Working to Improve Nutrition. in Northern Nigeria (WINNN)

UNICEF NIGERIA SC/110476 in Northern Nigeria (WINNN) ===================PROJECT SUPPORT SUMMARY Project Summary Project Title: Working to Improve Nutrition in Northern Nigeria (WINNN) Working to Improve Nutrition Report Donor Assisted Country Assisted Programme PBA Number : Seventh Progress and Utilization Update : The United Kingdom of Great Britain and Northern Ireland (DFID) : Nutrition : Nigeria : SC/2011/0476 Total Contribution : $38,419,895 Total Programmable Amount : $38,419,895 Fund Utilized during reporting period : $9,256,129 (20 August 2014 to 6 March 2015) Balance : $14,614,201 Project Period : October 2011 - September 2017 8 th Bi-annual Progress and Utilization Update to the United Kingdom Department for International Development Period Covered by the Report : October 2014 March 2015 Date Report Prepared : 12 March 2015 Project Summary Project Summary 1 April 2015 30 September 2015 1

Project Title: Working to Improve Nutrition in Northern Nigeria (WINNN) Report Donor Assisted Country Assisted Programme PBA Number : Eighth Progress and Utilization Update : The United Kingdom of Great Britain and Northern Ireland (DFID) : Nigeria : Nutrition : SC/2011/0476 Total Contribution : $38,641,491 Total Programmable Amount : $38,641,491 Fund Utilized during reporting period : $3,472,357 (1 April 2015 to 20 August 2015) Balance : $10,993,589 Project Period : October 2011 - September 2017 Period Covered by the Report : April 2015 September 2015 Date Report Prepared : September 2015 Photo on the cover page: Child getting screened for malnutrition in Zamfara (Source: UNICEF) 2

Table of Contents 1. Acronyms...4 2. Overview...5 3. Achievements...6 4. Key Challenges Faced During the Reporting Period... 12 5. Lessons Learned... 13 6. Plans for next six-months... 14 7. Expression of Thanks... 16 8. Financial Implementation (April 2015 to August 2015)... 17 Annex... 19 1a. Supplies procured during the reporting period (20 August 2014-6 March 2015)... 19 1b. Supplies for output 2 Infant and Young Child Feeding... 19 1c. Supplies for output 3 - Integration of Micronutrient Interventions into Routine Primary Health Services... 20 1d. Supplies for output 4 - Strengthening Political Commitment and Policy... 20 2. Donor Report Feedback Form... 21 3

1. Acronyms ACF BCC CMAM DFID FMoH HW IDS IEC IFPRI IYCF LGA LO-ORs MNCHW MNDC NBS NFN NPC NPHCDA ORIE ORS OTP RuTF SAM SC SCFN SCI SMART SPARC SNO SUN UK UNICEF WASH WFP WINNN Action Against Hunger Behaviour Change Communication Community-based Management of Acute Malnutrition Department for International Development Federal Ministry of Health Health Worker Institute of Development Studies Information, Education and Communication International Food Policy Research Institute Infant and Young Child Feeding Knowledge Attitude and Practices Local Government Area Low Oral Rehydration Salts Maternal New born and Child Health Week Micronutrient Deficiency Control Micronutrient Powder National Bureau of Statistics National Food and Nutrition Policy National Planning Commission National Primary Health Care Development Agency Operations Research and Impact Evaluation Oral Rehydration Solution Outpatient Therapeutic Program Ready to Use Therapeutic Food Severe Acute Malnutrition Stabilisation Center State Committee on Food and Nutrition Save the Children International Standardized Monitoring and Assessment of Relief and Transition State Partnerships for Accountability, Responsiveness and Capability State Nutrition Officer Scaling Up Nutrition United Kingdom United Nations Children s Fund Water, Sanitation and Hygiene Ward Focal Persons Working to Improve Nutrition in Northern Nigeria 4

