renewed efforts against child hunger€¦ · purpose of reach presentation. understanding of human...

August 2013

R E N E W E D E F F O R T S A G A I N S T C H I L D H U N G E R

REACH

�Foster a common understanding of nutrition governance

and its importance

�Understanding of REACH : why, who, where, what (what

not)

�REACH as part of the UN network and SUN

�Share early findings on progress in REACH countries

Purpose of REACH presentation

� Understanding of human and economic development costs of

undernutrition

� Lancet, 2008- nutritional deficits during pregnancy and the first

two years of life lead to irreversible damage (physical and

cognitive) yet preventable.

� Response fragmented, calling for improved coordination

� Response not only adequate provision of food and nutrients –need

maternal & child care, food security, health & sanitation

� No single-sector solution to the problems of malnutrition

� UN must collaborate across all sectors to support nat’l SUN effort

Why the need to act?

Food

Health

Care

THE UN AGENCIES CONTRIBUTE TO

UNITED NATIONS REACH IN BRIEFWHO?• REACH is an inter-agency partnership initiated by FAO, WHO, UNICEF, WFP (plus IFAD)

• Has 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)

• REACH international and national facilitators in-country who facilitate inter-agency collaboration and SUN

processes at CO level

• REACH Secretariat, hosted by WFP Rome

WHAT?• REACH is a country-led process designed to improve nutrition governance and management across the multi-

sectoral nutrition landscape

• It promotes multi-stakeholder , multi-sector approach to tackling undernutrition

• Supports national SUN focal points and facilitates SUN processes with UN nutrition team (dual role)

• REACH is not an implementing agency, it is the catalyst for building capacity for multi-sector nutrition governance

and opens the doors for REACH partners to implement at scale

WHERE AND HOW?• Direct ‘Intense’ (10): Bangladesh, Ethiopia, Ghana, Mali, Mozambique, Nepal, Niger, Rwanda, Tanzania + Uganda

• Moderate support countries with sustained commitment: Chad, Burundi

• Remote support: Mauritania + Sierra Leone

• Possible additional countries: Malawi, Guinea, The Gambia, Congo (Brazzaville) others?

FUNDING?• CIDA is largest donor (8 countries)

• USAID / EU (1 each)

• MDG-F; BMGF, ECHO, DFID have also supported

REACH – HISTORY

If we address these issues

With these strategies

Then we can achieve

Reduced undernutrition

Improved nutrition governance

This impact

• Little consensus on the causal problems of undernutrition

• Limited political commitment

• Weak coordination of government with UN agencies and other stakeholders

• Nutrition is not seen as a multi-sectoral issue

• Poor capacity development

• Accountability and responsibility is undervalued

• Increased awareness and consensus of stakeholders

• Strengthened national policies and programmes

• Increased human and institutional capacity

• Increased effectiveness and accountability

Political support to fund programs and coordinated nutrition efforts

The partnership seeks to accelerate progress towards MDG 1, target 2, by facilitating improved nutrition governance

REACH Theory of Change

NUTRITION GOVERNANCE

• Strong 'nutrition governance' countries –govt’ ensuring that their citizens’ right to food and nutrition security is realized and to that end, has:

– committed to having a national nutrition action plan, which is also part of the national development strategy, on how to fulfil their commitment

– set up inter-sectoral coordinating committees

– established multi-stakeholder mechanisms to ensure effective participation

– allocated budget lines for nutrition strategies and plans

– conducted regular assessments and surveillance to ensure the efforts are leading to improved food and nutrition security for all

• REACH theory of change assumes if large-scale and sustained reductions in undernutrition are to be achieved, high priority should be given to reinforcing functional capacities (governance)

• Advancing commitment-building, agenda setting, policy formulation, capacity-building for operations, and all other aspects of a long-term nutrition agenda at country level

• REACH approach whereby facilitation supports improving nutrition governance and better coordinated nutrition actions, across multiple sectors.

• REACH in-country staff (facilitators) support and follow developments as they unfold; understand in-depth the components and dynamics of nutrition governance.

