REACH Ending Child Hunger and Undernutrition

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Philomena Griselda Eaton
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1 RACH nding Child Hunger and Undernutrition Update on RACH and way forward Consultation with the xecutive Board of May RACH

2 Joint letter from heads of agencies underlines joint UN commitment [...] [...] RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 1

3 RACH partnership addresses undernutrition through joint action Initiating Partners Collaborating Partners RACH partnership is facilitated by an InterAgency team hosted by with an emphasis on strengthening and supporting country level action RACH partnership is expanding and actively seeking new partners Other UN bodies and agencies: IFAD, SCN, UNV, World Bank NGOs & Civil society: Save the Children, World Vision International, Rotary International, GAIN, Hellen Keller International, The Micronutrient Initiative Academia: Tufts, George Washington University, John Hopkins University (The Lancet) Private sector: The Boston Consulting Group Governments: Mauritania, Lao PDR... and various donors RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 2

The child is at the center: The aim is to deliver as one RACH is

and complementary feeding xclusive breastfeeding Complementary

supplementation and fortification Improve hygiene and parasite

nets and intermittent preventive treatment Deworming Food

Therapeutic feeding Improve household food security Local

Supplementary feeding Interventions are proven and known to be

4 The child is at the center: The aim is to deliver as one RACH is about exploiting synergies and scaling up Improve breastfeeding and complementary feeding xclusive breastfeeding Complementary feeding Care Health Increase micronutrient intake Micronutrient supplementation and fortification Improve hygiene and parasite control Household water treatment Hand washing with soap Bed nets and intermittent preventive treatment Deworming Food security Increase treatment of severe acute malnutrition Therapeutic feeding Improve household food security Local homestead food production Conditional cash transfers Supplementary feeding Interventions are proven and known to be effective. The challenge is to scale them up RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 3

One year of professional facilitation in Mauritania and Lao PDR A coordinated, structured process And a clear set-up involving all levels Set up of proper working structure Facilitated situation

Leadership on highest level Cooperation with government on all levels Mauritania Lao 1-3 months 3 months 9-12 months Ongoing Prepare Assess, mobilize, set-up working structure Detailed action

5 One year of professional facilitation in Mauritania and Lao PDR A coordinated, structured process And a clear set-up involving all levels Set up of proper working structure Facilitated situation analysis Coordinated joint action planning Coordinated implementation Involving all key stakeholders Sergio Teixeira Senoe Torgerson UN-core team to drive activities Multi-stakeholder technical team Leadership on highest level Cooperation with government on all levels Mauritania Lao 1-3 months 3 months 9-12 months Ongoing Prepare Assess, mobilize, set-up working structure Detailed action planning Ongoing RACH activities Regional information/ mobilization Country request for RACH support Country preparation xploratory interviews & mobilization (country phase) First assessment Set-up of working modus Detailed country analysis & action planning Resource planning & matching Implementation and monitoring RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 4

6 Mapping of nutrition stakeholders in Mauritania highlights opportunities for improving coordination Treatment Interventions Preventative Interventions Suppl. feeding Therapeutic Feeding Zinc ITN IPTp Breastfeeding Vit. A, Deworming Breastfeeding Compl. feeding Iodine Iodine Breastfeeding Compl. feeding Iodine Iron suppl. Handwashing Iodine Package Homestead food production Donor A/F Catalyst CB C T Various ( Fund) CHO, CIDA, UNOCHA UNICF N/A Global Fund WHO CHO, CIDA, UNOCHA UNICF World Bank Various incl. UNICF Spanish consumer Govt implementer CB Field Coordinator C M+ CB CSA NGOs / INGOs Health System Ministry of Health PS Agents Min.of Industry Min.of Commerce Technicians Ministry of Social Affairs INGOs Min. rural dev & Delivery Channel D CRNAMs CRNI, CRNAS Hospitals, Centres and Postes de Santé Mass Campaigns Mass Media Private sector CNCs Commun ity-based Government Other actor Treatment Physical component ducational component Physical and educational components 1. Tasks: A/F: Advocacy and Funding; C: Coordination/Management; CB: Capacity Building/Training; D: Delivery; M+: Monitoring & valuation; T: Technical Support RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 5