2. Overview The Working to Improve Nutrition in Northern Nigeria (WINNN) programme aims to enhance nutritional status of children under five years old through delivery of nutrition interventions under the routine health services in five Northern States (Jigawa, Zamfara, Kebbi, Katsina and Yobe). This is a six-year initiative (Oct 2011- September 2017) with the collaboration of DFID (Department for International Development), Federal Ministry of Health (FMoH), Save the Children International (SCI), Action Against Hunger (ACF) and United Nations Children s Fund (UNICEF). The programme is now in its fourth year of implementation. The programme aims at contributing to the improvement of nutritional status of 11 million under five children in the five States. The Theory of Change used by WINNN is given below (Figure 1). Figure 1: WINNN Theory of Change The WINNN programme has four specific output areas, which are: Output 1: Integration of Micronutrient Intervention into Routine Primary Health Services; Output 2: Delivery of Effective Treatment for Severe Acute Malnutrition (SAM) through Local Health Systems in Selected States and Local Government Areas (LGAs); Output 3: Delivery of Effective Infant and Young Child Feeding (IYCF) Interventions in Selected States and Local Government Areas; and Output 4: Strengthening of Nutrition Coordination and Planning Mechanisms at National and State Levels. 5

In the first year, 2012, the programme was initiated in Jigawa and Zamfara States and in the second year, 2013, the programme was expanded to the remaining three States i.e., Kebbi, Katsina and Yobe. At present, while Maternal Newborn and Child Health Weeks (MNCHW) and diarrhoea treatment with zinc and Low Osmolarity Oral Rehydration Salts (LO-ORS) is a Statewide activity, Community based Management of Acute Malnutrition (CMAM) and IYCF activities are limited to only 3 LGAs per State. This is the eighth progress report to DFID on the implementation of the programme, specifically highlighting the key achievements, activities undertaken and fund utilised, for the period covering April 2015 to September 2015 and also for the four years of the project for key interventions. 3. Achievements This section provides a summary of key achievements against the outputs and the activities supported during the reporting period. Output 1: Integration of Micronutrient Interventions into Routine Primary Health Services The main objective of this output is to improve the quality of the biannual Maternal Newborn and Child Health Week (MNCHW) programme in the five States with focus on delivery of micronutrient interventions which is implemented state-wide. The primary target population for this output is children aged 6-59 months who receive Vitamin A supplements through MNCHW every six months. Table 1: Number of children reached with Vitamin A Supplementation States (October 2014 to March 2015) (April 2015 to Sept 2015) Average coverag e Total Target Reached percent Target Reached percent percent Reached Jigawa 1,014,769 932,012 92 1,014,769 861,337 85 88 1,793,349 Kastina 1,320,816 1,223,120 93 1,320,816 1,159,670 88 90 2,382,790 Kebbi 744,223 706,131 95 744,223 688,077 92 94 1,394,208 Yobe 372,168 275,465 74 372,168 520,374 140 107 795,839 Zamfara 720,652 688,456 96 720,652 636,292 88 92 1,324,748 Total 4,172,628 3,825,184 92 4,172,628 3,865,750 93 92 7,690,934 Source: NPHCDA August 2015 Report During the reporting period, despite the Presidential and State elections and inauguration of new States Government, all WINNN States carried out MNCHW campaign, between July and August. UNICEF and partners have had to advocate with the States to ensure the conduct of the campaign. 6

Overall, 3.8 million children were reached with Vitamin A in the five States through MNCHW, which covered 93 percent of the total target population. Overall, 7,690,934 children aged 6-59 months were supplemented with Vitamin A capsules within two rounds of MNCHW in Year 4 and the average coverage was 92 percent. In the WINNN log frame, 85 percent was set as the target coverage for Year 4. Another target under this output is the distribution of iron tablets to pregnant women during the MNCHW campaign. The overall target set for Year 4 is 1,451,381 pregnant women. In the MNCHW round (June 2015), 766, 347 pregnant women received iron supplements and in the previous 2014 Nov-Dec round 710,013 women were reached, therefore 1,476,360 pregnant women were reached through two rounds of campaigns. Therefore, the set target was reached and even surpassed in Year 4. Similarly, during the reporting period, additional 78,202 children were treated with Zinc/ORs (Jan-May 2015). Support was provided to National Primary Health Development Agency (NPHCDA) to coordinate and moblise the States to initate timely planning and preparation for the MNCHW campaign. National level planning and review meeting was organised at Abuja level, in which all WINNN States participated. During this meeting, a bottleneck analysis was conducted to identify key barriers to universal coverage of the key interventions; and the process underscorsed poor social mobilisation and late release of funds for implementation as key challenges and the below presented thematic approach was formulated. The Federal Government, States and stakeholders unaminously endorsed MNCHW monitoring using tablet as an external verification process for real time monitoring, reporting and response to timely corrective action. Figure 2: Thematic approach to strengthen MNCHW At the State level, UNICEF supported the WINNN States to implement the following critical activities under the minimum package of MNCHW: 7

