National Nutrition Strategy to 2025 and Plan of Action 2016-2020

i Lao People’s Democratic Republic Peace Independence Democracy Unity Prosperity National Nutrition Strategy to 2025 and Plan of Action 2016-2020 December 2015 ii A prosperous country, with a healthy population, free from food insecurity, malnutrition and poverty. iii Foreword This 2016-2020 National Nutrition Strategy (NNS) has been improved based on the experiences, opportunities, obligations, and important participation of multiple domestic sectors and development partners and thanks to international interest in providing support and acts as means of adopting the policies and strategies of the long-term National Socio-Economic Development Plan (NSEDP) of the government of the Lao PDR. This NNS is a tool for all sectors related to nutrition and food security (NFS) and is to be used over a ten-year timeframe up until 2025. The National Plan of Action on Nutrition (NPAN) is to run for a five-year period and emphasizes the same kinds of implementation – using a multi-sectoral convergent approach with common focus points, common goals, and common timeframes while boosting resources and increasing support from development partners and the relevant stakeholders to the greatest extent possible to reduce all forms of malnutrition among women, children and disadvantaged groups, to achieve success, and meet the set targets. This NNS shows the necessity for and sincere efforts made by the government towards nutrition and I am absolutely confident that all the relevant sectors, development partners, and stakeholders will provide support for the adoption of this strategy to bring about positive changes with respect to nutrition in the Lao PDR. Vientiane Capital, 28 December 2015 Deputy Prime Minister in Charge of Social and Cultural Affairs Chair of the National Nutrition Committee [SEAL OF THE PRIME MINISTER OF THE LAO PDR AND SIGNATURE] Phankham VIPHAVANH iv Foreword Under the leadership of the Lao People’s Revolutionary Party (LPRP), the government of the Lao PDR has laid out the National Nutrition Policy (NNP) to promote nutrition with a focus on reducing undernutrition at a basic level among – for example – women and children and disadvantaged groups and to specify directions for nutrition to be included in the National Socio-Economic Development Plan (NSEDP) while working alongside the implementation of the National Growth and Poverty Eradication Strategy (NGPES). The timeframe for the Millennium Development Goals (MDGs) has now reached its final period but reducing malnutrition remains one of three challenging targets and will not be achieved in the Lao PDR in accordance with the MDGs. The challenges which have yet to be overcome and other problems of the world have been included in the Sustainable Development Goals (SDGs). This National Nutrition Strategy and Plan of Action (NNSPA) has been created with the aim of achieving SDG 2 – “End hunger, achieve food security and improved nutrition and promote sustainable agriculture” and also to contribute towards achieving the targets of the 8 th Five-Year NSEDP of the government of the Lao PDR (GoL). This 2016-2025 National Nutrition Strategy and 2016-2020 Plan of Action has been amended based on a full analysis of the nutrition situation in the Lao PDR and focuses on the immediate, underlying, and basic causes and on a multi-sectoral convergent approach with common focus points, common goals, and common timeframes while also seeking to raise support from our development partners and other relevant stakeholders so that malnutrition, especially among women and children and disadvantaged groups, may be reduced in the Lao PDR. I, on behalf of the health sector and as the main person in charge of improving this strategy, wish to express my profound gratitude to the Chair of the National Nutrition Committee (NNC) and the leaders of the relevant sectors, whose guidance and leadership have resulted in the high level of responsibility being applied to the amendment of this strategy. I wish to offer my praise and gratitude to the NNC Secretariat, the various sectors involved, our development partners, both domestic and international, and all of you who have made sacrifices and given up your valuable time to contribute to making this NNS a great success. It is my fervent hope that this NNS will be of benefit to implementation and be adopted into the work of each stakeholder in practice within their respective scopes of responsibility with a focus on resolving nutrition problems in the Lao PDR so that results are achieved in real terms. Furthermore, if any of you have any additional opinions on this strategy, we would be pleased to hear all that you have to say. Vientiane Capital, 28 December 2015 Minister of Health [SEAL OF THE MINISTER OF HEALTH AND SIGNATURE] Prof. Dr Eksavang Vongvichit v Acknowledgment of Gratitude The Secretariat to the National Nutrition Committee (NNC) wishes to express its gratitude to all of you from the health, agriculture and forestry, education and sports, planning and investment, and rural development and poverty eradication sectors, other relevant sectors, all levels of local government bodies, and organizations and development parties who have – both intellectually and in terms of your hard work – gone to such great efforts in the development of the National Nutrition Strategy to 2025 and Plan of Action to 2016 (NNSPA), listed as follows: Government sector Dr. Phankham Vilavanh, Deputy Prime Minister, leader of socio-economic development, Minister of Education and Sports, and NNC Chair Prof. Dr. Eksavang Vongvichit, Minister of Health and NNC Vice Chair Dr. Inlavanh