A supplementation in infants and children 6–59 months of age>>http://www.who.int/elena/titles/vitamina_children","Insufficient staff","Insufficient staffing levels of partner institutions particularly of Ghana Health Service(GHS) remains a challenge. We have continued to advocate for increased numbers for the beneficiary districts. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this gap.Occassional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has beed encouraged.","Infrastructure","We have poor roads linking most communities. There are ,however,plans by District Assemblies to improve road infrastructure. Insuffient staffing levels of partner institutions particularly of Ghana Health Service(GHS) remains a challenge. We have continued to advocate for increased numbers for the beneficiary districts. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this gap.Occassional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has beed encouraged.","Supplies","Occasional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has been encouraged.","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6051","Acute malnutrition","Preventive malaria treatment","","","","Pregnant women (PW)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Carry out education on malaria control in communities2.Support education to increase proportion of pregnant women accessing IPT service at health facilities","% of women who received two doses of SP during last pregnancy","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","19445","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Adherence","","","","","","","","","","","","","","","","","","","","","","","English" "6067","Integrated Nutrition Package","English","Community/sub-national","","LKA","Sri Lanka","Sri Lanka","Urban| Rural| Peri-urban","on-going","01-2009","01-2013","a) Prevalence of low birth weight reduced by 4 percentage point from 2006 level; b) Prevalence of underweight among children under 3 years of age reduced by 30%; c) Mean weight gain during pregnancy increased by 30 per cent from basline data to be established in 2009; d) Nutritional anaemia among children 6 to 24 months reduced by 30 per cent; e) Nutritional anaemia among adolescent reduced by 30 per cent;
","www.mri.gov.lk/nutrition
","","","","","","","","","","","","","National NGOs","Sarvodaya","","","","","","","Mainly by the UNICEF and shared with the Government, Ministry of Health","UN","United Nations Children's Fund (UNICEF)","Every other week for 4 months - 1 sachet per time
","Percentage of children 6 to 24 months with nutritional anaemia
","Quarterly and bi-annual review meetings at the district, provincial and national levels; External reviews at the mid-point of the project implementation; Final evaluation: During this phase, data will be collected and compared with baseline information. The same data collection techniques and instruments will be followed as in the baseline. The same group of interviewers will be re-trained before data collection and their work will be supervised at community level.
","","30.00%","","25%","not completed
","Sex","","","Adherence","","Supplies","","Communication","","","","","","","","","","","","","","","","","Very good coverage of the programme with poor adherence continously. Mid term review did not show much improvement
","Sri Lanka is having mild anaemia with very less moderate and hardly any severe anaemia. MMN was tested globally in moderate to severe set up. This may be the reason we did not see much improvement compared to other countries.
","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6073","Maternal, infant and young child nutrition","Breastfeeding promotion and/or counselling","","","","Women of reproductive age (WRA)","","Doha","Hospital/clinic|Media|Primary health care center","","Regular counselling during antenatal care clinic; establish a friendly baby hospital initiatives; develop a clear guidelines for breast feeding in Qatar in collaboration with WHO/EMRO","Number of health sectors applying breastfeeding programs. Percent of infants exclusively breastfed for the first 6 months of life. Percent of children with continued breastfeeding for up to 1 year.","Regular monitoring of the process through collecting data from the well baby clinic regarding feeding practices; develop a research regarding KAP about breast feeding in Qatar in collaboration with academic institution.","","","","","","","","","Staff skills/training","","","","","","","","","","","","","","","","","","","","Lacking awareness about importance of breast feeding","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6075","","Complementary feeding promotion and/or counselling","","","","Lactating women (LW)","","Doha","Hospital/clinic|Media|Primary health care center","","Regular counselling in well baby clinic to women by a nutritionist; distribute educational materials in ante-natal care clinic & well baby clinic; establish working group education in primary health care & women clubs","Number of nutritionists available per primary health care center. Percent of mothers referred to nutrition counseling during pregnancy.percentage of children growing within the 50 percentile.","Regular monitoring of the process through collecting data from the well baby clinic regarding feeding practices; develop a research regarding KAP about breast feeding in Qatar in collaboration with academic institution.","","","","","","","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","Insufficient staff","Recruit more nutritionists in PHC","Staff skills/training","Training of the staff working in well baby clinic on how to counsel the women","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6076","Overweight and diet-related NCDs","Nutrition education and counselling","","","","All population groups","","Doha","Community-based|Hospital/clinic|Kindergarten/school|Media|Primary health care center","","Comprehensive media campaign about healthy nutrition by all media channels; regular screening of population in PHC and provide appropriate counselling for high risk group; awarness through school sitting about healthy nutriton appropriate counselling in hospitals and clinics for special cases by expert nutritionists or dietitions.","Formative research on public knowledge about the importance of healthy eating. Social marketing campaign conducted. Number of media channels involved in the campaign out of total available.","Through different types of research","","","","","","Vulnerable groups|Sex|Socio-economic status","","","Insufficient staff","","Staff skills/training","","","","","","","","","","","","","","","","","","","expert Health communication companies to lead the media awareness campaign","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6077","Overweight and diet-related NCDs","Nutrition education and counselling","","","","School age children (SAC)","from 3 to 18 years old","Doha","Kindergarten/school","","Introduce nutrition in school curriculum","Percentages of schools that introduce the curriculm.","Review the schools curriculum","","","N/A","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6078","Overweight and diet-related NCDs","Promotion of fruit and vegetable intake","","","","All population groups","","Doha","Commercial|Community-based|Media","","Provide more fruit & vegetables in the schools, universities & work places cafeteria; comprehensive media campaign through all channels; increase advertisments regarding healthy meals; start food labelling of menus in restaurants","","STEPwise survey conducted. National nutrition surveillance system established.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6079","Overweight and diet-related NCDs","Promotion of reduced fat intake (total, saturated, trans)","","","","All population groups","","Doha","Community-based|Kindergarten/school|Media","","Percentages of schools that introduce the curriculm; comprehensive media campaign; food labelling introduce a policy regarding banning of trans fat.","Declare of the policy; number of media campaigns; introduce food labelling","Implement the policy; STEPwise survey; nutrition survey","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6080","Overweight and diet-related NCDs","Salt reduction","","","","All population groups","","Doha","Commercial|Media","","Policy to stop high salted products; comprehensive media campaign; food labelling
","Declare the policy; decrease the prevelance of high blood pressure
","Implement the policy; STEPwise survey; nutrition survey
",".",".","","","","Other","","eLENA titles related to sodium reduction>>>Reducing sodium intake to control blood pressure in children>>http://www.who.int/elena/titles/sodium_bp_children|Reducing sodium intake to reduce blood pressure and risk of cardiovascular diseases in adults>>http://www.who.int/elena/titles/sodium_cvd_adults","","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6081","","Growth monitoring and promotion","","","","Infants and young children","","Doha","Hospital/clinic|Kindergarten/school|Primary health care center","","By implementing the new growth monitoring chart","Number of trainings on growth monitoring and basic nutrition conducted.","Percentages of health care sectors implement the new growth monitoring chart","","","","","","","","","Staff skills/training","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6082","Overweight and diet-related NCDs","Implementation of legislation on marketing of unhealthy foods and beverages to children","","","","School age children (SAC)","","Doha","Community-based","","Introduce a policy","Establish the policy; percentages of schools providing healthy snacks","Regular monitoring of the snacks provided to children in the schools","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6074","National nutrition & physical activity action plan","English","National","","QAT","Qatar","Doha, Qatar|Al Wakrah, Qatar|Lusail, Ad Dawhah, Qatar","Urban","on-going","04-2011","04-2016","The national nutrition and physical activity action plan is comprehensive plan of action that contain eight area of actions:
ᅠ
","","","","Urban planning","","","","","","","","","","","","Research/academia","Qatar University & Rand","","","","","","Government","Health","","Government","Education and research","","Government","Sport","","Government","Urban planning","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6083","Overweight and diet-related NCDs","Labelling of food products","","","","All population groups","","Doha","Commercial","","introduce food labelling on both products & resturants level","Food labelling introduced; percentages of products labelled; percentages of resturants implemented","Collect data regarding all restaurants through Ministry of municipality; checking the products in supermarkets","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","English" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6084","Acute malnutrition","Iron and folic acid supplementation","","Folic acid|Iron","","Women of reproductive age (WRA)","15-45 years","Yen Bai province","Primary health care center","","Weekly iron-folic acid tablets; 200mg ferrous sulphaet/0.4 mg folic acid
Deworming every 4 months with one albendazole tablet (400 mg) in the first year and 6-monthly thereafter
","Anemia prevalence
","Periodical prevalence surveys and compliance monitoring by the research and training centre for community development.
","52000 (In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.)","missing","","STH infection 75%","(after 30 months) STH infection 22%","Vulnerable groups","","Intermittent iron and folic acid supplementation for menstruating women>>>Intermittent iron and folic acid supplementation for menstruating women>>http://www.who.int/elena/titles/iron_women","Adherence","Independent monitoring started early to be able to modify training and packaging","Financial resources","No solution","","","","","","","","","","","","","","","","","","","In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","English" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8875","","Deworming","","","","Women of reproductive age (WRA)","15-45","Yen Bai ","Community-based","","","Hookworm prevalence
","","250000","missing","","","","Vulnerable groups","","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" "6087","Alive & Thrive","English","Multi-national","","BGD|ETH|VNM","Bangladesh|Ethiopia|Viet Nam","Bangladesh|Ethiopia|Viet Nam","Urban|Rural|Peri-urban","on-going","01-2010","01-2013","Alive & Thrive (A&T) is a 6-year initiative (2009-2014) to improve infant and young child nutrition by increasing rates of exclusive breastfeeding and improving complementary feeding practices. The goal is reductions in mortality and stunting. A&T aims to reach more than 16 million children under 2 years old in Bangladesh, Ethiopia, and Viet Nam through household, community, health facility, and mass media interventions. The objectives are to: create delivery models in three distinct learning environments that improve IYCF practices at scale and can be replicated in other parts of the world; document impact, cost, and cost-effectiveness of IYCF interventions; foster innovation through a grants program; and disseminate learnings from A&T models, innovations, operations research, and evaluations.
","It has publications, program descriptions, tools, stories, videos, and other resources.
","8329|8281|8003","","","","International Food Policy Research Institute (IFPRI)","","","","","","","","","","Research/academia","University of California-Davis: oversees the small grants program and lends technical support","Private sector","GMMB: provides advocacy, communications, and public affairs expertise","","","$78.6 million","Bilateral and donor agencies and lenders","Bill and Melinda Gates Foundation","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6086","","Breastfeeding promotion and/or counselling","","","","Infants and young children","Infants and children under 2 years","four most populous regions (and the chartered cities) in more than 360 districts ","Community-based|Media","","Strategy 1. Policy dialogue
Policymakers often fail to recognize the impact of poor feeding practices on infant survival, educational potential, and economic development. The result is a lack of investment in interventions to reduce undernutrition and the absence of supportive legislation and policies.
Action plan
Strategy 2. Service delivery and behavior change communication
Alive & Thrive (A&T) applies well-tested marketing principles to improve IYCF practices.
Action plan
Strategy 3. Fortified complementary foods and related products
Many local diets fail to meet the nutritional requirements of children 6-24 months old. The private sector can help by producing and marketing affordable fortified products.
Action plan
Stunting/HAZ; Core WHO IYCF indicators; Early initiation of breastfeeding; Exclusive breastfeeding under 6 months; Continued breastfeeding at 1 year; Introduction of solid, semi-solid or soft foods; Minimum dietary diversity; Minimum meal frequency; Minimum acceptable diet; Consumption of iron-rich or iron-fortified foods; Anemia (Bangladesh only)
","A&T aims to document impact, cost, and cost-effectiveness of IYCF interventions and generate learning on how to achieve and replicate the projectメs impact.
Action plan
Alive & Thrive (A&T) is a 6-year initiative (2009-2014) to improve infant and young child nutrition by increasing rates of exclusive breastfeeding and improving complementary feeding practices. The goal is reductions in mortality and stunting. A&T aims to reach more than 16 million children under 2 years old in Bangladesh, Ethiopia, and Viet Nam through household, community, health facility, and mass media interventions. The objectives are to: create delivery models in three distinct learning environments that improve IYCF practices at scale and can be replicated in other parts of the world; document impact, cost, and cost-effectiveness of IYCF interventions; foster innovation through a grants program; and disseminate learnings from A&T models, innovations, operations research, and evaluations.
","It has publications, program descriptions, tools, stories, videos, and other resources.
","8329|8281|8003","","","","International Food Policy Research Institute (IFPRI)","","","","","","","","","","Research/academia","University of California-Davis: oversees the small grants program and lends technical support","Private sector","GMMB: provides advocacy, communications, and public affairs expertise","","","$78.6 million","Bilateral and donor agencies and lenders","Bill and Melinda Gates Foundation","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6088","Acute malnutrition","Promotion of improved hygiene practices including handwashing","","","","Infants and young children","","","Community-based|Media","","Home visits during pregnancy and first 2 years of life","Stunting/HAZ; Core WHO IYCF indicators; Early initiation of breastfeeding; Exclusive breastfeeding under 6 months; Continued breastfeeding at 1 year; Introduction of solid, semi-solid or soft foods; Minimum dietary diversity; Minimum meal frequency; Minimum acceptable diet; Consumption of iron-rich or iron-fortified foods;Anemia (Bangladesh only)","Baseline and endline surveys, qualitative research, process evaluations, special studies, routine monitoring, site surveillance","Intended total reach in 3 countries through community-based activities and mass media: 16 million households with children <2 years","","","Exclusive breastfeeding: Bangladesh 50%; Ethiopia 72%; Viet Nam 19; Stunting: Bangladesh 51%; Ethiopia 56%, Viet Nam 24% ","","","","Water, sanitation and hygiene interventions to prevent diarrhoea>>>Water, sanitation and hygiene interventions to prevent diarrhoea>>http://www.who.int/elena/titles/wsh_diarrhoea","","","","","","","","","","","","","","","","","","","","","","","","English" "6098","Labelling of foods with nutritional information","English","Other","","TUN","Tunisia","Tunisia","Urban|Rural|Peri-urban","planned","","","Food labelling including nutritional information has been specified by a decree issued on September 2008 by the Ministry of Public Health, the Ministry of Trade and Handicrafts and the Ministry of Energy and Small and Medium Enterprises. Educate consumers to read food labels before buying in order to make healthy choice is an action included in the national strategy to combat obesity and promote healthy life. Ministry of public health and representatives from all relevant government institutions, and private sector are partners in this programme.
","WHO Global Nutrition Policy Review 2009-2010, Module 6, Id:195, Respondent: Pr Jalila EL ATI National Institute of Nutrition and Food Technology 11 rue Jebel Lakhdar - Bab Saadoun 6 1007 Tunis, Tunisie
","","","","","","","","","","","","","","","","","","","","","Not yet available.","Government","","Food labelling including nutritional information has been specified by a decree issued on September 2008 by the Ministry of Public Health, the Ministry of Trade and Handicrafts and the Ministry of Energy and Small and Medium Enterprises. Educate consumers to read food labels before buying in order to make healthy choice is an action included in the national strategy to combat obesity and promote healthy life. Ministry of public health and representatives from all relevant government institutions, and private sector are partners in this programme.
","WHO Global Nutrition Policy Review 2009-2010, Module 6, Id:195, Respondent: Pr Jalila EL ATI National Institute of Nutrition and Food Technology 11 rue Jebel Lakhdar - Bab Saadoun 6 1007 Tunis, Tunisie
","","","","","","","","","","","","","","","","","","","","","Not yet available.","Government","","the school nutrition programme is to ensure that all school aged children have access to nutritious foods and beverages whilst on the school compound.