Table 2: Activities implemented under the minimum package of MNCHW Activity Target Reached LGA planning meeting with WFPs WFP and LGA staff 1,712 on Microplan development Community engagement and Community leaders (5 per ward) 8,560 dialogue Promotion through town Town announcers (2 per ward) 3,424 announcers Planning meeting with health Health workers (4 HW per ward) 6,955 workers Monitoring and supervision in low One Federal Monitor and State officers 20 performing and hard to reach LGAs State level review planning meetings State staff and LGA Nutrition focal persons 214 Source: SC programme data A real time monitoring of MNCHW using SMART phone (tablet) was carried out by the Federal and independent State monitors in all States, which has provided valuable positive information as well as challenges with implementation. In the WINNN states, 383 health facilities from 341 wards in 74 LGAs were monitored via online real time monitoring system. In all the health facilities randomly visited, the campaign was taking place and more than 95 percent of the facilities have Vitamin A, deworming and iron tablets collectively. In almost 90 percent of sites monitored, health education was being provided to caregivers attending the campaign. Currently, an independent evaluation with support from UNICEF is ongoning to assess the impact and effectiveness of the campaign. Based on the findings of the evaluation, other reviews and bottleneck analysis strategies will be devised to improve the key elements of the campaign highlighted in Figure 2. UNICEF has also started working with the Government to develop social mobilisation strategy. Output 2: Delivery of Effective Treatment for Severe Acute Malnutrition (SAM) through local health systems in selected States and LGAs This output aims to enhance the treatment for severe acute malnutrition (SAM) through local health systems through community based management of acute malnutrition (CMAM). All five States have CMAM programme running in 45 health facilities (5 sites per LGAs). The overall target for the fourth year is to treat 20,000 severely malnourished children and the target for the cure rate is 75 percent. 8

Figure 3: Number of children with SAM admitted to CMAM program, Sept 2014 to May 2015 Since September 2014, a total 45,253 children have benefited from the treatment. Therefore, the performance exceeded the set target by 126 percent. While this is highly encouraging, there is a need to review the supply availability and understand the gap to continue to meet this increased admission. Overall, the treatment performance is good and continues to improve, with cure rate of 86 percent, death rate at 2 percent and defaulter rate at 10 percent. However, it is concerning that the default rate continues to remains very high in Katsina and Kebbi. Whereas in other States the rate is very low, particularly in Jigawa and Yobe. Table 3: CMAM performance indicators (Average for Sept 2014- May 2015) Indicator Jigawa Katsina Kebbi Yobe Zamfara Average Recovery rate 96 76 76 93 87 86 Death rate 1 4 2 1.3 2 2 Defaulting rate 2 17 16 6 9 10 Support to strengthen the CMAM activities has continued. Nutrition monthly meeting are taking place to collect and review data from the CMAM sites and address bottlenecks and challenges in the field. State staff, LGA nutrition focal persons and UNICEF technical staff have visited CMAM sites that were identified as poor preforming. Now in each WINNN State, nine consultants have been positioned and field monitoring and supportive supervision will be intensified. In Kebbi and Zamfara, retraining of health workers have also started in low preforming Outpatient Treatment sites. Supply status of key nutrition commodities at the State level and WINNN LGA warehouses have been tracked on a monthly basis, as a result there has not been any stock outs at the State level in the past six months. 9