Keobounphanh, Deputy Minister of Health and Director of the NNC Secretariat Dr. Phouangparisak Pravongviengkham, Deputy Minister of Agriculture and Forestry and Deputy Director of the NNC Secretariat Mr. Litou Bouapao, Deputy Minister of Education and Sports and Deputy Director of the NNC Secretariat Dr. Kikeo Chanthabouly, Deputy Minister of Planning and Investment and Deputy Director of the NNC Secretariat Dr. Thongvanh Vilayheuang, Vice Chair of the National Committee for Rural Development and Poverty Eradication and ordinary member of the NNC Team from the Ministry of Health: Dr. Phath Keungxaneth, Dr. Chandavone Phoxay, Dr. Kaysone Choumlamany, Dr. Phasouk Vongvichit, Dr. Somchanh Xaysida, Dr. Bouthavong Phengsisomboune, Dr. Sivong Sengaloundeth, Dr. Phisith Phoutsavath, Dr. Bounthom Phengdy, Dr. Soutsakhone Chanthaphone, Dr. Khamseng Philavong, Dr. Latthiphone Oula, Dr. Kopkeo Souphanthong, Dr. Souvankham Phommaseng, Mr. Maikho Vongxay, and Dr. Khouanheuane Semgkhamyong Team from the Ministry of Agriculture and Forestry: Mr. Savanh Hanphom and Ms. Phimmasone Xaymonty Team from the Ministry of Planning and Investment: Ms. Sisomboune Anouvong and Mr. Molakot Vongxay Team from the Ministry of Education and Sports: Ms. Yangxia Lee and Ms. Soutthasone Manivong Team from the National Committee for Rural Development and Poverty Eradication: Dr. Bounkwang Souvannaphanh, and Mr. Kingkeo Sengsouvanh Development partners Dr. Viorica Berdaga, Dr. Stephen Rudgard, Mr. Koen Everaert, Dr. Dorothy Foote, Dr. Intong Keomoungkhoune, Dr. Uma Palaniappan, Ms. Nova Deleon David, Mr. Mike Adair, Mr. Solal Lehec, Ms. Aachal Chand, Dr. Jun Gao, Dr. Katrin Engelhard, Khounphet Mongkhongkham, UNICEF, EU, FAO, WFP, the UN network, MQSUN, SUN-CSA, WHO, and other development partners Vientiane Capital, 28 December 2015 Director of the NNC Secretariat [SIGNATURE] Dr. Inlavanh Keobounphanh vi Contents Brief Summary 5 Part 1 8 Preamble 8 Part 2 10 Nutrition and Food Situation in the Lao PDR 10 2.1 Current status 10 2.2 Causes of malnutrition and food insecurity 10 2.2.1 Immediate causes 11 2.2.2 Underlying causes 12 2.2.3 Basic causes 13 Part 3 15 Vision, Mission, Overall Goal, and Guiding Principles 15 3.1 Vision 15 3.2 Mission 15 3.3 Overall goal 15 3.4 Guiding principles 16 3.4.1 Define a realistic strategy 16 3.4.2 Support effective management 16 3.4.3 Achieve measurable outcomes for each period 16 3.4.4 Ensure efficient and effective implementation 17 3.4.5 Gender roles 17 Part 4 18 Core Strategies and Priority Areas of Intervention 18 4.1 Strategic Direction 1: Address immediate causes 21 4.2 Strategic Direction 2: Address underlying causes 21 4.2.1 SO3: Produce food so that it is available for consumption 22 4.2.2 SO4: Improve access to nutritious food 22 4.2.3 SO5: Improve mother and child care practices 22 4.2.4 SO6: Improve clean water [systems and practices], sanitation, and Environments 22 4.2.5 SO7: Improve access to health services 22 4.3 Strategic Direction 3: Address basic causes 23 4.3.1 SO8: Improve institutions and coordination 23 4.3.2 SO9: Improve human capacities 23 4.3.3 SO10: Improve the quantity and quality of information 24 4.3.4 SO11: Increase investments in nutrition 24 4.4 Strategic Direction 4: Linkages 24 Part 5 25 Capital Mobilization, Implementation, and M&E 25 5.1 Capital Mobilization 25 5.2 Implementation 25 5.2.1 Management structure 26 5.2.2 Implementation methods 27 5.3 M&E 27 References 28 Appendices 29 Ministries and organizations which participated in forming the national policies and NNSPA (in alphabetical order) 30 Acronyms 31 Plan of action 73 vii Global Nutrition Report 2014 “GOOD NUTRITION IS THE BEDROCK OF HUMAN WELL-BEING. Before birth and throughout infancy, good nutrition allows brain functioning to evolve without impairment and immune systems to develop more robustly. For young children, good nutrition status averts death and equips the body to grow and develop to its full potential. Over the course of the human lifespan, it leads to more effective learning at school, better-nourished mothers who give birth to better-nourished children and adults who are likelier to be productive and earn higher wages. In middle age, it gives people metabolisms that are better prepared to ward off the diseases associated with changes in diet and physical activity. Without good nutrition, people’s lives and livelihoods are built on quicksand.” International Food Policy Research Institute. 2014. Global Nutrition Report 2014: Actions and Accountability to Accelerate the World’s Progress on Nutrition. Washington, DC. viii Brief Summary Despite impressive gains in economic growth over the past decade, the Lao PDR (LPDR) has one of the highest rates of chronic malnutrition in Southeast Asia. According to the most recent data, approximately 44% 1 of children under the age of five years (CU5s) suffer from chronic malnutrition and stunting 1 . There has nevertheless been a small amount of progress just as there has been with other Millennium Development Goal (MDG) indicators. This undernutrition threatens lives and national socio-economic development and is associated with reduced school enrolment, poses a challenge to the attainment of education targets, and has an impact on development, which is set to lead to a future productivity deficit of more than 20% 2 . Child malnutrition (including fetal malnutrition caused by maternal malnutrition) was the cause of 45% of global child deaths in 2011 3 . The promotion of nutrition is therefore an urgent priority for development in the LPDR. Reduction of malnutrition is one of three challenging MDG targets and is seriously off track in the LPDR. As we are