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Donor Support to the Nutrition Sector in Kenya
Mapping Report
Faith M. Thuita, PhD
MQSUN Consultant to the SUN Donor Convenor, Kenya
March 2016
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ABOUT MQSUN
MQSUN aims to provide the Department for International Development (DFID) with technical services to
improve the quality of nutrition-specific and nutrition-sensitive programmes. The project is resourced by a
consortium of seven leading non-state organisations working on nutrition. The consortium is led by PATH.
The group is committed to:
Expanding the evidence base on the causes of undernutrition
Enhancing skills and capacity to support scaling up of nutrition-specific and nutrition-sensitive
programmes
Providing the best guidance available to support programme design, implementation, monitoring and
evaluation
Increasing innovation in nutrition programmes
Knowledge-sharing to ensure lessons are learnt across DFID and beyond.
MQSUN PARTNERS ARE:
Aga Khan University
Agribusiness Systems International
ICF International
Institute for Development Studies
Health Partners International, Inc.
PATH
Save the Children UK
CONTACT
PATH, 455 Massachusetts Avenue NW, Suite 1000
Washington, DC 20001 USA
Tel: (202) 822-0033
Fax: (202) 457-1466
ABOUT THIS PUBLICATION
This report was produced by Faith M. Thuita, PhD, for the government and the SUN Donor
network in Kenya through the UK Government‘s Department for International development
(DFID)-funded MQSUN project.
This document was produced through support provided by UKaid from the Department for
International Development. The opinions herein are those of the author and do not
necessarily reflect the views of the Department for International Development.
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ACKNOWLEDGEMENTS
I am indebted to Dr Hjordis Ogendo, the SUN donor convenor in Kenya (2014 – 2015) for providing
exemplary leadership to the SUN donor network, and to this activity in particular. All support extended to
me in the course of planning, information gathering and dissemination of findings is warmly
acknowledged.
I gratefully acknowledge the support of Dr Samora Otieno, DFID Kenya humanitarian advisor, and
technical assistance provided by Mr Albert Webale.
Special appreciation is extended to members of the donor network representing different donor agencies
who provided the information that forms the basis of this report.
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Table of Contents
Acronyms .................................................................................................................................................... 15
Background ................................................................................................................................................. 17
About the donor mapping ....................................................................................................................... 17
Purpose and scope of the Mapping ......................................................................................................... 17
Scaling up Nutrition in Kenya ................................................................................................................ 18
Overview of the Nutrition Situation in Kenya ........................................................................................ 19
The Policy Framework and Coordination of the Nutrition Sector .......................................................... 20
Government Commitments to Improve the Nutrition Situation ............................................................. 21
Donor support to the nutrition sector in Kenya ....................................................................................... 22
Findings ...................................................................................................................................................... 25
Coverage ................................................................................................................................................. 25
Nutrition sensitivity of programmes ....................................................................................................... 27
Nutrition Sensitive and Specific Interventions supported by donors in Kenya ...................................... 28
Conclusion .................................................................................................................................................. 46
Recommendations ....................................................................................................................................... 46
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Acronyms
ASDS Agricultural Sector Development Strategy
AMREF African Medical and Research Foundation
AMPATH Academic Model for Prevention and Treatment of HIV
APHIAplus AIDS, Population and Health Integrated Project plus
ASAL Arid and Semi Arid Lands
CDC Centers for Disease Control and Prevention
CfP Calls for Proposals
CHMT County Health Management Team
CRW Crisis Response Window
DEVCO Development Corporation
DFID Department for International Development
ECHO European Community Humanitarian aid Office
EmOC Emergency Obstetric Care
EDE Ending Drought Emergencies
EU European Union
FAO Food and Agriculture Organization
FCI Family Care International
FHI Family Health International
FNSP Food and Nutrition Security Policy
FtF Feed the Future
GIZ Gesellschaft für Internationale Zusammenarbeit
GNR Global Nutrition Report
GOK Government of Kenya
HINI High Impact Nutrition- specific Interventions
IDA International Development Assistance
IMAM Integrated Management of Acute Malnutrition
JHPIEGO Johns Hopkins Program for International Education in Gynaecology and Obstetrics
KHSSP Kenya Health Sector Support Project
MoDP Ministry of Devolution and Planning
MDG Millennium Development Goal
IFPRI International Food Policy Research Institute
INGO International Non Governmental Organization
KCL Kings College London
KHP Kenya Health Programme
MCHIP Maternal and Child Health Integrated Program
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MNCH Maternal Newborn Child Health
MoDP Ministry of Devolution and Planning
MOPHS Ministry of Public Health and Sanitation
MQSUN Maximising the quality of scaling up nutrition
MTEF Mid Term Expenditure Financial
MTIP Mid Term Investment Plan
MOH Ministry of Health
NACS Nutrition Assessment Counseling and Support
NASCOP National AIDS and STI control Programme
NHP Nutrition and Health Program
NICC Nutrition Interagency Coordinating Committee
NSI Nutrition-Specific Interventions
NNAP National Nutrition Action Plan
NCD Non communicable Disease
NDU Nutrition and Dietetics Unit
NGO Non Governmental Organization
NTWG Nutrition Technical Working Group
OVC Orphans and Vulnerable Chidren
PEPFAR President's Emergency Plan for AIDS Relief
PSI Population services International -
SAM Severe Acute Malnutrition
SHARE Supporting Horn of Africa Resilience
SMART Standardized Monitoring & Assessment of Relief & Transitions
SQEAUC Semi-Quantitative Evaluation of Access and Coverage
SUN Scaling Up Nutrition
TN Transform Nutrition
UNICEF United Nations Children's Fund
USG United States Government
USAID/ K United States Agency for International Development Kenya
WASH Water Sanitation and Hygiene
WHO World Health Organization
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Background
About the donor mapping
Donors are one of five key networks supporting Scaling up Nutrition (SUN) efforts in Kenya. Currently,
the European Union Delegation serves as the donor convenor with responsibility for coordination of
donors and development agencies supporting the nutrition sector in Kenya. The SUN donor convener
functions as a catalyst, with actual implementation of SUN initiatives being the responsibility of the
government and individual donors through implementing agencies. In addition, the convenor liaises with
the SUN secretariat to ensure that all efforts are linked and coordinated with the work of other SUN
constituent networks.
To support the roles and functions of the donor convenor, the MQSUN project contracted a short term
nutrition consultant to provide technical assistance to the EU delegation from September 2014. The key
role of the consultant is to support the SUN Donor Convenor to act as an enabler and catalyst for other
donors, government, and SUN networks for accelerated action to scale up of nutrition in Kenya. One of
the terms of reference for this consultancy was the mapping of nutrition programmes funded by
development partners in the country with a view to gauge the contribution of development partners in
Scale up of Nutrition in the country.
The donor contribution to SUN in a country is intended to be measured through a series of agreed upon
indicators that include the following;
Percentage of SUN donors that incorporate nutrition within their country plans in at least two
sectors.
Percentage of SUN donors that release funding according to schedule in a given year.
Percentage of SUN donors that integrate indicators to measure nutrition results
Percentage of SUN donors that implement programmes that are harmonised and aligned with
national nutrition policies and strategies.
The above indicators are designed to be as broad as possible in order to factor in the fact that the needs of
individual SUN countries are diverse and donor inputs and resources will be used to fund a variety of
programmes and initiatives that respond to an individual country‘s needs. The donor coordination group
is expected to measure progress against these indicators in collaboration with the Government SUN Focal
Point and to report on an annual basis to the international SUN Donor Network.
Purpose and scope of the Mapping
The mapping exercise sought to estimate donor support to the nutrition sector in Kenya with a view to
identify critical gaps, potential or existing overlaps and to guide harmonization and future planning. The
assessment also aimed at generating information for the government and other sector partners on current
and planned investments to the nutrition sector. It is anticipated that information on the level of resources
available and partners implementing funded programs will also be important for county level
coordination, planning, budgeting and tracking. These findings could also inform the Mid Term
Expenditure Financial (MTEF) reporting and planning.
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Scaling up Nutrition in Kenya
In August 2012, Kenya joined the Scaling-Up Nutrition (SUN) movement, setting out the approach in the
National Nutrition Action Plan which was approved in November, 20121. This signalled the county‘s
commitment to undertaking coordinated actions to improve the status of nutrition in the country. Key
achievements since the launch of SUN in Kenya include adoption of a set of High Impact Nutrition
Interventions (HINIs) and enhanced government leadership of the nutrition sector, which has resulted in
improved coordination of actors and a more coordinated approach to implementation and monitoring of
nutrition programmes2. This is evidenced by inclusion of the nutrition indicators in the County Health
Information System, Annual Operational Plan, and Medium-Term Expenditure Framework. In addition,
the nutrition budget is now aligned to the government‘s broader Medium-Term Development Plan. The
government, UN, donor and Civil Society networks are also in place. Individual networks meet on a
quarterly basis, while all networks are convened by the SUN Government Focal Point twice a year.
Recently, the first lady came on board as the national nutrition patron. It is anticipated that this will lead
to increased visibility of nutrition translating to heightened political and funding commitments to the
sector. Despite these achievements at the national level, the nutrition sector continues to face several
challenges. The inter-sectoral linkages to address malnutrition are however poor and low priority is
accorded to nutrition issues in national and county development plans, which leads to insufficient budget
allocation for nutrition-specific and nutrition-sensitive interventions. On-going advocacy efforts to
increase visibility of nutrition are yet to translate into political commitment and accountability towards
improved allocation of resources to tackle malnutrition in the country.
Scaling up nutrition has largely focused on rolling out the high impact nutrition interventions as
envisaged in the National Nutrition Action Plan (NNAP) which to date remains a priority. This has
however experienced some lag occasioned by challenges related to devolution. Over the past 2 years,
Kenya has undergone significant devolution. Financial and decision making authority now resides in 47
county level administrations. Kenya‘s 47 counties are however at different levels in terms of resource
mobilisation and support from partners. While a few counties have effective coordination structures in
place and have marshalled support to develop county-specific nutrition action plans, many are still
grappling with inadequate funding resources, weak coordination of stakeholders and technical capacity to
implement nutrition specific and sensitive interventions. Developing capacity of county nutrition
technical teams to identify nutrition priorities, develop nutrition action plans with benchmarks to track
progress and advocate for allocation of resources to fund implementation of activities will be important
for scale up of nutrition at county level.
The National Nutrition Action Plan (NNAP-2013-2017) sets out the activities for at-scale implementation
of high impact nutrition-specific interventions (HINI). The cost of the NNAP over five years is estimated
to be KES 70 billion or US$824 million, (87% for nutrition specific, 3% nutrition sensitive and 10% for
governance). The GoK has committed to spending KES 6 billion (US$70 million) over five years for the
NNAP which is to be shared across various ministries including health, agriculture, water and irrigation,
fisheries development, and national planning and development. Donors are aligning behind the
government‘s leadership on issues related to nutrition. DFID has committed Kshs. 2.29 billion (£16
million) to assist in scaling up nutrition in three arid, chronically nutrition-insecure counties: Turkana,
1 MOPHS (2012) National Nutrition Action Plan; available http://scalingupnutrition.org/wp--
‐content/uploads/2013/02/Kenya_KNN_Action--‐Plan_2012_2017.pdf.) 2 For more details on the GOK‘s involvement with SUN, visit: http://scalingupnutrition.org/suncountries/Kenya
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Wajir, and Mandera. The European Union has also committed to funding the €250 million (£196 million)
Supporting Horn of Africa Resilience (SHARE) initiative, which is designed to help people in the Horn of
Africa to recover from drought, as well as strengthen the population and regional economy to better
withstand future crises.