In Jigawa and Yobe, advocacy efforts have been intensified-not only for resource allocation for Ready to use Ready to use Therapeutic Foods (RuTF) but also for States to recognise community volunteers and allocate resources to provide incentives to continue enhancing their commitment and motivation. For instance, Jigawa has organised an advocacy meeting at the state level to acknowledge community volunteers role in CMAM programme. Bicycles have been provided to the volunteers as a token of appreciation and this has also helped them with transportation. These activities have increased community identification of new SAM cases and follow up of children under treatment and thus has resulted in low default rate. Both States have started allocation of funds for RuTF. Output 3: Delivery of IYCF promotion in selected States and LGAs This output aims to improve infant and young child feeding (IYCF) practices, particularly exclusive breastfeeding and 6-23 months children receiving minimum acceptable diet. In total, there are 218 health facilities and 716 IYCF active groups through which IYCF is being promoted in the 15 WINNN LGAs. The process indicator for this output is number of pregnant women and mothers of children <24 months reached through counselling on appropriate IYCF in the target LGAs. The target for the Year 4 is 106,581 women. In the last reporting period, 112,102 women have been reached with IYCF counselling and during this reporting period additional 49,957 women were reached. Therefore a total of 162,059 have been reached so far in year 4 and an additional 55,478 women were counselled compared to the set target for the Year 4. This is almost three times more women reached compared to the last reporting period. In the past couple of months, the focus has been on routine programme monitoring of IYCF programme implementation at community level and facility level. The monitoring reports shows that IYCF counselling of caregivers is taking place at two levels-health facilities and support groups. However, the key challenges include poor quality of counselling and inadequate health workers to carry Figure 4: Number of mothers reached with IYCF counselling out counselling. During the reporting period, the States partners were also trained on Communication for Development (C4D) approach, and these cohort of trainers have also been mobilised as monitors and have provided coaching to health workers and community volunteers during supportive supervision Kastina Zamfara Kebbi Jigawa Yobe Promotion of locally available complementary foods with food demonstration has been scaled up in 15 WINNN LGAs. A IYCF formative research was conducted in Kebbi in which information on food type and frequency were also collected. 10

The study which also carried out full day direct observations in 42 households found the main foods being consumed by young children aged 6 23 months are breastmilk and cereal-based staples, either kunu (cereal-based, watery or semi-solid porridge) or tuwo (boiled and cerealbased, solid staple food). Very few children were consuming leafy green vegetables and almost no animal-sources such as liver, eggs, or fish. The underlying factor for not feeding was not lack of knowledge but economic reasons. Therefore, there is a strong realisation that simply promoting high energy and micronutrient dense complementary foods will not work for the majority, and particularly the poorest of the poor who are more likely to have malnourished children. Thus, this warrants a need to introduce Micronutrient Powders to enhance the quality of complementary feeding. During the direct observation, hardly any mothers washed hands prior to feeding/eating episodes. Output 4: Strengthening of Nutrition Coordination and Planning Mechanisms at National and State Level The objective of this output is to provide technical support to enhance institutional framework and capacity for improved coordination and planning mechanisms at national, State and LGA levels to scale up effectively nutrition interventions and sustain them with a strong policy environment, Government ownership and resources. UNICEF continued its engagement with the Government, donors, and partners to promote nutrition as an overall development agenda and for resource mobilisation. The Federal Ministry of Health (FMoH) has officially released the costed Health Sector Component of National Food and Nutrition Policy; National Strategic Plan of Action for Nutrition (2014 2019). Furthermore, the revised NSPAN has been forwarded to the Cabinet for official approval. Table 4: Financial Contribution from States In addition, technical and financial support was provided to the Government to review and finalise the national protocol on treatment of severely malnourished children with medical complications through in patient/ stabilisation centers (SC). As part of capacity building efforts, UNICEF supported participation of the Federal and State authorities to attend Transforming Nutrition: Ideas, Policy and Outcomes organized by the Institute of Development Studies (IDS) and International Food Policy Research Institute (IFPRI). Joint monitoring visits have been organised. The Federal partners (FMoH, NPHCDA and National Population Council (NPC)) also participated in the MNCHW monitoring exercise in the November-December 2014 and July August 2015 rounds and another visit to WINNN States to monitor activities related to other outputs and review implementation. 11