all aware, the MDG timeframe is in its final stages and unmet and ongoing challenges worldwide have been encapsulated in 17 Sustainable Development Goals (SDGs) that build on the foundation laid by the MDGs 4 . This National Nutrition Strategy and Plan of Action (NNSPA) first and foremost seeks to achieve SDG 2 “End hunger, achieve food security and improved nutrition and promote sustainable agriculture,” and contributes directly to several others. It is increasingly clear that SDG 2 – as well as various other SDGs – will not be achieved without decisive and integrated action among all stakeholders in the LPDR. In order to respond to this high level of malnutrition, the Government of the LPDR (GoL) promulgated the first National Nutrition Policy (NNP) in December 2008 5 . Based on this policy, the 2010-2015 NNSPA was formulated and promulgated by the GoL 6 . Although the first NNSPA covered what was needed in detail and in full, its implementation was difficult due to the absence of coordination mechanisms and its adoption and monitoring within the various sectors. Another major limitation on the implementation of this NNSPA resulted from limited budgets to support direct nutrition interventions and promote indirect nutrition interventions. Limited and declining direct assistance for nutrition interventions, mainly implemented by the health sector, was another factor explaining the low coverage of these important interventions for nutrition, especially interventions associated with the first 1,000 days of life, something which is important for the world to approve as interventions to promote the Scaling Up Nutrition (SUN) movement. To begin to remedy this, the National Nutrition Committee (NNC) was created on 31 July 2013 with the mandate to provide the necessary overall leadership and guidance for the coordination of the NNSPA for the relevant sectors at all levels in order that the targets may be achieved. This 2016-2020 National Nutrition Strategy (NNS) builds on the above mentioned experiences and opportunities and receives important commitment and participation from many domestic sectors and development partners along with international interest and support while also reflecting the GoL policy for long-term strategic time frames. This NNSPA is therefore presented as a guideline for all sectors associated ix with nutrition and food security (NFS) with a 10 year horizon to 2025 in the LPDR. It forms the basis for implementing food security and nutrition interventions and is to operate in association with the National Socio-Economic Development Strategy (NSEDS) to 2020. This national nutrition strategy 6 has a 5 year horizon and aims to contribute to the adoption of the 8 th 5-year National Socio-Economic Development Plan (NSEDP) and has been improved and put together based on comprehensive analysis into malnutrition in the LPDR, which places strong emphasis on the immediate, underlying, and basic causes. Strategic directions and objectives To tackle the immediate causes at the level of the individual and focus on achieving sufficient food consumption and safety, emphasizing the first 1,000 days of life and reducing the prevalence of diseases caused by contaminated food and indirectly transmitted infectious diseases which impair the body’s ability to absorb food consumed; and To tackle the underlying causes (mostly at household and community levels), which requires improvements to the safety and diversity of food consumed so that people may have access to food at all times and locations, and moreover, to focus on improving maternal and child health (MCH) practices, clean water [systems and/or practices], and sanitation and [on providing] healthy environments and access to health services. The strategies aimed at tackling the fundamental causes (mostly at institutional and national level) have been specified to comprise capacity building at institutional level and improving coordination, human resource development, the quantitative and qualitative improvement of information, promotion for investment into nutrition interventions, and increased food security. These strategies also emphasize the socio culturally embedded causes of malnutrition and specify interventions which relate to many areas and the creation of broader national strategies in order to focus on ensuring rights and equality concerning access to nutritional natural resources. These strategies also explain the necessary and related policies of each sector which affects malnutrition. The NNS includes broad, deep, and complete content aimed at supporting the attainment of the GoL socio-economic development targets and the SDGs. This amended strategy embodies a multi-sectoral convergent approach designed to accelerate the reduction of maternal and child malnutrition and to prevent the advancing trend towards overnutrition. The main goal of this multi-sectoral convergent approach is to reduce CU5 chronic malnutrition (stunting) from 44% to 25% in 2025. The NNS is also consistent with the global nutrition targets and SDGs in that it aims to reduce the prevalence of underweight children, sudden malnutrition (wasting), and anemia, to prevent overnutrition, and to promote breastfeeding (Table 1). Attaining the strategy’s objectives will require management and administration systems, coordination mechanisms, and cooperation, communication, collaboration, and partnership between many relevant sectors along with development partners, including donors, international bodies, and the private sector so as to achieve x efficiency and effectiveness at all levels. One of these national strategies is to promote community-based nutrition (CBN) and food