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Nutrition element portfolio review usaid_ Roshelle Payes & Rebecca Egan_10.14.11


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Nutrition element portfolio review usaid_ Roshelle Payes & Rebecca Egan_10.14.11

  1. 1. USAID Nutrition Approach: Where are we now? Where are we going? How are we getting there?<br />
  2. 2. Global Health Initiative principles, components and target areas<br />Principles <br />Promote women, girls and gender equality focus<br />Encourage country ownership/leadership<br />Strengthen health system and program sustainability<br />Leverage and strengthen key multilateral organizations, global health partnerships and the private sector <br />Foster strategic coordination and integration<br />Improve metrics, monitoring and evaluation<br />Promote research and innovation<br />Implementation components<br />Target areas<br /><ul><li>Collaborate for impact
  3. 3. Do more of what works
  4. 4. Build on and expand existing platforms to foster stronger systems and sustainable results
  5. 5. Innovate for results
  6. 6. HIV/AIDS
  7. 7. Malaria
  8. 8. Tuberculosis
  9. 9. Maternal Health
  10. 10. Child Health
  11. 11. Nutrition
  12. 12. Family Planning and Reproductive Health
  13. 13. Neglected Tropical Diseases</li></ul>2<br />
  14. 14. 3<br />AComprehensiveApproach<br />PATHWAYS:<br />Addressing the root causes of hunger that limit the potential of millions of people<br />Establishing a lasting foundation for change by aligning our resources with country-owned strategies and supporting local capacity. <br />PRINCIPLES:<br />1) Invest in country-owned plans that support results-based programs;<br />2) Strengthen strategic coordination – globally, regionally, and locally;<br />3) Ensure a comprehensive approach – advancing agriculture-led growth, reducing under-nutrition, and increasing impacts of humanitarian food assistance;<br />4) Leverage the benefits of multilateral institutions; and<br />5) Deliver on sustained and accountable commitments.<br />OBJECTIVES:<br /><ul><li>Inclusive agriculture sector growth
  15. 15. Improve nutritional status</li></ul>Cross-cutting priorities:<br /><ul><li>Global research and innovation
  16. 16. Gender
  17. 17. Natural resources and climate consideration</li></li></ul><li>Role of Operating Units<br /><ul><li>Bi-lateral planning and program implementation
  18. 18. Coordination with host country
  19. 19. In-country donor coordination</li></ul>Missions<br /><ul><li>Policy guidance to Missions
  20. 20. Oversight of Mission programs
  21. 21. Regional programs</li></ul>Regional Bureaus<br />Global Health Bureau<br /><ul><li>Technical support to the field
  22. 22. Global technical leadership
  23. 23. Operations research and innovation
  24. 24. Economies of scale in commodity procurement and highly specialized expertise
  25. 25. Funding of and representation to international health organizations</li></ul>Food Security Bureau <br />4<br />
  26. 26. GHI/FTF Nutrition Goal<br />Our goal is to reduce child undernutrition by 30% in focus countries, measured by any one of four core indicators<br /><ul><li>Underweight (MDG 1c)
  27. 27. Stunting
  28. 28. Child Anemia
  29. 29. Maternal Anemia</li></ul>5<br />
  30. 30. Outline<br />Program Context <br /><ul><li>Burden of undernutrition
  31. 31. Causes and consequences</li></ul>Recent Sea Change in Nutrition Strategy<br />How the New Nutrition Strategy is implemented globally and in USAID’s programs<br />4. Review questions<br /><ul><li>Is it feasible to reach our 30% goal?
  32. 32. What is the optimal approach for delivering a comprehensive set of nutrition interventions?
