Action - Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative - Management of severe acute malnutrition - HIV cases

Programme: Feed the Future: The U.S. Government’s Global Hunger and Food Security Initiative

Programme description

Feed the Future, the U.S. government’s global hunger and food security initiative, is a $3.5 billion commitment to support country-driven approaches to address the root causes of poverty, hunger and undernutrition. A whole-of-government initiative led by the United States Agency for International Development (USAID), Feed the Future leverages the strengths of multilateral institutions, civil society and the private sector. Globally we aim to assist 18 million vulnerable women, hildren, and family members – mostly smallholder farmers – escape hunger and poverty. Together, we will increase agricultural productivity, decrease poverty, drive economic growth, and reduce undernutrition to improve millions of lives.

Over the next five years in Uganda, Feed the Future aims to help an estimated 709,000 vulnerable Ugandan women, children and family members—mostly mallholder farmers—escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. Significant numbers of additional rural populations will achieve improved income and nutritional status from strategic policy engagement and institutional investments.

To meet its objectives, Feed the Future Uganda is making core investments in three key areas:

1. Nutrition

  • Essential nutrition actions at health facility and community level
  • Management  of severe acute malnutrition at health facility level
  • Productionof ready-to-use therapeutic foods and complimentary foods
  • Social  Marketing of Complementary Foods
  • Behavior  Change Communication for Improved Nutrition
  • Micronutrient  interventions including food fortification
  • Capacity  building, policy, advocacy and research

2. Agriculture. The maize, coffee and bean belt are in Southwest and Central Uganda. The choice to focus on these value chains represents considerations regarding Ugandan government priorities, division of donor labor, and the highest impact interventions for the expected scale of Feed the Future resources.

  • Maize for Regional Food Security
  • Coffee  for Growth
  • Beans  for Nutrition
  • Value  Chain Investments
  • Agro  Input Supplies

3. Connecting Nutrition to Agriculture

  • Agriculture Research
  • Supporting  Policy & Enabling Environment
  • Partnership  Investment
  • Capacity  Building
  • Community  Connector

Programme type

Multi-national

Cost

$47.5 million

References

Status: 
On-going

Start date:

January
2011

End date:

December
2015
Area: 
Rural
Peri-urban
Place: 
North and Southwest Uganda
Target group: 
HIV cases
MAM child
SAM child
Stunted child
Women of reproductive age (WRA)
Delivery: 
Community-based
Hospital/clinic
Primary health care center
Implementation details : 

USAID will build on previous strategic investments in nutrition and take them to scale in the areas and populations of greatest need to support the GOU and private sector to reduce chronic undernutrition in the country with a primary focus on prevention. Through these interventions an estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition and prevent stunting and child mortality. The core investments in nutrition will focus on community and facility based prevention and treatment, targeted nutrition service delivery, the enabling environment for nutrition and capacity building. 

Community and Facility-Base Prevention and Treatment

USAID Uganda will support the scale up of the Essential Nutrition Actions (ENA)22 through key district-based programs to improve nutrition in facility and community settings in the areas of highest chronic undernutrition (North and Southwest Uganda). At the facility level, specific activities will include training on ENA with priority health cadres, including training on assessments, key messages, and follow-up. Antenatal care clinics (ANC) and postnatal care linics, immunization sessions and sick child clinics will provide key platforms to improve nutrition prevention and assessment, as will leveraging current assessment and treatment efforts supported by PEPFAR. At the community level, the Village Health Team (VHT) will be the main facilitator of ENA and assessment of undernutrition needing facility referrals; however, additional community based mechanisms including community outreach sessions, mother’s groups and schools can be included where feasible and appropriate. While the primary ENA messages focus on specific nutrition messages, additional emphasis will also be placed on key hygiene messages including water treatment, hand washing with soap and use of safe sanitation practices that all can drastically improve the overall nutritional status of children. In addition, with high fertility rates and a high unmet need for family planning, efforts to scale up and expand ENA in Uganda will additionally focus on healthy timing and spacing of pregnancies, which improves nutritional status. 

By emphasizing prevention, FTF programs will help to reduce not only chronic undernutrition, but should also reduce the number of severely/acutely malnourished children as well, resulting in fewer children outside HIV and emergency situations needing treatment for severe acute malnutrition. For the treatment of acute malnutrition, Uganda has adopted a national protocol for the Integrated Management of Acute Malnutrition (IMAM). Through a ommunity and facility based approach to treating under nutrition, therapeutic and/or supplementary food is provided to severe or moderately malnourished children, with medical support, nutrition education, and at-home follow up through community based volunteers. FTF and PEPFAR’s partnership on the production, distribution, and management of RUTF support the larger national IMAM protocols. 