security and to increase the level of support from the GoL and development partners, including the private sector, social organizations, and other bodies. This strategy emphasizes multi-sectoral unity with common efforts, goals, and timeframes with 22 common priority interventions to be implemented in areas with high malnutrition rates and numbers, areas of food insecurity, poor localities, and GoL priority focus points with a focus on tackling nutrition problems rapidly and in a sustainable manner through the involvement of multiple sectors while improving existing NFS services and interventions nationwide. Mobilizing support from development partners and the relevant stakeholders also requires focus on expanding resources and increasing the support of development partners to the extent possible in order to succeed and achieve these benefits together. This NNS has been approved by all the relevant ministries and the main development partners and demonstrates the necessity of the sincere efforts being made by the GoL in the implementation and adoption of the NNP and its firm commitment towards the implementation of this strategy so that it leads to improvements in NFS in the Lao PDR. 1 Part 1 Preamble The current CU5 malnutrition profile in the LPDR is dominated by undernutrition as measured by the rates of chronic malnutrition, underweight children, micronutrient deficiencies and low-birth weights 1 , the rates of chronic malnutrition or stunting being particularly high. Child malnutrition (including fetal malnutrition caused by maternal malnutrition) was the cause of 45% of global child deaths in 2011 3 . It is estimated that in the LPDR, 17,300 CU5s die annually, the deaths of whom 6,016 15 (40%) are related to malnutrition. Malnutrition is responsible for the disabilities of 50% of disabled children under the age of four years worldwide 7 . Chronic malnutrition (stunting) is closely related to low education levels and incomes when reaching adulthood. Malnutrition leads to increased expenses owing to the fact that it results in frequent sickness. Moreover, it leads to lower future national revenues. In the LPDR, malnutrition costs the country an estimated 197 million US dollars annually, approximately 2.4% of gross domestic product (GDP) 8 . 73% of these losses, equal to 142 million US dollars come as a result of malnutrition during the first 1,000 days of life while a third, equal to 38 million US dollars, are related to maternal nutritional status and the roles mothers play in looking after their children. Good nutrition is central to promoting the health of the multiethnic people so they may contribute to national construction and development and sustainable development on a global level. GoL response to malnutrition In response to the problem of malnutrition in the LPDR, in 2008, the GoL approved the first NNP (248/PM). The policy had a comprehensive and solid framework which acted as a direction for the specification for the 2010-2015 NNSPA and its official promulgation by the GoL 9 . In April 2011, Laos joined a number of countries to form the global SUN movement. In 2012, the GoL set up the National Nutrition Center, which operated under the Ministry of Health (MOH), and in 2013, established the National Nutrition Committee (NNC) (73/PM), which formed parts of the important efforts being made by the GoL to tackle nutrition problems. NSPA implementation was met with a number of challenges owing to a lack of effective multi-sectoral coordination mechanisms along with disjointed implementation, a failure to move in a united direction, a lack of focus points, and the fact that a number of important interventions were never implemented due to the constraints in the GoL budget and support allocated by development partners. In 2013, the first MDG Report found that there were severe challenges to overcome so the GoL and development partners increased their emphasis and support for nutrition interventions. The NNS to 2025 consists of five parts – Part 1: Preamble, which gives an overall explanation of nutrition and the NNS; Part 2: Nutrition and Food Situation, which explains the importance of the problems arising from and main causes of malnutrition in the Lao PDR; Part 3: Vision, Mission, Overall Goal, and Guiding Principles, which explains the NFS targets; Part 4: NNS Framework and Priority Areas for Solutions to Nutrition, which specifies concrete focus points to tackle the immediate, underlying, and basic causes of malnutrition; and Part 5, which 2 gives a general presentation on the mobilization of funding, resource allocation, implementation, and monitoring and evaluation (M&E). 3 Part 2 Nutrition and Food Situation in the Lao PDR 2.1 Current status Despite the ongoing and rapid growth of the national economy, the problems of malnutrition, especially among the vulnerable CU5 group and of food insecurity continue to pose a monumental challenge to national development. Over the past two years, although GDP per capita has almost tripled and poverty halved, malnutrition rates have reduced only slightly and progress is slow. In the Lao PDR, chronic malnutrition affects 378,388 CU5s, accounting for 44%, one of the highest rates in Southeast Asia. Micronutrient deficiency rates are also high with 41% of CU5s and 59% of children under the age of two years suffering from anemia, the latter figure being especially high. One in three women of reproductive age (WRA) nationwide are affected by anemia, which constitutes a severe public health problem. Although the underweight malnutrition rate among CU5s fell from 32% in 2006 to 27% in 2012, the sudden malnutrition (wasting) rate stood still at 