Multi-sectoral nutrition governance: Demystifying multi-sectoral nutrition actions Childhood Stunting Colloquium WHO, Geneva 14 October 2013
Multi-sectoral nutrition governance:Demystifying multi-sectoral nutrition actions
Childhood Stunting ColloquiumWHO, Geneva
14 October 2013
WHO?• Inter-agency partnership initiated by FAO, WHO,
UNICEF, WFP (plus IFAD)
• Partners from other UN agencies, the NGO
community, academia, private sector and donors
• Support to SUN at country level and part of the
UN network for the SUN Movement
(REACH and SCN co-facilitate the UN network)
• International + national facilitators who facilitate
inter-agency collaboration and SUN processes at
country level
• REACH Secretariat, hosted by WFP Rome
WHAT?• A country-led process designed to improve
nutrition governance
• A multi-stakeholder, multi-sectoral approach to
tackling undernutrition
• Not an implementing agency!
REACH is an inter-agency partnership that promotes a country-led, multi-sectoral approach to addressing undernutrition
Intense support
Moderate support
Remote support
Interested &/or emerging
Objective: Reduce child undernutrition
• By 2015: Reach MDG 1, Target 1C: half the proportion of underweight children <5
• Beyond 2015: Achieve sustainable acceleration of the rate of reduction of child undernutrition
REACH contributes to the "UN delivering as One"
SectorsS
ocia
l Pro
tectio
nAg
ricu
ltu
re
Multi-stakeholder platform
Country
government
FP Donors
UN
Ag
en
cie
s
Civil
Society
It catalyses multi-sectoral collaboration between UN Agencies, governments and civil society to combat child undernutrition
REACH applies a Theory of Change to accelerate progress towards MDG1, target 1C
Source: REACH Secretariat
If we address
these issues …
Little consensus on the causal
problems of undernutrition
Limited political commitment
Weak coordination of gov'ts
with UN agencies and other
stakeholders
Nutrition is not seen as a
multi-sectoral issue
Poor capacity development
Accountability and
responsibility is undervalued
with these
strategies to improve
governance…
REACH outcomes
1. Increased
awareness and
consensus of
stakeholders
2. Strengthened
national policies
and programmes
3. Increased human
and institutional
capacity
4. Increased
effectiveness and
accountability
then we can
achieve …
Political support to
fund programs and
coordinated nutrition
efforts
this impact
Improved
nutrition for
women and
children
Nutritional impact and
coverage
Action spans beyond 2015 as hunger remains a problem, and nutrition issues
gain a stronger emphasis in the post-2015 agenda
Where do we begin?
REACH applies a Theory of Change to accelerate progress towards MDG1, target 3
Source: REACH Secretariat
If we address
these issues …
Little consensus on the causal
problems of undernutrition
Limited political commitment
Weak coordination of gov'ts
with UN agencies and other
stakeholders
Nutrition is not seen as a
multi-sectoral issue
Poor capacity development
Accountability and
responsibility is undervalued
with these
strategies to improve
governance…
REACH outcomes
1. Increased
awareness and
consensus of
stakeholders
2. Strengthened
national policies
and programmes
3. Increased human
and institutional
capacity
4. Increased
effectiveness and
accountability
then we can
achieve …
Political support to
fund programs and
coordinated nutrition
efforts
this impact
Improved
nutrition for
women and
children
Nutritional impact and
coverage
Action spans beyond 2015 as hunger remains a problem, and nutrition issues
gain a stronger emphasis in the post-2015 agenda
Wasted children <5Wasted children <5
0
20
40
60
Source: DHS (2011); DHS (2005); DHS (2000); Other NS (1992); WHO Conversion tool from NCHS reference into estimates based on the WHO Child Growth Standards
Underweight children <5Underweight children <5 Stunted children <5Stunted children <5
0
5
10
15
67% 56.8%
44.4%
12.3% 12.3%
0
10
20
30
40
50
1992*
Other NS
2005*
DHS
2000*
DHS
23.8%
%
42.8% 42.8%
34.4%
MDG
target
28.7%
2011
DHS
1992*
Other NS
2005*
DHS
2000*
DHS
2011
DHS
52.2%
1992*
Other NS
2005*
DHS
2000*
DHS
2011
DHS
9.7%
N/a
*Note: Prevalence recalculated using 2006 WHO growth standards
DRAFT
%
%
WHO
threshold
30%
WHO
threshold
40%
WHO
threshold
15%
Identify the scope and magnitude of nutrition problems, illustrating how they have changed over time (Ethiopia)
Highest %
Compare prevalence with absolute numbers, by region, to inform planning and prioritisation exercises (Nepal)
Highest #’s
20-29.9%Far-western
Eastern
Central
Western
Mid-western
Stunting among children <5 years old, 2011
30-39.9%>40%
Prevalence of stunting
37%38%37%50%46%
261,262425,250232,564235,926162,018
Source: Census 2011 population projection, Estimated Target Population (2011-12), DoHS, Kathmandu, NDHS 2011
Highlight the nuances: While largest numbers of stunted children in North, stunting is on the rise in Southern & Eastern regions (Sierra Leone)
Highest
Largest absolute numbers of malnourished children in Northern region…
Largest absolute numbers of malnourished children in Northern region…
But stunting has decreased in North, while increasing in Southern and Eastern regionsBut stunting has decreased in North, while increasing in Southern and Eastern regions
Note: SMART 2010 prevalence data provided for children 6-59 months. Absolute numbers for children 0-59 months using SMART 2010 prevalence rates for children 6-59 months.Source: DHS, 2009; SMART Survey, 2010; REACH analysis.