","","","","","","","","","","","","","","","","","","","","","","A costed plan of action is being developed to support implementation of the policy","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6106","","School feeding programmes","","","","School age children (SAC)","","","Community-based","","","number of schools fully implementing the policy
","","all schools","Approx. 15%","","","","None","","","Insufficient staff","","Staff skills/training","","Adherence","","","","","","","","","","","","","","","","","","","English" "8816","Developing Village-based Advisors to improve food Security ","English","National","","KEN","Kenya","Siaya, Kenya|Busia, Kenya|Embu, Kenya|Kitui, Kenya|Machakos, Kenya|Makueni, Kenya","Rural","on-going","01-2012","01-2017","The Village-based Advisors Food Security project is improving productivity by promoting good farming practices among smallholder farmers, with the larger goal of increasing their food security and resilience to environmental shocks. The project identifies keen, hard-working farmers at the village level and develops them into モagro-entrepreneursヤ, called Village-based Advisors who provide inputs (such as improved seed), services (such as livestock vaccination) and advice on good farming practices to their community. These micro-businesses offer the double benefit of creating rural employment opportunities and building a sustainable system for delivering agricultural technologies.
The project is part of the U.S. Global Hunger and Food Security Initiative, also known as モFeed the Futureヤ, which seeks to address the root causes of hunger and poverty and create conditions where food assistance is no longer necessary. ᅠ
","http://kenya.usaid.gov/programs/economic-growth/1272
","","","Other","Farm Input Promotions Africa (FIPS-Africa)","","","","","US Agency for International Development (USAID)","U.S. Global Hunger and Food Security Initiative, also known as モFeed the Futureヤ","","","","","","","","","","","USD 2,000,000.00","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","The project is working to mitigate the negative effects of climate change on Kenyaメs smallholder farmers by increasing their use of improved varieties of crops and inputs like fertilizer; building their understanding of and ability to implement good soil and water management techniques, and providing better access to poultry vaccination.
The model relies on the use of モVillage-based Advisorsヤ (VBAs) who earn an income through the provision of improved inputs, advice and services to their fellow farmers. Unlike traditional group-based approaches, VBAs have a target to work with every farmer in their community, meaning thousands of farmers can be reached quickly and cost-effectively. The project builds on the entrepreneurialism and community spirit common among smallholder farmers.
FIPS-Africa is a pioneer of the ムsmall packメ approach ヨ where inputs such as seed are distributed to farmers in small quantities. This allows farmers to experiment on their own farm at a low cost and with minimal risk. Farmers are more likely to adopt if they have seen something work first.
","xx
","By June 2012, the project had trained over 100 VBAs who distributed over 34,000 small packs of seed of improved varieties of key staple crops to farmers and established nearly 4,000 multiplication sites for drought tolerant root tuber crops.","ByMarch 2013, the following additional achievements are expected: 1,800 demonstration plots for improved soil and water management or seed priming established 9,000 households growing improved varieties of root tuber crops; 56,000 more small p","Period","Local food production and consumption levelsFood import and export ratesRates of undernutitionRates of people living &lt; $1/day","Local food production and consumption levelsFood import and export ratesRates of undernutitionRates of people living < $1/day","Socio-economic status","","","Staff skills/training","","Infrastructure","","","","","","","","","","","","","","","","","","","The long drought of 2009 hit both people and ecosystems hard, putting millions of Kenyans on food relief and killing large numbers of animals. However, this environmental stress also dramatically highlighted the payoffs of improved natural-resource management. Over 750,000 hectares of semi-arid woodland and rangeland - brought under improved management thanks to USAID and partners - showed no decline in ecological condition despite the drought. The condition of some areas even improved
","Dorcas Nyangasi of Emuhaya is 22-years-old and successfully self-employed. Like many young people in rural areas, Dorcas had trouble finding work when she finished school: モMy mother thought I was depressed because they could not afford my college, or lonely because most of my friends were leaving the village. But the real reason was that I needed something to do.ヤ
Dorcasメs life was transformed when Farm Input Promotions-Africa (FIPS-Africa) trained her to be a Village-based Advisor (VBA), providing agricultural inputs, services and advice on good farming practices to smallholder farmers in her village. ᅠAs well as distributing seed, Dorcas sells vegetable and tree seedlings from her nurseries and vaccinates poultry against Newcastle disease, which used to devastate local flocks. ᅠAfter two-and-a-half years of being her own boss, Dorcas has more than 2,000 farmers buying her inputs and services. She explains, モwithin the first four months I noticed that I could make more money when I approached more farmers, so I expanded my operations to three more villages.ヤ
Dorcasメ hard work is not only improving her own livelihood ヨ it helps the other farmers in her community too. モI am happy because I have helped my village rise above the problem of hunger, there is poultry in abundance, and we have surplus sweet potatoes and cassava to sell,ヤ she says.
","English" "8907","Suplementacion con Hierro y Acido Folico a Embarazada y Puerperas","Spanish","National","","GTM","Guatemala","Guatemala","Urban|Rural|Peri-urban","on-going","","","Entrega de tabletas de hierro y acido folico a mujeres embarazadas y puerperas
","","","Plan Hambre Cero","Health","Direcciones de Areas de Salud y su red de servicios","","","","","","","","","","","","","","","","","El costo de la tableta de Hierro es de Q0.12El costo de la tableta de Acido Folico es de Q0.18Se entregan 52 tabletas al año por mujer de hierro y acido folico","Government","Finance","A travéz del presupuesto del Ministerio de Salud Publica y Asistencia Social","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8906","","Iron and folic acid supplementation","","Folic acid|Iron","Tableta de Sulfato Ferroso y tableta de acido folico","Pregnant women (PW)","Mujeres embarazadas y puerperas","Guatemala","Hospital/clinic|Primary health care center","","Se entregan 52 tabletas de hierro y 52 tabletas de acido folico por año mujer
13 tabletas de cada una de forma trimestral para que la mujer consuma una tableta a la semana.
","Numero de embarazadas y puerperas con entrega de hierro y acido folico * 100
Numero de embarazadas y puerperas
","A travéz del registro en el Sistema de Información Gerencial en Salud -SIGSA-
","90,491","90%","Period","Mujeres embarazadas y puerperas con entrega de hierro y acido folico","Mujeres embarazadas y puerperas suplementadas con hierro y acido folico","Vulnerable groups","","","Adherence","","","","","","","","","","","","","","","","","","","","","","","Spanish" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","While Tanzania has achieved high vitamin A supplementation coverage over the past few years, there is concern that this achievement is fragile because of decentralization. A2Z is supporting national, zonal, regional, and district health teams to institutionalize twice-yearly distributions through ongoing advocacy and routine planning and budgeting. This activity is conducted in collaboration with the National Program for Extension of Tools and Strategies, the Tanzania Essential Health Interventions Project, Ifakara Health Research and Development Centre, the Tanzania Food and Nutrition Center (TFNC), and UNICEF. To foster sustainable vitamin A supplementation, the A2Z project is supporting behavior change communication through community workers and a popular radio serial. Based on information gathered on sustainability indicators by TFNC with support of A2Z and HKI, those districts that have not yet integrated funding for vitamin A supplementation in their plans are receiving additional technical support. Several resources developed in Tanzania are available to ensure program sustainability.
","Given the twice-yearly nature of the VAS program as well as its historic evolution from immunization campaigns, it is easy for district staff to see the program as separate from their regular day-to-day work. Considering the program to be part of the routine work for the district is critical for sustainability, and is reflected in both attitudes and the support provided to the program. Ninety-one (76%) of the 119 districts regarded implementation of the twice-yearly VAS and deworming program to be a routine activity. About 84% considered VAS and deworming a very important service, and 99% thought the service should continue. Although the majority of the districts viewed VAS/deworming as a routine activity, more than half (55%) had not yet included VAS/deworming services in their routine supervision checklist. Moreover, payment of allowances to staff for VAS/deworming while at their normal duty stations implies that these services were viewed as special rather than routine. The allowance scheme in particular, with an excessive number of supervisors at some distribution sites and inadequate supervision at other sites, may increase a district’s vulnerability to a decline in coverage. Overall, 11 districts (9%) were judged vulnerable with low sustainability related to supervision and monitoring
","Those districts that have not yet integrated funding for vitamin A supplementation ","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Others, please specify below","For an activity to be sustained, it must be considered part of the district’s regular activities, and thus must be included in the annual planning process.","Management","The VAS program requires clear management for effective and efficient implementation, and thoughtful management also reflects the value placed on the program. Poor management may make the program vulnerable, and less likely to be sustained in an effective fashion.","Supplies","The VAS program depends on effective logistics, and capsule and promotional materials must reach distribution sites on time and in adequate quantities for the program to be effective. Poor logistics supply management makes the program vulnerable. Adequate communication between programs and departments within district councils facilitated effective use of available resources in 117 (98%) of the districts assessed.","Financial resources","Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.","Insufficient staff","Twice yearly VAS distribution involves extended outreach to communities, and thus requires significant mobilization of both health staff and community volunteers. Failure to plan for adequate human resources is likely to place districts at risk of not sustaining their coverage achievements.","","","","","","","","","","","","Planning
Districts should be encouraged to budget for the program in their own CCHP budget including the basket fund which is considered the most reliable source of funds. Once basket funds are planned, they cannot be reallocated
Advocacy and community ownership
The program is more likely to continue effectively if it is understood and valued by community members who are involved with planning and implementation.
Management and Leadership
Efforts should be made to protect the current best practices in management and leadership reported in most of the districts.
Logistics Supply
Key actors at the national level need to ensure timely procurement and delivery of supplies to the districts
Supervision and Monitoring
Districts should determine the appropriate number of site supervisors to contain costs and include VAS/deworming in the routine supervision checklist to ensure that children missed during the twice-yearly events are reached through “mop up” actions.
Advocasy and Community Ownership
The successful efforts to date should continue to build community ownership of the program through well-designed, regular sensitization meetings and advocacy to engage the community, mobilize participation, and raise the profile of VAS/deworming events.
Availability of Financial Resources
Ensuring adequate provision for the VAS/deworming program within the basket fund can improve the financial sustainability of the program.
Availability of Human Resources
Local councils and the central government need to fill staff positions and find secure mechanisms to ensure mobilization of adequate human resources to sustain service delivery.
Programme Effectiveness
Efforts should be made to maintain the high performance of the majority of districts and help the few low performing districts improve their coverage.
","","English" "11473","A2Z: The USAID Micronutrient and Child Blindness Project","English","Multi-national","","TZA","United Republic of Tanzania","Dar es Salaam, Tanzania","Urban|Rural|Peri-urban","completed","01-2006","01-2011","A2Z: The USAID Micronutrient and Child Blindness Project consolidates, builds, and expands on USAID's long-term investment in micronutrients, child survival, and nutrition. A2Z takes proven interventions to scale, introduces innovation, expands services, and builds sustainable programs to increase the use of key micronutrient and blindness interventions to improve child and maternal health. With work in vitamin A supplementation of children, newborn vitamin A, food fortification, maternal and child anemia control, monitoring and evaluation, and health systems strengthening, A2Z's focus countries have included Bangladesh, Cambodia, the East, Central and Southern Africa region, India, Nepal, Philippines, Tanzania, Uganda and West Bank.
","With advocacy from A2Z/HKI and other donors, the Government of Tanzania in December 2006 adopted a policy for the use of zinc for the treatment of diarrhea. A2Z/HKI provided technical support to the National IMCI coordinator to incorporate zinc therapy as part of diarrhea management and developed modified IMCI guidelines. Zinc treatment and low osmolarity solution oral rehydration salts (ORS) have been incorporated into the National Standard Therapeutic Guidelines. The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University. The formative research also tested the acceptability of zinc treatment for diarrhea among mothers and caretakers. The findings of the study are expected to be used to assist in the development of health worker training modules and behavior change communication materials for use by the Ministry of Health and Social Welfare and the community.
","Under-five mortality rate
","","","","","","","Vulnerable groups","","Zinc supplementation in the management of diarrhoea>>>Zinc supplementation in the management of diarrhoea>>http://www.who.int/elena/titles/zinc_diarrhoea","","","","","","","","","","","","","","","","","","","","","","The project facilitated formative research to learn about the health-seeking practices of the community around diarrhea by Ifakara Health Research and Development Centre and Johns Hopkins University.
","","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.
","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" "11489","Nutritional Improvement for children in urban Chile and Kenya (NICK) Project","English","Multi-national","","KEN","Kenya","Mombasa, Kenya","Urban","on-going","01-2010","01-2013","NICK (Nutritional Improvement for children in urban Chile and Kenya) is a three year study that started in October 2010 with funding from the UK Government Department for International Development (DFID) through the Economic and Social Research Council. This study helps the cities of Mombasa in Kenya and Valparaíso in Chile reduce child malnutrition using participatory action research to broaden stakeholder participation at municipal level to change the social determinants. These determinants control the everyday conditions in which people are living and include education, income, working conditions, housing, neighbourhood and community conditions, and social inclusion. It is envisaged that this study will contribute to existing knowledge and also serve as a useful guide for action not only in Kenya and Chile but also in other countries with high levels of child malnutrition.
The NICK project is being implemented in one Mombasa informal settlement (with one matched control settlement). The project, which started on October 1st 2010 and ends on September 30th 2013, is guided by the following central question: Can child malnutrition amongst families living in poverty in informal settlements and slums in Mombasa and Valparaíso be reduced through broadening community and stakeholder participation to change the social determinants of nutritional status?
The project seeks to address the following research questions:
Given the recognition that the determinants of child malnutrition are systemic and require multi-disciplinary concerted efforts to address, the Kenyan research team decided to explore ways of ensuring that the project is integrated into the national efforts that focus on child nutrition. The initial steps, therefore, involved holding discussions with the Nutrition Division in the Ministry of Public Health and Sanitation (MOPHS). During these discussions (in January 2011), it emerged that there are multiple efforts being put in place to strengthen interventions on child malnutrition and related problems among the urban poor. One such initiative was the proposed formation of Urban Nutrition Working Groups (UNWG).
The Kenyan NICK team considered that establishing an UNWG in Mombasa was critical entry point that would help to make NICK activities an integral part of local initiatives with a high possibility of sustainability. This UNWG would function as the participatory action research (PAR) group that was needed for the NICK Project. The team, therefore, sought the support of the national nutrition office to do the following:
Following the granting of permission to work with the Provincial Nutrition Officer, several meetings were held in Mombasa to plan for an initial meeting with local stakeholders to introduce the project and form a Participatory Action Research (PAR) group. The agreement was that the UNWG would also serve as the PAR group. The research group also met with Dr. Shariff,3 the Director of Medical Services, in the Ministry of Public Health and sanitation (MOPHS) who was supportive of NICK and emphasized the need for the project to enhance the implementation of national nutrition priorities. The team also met with members of the Kenya Food Security Steering Group (KFSSG) who had just completed a national survey on Urban Food Security.
The preparatory phase was also utilized to carry out literature reviews and interviews to consolidate the situational analysis. A research permit was acquired, which was granted by the National Council for Science and Technology. With this permit, the Kenyan research team was able to plan for the baseline survey.
(i) Formation of the Provincial Nutrition Technical Committee and UNWG
This meeting was held in Mombasa on April 29th 2011. It brought together 24 participants who were drawn from the participating government departments and other partners. During this meeting, the team agreed to form the Provincial Nutrition Technical Committee under the leadership of the Provincial Nutritionist. Thirteen members were also nominated to form the UNWG under the leadership of the District Nutrition Officer. The members were supportive of this group due to the potential to have a coordinated approach to addressing child nutrition in the region.
(ii) Conduct of the baseline survey
During the initial meeting, it was agreed that the UNWG would be involved in carrying out the baseline survey. As part of community service, the members agreed that anthropometric measurements would be done for every child up to 5 years in the two study sites of Chaani (intervention) and Kongowea (control). Over 900 children were weighed and measured. Data from children 12-59 months indicate higher than national averages for stunting, with Chaani worse off than Kongowea.