  33. 33. How do we overcome the issues related to engaging the private sector?</li></ul>6<br />
  34. 34. One in three children suffers from stunting<br /><ul><li>South Asia has made the most progress
  35. 35. Overall number of stunted children in Africa has actually increased</li></ul>Number of stunted children, 2010<br />1990<br />Prevalence of children with stunting, by region<br />2008<br />7<br />
  36. 36. High global prevalence of anemia in children and women<br /><ul><li>In some countries, anemia prevalence is significantly higher
  37. 37. Any anemia has health and productivity consequences</li></ul>Global Burden of Anemia in Children and Women<br />Children: 47% prevalence293 million children<br />Haiti: 48%<br />Mali: 82%<br />Uganda: 72%<br />Ghana: 59%<br />Tanzania: 72%<br />Women of reproductive age:<br />30% prevalence<br />468 million women<br />Malawi: 44%<br />8<br />
  38. 38. Determinants of nutrition<br />NUTRITION<br />Health<br />Food/nutrientintake<br />Maternal and child care practices<br />Access to food<br />Water, sanitation, and health services<br />Revised Source: Ruel, SCN News 2008<br />9<br />
  39. 39. Improving nutrition is required to achieve all MDGs<br />Health: contributes to 3.5 million deaths each year from common illnesses otherwise not fatal<br />Education: lower IQ and school performance<br />Economic growth: costs countries 3-6% of GDP<br />Poverty: wages that are half as high in adulthood in children who were undernourished in early life<br />Infectious disease treatment: hastens HIV progression and reduces adherence to treatment<br />10<br />
  40. 40. Outline<br />Program Context <br /><ul><li>Burden of undernutrition
  41. 41. Causes and consequences</li></ul>Recent Sea Change in Nutrition Strategy<br />How the New Nutrition Strategy is implemented globally and in USAID’s programs<br />4. Review questions<br /><ul><li>Is it feasible to reach our 30% goal?
  42. 42. What is the optimal approach for delivering a comprehensive set of nutrition interventions?
  43. 43. How do we overcome the issues related to engaging the private sector?</li></ul>11<br />
  44. 44. Evidence-based and consensus-driven global efforts exist<br />1<br />Investing in nutrition is one of the most cost-effective buysin development (Copenhagen Consensus 2006)<br />2<br />A core package of interventions isproven to improve nutrition (Lancet Series 2008)<br />3<br />That core package costs a certain amount(World Bank 2009)<br />4<br />Targeting from pregnancy to two yearswill have the most impact<br />5<br />Countries are eager to scale up nutritionand our partners are aligned to support them (SUN)<br />12<br />
  45. 45. The sea change in global nutrition programs is reflected in USAID’s nutrition programs<br />Integrated, food-based<br />1,000 days<br />Diet quality and diversity<br />+Prevention<br />+Agriculture, social protection<br />National<br />1. Type of interventions<br />2. Age target<br />3. Measurement<br />4. Focus<br />5. Delivery systems<br />6. Scale<br />Vertical, supplementation<br />Under fives<br />Nutrient-specific<br />Treatment<br />Health<br />Pilot<br />With these new approaches we aim for a 30% reduction in undernutrition<br />13<br />1<br />2<br />3<br />4<br />5<br />6<br />
  46. 46. From vertical micronutrient programsto food-based, integrated approaches<br />1<br />2000<br />2005<br />2010<br />USAID supports Tanzania’s vitamin A supplementation program which has achieved high coverage for the past 10 years<br />USAID supports district-level planning and budgeting to transition the VAS program to GOT ownership<br />2011<br />In support of Tanzania’s draft National Nutrition Strategy, USAID launches a new bilateral in high burden focus regions (FTF zone of influence) with a focus on preventing stunting and behavior change<br />Improving nutrition in Tanzania bilateral <br />14<br />
  47. 47. From under five or population-wide targeting to the 1,000 days window<br />2<br />By 2009<br />1<br />It is the period of most vulnerability<br />2<br />Interventions after this period are not likely to have impact<br />Programs target pregnant women and young children under 2 years of age<br />3<br />Interventions in this period have immediate and long term consequences<br />2010<br />15<br />
