Tools for planning, costing, implementing and financing scaled-up multisectoral actions that contribute to people's nutrition

Planning, costing, implementing and financing scaled-up multisectoral actions that contribute

to people’s nutrition

Community of Practice

12 February 2015

Agenda

Planning, Costing and FinancingCommunity of Practice

Agenda item Presenter Topic

I. Stocktaking 1. Sandra Mutuma (ACF)2. Kaia Engesveen (WHO)3. Tina Lloren (FANTA)

Aid for NutritionHealth Accounts and OneHealth ToolCosting in Malawi and Zambia

II. Nutrition-sensitive “how to”

1. Charlotte Dufur and Benoist Veillerette (FAO)

2. Holly Sedutto (REACH)

Nutrition-sensitive investments in agricultureCompendium of Actions for Nutrition

III. Financing 1. Meera Shekar (WB with R4D, 1000 Days, BMGF, CIFF)

Costing and financing the new WHA targets for nutrition

IV. Conclusions and way forward

1. Patrizia Fracassi (SMS)

Sandra Mutuma (ACF)

Stocktaking


Kaia Engesveen (WHO)

Tina Lloren (FANTA)

Questions

Stock-taking and potential priorities for COP1 2015

Based on ACF Aid for Nutrition publications

Sandra MutumaSenior Nutrition Advisor

Sun COP1: ACF

• Tracking of nutrition specific interventions needs to improve to minimise overestimation of aid for nutrition-specific interventions

• Lack of alignment between SUN country costed plans for direct nutrition interventions, OECD DAC Basic Nutrition code and the SUN nutrition-specific interventions

• Disaggregated data per nutrition-specific intervention is a major data gap and can be a feature of a minimum standard of reporting, aid transparency, effective identification of funding and intervention gaps and assist advocacy and policy prioritisation

• OECD Basic Nutrition code includes household food security, school feeding and research/surveys

• Advocating for, and tracking investments to increase nutrition capacity in addition to tracking interventions is important

• Need alignment of domestic and external definitions and reporting procedures for nutrition- specific interventions

SUN COP1: ACF

• Minimal funding was invested in nutrition programmes that incorporated interventions from all 3 categories of proven direct interventions (ACF Aid for Nutrition, 2012 and 2013)

• Short-term funding cycles for nutrition-specific interventions particularly acute malnutrition management

• Coordinated donor funding for a comprehensive minimum package of nutrition-specific interventions

• ACF will be advocating for longer external funding cycles for nutrition-specific interventions, 5 years+ supported by increasing domestic investment

• ACF has dedicated 3 staff members to advocacy in this area active in SUN COP1, ICAN Accountability and Financing sub-groups

• ACF will be undertaking detailed tracking of French aid and potentially UK, Spain, USA and Canada (TBC)

too.

Sandra Mutuma (ACF)

Stocktaking



Tina Lloren (FANTA)

Questions

Planning: WHO supports evidence-informed policy planning in nutrition

Planning and adaptation of global targets, strategies and guidelines

• Global Nutrition Targets Policy Briefs – new!

• Landscape Analysis country assessment of commitment and capacity

• Evidence-informed policy planning for nutritionthrough EVIPnet research networks in all regions

• e-Library of Evidence for Nutrition Actions (eLENA) with evidence/guidance on 100+ nutrition actions

• Global Nutrition Targets Tracking Tool for countries to set nationally realistic goals

• OneHealth Tool for costing

• Health Accounts for expenditure tracking

Analysis

Action

Assessment

Surveillance

• Nutrition Landscape Information System (NLIS)

• WHO Growth Standards

Implementation

• Global database on the Implementation of Nutrition Action (GINA) with lessons learnt from countries

• Joint UN strategic planning and costing tool (ongoing work to add functionalities related to cost

effectiveness and economic benefits)

• Capacity building: workshops are organised at country level by national health planning committees. Regionalworkshops in 2015 will include those aiming to inform strategic planning for NCDs.