6%. Moreover, the chronic and underweight malnutrition rates of the 6-24-month age group are markedly higher than those of other age groups. Malnutrition continues to have an impact on other vulnerable groups, including WRA, pregnant women, and women who breastfeed, and this is related to infant and child care. Decisive actions must therefore take place for these vulnerable groups, especially during the first 1,000 days of life, in order to reduce malnutrition rates in the Lao PDR. In addition to the problem of malnutrition, there is an increasing trend of overnutrition. In 2013, it was found that 25.6% of persons aged 18-64 years were overweight, of whom 7.3% were obese women and 28.7% were overweight, compared to 14.3% of WRA in 2006. Moreover, there is evidence which points to a rising trend of overnutrition in the CU5 group, which leads to a risk of obesity and communicable diseases. While overweight levels may still be low, in order to meet the global target in the new era, it is important to prevent an increase in overweight children. Factors concerning malnutrition mostly relate to household poverty, mothers with low education levels, and ethnic groups residing in remote areas with no access to clean water, sanitation, environment and health services. Malnutrition is also associated with beliefs, customs, and traditions which can lead to incorrect nutritional practices. Despite the progress made with the reduction of iodine deficiency (ID), challenges remain to our becoming an ID-free country, something which this strategy aims to achieve in 2020. Currently, 89% of households consume iodized salt 10 but the quality of the iodized salt still often fails to meet standards. Despite expansions in the coverage of vitamin A supplementation (VAS), the distribution of deworming tablets to children aged 12-59 months, and the handing out of iron supplements to WRAs and pregnant women, there are still challenges to achieving full coverage and challenges concerning the quality of services. 4 2.2 Causes of malnutrition and food insecurity 2.2.1 Immediate causes The NNP is based on the 1990 UNICEF conceptual framework, which specifies the main causes for malnutrition in children at three levels – immediate, underlying, and basic. Figure 1 – Causes of malnutrition in the Lao PDR The quantity and quality of nutrients [being consumed] are insufficient for bodily needs. Diseases caused by contaminated food and infectious diseases impair the body’s ability to absorb food consumed. The factors leading to food intake which is insufficient in terms of quantity and quality include poor and incorrect infant and child feeding practices – the rate of breastfeeding in the first hour of life remains low (39%), the rate of exclusive breastfeeding for the first six months is low (40%), and many children fail to consume sufficient and diverse food at each meal. The practice of food restrictions and taboos for breastfeeding women affects health and nutrition. Food restrictions and taboos deprive both mother and child of sufficient and diverse food intake. Food intake lacks variety and is mostly based on rice (which accounts for 67% of food consumed) and the consumption of fats, meat, vegetables, and fruits is extremely low. Some households are unable to ensure food security and have extremely low intakes of protein and micronutrients. Their intake of micronutrients is insufficient, leading to micronutrient deficiencies, such as iron deficiency anemia (IDA), vitamin A deficiency (VAD), and vitamin B1 deficiency, besides others. A. Immediate Causes 1. Inadequate nutrient intake 2. Food- water- vector-borne and infectious diseases B. Underlying Causes 6. Poor environmental hygiene 5. Poor mother and child care practices 4. Lack of access to food 3. Food unavailability Household food insecurity 7. Poor access to health services C. Basic Causes (Institutional and Resource-Based) 11. Limitations to investment into nutrition interventions 10. Limitations concerning information on nutrition on nutrition 9. Insufficient human resources 8. Limitations to coordination D. Basic Causes (Social and Economic) Access to fundamental resources and services for households is insufficient in terms of quantity and quality (land, water, energy, markets, education, employment, income, technology, information, etc.). 5 The national average caloric intake is sufficient and this is one of the indicators for sufficient food intake in terms of quantity but there are disparities between different areas and seasons. In addition, high micronutrient deficiency rates indicate insufficient quality of food intake, especially a lack of variety of foods consumed at each meal to ensure the intake of all necessary micronutrients (such as vitamins and minerals). Food consumption data indicates an excess nationwide average daily caloric intake but the intake of 23% of the population falls below recommended daily intake (RDI) standards 11 . The major problem is the lack of diversity in the nutritional values of food consumed. Food consumption in Laos is mostly based on rice. On average, 73% of caloric intake comes from carbohydrates, 12% from meat, and 15% from fats. This survey showed that the consumption of fats, oils, and fruits was also low 12 . Food consumed lacks animal protein. The survey also showed that infant and young child feeding (IYCF) in the poorest households is extremely low (16%) and in the 6-23 month age group 1 , consumption of all food groups (acceptable foods) is extremely low at just 5%. There is clear evidence for the relationship between infectious diseases and malnutrition in the LPDR. Diarrhea, malaria, and parasitic infections require