Stunting prevalence of children 6-59 months, 2010
34.5%
Lowest
39%
39.6%22%
109,000 children
44,000 children85,000 children
89,000 children
Change in stunting prevalence, 2008 - 2010
-5+% +15+%
IncreaseDecrease
0
West Urban
West Rural Moyamba
Bonthe
Pujehun
BoKenema Kailahun
Koinadugu
Tonkolili
Bombali
Port Loko
Kambia
Kono
Summarise the nutrition situation from A to Z(Iringa Region, Tanzania)
Requiring action
Serious problem requiring urgent action
Not currently a serious problem
Not applicable
DRAFT
↑↑↑↑ Improving ↓↓↓↓ Deteriorating →→→→ No Change
Indicator URBAN Severity Trend RURAL Severity Trend
Nutritional Im
pact
Stunting Prevalence of stunting among children 6-59 mo. old 35.0 % ↓↓↓↓ 45.5% ↑↑↑↑
Wasting GAM prevalence among children 6-59 mo. old 3.8 % ↓↓↓↓ 6.7% ↓↓↓↓
SAM prevalence among children 6-59 mo. old 1.4% ↓↓↓↓ 2.4% ↓↓↓↓
Vitamin A deficiency Children <5 with Vitamin A deficiency 63.3 % n.a. 73.1% n.a.
Iron deficiency Children 6-59 mo. old with anemia 59.7 % n.a. 72.0 % n.a.
Women 15-49 yrs.old with anemia 51.8 % n.a. 55.1 % n.a.
IDD Median urinary iodine level for school-aged children 89.6 µg/L n.a. 59.2 µg/L n.a.
Underlying Cau
ses
Food Security Households with poor or borderline food consumption - - - - - - - - - - - -
Global Hunger Index Score - - - - - - - - - - - -
Health and
Sanitation
Under 5 mortality rate 100 ↑↑↑↑ 111 ↑↑↑↑
Proportion of institutional deliveries 81.8 % ↑↑↑↑ 44.5% . ↑↑↑↑
Households with access to improved water sources 85.3 % n.a. 37.1 % n.a.
Households with access to improved sanitation facilities 43.7 % TBD n.a. 12.3 % TBD n.a.
Care Timely initiation of breastfeeding 75.0 % ↑↑↑↑ 12.3 % ↑↑↑↑
Infants 0-5 mo. old exclusively breastfed - - - - - - - - - - - -
Children 6-23 mo. old receiving an acceptable diet 12.3 % n.a. 13.3% n.a.
Households with a washing station equipped with water and soap/cleansing material 48.6 % n.a. 24.3% n.a.
Households taking 30+ minutes to fetch water 18.1 % ↑↑↑↑ 48.6 % ↑↑↑↑
Basic Cau
ses
Education Females that completed primary school or higher 49.0% ↑↑↑↑ 11.2% ↑↑↑↑
Females 15-49 yrs. who are literate 67.8 % ↑↑↑↑ 25.5 % ↑↑↑↑
Population Total fertility rate 4.5 ↓↓↓↓ 6.6 ↓↓↓↓
Gender Women who were married before 18 yrs. 42.4 % n.a. 56.4 % n.a.
Women ages 15-19 who already had a child or are currently pregnant 30.8 % . ↑↑↑↑ 41.5 % ↑↑↑↑
Poverty Population living under national poverty line 49.6 % ↑↑↑↑ 56.9 % - - ↑↑↑↑
GINI Index - - - - - - - - - - - -
Not currently a serious problemRequiring action
Urgent Problem requiring urgent action
Not applicable SEVERITY TRENDS
Underscore any marked disparities e.g. rural/urban divide, gender… (Mozambique)
What can be done?
What does multi-sectoral action really mean?