• REACH facilitators use a common theory and methodology of multi-sectoral nutrition governance ; continued and wide range of experience-sharing

Nutrition Causal AnalysisCompile and analyse available data


Stakeholder/ Activity MappingIdentify the landscape of nutrition actors across

multiple sectors, their activities, and interactions



Delivery Mechanism AnalysisIdentify the mechanisms used to

deliver nutrition actions, synergies

and opportunities to scale up




Indicator DashboardProvide a synthesised tool to

understand the nutrition issues in-

country and the measures being

taken to address them





Situation AnalysisOutcome 1

Selection of Country Priority InterventionsBased on the analysis and scientifical evidence for

interventions , together with stakeholders



Coverage AssessmentCoverage Assessment





















Facilitating policy, costing, planning and other operational

exercises Establish or strengthen multi-sectoral nutrition plans

Integrate nutrition into sectoral plans

Develop Costing/ Budget Investment Cases





Capacity Development

Planning


Planning Communications Plan Communications Plan


Planning Outcome 2



































Planning


Planning Communications Plan Communications Plan


Planning Outcome 2





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Implementation

REACH

The Greater Nutrition ArchitectureDistinguishing between REACH, SCN and SUN

Understanding REACH’s role in the UN Network

Executive Exec.Committee, UN and NGOs

UN NUTRITION COORDINATION AT THE GLOBAL LEVEL

1000 DAYS drives the acceleration for scaling up nutrition

UN SCN

Technical Commitee

• WHAT: UN harmonization forum• (working groups/task forces)• PURPOSE: Provides technical

guidance and policy harmonization (no field presence)

• AGREEMENTS: Strategic framework and action plan

• FUNDING: From members

SCN Secretariat

REACH

4 UN Agencies +IFAD

Steering Committee

• WHAT: UN Coordinating Mechanism

• PURPOSE: Supports improvements in governance and management to scaling up nutrition

• AGREEMENTS: MOU between the four agencies

• FUNDING: Several donors for country operations

REACH Secretariat

SUN

Lead group

SUN Movement Secretariat

• WHAT: A “movement”• PURPOSE: Provides political space

and commitment to scaling up nutrition efforts

• AGREEMENTS: Framework and road map

• FUNDING: can mobilize funds

SUN Networks

REACH

Emerging Findings from REACH countriesReviewing performance for each REACH outcome

Increased awareness and consensus of stakeholders

Strengthened national policies, plans and programmes

Increased governance and management capacity

Increased effectiveness and accountability

REACH M&E framework includes 4 essential components

of nutrition governance

1

2

3

4

REACH

1. Increased awareness and consensus of

stakeholders

70% of countries have seen an overall improvement in their stakeholder awareness level

� All REACH countries have a high-to-medium level of stakeholder awareness on

nutrition issues

� 70% of countries1 have an overall high level stakeholder awareness2

Average score of the combined four stakeholder groups3

1Chad is not included in the analysis2High awareness = ≥80%; medium awareness = 79-40% 3Stakeholder groups: Government Ministries, UN Agencies, NGOs and Donors

60%

65%

70%

75%

80%

85%

90%

95%

100%

Early 2013

Initial situation

Countries with high-level nutrition champions and countries in an emergency context had a high awareness about nutrition issues

Operating in an emergency context

→ creates awareness on acute malnutrition

High-level champions (e.g. President,

PM, Minister) & performed awareness

and consensus building activities

-High-level champions & no

awareness promotion

-Non high-level/No champions

& some awareness promotion

Note: High awareness = ≥80%; medium awareness = 79-40% 1Stakeholder groups: Government Ministries, UN Agencies, NGOs and Donors; Data refers to initial situation

Stakeholder awareness among UN Agencies

� In all countries, the UN agencies had a high level of awareness,

especially the REACH partner agencies - UNICEF, WHO, FAO

and WFP.