close attention. Historically, malaria is one of the causes of morbidity and mortality and has been implicated in anemia. In recent years though, progress has been achieved with reductions in malarial cases and deaths but preventive methods must be continued. Incidence of diarrhea was recorded at 10% and it was also found that diarrhea peaks at 12-23 months, which coincides with the weaning period 1 . Especially during this period, feeding with safe food and clean water is of great importance in avoiding food- and waterborne diseases. Nearly 54% of children aged 24-59 months have intestinal parasitic infections and this constitutes a public health problem. Also, acute respiratory infections (ARI), measles/rubella and dengue fever as well as several vaccine preventable diseases reduce children's appetites and impair absorption making them more prone to malnutrition. 2.2.2 Underlying causes The availability of adequate food strongly influences the NFS status. The most significant difficulty concerning the availability of food in Laos is the low level of domestic production of food. The largest source of food was the household’s own food production, 82% of total value of food consumed came from households’ own food production while the national average of households’ own food production was just 45%. This food produced by households is mainly food which provides calories (rice) while other foods which households lack are purchased. The low level production is mainly due to insufficient productivity in high risk agricultural sectors. The main causes of these problems include the small size of land holdings – with some 50% of the farming households owning less than one hectare of land – and the prevalent absence of secure land tenure. Production mostly relies exclusively upon rainfall during the wet season and there is little dry season production. There is a high risk from natural disasters owing to climate change, including flooding, landslides, drought, and so forth. There is little effective facilitation to support production, such as fertilizers, seeds, preparation, and equipment. Agro-processing and modern food and seed storage equipment remains limited. There is a shortage of suitable infrastructure for the distribution of agricultural produce and a lack of a service 6 framework. Limited knowledge decreases productivity and increases food security risks. In addition, the LPDR is becoming more and more inter-linked with regional and global economies and is importing foods from overseas so the impact external crises or disasters have on food availability in the LPDR is unavoidable. Access to a variety of foods is essential to good health and nutrition and there are many important components. In the LPDR, from a physical perspective, infrastructure, such as roads, transportation, and markets, is limited, and such infrastructure plays an essential role in ensuring food is available at all locations and times it is needed. There are also limitations to processing systems and seasonal food preservation techniques to allow consumers access to all kinds of foods throughout all seasons so as to resolve the problem of food insecurity. In certain remote areas, access to natural resources, the use of non-timber forest products (NTFPs), the promotion of household cultivation, and the provision of a wide variety of traditional seeds are of great nutritional value and come at a low cost but there remain constraints and these are unsustainable. Poor mother and child care practices also represent an underlying cause of all forms of malnutrition. Mothers mostly lack knowledge concerning suitable food intakes, especially when pregnant and postpartum. Women still have extremely low food intakes at household level. Food restrictions and taboos are frequently practiced by women across all ethnic groups, especially during pregnancy and postpartum, which has a negative impact on the nutritional status of both mother and child. Burdens and workloads placed on women affect the health of both them and their child. There is a huge disparity in family planning (FP) in rural areas and certain ethnic groups and most mothers lack knowledge about how to look after their children correctly and suitably. There is evidence which shows that there is a close link between sanitation and chronic malnutrition (stunting). A lack of environmental hygiene, such as the use of contaminated water, poor sanitation, and incorrect hygiene practices, including difficulties in access to public health services, represents an underlying cause of malnutrition. Although the LPDR has made progress in improving access to safe water (72%), the rate of defecation remains high in poor sectors of the public, reaching 80% and 45% in rural sectors of the public 13 . The unsuitable disposal of child feces remains a significant problem with only 17% of caregivers following the recommendations correctly. A 2005-2006 survey showed that despite improvements to access to clean water sources, approximately 60% of households were using water which had been contaminated with animal feces – both from natural and household water sources. This also relates to unsafe water storage practices. Hand washing after toilet use was also not widely practiced with only around 21% of rural households practicing it. Most women do not wash their hands before preparing food or feeding their child. Moreover, there is a clear disparity between rural and urban areas with respect to toilet use which is consistent with sanitary principles. 