Information on current and projected funding levels to the nutrition sector, types of programmes funded
and partners implementing these programmes in the country is important for planning at both the national
and county government levels. It is particularly important to profile funding support targeted at both
nutrition specific and nutrition sensitive programmes as both are critical if the persistent challenge of
malnutrition in the country is to be addressed effectively.
Overview of the Nutrition Situation in Kenya
Over the past 20 years, the picture of the nutritional landscape of Kenya, as portrayed by the indicators of
children under five has been grim. However, latest statistics from the recently carried out Kenya
Demographic Health Survey (KDHS) indicate that there has been a remarkable improvement in the last
five years. Previously identified as one of the 36 countries that carry 90% of the global stunting burden,
the latest demographic health survey indicates that a reduction in stunting levels, a trend that had
previously remained relatively stagnant over the past two decades.
The figure below shows the trend in nutritional status of under fives over the past decade.
Sources: KDHS 2003, 2008-09, 2014
Stunting and wasting levels have tremendously reduced to from 35.3% to 26% and 6.7% to 4%
respectively. Even more noteworthy is Kenya's attainment of its 11% underweight target. This
improvement in nutritional indicators is indeed remarkable.
At county level, Turkana and West Pokot counties have emerged as the counties with the worst under five
nutritional indicators. West Pokot county has the highest stunting (45.9%) and underweight (38.5%)
rates. Turkana on the other hand is the county with the highest rate of wasting (23%) and the second
leading in underweight (34%). The top nine counties with the worst wasting rates are in the arid and semi
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arid lands (ASAL). However, it is interesting to note that Garissa, although in the ASAL, is the county
with the second lowest stunting rates in the country. The top three counties with the lowest rates of
underweight are Nyeri, Nairobi and Kiambu. These three countries are also among the top four with the
lowest rates of stunting, with Nyeri being in the lead.
According to the KDHS 2014, mothers living in rural areas are more likely to have stunted children than
those living in urban areas. In addition, level of education and wealth quintile are inversely correlated
with risk of stunting. These factors were found to interact in a similar fashion with wasting and
underweight indicators in the 2014 KDHS.
Five years ago, Kenya adopted a package of eleven high impact nutrition interventions recommended by
the WHO following research findings of the 2008 Lancet series, and further research by the World Bank
in 2009 which identified 13 highly cost- effective interventions. Although it may be too early to attribute
the improvement in some of the indicators to implementation of the HINI, it is worthwhile to highlight
the current situation. The KDHS collected data on three of the eleven HINI, namely exclusive
breastfeeding, optimal complementary feeding and zinc treatment for diarrhoea.
Sixty one percent of mothers of infants less than six months are exclusively breastfeeding. This is a
tremendous improvement and has surpassed the Ministry of Health's (MOH) 2016/ 17 target. However,
the percentage of children receiving a minimum acceptable diet3 declined from 39% in 2008/ 09 to 21%
in 2014. The rate of breastfeeding between 18- 23 months also decreased from 59.3% to 51%. According
to the Lancet, breastfeeding could reduce child mortality by about 13%, and improved complementary
feeding would reduce child mortality by about 6%. (Jones et al, 2013). Although the rate of optimal
complementary feeding practices has declined, it is encouraging to note that over the past five years, the
under five- and infant mortality rates have decreased from 74 to 52 deaths and 52 to 39 deaths per 1,000
live births in 2008/ 09 and 2014 respectively. These decreases in mortality are an indicator of a reversal of
trends seen in the last twenty years.
Zinc treatment for diarrhoea is the third HiNi that was accessed during the last KDHS. Diarrhoea, a
preventable and treatable disease, is a leading cause of malnutrition and deaths of children under five
years (WHO, 2013). Appropriate treatment of this condition is therefore a vital component in prevention
of under five deaths. The rate of zinc treatment for diarrhoea has improved from 0.2% in 2008/09 to the
current 8%. Although this is way below MOH's target of 80% by 2016/17, it is anticipated that with the
rolling out of HINI countrywide that these statistics will improve.
The Policy Framework and Coordination of the Nutrition Sector
Kenya has a number of policy instruments to help expedite the country‘s social and human development.
The right of ‗every child to basic nutrition, shelter and health care‘ is enshrined in the Government of
Kenya‘s constitution that was promulgated in 2010. The government also has a well-articulated multi-
sectoral Food and Nutrition Security Policy (2011), a National Nutrition Action Plan7 (2012-17) and a
draft Food Security and Nutrition Strategy. Further, the government has enacted laws for mandatory
fortification of cereal flours and vegetable oils as well as a commitment to the protection and promotion
of appropriate infant feeding practices through passing of the breastmilk substitutes regulation and control
bill (2012). The semi-autonomous nature of counties however means that national government policies
and plans cannot be directly enforced. This is resultant from devolution of administrative, governance
3 Minimum acceptable diet is indication of the proportion of children in a population who receive the
minimum dietary diversity and minimum meal frequency
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structures and political power from national and provincial level to 47 counties. ASAL counties are
reportedly more engaged in the National Nutrition Action Plan although their engagement reportedly
varies as nutrition competes with other county level priorities. It is also noteworthy that with devolution,
the Ministry of Devolution and Planning (MoDP) now has authority for national planning and
coordination.
The creation of a multi-sectoral Food Security and Nutrition Secretariat to ensure broad based, cross-
sectoral coordination and monitoring of nutrition initiatives was envisaged as a key structure in the Food
and Nutrition Security Policy. This has however not been established to-date. The Nutrition Interagency
Coordinating Committee (NICC)4 which is chaired by the Head of the Nutrition and dietetics Unit in the
MoH oversees progress with the implementation of the NNAP. Thus nutrition specific actions are well
coordinated. There however is no coordination mechanism for nutrition - sensitive actions. The Nutrition
and dietetics Unit (NDU) does not have convening power over other line ministries and their attendance
at NICC meetings is voluntary. In recognition of the need for much greater inter- ministerial engagement
in nutrition, the MoH recently wrote to nine nutrition - relevant ministries to request that they nominate a
Nutrition Focal point in order to help generate a stronger discourse concerning nutrition- sensitive
approaches.
The SUN networks in Kenya under the leadership of the SUN focal point seek to obtain political
commitment and accountability for addressing malnutrition and raising the profile of nutrition by
emphasising its role in ensuring overall health and well-being. A recent development is that the Nutrition
and Dietetics Unit, with support of the main development partners, successfully secured the agreement of
the First Lady to act as Nutrition Patron in Kenya.
Government Commitments to Improve the Nutrition Situation
Kenya launched Vision 2030 in 2008 as the country‘s long- term development blueprint. The purpose of
vision 2030 was to transform Kenya into a middle income country. This was achieved in September
20145. Although Vision 2030 does not include nutrition as a developmental outcome, this is addressed in
a number of subsequent government policies detailed below:
The Kenya National Food and Nutrition Security Policy (FNSP 2011) has three major objectives
namely: 1. To achieve adequate nutrition for optimum health of all Kenyans; 2. To increase the quantity
and quality of food available, accessible and affordable to all Kenyans at all times; and, 3. To protect
vulnerable populations using innovative and cost-effective safety nets linked to long-term
development.
The National Nutrition Action Plan (NNAP-2013-2017) sets out the activities for at-scale implementation
of high impact nutrition-specific interventions (HINI). The high impact nutrition interventions are
incorporated into the health system and are the backbone of the NNAP led by the MoH. At present, this
provides the strongest links with nutrition of all government led programmes. Development partners are
providing important support too, an example being Health Systems Strengthening that is supported by a
4 The NICC has four steering committees: Maternal Infant and Young Child Nutrition, Food Security and Emergency Nutrition Task Force,
Micronutrient Deficiency Control Council And the Healthy Diets and Lifestyles Steering Committee 5 World Bank, Kenya: A Bigger, Better Economy, September 30, 2014
http://www.worldbank.org/en/news/feature/2014/09/30/kenya-a-bigger-better-economy accessed on 2nd April 2015
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number of donors. DFID supports HINI systems strengthening in 11 Counties (Turkana, Mandera, Wajir,
Garissa, Tana River, Baringo, Marsabit, Samburu, West Pokot, Laikipia and Isiolo). over 4 years (2012 -
2016).
The government actively seeks to reduce vulnerability to droughts and risk of emergencies in 23 Arid and
Semi Arid (ASAL) by 2022 through sustainable development as opposed to repeatedly reacting to the
effects of droughts. This is articulated in the Common Programme Framework for Ending Drought
Emergencies (EDE)6. Nutrition is given serious attention in the EDE as a key to building resilience and
thus reducing vulnerability to future droughts. The EDE therefore has the potential to operationalise
comprehensive approaches to addressing undernutrition that combine nutrition‐sensitive and nutrition-
specific interventions.
The Agricultural Sector Development Strategy (ASDS) aims to achieve an agricultural growth rate
of 7% per year between 20013- 17. The ASDS Mid Term Investment Plan (MTIP) for 2013 -2017
has a number of references to food and nutrition security and has earmarked KES 20 million to the FNSP
(approximately €194,000) out of a total MTIP budget of KES 460.2 million (i.e. roughly 4% of
the total budget).
Against this backdrop, this study sought to profile the investment that development partners are making to
the nutrition sector to complement government efforts in addressing the nutrition challenges that face the
country.
Donor support to the nutrition sector in Kenya
Nutrition specific interventions
Timely nutrition-specific interventions (NSI) at critical points in the lifecycle can have a dramatic impact
on reducing malnutrition globally if taken to scale in high-burden countries. If scaled to 90 percent
coverage, it is estimated that 10 evidence-based, nutrition-specific interventions could reduce stunting by
20 percent and severe wasting by 60 percent7. Nutrition specific interventions include: Management of
severe acute malnutrition; Preventive zinc supplementation; Promotion of breastfeeding and Appropriate
complementary feeding ; Management of moderate acute malnutrition; Peri-conceptual folic acid
supplementation or fortification; Maternal balanced energy protein supplementation; Maternal multiple
micronutrient supplementation; Vitamin A supplementation and maternal calcium supplementation.
Nutrition sensitive Interventions
These are interventions that target the underlying and basic causes of malnutrition. Such interventions
have the potential to reduce malnutrition through improved diets and health especially of young children.