�Most countries considered UNFPA as another UN partner for

nutrition issues:

Note: Data refers to initial situation

Other UN Agencies

with a role in nutrition

% of countries naming the

other UN Agencies

UNFPA 46%

UNDP 18%

IFAD, UNAIDS, UNHCR,

UN Womeneach 9%

Situational Analysis: High prevalence of all types of undernutrition throughout Bangladesh

Sources: HFSNA 2009 (WHO 2006) and BBS population projection 2010

Underweight (0-59 months)Underweight (0-59 months)

Very high

High

Medium

Low

WHO Prevalence Situation

Classification (1994)

Stunting (0- 59 months)Stunting (0- 59 months)

Chittagong

Khulna

42.8%

0.5 m

Sylhet

Dhaka

Barisal

Rajshahi1

41.7%

1.3 m

36.9%

1.9 m

42.3%

0.4 m

29.6%

0.6 m

33.8%

1.3 m

Chittagong

Khulna

56.6%

0.6 m

Sylhet

Dhaka

Barisal

Rajshahi1

49.6%

1.6 m

51.3%

2.7 m

49.4%

0.5 m

40.1%

0.8 m

44.2%

1.7 m

ChittagongKhulna

13.5%

0.1 m

Sylhet

Dhaka

Barisal

Rajshahi1

13.4%

0.4 m

12.3%

0.7 m

16.1%

0.2 m

12.4%

0.2 m

15.2%

0.6 m

Wasting (6-59 months)Wasting (6-59 months)

Chittagong

Chittagong

REACH

2. Strengthened national policies, plans

and programmes

70% of countries have revised or improved their nutrition

policies

Uganda

Tanzania

Mozambique

Bangladesh

Ghana & Mali

Endorsed:

Nepal & Rwanda

Being endorsed:

Ethiopia

Initial

situation

Current

trend

Being

devised

Completed,

current

(endorsed/

being endorsed)

Tanzania

Bangladesh

(being revised)

Endorsed:

Nepal & Rwanda

Ethiopia, Mali,

Mozambique

Being endorsed:

Ghana, Niger,

Uganda

Niger

Completed,

outdated

(not endorsed)

Completed,

outdated

(endorsed)

Note: Chad is not included in the analysis

Compared to the previous 30%, now 70% of countries have completed a nutrition action plan

Nepal

Niger

Uganda

Bangladesh

Ghana

Mali

Tanzania

Rwanda

Ethiopia

Mozambique

Initial

situation

Current

trend

No Action

Plan

Plan completed

(endorsed)

Plan in

development

(not endorsed)

Mali

Rwanda, Ethiopia

Mozambique

Nepal, Niger, Uganda

Tanzania

- Rwanda has been revising it action plan as the current one will expire in 2013.

- Ethiopia has reviewed its national plan, which was launched in 2013.

- Mozambique has also begun reviewing its action plan.

- Uganda has endorsed its plan but is working on a detailed costing plan.

Bangladesh

Ghana

Note: Chad is not included in the analysis

REACH

3. Increased governance and

management capacity

While initially 20% of countries had started establishing

governance and management coordination structures,

60% have completed the process now

� Initially, only 20%* of countries had started the process of

establishing a high level nutrition coordination mechanism NCM

(Rwanda & Uganda)

� Currently, 60% of the countries have formally established an NCM →

out of these

- 83% have a committee that is meeting regularly

- 50% have more than four relevant nutrition sectors participating

- 50% have established an operational secretariat

*Chad is not included in the analysis

REACH

4. Increased effectiveness and accountability

REACH DashboardBangladesh example

6.5%28.7%4

54

% of < 5 / P women with low serum retinol% of < 5 with low serum retinol5

< 5 mortality rate per 1000 live birthsInsufficient macro and micronutrient intake

67.9%38.8%

% < 5 with iron deficiency anemia (IDA)Iron deficiency anemia in pregnant women

25.0%7% Households with poor or borderline FCS scores 8

6.7%97.1%

Soil, water borne & endemic diseases

58.8%9.8%

% Population washing hands before eatingDiarrhea prevalence children < 5

0.5%6

4.0%% < 5s slept under ITN last night% malaria prevalence children < 5

1.9%2% pregnant women at risk of getting malaria

44.6%3STH % < 5 infected

74.7%% of households without access to hygienic latrines

3.0%% children < 5 SAMHigh prevalence of acute malnutrition 14.0%MAM prevalence for children <5 (not including