The KDHS indicates high levels of stunting and underweight in the Coastal Province.
A household baseline survey was conducted (between June and July 2011) during which over 800 households were interviewed. The main issues addressed were child nutrition, health seeking behaviour and coping mechanisms. Data analysis is ongoing. The Kenyan team is now facilitating the UNGWA through three 6-monthly cycle of action and reflection to develop, implement and improve a range of small scale multisectiorial action to change the social determinants of child undernutrition.
(iii) 1st UNWG/PAR workshop – July 2011
This was a three-day meeting that was attended by 16 participants including the London-based researchers. A follow-up meeting for the UNWG was held on 20th July during which the first multisectorial action plan was finalised.
(iv) Community level activities
Community sensitization is ongoing. The UNWG has held meetings with health officials and village elders in Chaani (the intervention site). A public meeting was held with the community members on 7th November 2011, which was attended by over 250 people. So far 17 formalized groups have been identified and the next steps are to assess the training and research needs of these groups. Support for this group, in the form of training and provision of seed funds will be initiated in January 2011.
","
","","","Over 800 households; Over 900 children","","Anthropometric measurements","","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","Others, please specify below","Competing interestsThe UNWG members are very busy with multiple responsibilities, which limits the amount of time they have for NICK activities, which are seen as not being directly part of their mandates. The implementation of national level campaigns, such as the polio campaign, interfered with planned programme activities.","Others, please specify below","Time constraints among Government officialsIt was difficult for the research team to interview the district level officers as key respondents for the baseline survey due to time constraints. Although some of them are interested in research they are hard pressed to put aside an hour for an interview.","Management","Managing expectationsIt has been difficult due to the low project budget. In Kenya, there is a tendency for officers to be given allowances when they attend meetings. Doing this would deplete the project budget completely. The research team has shared the project budget with the UNWG and an agreement has been reached to facilitate travel but not to provide ‘sitting allowances’ as a compromise.","Adherence","Balancing between studies and field activitiesCombining the field activities and the research activities of the extension research project on domestic violence and child undernutrition led to some delay in the implementation of community level activities and the 2nd PAR workshop. These activities will be initiated in earnest in January 2012. The PAR workshop will be held in February 2012","","","","","","","","","","","","","","
The current project implementation process introduces a different mechanism of working in partnership at the community level for the implementation partners. Although the project has experienced some challenges, the achievement to-date indicates that with more support and additional training, the UNWG is in a position to implement sustainable interventions to address the social determinants of child nutrition. The baseline survey tools that will be used at the end of the project will be a good measure of whether this approach will have borne the anticipated outcome of multiple implementers working together for the common good.
","","English" "11493","Strengthening Agricultural Technologies among People Living with HIV: Lessons Learned in the Border Towns of Busia, Kenya and Busia, Uganda","English","Multi-national","","KEN|UGA","Kenya|Uganda","Busia, Kenya|Busia, Uganda","Rural|Peri-urban","completed","01-2007","01-2008","The Food and Nutrition Technical Assistance Project (FANTA) of the Academy for Educational Development (AED) and the Ministry of Health (MOH) AIDS Control Programs (ACPs) in Kenya and Uganda worked together between 2007 and 2008 to integrate nutrition into the activities of HIV support groups in the border towns of Busia Uganda and Busia Kenya, funded by USAID/East Africa. The aim was to build skills in nutrition and disseminate national materials on nutrition and HIV developed by the national ACPs. However, PLHIV in the border towns increasingly reported lack of access to adequate food, in terms of quantity and variety, as the main reason they could not apply the dietary practices recommended during counseling sessions. In response, between September 2007 and September 2008 FANTA and the ROADS Project collaborated to facilitate the diffusion and use of appropriate technologies to improve the productivity of PLHIV agricultural activities developed under the ROADS Project in the two border towns.
","http://www.fantaproject.org/downloads/pdfs/FANTA_Busia2008.pdf
","8762|8576|8430|8302|8241|8671|8237","","Food and agriculture","Ministry of Agriculture, Department of Culture and Social Services, Kenya│Ministry of Animal Industry and Fisheries (MAAIF), Uganda│National Agricultural Advisory Services (NAADS), Uganda","","","Family Health International (incl.AED)","","","","","","National NGOs","AIDS Support Organisation; National Agricultural Research Organization (NARO), Uganda","Research/academia","Busia Agricultural Training Centre (BATC) in Kenya, Kenya Agricultural Research Institute (KARI)","","","Other","Africa 2000 Network","","Bilateral and donor agencies and lenders","US Agency for International Development (USAID)","East Africa","Other","","Busia Parish Catholic Church, Kenya","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","11492","","Promotion of food security and agriculture","","","","Pregnant/lactating women with HIV/AIDS","","Busia , Kenya and Busia Uganda","Community-based","","The process involved identifying simple technologies to increase farm and garden outputs and linking clusters of people living with HIV (PLHIV) with local agricultural institutions including the Ministry of Agriculture (MOA), Department of Culture and Social Services, Kenya Agricultural Research Institute (KARI), and Busia Agricultural Training Centre (BATC) in Kenya and the MOA, Ministry of Animal Industry and Fisheries (MAAIF), National Agricultural Research Organization (NARO), and National Agricultural Advisory Services (NAADS) in Uganda, as well as community development officers, community-based organizations (CBOs), and nongovernmental organizations (NGOs) in the districts. FANTA facilitated the development of a participatory learning process to motivate groups of PLHIV to learn the new technologies to increase farm and garden output.
In phase one of the participatory learning process, FANTA and ROADS helped members of the clusters and agricultural institutions understand the agricultural technologies used in Busia, Kenya and Busia, Uganda to improve productivity. Phase two facilitated a process of linking cluster with agricultural institutions to help cluster members implement existing technologies that they had not widely used and to assess the impact of the process on the adaptation of the technologies. Neither FANTA nor ROADS invested substantial funds in the process, but provide technical assistance and connected the clusters to locally available technical assistance and support.
Three sensitization meetings were held, one joint meeting between cluster representatives, the FHI Cluster Coordinators, and FANTA staff and two meetings with groups on either side of the border. The meetings laid the foundation for agreement on the purpose of the activity and sharing of expectations. Over a period of two weeks, the group representatives identified viable and interesting agricultural technologies used in their localities and discussed how easily they could be implemented by PLHIV living in the towns (urban setting) and how they could improve their food diversity. In meetings with the agricultural institutions (mainly from Kenya), examples of agricultural technologies and activities were identified and discussed. Ministry of Agriculture and BATC extension personnel were available in the meetings to explain the different technologies.
The cross-border learning process was initiated by 14 representatives of the Ugandan clusters, who visited their peers on the Kenyan side of the border in November 2007. For two days they visited homes and training centers to see different agricultural technologies and livelihood activities implemented in Kenya and discussed the
feasibility of their adoption in their own context. At BATC the Ugandan visitors toured all the Group identification of learning content and methodology Preliminary sensitization meetings with cluster groups Group consultative meetings Meetings of Cluster representatives with departments of agriculture, NGOs, research institutions, and farmer training Cross‐border learning and home visits Arrange meetings among ROADS representatives, cluster representatives from Kenya and Uganda, and FANTA. Explain the different technologies that could be used in the locale and by PLHIV. Agree on how groups would implement the technologies and priorities. Group consensus meetings See different technologies in the communities and discuss.
Visits were also made to school gardens, community land (e.g., belonging to clusters of orphans and vulnerable children [OVC] in Kenya), seed multiplication sites, and farmer training centers. The cluster members discussed opportunities for and challenges of implementing similar activities in the urban Uganda context. Group consensus meetings were held to prioritize what the clusters wanted to learn about and the optimal methods of learning.
","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 Liberia, Feed the Future aims to help an estimated 332,000 vulnerable Liberian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 96,000 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 Liberia is making core investments in three key areas:
1. Transforming Staples’ Value Chains
2. Developing Income and Diet Diversification Value Chains
Target region
The Feed the Future Strategy is focusing on counties with the highest populations, the most farmers, the largest numbers living in poverty, and the greatest potential for agriculture development: Bong, Lofa, Nimba, Grand Bassa, Montserrado, and Margibi. These counties are located along Liberia’s main economic development corridors and collectively include around 75 percent of all Liberian households. Nutrition activities are focused in Bong, Lofa and Nimba counties.
","FTF interventions will encourage employment of women extension agents in the public sector and ensure that they are well represented in extension-related training activities in the public and private sectors. Women typically have more limited access to seeds, tools, credit, and marketing information than men. Liberia FTF MYS activities will give explicit attention to issues of equity in access in order to increase women‘s access and FTF will also provide support for women to participate in producer/marketing groups and associations.
Through private and public sector extension, USAID will provide lead farmers and producer organizations identified as change agents with specialized skills. Change agents will also receive support to acquire planting material and inputs through public and private sector channels. Availability of improved planting materials is facilitated through investments in CARI, private sector players, and CORAF. USAID will promote suppliers of seeds, fertilizers, insecticides, herbicides, tools, and livestock by developing their technical knowledge and skills and through support for increased agricultural credit. These entrepreneurs will provide services to others in their respective value chains. Over the five years of the FTF program, both the public and private provision of extension services will reinforce and expand the skill sets of change agents to increase productivity and coordinate with county and local health service providers to extend the reach of nutrition-related behavior change in order both to raise incomes and to improve health outcomes.
Small-scale rice and cassava processors will be a central focus of FTF interventions. Those interventions will help processors to build a supplier base, acquire equipment, access finance, and implement appropriate business practices. It is expected that they will then provide farmers with technical assistance to assure themselves of sufficient supplies of quality commodities to process. The program will work with and support both processors and traders to invest in processing equipment, storage facilities, and transport. It will work with farmers on improving post-harvest handling practices and on producing a consistent and predictable flow of goods. Over the five years, USAID direct beneficiaries will develop the skills, knowledge, and attitudes - plus have the capital, equipment, clients, and market linkages - to continue to expand their production, processing, and/or marketing businesses.
Given the paucity of reliable data, a significant initial activity in the primary implementation mechanism for the Liberia FTF MYS – USAID‘s Food and Enterprise Development program - will be directed to a series of baseline surveys to collect production, labor, and market information and to facilitate MOA data collection and analysis, especially related to the focus counties. Based on the prioritized constraints that are identified, targeted and sequenced support will be directed to specific steps on the value chain, including to:
Nutritional benefits will accrue from both increased availability of and access to Liberia‘s primary food staples (rice and cassava). Increased commercialization will provide smallholders the increased incomes needed to obtain more and better food and improved processing will promote fortification to enhance the nutritional value of cassava and to improve the quality of rice. Public and private extension change agents will be trained to engage farmers, communities and farmer organizations across the range of behavioral change needed to promote essential nutrition actions.
","The Feed the Future MYS and Monitoring and Evaluation (M&E) activities will have the following four overarching objectives:
The FTF M&E system is designed flexibly to take into account the systems and indicators being implemented by aligned USG activities, as well as those which the GOL is developing under LASIP reflecting the Government‘s CAADP commitments. The Mission‘s newly-awarded M&E program will facilitate the coordination and collaboration work to build the FTF M&E system with appropriate linkages reflecting WOG activities that impact on the FTF Results Framework.
Collecting, managing, and reporting data to track indicators is a critical component of Liberia‘s FTF M&E activities. There are three basic levels at which data will be collected: at the national, target-county, and project-levels; the latter two being the zones of influence‘ of Liberia‘s FTF program. In general, national-level data will be collected every five or every two years, depending on data source. Typically, target-county level data will be collected every two years or mid-way through the FTF program, depending on data source. Project-level data will be collected annually. Given that much of the data will be for agriculture, data collection will reflect systems, which span growing seasons across more than a single year. The centrally-funded M&E contractor, recently awarded by the Mission, will work with USAID Implementing Partners (IP), GOL, and other entities as appropriate in data collection, management, and reporting as well as in conducting baselines. These will be collective efforts reflecting the importance of data collection and baselines not only for USG priorities but also to partners and other stakeholders in the private sector and GOL.
Ensuring baseline data are available to measure changes resulting from FTF interventions and to contextually monitor the situation in Liberia is essential to the FTF program. For the eight higher-level indicators, USAID/Liberia will coordinate with the centrally-funded contractor to confirm available national-level baseline data for the poverty and agriculture sector GDP indicators. The centrally-funded contractor will lead efforts to obtain baseline data on per capita income at the target county level. Reliable data on underweight, stunted, and wasted children, as well as on underweight women, are available from Liberia‘s Comprehensive Food Security and Nutrition Survey (CFSNS), a bi-annual survey endorsed and led by GOL with World Food Program oversight. These baseline data are given in Annex C. As the indicator on women‘s empowerment is being developed, USAID/Liberia will address baseline needs for it as further information on requirements becomes available.
There are an additional six indicators which require baselines to measure project-level activity. In collaboration with the MOA, USAID/Liberia IPs will lead baseline data collection on crop and animal production improvements (indicators 9 and 10 in the results framework), on the value of incremental sales (indicator 16 in the results framework), and on the application of improved technologies and practices by individuals and organizations receiving USG assistance (indicators 13 and 15 in the results framework).
Prior to initiation of FTF MYS activities under the FED program, the Mission will initiate a pre- and post-impact evaluation process to articulate the relevant analytical framework for evaluating program impact in the target counties. Current expectations are to utilize a quasi-experimental design for the impact evaluation. However, a final determination has not been made and plans are to further discuss with the Mission‘s M&E program and others. In addition, Liberia is a non-presence, monitored member of the West Africa regional Famine Early Warning System Network (FEWSNET). The FTF M&E activities will utilize these data on food prices, regional trade flows, market development in data frameworks for on-going assessment and monitoring of both impacts and risks.
Currently, Liberia‘s capacity to collect, process, and report data is extremely weak. While USAID/Liberia identified some sources of reliable data, notably that reported in the 2010 CFSNS, there is a paucity of agricultural and trade data available. To address this, USAID will work closely with GOL to build Liberian capacity in this area. The GOL has the primary responsibility to collect poverty, rural and agricultural statistics but the FTF M&E system will support and strengthen the GOL‘s activity in cooperation with other development partners. It will also strengthen the MOA‘s Food Security and Nutrition Unit and the Agriculture Coordination Committee to build compatible and consistent M&E systems for food security related activities. The FTF M&E system will support the capacity of critical national institutions especially the Liberian Institute of Statistics and Geo Information Services (LISGIS) and the MOA to improve the reliability, timeliness, and relevance of data for which they are responsible. It will strengthen these institutions to setup management information systems to inform high-level decision-making and will encourage the involvement of these critical institutions in oversight of FTF activities using the M&E system as the focal point. Furthermore, it will carry these activities to the county level and in particular will emphasize MOA M&E capacity in Bong, Lofa, Nimba, and Grand Bassa counties.