% of LGAs WINNN funds were also used to organise CMAM, IYCF and Micronutrient Deficiency Control (MNDC) taskforce meetings to coordinate ongoing efforts by different stakeholders. The State Food and Nutrition Committee (SCFN) meetings has been organised in most of the States. With the new Government in place in many States, UNICEF has stepped up advocacy effort at the State level, including advocacy visit with the Governors to further increase the Government s contribution for children and women, including for nutrition. A tool to track State Government commitments, allocation and release has been developed. It is highly encouraging that US$1.7 million of US $2.1 million allocated by the eleven northern state governments is from five WINNN states. The aim now is to increase the Government contribution at the State level by at least one third, i.e., from US$ 1.7 million to $ 2.2 million in this fiscal year. UNICEF is also supporting National Bureau of Statistics (NBS) to conduct the national SMART survey using tablets in all 36+1 States, which WINNN is also contributing to. The field data collection started in July and will be completed by the end of September 2015. The survey has been recognised as a national monitoring tool to track progress towards Government s Saving One Million life Initiative. The result from the survey will also be used as a basis for the US$500 million World Bank supported Performance for Results project to decide the amount of fund to be disbursed to states Vitamin A supplementation coverage is one of the performance indicators that is linked to fund allocation to states. 4. Key Challenges Faced During the Reporting Period The elections and post-election Government s transition processes impacted negatively on timely implementation of activities between Figure 5: Timely fund release to LGAs for MNCHW March and June 2015. (Source: SMART tablet Monitoring-Nov Round) However, the implementation pace has 80 picked up and as 60 highlighted in the previous section of the 40 report, the set targets 20 for the outputs for the 0 Year has been met. LGAs from WINNN States LGAs from non WINNN States Delay and inadequate release of funds by States remains a key challenge and bottleneck for effective implementation of MNCHW. As per the external monitoring of MNCHW with SMART tablet, only 58 percent of LGAs in WINNN States received funds on time to implement the campaign. Apart from advocating for increased Government contribution, there is also a need to start the planning process early, at least three months before the campaign. 12

5. Lessons Learned The CMAM programme has been used as an entry point to the integration of nutrition in child survival and development programmes (Health, Water Sanitation and Hygiene (WASH), Child Protection, Nutrition and Education). This has increased demand for other health services such as acceptance of polio vaccination in hard to reach communities. Furthermore, regarding Value for Money, there has been significant saving on the procurements. $1.4 million saving only on RuTF in the past three years. Both Federal and State Government partners have highly appreciated WINNN support to build the Government s capacity to use innovation such as real time monitoring of MNCHW using SMART phones which has increased the effectiveness, efficiency and accountability of MNHCW monitoring and has allowed timely information sharing with States to address supply shortages during the campaign. This nature of real time monitoring and reporting to States to take immediate corrective action during the campaign has not happened ever in the past. In total, 74 LGAs, 341 Wards, 383 Health Facilities in WINNN States were visited by the Federal, zonal and State monitors. The NPHCDA endorsed this monitoring exercise as national external monitoring process for MNCHW and for the June round and the monitoring was scaled up the exercise in all 37 States. This is another example of an approach introduced and piloted in WINNN States influencing national policy change in other States beyond WINNN. Figure 6: Location of health facilities monitored with SMART phone in the 5 WINN states during MNCHW 13