REACH applies a Theory of Change to accelerate progress towards MDG1, target 2
Source: REACH Secretariat
If we address
these issues …
Little consensus on the causal
problems of undernutrition
Limited political commitment
Weak coordination of gov'ts
with UN agencies and other
stakeholders
Nutrition is not seen as a
multi-sectoral issue
Poor capacity development
Accountability and
responsibility is undervalued
with these
strategies to improve
governance…
REACH outcomes
1. Increased
awareness and
consensus of
stakeholders
2. Strengthened
national policies
and programmes
3. Increased human
and institutional
capacity
4. Increased
effectiveness and
accountability
then we can
achieve …
Political support to
fund programs and
coordinated nutrition
efforts
this impact
Improved
nutrition for
women and
children
Nutritional impact and
coverage
Action spans beyond 2015 as hunger remains a problem, and nutrition issues
gain a stronger emphasis in the post-2015 agenda
Making ‘practical’ nutrition knowledge across the multi-sectoral landscape more accessible and coherent
Audience
• Primary audience: REACH facilitators
• Secondary audience: Others, particularly non-technical practitioners
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
Potential actions1
What d
Food Consumption2
•Improvement of local recipes
•Public guidance & consumer
awareness/protection
Horticulture/Crops
•Diversification & locally adapted
varieties
•Biofortification
Livestock & Fisheries/Aquaculture
•Small-scale animal husbandry
•Animal health services
Food Processing & Storage
•Fortification
•Food preservation (incl.
complementary foods)
•Food storage
Treatment of Acute Malnutrition
•Treatment of SAM
•Treatment of MAM
Disease Prevention & Management
•Deworming
•ORT
•Vaccinations (polio, measles, etc.)
•IPTp (anti-malaria)
•HIV treatment & PMTCT
•DOTs for TB & antibiotics for
pneumonia
Micronutrient Supplementation
•Iron+folic acid/Iron supplementation
•Vitamin A/D/E/zinc/Ca
supplementation
•Multiple micronutrient supplements
(powders & capsules)
Water & Sanitation
•Construction of safe water points
•Latrine construction
Food, agriculture & diets Health-based
Capacity development * Nutrition education & social marketing
Infant & Young Child Feeding
•Breastfeeding promotion & support
•Complementary feeding & support
•Infant feeding in context of HIV
Hygiene
•Personal hygiene promotion
•Food hygiene & preparation
Care for Children/ P&L Women
•Childcare support/caregiver workload
•Care to pregnant/lactating women
Health Behaviours
•Health-seeking behaviour
•Insecticide-treated nets (anti-malaria)
•Household water treatment
•Family planning behaviour
Maternal & child care
In-kind Transfers
•General food distribution
•Blanket Supplementary Feeding
•Food-for-assets/training
•School feeding
Cash & Vouchers
•Cash/Vouchers-for-
work/training/education
•Conditional cash transfers
Other Social Protection
•Public works
•Maternity/paternity protection
•Subsidies/taxes
Social protection
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 categories Source: REACH Secretariat
Developing ‘Action Sheets’ on nutrition-related actions for thematic areas, including nutrition-sensitive, that transcend institutional mandates
Conte
xt a
ssessm
ent �
Do n
o h
arm
�E
quity �
Wom
en’s
em
pow
erm
ent �
Multi-secto
ral colla
bora
tion �
M&
E (
exp
licit n
utr
itio
n o
utc
om
es &
indic
ato
rs)
REACH applies a Theory of Change to accelerate progress towards MDG1, target 2
Source: REACH Secretariat
If we address
these issues …
Little consensus on the causal
problems of undernutrition
Limited political commitment
Weak coordination of gov'ts
with UN agencies and other
stakeholders
Nutrition is not seen as a
multi-sectoral issue
Poor capacity development
Accountability and
responsibility is undervalued
with these
strategies to improve
governance…
REACH outcomes
1. Increased
awareness and
consensus of
stakeholders
2. Strengthened
national policies
and programmes
3. Increased human
and institutional
capacity
4. Increased
effectiveness and
accountability
then we can
achieve …
Political support to
fund programs and
coordinated nutrition
efforts
this impact
Improved
nutrition for
women and
children
Nutritional impact and
coverage
Action spans beyond 2015 as hunger remains a problem, and nutrition issues
gain a stronger emphasis in the post-2015 agenda
How are we doing?