• Countries which have used or been trained on OHT: Angola, Benin, Botswana, Burkina Faso, Cap Vert, China, Comoros, DRC, Ethiopia, Gambia, Kenya, Lesotho, Liberia, Malawi, Madagascar, Mauretania, Morocco, Mozambique, Nigeria, Papua New Guinea, Paraguay, Rwanda, Senegal, Sierra Leone, South Africa, Sri Lanka, Sudan, Swaziland, Tajikistan, Tanzania, Turkmenistan, Uganda, Viet Nam, Zambia, Zanzibar

Costing: The OneHealth Tool includes both nutrition-specific and sensitive interventions in health sector

http://www.who.int/nutrition/publications/onehealth_tool/en/

SHA2011 (OECD/WHO) includes expenditures for nutrition specific and sensitive conditions

51 countries have/will undertake HA using SHA2011:

Expenditure tracking: WHO supports countries developing Health Accounts

Nutrition dashboard screenshot examples:

Sandra Mutuma (ACF)

Stocktaking



Tina Lloren (FANTA)

Questions

Food and Nutrition Technical Assistance III Project (FANTA)FHI 360 1825 Connecticut Ave., NW Washington, DC 20009Tel: 202-884-8000 Fax: 202-884-8432 Email: [email protected] Website: www.fantaproject.org

FANTA UPDATES ON COSTING ACTIVITIESMeeting of the Scaling Up Nutrition Community of Practice: Planning, Costing, Implementing, and Financing Multisectoral Actions for Improved Nutrition

Tina Lloren and Gilles Bergeron

February 12, 2015

Two Activities to Share

Community-based management of acute malnutrition (CMAM) costing in Malawi

Testing of the nutrition assessment, counseling, and support (NACS) costing tool in Zambia

13

Malawi: Costing of CMAM Services

• The original operations plan for CMAM developed by the Malawi

MOH in 2009, expired in 2012 and has not yet been replaced. The

MOH requested FANTA’s support to develop and cost a new CMAM

operational plan (2015–2020)

• Steps:

– Collection of costing data (late 2014–February 2015)

– Workshop with district and zonal health managers to introduce them to

the CMAM costing tool and augment basic costing skills using the tool

– Data entry, analysis, and interpretation

– Workshop with stakeholders to validate the results

– Incorporation of information into the CMAM operational plan

– Preparation of a detailed CMAM costing report

14

Malawi: Costing of CMAM Services

• FANTA’s CMAM costing tool is a set of Excel spreadsheets that allow users to determine the cost of implementing CMAM at the national or sub-national level. The FANTA CMAM costing tool was applied for the first time in Ghana in 2013.

• Data are needed on:

– Background/scale– Demographic, epidemiological, and program data– Prices– Salaries– Supplies– Frequency of deliveries– Group-level differentiations– Other time-dependent variables

15

Zambia: Field Testing of the NACS Costing Tool

• NACS is a client-centered programmatic approach for integrating a set of priority nutrition interventions into health care services. The core components are:

– Nutrition assessment (anthropometric, biochemical, clinical, etc.)

– Nutrition counseling based on assessment results

– Nutrition support (specialized food products and referral to economic strengthening, livelihood, and food security support)

17


• FANTA developed a NACS costing tool and user’s guide to help countries and projects plan and budget for NACS implementation

• The NACS costing tool has similar characteristics to the CMAM costing tool (Excel-based, similar domains on information needed)

• Target groups currently include pregnant and lactating women with HIV, adults with HIV, children under 2, and orphans and vulnerable children over 2

18


• Tool will be field tested in Kitwe District, CopperbeltProvince, Zambia by middle of 2015

• Final tool expected to be published on the FANTA website by late 2015

19

This presentation is made possible by the generous support of the

American people through the support of the Office of Health,

Infectious Diseases and Nutrition, Bureau for Global Health, U.S.

Agency for International Development (USAID), under terms of

Cooperative Agreement No. AID-OAA-A-12-00005, through the Food

and Nutrition Technical Assistance III Project (FANTA), managed by

FHI 360. The contents are the responsibility of FHI 360 and do not

necessarily reflect the views of USAID or the United States

Government.