6. Plans for next six-months Output 1: Integration of Micronutrient Interventions into Routine PHC Services The NPHCDA and the WINNN States will be supported to plan early for MNCHW and facilitate timely and adequate fund release from the States. A comprehensive report from online monitoring of MNCHW will be produced and used as a basis for discussion during planning of next round of MNCHW. UNICEF will also support the States to mobilise funds from the World Bank s Performance Based Funding (PBF) project. A high level advocacy event with the Permanent Secretaries and Health Commissioners will be organised to advocate for adequate and predictable financing for MNCHW. Based on the findings of the external MNCHW monitoring, a score card for each State will be generated and disseminated. Effectiveness of MNCHW monitoring using SMART tablet will be documented. Based on the ORIE s OR on MNCHW, other research and reviews, social mobilisation strategy will be developed to increase awareness and participation of caregivers. The strategy will also include strong M&E component to monitor and measure the acceptance and participation of caregivers in the campaign and also assess the effectiveness of the interventions. Zinc/ORS and iron supplementation is now being implemented as a routine (beyond MNCHW) activity in health facility and has been rolled out beyond WINNN LGAs. A review will be carried out to assess the implementation of Zinc/ORS treatment in WINNN States. An analysis is also ongoing to ascertain if the funds allocated by DFID is adequate to supply Zinc/ ORS and iron supplements for State wide implementation. Output 2: Delivery of Effective Treatment for Severe Acute Malnutrition In order to further increase the Government s contribution, particularly for RUTF, UNICEF will intensify advocacy at Federal and State levels. Another area of focus is addressing high defaulting rate in Kastina and Kebbi. Community sensitisation/ mobilisation activities will be carried out in catchment areas with high defaulting rate. In low performing LGAs/CMAM sites, supportive supervision and refresher training will be organised. Technical support will be provided to conduct monthly CMAM monthly meeting. In the next couple of months priority is to strengthen supply logistics management and reporting. All health facilities that are implementing CMAM program will be monitored using online realtime monitoring system using SMART phone to strengthen the monitoring and support for the program. The monitoring will help understand the program better both from supply and program side and used as a verification to what has been reported by health workers before. This will help States to take corrective action required on time. All CMAM health facilities will be supplied with Information, Education and Communication (IEC) materials, including on IYCF and WASH, in respect with UNICEF converging strategy. Also supplies such as soaps and utilities for hand washing will be provided. Support will also be provided to ensure each health facility meets minimum WASH operating standard. 14

Output 3: Delivery of Effective Infant and Young Child Feeding Interventions A significant number of mothers are being reached with IYCF promotion, however there is a need to ascertain the quality of promotion/ counselling. An assessment is planned to assess the quality of IYCF counselling both at health facility and community levels and functionality of the support groups. The health facilities and support groups providing IYCF counselling will also be mapped to determine the accessibility for caregivers. Effectiveness of food demonstration and complementary recipes will also be assessed. Existing training manuals and promotional materials will also be reviewed. The WINNN partners are engaging with ORIE to conduct an operational research to understand barrier to key IYCF practices. For each WINNN LGA, C4D framework on IYCF has also been developed, which has identified context specific issues that need to be addressed to create enabling environment to promote optimum IYCF practices. Based on these work, a Behaviour Change Communication (BCC) strategy will be developed and implemented. As part of the strategy, communication/social mobilisation approach will be devised to reach adolescents and also to mobilise as community advocates. Approaches and tools will also be developed to engage with religious leaders, men, grandmothers and youths. To complement community approach, comprehensive media campaign and IEC merchandising will be carried out. SMS platform such as U report will also be utilised to promote key IYCF messages and to also capture public knowledge and perception about IYCF through SMS polls. The Health workers and caregivers will also be able also interact and ask questions regarding nutrition through U report platform. Output 4: Strengthening of Nutrition Coordination and Planning Mechanisms The key strategic shift and priority for the next six months is intensify advocacy with an aim to increase the State Government contribution in WINNN States by at least one third compared to last year, i.e., bringing the total to US$ 2.2 million. A national advocacy strategy, with common vision for collective action and owned by all partners and donors will be developed to support activities at the Federal and State levels in a systematic and coordinated manner. To enhance harmonization, synergy and coherence, monthly advocacy coordination meetings will be organised with nutrition stakeholders. Support will also be provided to build a worth of knowledge, promote learning and track advocacy results. Needs assessment and capacity gap will be carried out and NPC, FMoH and State partners (inccluding the State Committees) will be supported to strengthen their capacity to coordinate and implement advocacy activities. At the State level, support will be provided to develop five- year state strategic plans in line with the National Food and Nutrition (NFN) Policy. Financial tracking of State s commitment, allocation and release will be tracked. To ensure budget allocation and release, WINNN will work closely with governance programme such as State Partnerships for Accountability, Responsiveness and Capability (SPARC). UNICEF will also support various advocacy activities at the State level -media campaigns, engagement with civil societies and other strategic consultations. Nutrition champions at both state and federal levels will be identified and mobilised. 15