The 2013 lancet series on maternal and child nutrition shows that nutrition sensitive interventions and
programmes in agriculture, social safety nets, early child development and education have enormous
potential to enhance the scale and effectiveness of nutrition specific interventions while improving
nutrition can in turn help nutrition- sensitive programmes achieve their own goals. Nutrition-specific
interventions on their own eliminate under-nutrition; however, in combination with nutrition-sensitive
6 Republic of Kenya (2014) Ending Drought Emergencies Common Programme Framework
7 Zulfi qar A Bhutta, Jai K Das, Arjumand Rizvi et al. Maternal and Child Nutrition 2: Evidence- based interventions for
improvement of maternal and child: what can be done and at what cost? Lancet 2013; 382: 452- 77
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interventions, there is enormous potential to enhance the effectiveness of nutrition investments in the
country.
There are however a lot grey areas in determining nutrition sensitivity of programmes. Lack of clear
criteria/guidance on methodology of determining nutrition sensitivity in programmes gives room to high
level of subjectivity in designing nutrition sensitive projects. Formal guidance is urgently needed to
strengthen nutrition sensitive programming. According to the Lancet Series 20138, there are 9 pathways
and interventions that are considered nutrition sensitive: Agriculture& food security, Social safety nets,
Early Child development, Maternal mental health, Women‘s empowerment, Child protection, Classroom
education, Water and sanitation, Health and family planning services.
FAO has further elaborated on these pathways, particularly with a focus on improving nutrition through
agriculture9 by stating that (relevant to these DEVCO projects)
‘Agriculture and rural (urban) development have enormous potential to influence nutrition positively-
they can do so most effectively if nutrition relevant outcomes are clearly articulated in the design of a
project or policy , and if activities and indicators follow suit’.
The Lancet series ( 2013) and FAO elaboration (above) provide a framework to try and categorise these
projects in terms of their nutritional sensitivity or otherwise. A key challenge is the low understanding of
linkages between food security, basic education and water and sanitation strategies on one hand, and
nutrition on the other. Furthermore, programme strategies are vertical in nature and lack nutrition as an
outcome indicator. As a result, there is need to sensitize policy makers and programmers on the causal
factors of malnutrition and influence them to address malnutrition in a holistic approach and broad
manner.
SUN Donor Resource Tracking and attendant challenges
It is noteworthy that there is no common, agreed-upon approach to track resources for nutrition-sensitive
development assistance, which aims to leverage investments in sectors beyond health where most
nutrition sensitive interventions are nested. In 2013, a SUN Donor Network working group on resource
tracking developed a methodology for tracking financial investments in nutrition to increase
accountability and improve tracking of external development assistance for nutrition. The methodology
focused on developing an approach to quantify nutrition-sensitive spending. This was rooted in a decision
by the SUN donor group to find an improved way to track nutrition resources, primarily those resources
allocated through other sectors besides health where nutrition is typically nestled.
The methodology for calculating nutrition-sensitive investments is complex. The donor methodology
states that investments can only be classified as nutrition-sensitive if a project includes a nutrition
objective or indicator, contributes to nutrition outcomes and aims to improve nutrition for women,
children or adolescent girls. Since there is no single sector code for nutrition-sensitive programmes, a list
of codes that relate to nutrition was combined with keyword searches to identify programmes that
warranted further investigation. Each programme that might be nutrition-sensitive was manually assessed
by checking project documents.
8 The Lancet, Maternal and Child Nutrition, Executive Summary of The Lancet Maternal and Child Nutrition Series 2013
9 Herforth A, Jones A and Pinstrup- Andersen P. Prioritizing Nutrition in Agriculture and Rural Development: Guiding Principles
for Operational Investments. The World Bank. November 2012
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This methodology was used to gauge nutrition investments by the SUN Donor Network among 9 bilateral
donors, the European commission and two foundations (CIFF and Bill Melinda gates) between 2010
(Baseline for when the SUN Movement began); and 2012 which provides a comparative year. Findings
showed an overall increase in spending from 2010 to 2012 for both nutrition specific and nutrition
sensitive categories. Total nutrition specific investments (disbursements) among reporting donors
increased from USD 325 million (2010) to USD 411 million (2012), representing 27%. For nutrition-
sensitive investments, there was an increase from USD 937 million (2010) to USD 1.1 billion (2012),
representing 19% excluding the US who did not use the methodology.
This evaluation however faced several challenges with application of the methodology and recognises its
limitations as follows:
Stringent nutrition-sensitive criteria sometimes excluded projects that were clearly nutrition-
sensitive due to their lack of focus on actions ―aimed at individuals‖ (e.g. advocacy and research,
nutrition tracking systems, nutrition products);
An inefficient keyword search that failed to identify significant additional spending;
Variability among donors in the size, number and type of components within projects and
whether these projects should be classified as nutrition-specific only, sensitive or have relevant
portions allocated to each category.
Given the wide range of challenges and unique reporting approaches of individual donors, no
standard approach was applied; however, donors agreed to ensure that such projects are not
double-counted and to maintain consistency in the application of the methodology.
Although partially mitigated by a detailed methodology with stringent criteria for inclusion, the
approach is subjective. Furthermore, participating donors are different in their objective,
organizational structure and tracking and reporting mechanisms, and therefore it is inherently
challenging to create a single reporting methodology that can be universally applied.
Based on these challenges, the SUN Donor Network has discussed possible revisions to the methodology:
for example, developing descriptions to clarify what classifies as a nutrition objective or indicator and a
standardized list of types of objectives, outcomes, indicators and activities that are nutrition-sensitive to
avoid inconsistent classification. Due to the resource-heavy and time-consuming nature of the exercise,
donors have also begun to discuss ways to make the process more manageable, including potentially
altering the frequency of reporting from every year to alternate years. Donors have also discussed how
they can use the data to discuss the specifics of how to work together to make investments in other sectors
more sensitive to nutrition
Despite these challenges, the methodology represents an approach for donors to track external nutrition
development assistance in a transparent, consistent/comparable manner. Improved tracking of donor
spending on nutrition is important not only for accountability purposes but also to measure progress in
mobilizing resources and to improve the quality of nutrition aid by highlighting gaps and inspiring
changes to investments in other sectors in a way that will impact nutrition outcomes. Despite
methodology limitations, the Donor Network feels this is a significant step forward on tracking resources
and developing a common approach.
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Categorization of Budget allocations
Budget allocations categorized as “nutrition-sensitive”
Categorization of budget allocation requires provision of the programme description to get a better
understanding on how the programme contributes to nutrition-sensitive outcomes, which are explicit in
the design through activities, indicators, expected results or target populations. Budget allocations that are
relevant to nutrition are those that clearly mention a nutrition objective and/or outcome and/or action as
part of an integrated program or as part of a department mandate. Interventions or programmes are
categorized as ―nutrition-sensitive‖ if they address the underlying determinants of fetal and child nutrition
and development— food security; adequate caregiving resources at the maternal, household and
community levels; and access to health services and a safe and hygienic environment—and incorporate
specific nutrition goals and actions. Nutrition-sensitive programmes can also serve as delivery platforms
for nutrition-specific interventions, potentially increasing their scale, coverage, and effectiveness.
Examples include : agriculture and food security; social safety nets; early child development; maternal
mental health; women’s empowerment; child protection; schooling; water, sanitation, and hygiene;
health and family planning services.
Findings
The mapping exercise sought to profile donor support to the nutrition sector in Kenya with a view to
identifying critical gaps, potential or existing overlaps and to guide harmonization and future planning.
The assessment also aimed at generating information that may be useful for the government and other
sector partners on current and planned investments to the nutrition sector. It is anticipated that information
on level of resources available and partners implementing funded programs will be important for county
level coordination, planning, budgeting and tracking. These findings could also inform the MTEF
reporting and planning processes.
Findings on the key types of nutrition programs supported by donors and extent to which these are
aligned to the national nutrition programme priorities as espoused in the National Nutrition Action Plan
(NNAP) are presented. Delivery strategies and the geographical focus of programmes supported by
donors are also presented.
Coverage
A total of 12 donor agencies were covered in the mapping and are discussed in this report. They are;
DFID Kenya, EU, USAID Kenya, CIFF, Norwegian Ministry of Foreign Affairs, German Development
Cooperation (GIZ), French Ministry of Foreign Affairs, World Bank, JICA, DANIDA, Finish Ministry of
Foreign Affairs and CIDA. Only three of these agencies: EU, CIFF and World Bank are multi-lateral
donors. The rest are all bilateral donors. Findings of the mapping show that majority of the donors are
supporting potentially nutrition sensitive programmes. Cumulatively, the donors are supporting 32
major programmes/overall initiatives that are nutrition or nutrition related in nature. Typically, funds for
these programmes from donors are disbursed 1) Through bilateral agreements with UN agencies who
may contract implementing partners and 2) Directly to INGOs/NGOs. Table 1 below summarizes the
overall categorization of the different programmes supported by the donors
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Table 1: Overall categorization of programmes/Interventions
Donor Programme supported Overall categorization of
Programme
DFID Enhancing Nnutrition Ssurveillance, Resilience and Response
(ENSuRRe) Programme
Nutrition specific
Kenya Health Programme Nutrition sensitive
Programme on Reducing Maternal and Newborn Deaths in
Kenya
Nutrition sensitive
Kenya Social Protection Programme II Nutrition sensitive
Hunger Safety Net Programme Phase 2 (HSNP 2) Nutrition sensitive
Arid Lands Support Programme (ASP) Nutrition sensitive
Refugee programme Nutrition sensitive
European Union ECHO Nutrition specific
Agriculture and rural development Nutrition sensitive
Maternal and child nutrition programme under SHARE Nutrition specific
MCH Nutrition sensitive
USAID NHPplus Nutrition sensitive
FFP Nutrition specific
OFDA Nutrition specific
Kenya Agricultural Value Chains Enterprises Project
(KAVES)
Nutrition Sensitive
Resilience and Economic Growth in the Arid Lands-
Increased Resilience (REGAL-IR)
Nutrition sensitive
Water and sanitation programmes Nutrition sensitive
CIFF De-worming programme Nutrition sensitive
GIZ Food Security and Drought Resilience Programme Nutrition sensitive
Food Security through improved Productivity Programme Nutrition sensitive
GIZ-Health Sector Programme Nutrition sensitive
SIF Project Nutrition sensitive
Norwegian
Ministry of
foreign affairs –
Nairobi
Micronutrient powder Nutrition specific
JICA Maternal and child health programme Nutrition sensitive
DANIDA Maternal and child health programme
Nutrition sensitive
Non Communicable Diseases Nutrition sensitive
Finish Ministry
of FA - Nairobi
Food security Nutrition sensitive
Cash transfer Programme Nutrition specific
CIDA Vitamin A supplementation Nutrition specific
World Bank HSSF including scaling-up of RBF Nutrition sensitive
(ii) Governance and stewardship including
a. scaling up of HISP and
b. county capacity building
Nutrition sensitive
Supply of Nutrition commodities Nutrition specific
Essential Medicines and Medical Supplies including
warehousing and procurement reforms
Nutrition sensitive
As seen in the table 1, the programmes being supported by the donors have been categorized broadly into
nutrition specific and nutrition sensitive with most of the major donors supporting nutrition sensitive
programmes. It is note-worthy that out of the 33 programmes supported by the donors, 24 of them are
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categorized as nutrition sensitive. The budgetary implication is presented elsewhere in this report.