20

Benoist Veillerette and Charlotte Dufur (FAO)

Nutrition-sensitive “how to”


Holly Sedutto (REACH)

Questions

Making Agriculture Investments Nutrition Sensitive:

definitions, opportunities and challenges

FAO Contribution to SUN Community of Practice – 12 February 2015

Charlotte Dufour

Benoist Veillerette

What are we talking about Investment = building assets (physical, natural, human) for

a better future;

focus on public investments: public goods i.e. different from TA, NGO, private investment)

financed from budget and/or loans from IFIs (World Bank, IFAD, regional banks)

Public investments can have positive – and negative –impact on nutrition

hence the need for these investments to be nutrition sensitive, i.e. to consider nutrition

We are not (only) talking about agriculture

• Agricultural services: extension, research, seed sector development...

• Value Chain Development;

• Rural Infrastructure, e.g. irrigation and drainage, rural roads, water supply

• Community Driven Development, poverty reduction, empowerment of rural communities and women

• Post-conflict recovery

• Natural resource management / green investments.

The checklist...

Target “practitioners”: national stakeholders (e.g. in governments) and those providing assistance (UN agencies, financing institutions, NGOs, CSOs)

Is organized around 10 key principles/ recommendations

Contains:

guiding questions

useful tips

references

Ten Key Recommendations1. Explicit Nutrition Objectives and indicators

2. Assess context at local level

3. Target vulnerable and improve equity

4. Coordinate with other sectors

5. Improve natural resource base

6. Empower women

7. Facilitate diversification

8. Improve processing, storage and preservation

9. Marketing of Nutritious food

10. Incorporate nutrition promotion and education

Checklist – Situation Appraisal

Institutional and policy framework

Nutritional Situation

Health and Sanitation environment

Food consumption and dietary needs

Food availability and seasonability

Household access to food

Gender and care practices

Access to assets and marketing opportunities

Policy framework and regulations

Applications so far• CAADP Investment

Plans – Mainstream nutrition

• FAO/IFAD Training Workshop in July 2014

• Seven investment projects supervised by the World Bank (largely financed by GAFSP)

opportunities Strong commitment: SUN,

ICN2, Governments and IFIs (e.g. World Bank and IFAD)

Further apply the checklist, capacity development

Upcoming PHRD and other investment projects

E-learning

Entry Points… and their challenges

Make Nutrition an Objective… challenging as most projects have ONE PDO (Development Objective)

Add a separate nutrition component… e.g. nutrition education

Mainstream nutrition in several components: shape investment in such a way…, e.g. agricultural research and extension

Demonstrate impact in nutrition through M&E Cost Benefit Analysis Document good practices / impact assessments

Challenges with M&E• Identify intermediary indicators between agricultural production and

stunting

• Stunting– attribution

– long term (for a project)

– need for a large sample

• Dietary Diversity Score – (FAO/FANTA)– universal food groups vs. local habits / culture and diversity

– how many food groups

– for whom (household, women, children)

– for how long (24 hours / 7 days)

– Minimal quantities (15 grams?)

• Need practical system (project M&E often weak)

• M&E should not be added (by the way...) but result from clear and customized result chain / impact pathway from the start

Challenges with Cost Benefit Analysis

• Economic justification remains in high demand by both governments and IFIs

• Develop guidelines and case studies in connection to IFAD for a nutrition investment programmes

• How to integrate nutrition benefits in the analysis; so far focused on production, revenues in US$

• look into what is being done for climate change mitigation (Ex-Act)

• CONCLUSION: Not pile up with climate change, gender analysis… but address together (win win)

Benoist Veillerette and Charlotte Dufur (FAO)

Nutrition-sensitive “how to”


Holly Sedutto (REACH)

Questions

Demystifying multi-sectoral nutrition actions:Progress on Compendium of Actions for Nutrition

SUN CoP1

Costing and Financing, Conference Call

12 February 2015

Audience

• Primary audience: REACH facilitators, UN network

• Secondary audience: SUN focal points & gov’t ministries have voiced interest in the CAN

Purpose

• To help breakdown what multi-sectoral nutrition action means into concrete terms

• To highlight the types of nutrition-related interventions carried out within the respective sectors and any cross-cutting issues