  48. 48. From nutrient-specificto measuring diet quality and diversity<br />3<br />2005<br />2007<br />2010<br />USAID provides technical assistance to WHO and UNICEF to improve measurement assessing infant and young child feeding practices <br />Consensus Meeting: Definitions Established<br />Indicators Calculated for All Countries and Guidance Provided<br />2011<br /><ul><li>Minimum acceptable diet used to measure progress for GHI and FTF
  49. 49. Modules and calculation methodology provided to Demographic Health Surveys</li></ul>16<br />
  50. 50. From recuperative to preventive approaches<br />4<br />2000<br />2005<br />Prevalence of stunting, 2000 and 2005<br />Haiti Study: prevention approach has greater impact on nutritional status than recuperative approach<br />2011<br />2010<br />2011<br /><ul><li>Technical Reference Materials developed for FFP applicants
  51. 51. Food for Peace lists PM2A as preferred MCHN approach in multi-year program guidance
  52. 52. Burundi and Guatemala to identify most cost effective approaches</li></ul>17<br />
  53. 53. From health delivery systemsto maximizing multi-sectoral synergies <br />5<br />2000<br />2007<br />2010<br />Changes in anthropometry, 2004-2009<br />Most Nutrition Programs focused on health platforms ONLY: Minimal evidence for Agriculture and Health Linkages<br />Analysis of program approaches that worked: World Bank Report , CSHGP and FFP MYAP evaluations<br />2011<br /><ul><li>Bilateral programs with integrated platforms developed in 15 FTF/GHI countries
  54. 54. Synergies with FFP, PEPFAR and other donors (e.g. in Uganda, Mozambique, Bangladesh)
  55. 55. New Research (CRSP) to further evaluate synergies between agriculture and nutrition (e.g. Ugandaand Nepal)</li></ul>18<br />
  56. 56. From pilots to scale<br />6<br />2002: Senegal began the Nutrition Enhancement Program (NEP)<br />SENEGAL: National Nutrition Enhancement Program<br />2006: USAID-funded community-based growth promotion programs were introduced nationwide as part of phase II of NEP<br />1996-2006: USAID supported preventive nutrition programs in 4 health regions<br />2015 MDG 1 GOAL<br />19<br />
  57. 57. Outline<br />Program Context <br /><ul><li>Burden of undernutrition
  58. 58. Causes and consequences</li></ul>Recent Sea Change in Nutrition Strategy<br />How the New Nutrition Strategy is implemented globally and in USAID’s programs<br />4. Review questions<br /><ul><li>Is it feasible to reach our 30% goal?
  59. 59. What is the optimal approach for delivering a comprehensive set of nutrition interventions?
  60. 60. How do we overcome the issues related to working with the private sector in the nutrition program?</li></ul>20<br />
  61. 61. USAID is part of a multilateral partnership to scale up nutrition<br />WHAT IT IS:<br /><ul><li>Over 100 of our development partners involved (civil society, private sector, UN, donors)
  62. 62. Coordination of these partners to encourage synergy of purpose and ensure complementarity of action based on countries’ requests</li></ul>WHY WE ARE INVOLVED:<br /><ul><li>GHI/FTF principles are aligned with SUN
  63. 63. Increases our leverage and alignment with partners
  64. 64. Provides us with concrete milestones to measure progress on scaling up nutrition
  65. 65. Facilitates high-level dialogue/advocacy on nutrition in countries that can drive policies and programs
  66. 66. Provides a barometer for country ownership: political leadership, inclusivity of process, country budgetary commitments</li></ul>SCALING UP NUTRITIONMOVEMENT<br />21<br />
  67. 67. Integrated frameworks reflect country priorities in multiple sectors and our FTF-GHI principles<br />GHI<br />Health zones<br />Women, girls and gender equality <br />Country ownership<br />Health systems strengthening<br />Multilaterals and partnerships<br />Coordination and integration<br />Metrics, monitoring, evaluation<br />Research and innovation<br />Ministry of Health<br />Health bilaterals and local partners<br />Country health sector strategy<br />FTF MYSBESTGHI STRATEGYCDCS<br />INTEGRATED NUTRITION INVESTMENT FRAMEWORK<br />FFP MYAPs<br />Agriculture production potential areas<br />FTF<br />Local civil society<br />Country investment plan/CAADP<br />1. Country ownership<br />2. Coordination<br />3. Comprehensive approach<br />4. Multilaterals and partnerships<br />5. Results and commitments<br />Ministry of Agriculture<br />22<br />