2.2.3 Basic causes The basic causes of malnutrition in the LPDR are rooted in a number of systemic factors. Food security and nutrition objectives are included and clearly visible in the 8 th NSEDP (2016-2020). The basic causes are causes at institutional and national level and include infrastructure through which support may be provided, legislation, organizations, coordination, human resource development, information systems, gender roles, surveillance, M&E, and investment into NFS. Although progress is 7 currently being made in many areas, there remain constraints in terms of human resources, organization and implementation, and monitoring within the various sectors. One of the main constraints is insufficient budgets to provide support for direct and indirect nutrition interventions. Certain important interventions are not being implemented due to limitations in the GoL budgets and the allocation of support from development partners. There is a declining trend in funding from donors to assist directly with interventions aimed at solving the problem of malnutrition. Mechanisms for inter-sector coordination remain unsystematic and not as effective as they should be. Implementation is disjointed, there is a failure to move in a united direction, and there is a lack of focus points. Access to basic resources and services for households, such as land, water sources, energy, markets, education, employment, incomes, technology, information, and so forth is insufficient in terms of both quantity and quality. There is therefore a need for capacity building among organizations and personnel, for improved legislation, and for coordination and coherent and unified implementation through the participation of multiple sectors, development partners, and foreign stakeholders with a focus on improving the nutritional status and health of all people. 8 Part 3 Vision, Mission, Overall Goal, and Guiding Principles 3.1 Vision The NNSPA adopts the vision specified in the 8 th Five-Year NSEDP (2016-2020): A prosperous country, with a healthy population, free from food insecurity, malnutrition and poverty. 3.2 Mission Establish effective overall mechanisms through policies, strategies, programs and interventions. Arrange priorities, ensure coordination, and implement plans through multi-sectoral unity and M&E in order to achieve good NFS in the Lao PDR. 3.3 Overall goal To reduce malnutrition rates among women and children and improve the nutritional status of the multiethnic people so that they may be healthy and have a high quality of living and thus contribute to the preservation and development of the nation so that it is elevated from its status as a least developed country (LDC) in 2020 and attains its strategic targets in 2025; Table 1: Indicators for the overall goal Indicator 2012 baseline data (%) 2015 baseline data (%) 2020 targets (%) 2025 targets (%) Malnutrition rates from data gathered CU5 chronic malnutrition rate (above or below World Health Organization (WHO) standards) 44 42 b 34 25 CU5 sudden malnutrition rate (wasting) (WHO standards) 6 6 5 5 CU5 underweight rate (WHO standards) 27 22 17 12 CU5 anemia rate (hemoglobin<11g/dL) 41 40 30 20 WRA anemia rate (hemoglobin<12g/dL) 36 a 30 23 15 Low birth weight (LBW) 15 11 8 CU5 overweight rate 2 2 2 2 Breastfeeding rate 40 40 50 60 ID rate among school-age-children (SAC) 27 c 17 10 Support and promotion for the implementation of this NNS will help to attain the targets of the 8 th Five-Year NSEDP (2016-2020) and especially, help to reduce the maternal mortality ratio (MMR) and the child mortality rate (CMR) and contribute to the eradication of poverty. The relevant indicators are listed below: 9 Health Infant mortality rate (IMR) e 68/1,000 30/1,000 20/1,000 CU5 mortality rate (U5MR) 40/1,000 40/1,000 30/1,000 MMR 220/100,000 d 160/100,000 100/100,000 Poverty Poverty head count ratio (PHCR) 23.2 f N/A N/A Sources: a: 2006 National Maternal and Child Nutrition Survey (MICS3-NNS) b: 2011/12 Lao Social Indicator Survey (LSIS); Remark: Anthropometric data (chronic malnutrition, wasting, underweight, and body mass index (BMI)) will be available in 2015 from the 2015 National EPI Survey Anthropometry Tag-on survey so these statistics and targets may need to be revised at the end of 2015. c: 2014 School Survey on Iodine d: 2013 WHO MMR estimates 3.4 Guiding principles The NNS to 2025 is based on four principles, which are aligned with National Nutrition Policy (NNP) and the 8 th Five-Year NSEDP and are also in line with the national socio-economic development goals aimed at achieving the outstanding MDGs and moving towards the successful fulfillment of the SDGs. 3.4.1 Define a realistic strategy  This NNS shall aim to address the problems of the nation and of the multiethnic people.  The steps specified in this strategy shall enable the achievement of the targets set and be implemented in such a way that nutrition interventions are improved during each period. 3.4.2 Support effective management  Ensure transparency in implementation, assessment, and reporting on the outcomes achieved.  Specify strategies which are clear, concrete, and measurable and which can be inspected, monitor progress, and specify a clear framework of responsibilities.  Achieve multi-sectoral harmony and unity through the use of common priorities, focus points, targets, and schedules for planning, implementation, and M&E.  Build CBN systems and increase support from the GoL, domestic and external development partners, the public, and the private sector. 10 3.4.3 Achieve measurable outcomes for each period Short-term outcomes shall be measured during 2016-2018. Medium-term outcomes shall be measured during 2016-2020. Long-term outcomes and guaranteed sustainability shall be measured during 2016-2025. 