• To identify the linkages between sector-specific action and opportunities for integrated action

… in a logical and synthesised manner

Making ‘practical’ nutrition knowledge across the multi-sectoral

landscape more accessible and coherent

The process: Development in consultation with CAN focal points in

each agency to leverage comparative advantages

Design

Drafting

Review

Finalisation

Dissemination

Update

Phase Steps

• Establishing classification structure• Defining the format & graphic design• Establishing the scope of content

• Technical resources to consult• Liaizing with technical specialists• Soliciting original inputs

• Review drafts• Organize technical consultations• Collate comments across agency/org

• Revise as per comments• Finalize revised version• Editing and page layout

• Electronic & print (live launch?)• Circulate with facilitators, country FPs

& interested others

• Identify processes for updating• Identify timeline for reviewing &

updating

Summary Status*

Done

Mostly completed

In process

Pending (Feb/Mar)

Pending(Apr)

TBD

*Note: The ‘summary status’ highlighted above refers to the present version of the Compendium of Actions for Nutrition (CAN).

‘Action Sheets’ on nutrition-related actions for thematic areas,

including nutrition-sensitive, that transcend institutional mandates

Conte

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Potential actions1

Consumption2

• Improvement of local recipes

• Public guidance & consumer

awareness/protection

• Complementary feeding

Horticulture/Crops

• Diversification & locally adapted

varieties

• Biofortification

Livestock & Fisheries

• Animal husbandry, fisheries & insect

farming

• Animal services

Food Processing, Fortification &

Storage

• Food processing (excluding fortification)

• Fortification (including salt iodization &

complementary foods)

• Food storage

Food, agriculture & diets Health-based

Maternal, Neonatal & Child Health Care• Ante- & post-natal care

• Facility-based delivery

• Basic paediatric health services

Micronutrient Supplementation• Iron & folic acid/Iron supplementation

• Vitamin A/D/zinc/Ca/iodine supplementation

• Multiple micronutrient supplementation

Management of Acute Malnutrition • Mgt of severe acute malnutrition (SAM)

• Mgt of moderate acute malnutrition (MAM)

• Food technology support for specialized

nutrition foods

Disease Prevention & Management• Anti-malaria

• Diarrhoea mgt. (e.g. ORT w/ zinc)

• Vaccinations (measles, polio, etc.)

• HIV mgt. & PMTCT

• Mgt. of tuberculosis

• Mgt. of respiratory infections

Water & Sanitation • Improvement of water supply/source quality

• Sanitation facilities management

Capacity development Nutrition education & social marketing

• Food assistance for vulnerable population groups• School-based social safety nets• Assisted health services• Poverty reduction &/or emergency risk mitigation

Market Regulation & Insurance • Minimum maternity protection• Insurance (health, unemployment, weather, etc.)• Macroeconomic levers

Social Safety Nets

Social

protection

Infant & Young Child Feeding

• Protection, promotion & support of

optimal breastfeeding

• Improvement of complementary feeding

Hygiene

• Hand-washing

• Household water treatment & storage

• Food hygiene

• Sanitation management

Care for Children/ P&L Women

• Care to pregnant/lactating women

• Childcare support/caregiver workload

Health Behaviours

• Health-seeking behaviour

• Insecticide-treated nets (anti-malaria)

• Family planning behaviour

Maternal & child care3

1. Each country’s NNP is specific to the country’s situation and therefore a selection of tailored actions is pursued2. Action Sheets being developed for the thematic areas marked in bold, italic text under the four respective categories3. Cross-cutting areas marked in diamond shapes while actions related to the education sector are mainstreamed into the four respective categories

Food, Agriculture and Diets: Actions and sub-actions by Action Sheet

CONSUMPTION ACTION SHEET

• Improvement of local recipes

- Trials of improved practices

- Nutrition training/sensitisation/counselling for mothers &/or other caregivers

- Nutrition education in schools & in the workplace

• Public guidance & consumer awareness/protection

- Formulation of national, food-based dietary guidelines

- Public information (social marketing) campaigns

- Food labelling & commercial advertising

• Complementary feeding

- Dietary diversification

- Fortified complementary foods

HORTICULTURE/CROPS ACTION SHEET

• Diversification & locally adapted varieties

-Fruit and vegetable gardens

-Intercropping, rotation & sequencing

-Inputs & irrigation

-Market linkages and consumption promotion

•Biofortification

-Introduction of micronutrient-rich plant varieties

-Social marketing campaigns and market linkages

LIVESTOCK & FISHERIES ACTION SHEET

• Animal husbandry, fisheries & insect farming

-Extensive animal rearing (e.g. cattle among (agro)pastoralists)