  68. 68. USAID’s rapid mobilization of country programming has made good progress since 2009<br />23<br />On track<br />In progress<br />Little/no change<br />Integrated Nutrition Frameworks: from 0 to 15 countries<br />Nutrition procurements: from 7 to 16 countries (9 nutrition-sensitive and 7 nutrition-focused)<br />Nutrition focused staff: from 5 to 19 countries<br />
  69. 69. USAID’s country focus is driven by the magnitude of the problem, country context and GHI and FTF strategy<br />Criteria:<br /><ul><li>Prevalence and magnitude of undernutrition
  70. 70. Country ownership
  71. 71. Existing platforms
  72. 72. Alignment with FTF and GHI</li></ul>36 countries account for 90% of the global burden of stunting<br />24<br />
  73. 73. USAID nutrition programs in 22 of the 36 highest burden countries<br />Ethiopia<br />Ghana*<br />Kenya<br />Liberia*<br />Malawi<br />Mali<br />Mozambique<br />Rwanda*<br />Senegal*<br />Tanzania<br />Uganda<br />Zambia<br />Bangladesh<br />Cambodia<br />Nepal<br />Guatemala<br />Haiti*<br />Burundi<br />Burkina Faso<br />DR Congo<br />Madagascar<br />Niger<br />South Sudan<br />Cote D’Ivoire<br />Nigeria<br />South Africa<br />Vietnam<br />17core countries<br />+6Food for Peace <br />+4PEPFAR<br />SUN+Peru+Benin+Laos<br />17 countries with over 80% of the GHCS nutrition resources<br />25<br />*Not in the 36 highest burden countries due to population size<br />
  74. 74. Monitoring and evaluation<br /><ul><li>DHS baselines
  75. 75. DHS includes new indicators
  76. 76. Core set of nutrition indicators for both GHI-FTF
  77. 77. Working with global partners to align monitoring and evaluation for nutrition (SUN)</li></ul>26<br />
  78. 78. Comprehensive Nutrition Investment Plan<br />MATERNAL CHILD HEALTH<br />INFECTIOUS DISEASES<br /><ul><li>Health worker capacities to screen and refer
  79. 79. Nutrition service delivery (including CMAM)
  80. 80. Birth spacing and family planning</li></ul>WATER<br /><ul><li>Community-facility referrals
  81. 81. Ready-to-use therapeutic food production
  82. 82. OVCs as target population
  83. 83. Maternal and child anemia
  84. 84. Access to improved water sources
  85. 85. Hygiene behaviors
  86. 86. Sanitation</li></ul>NUTRITION<br />+Social and behavior change<br />+Monitoring and evaluation<br />+Community capacity<br />AGRICULTURE<br />SOCIAL PROTECTION<br /><ul><li>Small holder production diversification
  87. 87. Women’s control of productive assets
  88. 88. Agriculture extension workers
  89. 89. Income and employment generation
  90. 90. Food supplementation to the most vulnerable
  91. 91. Asset transfers
  92. 92. Community volunteers
  93. 93. Nutrition service delivery (including CMAM)</li></ul>HARNESSED AND MAXIMIZED TO ACHIEVE IMPACT<br />27<br />
  94. 94. USAID Mission bilaterals: NEPAL EXAMPLE<br />Nepal Family Health Program II<br /><ul><li>Prevention
  95. 95. Scale up</li></ul>Child Survival and Health Grants<br /><ul><li>Food Based
  96. 96. Agriculture
  97. 97. Dietary Diversity</li></ul>UNICEF<br /><ul><li>Prevention
  98. 98. Social Protection</li></ul>Integrated MCH, FP and Nutrition Bilateral<br />Integrated Agriculture and Nutrition Bilateral<br />Integrated, Food Based<br />1,000 Days<br />Prevention<br />Agriculture, Social Protection<br />Dietary Diversity and Quality<br />Scale up<br />Reduction in underweight from 38% to 29%, Government of Nepal Target <br />28<br />
  99. 99. USAID partners with a number of other USG agencies on a range of programs …<br />ILLUSTRATIVE<br /><ul><li>Nutrition surveillance and M&E
  100. 100. Chronic diseases
  101. 101. Food fortification</li></ul>CDC<br /><ul><li>McGovern Dole (school feeding)
  102. 102. Nutrition and agriculture research
  103. 103. Food safety systems</li></ul>USDA<br /><ul><li>Micronutrient biomarkers (BOND program)
  104. 104. Non Communicable Diseases
  105. 105. HIV and nutrition</li></ul>NIH<br />State<br /><ul><li>1,000 Days Partnership
  106. 106. SUN-related diplomacy</li></ul>PEPFAR<br /><ul><li>Nutrition Assessment, Counseling, and Support, including Food by Prescription
  107. 107. Linking with economic strengthening/livelihoods/food security programs
  108. 108. Community-based agriculture