Whereas it is easy to categorize nutrition specific programmes in the sense that all the resources are used
for improvements in the nutritional outcomes, there continues to be a need for clearer technical guidance
on definition and categorization of nutrition sensitive programmes.
Nutrition sensitive Programmes
This section provides a synopsis of the context of nutrition sensitivity in programming as compared to
nutrition specific programming. It should be appreciated that there is still a lot of ground to be covered in
defining and determining nutrition sensitivity of programmes. According to the Lancet Series 201310
there
are about nine possible pathways, commonly referred to as nutrition sensitive interventions:
• Agriculture& food security
• Social safety nets
• Early Child development
• Maternal mental health
• Women's empowerment
• Child protection
• Classroom education
• Water and sanitation
• Health and family planning services
Nutrition sensitive interventions and programmes are commonly perceived as those that address the
underlying determinants of malnutrition especially among vulnerable population sub-groups. These
include interventions on agriculture and food security, social safety nets, early childhood development,
maternal mental health, women‘s empowerment, child protection, schooling, health and family planning
services, WASH, as well as technical and financial support given at national levels for development of
policies. Conversely nutrition specific interventions refer to interventions that directly address inadequate
dietary intake or disease. According to Lancet 2013, interventions and programmes termed as nutrition
specific are those that address the immediate causes of malnutrition (classification according to UNICEF
conceptual framework). Consequently interventions focusing on maternal and child- health, nutrition,
dietary or micronutrient supplementation including food fortification, promotion of optimum
breastfeeding; complementary feeding and responsive feeding practices and stimulation; dietary
supplementation, disease prevention and management as well as nutrition in emergencies can all be
classified as nutrition specific interventions. It is however recognized that these two
approaches/categorizations are in essence complementary with nutrition sensitive programmes doubling
up as delivery platforms for nutrition specific programmes.
Agriculture and other rural development programmes though with enormous potential to influence
nutrition positively can only do so most effectively if nutrition relevant outcomes are clearly articulated in
the project design and if relevant activities and indicators for realization and evaluation of stated
outcomes are also included in programme design. Example: Whereas improving agricultural productivity
is potentially nutrition sensitive, it is important to articulate and mainstream nutrition outcomes in the
programme design and implementation. This will enhance potential for realization of the stated nutrition
10
http://www.unicef.org/ethiopia/Lancet_2013_Nutrition_Series_Executive_Summary.pdf
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objectives that should be accompanied by indicators to measure progress at the output, outcome or impact
levels to make a given programme ‗qualify‘ as nutrition sensitive.
Nutrition Sensitive and Specific Interventions supported by donors in Kenya
The section below provides an overview of each donor agency outlining the kind of programmes being
supported and specific types of interventions being implemented. Overall funding levels, geographical
outlay and approximate time frames for funding are indicated.
DFID Kenya
DFID‘s support to nutrition in Kenya is through four programmes namely: 1. Enhancing nutrition
surveillance, response and resilience in the arid and semi-arid lands of Kenya; 2. The Kenya Health
Programme, 3. The social protection programme and 4. The refugee progamme
a) Enhancing Nutrition Surveillance, Resilience and Response (ENSuRRe) Programme
Through the programme , DFID made a financial commitment of up to USD 30,223,188 between 2012
and March 2016 to support the scale up of nutrition-specific interventions in the arid and semi-arid lands
(ASALs) of Kenya through Government-led health systems. This includes USD 12 million to a
consortium of NGOs to support the delivery of nutrition services in the counties of Mandera, Wajir and
Turkana. It also includes USD 17,583,188 allocated to UNICEF to support: i) the delivery of nutrition
services through its NGO partners in the other ASAL areas; and ii) system strengthening activities and
coordination of the nutrition sector at county and national level. There is a further USD 474,000 to
support all monitoring and evaluation programme activities.
The context in which this support is being provided remains similar to that originally stated in the sense
that the ASAL areas of Kenya continue to have particularly high levels of need, yet have some of the
lowest capacities to respond. The prevalence of acute malnutrition is routinely above the WHO
'emergency' threshold of 15%, and in 2014, the nutrition situation deteriorated further in many counties
(e.g. Turkana North). The causes of elevated levels of malnutrition (wasting) continue to be complex and
can be quite specific to local areas. Underlying causes include: recurrent drought, long term household
food insecurity; high incidence of diseases; low access to health services; poor hygiene and sanitation;
and sub-optimal maternal, infant and young child feeding practices. Fundamental causes include poverty
(96% of the Turkana population for instance lives below the national poverty line), conflict and
insecurity, and low levels of formal education.
This overall programme is nutrition specific since all the budget is allocated purely for the achievement of
nutritional objectives. The nutrition specific interventions that are implemented include; treatment of
childhood illnesses and supplementation for pregnant and lactating women with acute and moderate
malnutrition, micro-nutrient supplementation, promotion and support of appropriate Infant and Young
Child Feeding practices, strengthening nutrition information systems, capacity building and support in
nutrition programme planning, support in advocating for increased budget allocations to the health sector
(nutrition included) and some minimal sanitation initiatives.
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Kenya Health Programme
The DFID Kenya Health Programme (KHP) is a five-year programme that began in October 2009. The
programme end date has been extended to December 2015. Current partners include Population services
International - PSI, World Health Organization - WHO, Family Care International - FCI MENTOR
Initiative and Kings College London (KCL) who have made good progress in programme delivery
working in close partnership with the Kenyan Ministry of Health (MOH).
For the Kenya Health Programme (KHP), DFID committed USD 167.9 million over a period of 5 years
(2010-2015). Of this, USD 74.7 million is for malaria control; USD 35.6 million for condom distribution
and family planning; and USD 19.7 million for strengthening Health Systems. USD 31.6 million has
provisionally been ear-marked for support to local Health facilities. From a nutritional perspective, the
amounts allocated to family planning and strengthening of the health care systems at national and county
level are of interest as these two programs have potential to improve nutritional outcomes given the role
that large household size and poor access to health care play in causation of malnutrition.
The programme aims to increase access to affordable and quality basic health services through funding
support to several health components that include;
1. Improving health systems and accountability mechanisms
2. Increased and consistent use of Family Planning commodities to improve family planning
3. Improving the efficiency of government health facilities
4. Social Marketing of condoms to reduce HIV infection
Besides the recognizable systems strengthening initiatives in a few counties, support is being extended in
establishment and orientation of county health management teams (CHMT) beside reviewing the planning
templates and providing orientation to all 47 counties on their applications. Support for the programme is
being channeled through proven international and local NGOs, United Nation partners and other
Development Partners.
This overall programme is classified as nutrition sensitive in the sense that the interventions being
supported have the potential to influence the underlying causes of malnutrition. The interventions are
clustered around; capacity building for health professionals on Maternal and Neonatal Health, increasing
community-based maternal and new-born child healthcare services in Kenya using faith-based
organizations, training, empowering and employing mothers living with HIV to improve access to HIV
prevention and support services for women and children, operations research on family planning and safe
abortion services as well as food and livelihood security programmes for people living with HIV/AIDS .
b) Programme on Reducing Maternal and Newborn Deaths in Kenya
The UK has invested up to 118 million for 5 years since 2013, hence the support running up to 2018, to
reduce maternal and newborn deaths in Kenya by increasing access to and uptake of quality maternal
health care. USD 14.7 million is allocated for health workers training, USD 76.9 million is allocated for
county level health systems strengthening and testing of innovative approaches, USD 2.2 million is
allocated for national level health systems strengthening, USD 18 million is allocated for supporting
access to services for the poorest women and USD 2.7 million is allocated for monitoring and evaluation
with the remaining balance set aside as contingency.
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This is specifically going towards scaling up of training for public sector doctors, nurses and clinical
officers in emergency obstetric and neonatal care, health systems strengthening in three counties (Homa
Bay, Bungoma and Turkana), provision of technical assistance for health systems strengthening to the
Ministry of Health at national level, supporting demand-side financing strategies, such as output-based
aid (OBA) in the same three counties to access services at subsidised rates and improve the
responsiveness and quality of services. A service provider has been contracted to support health systems
strengthening and demand-side interventions in Bungoma while UNICEF Kenya is implementing the
same interventions in Turkana and Homa bay.
c) Kenya Social Protection Programme II
The Social Protection Programme Phase II (SPP II, 2013-17), supports two outputs: 1. the
development of a national social protection system, led by the Government of Kenya (GoK), through
technical assistance (TA) to GoK‘s new National Safety Net Programme (NSNP); and 2. expansion of
the Cash Transfer to Orphans and Vulnerable Children Programme (CT-OVC), a central component of
the NSNP, and its transition to more sustainable GoK funding. DFID support is required to help deliver
improved social protection to an increased number of households with orphans and vulnerable children,
and to help Kenya build its own welfare system to increasingly provide this support itself. SPP II is USD
60.4 million: USD 26.8 million of this was already approved under the original SPP1 in 2007 and has
been rolled into SPP2. An additional USD 33.6 million was added to deliver the results under SPP2.
Funding goes through the World Bank (WB). This social protection programme has the potential to
contributes to nutrition outcomes since it directly deals with the empowerment of the vulnerable
particularly orphaned children.
d) Hunger Safety Net Programme Phase 2 (HSNP 2)
The Hunger Safety Net Programme Phase 2 (HSNP 2) has two outputs namely that: 1. Government of
Kenya (GoK) supports cash transfers to help meet chronic and acute needs in the arid and semi-arid lands,
which are integrated within the wider National Safety Net Programme; and 2. HSNP households receive
timely, predictable electronic cash transfers. HSNP Phase 1 (HSNP 1) was piloted as one component of
DFID Kenya‘s larger Social Protection Programme Phase 1 (2007-13). HSNP1 spent USD 63.9 million
and tested an alternative approach to food aid in four of the poorest and most vulnerable counties of
Northern Kenya: Marsabit, Mandera, Wajir and Turkana. Under HSNP 2, the UK is expanding and
increasing support in the four counties and building sustainability through the GoK which, for the first
time, is also co-funding HSNP in line with its proposed medium term plan.
The total DFID funding that stretches from 2014 to 2017 is to the tune of USD 134 million. Funding
comprises: Electronic cash transfers going directly to beneficiary bank accounts (82% of total funds),
support to an internationally procured Project Implementation and Learning Unit (PILU) within the
National Drought Management Authority (12% of total funds) and a DFID held contingency (6% of total
costs).
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e) Arid Lands Support Programme (ASP)
DFID provide USD 22.6 million over four years from 2012 to 2016, to build more resilient livelihoods for
some of the poorest people in northern Kenya. This programme complements the Hunger Safety Net
Programme (HSNP), to ensure longer-term resilience to drought and other shocks in the four counties of
Turkana, Marsabit, Mandera and Wajir. The funding goes towards improving government coordination
and planning in the region (USD 2.95 m), supporting existing community-level adaptive initiatives (USD
12.7 m), scaling up a livestock insurance scheme (USD 2.16 m) and creating a fund, designed to improve
rapid disaster response and reducing risks associated with shocks such as droughts (USD 4.77 m).