REACH applies a Theory of Change to accelerate progress towards MDG1, target 2
Source: REACH Secretariat
If we address
these issues …
Little consensus on the causal
problems of undernutrition
Limited political commitment
Weak coordination of gov'ts
with UN agencies and other
stakeholders
Nutrition is not seen as a
multi-sectoral issue
Poor capacity development
Accountability and
responsibility is undervalued
with these
strategies to improve
governance…
REACH outcomes
1. Increased
awareness and
consensus of
stakeholders
2. Strengthened
national policies
and programmes
3. Increased human
and institutional
capacity
4. Increased
effectiveness and
accountability
then we can
achieve …
Political support to
fund programs and
coordinated nutrition
efforts
this impact
Improved
nutrition for
women and
children
Nutritional impact and
coverage
Action spans beyond 2015 as hunger remains a problem, and nutrition issues
gain a stronger emphasis in the post-2015 agenda
Critical to understand who is doing what where for the selected actions and compare to the need e.g. stunting levels (Rwanda)
Once actions are selected and implemented, information systems/ tools needed to track progress (Mozambique)
Key
ProblemsIntervention areas Status Indicator Status Year Coverage Indicator Coverage Year
Ca
re
Po
or
IYC
F
Pra
ctic
es Exclusive
breastfeeding
% of children (0-5 months) exclusively breastfed
% of women who started timely initiation of breastfeeding
42.8
76.7
2011
2011
% of pregnant/lactating women receiving promotion on
exclusive breast feeding
- -
Complementary
Feeding
% of children 6-23 mo who fed according to IYCF practices 13.0 2011 % of mothers receiving education on complementary
feeding
- -
Ina
de
qu
ate
ma
tern
al
care
Family Planning % adolescents girls 15-19 using contraceptives
Median month interval between births between births
among women 15-49 yrs
8.4
34.8
2011
2011
% of adolescent girls 15-19 counseled on the use of
contraceptives
% of women 15-49 using contraceptives and declared
they want to wait 2 or more years to have their next
child
-
6.6 2011
Hygiene promotion % of children 6-59 mo with diarrhea 11.1 2011
% of households with a hand washing station equipped
with water and soap/cleansing material
% of children being treated with ORS and Zinc
31.7
-
2011
-
Distribution of
nutrition supplement% of pregnant women 15-49 yrs who are underweight - -. % of pregnant women receiving food supplements - -
He
alt
h a
nd
Sa
nit
ati
on
So
il,
wa
ter
bo
rne
en
de
mic
dis
ea
ses Latrines % of children whose feces were securely eliminated 77.8 2011 % of HH with improved sanitation 21.7 2011
Deworming % of children 12-59 mo with parasites detected in stools - -% children 12-59 months who were dewormed in the
past 6 months46.3* 2011
Healthcare
ANC% of pregnant women attending 4+ ANC visits
Median month of pregnancy for first ANC visit
50.6
5.4
2011
2011
% of women receiving IPT during pregnancy in ANC
% of pregnant women 15-49 yrs who during ANC
received counseling, were tested and received the
results for HIV
18.6
42.3
2011
2011
Mic
ron
utr
ien
t
De
fici
en
cie
s Vitamin A
Supplementation % of children with Vitamin A deficiency 68.8 2002
% of children 6-59 months receiving VAS in the past 6
months71.5 2011
Iron/folate
Supplementation % of pregnant women with anemia 50.9 2011
% of women who consumed iron/folate supplements for
90+ days during pregnancy25.9 2011
Distribution of MNPs % of children 6-59 mo with anemia 68.7 2011 % of children 6-59 mo receiving MNPs - -
Fo
od Insu
ffic
ien
t m
acr
o
an
d m
icro
nu
trie
nt
inta
ke
Iodized saltMedian urinary iodine level (µg/L) among school aged
children 6-12 yrs60.3 2004 % households consuming iodized salt 44.8 2011
Food Fortification% of processing industries that fortified selected foods and
comply with the regulation and standards developed - -. % of fortified products in the market (wheat four and oil) - -
Nutrition Education % of households with poor or borderline food consumption 27.4. 2010% of children 6-23 mo consuming vitamin A rich foods
% of children consuming iron rich foods
71.0
45.2
2011
2011
Fo
od
Inse
curi
ty
Production of
nutritious foods
% of households consuming Iron rich foods
% of households consuming vitamin A rich foods
-
-.
-
-
% of households producing iron rich foods
% of households producing vitamin A rich foods
-
-
-
-
Appropriate processing
and storage
% of households with chronic food insecurity
% of producers that had crop losses**
34.0
68.8
2009
2012
% of households storing their harvest in
traditional/improved barn56.0 2009
Cash
transfers/subsidies% of income spent on food 51.4 2008 % of households that benefited from income transfer - -
Market
Centre
Drying
Floor
Well
Police
Post
Mosque
Church
Vocational
Centre
Community
Bank
PHU
School
Town
Crier
R O A D
Committees at village level
committees at Chiefdom or ward level
Village in Moyamba district, Sierra LeoneHow does Fatou’s household access/benefit from nutrition actions?
Thank you