SAM)

36 %% of children breastfed within 1 hr of birth 10

Poor IYCF Practices48.7%% of infants 0-6 months of age who are

exclusively breastfed 9

57.6%% of infants 6-8 months of age who receive solid, semi-solid or soft foods along with breast milk 9

StatusProblem indicatorKey problems

40.0%

26.0%

% pop. living under national poverty line

Household food insecurity - % of population undernourishedInsufficient access to

food

HEALTH

FOOD

9.8%% < 5 with diarrhea

na

na not applicable

1. Equals ~ 37,000 of under-five deaths, according to Unicef 2009 2. 19/1000 estimated malaria cases all ages in Bangladesh 3. Data for rural Bangladesh only 4. Before 21.7% according to WHO VMNIS/HKI 1997/1998 5. Tissue concentrations of vitamin A which are low enough to have adverse health consequences 6. Operational coverage of any net per 2 persons at risk in 2007 (IRS/ITN), Global Malaria Report 2008 7. Due to country-specific Issues like differing applications of the methodology, different thresholds (cut off points), cross country comparisons are not made 8. Food Consumption Score (FCS) is a bench mark for WFP (<42 SCORE), HFSNA 2009, P-66 9. HFSNA 2009; 10. MICS 2006

data na

data na

Nutrition education for dietary diversity

Conditional cash transfers

Local homestead food production

Iron/ folic acid suppl./ fort. MNP/ Sprinkles

Vitamin A supplementation for childrenVitamin A supplement for post partum women

Supplementary feeding for MAM

Therapeutic feeding for SAM

Latrine provision and usage promotion

De-worming

IPTp

ITN (bed nets)

Hand washing with soap

Household water treatment education and equipment

Complementary feeding promotion

Exclusive breastfeeding promotion

Early initiation of breastfeeding promotion

Interventions

Zinc for diarrhea

Coverage

Coverage (full)

N.A.

N.A.not availablecurrently not serious problemserious problem requiring urgent action problem requiring action

% households using HWT methods% households with access to improved water source

The UN is increasingly working jointly together to enhance its effectiveness in tackling nutrition-related issues

UN as One:

- 64% of countries have at least 1 joint UN program/programming developed and funded as of early 2013.

UN In-country Focal Points: From an initial 30%, 80% of countries have identified all focal points with nutrition governance responsibilities from the four UN REACH partner agencies (WHO, FAO, UNICEF and WFP) as of early 2013.

UN nutrition coordination:

- 100% of countries have a UN nutriMon coordinaMon mechanism → out of which 64% are operational (in 7 out of 11 countries) as of early 2013.

UN strategy in nutrition:

- More than 1/3 of countries have an inter-agency common strategy as of early 2013.

Time

period

REACH countries* with UN nutrition focal points (FP)

% of countries with

4 FP 3 FP 2 FP 1 FP 0 FP

Initially 30% - 20% 10% 40%

Early 2013 80% 10% - 10% -*Does not include Chad

Insights on UN Coordination

Challenges:� Lack of funding for new REACH countries at global level

� Some countries UN agencies or national government not working

� Competition for resources

� REACH seen as a competitor (confusion that it is a new brand)

� UNDAF is structured by themes ; nutrition cuts across; coordinated across several themes

� Many demands on UN nutrition focal points; cannot participate adequately

� UN nutrition coordination not recognised /does not count performance

� Staff turnover and lack of institutional memory

� Nutrition Focal Point mechanism is informal and so decisions cannot be implemented along the formal UN governance structure

� Difficulties in transferring funds from one agency

� Poor information sharing

Insights on UN Coordination

Opportunities:

�REACH is light coordination mechanism

�Demand for REACH is being met by some UN agencies- pooling resources

�Some agencies have put in place rotational UN nutrition leadership and shared responsibilities

�Joint initiatives and joint programmes foster better clarity and collaboration and reduce competition for resources

�UN nutrition strategy are becoming more frequent (based on UNDAF) ; joint fund raising

Thank you

renewed efforts against child hunger€¦ · purpose of reach presentation. understanding of human...

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