","Planned interventions targeted at the key value chain constraints and implemented via the actions of private and public change agents will reach over 92,000 rice and cassava farmers in the six target counties","Bong, Lofa, Nimba, Grand Bassa, Montserrado, and Margibi. These counties are located along Liberia’s main economic development corridors and collectively include around 75 percent of all Liberian households. Nutrition activities are focused in Bong, Lofa ","","Gross margin per unit of land or animal of selected product (crop/animal varies by county);Percent increases in crop yields; Number of farmers and others who have applied new technologies or management practices as a result of USG assistance; Number of private enterprises; producer orgs; water users, trade, business associations; &amp; CBOs that applied new technologies or management practices as a result of USG assistance; Value of incremental sales (collected at farm-level) attributed to FTF implementation; Value of agricultural and rural loans; 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 six months of age; Prevalence of anemia among women of reproductive age","Gross margin per unit of land or animal of selected product (crop/animal varies by country);Percent increases in crop yields; Number of individuals who have received USG supported short-term ag sector productivity or food security training;Number of new additional ha under improved technologies or management practices as a result of USG assistance; Number of farmers and others who have applied new technologies or management practices as a result of USG assistance; Number of private enterprises; producer orgs; water users, trade, business associations; & CBOs receiving USG assistance; Number of private enterprises; producer orgs; water users, trade, business associations; & CBOs that applied new technologies or management practices as a result of USG assistance; Value of incremental sales (collected at farm-level) attributed to FTF implementation; Kilometers of roads improved or constructed; Value of agricultural and rural loans; Value of new private sector investment in the ag sector or food chain leveraged by FTF implementation; Number new laws and policies implemented to support private enterprise growth; Number of jobs attributed to FTF implementation; 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 six months of age; Prevalence of anemia among women of reproductive age","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","Supplies","Promote high-yield seed and related inputs, including demonstration plots to test the use of improved seeds, fertilizer, and pesticides, and to introduce better land and water practices and farming methods;","Staff skills/training","Build capacity in both public (county-level) and private sector extension, including farmer organizations, traders or other private sector actors to invest in small sized processing mills and storage facilities","Financial resources","Provide access to finance and credit guarantees, directed at lead farmers and small processors","Stakeholder","Implement training to capacitate processors to become key change agents in market and credit transactions","Communication","Improve the transparency of market price information to farmers and strengthen business service providers, as an alternative means to make extension type services","","","","","","","","","","","","","","English" "11523","Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative","English","Multi-national","","LBR","Liberia","Bong County, Liberia|Lofa County, Liberia| Nimba County, Liberia|Grand Bassa County, Liberia|Montserrado County, Liberia|Margibi, Liberia","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 Liberia, Feed the Future aims to help an estimated 332,000 vulnerable Liberian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 96,000 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 Liberia is making core investments in three key areas:
1. Transforming Staples’ Value Chains
2. Developing Income and Diet Diversification Value Chains
Target region
The Feed the Future Strategy is focusing on counties with the highest populations, the most farmers, the largest numbers living in poverty, and the greatest potential for agriculture development: Bong, Lofa, Nimba, Grand Bassa, Montserrado, and Margibi. These counties are located along Liberia’s main economic development corridors and collectively include around 75 percent of all Liberian households. Nutrition activities are focused in Bong, Lofa and Nimba counties.
","FTF Core Program 2 will undertake investments in horticulture pilots to encourage smallholders in relevant areas of all focus counties over time, but will initially focus on peri-urban locations near Monrovia which are close to the largest and most lucrative market and minimize constraints related to storage and transport. These activities will build on a change agent model similar to that for the rice and cassava value chains by supporting lead traders and lead farmers to acquire equipment for transport and storage and to acquire business and marketing knowledge. Key FTF horticulture interventions will include formation and strengthening of farmer associations, post-harvest management and logistics support, promoting public-private partnerships, and providing information and training for behavior changes to promote improved family nutrition.
FTF investments to develop the goat value chain will implement pilot activities that are closely coordinated with the substantial USDA Food for Progress goat value chain enhancement program that will be working to re-establish breed stock and infrastructure for processing. The change agent focus of investment will be on community animal health workers and Core Program 2 activities will train and lend support to them so that they can directly assist improved breeding through the provision of services and infrastructure, making commercialization profitable. USAID/Liberia will determine the scope and scale of change agent engagement in pilot sites based on local conditions and in close coordination with the USDA program.
The US Government in Liberia will make an estimated 30 percent of FTF MYS investments in Core Program 2, with roughly 60 percent of these directed to interventions to address vegetable value chain pilot activities and the remaining 40 percent for implementation of goat pilots. Reflecting the phased approach to Liberia FTF value chain interventions, only 10 percent of first-year investment will be in the diet diversification value chains, while 63 percent of MYS vegetable and goat value chain investments will be carried out in years four and five. As with Core Program Area 1, given the lack of reliable data a significant initial activity in the primary implementation mechanism for the Liberia FTF MYS – USAID‘s Food and Enterprise Development program - will be directed to ensure relevant baseline surveys to collect production, employment, and market information and to facilitate data collection and analysis, especially related to the focus counties. These investments will be phased to take advantage of opportunities that already exist in peri-urban areas for vegetables and related to the USDA program for goats. Within the proposed total program level, anticipated investment levels in these value chains will be lower in the first two years of strategy implementation and will ramp.
","","
The Feed the Future MYS and Monitoring and Evaluation (M&E) activities will have the following four overarching objectives:
The FTF M&E system is designed flexibly to take into account the systems and indicators being implemented by aligned USG activities, as well as those which the GOL is developing under LASIP reflecting the Government‘s CAADP commitments. The Mission‘s newly-awarded M&E program will facilitate the coordination and collaboration work to build the FTF M&E system with appropriate linkages reflecting WOG activities that impact on the FTF Results Framework.
Collecting, managing, and reporting data to track indicators is a critical component of Liberia‘s FTF M&E activities. There are three basic levels at which data will be collected: at the national, target-county, and project-levels; the latter two being the ‗zones of influence‘ of Liberia‘s FTF program. In general, national-level data will be collected every five or every two years, depending on data source. Typically, target-county level data will be collected every two years or mid-way through the FTF program, depending on data source. Project-level data will be collected annually. Given that much of the data will be for agriculture, data collection will reflect systems, which span growing seasons across more than a single year. The centrally-funded M&E contractor, recently awarded by the Mission, will work with USAID Implementing Partners (IP), GOL, and other entities as appropriate in data collection, management, and reporting as well as in conducting baselines. These will be collective efforts reflecting the importance of data collection and baselines not only for USG priorities but also to partners and other stakeholders in the private sector and GOL.
Ensuring baseline data are available to measure changes resulting from FTF interventions and to contextually monitor the situation in Liberia is essential to the FTF program. For the eight higher-level indicators, USAID/Liberia will coordinate with the centrally-funded contractor to confirm available national-level baseline data for the poverty and agriculture sector GDP indicators. The centrally-funded contractor will lead efforts to obtain baseline data on per capita income at the target county level. Reliable data on underweight, stunted, and wasted children, as well as on underweight women, are available from Liberia‘s Comprehensive Food Security and Nutrition Survey (CFSNS), a bi-annual survey endorsed and led by GOL with World Food Program oversight. These baseline data are given in Annex C. As the indicator on women‘s empowerment is being developed, USAID/Liberia will address baseline needs for it as further information on requirements becomes available.
Gender is a cross-cutting issue in the GOL‘s agriculture sector investment plan and is integrated in the US Government‘s Liberia FTF MYS. To measure FTF gender impacts, USAID/Liberia will disaggregate data as appropriate by gendered household type or by sex and will track data for the women‘s empower index being developed as well as for women specific indicators in the RF. Annex C identifies indicators to be disaggregated by gendered household type or by sex (as well as by other characteristics). Data will be disaggregated by gendered household type for the following indicators: prevalence of poverty, per capita income, gross margin per unit of land/animal, increases in crop yields, and prevalence of households with moderate or severe hunger. There are numerous indicators which will be disaggregated by sex. These are identified in Annex C. The Liberia RF also considers women specific indicators including prevalence of underweight women, women‘s dietary diversity, and prevalence of anemia among women. It is expected that a rich picture of the extent to which the FTF program is achieving positive gender impacts will emerge via this disaggregation. And in particular, the tracking will allow USAID/Liberia to make rapid programming adjustments in this regard if necessary.
Prior to initiation of FTF MYS activities under the FED program, the Mission will initiate a pre- and post-impact evaluation process to articulate the relevant analytical framework for evaluating program impact in the target counties. Current expectations are to utilize a quasi-experimental design for the impact evaluation. However, a final determination has not been made and plans are to further discuss with the Mission‘s M&E program and others. In addition, Liberia is a non-presence, monitored member of the West Africa regional Famine Early Warning System Network (FEWSNET). The FTF M&E activities will utilize these data on food prices, regional trade flows, market development in data frameworks for on-going assessment and monitoring of both impacts and risks.
Currently, Liberia‘s capacity to collect, process, and report data is extremely weak. While USAID/Liberia identified some sources of reliable data, notably that reported in the 2010 CFSNS, there is a paucity of agricultural and trade data available. To address this, USAID will work closely with GOL to build Liberian capacity in this area. The GOL has the primary responsibility to collect poverty, rural and agricultural statistics but the FTF M&E system will support and strengthen the GOL‘s activity in cooperation with other development partners. It will also strengthen the MOA‘s Food Security and Nutrition Unit and the Agriculture Coordination Committee to build compatible and consistent M&E systems for food security related activities. The FTF M&E system will support the capacity of critical national institutions especially the Liberian Institute of Statistics and Geo Information Services (LISGIS) and the MOA to improve the reliability, timeliness, and relevance of data for which they are responsible. It will strengthen these institutions to setup management information systems to inform high-level decision-making and will encourage the involvement of these critical institutions in oversight of FTF activities using the M&E system as the focal point. Furthermore, it will carry these activities to the county level and in particular will emphasize MOA M&E capacity in Bong, Lofa, Nimba, and Grand Bassa counties.
In-line with FTF‘s global knowledge learning agenda, USAID/Liberia will engage in the following activities:
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 Liberia, Feed the Future aims to help an estimated 332,000 vulnerable Liberian women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 96,000 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 Liberia is making core investments in three key areas:
1. Transforming Staples’ Value Chains
2. Developing Income and Diet Diversification Value Chains
Target region
The Feed the Future Strategy is focusing on counties with the highest populations, the most farmers, the largest numbers living in poverty, and the greatest potential for agriculture development: Bong, Lofa, Nimba, Grand Bassa, Montserrado, and Margibi. These counties are located along Liberia’s main economic development corridors and collectively include around 75 percent of all Liberian households. Nutrition activities are focused in Bong, Lofa and Nimba counties.
","FTF investments in Core Program 3 will address selected aspects of the LASIP program for institutional development to support the value chains that are the focus of Core Program Areas 1 and 2. FTF investments in agriculture policy, advocacy support, and research will fund key institutions to carry out actionable research leading to improved land, soil, and water resource management and use and agronomic practices and more productive animal husbandry. FTF Program Area 3 activities will be integrated in the value chain support in order to expand the capacity of civil society groups to analyze and advocate for policy reforms (e.g., in regard to rice pricing and sanitary and food safety standards for food and meat processing) and to help create a more market-friendly policies and an improved trading environment for Liberian smallholders.
The Liberia FTF MYS will assist the MOA to define and implement its decentralized, demand-driven, participatory, pluralistic (i.e., engaging public, private, civil society actors), and accountable agricultural extension system. The critical role of women extension agents will be emphasized and opportunities for them to develop professionally, both in terms of education and field practice, will be supported. Program Area 3 investments will target partnerships with the public and private sectors and other development partners to: accelerate adoption of modern agronomic technologies and practices at the farm level; create effective knowledge distribution mechanisms; and build capacity of the MOA to provide specialized extension services. Revised agricultural extension curricula will provide more effective training in areas such as land use and techniques to reduce soil fertility losses, water resources management, low-cost and organic fertilizers, post-harvest loss reduction, pest management measures, participatory extension methodologies, women‘s participation in extension activities, farmer organization development, participatory rural appraisal, farmer field school methodology, and farmer-to-farmer extension. These investments will support widespread provision of high quality extension to Liberian smallholders. Core Program 3 interventions on market structure development will create opportunities to establish market information systems to support private and public decision making and invest in alternative profit sharing/contract models between change agents and farmers to ensure equitable market exchanges, based on transparent information and rational decision making behavior. These activities will provide the foundation for fair and transparent markets accessible to all Liberian smallholders.
All FTF MYS investments in Core Program 3 will be integrated to support value chain activities in transforming rice and cassava staples value chains and piloting the income and diet diversification vegetable and goat value chains. Thus, these activities to advance the enabling environment and build capacity will contribute to ensure benefits of the value chain investments reach all 142,375 households the program will work with, including the 91,120 poor households.
","","
The Feed the Future MYS and Monitoring and Evaluation (M&E) activities will have the following four overarching objectives:
The FTF M&E system is designed flexibly to take into account the systems and indicators being implemented by aligned USG activities, as well as those which the GOL is developing under LASIP reflecting the Government‘s CAADP commitments. The Mission‘s newly-awarded M&E program will facilitate the coordination and collaboration work to build the FTF M&E system with appropriate linkages reflecting WOG activities that impact on the FTF Results Framework.
Collecting, managing, and reporting data to track indicators is a critical component of Liberia‘s FTF M&E activities. There are three basic levels at which data will be collected: at the national, target-county, and project-levels; the latter two being the ‗zones of influence‘ of Liberia‘s FTF program. In general, national-level data will be collected every five or every two years, depending on data source. Typically, target-county level data will be collected every two years or mid-way through the FTF program, depending on data source. Project-level data will be collected annually. Given that much of the data will be for agriculture, data collection will reflect systems, which span growing seasons across more than a single year. The centrally-funded M&E contractor, recently awarded by the Mission, will work with USAID Implementing Partners (IP), GOL, and other entities as appropriate in data collection, management, and reporting as well as in conducting baselines. These will be collective efforts reflecting the importance of data collection and baselines not only for USG priorities but also to partners and other stakeholders in the private sector and GOL.
Ensuring baseline data are available to measure changes resulting from FTF interventions and to contextually monitor the situation in Liberia is essential to the FTF program. For the eight higher-level indicators, USAID/Liberia will coordinate with the centrally-funded contractor to confirm available national-level baseline data for the poverty and agriculture sector GDP indicators. The centrally-funded contractor will lead efforts to obtain baseline data on per capita income at the target county level. Reliable data on underweight, stunted, and wasted children, as well as on underweight women, are available from Liberia‘s Comprehensive Food Security and Nutrition Survey (CFSNS), a bi-annual survey endorsed and led by GOL with World Food Program oversight. These baseline data are given in Annex C. As the indicator on women‘s empowerment is being developed, USAID/Liberia will address baseline needs for it as further information on requirements becomes available.
Gender is a cross-cutting issue in the GOL‘s agriculture sector investment plan and is integrated in the US Government‘s Liberia FTF MYS. To measure FTF gender impacts, USAID/Liberia will disaggregate data as appropriate by gendered household type or by sex and will track data for the women‘s empower index being developed as well as for women specific indicators in the RF. Annex C identifies indicators to be disaggregated by gendered household type or by sex (as well as by other characteristics). Data will be disaggregated by gendered household type for the following indicators: prevalence of poverty, per capita income, gross margin per unit of land/animal, increases in crop yields, and prevalence of households with moderate or severe hunger. There are numerous indicators which will be disaggregated by sex. These are identified in Annex C. The Liberia RF also considers women specific indicators including prevalence of underweight women, women‘s dietary diversity, and prevalence of anemia among women. It is expected that a rich picture of the extent to which the FTF program is achieving positive gender impacts will emerge via this disaggregation. And in particular, the tracking will allow USAID/Liberia to make rapid programming adjustments in this regard if necessary.
Prior to initiation of FTF MYS activities under the FED program, the Mission will initiate a pre- and post-impact evaluation process to articulate the relevant analytical framework for evaluating program impact in the target counties. Current expectations are to utilize a quasi-experimental design for the impact evaluation. However, a final determination has not been made and plans are to further discuss with the Mission‘s M&E program and others. In addition, Liberia is a non-presence, monitored member of the West Africa regional Famine Early Warning System Network (FEWSNET). The FTF M&E activities will utilize these data on food prices, regional trade flows, market development in data frameworks for on-going assessment and monitoring of both impacts and risks.