7 Mapping of the problem and level of response in different regions In Mauritania: limited coverage by development partners in North and South ast Important undernutrition issue is acute malnourishment severe rates high Development partner nutrition activities concentrated in South Highest % % % Moderate wasting Severe wasting None or more No. of development partners involved in nutrition per Wilaya Lowest % UNDP Nouakchott ~8,000 children / ~1,000 children 6% 1% Trarza ~6,000 children / ~1,000 children 11% 1% Sud ~17,000 children / ~ 2,000 children 19% 3% Nord ~3000 children / ~1,000 children 7% 1% Centre ~21,000 children Sud st / ~3,000 children ~11,000 children / 16% 3% ~2,000 children 11% 2% UNICF UNFPA WHO UNDP FLM WVI All UN Agencies WVI Nouakchott UNICF UNFPA WHO UNICF UNDP FLM CRF Trarza Source: Wasting rates by region from MICS 2008; Nouakchott rate from Rapide 2008; Population figures from 2008: based on DHS Population Survey RACH Briefing to the B of -29May09 -CP-BR.ppt RACH WVI ACF CP Sud UNICF UNFPA WHO Centre UNDP CP Nord UNDP CP UNICF UNDP UNFPA WVI CP Sud st SS 6

8 Current status of nutrition situation in Mauritania Level of problem and current coverage of interventions Area Improve breastfeeding and complementary feeding Intervention Problem indicator Status Coverage indicator Status xclusive Breastfeeding % of <6 mo.-olds excl. breastfed 16% % Mothers addressed w/ B promo 85% 95% 20% Complementary Feeding % Children 6 11 months receiving 12% % Mothers receiving CF education 85% 95% appropriate complementary foods Increase micronutrient intake Improve diarrhea and parasite control Treat severe acute malnutrition Vitamin A Iron Zinc stimated % of children < 6 with Vitamin A deficiency % < 5 w moderate, severe anemia % < 5 w/ diarrhea 17% 85% 26% Children < 5 covered w/ 2 doses of VAS in last year % Children < 5 receiving iron supplement. % Mothers receiving iron supplement. 70% 80% 0% <76% % of children < 5 consuming zinc 0% supplementation or fortification 3 Iodine % School-age children w/ urinary iodine 80% % of HHs consuming iodized salt 24% levels below 100 µg/l Household water treatment Handwashing with soap % HH using HWT methods % HH with access to improved water source % Population washing hands before eating % < 5 w/ diarrhea 22% 53% 22% 26% % HHs provided with equipment/education on HWT % HHs/mothers addressed with HW promotion programs ITN (bednets) % < 5s slept under ITN last night 2% % of HH with an ITN 12% 4 % Malaria prevalence children < % IPTp (Intermittent preventative treatment) Deworming Therapeutic feeding % pregnant women at risk of getting malaria STH & schistosomiasis, % < 5 % children <5 SAM 58% <20% 1.8% % P women given IPT dose at ANC under direct observation % children < 5 who got deworming drugs in last yr % < 5 w/ SAM who received therapeutic feeding 0%/17% 11%-17% <76% 70%-80% 35% 5 Improve household food security Supplementary Feeding Conditional Cash Transfers Local Homestead Food Production MAM prevalence for children <5 % Population living under national poverty line % Population undernourished Household Food insecurity RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 12% 46% 8% 20% % of MAM children < 5 covered by supp. food aid % of households under poverty line receiving cash transfers % HHs provided support for local homestead food production currently not serious problem problem requiring action serious problem requiring urgent action 59% 5 0% 7% Improvement coverage (full) Deterioration over last yrs. 7

9 RACH aims to exploit synergies and scale up Current channel usage analyzed by intervention: xample Mauritania Interventions Health units Vitamin A Deworming Iodine IPTp Iron xclusive breastfeeding Complement. feeding HH water treatment Handwashing with soap Supplement. feeding Threapeutic feeding Zinc ITN Cond. cash transfer Homestead Food Prod. Community health worker Schools Delivery channels Feeding Center CNC Cooperatives NGOs / INGOs Synergies Scale up Mass Campaign Mass Media Private Sector Current coverage Target coverage Activities at nat'l scale >25% coverage <25% coverage for non-critical RACH cases Briefing to the B of -29May09 -CP-BR.ppt RACH No activities in place duc. activity only 8