The Arid Lands Support Programme (ASP) use Hunger Safety Net Programme mechanisms, such as the
existing payment platform. ASP indicators are fed into a common monitoring and evaluation framework
for both ASP and HNSP. The ASP also supports institutional strengthening of the Government of Kenya
in coordination, policy development and monitoring and evaluation
f) Refugee Programme
DFID is providing USD 69.5 million over three years (2012-2015) for refugees in Dadaab and Kakuma
camps in Kenya. This includes USD 56.9 million as part of the original business case primarily aimed at
supporting Somali refugees in Dadaab, and an additional USD 12.6 million approved in 2013/14 to
support increasing needs in Kakuma, and bridge funding gaps for adequate food distribution and nutrition
within the wider Kenya refugee programme. This overall package of funding supports:
• Treatment of acutely and moderately malnourished children
• Improved access to primary healthcare
• Improved essential sanitation and hygiene services
• Contribute to general food distributions to avoid severe ration cuts and protect nutrition gains.
• Enhanced protection services for refugees
European Union Delegation
The European Union Delegation has increased funding support to the nutrition sector in Kenya over time,
especially over the last 4-5 years. The scope of support extended spans both nutrition sensitive and
nutrition specific programmes. The mode of funding has taken on various formats as follows: direct
funding of NGOs through calls for proposals; supporting a maternal and young child nutrition programme
through an agreement involving the Kenya government, EU and UNICEF; through the Agriculture and
rural development programme under SHARE; via humanitarian support through ECHO.
Since 2007, the EU Delegation in Kenya has launched five calls for proposals (CfP). The first two calls
launched in 2008 and 2009 focused on maternal and child health, vocational training, income generating
activities and governance. These had a budget allocation of USD 3.87 million and USD 3.99 million
respectively. The third, fourth and fifth CfP launched in 2010, 2012 and 2013 had budget allocation of
USD 3.99 million, USD 11.4 million and USD 2.85 million respectively. These calls adopted a more
integrated approach by focusing on maternal and child health combined with nutrition and family
planning.
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The current support is therefore a culmination of the fifth call for proposals that was launched in 2013
with a budget allocation of USD 2.85 million. Like the previous calls, it adopted a more integrated
approach by focusing on maternal and child health combined with nutrition and family planning. It targets
urban informal settlements in Nairobi, Mombasa and Kisumu counties. The four main results expected
are:
Reduced Child and Maternal mortality ratios
Improved nutrition status of mothers, new-born and children under five years
Improved uptake of family planning
Improved capacity of health-care delivery systems
The nutrition interventions hinge around increasing access to nutrition services for mothers, new-borns
and children under five. The rest focus on broader health outcomes particularly targeting improvement of
women‘s health and service delivery systems. They include; Interventions towards behavior change in
health seeking practices, Capacity building for communities and service providers, family planning and
reproductive health interventions. Special attention is given to strengthening healthcare delivery systems
including improving health information system for monitoring and evaluating MCH activities.
It is noteworthy that the EU Delegation is planning to launch the sixth call for proposals before the end of
the year for a further USD 4.56 million. This call will focus exclusively on support for nutrition. This is
because the EU recognizes that under-nutrition has not been adequately addressed and has therefore
stepped up global efforts to eradicate hunger and under-nutrition in the world, particularly focusing on
reducing the number of undernourished children. Subsequently, the EU committed to meet at least 10% of
the World Health Assembly's global target to reduce stunting of 70 million children by 2025, pledging to
help reduce this number by at least 7 million. The decision was also informed by the realization that
multisectoral nutrition interventions have a strong potential to support achievement of MDG 4 and 5 on
child health and maternal mortality which are not likely to be achieved in 2015. Importantly, the EUD has
also committed to enhance mobilization and political commitment for nutrition through political dialogue
and advocacy in close collaboration with the SUN Movement. Currently, EU Delegation is the SUN
donor convener in Kenya.
a) Maternal and Child Nutrition Programme
The EU is currently supporting a maternal and young child nutrition programme through an agreement
between GoK-EU-UNICEF. The project that is funded to the tune of USD 30 million for 48 months
from November 2014 to October 2018 has the purpose of strengthening community resilience to handle
shocks and stress through improved access, provision and monitoring of health, nutrition and sanitation
status of the most deprived populations (women and children) in nine counties in the Arid and Semi- Arid
Lands (ASAL). The specific overall objective is to improve maternal and child nutrition in deprived
communities in Mandera, Wajir, Turkana, West Pokot, Tana River, Samburu, Kitui, Kwale and Kilifi
counties.
The broad implementation strategies include;
Creating increased demand for health services
Facilitating access and utilization of basic social services
Evidence base and knowledge management
Leveraging resources for progressive investment
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This is a nutrition specific programme with all interventions geared towards achieving nutrition objectives
and outcomes. The interventions revolve around the following themes:
Behaviour change communication for creating the requisite demand for nutritional services
Enhanced advocacy and nutritional planning at all levels
Capacity building of key actors
Provision of technical support for instance for refining of the national nutrition survey guidelines
using SMART and SQEAUC methodology
Operation research in relevant areas such as formative analysis of underlying drivers of malnutrition
Child survival interventions such as capacity development of county level health staff to plan, cost,
advocate for resources, implement and coordinate high impact child survival strategies
Enhancing community health communication strategy in order to fast-track the relevant social change
Building partnerships between key stakeholders at all levels
Enhancement of social transfer innovations
Improving inter-sectoral planning, budgeting and coordination between nutrition, health and WASH
sectors
b) Agriculture and Rural Development Programme
Besides funding of the maternal and child nutrition programme, the agriculture and rural development
projects funded under SHARE have also allocated a certain proportion of the budget for nutrition
components which is a positive initiative. While it is difficult to gauge exact amounts, it is estimated that
30 – 40% of funds are allocated for nutrition activities in these projects. It is for this reason that this
programme is designated as being nutrition sensitive. The bulk of the interventions are clustered around
initiatives to promote food security and livelihoods in ASAL and non-ASAL areas and include;
ASAL areas:
ASAL Agricultural Productivity Research Project
Index Based Livestock Insurance
Improving community drought response and resilience
Pastoralists livelihood improvement projects including promotion and strengthening enterprises and
market systems in drought prone areas
Water and Sanitation Services for the ASAL Areas
Non-ASAL areas:
Coffee research
Kenya Cereal Enhancement Programme
Livelihood diversification programmes through promotion of sorghum, cassava and green grams via
the value chain development initiatives
c) ECHO
ECHO is the arm of the EU that focuses on humanitarian aid. ECHO is a donor that does not function
with multiyear funding instead it works with a yearly budget hence decisions on allocation is done every
year. Therein is a clear disadvantage when dealing with protracted emergency situations. Since 2006,
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ECHO had steadily invested in policy, coordination, advocacy and integration of malnutrition in the
health system although humanitarian funding should not be used to strengthen the health system but to
respond to consequences of shocks that reach very high level when national capacities are overwhelmed
the direction of which ECHO is now taking.
Through ACF, Save the Children and Islamic Relief, ECHO is a nutrition specific programme supporting
interventions geared towards achieving with purely nutrition objectives and outcomes. Such interventions
include: prevention, early detection, and treatment of acute malnutrition among children under five and
PLW; promoting and supporting optimal Infant and Young Child Feeding (IYCF) practices and maternal
nutrition, WASH and livelihood activities as well as advocating for increased funding and commitment
to nutrition and county drought contingency plans, health systems strengthening. As part of the DRR
process, ECHO will be supporting CONCERN to work with the MOH and other partners to scale up the
IMAM surge capacity model.
USAID Kenya
USAID Kenya is supporting diverse nutrition specific and nutrition sensitive initiatives in Kenya through
a variety of programmes implemented by a range of implementing partners as detailed below.
a) Resilience and Economic Growth in Arid lands – Improving Resilience (REGAL-IR)
The Resilience and Economic Growth in Arid Lands – Improving Resilience is a 5- year project (2012 –
2017) funded by the United States Agency for International Development . The project was designed to
decrease vulnerabilities, build resilience, and stimulate growth in selected ASAL areas. The goal is to
support Government of Kenya and donor efforts to work with pastoral and transitional communities to
reduce hunger and poverty, increase social stability, and build strong foundations for economic growth
and environmental resilience. The project targets at least 93,000 households (558,000 people), including
children and women of reproductive age, as well as community structures. The project is being
implemented in five counties in Northern Kenya, namely: Garissa, Isiolo, Marsabit, Turkana and Wajir.
These counties have the highest number and percentage of households in need of food assistance across
Kenya and thus offer the greatest opportunity for reducing the food assistance caseload in the arid lands.
The project approach entails support to community members and structures to strengthen social,
economic, and environmental resilience. Focus areas include diversification of livelihood opportunities,
community management of natural resources, improving livestock market access, disaster risk reduction,
and improving nutritional outcomes. There project has a specific focus of improve awareness of good
nutritional behaviors, access to and consumption of high-protein and nutrient-dense foods, targeting
women of reproductive age and children in their critical first 1000 days implemented by the Global
Alliance for Improved Nutrition (GAIN).
Overall, it is expected that the interventions will lead to improved resilience and reduced need for
recurring humanitarian relief in five counties in Northern Kenya. Specifically, the project‘s integrated
approach will lead to increased household income owing to improved ability to engage in income
generating activities and creation of vibrant centres that provide pastoralists with access to markets.
Livestock productivity will also be enhanced through support to livestock keepers, NGOs and CBOs
utilizing improved rangelands and water resources practices. By the end of the project local structures and
organizations such as water and drought management committees, peace committees, and other
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governance mechanisms will have been assisted and strengthened to improve resilience and further
sustainable development. The combined effect of community empowerment, ownership of development
activities and improved coordination will contribute to poverty reduction, and improved quality of life
among pastoralist families.
b) Nutrition and Health Program Plus (NHPplus)
Currently, USAID Kenya is supporting implementation of the Nutrition and Health Program Plus
(NHPplus) which has a financial commitment of USD 42 million spread over 5 years. The programme
aims at increasing access and demand for nutrition services, and improving food and nutrition security, as
well as offering commodity management support. This program is aligned with the USAID/K Health
Sector Five Year (2010-2015) Implementation Framework and the Kenya Multi-Year Feed the Future
(FtF) strategy (2011- 2015).
Programme activities and services are being delivered at national level, while others focus on FtF
geographic counties that include; Busia, Kitui, Meru, Tharaka Nithi, Trans-Nzoia, Taita Taveta, Makueni,
Kakamega, Vihiga and Samburu. Nutrition activities are also implemented in close partnership with
MNCH activities aimed at ending preventable child and maternal deaths through scaling-up emergency
obstetric care (EmOC). The four MNCH focus counties which NHPplus also provide support include
Busia, Tharaka Nithi, Kitui and Samburu. In these counties, NHPplus collaborates with other USAID
partners implementing MNCH interventions to ensure greater programme effectiveness for women and
children under two years with regards to nutrition.
Within FtF areas (Busia, Tharaka Nithi,Kitui, Samburu and Marsabit), NHPplus works directly with FtF
partners to enhance the return on agricultural commodities along the value chain, support food safety and
quality standards, strengthen the ability of communities and individuals to utilize food and diversify their
diets as well as linking poor households vulnerable to under-nutrition and/or HIV with livelihood and
economic opportunities.