Currently, Liberia‘s capacity to collect, process, and report data is extremely weak. While USAID/Liberia identified some sources of reliable data, notably that reported in the 2010 CFSNS, there is a paucity of agricultural and trade data available. To address this, USAID will work closely with GOL to build Liberian capacity in this area. The GOL has the primary responsibility to collect poverty, rural and agricultural statistics but the FTF M&E system will support and strengthen the GOL‘s activity in cooperation with other development partners. It will also strengthen the MOA‘s Food Security and Nutrition Unit and the Agriculture Coordination Committee to build compatible and consistent M&E systems for food security related activities. The FTF M&E system will support the capacity of critical national institutions especially the Liberian Institute of Statistics and Geo Information Services (LISGIS) and the MOA to improve the reliability, timeliness, and relevance of data for which they are responsible. It will strengthen these institutions to setup management information systems to inform high-level decision-making and will encourage the involvement of these critical institutions in oversight of FTF activities using the M&E system as the focal point. Furthermore, it will carry these activities to the county level and in particular will emphasize MOA M&E capacity in Bong, Lofa, Nimba, and Grand Bassa counties.
In-line with FTF‘s global knowledge learning agenda, USAID/Liberia will engage in the following activities:
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 Kenya, Feed the Future aims to help an estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 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 Kenya is making core investments in three key areas:
Target Regions
Feed the Future is targeting high-rainfall areas with dense populations, high poverty and malnourishment, as well as semi-arid areas. Both areas have great potential for raising agricultural productivity. These target areas also encompass the highest concentrations of malnourished children, female-headed households, and rural poor.
Highlights
Science and Technology. U.S. support to the Kenya Agricultural Research Institute focuses on research on crops for the semi-arid zone, including improved seeds, pest control, and food safety for maize, sorghum, millet, sweet potato, cowpea, and pigeon pea. Feed the Future also works with the Kenya Plant Health Inspectorate Services to increase quality and availability of drought-tolerant crops and varieties.
Engaging Women and Youth. Feed the Future supports activities that empower women and improve the nutritional status of women and children. Women manage an estimated 44 percent of Kenya’s smallholder households and are active at every point in the food chain. Their contribution to commodities, grown mainly in home gardens, is quite significant, providing essential nutrients and often the only food available during the lean seasons or when the main harvest fails. Feed the Future will also engage youth in farming, processing and trading to relieve high levels of youth unemployment. More than 67 percent of the under- and unemployed in Kenya are young women and men of 15 to 30 years of age.
Value Chains. Feed the Future is focusing its efforts on improving several key agricultural value chains: horticulture, dairy and maize for the High Rainfall (HR) areas; and drought-tolerant crops (sorghum/millet and root crop systems), drought-tolerant maize, horticulture, and pulses for Semi-Arid (SA) areas. Attention is focused on every “link” in the value chain—from inputs like fertilizer and seeds, to credit, to production methods, storage, transport, processing, farmers’ cooperatives, and markets in Kenya, East Africa and overseas.
","MAIZE AND DROUGHT-TOLERANT STAPLE CROP VALUE CHAIN
Kenya’s maize sub sector is approaching a critical time when input supply characteristics, land reform, availability of supporting factors of production, and market price dynamics will define the competitiveness of the industry in the mid- to long term. This environment presents an opportune moment for the USG’s current and future investments. At the same time, there has been a dearth of investment in alternative staple crops and, as a result, there is a lack of data. In collaboration with the private sector, FTF will support value chain assessments that deepen and fill gaps in existing knowledge – especially related to these crops in SA2 – to inform the FTFS’ further implementation and private sector investments.
As noted, yields of staple crops in Kenya are low relative to regional averages. Addressing productivity issues in maize and drought-tolerant staples will be a key focus. Promoting improved transfer of technologies will require investment in agricultural research to develop improved technologies. This will be especially important for the neglected drought-tolerant crops. Equally important is the dissemination of knowledge of these technologies, accompanying management practices, the extension services to transfer knowledge on how best to use technologies, and the commercialization and dissemination of technologies to farmers who need them. Consequently interventions will leverage private sector partners in concert with public sector extension services (although limited in certain counties of the two focus areas) to disseminate and commercialize improved technologies through ―smart‖ extension methods, e.g., ICT.
Achieving productivity growth also will require program investments to promote improved access to high-quality inputs that are affordable and provide the knowledge (extension services) on how to use them optimally, including improving input use efficiency through proper soil and water management techniques. Seed and fertilizer companies and agro-dealers will play key roles in setting up demonstration plots and holding ―farmer field days‖ so that farmers can learn about different varieties and practices. Efforts will be made by the Mission to incorporate gender awareness and nutrition- and food preparation-related messaging during those ―field days.‖ The seed and fertilizer companies have also begun to package inputs into smaller quantities, thereby more affordable to poor farmers. The current KMDP is working through its sub-grantees, like Farm Input Promotions (FIPS) – which uses samples of inputs (i.e., seeds, fertilizers, etc.) donated by private companies – for demonstration on farmers’ fields, provides extension information, and sells inputs in small affordable packages, an approach that has been effective in increasing access to inputs and extension services to women.
Market access will be essential to increasing smallholder incomes. The Mission will facilitate a more structured market for staple food crops by: 1) increasing smallholder farmers’ understanding of end-market requirements; 2) facilitating access to training to meet end-market requirements; and 3) improving farmers’ market intelligence and capacity to make informed decisions. Public and private sector investments in storage and centralized market infrastructure will improve the benefits smallholders gain from market engagement and lead to increases in rural household incomes.
Regarding sorghum, market outlets seek varieties with high milling and brewing qualities, and subsistence farmers require high-yielding varieties with specific taste, color and cooking characteristics. The segmentation of these varieties and products to meet the specific market demands has not been done and, as a result, farmers’ marketing strategies are ―hit or miss.‖ Hence, the program will segment the market niches and match the niches to sorghum varieties and products. This approach will highlight the opportunities for farmer organizations to deliver to the segmented market outlets through the segmented sorghum varieties and products.
Fostering investments by the private sector as well as access to rural finance will be essential to the sustainability and scalability of productivity improvements. Kenya has a vibrant private sector hungry for profitable opportunities. To both meet the development challenges and make a profit, USAID/K will use its new Innovation Engine (see below) to buy down the risks for private sector investments in innovative areas. To improve access to rural finance, the Mission’s program, along with USAID/EA's FTFS program-related activities, will:
By tapping into the networks of EAGC, the activities will help build regional linkages for traders. In addition, access to rural finance will be further improved through USAID's recently commenced Financial Inclusion for Rural Microenterprises (FIRM) project which – in collaboration with the U.K. Department for International Development (DFID) – will improve productivity and growth of agricultural value chains through expanded financial services to underserved groups, geographic locations and new product areas. FIRM will facilitate opportunities for agribusiness development and overall market efficiencies through a package of financial services to vulnerable groups, including young and female smallholder farmers in rural and agricultural sectors.
Value chain development in HR1 and SA2 will require the aggregation of farmers in order to facilitate access to markets, services, financing and technology transfer. Previously, the KMDP contributed to the development of farmer associations, including women associations, in the Western Province and Rift Valley and will continue to do so in the targeted FTFS counties of those provinces. Consequently, the FTFS program will strengthen farmer groups, associations and cooperatives where they can effectively benefit their members.
A key outcome of KMDP from 2002-2010 was to foster a more responsive policy environment for the maize sub-sector. Despite KMDP's involvement in a relatively successful decade of reform, the maize sector and, to a large extent, other staple crops are still characterized by highly guarded value chain positions and often distorted policy. Consequently, the FTFS program will be a strong advocate of a market-driven approach at the national level, providing a key voice to discussions regarding GOK agricultural policies and simultaneously strengthening value chain players to advocate for better policies. The planned continuation of USAID support to the Tegemeo Institute, for example, will play a key role in advocacy based upon empirical evidence to further bolster the GOK policy dialogue.
Finally, promoting NRM and adaptation to climate change will be needed to support the sustainability of impacts under FTF. This will involve the inclusion of sustainable intensification practices (―climate smart‖ practices) in staple crop production including: 1) soil management techniques, such as conservation agriculture and integrated soil fertility management; 2) the inclusion of fertilizer and fodder trees into annual crop production systems (―evergreen agriculture‖); 3) water efficiency measures, such as rainwater capture and storage; and 4) integrated pest management. The ―climate smart‖ practices will be used in combination with drought-tolerant varieties of seeds and inputs to increase productivity, fertilizer use efficiency and climate resilience. While access to and sustainable management of natural resources will be a central theme regardless of income group or geographic area, it is particularly key to addressing the vulnerability of the poorest and most food insecure.
","The Mission is currently reviewing options for reinforcing its existing monitoring and evaluation (M&E) framework by establishing a comprehensive knowledge management system that builds links to ongoing initiatives aimed at strengthening U.S. Government, national and regional agriculture sector-wide M&E and knowledge management.
USAID/K will link to the GOK-led and CAADP-mandated ―National Integrated Monitoring and Evaluation System‖ which will serve as a mutually agreed framework for performance monitoring towards the goal of increasing food security. The Mission also will link its knowledge management system to the Regional Strategic Analysis and Knowledge Support System (ReSAKSS), an information and knowledge management initiative, to promote and support effective and sustainable agricultural and rural development strategies across Africa. Through ReSAKSS, the Mission will collaborate with the USAID/EA and other Missions in Africa in tracking intra-regional trade data. The Mission will also use ReSAKSS to provide meta-analyses contributing to synthesized studies suitable for shared learning by numerous stakeholders.
The Mission will utilize the following tools in establishing and maintaining its M&E efforts: The Mission’s FTFS Results Framework which is the conceptual and analytical structure that establishes the goals and objectives of the FTF Initiative in Kenya; A performance monitoring/management plan (PMP) comprised of standard and custom FTF performance indicators to track progress toward desired results. Data systems will be developed and refined based on findings of a Mission-wide data quality assessment (DQA) carried out in March/April 2011; Tegemeo Institute poverty analyses in conjunction with Africa Bureau/Sustainable Development Office (AFR/SD); The Mission will undertake local capacity-building investments to improve the quality and frequency of data collection and use; Biannual independent indicator surveys by Tegemeo Institute to gauge progress made towards achieving results and a feedback loop to improve performance; Mid-term and impact evaluations will be carried out to determine the measureable effects of the FTFS investments; and The Mission will engage in regular knowledge-sharing activities with FTFS development partners and implementers to foster learning and use of M&E findings.
","Estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality.",".","","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Vulnerable groups","","Biofortification of staple crops>>>Biofortification of staple crops>>http://www.who.int/elena/titles/biofortification","Financial resources","Business service provider interventions▪Grow market linkages (domestic and regional)▪Facilitate market development including structured trade and transparent transactions▪Link to input suppliers to expand services▪Provide value chain financing","Supplies","Input supplier interventions▪Expand inventory, crop and dairy services, & reach▪Link to business service providers▪Pilot aggregation (e.g., for WFP P4P program)▪Capacity building for business and financial mgmt.▪New business models","Infrastructure","Processor/buyer interventionsProposed Future USG Engagement▪Capacity building in business and finance▪Development of innovative business models▪Development of premium product schemes▪Link to input suppliers, business service providers, and producer organizations","Stakeholder","Producer organization interventions▪Continue capacity building in business, finance, contracts, grades/standards, productivity▪Link to input suppliers, business service providers, processors","","","","","","","","","","","","","","To capture lesons learnt
Combined Evaluation
Impact study
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 Kenya, Feed the Future aims to help an estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 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 Kenya is making core investments in three key areas:
Target Regions
Feed the Future is targeting high-rainfall areas with dense populations, high poverty and malnourishment, as well as semi-arid areas. Both areas have great potential for raising agricultural productivity. These target areas also encompass the highest concentrations of malnourished children, female-headed households, and rural poor.
Highlights
Science and Technology. U.S. support to the Kenya Agricultural Research Institute focuses on research on crops for the semi-arid zone, including improved seeds, pest control, and food safety for maize, sorghum, millet, sweet potato, cowpea, and pigeon pea. Feed the Future also works with the Kenya Plant Health Inspectorate Services to increase quality and availability of drought-tolerant crops and varieties.
Engaging Women and Youth. Feed the Future supports activities that empower women and improve the nutritional status of women and children. Women manage an estimated 44 percent of Kenya’s smallholder households and are active at every point in the food chain. Their contribution to commodities, grown mainly in home gardens, is quite significant, providing essential nutrients and often the only food available during the lean seasons or when the main harvest fails. Feed the Future will also engage youth in farming, processing and trading to relieve high levels of youth unemployment. More than 67 percent of the under- and unemployed in Kenya are young women and men of 15 to 30 years of age.
Value Chains. Feed the Future is focusing its efforts on improving several key agricultural value chains: horticulture, dairy and maize for the High Rainfall (HR) areas; and drought-tolerant crops (sorghum/millet and root crop systems), drought-tolerant maize, horticulture, and pulses for Semi-Arid (SA) areas. Attention is focused on every “link” in the value chain—from inputs like fertilizer and seeds, to credit, to production methods, storage, transport, processing, farmers’ cooperatives, and markets in Kenya, East Africa and overseas.
"," DAIRY VALUE CHAIN
The FTFS will build on the Kenya Dairy Sector Competitiveness Program (KDSCP), currently running through April 2013, which aims to improve Kenya’s dairy industry competitiveness, and increase the economic benefits to stakeholders in the entire dairy value chain. However, the KDSCP is only operating in the Central, Rift Valley and a small section of Western Provinces due to high density of dairy cattle and favorable agro-ecological conditions necessary for dairy production.
To improve productivity, KDSCP works with male and female dairy farmers to facilitate their transition from loosely organized groups into sustainable business associations able to either access or provide expanded and diversified services to their members. The KDSCP’s BDS approach facilitates service provision to all actors along the value chain, using a wide range of change agents to train farmers on productivity-enhancing technologies to increase production per cow and reduce costs of production. Fodder preservation is the key to smoothing milk flows over the entire year, and new fodder varieties developed by Kenya Agricultural Research Institute (KARI) can improve nutrition and decrease feed costs while increasing milk production. An emerging technology developed by International Center for Insect Physiology and Ecology (ICIPE) to control crops pests has spillover benefits for dairy. Planting of desmodium and napier grass at specific locations in crop fields controls cereal pests; these crops are also excellent fodder for dairy. Interestingly, it appears that women are more likely than men and youth to adopt many of these feed technologies.
Renewed efforts will be required to bring down the cost of high quality semen, so that smallholders can afford to use AI and improve the genetic potential of their animals. Efficiency of AI can be increased by improving farmers’ ability to recognize correct breeding times and improved skills of inseminators.
Milk cooling centers – a key change agent – provide an excellent platform for producers to access goods and services. The centers enable producers to bulk and chill milk as well as consolidate their needs for services and goods, thereby making it more efficient for the private sector to engage with smallholders. Processors are also key change agents whereby, through a ―check off system,‖ farmers are supplied with feed and AI and vet services, and pay for those services by having the processor deduct costs from each producer’s milk sales. Many banks that lend to dairy farmers require that they have contracts with these processors in order to guarantee their loans.
KDSCP currently focuses much of its activities on dairy quality standards, and assisting farmers, traders and processors to adopt practices that will improve the quality of milk. It works through private and public sector service providers to train smallholder dairy farmers on milk testing techniques, disease prevention and testing with modern technologies. Business Development Service (BDS) providers also facilitate farmer associations to negotiate long-term supply contracts with processors, and to receive premiums for chilled milk. More work is required, however, towards establishing premiums for other important attributes, such as butterfat content. Market information is now more widely accessible to producers through working groups that act to better coordinate the local dairy sector.
It will be important to increase the capacity of cooling centers to implement quality control frameworks, such as Hazard Analysis and Critical Control Points (HACCP), and provide assistance to acquire International Standards Organization (ISO) or equivalent quality certification. Achieving these levels of quality will be essential for Kenyan milk to enter COMESA and other international markets. Support to the Kenya Dairy Board (KDB) and the East and Southern African Dairy Association – important partners in moving Kenya towards meeting regional standards for dairy products – will also help expand Kenya’s reach into COMESA markets.