-Homestead animal rearing (e.g. poultry, sheep, goats)

-Aquaculture & capture fisheries

-Insect-farming

-Processing, handling, market access and consumption

•Animal services

-Vaccinations, parasite control, breeding support & other veterinary services

-Feed & water

-Shelter & settlement

-Basic hygiene education

FOOD PROCESSING, FORTIFICATION & STORAGE

ACTION SHEET

• Food processing (excluding fortification)

-Malting, drying, pickling and curing at household level

-Other nutrition–oriented food processing

-Nutrition education

•Fortification (including salt iodisation)

-Mass and community fortification

-Point-of-use fortification

-Fortified complementary foods

-Nutrition education and social marketing campaigns

•Food storage

-Household food storage/silos

-Large-scale food storage

Maternal and Child Care: Actions and sub-actions by Action Sheet

INFANT & YOUNG CHILD FEEDING ACTION SHEET

• Promotion, protection and support of optimal breastfeeding practices

- Health service level actions (professional, lay & peer)

- Community level actions

- Communication (media & social marketing)

• Improvement of complementary feeding

- Availability of appropriate complementary foods

- Access to complementary foods

- Food technology & quality & safety of complementary foods

- Basic instruction/nutrition education on optimal complementary feeding

CARE FOR CHILDREN/PREGNANT & LACTATING WOMEN ACTION

SHEET

•Care to pregnant & lactating women

-Reduced working hours/special leave (e.g. Maternity Protection)

-Provision of essentials (food, water, shelter) and nutrition education to support good

maternal nutrition and recommended child feeding practices

-Income &/or productive assets support

-Psycho-social support to help mothers adopt the recommended breastfeeding

practices

•Childcare support/caregiver workload

-Childcare services & support

-Provision of essentials (food, water, shelter) to support good child feeding practices

HYGIENE ACTION SHEET

•Hand-washing

-Hand-washing education & promotion

-Provision of water, soap and other supplies

-Hand-washing facilities

•Household water treatment & storage

-Water treatment methods for drinking water

-Safe storage of drinking water

•Food hygiene

-Food hygiene education & support

-Infrastructure & technology

•Sanitation Management

-Sanitation management education & sanitation environment support

HEALTH BEHAVIOURS ACTION SHEET

•Health-seeking behaviour

-Instruction on early signs/symptoms of pregnancy as well as illness

and disease

-Promotion of uptake of health services for pregnancy & post-partum

assistance as well as illness/disease prevention & management

•Insecticide-treated bednets (anti-malaria)

-Distribution of insecticide-treated nets

-Social marketing campaigns on bednets

•Family planning behaviour

-Voluntary family planning and reproductive health education &

support

-Social marketing campaigns

Health-based: Actions and sub-actions by Action Sheet

MATERNAL, NEONATAL & CHILD HEALTH CARE ACTION SHEET

• Antenatal & postnatal care- Basic nutrition education & health counselling- Micronutrient supplementation- Nutrition & medical screening & referrals- Supplementary feeding (balanced energy protein &

multiple micronutrient)- Disease prevention & management (including anti-

malaria interventions)• Facility-based delivery

- Obstetrics & neonatal care- Infant & young child feeding counselling & support

• Basic paediatric health services - Growth monitoring & promotion- Vaccinations- Diseases prevention & management (incl anti-malaria)