At national level, NHPplus is expanding NACS services beyond HIV, offering technical and financial
support to roll-out NACS to include High Impact Nutrition Interventions (HINI). To achieve this,
engagement is initiated at national and sub-national levels to create a heightened profile for nutrition and
strengthen budgeting, planning and monitoring and evaluation (M&E) allowing the GOK to gradually
manage nutrition service provision on its own. Commodity management support for vulnerable
populations is carried out following PEPFAR Food and Nutrition guidance. A critical element of this
work involve coordination with and strengthening of existing USAID/K efforts such as the APHIAplus
and AMPATH projects working with different partners in five geographic areas of Kenya namely;
• Pathfinder International (APHIA activities in Nairobi/Coast)
• JHPIEGO (APHIA activities in Central/Eastern)
• FHI360 (APHIA activities in Rift Valley)
• PATH (APHIA activities in Nyanza)
• AMREF (APHIA activities in Northern Arid Lands)
Though the programme has clear nutrition objectives and outcomes, it is classified as being nutrition
sensitive because of its integrated nature. The broad range of interventions include; those that influence
specific behavior changes in nutrition practices, building the capacity of health workers in nutrition beside
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improving the nutrition service delivery management, coordination and implementation, improving
production, supply and distribution of nutrition commodities, increasing market access and consumption
of diverse quality foods as well as increasing resilience of vulnerable households and communities.
Kenya Agricultural Value Chains Enterprises Project
The Kenya Agricultural Value Chains Enterprises is a five year (Jan 2011 – Jan 2018) US Presidents feed
the future project with funding of 40 million US dollars. The project promotes value chain growth and
diversification. It increases the productivity and incomes of smallholder farmers, and other actors along
the value chain, who are working in the dairy, maize and other staple and horticulture sectors. The activity
works with more than 30 Kenyan government and private sector organizations.
The project develops smallholder enterprises that combine maize, high - value horticultural crops, and
dairy farming to generate wealth, thereby enhancing food security, improving nutrition, and increasing
economic opportunities for women, youth, and other vulnerable populations. Engagement with the private
sector in a meaningful, comprehensive way ensures the sustainability of the activity‘s work.
To improve nutrition and health, particularly for women and children, the project
promotes good nutrition and hygiene practices and develops infrastructure to improve access to clean,
safe drinking water. The activity builds the capacity of local organizations by providing hands - on
technical, financial, and managerial training, so that local organizations can continue providing high -
quality services to farmers beyond the life of the project. The activity also promotes sustainable natural
resource management to help farmers adapt to the effects of climate.
FINTRAC is the implementing partner with funding support extended through various organizations. The
project is being implemented in 22 counties in high rainfall and arid and semi-arid areas including:
Bomet, Trans Nzoia, Elgeyo-Marakwet, Uasin Gishu, Nandi, Kericho, Bungoma, Busia, Kakamega,
Vihiga, Siaya, Homabay, Kisumu, Nyamira, Kisii, and Migori in the western region, and Meru, Tharaka,
Machakos, Makueni, Kitui and Taita- Taveta in eastern regions of Kenya.
Key partners include: Ministry of Agriculture, Livestock and Fisheries; County governments, Agricultural
Sector Development Support Programme (ASDSP), Kenya Plant Health Inspectorate Services (KEPHIS),
Pest Control Products Board (PCPB), Horticultural Crops Development Authority (HCDA), Kenya
Agricultural Research Institute (KARI), public and
private sector actors in the dairy, maize, and horticulture value chains.
c) USAID/OFDA
USAID/OFDA, as a humanitarian funder, is primarily response-driven. Funding support provided
through OFDA is therefore for nutrition specific emergency programming responding to needs as they
arise and/or reviewing funding levels on an annual basis. The level of funding from 2012 to 2014 was
USD 6million and in 2015 it is USD 1.5 million. The focus of the support is geared towards preparing and
responding to nutrition emergencies and accelerating recovery in the arid and semi-arid counties and
urban informal settlements of Kenya. The objectives are as follows:
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1. Increased access to and demand of quality high impact nutrition interventions, including management
of acute malnutrition among the most vulnerable populations in arid and semi-arid counties and urban
informal settlements in Nairobi
2. Strengthened nutrition capacities at the county level to support emergency response and preparedness
3. Enhanced coordination and nutrition information systems at both national and sub-national level for
improved programming and early warning
The targeted population is women and children under five years in the arid and semi-arid counties and
Nairobi as well as Kisumu urban informal settlements.
d) AIDS, Population and Health Integrated Project plus (APHIAplus)
USAID‘s AIDS, Population and Health Integrated Project plus (APHIAplus) is a five year (2011 – 2015).
Through the APHIAplus project, USAID/Kenya supports an integrated service delivery model to improve
the health of Kenyans across the country. APHIAPlus combines family planning, maternal/ child health,
malaria, nutrition, tuberculosis and HIV/AIDS prevention, care, and treatment services to provide an
integrated, high quality, equitable approach to sustain able services at the national, county, and
community levels. Integrating these activities through one program (APHIAplus) provides more effective
communication and coordination with county health administrators. Seamless services and technical
support at the local level ensure health workers address the unique needs of each geographic area across
the country. The goal of the project is to provide integrated health services for more than ten million
people. Implementing partners work at a community level to improve the health and general well-being of
families through increased access to food, water, sanitation, and hygiene, education, life skills and income
generating activities. Regional partners implement nutrition programs as part of an integrated MNCH
package in line with GOK‘s priorities.
The Center for Disease Control and Prevention (CDC), with PEPFAR funding, supports the
administrative capacity of NASCOP to manage HIV programs, including nutrition as a core component of
HIV care and support.
Children's Investment Fund Foundation (UK) (CIFF)
The Children's Investment Fund Foundation (CIFF) supports de-worming as part of an integrated
programme alongside supporting early childhood education, hence qualifying as a nutrition sensitive
programme. It is a 5 year programme with a total investment of USD 23,463,000. Currently the
programme is in its 3rd
year and anticipating to start the 4th year in July 2015.
Norwegian Ministry of foreign affairs
Norway is providing support to the health/nutrition sector in Kenya through support to the Red Cross and
the Norwegian Refugee Council, in addition to larger global agreements with the WFP and UNICEF.
It is reported that Norway through international agreement is providing USD 2 million for micronutrient
powders (MNPs) in the Arid counties.
The German Development Cooperation (GIZ)
The German Development Cooperation (GIZ) is majorly supporting the implementation of food security
programmes in Northern and Western Kenya.
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a) Food Security and Drought Resilience Programme
The objective of the food security and drought resilience programme supported to the tune of USD 3.42
million between 2014 and 2016 is to improve food security and drought resilience in Turkana and
Marsabit counties. The focus of this programme is on implementing reforms in the agricultural sector
particularly strengthening drought resilience plus strengthening the respective county plans development
and implementation. There are nutrition related activities that include strengthening investments in food
security through technology transfer and training in nutrition security.
b) Food Security through Improved Productivity Programme
The focus of the food security through improved productivity programme in Bungoma, Kakamega, and
Siaya supported to the tune of USD 7.29 million between 2014 and 2016 is on reforms in the agricultural
sector particularly on irrigation agriculture and intensifying on small scale production systems. Nutrition
related activities include: training on gender specific innovations to increase food production and
increasing agricultural income of men and women.
c) GIZ- Health Sector Programme
The cooperation is supporting a GIZ- Health Sector Programme (for the same period of 2014 – 2016) to
the tune of USD 798,000 in the counties of Kwale, Kisumu, Vihiga, Nairobi. This support is concerned
with three key areas namely; Healthcare Financing, quality management and county support. Counties are
supported in the areas of planning and budgeting, financial management and monitoring and evaluation of
service providers. The nutrition related objectives in this sector support include:
i. Increasing the proportion of expectant women whose deliveries are undertaken by qualified personnel
ii. Increasing the proportion of women in their reproductive age who use contraceptives
iii. Increasing the proportion of women in their reproductive age who have access to basic health
services to improve maternal and neonatal health.
d) SIF Project
The SIF project supported by the cooperation to the tune of USD 1,756,975 is implementing activities to
improve the living conditions of the refugees and the local population in the host area of Kakuma in
Turkana county between 2015 and 2017. The specific activities of the project include measures for
increased food security for refugees and the local population, strengthening of conflict resolution
mechanisms of the two groups, and strengthening of medical care for refugees and the local population.
Nutrition specific and related activities include:
Improved access of women in refugee community and host population to supplementary feeding
Provision of training to health care workers in the area of undernutrition and malnutrition with regard
to pregnant and lactating women as well as children under five
Nutrition sensitive activities include:
Equipping of health facilities in refugee camp and host community with essential medical equipment.
Improvement of quality of health care services in health facilities in refugee camp and host
community.
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French Ministry of foreign affairs
France through a call for proposals is funding an emergency intervention to provide food assistance and
improve nutritional outcomes of vulnerable households affected by drought and displacement in Mandera
County for a duration of 10 months (May 2015 – Feb 2016) totaling to USD 315,000. The targeted
population is 500 vulnerable IDP households (3,000 individuals) and the programme objective is to
improve food security and nutritional outcomes of these vulnerable households through delivery of Cash
for Work programming with agricultural and livelihood support. Mpesa transfers will have a value of
approximately 52 EUR. This will cover approximately 50% of the Minimum Expenditure Basket for one
household (based on the recent market monitoring), providing sufficient funds for households to afford
almost all of the Food Component of the Minimum Expenditure Basket. This will ensure that households
are able to access sufficient food to meet minimum nutritional requirements, and will be able to use other
sources of income to make small investments for example in non-food household items. There is
possibility of a follow-on further call for proposals worth a similar amount (USD 315,000) in the course
of 2015. This is classified as a nutrition specific programme.
World Bank
The World Bank support to the nutrition sector in Kenya is mainly through the Kenya Health Sector
Support Project (KHSSP) which aims to improve (i) the delivery of quality essential health and nutrition
services and utilization by women and children especially among the poor and drought affected
populations; and (ii) the effectiveness of planning, financing, and procurement of pharmaceutical and
medical supplies. ). The total IDA Credit of USD 197.8 million equivalents is complemented by a grant
of USD 20 million from the Health Results Innovation Trust Fund (HRITF). The project has been on-
going since January 2011and will close in December 2016. This project has been supporting: (i) delivery
of essential health and nutrition services by financing, for example, Health Sector Services Fund
nationwide; (ii) the emergency response to deliver essential health and nutrition services for the drought
affected arid and semi-arid regions of Kenya including supply of nutrition commodities to manage acute
malnutrition among children under five years and pregnant and lactating women and scaling up of results
based financing in 20 ASAL counties; and (iii) scaling-up of ongoing activities to improve the availability
of essential medicines and medical supplies at the primary health care facilities. The project is also
supporting first phase of the health insurance subsidy for the poor (HISP) and building capacity of county
health systems to better manage PFM for effective service delivery.
Other Donors
JICA, DANIDA and the Finish Ministry of Foreign Affairs shown in table 2 are supporting maternal and
child health projects as well as food security projects through the Kenya Red Cross as the implementing
partner.