7. Expression of Thanks On behalf of the children of Nigeria, UNICEF would like to thank DFID for all past and current contributions, including this generous contribution, while looking forward to continued support from the donor. This grant has made it possible to provide critical inputs to meet major funding gaps to continue treatment of severely malnourished children, provide lifesaving vitamin A capsules, deworming tablets to children below five years and promote infant and young child feeding. It has also made it possible for UNICEF to provide the much needed technical assistance and advocacy with Government at National and State levels for improved policy framework and Government ownership for scaling up nutrition, overall for the ultimate benefit of the Nigerian children and women. 16

8. Financial Implementation (April 2015 to August 2015) Input Type Requisition Description Expenditure from 1 April 2015-18 August 2015 in US$ Output 1 - Management of Severe Malnutrition DCT, Direct Payment & Reimbursement to Implementing Partners Travel Supply National Nutrition and Health Survey using SMART methods, Training of Government Officials, Real time monitoring of CMAM etc. Supportive monitoring & supervision of CMAM activities etc. Procurement of CMAM supplies, Haulage & Distribution etc. 409,378.25 23,734.78 1,140,221.36 Services CMAM Nutrition Consultants 75,805.19 Staff Cost Staff and other personnel costs 832,184.91 Direct Charge & Other Direct Costs Direct Charge & Other Direct Costs 44,905.08 Total 2,526,229.57 Output 2 Infant and Young Child Feeding DCT, Direct Payment & Reimbursement to Implementing Partners WINNN Mtg & IYCF Master Trainers Mtg; World Breastfeeding Week etc. 57,660.31 Travel Monitoring of IYCF 17,986.83 Supply - Services - Staff Cost Staff and other personnel costs 123,004.25 Direct Charge & Other Direct Costs Direct Charge & Other Direct Costs (1,250.00) Total 197,401.39 Output 3 - Micronutrient Deficiency Control DCT, Direct Payment & Reimbursement to Implementing Partners 2015 May/June MNCHW Plg & Trg of Moni 531,590.82 Travel Joint Nutrition Programme Monitoring 17,267.07 Supply - Services Consultancy for IYCF formative research 9,938.00 Staff Cost Staff and other personnel costs 152,775.96 17

Direct Charge & Other Direct Costs Total General operating and other direct costs 82.15 711,654.00 Output 4 - Nutrition Policy Support DCT, Direct Payment & Reimbursement to Implementing Partners Nut work plan dissemination & ops strategy devpt mtg 7,541.90 Travel Participate in Regional Nutrition Network mtg; Quarterly review, WINNN Annual Workplan Development etc. 29,383.97 Supply - Services - Staff Cost - Direct Charge & Other Direct Costs General operating and other direct costs 146.34 Total 37,072.21 SUMMARY Total Contribution to date (Sept 2011-August 2014) 38,641,491 Expenditure (Sept 2011- March 2015) 24,175,544 Expenditures (1 April 2015-18 August 2015) 3,472,357 PBA Balance 10,993,589 PBA Expiry Date 30-Sep-17 18