  109. 109. Community worker nutrition training</li></ul>Peace Corps<br /><ul><li>MYAPs
  110. 110. Commodity improvement
  111. 111. Monitoring, evaluation, early warning, surveillance</li></ul>DCHA<br />29<br />
  112. 112. … as well as with a number of other stakeholders and USAID/W implementing partners<br />Civil society<br /><ul><li>Comprehensive approach
  113. 113. Advocacy
  114. 114. Food products
  115. 115. Market-driven solutions</li></ul>Private sector<br /><ul><li>WFP: emergency nutrition
  116. 116. UNICEF: IDD, Comprehensive approach</li></ul>UN<br /><ul><li>WHO: surveillance and capacity
  117. 117. FAO: agriculture policies
  118. 118. REACH: country-specific</li></ul>FANTA 2<br />SUN<br /><ul><li>Food and Nutrition Technical Assistance in 20+ countries
  119. 119. Food security programming and policy
  120. 120. HIV and nutrition</li></ul>A2Z<br /><ul><li>Micronutrient supplementation and fortification programs
  121. 121. Child blindness </li></ul>IYCN<br /><ul><li>Infant and young child feeding practices
  122. 122. PMTCT</li></ul>GAIN<br /><ul><li>Public-private partnerships
  123. 123. Food fortification
  124. 124. Nutritionizing agriculture value chains</li></ul>30<br />
  125. 125. Outline<br />Program Context <br /><ul><li>Burden of undernutrition
  126. 126. Causes and consequences</li></ul>Recent Sea Change in Nutrition Strategy<br />How the New Nutrition Strategy is implemented globally and in USAID’s programs<br />4. Review questions<br /><ul><li>Is it feasible to reach our 30% goal?
  127. 127. What is the optimal approach for delivering a comprehensive set of nutrition interventions?
  128. 128. How do we overcome the issues related to engaging the private sector?</li></ul>31<br />
  129. 129. Review question 1<br />Can we reach our goal with our funding levels?<br />The goal of reducing undernutrition by 30% was established in anticipation of significant increases and front-end loading of funding. Food prices have also increased drastically. The current budget scenario requires us to examine the feasibility of that 30% target.<br />Options:<br /><ul><li>Identify efficiencies
  130. 130. Use subnational targets
  131. 131. Reduce global target based on country-level analysis
  132. 132. Cut additional countries
  133. 133. Increase multilateral cooperation</li></ul>32<br />
  134. 134. USAID has made budget choices to increase our impact and depth of investment<br />33<br />
  135. 135. USAID has prioritized countries and plans to sustain this commitment<br />34<br />
  136. 136. Review question 2<br />What are the most important approaches for delivering a comprehensive package of interventions?<br />Options:<br /><ul><li>Co-locate nutrition, health, agriculture, and social protection to achieve geographic synergies
  137. 137. Develop socio-economic targeting approach (poverty quintile)
  138. 138. Support high-level multisectoral government coordination mechanisms (e.g. Malawi)
  139. 139. Work with other donors on prioritization of interventions
  140. 140. Continued learning on cost-effectiveness of agriculture-health linkages</li></ul>35<br />
  141. 141. Review question 3<br />How do we overcome the issues related to engaging the private sector?<br />OPTIONS:<br /><ul><li>How do we nutritionalize value chains?
  142. 142. How do we focus them on the bottom of the pyramid?
  143. 143. How do we build capacity of small and medium scale enterprises?
  144. 144. What are meaningful incentives for the private sector?</li></ul>36<br />
  145. 145. 37<br />Update: GH Portfolio<br />2010<br />2012<br /><ul><li>Food and Nutrition Technical Assistance Project 2 (FANTA 2)
  146. 146. A2Z Micronutrient and Child Blindness Project
  147. 147. Infant and Young Child Nutrition Project
  148. 148. Global Alliance for Improved Nutrition
  149. 149. Child Survival and Health Grants Program
  150. 150. Maternal and Child Health Integrated Program
  151. 151. Iodine Deficiency Disorder (UNICEF)
  152. 152. NEW AWARD: Food and Nutrition Technical Assistance Project 3 (FANTA 3)
  153. 153. NEW AWARD: Strengthening Partnerships, Results, and Innovation for Nutrition Globally (SPRING)
  154. 154. Global Alliance for Improved Nutrition
  155. 155. Child Survival and Health Grants Program
  156. 156. Maternal and Child Health Integrated Program
  157. 157. Iodine Deficiency Disorder (UNICEF)</li>