With increased organization of producers into business associations, producers will be able to increase their investments in herds through upgrading breed quality and investing in feed and animal health technologies. Service providers will have expanded demand for their goods and services (e.g., silage making equipment and forage choppers) and some, such as processors, will have an incentive to invest in expanded facilities. Some examples of investment include Nestlé’s investment in upgrading a milk powder plant at the Kenya Creameries Cooperative (KCC), while the Brookside Dairy has set up a new powder plant. Farmer-owned chilling plants have invested in trucks to transport milk to processors, and two Kenyan insurance agencies are offering insurance products to farmers.
As banks become more knowledgeable about the risks and opportunities in the dairy sector, they are increasingly lending to the sector. Several banks have come forward to finance dairy investments by using guarantee mechanisms to decrease their risk. Access to rural finance will be further improved through USAID’s FIRM Project which, in collaboration with DFID, has established a Value Chain Finance Center to promote financial access through the rural areas for firms all along the value chain.
The FIRM Project (currently running through CY 2013) has conducted a dairy value chain finance analysis that identified profitability at key parts of the value chain. Banks will increase lending in those areas of the value chain that have the most banking potential, thereby increasing investment in the sector. It will be important to identify the less bankable parts of the value chain, such as the dairy feed sector, and concentrate support to improve bankability in those parts to further develop the dairy industry.
The dairy sector also has great potential to contribute to improved NRM practices, so current and future implementers will incorporate best management practices for improved grazing, pasture management, and ―cut and carry‖ techniques to enhance productivity and ecosystem function. This will include encouraging farmers to grow fodder varieties that are complementary to annual crop production, e.g., varieties that are nitrogen fixing or important for biological control of crop pests. Such practices can have co-benefits to staple crop production since inter-cropping certain fodder varieties with annual crops (―evergreen agriculture‖) can increase crop productivity. Manure and run-off from dairy can become environmental and health hazards, but properly managed manure can contribute greatly to improved soil fertility and soil quality, including the retention of water and important soil nutrients. Use of manure is a critical component of integrated soil fertility management and thus, for dairy farmers who also cultivate crops, this is another important co-benefit. Additionally, the generation of biogas will become increasingly important as a source of energy for households as electricity and kerosene become more expensive. Consequently, the nexus between dairy farming and agriculture and ―clean energy‖ will be another area of opportunity to be addressed during the course of the Strategy’s implementation.
These interventions will be particularly important as one aspect of adapting to climate change, and producers will need training in these technologies and practices.
More dairy products available at lower costs encourage increased consumption of this nutrition rich product among lower-income groups. KDSCP works in the informal milk chain where women, the youth and very-poor dominate. Gender sensitive programming and improving quality standards naturally fits with increasing nutritional opportunities in the informal milk chain because mothers often are responsible for child rearing. Not only availing more dairy products and improving milk quality, but increasing messaging about the nutritional benefits of dairy products will encourage consumption of this nutritionally packed food product. Also, improving the informal milk chain will enhance economic benefits for women who dominate informal milk trade and rural youth engaged in off-farm milk transport services.
New support to and capacity building of various GOK and stakeholder organizations will be important to identify issues constraining Kenya’s dairy sector competitiveness. The ongoing KDSCP, however, is building capacity of the Dairy Task Force, with a focus on policy advocacy. The rejuvenated Task Force is currently leading the implementation of policy changes and action plans that are critical to the dairy sector. Assessments of key issues have provided the necessary analyses to inform stakeholders and GOK decision makers. The Task Force is increasing the interaction among value chain actors, the GOK and development partners, and has seen increased efficiencies in the sector, both for donor projects as well as private sector investments. The Dairy Master Plan – which was initially shelved due to inadequate collaboration – is now back on track.
","The Mission is currently reviewing options for reinforcing its existing monitoring and evaluation (M&E) framework by establishing a comprehensive knowledge management system that builds links to ongoing initiatives aimed at strengthening U.S. Government, national and regional agriculture sector-wide M&E and knowledge management.
USAID/K will link to the GOK-led and CAADP-mandated ―National Integrated Monitoring and Evaluation System‖ which will serve as a mutually agreed framework for performance monitoring towards the goal of increasing food security. The Mission also will link its knowledge management system to the Regional Strategic Analysis and Knowledge Support System (ReSAKSS), an information and knowledge management initiative, to promote and support effective and sustainable agricultural and rural development strategies across Africa. Through ReSAKSS, the Mission will collaborate with the USAID/EA and other Missions in Africa in tracking intra-regional trade data. The Mission will also use ReSAKSS to provide meta-analyses contributing to synthesized studies suitable for shared learning by numerous stakeholders.
The Mission will utilize the following tools in establishing and maintaining its M&E efforts: The Mission’s FTFS Results Framework which is the conceptual and analytical structure that establishes the goals and objectives of the FTF Initiative in Kenya; A performance monitoring/management plan (PMP) comprised of standard and custom FTF performance indicators to track progress toward desired results. Data systems will be developed and refined based on findings of a Mission-wide data quality assessment (DQA) carried out in March/April 2011; Tegemeo Institute poverty analyses in conjunction with Africa Bureau/Sustainable Development Office (AFR/SD); The Mission will undertake local capacity-building investments to improve the quality and frequency of data collection and use; Biannual independent indicator surveys by Tegemeo Institute to gauge progress made towards achieving results and a feedback loop to improve performance; Mid-term and impact evaluations will be carried out to determine the measureable effects of the FTFS investments; and The Mission will engage in regular knowledge-sharing activities with FTFS development partners and implementers to foster learning and use of M&E findings.
","Estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality.",".","","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Socio-economic status","","","Supplies","","Financial resources","","Infrastructure","","Stakeholder","","","","","","","","","","","","","","","To capture lessons learned
Combined Evaluation
Impact study
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 Kenya, Feed the Future aims to help an estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 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 Kenya is making core investments in three key areas:
Target Regions
Feed the Future is targeting high-rainfall areas with dense populations, high poverty and malnourishment, as well as semi-arid areas. Both areas have great potential for raising agricultural productivity. These target areas also encompass the highest concentrations of malnourished children, female-headed households, and rural poor.
Highlights
Science and Technology. U.S. support to the Kenya Agricultural Research Institute focuses on research on crops for the semi-arid zone, including improved seeds, pest control, and food safety for maize, sorghum, millet, sweet potato, cowpea, and pigeon pea. Feed the Future also works with the Kenya Plant Health Inspectorate Services to increase quality and availability of drought-tolerant crops and varieties.
Engaging Women and Youth. Feed the Future supports activities that empower women and improve the nutritional status of women and children. Women manage an estimated 44 percent of Kenya’s smallholder households and are active at every point in the food chain. Their contribution to commodities, grown mainly in home gardens, is quite significant, providing essential nutrients and often the only food available during the lean seasons or when the main harvest fails. Feed the Future will also engage youth in farming, processing and trading to relieve high levels of youth unemployment. More than 67 percent of the under- and unemployed in Kenya are young women and men of 15 to 30 years of age.
Value Chains. Feed the Future is focusing its efforts on improving several key agricultural value chains: horticulture, dairy and maize for the High Rainfall (HR) areas; and drought-tolerant crops (sorghum/millet and root crop systems), drought-tolerant maize, horticulture, and pulses for Semi-Arid (SA) areas. Attention is focused on every “link” in the value chain—from inputs like fertilizer and seeds, to credit, to production methods, storage, transport, processing, farmers’ cooperatives, and markets in Kenya, East Africa and overseas.
","HORTICULTURE VALUE CHAIN
Horticulture has a distinct link to decreasing under-nutrition. Promoting production and marketing of high-nutrition horticultural crops and increasing messaging about the nutritional benefits associated with highly nutritious horticultural products will encourage increased consumption of these foods. For example, kitchen and community gardens provide excellent sources of nutrition for those who have limited access to land and/or resources. These gardens are also often managed by women. Decision-making over products from ―kitchen gardens‖ is often relegated to women for household consumption. Also, women earn direct income from marketing of surpluses from kitchen gardens.
KHCP is currently working in seven zones, including the HR1 and SA2 regions. Consequently, during the course of the FTFS implementation but in a deliberate timed fashion, the KHCP will evolve its program of activities to focus on the HR1 and SA2 regions.
Currently, KHCP expects to have the following impacts by February 2015, but these will be revised in accordance with the smooth transition to the new focus areas:
The Mission is currently reviewing options for reinforcing its existing monitoring and evaluation (M&E) framework by establishing a comprehensive knowledge management system that builds links to ongoing initiatives aimed at strengthening U.S. Government, national and regional agriculture sector-wide M&E and knowledge management.
USAID/K will link to the GOK-led and CAADP-mandated ―National Integrated Monitoring and Evaluation System‖ which will serve as a mutually agreed framework for performance monitoring towards the goal of increasing food security. The Mission also will link its knowledge management system to the Regional Strategic Analysis and Knowledge Support System (ReSAKSS), an information and knowledge management initiative, to promote and support effective and sustainable agricultural and rural development strategies across Africa. Through ReSAKSS, the Mission will collaborate with the USAID/EA and other Missions in Africa in tracking intra-regional trade data. The Mission will also use ReSAKSS to provide meta-analyses contributing to synthesized studies suitable for shared learning by numerous stakeholders.
The Mission will utilize the following tools in establishing and maintaining its M&E efforts: The Mission’s FTFS Results Framework which is the conceptual and analytical structure that establishes the goals and objectives of the FTF Initiative in Kenya; A performance monitoring/management plan (PMP) comprised of standard and custom FTF performance indicators to track progress toward desired results. Data systems will be developed and refined based on findings of a Mission-wide data quality assessment (DQA) carried out in March/April 2011; Tegemeo Institute poverty analyses in conjunction with Africa Bureau/Sustainable Development Office (AFR/SD); The Mission will undertake local capacity-building investments to improve the quality and frequency of data collection and use; Biannual independent indicator surveys by Tegemeo Institute to gauge progress made towards achieving results and a feedback loop to improve performance; Mid-term and impact evaluations will be carried out to determine the measureable effects of the FTFS investments; and The Mission will engage in regular knowledge-sharing activities with FTFS development partners and implementers to foster learning and use of M&E findings.
","Estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. ",".","","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Sex","","","Supplies","","Financial resources","","Stakeholder","","Infrastructure","","","","","","","","","","","","","","","To capture lessons learnt
Combined Evaluation
Impact study
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 Kenya, Feed the Future aims to help an estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 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 Kenya is making core investments in three key areas:
Target Regions
Feed the Future is targeting high-rainfall areas with dense populations, high poverty and malnourishment, as well as semi-arid areas. Both areas have great potential for raising agricultural productivity. These target areas also encompass the highest concentrations of malnourished children, female-headed households, and rural poor.
Highlights
Science and Technology. U.S. support to the Kenya Agricultural Research Institute focuses on research on crops for the semi-arid zone, including improved seeds, pest control, and food safety for maize, sorghum, millet, sweet potato, cowpea, and pigeon pea. Feed the Future also works with the Kenya Plant Health Inspectorate Services to increase quality and availability of drought-tolerant crops and varieties.
Engaging Women and Youth. Feed the Future supports activities that empower women and improve the nutritional status of women and children. Women manage an estimated 44 percent of Kenya’s smallholder households and are active at every point in the food chain. Their contribution to commodities, grown mainly in home gardens, is quite significant, providing essential nutrients and often the only food available during the lean seasons or when the main harvest fails. Feed the Future will also engage youth in farming, processing and trading to relieve high levels of youth unemployment. More than 67 percent of the under- and unemployed in Kenya are young women and men of 15 to 30 years of age.
Value Chains. Feed the Future is focusing its efforts on improving several key agricultural value chains: horticulture, dairy and maize for the High Rainfall (HR) areas; and drought-tolerant crops (sorghum/millet and root crop systems), drought-tolerant maize, horticulture, and pulses for Semi-Arid (SA) areas. Attention is focused on every “link” in the value chain—from inputs like fertilizer and seeds, to credit, to production methods, storage, transport, processing, farmers’ cooperatives, and markets in Kenya, East Africa and overseas.
","Women will form a core target group in the s FTFS because of their critical role in food production and nutrition in Kenya. It is estimated that nearly half or 44 percent of Kenya’s smallholder households are managed by women. This is largely attributed to rapid rural to urban migration by men in search of employment. Women are active at every point in the food chain and are often responsible for protecting the safety and wholesomeness of food in their households. Their contribution to food commodities such as pulses, potatoes, legumes, sorghum, fruits and vegetables is quite significant. Grown mainly in home gardens, they provide essential nutrients and are often the only food available during the lean seasons or when the main harvest fails.
In the dairy sector, women and the ultra-poor predominate in the informal milk chain. A gender value chain assessment completed by USAID in High Rainfall Zone 1 found that while the ―morning‖ milk is sold to processors, the ―evening‖ milk is often left for family consumption under the control of women in the majority of male-headed households. Most surpluses after consumption are sold in the informal chain, generating income directly for women in these households.
By FY10, female-headed households comprised 49 percent of households that benefited from USAID/K assistance. Strategies that contributed to increased women’s participation included decentralized extension approaches that are tailored to suit women’s time schedules, promotion of ―gender-balanced‖ crops and leadership training for women, and use of embedded business development service (BDS). The horticulture program recorded the highest number of women beneficiaries by supporting nutritious crops – including leafy vegetables, sweet potatoes, beans and butternut squash – where women predominate in production and marketing, and where they have greater control over revenues. Horticulture marketing contracts between women’s groups and buyers were established, allowing women to receive their payments directly.
The Kenyan FTFS will support activities that economically empower women and improve the nutritional status of women and children. Building on USAID/K’s past successes in gender and value chains, the FTFS will: Increase women’s gains by expanding support to nutritious horticultural and staple food crops; Promote private sector response by which small improvements to the informal milk chain, where women and the poor and ultra-poor predominate, could lead to healthier and more affordable options; Through the FTF Innovation Engine, seek innovations that promote local-level processing of fortified foods, such as through ―posho mills,‖ that are easily accessible and affordable to rural women; Catalyze social innovation approaches that reduce gender inequalities in agricultural production and benefits from production – such as innovations in agricultural labor saving technologies and practices to reduce women’s labor burden, linking women to extension and markets and promoting farming as a family business; Undertake gender-value chain assessments for each of the targeted sub-sectors in FTF geographical areas to guide implementation; and Scale-up training on integration of gender in value chains to all FTFS partners.
","The Mission is currently reviewing options for reinforcing its existing monitoring and evaluation (M&E) framework by establishing a comprehensive knowledge management system that builds links to ongoing initiatives aimed at strengthening U.S. Government, national and regional agriculture sector-wide M&E and knowledge management.
USAID/K will link to the GOK-led and CAADP-mandated ―National Integrated Monitoring and Evaluation System‖ which will serve as a mutually agreed framework for performance monitoring towards the goal of increasing food security. The Mission also will link its knowledge management system to the Regional Strategic Analysis and Knowledge Support System (ReSAKSS), an information and knowledge management initiative, to promote and support effective and sustainable agricultural and rural development strategies across Africa. Through ReSAKSS, the Mission will collaborate with the USAID/EA and other Missions in Africa in tracking intra-regional trade data. The Mission will also use ReSAKSS to provide meta-analyses contributing to synthesized studies suitable for shared learning by numerous stakeholders.