10 Joint action planning to develop country-wide scale-up plan Scale-up plans are integration into national nutritional action plans 1 Status analysis Current and planned activities of all key actors 2 Joint planning I III Maintain programs already at scale II xploit synergies Scale up successful and new programs 3 Scale-up plan Integrated, overall scale-up plan RACH scale-up plan National Plan of Action Workplan on Nutrition Workplan... Scale-up programs to be integrated into actor's plans 4 Implementation coordination and monitoring Implementation Investment need for scale-up modest in comparison to potential impact. Resource needs for Mauritania estimated at $15 20 M p.a., for Lao PDR at $25-30 M p.a RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 9

11 What makes this approach effective Solution driven: Starts and focuses on the child's needs versus agencies' mandates ffective Teamwork: Sets up working team of stakeholders with the government in the lead Fact driven and action oriented: Systematic situational and gap analysis, planning, implementation and monitoring Dedicated process facilitator: ncouraging and supporting coordination and joint teamwork Full-country perspective: Focuses on delivering at scale, starting by systematically identifying gaps Ambitious and aspirational: Aims for a step change, not incremental improvements Delivers as One: "ON UN" and government cooperation at all levels, exploiting synergies RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 10

First results already achieved at all levels In country: Operational improvements Funding: First

Clinton Foundation Program re-design based on district level activity mapping National: Government

in this approach" Finance Minister, Mauritania Regional Coordinator for West Africa The way forward:

12 First results already achieved at all levels In country: Operational improvements Funding: First resources mobilized Vit A Vit A Stopped double dosage of Vitamin A 1M deworming tablets secured via Clinton Foundation Program re-design based on district level activity mapping National: Government fully engaged 7,5 M over 3 years For Mauritania Regional: RACH hub created "We are willing to coinvest in this approach" Finance Minister, Mauritania Regional Coordinator for West Africa The way forward: Roll-out to further high undernutrition burdened countries RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 11

13 Summary of feedback from country mid-term visits From Mauritania and Lao PDR RACH process added value Common language and understanding of problem generated Synergies identified through joint planning Quick wins in the country showed practical value added of RACH Realization that RACH process applicable to many other development issues Independent and skilled facilitator appreciated Neutrality and location within the Resident Coordinator's office welcomed Interpersonal skills, diplomacy and structured process management a real plus Dedicated facilitator ensured ongoing intensive focus xplicit government support and involvement important success factor Long-term sustainability ensured by government involvement Governmental technical experts fully integrated Government buy-in and alignment along RACH promoted interventions made easier Standardized RACH approach valuable, tailoring to country needs also important Systematic approach provided fact-based, high-level view of current activities and gaps RACH stocktaking, analysis and planning of scale-up strategies helped clarify process Tailoring to specific country situation valuable RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 12

14 RACH is now entering the next stage of development Through onwards Lay the foundation stablish fully operational partnership Rollout broadly Define vision, strategy, and value added role Define set of interventions Test process in pilot countries Assemble first content and concept for knowledge dissemination stablish, communicate and launch Partnership Staff up RACH core team for continuity Bring pilot countries to full success through implementation Roll-out to additional 4-10 countries stablish funding support mechanism xtend RACH knowledge system Adapt governance mechanisms xtend partner base, e.g. private sector Broad roll-out process to further countries Fully operational knowledge sharing mechanisms Further partnership extension Continued progress and impact evaluation and improvement Committed and growing partnership Impact in selected countries Broad impact RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 13

15 RACH is about coordination to make a difference to this child RACH Briefing to the B of -29May09 -CP-BR.ppt RACH 14

Community Mobilization

Community Mobilization Objectives Target Group A capacity-building process through which community members, groups, or organizations plan, carry out, and evaluate activities on a participatory and sustained