Table 2 – Summary of Donor Support
Donor Total funding (USD) Funding period Targeted counties
JICA 479,167 2015 – 2018 Isiolo
DANIDA 927,083 2015 – 2018 Dadaab, Nairobi, Nyeri
Finish Ministry of
Foreign affairs
43,750 2015 Malindi
CIDA 929,989 2012 – 2015 -
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Alignment of funding support to national nutrition priorities as espoused in the national nutrition
action plan and the national food and nutrition security policy
According to the National Nutrition Action Plan framework, the following constitute the national
nutrition priority areas (both nutrition specific and nutrition sensitive interventions);
1. Improve nutritional status of women of reproductive age
2. Improve nutritional status of children under five
3. Reduce the prevalence of micronutrient deficiencies in the population
4. Nutrition in Emergencies
5. Management of IMAM/SAM or curative nutrition services
6. Improve prevention, management and control of diet related NCDs
7. Improve nutrition in schools and other institutions
8. Improve knowledge, attitudes and practices on optimal
9. Strengthen the nutrition surveillance, monitoring and evaluation
10. Enhance evidence-based decision-making through operations research
11. Strengthen coordination and partnerships for key nutrition actors
12. Food & agriculture
13. WASH
14. Social protection
Table 1 and Figure 1 illustrate the extent to which the interventions the donor agencies are supporting
reflect the national priorities. It is clear that almost all the national priority areas are included in the donor
framework of support except two that are totally missing. The two are improving prevention, management
and control of diet related NCDs and improving nutrition in schools and other institutions. However the
extent of support varies with food security and social protection intervention being highly favoured
followed by direct child and maternal health/nutrition interventions and research and information systems
in that order.
Figure 1: Graphical representation of programme delivery strategies
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Policy level strategies refer to activities and engagement at the national level, health facility level refers to
activities concentrated at the institutional level particularly capacity building for personnel while
community level focuses more on active involvement of community members and activities occurring at
community level as opposed to facility level.
Table 3: Number of interventions supported by each donor
Type of interventions No. of interventions/programmes mentioned in each type of intervention
DF
ID
No
rwa
y
GIZ
Fre
nch
CID
A
Wo
rld
Ba
nk
CIF
F
EU
Fin
lan
d
US
AID
JIC
A
DA
NID
A
TO
TA
L
Food security and
social protection
3 1 3 1 25 1 5 39
Child and maternal
health/nutrition
8 7 1 1 17
Research and
information systems
5 15 20
Malnutrition treatment 5 1 1 3 10
Capacity building for
community and
workers
4 9 2 15
Systems support 1 3 7 4 15
Advocacy,
coordination and
partnership
1 5 6
Behaviour change 4 1 5
Nutrition planning 2 2 4
Scale up of HINI 4 1 4
WASH 5 5
Family planning 4 4
Micronutrient
supplementation
2 1 3
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Table 4: Geographical Spread of Donor Support by County County Relative frequency of counties (No. of times mentioned)
ASAL counties:
Wajir 15
Marsabit 14
Turkana 13
Mandera 12
Kitui 12
Samburu 11
Garissa 10
West Pokot 10
Isiolo 9
Kwale 8
Baringo 8
Kilifi 7
Tharaka Nithi 7
Machakos 6
Makueni 6
Tana River 6
Embu 6
Meru 6
Narok 6
Nyeri 6
Kajiado 5
Taita Taveta 5
Dadaab 3
Kakuma 2
Elgeyo Marakwet 1
Laikipia 1
Chogoria Hospital (Meru) 1
Total 196
High potential arable counties:
Nairobi 8
Kakamega 5
Kisumu 4
Mombasa 4
Busia 3
Bungoma 3
Trans Nzoia 2
Kericho 2
Homa Bay 2
Vihiga 2
Kiambu Hospital (Kiambu county) 1
Thika 1
Nanyuki Hospital (Laikipia) 1
Mama Lucy Hospital (Nairobi) 1
Muranga 1
Nakuru 1
Malindi 1
Siaya 1
Nandi 1
Buret 1
Total 45
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Funding Levels
We focused on assessing current funding commitments and projections for the next 5 years. The funding
reflected in table 6 below is based on the weighting of the overall programme budgets as reflected in table
5. Information on disbursements over the past few years is described where this was available. Analysis
of funding data revealed that multi-year projects may be committed in one year but disbursed over several
years. There is however some variation in how disbursements against multiannual commitments are
reported.
Table 5; Weighting of the overall programme budgets
Donor Programme
supported
Budget
weighting
(% going
to
nutrition)
Rationale for the weighting
DFID Kenya Kenya Health
Programme
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
Enhanced nutrition
surveillance, resilience
and response
programme
100 The entire programme aimed at achieving purely and
clearly stated nutrition objectives, outcomes and specific
interventions
Programme on
Reducing Maternal and
Newborn Deaths in
Kenya
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
Hunger Safety Net
Programme phase 2
25 The programme classified under nutrition sensitive but
no stated nutrition objectives and outcomes
Arid Lands Support
Programme
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
Kenya Social
protection Programme
2
25 The programme classified under nutrition sensitive but
no stated nutrition objectives and outcomes
Refugee programme 75 clearly stated nutrition objectives, outcomes and specific
interventions but part of an overall integrated programme
European
Union
ECHO 100 All interventions aimed at achieving purely and clearly
stated nutrition objectives, outcomes and specific
interventions
Agriculture and rural
development
25 The programme classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
Maternal and child
nutrition programme
under SHARE
100 The entire programme is aimed at achieving purely and
clearly stated nutrition objectives, outcomes and specific
nutrition interventions
MCH 50 No stated nutrition objectives and outcomes but some
specific nutrition interventions are mentioned
USAID NHPplus 75 clearly stated nutrition objectives, outcomes and specific
interventions but part of an overall integrated programme
FFP 100 All interventions aimed at achieving purely and clearly
stated nutrition objectives, outcomes and specific
nutrition interventions
OFDA 100 All interventions aimed at achieving purely and clearly
stated nutrition objectives, outcomes and specific
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interventions
Kenya Agricultural
Value Chains
Enterprises Project
(KAVES)
25 Project classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
Resilience and
Economic Growth in
the Arid Lands-
Increased Resilience
(REGAL-IR)
25 Programme classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
Water and sanitation
programmes
25 Programmes classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
CIFF De-worming and early
childhood education
programmes
25 Interventions classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
GIZ Food security and
drought resilience
programme
50 No stated nutrition objectives and outcomes but some
specific nutrition interventions are mentioned
Food security through
improved productivity
programme
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
GIZ-Health Sector
programme
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
SIF Project 50 No stated nutrition objectives and outcomes but some
specific nutrition interventions are mentioned
Norwegian
Ministry of
foreign
affairs
Micronutrient powders 100 The entire programme aimed at achieving purely
nutrition objectives, outcomes
JICA Maternal and child
health
25 Interventions classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
DANIDA Maternal and child
health
Non Communicable
diseases
25 Interventions classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
French
Ministry of
Foreign
Affairs
Cash transfer
programme
100 The objective of the entire programme is to achieve
purely nutrition objectives, outcomes
Finish
Ministry of
Foreign
affairs
Food security 25 Interventions classified under nutrition sensitive but
insufficient information to determine clarity on any
nutrition objectives and outcomes
World Bank HSSF including
scaling-up of RBF
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
(ii) Governance and
stewardship including
a. scaling up of HISP
and
b. county capacity
building
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
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Supply of Nutrition
commodities
100 The entire programme aimed at achieving purely
nutrition objectives, outcomes
Essential Medicines
and Medical Supplies
including warehousing
and procurement
reforms
25 Interventions classified under nutrition sensitive but no
stated nutrition objectives and outcomes
CIDA Vitamin A
supplementation
100 The entire programme aimed at achieving purely
nutrition objectives, outcomes
Table 6: Amount (Total and weighted allocations) and duration of funding by donors
Donor agency Level of funding (USD)
Number of
programmes
supported
Total
programme
funding
Estimated
nutrition
funding
Average yearly funding for
nutrition
DFID 7 602,623,188 208,073,188 60,293,157
EU Delegation 4 60,384,708 42,954,177 18,554,177
USAID Kenya 6 92,087,164 52,787,164 19,170,721
GIZ 4 13,264,975 4,610,488 2,305,244
CIFF 1 23,463,000 5,865,750 1,173,150
Norweigian Ministry of
Foreign Affairs
1 2,000,000 2,000,000 2,000,000
Finish Ministry of
Foreign Affairs
1 43,750 10,938 10,938
JICA 1 479,167 119,792 29,948
DANIDA 2 927,083 231,771 57,943
French Ministry of
Foreign Affairs
1 630,000 630,000 630,000
CIDA 1 929,989 929,989 309,996
World Bank 4 217,800,000 64,050,000 10,675,000
TOTAL 33 1,014,633,024 382,263,256 115,210,274
Table 7: Amount (Total and weighted allocations) – Specific verses Sensitive programmes
Total allocation Nutrition allocation Yearly estimate of nutrition
allocation
Nutrition Specific 93,514,341 93,514,341 31,162,447
Nutrition Sensitive 921,118,683 288,748,915 84,047,827
Total 1,014,633,024 382,263,256 115,210,274
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The average duration for donor/commitment support is about 3 years (see detailed financial allocations
annex 1 below). Realistic projections for the next five years can only be extrapolated on the basis of the
total average yearly funding of USD 115 million (see table 6 above) bringing to USD 575 million as the
projected total funding for nutrition support from all the donors assuming the current level of funding is
maintained.
Nb: This reporting does not capture core funding for UN agencies who support many nutrition programmes in Kenya.
Conclusions
Most of the nutrition programmes supported by donors address the national nutrition priority areas
focused on scaling up of the high impact nutrition interventions.
Most donor funding is going to programmes in counties within the ASAL areas with multiple donor
agencies funding nutrition programmes within the same counties. A good proportion of this funding
is simultaneously addressing access to food and health services, building resilience of communities to
cope with the cyclic effects of drought and strengthening government systems to deliver improved
health services.
Given the low government funding to the nutrition sector, donor funding is playing a central role in
the country‘s efforts to address malnutrition and in particular, meeting the funding gaps at national
and county level.
There is a relatively high level of funding dedicated to potentially nutrition sensitive programmes.
The for majority of these programmes do not however reflect systematic mainstreaming of nutrition
in their design and implementation.
Recommendations
While substantive funding is dedicated to potentially nutrition sensitive programmes by donor
agencies, implementing partners need technical support to mainstream nutrition more robustly in
programme design to enhance nutrition sensitivity of such programs. This should entail inclusion of
specific nutrition outcomes supported by activities and indicators at the output and outcome levels.
Harmonization of funding projections among donors is necessary to ensure more rational spread of
available resources based on population size and stunting levels. Currently, some counties with high
stunting rates in non ASAL areas are not supported or have minimal funding (Bomet (36%;
Nyandarua (29%); Uasin Gishu (31%); Narok (33%)
Findings of this mapping should be used to lobby donors to include nutrition as a focus area in
specific donor country development agreements.