The Mission will utilize the following tools in establishing and maintaining its M&E efforts: The Mission’s FTFS Results Framework which is the conceptual and analytical structure that establishes the goals and objectives of the FTF Initiative in Kenya; A performance monitoring/management plan (PMP) comprised of standard and custom FTF performance indicators to track progress toward desired results. Data systems will be developed and refined based on findings of a Mission-wide data quality assessment (DQA) carried out in March/April 2011; Tegemeo Institute poverty analyses in conjunction with Africa Bureau/Sustainable Development Office (AFR/SD); The Mission will undertake local capacity-building investments to improve the quality and frequency of data collection and use; Biannual independent indicator surveys by Tegemeo Institute to gauge progress made towards achieving results and a feedback loop to improve performance; Mid-term and impact evaluations will be carried out to determine the measureable effects of the FTFS investments; and The Mission will engage in regular knowledge-sharing activities with FTFS development partners and implementers to foster learning and use of M&E findings.
","Estimated 502,000 vulnerable Kenyan women, children and family members—mostly smallholder farmers—escape hunger and poverty. More than 230,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality.",".","","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Number of new technologies or management practices made available for transfer as a result of USG assistance; Number of rural households benefiting directly from USG interventions; Number of producers organizations, water users associations, trade and business associations, and community-based organizations (CBOs) receiving USG assistance; Percentage of children < 5 years who are underweight","Sex","","","","","","","","","","","","","","","","","","","","","","","","To capture lessons learnt
Combined Evaluation
Impact study
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" "11637","Purchase for Progress (P4P) Pilot Initiative ","English","Multi-national","","AFG|BFA|COD|SLV|ETH|GHA|GTM|HND|KEN|LAO|LBR|MWI|MLI|MOZ|NIC|RWA|SLE|SSD|UGA|TZA|ZMB","Afghanistan|Burkina Faso|Democratic Republic of the Congo|El Salvador|Ethiopia|Ghana|Guatemala|Honduras|Kenya|Lao People's Democratic Republic|Liberia|Malawi|Mali|Mozambique|Nicaragua|Rwanda|Sierra Leone|South Sudan|Uganda|United Republic of Tanzania|Zambia","","Rural|Peri-urban","on-going","01-2008","01-2013","As the world’s largest humanitarian agency, WFP is a major staple food buyer. In 2012, WFP bought US$1.1 billion worth of food – more than 75 percent of this in developing countries WFP buys locally in developing countries when its criteria of price, quality and quantity can be met. P4P is a logical continuation of this local procurement with the intent to achieve a higher developmental gain with WFP’s procurement footprint by buying increasingly in a smallholder-friendly way.
Through P4P, WFP’s demand provides smallholder farmers in 20 pilot countries with a greater incentive to invest in their production, as they have the possibility to sell to a reliable buyer and receive a fair price for their crops. It is envisioned that in the wake of WFP purchasing in a more smallholder-friendly way, other buyers of staple commodities including Governments and the private sector will also increasingly be able to buy from smallholders.
P4P at the same time invests in capacity building at country level in areas such as post-harvest handling or storage, which will yield sustainable results in boosting national food security over the long term. The five year pilot P4P (2009 - 2013)[1] rests on three pillars:
WFP usually buys food through large competitive tenders. Through P4P, WFP is testing new procurement approaches more suited to smallholder farmers and:
Country approaches to P4P are tailored to suit the opportunities and constraints within each country. Generally, however, each programme has applied one or more of the general approaches:
Approach #1: Farmers’ organisations and capacity building partnerships:
Approach #2: Support to emerging structured trading systems
Approach #3: Small and medium traders
Approach #4: Developing local food processing capacity
.
","M&E system specifies data collection and analysis methods designed to track a number of indicators of programme performance.
The M&E system collects data from a number of sources including:
The M&E system also incorporates peer review to identify and validate best practices. At the country level, these include stakeholder meetings, workshops, and annual reviews. At the regional level, WFP is using writeshops and regional workshops to consolidate and validate learning. At the global/programme level, a Technical Review Panel meets annually to review and help interpret results and to guide implementation. Peer review meetings, annual reviews, internal (to WFP) stakeholder groups, and external evaluations also serve to validate results.
Managing the learning process for a programme with the scope and scale of P4P has been challenging and the design and evolution of the M&E system reflect these challenges. In particular:
Economic Research Consortium (AERC) to manage collection and analysis of the quantitative data.
Since P4P's launch in September 2008,
Stories From the Field: Ethiopi
Women farmers face many obstacles that they need to overcome to become successful business women. But the example of Mashuu, from Chefo Umbera, southern Ethiopia, shows that with the right support, female farmers can become independent market players.
When she left school, Mashuu noticed her peers marrying early, sometimes to men who took more than one wife. Mashuu saw her future differently, and together with two sisters and a sister-in-law, formed a women’s group, hoping to empower women through family planning education and HIV/AIDS awareness. They started with four members – today, there are 165.
“As the group started to grow, I realized we needed to become strong and independent economically,” said Mashuu. And that was how Jalela Primary Cooperative was born. Women bring their cereal harvests to Jalela, and the cooperative then sells it to Mira, their local cooperative union. The union sells the aggregated commodities to buyers such as WFP.
The 2011 drought-induced crop failure led to high market prices and a shortage of marketable produce in Ethiopia. This caused most cooperatives to default on their contracts with WFP. But Jalela still sold 30 metric tons of maize to WFP. The net profit of about US$170 was in part kept for the cooperative and in part distributed to the co-op members. Mashuu still has high hopes for the future despite the difficulties with the 2011 drought. She has plans to build a grain mill, start dairy production, and even bring electricity to the Jalela co-op. “We are going to change our lives,” she concludes.
The Experience in Guatemala
In Guatemala, P4P focuses on sales beyond WFP for two reasons: to promote long-term sustainability and to provide alternative outlets for farmers’ surplus production. Since WFP in Guatemala distributes only a few thousand metric tons (mt) of food every year, the quantities it can purchase from smallholder farmers’ organizations is relatively small, as illustrated in the table below.
P4P assisted Farmers’ Organizations (FOs) are located in northern and eastern regions of Guatemala as well as on the Pacific Coastal plain. A market study examined potential alternative buyers for both bulked and processed grain, including regional and national buyers such as the food industry, private traders, exporters, NGOs and the Government of Guatemala. According to information collected between 2008 through 2012, approximately a third of the P4P supported FOs have sold maize or beans to buyers beyond WFP. Of the total of 6,800 mt sold, 70% was maize (4,800 mt) and the rest beans (2,000 mt).
A maize processor in Guatemala that produces tortilla flour purchased 59% of the total tonnage. The second biggest buyer was Wal-Mart, which purchased 918 mt of beans. Sales to other national supermarkets, large traders and exporters represent 11% of the total (750 mt). Some 739 mt of maize and beans were sold on local markets (local grocery stores, municipal markets and traders). Small amounts were also purchased by NGOs, FAO and other P4P supported FOs.
With support from FAO, some FOs have developed the capacity to produce seed as well as grain. This represents 1.3% of the tonnage sold, but 4.2% of the income generated through collective sales beyond WFP. Such a successful focus on higherincome options has motivated the FOs to explore other markets such as retail packaging of beans, production of red beans specific to the El Salvador market, and fresh corn on the cob.
The P4P team works with the FOs to encourage sales beyond WFP. Commercialization committees are formed in the FOs and a roster of identified potential buyers in the market is shared with all. Training on effective negotiation t e c h n i q u e s a n d t h e development of business plans also begins this year.
Potential buyers are invited to the field to see the production of the grains, post-harvest management and quality control. This also allows them to become familiar with the maturity of the organization, increasing the confidence of buyers in the capacity of the FOs to establish commercial relations. This is complemented by demonstrating tools such as the “Blue Box”1, which is both a training tool and a field laboratory, which separates produce that does not meet specifications. Through partnering with P4P, FOs gained the trust of the commercial sector and confidence in their own abilities to reach a broad range of markets.
Farmers organizations’ experience steady progression in Mozambique
In Mozambique, farmers’ organizations (FOs) were created by both national government and nongovernmental organizations to facilitate technical assistance in agricultural production and marketing. This was especially important in the recovery period that followed the 1992 General Peace Agreement.
Most FOs gradually evolved from the village level to linking with other FOs at a district level. The district level is often represented by an ‘umbrella’ association of FOs, the tier with which P4P in Mozambique works directly. There are currently 10 such “umbrella” FOs in Mozambique participating in P4P. As of 2012, WFP has bought almost 10,000 metric tons (mt) of maize, beans and pulses from these FOs, valued at $5.8 million.
Apart from selling to WFP, P4P is helping FOs to identify sustainable and fair markets for sales beyond WFP. Prior to participating in the P4P initiative, many farmers had limited or no experience in selling collectively to markets. In 2009, sales beyond WFP were only 644 mt, tripling by 2012 to 1,800 mt. The table below summarizes crops sold by all 10 FOs under P4P in Mozambique and the income generated from sales per year.
P4P’s support to smallholder farmers in accessing markets for crops such as maize, beans and pulses has had a positive impact. When P4P began in 2009, soybean was the mostsold commodity by P4P supported FOs (2,480 mt). Maize was second at 926 mt, sesame third with 699 mt, followed by pigeon peas at 538 mt of sales. The possible profit margin for growing and selling maize is beginning to compete with the profits available in the soy and sesame trade, although commercial maize value remains low compared to other commodities. Buyers that are purchasing commodities from these FOs are:
The volume of products marketed in relation to the number of buyers demonstrates that the market in Mozambique is neither structured nor stable. There are often a high number of buyers intervening at the same time in more than one crop. Quality issues are often secondary for many buyers, as product availability is often considered more important.
While marketing platforms still have a long way to go in Mozambique, participating in P4P has helped with sales to markets beyond WFP. The relative consistency of having WFP as a buyer and the training provided by P4P and partners has helped many FOs meet the demands needed for selling to other buyers of quality.
Malawi – How a farmers’ organization is progressing
Kafulu Smallholder Farmers Organization (FO) was established in 2003. At the time of its establishment, Kafulu had two clear objectives: to achieve food security in the area and to find markets for their surplus. Currently the FO has 1,400 members (of which 500 are women) and with assistance from the National Agricultural Smallholder Farmers Association of Malawi (NASFAM), they have been able to build a warehouse. Kafulu had experience of selling maize collectively before P4P started in Malawi, however, since joining P4P they have been given the opportunity to learn the skills needed to achieve better deals with buyers.
A Challenging Beginning
Though Kafulu has progressed in their ability to connect to markets, the process has not been without difficulty. When the FO decided to participate in P4P it obtained credit in the 2008/2009 season, allowing them to expand their inputs loan scheme. In the 2009/2010 season, the organization again had access to credit, but faced severe problems in repayment. Loans were given to individuals and not directly to the FO and as a result, some individuals were unable to meet repayment obligations causing tensions among members. In addition, Kafulu signed a contract with WFP for the sale of 526 metric tons (mt) of maize, but was not able to deliver anything at all due to quality problems. The FO then had to sell the maize to other buyers who were not looking for high quality and they received a lower price.
In spite of these difficulties, Kafulu persevered. They managed to retain most of the membership despite the credit repayment issue, and tried to sell to WFP once again. In the 2010/2011 season, Kafulu delivered 100 mt of maize to WFP, this time with no quality issues.
Towards Graduation
By then, Kafulu farmers saw a clear way ahead: “We want to sell to people like WFP, because they are able to get a lot of money at one time and they offer fair prices for quality produce”,
stated one of the members of the Executive Committee. Although Kafulu farmers did not know then, they were completing the first step towards graduation - they had learnt how to condition their crop for higher quality standards and they had managed to aggregate at least twice. This placed them in a better position to compete with other FOs.
In the 2011/2012 season, Kafulu managed to aggregate 460 mt of maize, which they deposited into the warehouse receipt system (WRS) at the beginning of the season. From this deposit, they managed to get 70 percent of the receipt value as credit, which allowed them to wait until later in the season to sell when better prices were available.
Market Experience Today
In February 2013, Kafulu was awarded a contract for almost 230 mt of maize from WFP. They competed directly with medium and big traders in the Malawi market. By that time, they had already sold half of their maize to other buyers, at prevailing prices of around 90 MWK/kg (USD 0.27), making a good profit and enabling them to repay the credit and fees for the warehouse.
Kafulu FO still has problems with its membership stemming from past individual loan defaults and it is now dealing with the challenges of managing a WRS on its own. However, the FO has more knowledge of markets and is now prepared to engage competitively in them.
","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" "23194","ACF programme communautaire: Prise en Charge de la Malnutrition Aiguë dans le district de Fada N’Gourma","English","Community/sub-national","","BFA","Burkina Faso","Fada N’Gourma, Burkina Faso","Rural","on-going","08-2012","","ACF à travers le programme nutrition santé appuie le DS de Fada à la prise en charge de la malnutrition aigüe depuis août 2012 suite à la crise alimentaire de 2012 au sahel. Ces appuis se font par le renforcement des capacities à travers les formations, les dotations de matériels médico techniques, la subvention des évacuations et des soins médicaux, et des visites d’appuis techniques lors des séances de prise en charge. Au niveau communautaire, ACF travaille en partenariat avec le GRET qui mène des activités de sensibilisations, de dépistage, de Visite à Domicile (VAD) à travers des animateurs.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Fada N’Gourma:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/ACF-SQUEAC-BF-GOURMA-2014-VF.pdf
","","","","","","","Action Against Hunger (AAH) / Action contre la faim (ACF)","","","","","","","","","","","","","","","Government","Development","L’Agence Suédoise de Développement International (ASDI)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23193","","Management of severe acute malnutrition","","","","SAM child","Enfants de 0 à 59 mois","District de Fada N’Gourma","Community-based|Primary health care center","","Les interventions concernaient au départ deux communes à savoir Matiacoali et Diabo. En mai 2013, l’appui d’ACF au district s’est étendu à l’ensemble des 6 communes dans les 39 Centre de Santé et de Promotion Sociale (CSPS), le CHR et le Centre de Récupération et d’Education Nutritionnelle (CREN) confessionnel toujours avec un financement d’ASDI. Le programme appuie régulièrement le district dans la prise en charge. ACF assure également une approche NAC (Nutrition à Assise Communautaire) à travers son partenaire Groupe de Recherche et d’Echange Technologique (GRET) qui intervient dans le DS de Fada depuis 2009.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
- Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
- Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du 15 janvier au 11 février 2014 en utilisant la méthodologie « Semi Quantitative Evaluation of Access and Coverage » (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d´identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Les analyses quantitatives et qualitatives ont revele un nombre relativement important de points d’attention en terme de depistage, acces et qualite de soins, freins et pesanteurs socioculturels, difficultes de notification des cas, qui, sans enlever l’appreciation positive de ce resultat meritent neanmoins le renforcement de l’accompagnement des activites de PeC dans le district.
L’implication communautaire: insuffisance de communication des ICP avec les ASBC et faible motivation des ASBC, faible implication des autorites et des leaders dans la PeC, faible interet des hommes dans la sante des enfants…
L’organisation des activités communautaires: bien que la population soit informee du role des ASBC au sein de la communaute, il y a une insuffisance de connaissance sur la malnutrition, le programme de prise en charge. Il devient donc important de revoir l’approche de sensibilisation communautaire pour en ameliorer l’impact et assurer une meilleure implication des agents de santé communautaire.
Les dysfonctionnements au niveau de la prise en charge: long temps d’attente, rejet ou limitation du nombre de cas PeC par jour, mauvais accueil, l’insuffisance de depistage systematique en consultation curative …
Les facteurs socio-culturels, notamment pour le recours aux soins, le refus de certains maris ou des interdictions faites aux meres, le recours a la geomancie, les pratiques ancrees nefastes.
L’occupation des mères: Travaux menagers, travaux champetres, faible implication des hommes…
Les problèmes de distance, d’enclavement ou d’eloignement temporaires dans les hameaux de culture, s’ils n’ont pas ete demontres comme un facteur determinant a la couverture (voir resultats de la petite enquete), peuvent avoir un impact sur la qualite du service, notamment au niveau de la gestion des intrants, et de la disponibilite des agents de sante. En effet, la fluctuation des admissions ne permet pas aux agents de santé d’évaluer correctement les quantités d’intrants nécessaires par mois.