Annexe 1a. Supplies procured during the reporting period (20 August 2014-6 March 2015) Output S/NO Cat. No. Item Description Quantity Unit Output 1 CMAM SO 20159152 1 S0000240 Therapeutic spread,sachet 92g/CAR-150 43,500 Cartons 2 S0000208 F-75 therap. diet,sachet,102.5g/car-120 40 Cartons 3 S0000209 F-100 therap. diet,sachet,114g/car-90 35 Cartons 4 S1555370 5 S1505046 Albendazole 400mg chewable tabs/pac- 100 Amoxici.pdr/oral sus 125mg/5ml/BOT- 100ml 2,998 PAC 2,900 BOT 6 S1561125 ReSoMal, 42g sachet for 1 litre/car-100 40 Cartons SO 20153856 U320000 Admission and f/up cards 120,000 EA SO 20155161 SO 20159678 U320000 OTP Ration cards 120,000 EA 1 U458000 Procurement of ARCGIS 10.2 Software 45 Each 1 U458000 Procurement of Tableau Software 10 Each 1b. Supplies for output 2 Infant and Young Child Feeding Output S/NO Cat. No. Item Description Quantity Unit SO 20155076 Output 2 IYCF U320000 C-IYCF Counselling card (English) 1,000 EA U320000 C-IYCF Participant Material 500 EA U320000 C-IYCF Facilitator's Guide 500 EA U320000 C-IYCF Key messages Nigeria (English) 1000 EA U320000 C-IYCF Training Aids 1,000 EA U320000 Brochure: Material Nutrition (English) 4,000 EA U320000 Brochure: How to feed a baby after 6 mon 4,000 EA U320000 Brochure: How to breastfeed your baby (E 4,000 EA U320000 C-IYCF Facilitator's Guide 200 EA 19

1c. Supplies for output 3 - Integration of Micronutrient Interventions into Routine Primary Health Services Output S/NO Cat. No. Item Description Quantity Unit SO 20158179 1 U458000 SO 20151497 1 S1555370 2 S1550025 Output 3 IYCF Procurement of Samsung Galaxy for Monitoring Albendazole 400mg chewable tabs/pac- 100 Fe (as fum.) + folic 60+0.4mg tab/pac- 1000 40 Each 68,000 PAC 200,000 PAC 3 S1580020 Zinc 20mg tablets/pac-100 70,000 PAC 4 S1561121 ORS low osm. 20.5g/1L CAR/10x100 6,000 Cartons 5 S1505046 Amoxici.pdr/oral sus 125mg/5ml/BOT- 100ml 2,900 Cartons SO 20153656 1 U320000 National Micronutrient Guidelines 20,000 Each 1d. Supplies for output 4 - Strengthening Political Commitment and Policy Output S/NO Cat. No. Item Description Quantity Unit Output 4 IYCF SO 20155674 1 U458000 SMART Survey Preliminary Report 10,000 Each 20

2. Donor Report Feedback Form Country Nigeria Project Title Working to Improve Nutrition in Northern Nigeria (WINNN) Donor DFID Grant Number SC/110476 Duration April 2014-September 2015 Donor Report Feedback Form UNICEF is working to improve the quality of our reports and would highly appreciate your feedback. Kindly answer the questions below for the above-mentioned report and return to UNICEF by email to: Name: Samuel Momanyi Email: smomanyi@unicef.org SCORING: 5 indicates highest level of satisfaction while 0 indicates complete dissatisfaction *** 1. To what extent did the narrative content of the report conform to your reporting expectations? (For example, the overall analysis and identification of challenges and solutions) 5 4 3 2 1 0 If you have not been fully satisfied, could you please tell us what did we miss or what could we do better next time? 2. To what extent did the fund utilization part of the report meet your reporting expectations? 5 4 3 2 1 0 If you have not been fully satisfied, could you please tell us what did we miss or what could we do better next time? 21

3. To what extent does the report meet your expectations in regard to the analysis provided, including identification of difficulties and shortcomings as well as remedies to these? 5 4 3 2 1 0 If you have not been fully satisfied, could you please tell us what could we do better next time? 4. To what extent does the report meet your expectations with regard to reporting on results? 5 4 3 2 1 0 If you have not been fully satisfied, could you please tell us what did we miss or what could we do better next time? 5. Please provide us with your suggestions on how this report could be improved to meet your expectations. 6. Are there any other comments that you would like to share with us? 22