Future mapping should cover county donor support for nutrition
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Need for network/GoK to institute a tracking system for donor off budget support to the nutrition
sector
Need for further analysis to derive funding gap based on NNAP budget projections Verses off and on-
budget allocations
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Annex 1: Detailed financial commitment by programmes
Donor agency Programme supported Level of funding (USD)
Duration in
years
Total
programme
funding
Estimated
nutrition
funding
Average
yearly
funding for
nutrition
DFID: Kenya Health
Programme
3.7 167,900,000 41,975,000 11,344,595
Enhanced nutrition
surveillance, resilience
and response
programme
3 30,223,188 30,223,188 10,074,396
Programme on reducing
maternal and newborn
deaths
5 118,000,000 29,500,000 5,900,000
Hunger safety net
programme 2
3 134,000,000 33,500,000 11,166,667
Arid Lands Support
Programme
4 22,600,000 5,650,000 1,412,500
Kenya Social protection
programme
5 60,400,000 15,100,000 3,020,000
Refugee programme 3 69,500,000 52,125,000 17,375,000
Sub-total 602,623,188 208,073,188 60,293,157
EU Delegation: Agriculture/Rural
Development
1 19,440,708 4,860,177 4,860,177
Maternal and Child
Nutrition under SHARE
4 30,000,000 30,000,000 7,500,000
MCH Programme 3 5,700,000 2,850,000 950,000
ECHO 1 5,244,000 5,244,000 5,244,000
Sub-total 60,384,708 42,954,177 18,554,177
USAID Kenya: NHPplus 5 42,000,000 31,500,000 6,300,000
OFDA 4 7,500,000 7,500,000 1,875,000
FFP 3 4,187,164 4,187,164 1,395,721
Kenya Agricultural
Value Chains
Enterprises Project
(KAVES)
1 12,000,000 3,000,000 3,000,000
Resilience and
Economic Growth in
the Arid Lands-
Increased Resilience
(REGAL-IR)
1 6,400,000 1,600,000 1,600,000
Water and sanitation
programmes
1 20,000,000 5,000,000 5,000,000
Sub-total 92,087,164 52,787,164 19,170,721
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GIZ Food security and
drought resilience
programme
2 3,420,000 1,710,000 855,000
Food security through
improved productivity
programme
2 7,290,000 1,822,500 911,250
GIZ-Health Sector
programme
2 798,000 199,500 99,750
SIF Project 2 1,756,975 878,488 439,244
Sub-total 13,264,975 4,610,488 2,305,244
CIFF 5 23,463,000 5,865,750 1,173,150
Norweigian
Ministry of
Foreign Affairs
Micronutrient powders - 2,000,000 2,000,000
2,000,000
Finish Ministry
of Foreign
Affairs
Food security 1 43,750 10,938 10,938
JICA Maternal and child
health
4 479,167 119,792 29,948
DANIDA Maternal and child
health,
Non communicable
diseases
4 927,083 231,771 57,943
French
Ministry of
Foreign Affairs
Cash transfer
programme
1 630,000 630,000 630,000
CIDA Vitamin A
supplementation
3 929,989 929,989 309,996
World Bank HSSF including scaling-
up of RBF
6 58,600,000 14,650,000 2,441,667
Governance and
stewardship including
scaling up of HISP and
county capacity
building
6 48,285,000 12,071,250 2,011,875
Supply of Nutrition
commodities
6 12,800,000 12,800,000 2,133,333
Essential Medicines and
Medical Supplies
including warehousing
and procurement
reforms
6 98,115,000 24,528,750 4,088,125
Sub-total 217,800,000 64,050,000 10,675,000
TOTAL 3.2 1,014,633,024 382,263,256 115,210,274
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ANNEX 2: KENYA NUTRITION DONOR ANALYSIS
DONOR KEY PROGRAMMES FUNDED COUNTY / REGION ANALYSIS OF FUNDING SUPPORT – Current &
Projected
DFID Enhancing nutrition surveillance, response and resilience
In the arid and semi-arid lands of Kenya
USD 27.29 million between 2012 and October 2015 USD 12.32 million to a consortium of NGOs for nutrition services in Mandera, Wajir and Turkana, USD 14.97 million allocated to UNICEF to support: i) the delivery of nutrition services through its NGO partners in the other ASAL areas; ii) system strengthening activities and coordination of the nutrition sector at county and national level; iii) support all monitoring and evaluation programme activities)
The DFID Kenya Health Programme Systems strengthening support is being extended in establishment and orientation of county health management teams (CHMT) and providing orientation to all 47 counties on the planning templates and their applications
A five-year programme that began in October 2009. The programme end date has been extended to December 2015. Of interest is the USD 35.55 million for family planning; and USD 19.75 million for strengthening Health Systems.
The Social Protection Programme supports two outputs at the national level: 1. development of a national social protection system and 2. expansion of the Cash Transfer to Orphans and Vulnerable Children Programme
Social Protection Programme phase II is supported to the tune of USD 60.4 million: USD 26.8 million having been already approved under the original SPP1 in 2007 and has been rolled into SPP2. An additional USD 33.6 million was added to deliver the results under SPP2. Funding goes through the World Bank (WB).
The refugee programme Covers refugees in Dadaab and Kakuma
DFID is providing USD 69.5 million over three years (2012-2015). This includes USD 56.9 million as part of the original business case primarily aimed at supporting Somali refugees in Dadaab, and an additional USD 12.6 million approved in 2013/14 to support increasing needs in Kakuma
Programme on reducing maternal and
newborn deaths Homa Bay, Bungoma and Turkana The UK has invested up to 118 million for 5 years since
2013, hence the support running up to 2018,
Hunger safety net programme 2 Marsabit, Mandera, Wajir and
Turkana The total DFID funding that stretches from 2014 to 2017 is to the tune of USD 134 million.
Arid Lands Support Programme Turkana, Marsabit, Mandera and
Wajir DFID provide USD 22.6 million over four years from 2012 to 2016
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European Union Delegation The fifth call for proposals that adopted a more integrated approach by focusing on maternal and child health combined with nutrition and family planning
Targets urban informal settlements in Nairobi, Mombasa and Kisumu counties
The current support is a culmination of the fifth call for proposals that was launched in 2013 with a budget allocation of USD 2.85 million. The Delegation is planning to launch the sixth call for proposals before the end of the year for a further USD 4.56 million. This call will focus exclusively on support for nutrition
Maternal and child nutrition programme
Nine counties in the Arid and Semi- Arid Lands (Mandera, Wajir, Turkana, West Pokot, Tana River, Samburu, Kitui, Kwale and Kilifi)
The programme is funded to the tune of USD 1 21.66 million for 48 months from November 2014 to October 2018
Agriculture and rural development projects
Spread across ASAL and Non-ASAL areas namely Turkana, West Pokot, Baringo, Marsabit, Samburu, Isiolo, Mandera, Wajir, Garissa, Tana River, Lamu, Kilifi, Kwale, Taita Taveta, Kitui, Makueni, Embu, Tharaka Nithi, Meru, Laikipia, Nyeri, Kajiado, Narok, Thika, Kericho, Buret, Bungoma, Kakamega, Nakuru, Nandi, Trans Nzoia and Machakos
It is estimate that 30 – 40% of funds are allocated for nutrition activities in these projects which translate to about USD 6.84 million in the current year
ECHO ECHO activities are concentrated in the ASAL counties of Mandera, Wajir, Turkana, West Pokot, Marsabit and Dadaab refugee camp
ECHO does not function with multiyear funding instead it works with a yearly budget estimated at USD 4.56 million that basically goes towards humanitarian support particularly the scaling up of high impact nutrition interventions
GIZ Food security and drought resilience
programme Turkana and Marsabit counties USD 3.42 million between 2014 – 2016
Food security through improved
productivity programme In Bungoma, Kakamega, and Siaya counties
Supported to the tune of USD 7.29 between 2014 – 2016
GIZ- Health Sector Programme In the counties of Kwale, Kisumu,
Vihiga, Nairobi Supported for the period of 2014 – 2015 to the tune of USD 798,000
SIFT project Refugees and the local population in the host area of Kakuma in Turkana county
Supported to the tune of USD 1,756,975 between 2015 and 2017
CIFF De-worming and Early Childhood Education
It is a 5 year programme with a total investment of USD 23,463,000. Currently the programme is in its 3rd year and anticipating to start the 4th year in July 2015
Norway micronutrient powders (MNPs) Arid counties Norway through international agreement is providing USD 2
million
JICA Maternal and child health programme Isiolo USD 479,167 between 2015 - 2018
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DANIDA Refugee and maternal and child
health programme Dadaab, Nairobi, Nyeri USD 927,083 between 2015 - 2018
Finish Ministry of Foreign affairs
Food security Malindi USD 43,750 for 2015
French Ministry of Foreign affairs
Nutrition emergency Mandera county USD 315,000 for the year 2015/2016. There is a possibility of further support of USD 315,000 for this year
USAID Kenya Nutrition and Health Program Plus (NHPplus)
Programme activities and services are being delivered at national level, while others focus on FtF geographic counties that include; Busia, Kitui, Meru, Tharaka Nithi, Trans-Nzoia, Taita Taveta, Makueni, Kakamega, Vihiga, Samburu and Marsabit.
This program is aligned with the USAID/K Health Sector Five Year (2010-2015) Implementation Framework and the Kenya Multi-Year Feed the Future (FtF) strategy (2011- 2015) with an annual financial commitment of about USD 9.12 million
OFDA Response driven - Nutrition
specific emergency programming
The level of funding from 2012 to 2014 was USD 6million and in 2015 it is USD 1.5 million.
Food For Peace (FFP) - Financial commitment of USD 4,187,164 between 2012 and
2015
Kenya Agricultural Value Chains Enterprises Project (KAVES)
22 Counties in high rainfall and arid
and semi arid areas including:
Bomet, Trans Nzoia, Elgeyo-
Marakwet, Uasin Gishu, Nandi,
Kericho, Bungoma, Busia,
Kakamega, Vihiga, Siaya, Homabay,
Kisumu, Nyamira, Kisii, and Migori
in the western region, and Meru,
Tharaka, Machakos, Makueni, Kitui
and Taita- Taveta
$40 million (Jan 2013- Jan 2018) Annual commitment of USD 12,000,000 for 2015
Resilience and Economic Growth in the Arid Lands-Increased Resilience (REGAL-IR) thro ADESO
Programe activities in 5 ASAL counties – Isiolo, Marsabit, Turkana, Wajir and Garrisa
Annual commitment of USD 6,400,000 for 2015
Water and sanitation programmes -TBD Annual commitment of USD 20,000,000 for 2015
CIDA Vitamin A supplementation - Financial commitment of USD 929,989 between 2012 and
2015
World Bank Kenya Essential Package for Health and Nutrition services
drought affected arid and semi-arid regions of Kenya
Support of USD 12.8 million. The project has been on-going since January 2011. was extended to December 2016.
Programme on availability of essential medicines and medical supplies
enhanced focus on the drought affected counties
Financial commitment of USD 44 million .The project has been on-going since January 2011. Was extended to December 2016.
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Scale up activities and restructuring due to devolution
Financial commitment of 61 million up to December 2016