Tous ces facteurs ont un impact négatif sur la fréquentation des services de PCIMA et méritent de se pencher sur l’amélioration de :
- La régularité et la qualité des dépistages
- La qualité de l’accueil et de la PCIMA
- L’identification et la recherche précoce des absents ou abandons
- Les méthodes de communication pour les changements de comportement en pratiques de soins
- La coordination des activités des ONG.
L’Association de Solidarité et Coopération Internationale (LVIA) et son partenaire Medicus Mundi Italie (MMI) apportent un soutien à la Direction Régionale de la Santé du Centre-Ouest et au District sanitaire de Koudougou depuis mai 2013 pour la mise en oeuvre de la Prise en Charge Intégrée de la Malnutrition Aiguë (PCIMA). L’appui de LVIA-MMI au District Sanitaire (DS) de Koudougou porte principalement sur le renforcement des capacités des agents de santé pour la mise en oeuvre de la PCIMA, l’appui au DS pour la réalisation des campagnes de dépistage trimestrielles, la subvention totale de la prise en charge des complications en interne (frais de transport, traitement diététique et médical, alimentation de l’accompagnant), l’acheminement et le stockage des Aliment Thérapeutique Prêt à l’Emploi (ATPE), et la fourniture de farines enrichies pour la consolidation après guérison des cas de MAS.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Koudougou:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/SQUEAC_Rapport_KOUDOUGOU_2014.pdf
","","","","","","","Other","Medicus Mundi Italie (MMI)","","","","","National NGOs","Association de Solidarité et Coopération Internationale (LVIA)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23201","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Koudougou","Primary health care center","","La prise en charge ambulatoire des cas de MAS est assurée au niveau des 62 Centre de Santé et de Promotion Sociale (CSPS) du district, ainsi que de 7 Centre de Récupération et d'Education Nutritionnelle (CREN) gérés par des organisations confessionnelles. La prise en charge des complications en interne (PCI) est assurée au niveau du CHR de la ville de Koudougou et du Centre Médical Maximilien Kolbé de Sabou.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
","Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du 17 février au 14 mars 2014 en utilisant la méthodologie « Semi Quantitative Evaluation of Access and Coverage » (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d´identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Les principales barrières étaient en lien avec le contexte socio-culturel (méconnaissances sur la malnutrition, stigmatisation et honte, recours à la medicine traditionnelle en lien avec les croyances, voyage et déplacements des mères, manqué d’implication des hommes dans la santé des enfants) et avec des insuffisances au niveau de la qualité de la prise en charge (enfants MAS dans le programme MAM, sous notification des abandons, dépistage passif non systématique, manque d’informations données aux mères).
Parmi les facteurs influençant positivement l’accessibilité, la couverture géographique des formations sanitaires est à souligner. Le niveau de couverture constaté est également le résultat des actions entreprises dans le cadre du passage à l’échelle appuyé par LVIAMMI et les organisations locales : les campagnes de dépistage, la gratuité de la prise en charge, les actions de sensibilisation ont favorisé une bonne connaissance de l’existence du traitement, et une réaction en chaîne face à l’efficacité du celui-ci.
","","English" "23207","LVIA-MMI programme communautaire: Prise en Charge de la Malnutrition Aiguë Sévère dans le district de Nanoro","English","Community/sub-national","","BFA","Burkina Faso","Nanoro, burkina faso","Rural","on-going","05-2012","","L’Association de Solidarité et Coopération Internationale (LVIA) et son partenaire Medicus Mundi Italie (MMI) apportent un soutien à la Direction Régionale de la Santé du Centre-Ouest et au District sanitaire de Nanoro depuis mai 2012 pour la mise en oeuvre de la Prise en Charge Intégrée de la Malnutrition Aiguë (PCIMA). L’appui de LVIA-MMI au District Sanitaire (DS) de Nanoro porte principalement sur le renforcement des capacités des agents de santé pour la mise en oeuvre de la PCIMA, l’appui au DS pour la réalisation des campagnes de dépistage, la subvention des traitements pour la prise en charge des complications, l’acheminement des ATPE et la fourniture de farines enrichies pour la consolidation après guérison des cas de MAS.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Nanoro:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/SQUEAC_Rapport_NANORO_2014.pdf
","","","","","","","Other","Medicus Mundi Italie (MMI)","","","","","National NGOs","Association de Solidarité et Coopération Internationale (LVIA)","","","","","","","","Bilateral and donor agencies and lenders","European Commission Humanitarian Aid & Civil Protection (ECHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23206","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Nanoro","Primary health care center","","Sur le plan sanitaire, le district est divisé en 20 aires de santé. La structure de santé de référence est le Centre Médical avec Antenne chirurgicale (CMA) de Nanoro, géré par les religieux camiliens.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
","Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du 17 février au 14 mars 2014 en utilisant la méthodologie «Semi Quantitative Evaluation of Access and Coverage» (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d´identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Ces différentes barrières soulignent la complémentarité nécessaire entre une prise en charge de qualité au niveau des formations sanitaires et des activités de mobilisation communautaire adaptées au contexte. La poursuite et le réajustement des actions entreprises, sur la base des constats dégagés par l’investigation, permettront d’atténuer les barrières et d’améliorer la couverture de la PCIMAS. Pour être suivies d’effet, les réorientations proposées nécessiteront une implication de tous les acteurs impliqués dans la prise en charge de la malnutrition.
Facteurs positifs (boosters):
- Appréciation de la prise en charge: Gratuité, Perception positive du traitement, Efficacité du traitement
- Recours au CSPS pour le traitement de la malnutrition, traitement connu
- Connaissances sur la malnutrition
- Implication des acteurs clés au niveau de la communauté (ASC, TPS, leaders)
- Activités des ASC : campagnes de dépistage, suivi des cas
Action Contre la Faim Espagne (ACF-E) met en place un programme de renforcement des capacités de prise en charge de la malnutrition aiguë dans tout le cercle sanitaire de Kita depuis juillet 2012 (une partie seulement du cercle était couvert depuis 2011). La prise en charge de la malnutrition aigüe sur Kita se fait au niveau du CSRef (Centre de santé de référence, situé à Kita) pour les enfants MAS avec complications (en URENI), au niveau des CScom (centres de santé communautaires) pour les enfants MAS sans complications (en URENAS) et MAM (en URENAM). Il est aussi à noter que des Agents de santé communautaire (65) ont été formés en 2012 au dépistage et à la prise en charge de la MAM.
ACF-E supporte techniquement et logistiquement les autorités sanitaires pour le dépistage et la PEC de la malnutrition aigüe sur toutes les aires de santé fonctionnelles du cercle de Kita à travers 2 projets: un financé par ECHO depuis 2012 (35 CScom) et un autre nommé PASAN, financé par AECID depuis 2011 (6 CScom8) et pour lequel ACF-E est en appui à une ONG nationale (Stop Sahel).
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Kita:
","","","","","","","Action Against Hunger (AAH) / Action contre la faim (ACF)","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","European Commission Humanitarian Aid & Civil Protection (ECHO)","Spanish Agency for International Development Cooperation (AECID)","Bilateral and donor agencies and lenders","Other","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23243","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Kita","Primary health care center","","Le District sanitaire de Kita est constitué de 46 aires de santé. 3 sont toujours considérés comme non fonctionnelles6 (Kolé, Niantasso, Sanko). L’aire de santé de Sibikily vient d’être dotée en personnel et ACF-E leur a fait une formation sur la PEC de la malnutrition aigüe.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite en decembre 2013 en utilisant la méthodologie « Semi Quantitative Evaluation of Access and Coverage » (SQUEAC). Une première évaluation de la couverture du programme nutritionnel a été menée en mars 2013 et montrait des taux de couverture actuelle de 24,9% [IC95% : 14,5%-39,2%]. L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d’identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Au total, cette investigation met en avant le besoin de poursuivre le travail entrepris par les équipes d’ACF-E en collaboration avec les autorités sanitaires, le personnel des CScom et les relais communautaires. L’implication des ASC dans la PEC de la MAS est à envisager.
L’hypothèse d’hétérogénéité de la couverture a été confirmée, avec des zones de plus haute couverture dans les villages proches des CScom (<5kms) où des RC mènent des activités de dépistage et de sensibilisation et des zones de plus faible couverture dans les villages éloignés des CScom, d’autant plus si peu de dépistage des enfants malnutris aigus est effectué.
L´IRC (International Rescue Committee) a démarré en septembre 2013 un programme d´appui au district sanitaire que comprends, entre autres activités, la prise en charge de la malnutrition aigüe sévère. Ce programme PECIMA a été mis en oeuvre dans 10 aires de santé fonctionnelles de 8 communes du district.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Nara:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/Rapport-SQUEAC_Nara_VF1.pdf
","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23249","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Nara","Primary health care center","","Le programme à Nara s’articule autour des stratégies suivantes:
- Gratuité des soins dans les CSCom: Assurer une gratuite de soins chez les enfants de moins de 5 ans souffrant de MAS. Les CSCom bénéficient d’un appui en ressources humaines (équipe mobile qui passe dans les CSCom selon le jour d’affluence (Foire/Marché hebdomadaire): une fois par CSCom par semaine), en matériel et intrants pour assurer de façon optimale les activités de prise en charge en respectant le protocole national du Mali. Aussi la réhabilitation des espaces d’accueil dans les CSCom appuyés afin de faciliter la réalisation des activités, suivies par le Médecin Superviseur.
- Référence et contre référence des cas compliqués: Les enfants présentant des complications lors du suivi sont référés au CSRéf de Nara pour une meilleure prise en charge. Après la stabilisation, ces enfants retournent dans leur CSCom d’origine pour poursuivre leur traitement. Le transport aller-retour de ces patients est assuré par IRC.
- Dépistage systématique au niveau des CSCom: Tous les enfants consultés dans les structures sanitaires appuyées par IRC bénéficient d’un dépistage systématique fait par le Périmètre brachial, le Z score et la recherche des oedèmes.
- Renforcement du volet communautaire: Le dépistage de la malnutrition aigüe, la reference des cas, la sensibilisation, la recherche des absents et des abandons sont des activités développées par lesanimateurs communautaires du projet en synergie avec les agents terrain du partenaire local CSPEEDA et les relais communautaires. Le réseau de relais communautaires est mis en place au niveau
La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du du 14 mars au 3 avril 2014 en utilisant la méthodologie «Semi Quantitative Evaluation of Access and Coverage» (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d’identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Les barrières identifiées auprès de l´étude ont soulevées les faiblesses du volet communautaire du programme PECIMA d´IRC. La méconnaissance de la malnutrition, en termes de non reconnaissance des signes ainsi que des causes ou conséquences de la maladie, c´est une barrière qu´a ressorti auprès de toutes les étapes de l´investigation et ce qui semble gagner de l’importance dans les zones plus éloignés des CSCom, comme a été constaté à travers l’enquête dans les petites zones. La méconnaissance du programme est beaucoup ressortie, mais uniquement dans les zones plus distantes. En effet, dans le contexte de Nara, la distance n´est pas seulement une barrière essentielle à l’accès pour les bénéficiaires (mais aussi pour le programme: les activités de sensibilisation et de dépistage, que sont déjà globalement insuffisantes –ni continus ni régulières ni à niveau communautaire ni des CSCom- sont Presque inexistants dans les aires reculées.
Ces barrières que contribuent à la présentation tardive des admissions expliquent la sévérité des cas qu´arrivent aux centres ainsi que le faible niveau de couverture, et sont en plus augmentés par autres aspects déficitaires de la prise en charge (application correcte du protocole) et du suivi: suivi de cas au niveau individuel (des absences, recherche des abandons) et au niveau programme (qualité des données, monitorage des indicateurs de routine).
","","English" "23252","IMC programme communautaire: Prise en Charge de la Malnutrition Aiguë dans le district de Amdam","French","Community/sub-national","","TCD","Chad","Sila, Chad","Rural","on-going","07-2010","","L’histoire de la PCIMA dans le district d’Amdam avait commencé avec l’arrivée de MSF-Hollande, Septembre 2007 avec un programme de soins de santé primaire (consultation curative, CPN), nutrition sous clinique mobile et appui en personnel à l’hôpital du district. En 2010, avec l’appui d’ECHO, International Medical Corps redémarrera la PCIMA avec 16 sites et depuis Novembre 2012 jusqu'à nos jours, le district compte actuellement 19 sites de prise en charge CNA/CNS et 1 centre de stabilisation à l’hôpital du District. Parmi les 19 sites CNA/CNS, 3 sont fixes et 16 cliniques mobiles.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/.
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Amdam:
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","European Commission Humanitarian Aid & Civil Protection (ECHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23251","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Amdam","Community-based|Primary health care center","","Le District d’Amdam compte 4 zones de responsabilité et selon les possibilités du financement International Medical Corps était en mesure de mettre en oeuvre son programme de nutrition dans toutes les zones de responsabilité d’Amdam avec 2 CNA fixes et 11 cliniques mobiles (des Juillet 2010 jusqu’en Octobre 2012) Depuis Novembre le réseau de clinique mobile a été augmentée avec l’ouverture de 6 nouveaux sites, ce qui donne un total de 16 cliniques mobiles et 3 CNA fixe sur l’ensemble du District.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du du 14 mars au 3 avril 2014 en utilisant la méthodologie «Semi Quantitative Evaluation of Access and Coverage» (SQUEAC). Une première enquête utilisant la méthodologie SQUEAC était réalisée par International Medical Corps en Avril 2012 et avait trouvé un taux de couverture de 34%. L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d’identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Certaines insuffisances ont été identifiées lors de cette enquête notamment l’insuffisance d’engagement du personnel soignant du Ministère de la sante travaillant dans les centres de santé fonctionnels pour le succès du programme. Ceux-ci nous ont semblé considérer le programme de Nutrition comme étant une affaire des ONG. Le travail mené par les relais communautaires nécessite un suivi rapproché bien qu’il y a nécessité d’augmenter leur nombre il faut d’abord encadrer ceux qui existent déjà afin d’améliorer leur performance dans le travail.
Il y a une certaine adéquation entre les tendances des admissions et le calendrier saisonnier. Ce qui signifierait que le programme répond d’une manière ou d’une autre aux besoins mais cela est à prendre avec réserve parce qu’étant donné que l’hypothèse de la distance et l’inaccessibilité font partie des barrières majeures au programme il y a lieu de penser que ces tendances d’admissions traduiraient juste une indication sur la réalité.
L’amélioration de la sensibilisation communautaire à travers une augmentation du nombre des relais communautaires, l’augmentation de sites dans les villages lointains ainsi que le renforcement de la clinique mobile surtout dans les zones éloignées: Teleguey et Koutoufare constituent pour le moment des solutions incontournables pour l’amélioration de la couverture nutritionnelle dans le district d’Amdam.
","","French" "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 programme focusses on the promotion of iodised salt consumption to eliminate IDDs which are prevalent in Ghana. This is done through enforcement of the Public Health Amendment law 2012 Act 851, which states that salts for human and animal cosumption must be iodised. The programme also trains salt producers on effective ways of iodising salt.
","Total goitre rates, urinary and salt iodine concentrations,Household iodated salt consumption coverageMarket coverage of iodated salt
","Vulnerable groups","","Iodization of salt>>>Iodization of salt>>http://www.who.int/elena/titles/salt_iodization","Financial resources","Creating awareness of the importance of the program in policy makers to make funds available for the programme","Stakeholder","Lyasing with international organizations to inculcate IDD in their programms","Supplies","Imposing tax exemption on the importation of potassium iodate to reduce the cost of salt iodisation","","","","","","","","","","","","","","","","Establishment of salt banks at salt producing areas to mop up salts produce by small scale salt producers
","","English"