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

1. Planning, costing, implementing and financing
scaled-up multisectoral actions that contribute
to people’s nutrition
Community of Practice
12 February 2015

2. Agenda
Planning, Costing and Financing
Community of Practice
Agenda item Presenter Topic
I. Stocktaking 1. Sandra Mutuma (ACF)
2. Kaia Engesveen (WHO)
3. Tina Lloren (FANTA)
Aid for Nutrition
Health Accounts and OneHealth Tool
Costing in Malawi and Zambia
II. Nutrition-sensitive
“how to”
1. Charlotte Dufur and
Benoist Veillerette
(FAO)
2. Holly Sedutto (REACH)
Nutrition-sensitive investments in
agriculture
Compendium 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)

3. Sandra Mutuma (ACF)
Stocktaking
Planning, Costing and Financing
Community of Practice
Kaia Engesveen (WHO)
Tina Lloren (FANTA)
Questions

4. Stock-taking and potential
priorities for COP1 2015
Based on ACF Aid for Nutrition
publications
Sandra Mutuma
Senior Nutrition Advisor

5. 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

6. 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.

7. Sandra Mutuma (ACF)
Stocktaking
Planning, Costing and Financing
Community of Practice
Kaia Engesveen (WHO)
Tina Lloren (FANTA)
Questions

8. 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 nutrition
through 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

9. • 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. Regional
workshops 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/

10. 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:

11. Sandra Mutuma (ACF)
Stocktaking
Planning, Costing and Financing
Community of Practice
Kaia Engesveen (WHO)
Tina Lloren (FANTA)
Questions

12. Food and Nutrition Technical Assistance III Project (FANTA)
FHI 360 1825 Connecticut Ave., NW Washington, DC 20009
Tel: 202-884-8000 Fax: 202-884-8432
Email: fantamail@fhi360.org Website: www.fantaproject.org
FANTA UPDATES ON COSTING
ACTIVITIES
Meeting 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

13. 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

14. 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

15. 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

17. 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

18. Zambia: Field Testing of the NACS Costing Tool
• 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

19. Zambia: Field Testing of the NACS Costing Tool
• Tool will be field tested in Kitwe District, Copperbelt
Province, Zambia by middle of 2015
• Final tool expected to be published on the FANTA
website by late 2015
19

20. 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

21. Benoist Veillerette and Charlotte Dufur (FAO)
Nutrition-sensitive “how to”
Planning, Costing and Financing
Community of Practice
Holly Sedutto (REACH)
Questions

22. Making Agriculture Investments
Nutrition Sensitive:
definitions, opportunities and challenges
FAO Contribution to SUN Community of Practice – 12 February 2015
Charlotte Dufour
Benoist Veillerette

23. 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

24. 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.

25. 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

26. Ten Key Recommendations
1. 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

27. 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

28. 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

29. 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

30. 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

31. 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)

32. Benoist Veillerette and Charlotte Dufur (FAO)
Nutrition-sensitive “how to”
Planning, Costing and Financing
Community of Practice
Holly Sedutto (REACH)
Questions

33. Demystifying multi-sectoral nutrition actions:
Progress on Compendium of Actions for Nutrition
SUN CoP1
Costing and Financing, Conference Call
12 February 2015

34. 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

35. 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).

36. ‘Action Sheets’ on nutrition-related actions for thematic areas,
including nutrition-sensitive, that transcend institutional mandates
ContextassessmentDonoharmEquityWomen’sempowerment
Multi-sectoralcollaborationM&E(explicitnutritionobjectives&indicators)
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 pursued
2. Action Sheets being developed for the thematic areas marked in bold, italic text under the four respective categories
3. Cross-cutting areas marked in diamond shapes while actions related to the education sector are mainstreamed into the four respective categories

37. 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

38. 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

39. 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

40. 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

41. Meera Shekar (WB)
Financing
Planning, Costing and Financing
Community of Practice
Questions

42. 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 FfD
July 2015
Rio Nutrition
Summit
June 2016
TBD(Possible)Phase 3
•Low Birth Weight
•Childhood Overweight
Possible

43. 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 Projected
2025
Totalnutritionspendingglobally
(US$billions)
2. Moderate
expansion of
funding
3. Continuation of
recent trends
4. Flat-lining
Available
financing
sources
1. Maximum effort:
resources needed are
fully mobilized

44. Conclusions and
way forward
Planning, Costing and Financing
Community of Practice