MICRONUTRIENT SUPPLEMENTATION ACTION SHEET

•Iron or Iron/folic acid supplementation

-Iron/folic acid supplementation for women

-Iron supplementation for children

-Nutrition education & behaviour change communication <also

applicable to below Action 2 >

•Supplementation of vitamins A/D/calcium/zinc/iodine

-Vitamin A supplementation

-Vitamin D supplementation

-Calcium supplementation

-Zinc supplementation

-Iodine supplementation

•Multiple micronutrient supplementation

-Point-of-use fortification

-Multiple micronutrient supplements

-Nutrition education & behaviour change communication

MANAGEMENT OF ACUTE

MALNUTRITION ACTION SHEET

•Management of severe acute

malnutrition

-Outpatient management of severe acute

malnutrition (SAM)

-Inpatient management of SAM

•Management of moderate acute

malnutrition

-Targeted supplementary feeding

-Blanket supplementary feeding

•Food technology support for specialized

nutritious foods

-Local production of specialized nutritious

foods for management of acute

malnutrition

WATER & SANITATION ACTION

SHEET

•Improvement of water supply & source

quality

-Safe water kits

-Water source & distribution systems

-Water treatment for water sources

•Sanitation facilities management

-Community led total sanitation

-Sanitation systems

-Latrine construction &/or rehabilitation &

excreta mgt.

-Water, sanitation (& hygiene) education

& social marketing

PREVENTION & MANAGEMENT OF SOIL, WATERBORNE &

ENDEMIC DISEASES ACTION SHEET

•Anti-malaria

-Deworming for management of intestinal parasites <also applicable to

Diarrhoea management>

-Intermittent preventive treatment of malaria for pregnant women

-Iron supplementation

•Diarrhoea management

-Oral rehydration treatment with zinc

-Management of severe acute malnutrition

-Water, sanitation & hygiene interventions to prevent diarrhoea

•Vaccinations

-Measles vaccination

-Polio vaccination

-Rotavirus & cholera vaccinations

•HIV management & prevention of mother to child transmission

-Antiretroviral therapy or prophylaxis

-Supplementation

-Infant feeding counselling & support

-HIV/AIDS education

•Management of tuberculosis

-Direct Observed Treatment Short-course (DOTS) treatment

-Nutrition Counselling

-Supplementation

-Management of acute malnutrition in individuals with active TB

•Management of respiratory infections

-Antibiotics treatment

-Nutrition counselling

-Supplementation

Social Protection: Actions and sub-actions by Action Sheet

SOCIAL SAFETY NETS ACTION SHEET

• Food assistance for vulnerable population groups

- Blanket feeding

• School-based Social Safety Nets

- School feeding for school-age children

• Assisted health services

- Maternal health visits

- Child health visits

• Poverty reduction &/or emergency risk mitigation

- General food distribution

- Public works programmes & asset protection

- Price subsidies

MARKET REGULATION & INSURANCE ACTION SHEET

•Minimum maternity protection

-Maternity protection

-Childcare support

•Insurance

-Health insurance

-Unemployment insurance

-Livelihood-related insurance

•Macroeconomic Levers

-Minimum wage

-Price subsidies

-Tariffs/Taxes

Meera Shekar (WB)

Financing


Questions

What will it cost to meet the six WHA nutrition targets?

How can we leverage financing to meet those needs?(Building on previous costing and financing estimates)

42

• Stunting

• Breastfeeding*Phase 1

• Wasting

• AnemiaPhase 2

Outputs for:

Addis FfDJuly 2015

Rio Nutrition Summit

June 2016

TBD(Possible)Phase 3

•Low Birth Weight

•Childhood Overweight

Possible

Estimating the costs & resource gaps to meet the WHA nutrition

targets, & identifying financing pathways to fill the gaps

Total cost of nutrition

scale-up to meet WHA

targets

External

Domestic

Out of pocket

Resource gap

Possible scenarios to be modeled

2009 2010 2011 2012 2013 Projected2025

Tota

l nu

trit

ion

sp

end

ing

glo

bal

ly

(US$

bill

ion

s)

2. Moderate expansion of

funding

3. Continuation of recent trends

4. Flat-lining

Available financing

sources

1. Maximum effort: resources needed are

fully mobilized

Conclusions and way forward


Healthcare

Tools for planning, costing, implementing and financing scaled-up multisectoral actions that contribute to people's nutrition