 

Capacity Building

 

Capacity building at the national and district level is critical. Nutrition has only recently become a priority in the health sector, and without strong nutrition champions and policies centrally, nutrition priorities will not be realized. USAID will continue to train health workers in new IMAM guidelines for use in health facilities and will expand technical assistance and capacity building at the national level beyond the health sector to include Agriculture and other ministries who can contribute to a national action plan on nutrition.

Target population size : 
estimated 709,000 vulnerable Ugandan women, children, and family members—mostly smallholder farmers—will receive targeted assistance to escape hunger and poverty. More than 450,000 children will be reached with services to improve their nutrition
Coverage level (%): 
This component will reach children in 47 districts in the Southwest and North of Uganda
Outcome indicator(s): 

Some key outputs of nutrition activities are: nutrition officers placed in a majority of districts; active Food and Nutrition Councils organized in districts; mandatory fortification of major manufactured foods; therapeutic food reconstituted from locally available foods developed and distributed to district and regional hospitals; and community behavior changes to prevent undernutrition.

M&E system: 

PERFORMANCE MONITORING

Through an interactive approach across Mission teams and in collaboration with other donors and the GOU, the USG FTF effort will go beyond the status quo of performance monitoring. At the basic level, data will be collected by implementing partners and reported to USAID/Uganda through quarterly reports while quality will be assessed via Data Quality Assessment visits to the field.

IMPACT EVALUATION

To build an evidence base to adjust ongoing projects and inform future programs, we will design rigorous impact evaluations for select FTF programs. We have already identified such an opportunity with our Community Connector program, which fully integrates agriculture and nutrition activities at the household level. Discussions have been held with partners within the MIT Poverty Action Lab consortium on the use of Randomized Control Trial (RCT) experiments. We will use the results of these impact evaluations to test the hypotheses of our FTF strategy and make mid-stream adjustments to programs if necessary, or scale up programs that are working well. Using the earning component of FTF programs like Community Connector is in line with the Mission’s continuing CLA component. We will also partner with other donors to disseminate and promote lessons learned. USAID/Uganda, through unbiased and independent impact evaluations, will identify interventions that work; we will be an active contributor to the greater discourse in testable development hypotheses and our programs will benefit from our increased understanding

CAPACITY BUILDING/SUPPORT TO DATA COLLECTION

A key component of our Feed the Future program will be capacity building of the Government of Uganda in the collection, analysis, and use of agriculture and nutrition data for planning, monitoring, and evaluation. We will work with all relevant government agencies and ministries including the Uganda Bureau of Statistics, the Ministry of Agriculture, Animal Industry and Fisheries, and the Ministry of Health. We will work in partnership with the National Planning authority as they attempt to convene the multisectoral Food and Nutrition Council as a cohesive and functional unit. We will seek to build local academic institutions’ capacity in nutrition through improved pre-service and in-service training, and enhanced research capacity. In addition to training in data collection and assistance in improving data systems, we will build analytical capacity in the Ministry of Agriculture by establishing a Strategic Analysis and Knowledge Support System (SAKSS) node.

NUTRITION COLLABORATIVE RESEARCH AND SUPPORT PROGRAM (CRSP) 

We will use the Nutrition CRSP to assist us with specific research questions that tell us about the impact of our nutrition-related FTF programs. We have already had preliminary discussions with a Nutrition CRSP team. The Nutrition CRSP is intended to investigate effective ways of translating research results into widespread development practice. The CRSP anticipates the development of a well-balanced research strategy that is both innovative and problem solving, responds to the food and nutrition scientific needs, and to the capacity development requirements of Uganda. USAID/Uganda, through the CRSP, will be better positioned to build more effective strategies and programs, while establishing a research capacity within the Mission and the country as a whole. As programs continue to be developed and procured in the coming months, the CRSP will assist in collecting the relevant local and international knowledge base needed to better implement, evaluate, and learn from our programs. Within individual programs, the CRSP will be an active participant in identifying and rigorously measure testable hypotheses related to food security.

Post-intervention: 

Prevalence of households with moderate or severe hunger;Prevalence of children 6-23 months receiving a minimum acceptable diet; Prevalence of exclusive breastfeeding of children under 6 months; Number of health facilities with established capacity to manage acute under nutrition; Prevalence of anemia among children 6-59 months; Prevalence of Poverty: Percent of people living on less than $1.25/day; Expenditures of rural households;Prevalence of stunted children under five; Change in average score on Household Hunger index; Percent of children 6-23 months who received a Minimum Acceptable Diet.

Outcome reported by social determinants: 
Vulnerable groups
Sex

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