3.4.4 Ensure efficient and effective implementation The interventions aimed at solving NFS problems will be implemented using investment which is low but maximizes impacts for the multiethnic people, prioritising vulnerable groups, especially children in their first 1,000 days of life from conception through to the age of two years and continuing this emphasis until they reach the age of five years and are enrolled into schools. These interventions shall also place strong emphasis on WRA, pregnant, postpartum, and breastfeeding women, the elderly, and persons suffering from infectious diseases such as malaria, diarrhea, HIV/AIDS, and other such diseases. Geographically, focus shall be placed on groups residing in remote areas high up in the mountains where there is high child malnutrition rates while in urban areas, focus shall be placed on groups with low education, areas to which people have recently been relocated, and persons affected by natural disasters, placing them in an emergency situation or having a long-term impact. 3.4.5 Gender roles This NNS shall promote gender roles, placing emphasis on women’s access to health services, to NFS information, and to food. Women and girls shall receive an education and training and be enabled to earn an income and participate in household and community decision making on an equal basis with men. 11 Part 4 Core Strategies and Priority Areas of Intervention This strategy sets out 4 strategic directions, 11 strategic objectives (SOs), and 29 interventions, of which 22 fall under Priority 1. It is a ten-year strategic implementation framework aimed at reducing maternal and child malnutrition rates while also improving the nutritional status and food security of the multiethnic people and attaining these strategic targets for 2025. Figure 2: Strategic framework Strategic Direction 2: Address underlying causes SO5: Improve MCH practices SO6: Improve clean water [systems and practices], sanitation, and environments SO4: Improve access to nutritious food SO3: Produce food for consumption SO7: Improve access to health & nutrition services Strategic Direction 3: Address basic causes SO10: Increase the quantity and quality of information SO11: Increase investments in nutrition interventions SO9: Develop human resources SO8: Improve institutions and coordination NNS Strategic Direction 1: Address immediate causes Strategic Direction 4: Linkages SO 1: Improve nutrient intake SO 2: Prevent food- and waterborne and infectious diseases Relevant policies and strategies (examples):  MNCH and immunization  Communicable and non communicable disease control  Gender roles  Land allocation improvement  Energy and mines  Water resources and the environment  Climate change – natural disasters  Telecommunication and transportation systems  Human rights  Poverty reduction 12 The NNS specifies three periods: 1) the Short-Term Period, during which focus shall be placed on implementing the high priority interventions which will yield the greatest benefits and which shall cover the first three years, allowing for the achievement of outcomes and the paving of long-term foundations; 2) the Medium Term Period, during which focus shall be placed on the implementation of interventions which lead on from the Short-Term Period by strengthening the important management structure and which shall cover the first five years; and 3) the Long-Term Period, during which focus shall be placed on interventions which lead on from the Medium-Term Period by continuing to strengthen the management structure and NFS services, which shall produce long-term outcomes over the ten-year period and guarantee sustainability. This strategy is comprehensive and composed of Priority 1 and Priority 2 interventions. The Priority 1 interventions specified focus on using investment which is low but maximizes short-term impacts, which shall lay the foundations for solving the problem of malnutrition and food insecurity in high risk areas and for ensuring these solutions are sustainable. There are 22 Priority 1 interventions and these aim to address the issue of nutrition directly and indirectly. Of these, 10 fall under the health sector, 4 under the agriculture sector, 4 under the education sector, and 4 are multi sectoral. The vast majority of these nutrition interventions fall within SOs 1, 2, 3, 4, 5, 6, 8, 9, 10, and 11 of Strategic Directions 1-3. The remaining interventions are Priority 2. Table 2: 22 Priority 1 interventions 22 priority interventions 4 interventions of other sectors 1. Promote capacity building in institutions in order to ensure that NFS is provided efficiently and effectively. 2. Improve NFS management and coordination across multiple sectors. 3. Improve nutrition information and surveillance systems, scientific research, and the M&E of NNSPA implementation. 4. Increase support and investment for NFS. 10 interventions of the health, nutrition, and clean water – sanitation sectors 5. Provide micronutrients, vitamins, and minerals, create a needs plan 4 interventions of the agriculture sector 15. Increase the cultivation of crops which have high nutritional value. 16. Produce and promote meat which has protein for household consumption: poultry, fish, and other aquatic life. Provide materials and equipment for production along with the necessary infrastructure: small scale irrigation, agricultural service units, and so forth. 17. Build post-harvest facilities (including food dehydrators, and food storage facilities) and apply technology to food processing, preservation, and storage so that it remains safe and nutritious as a means of ensuring food availability all year round. 13 for each product and medicine related to nutrition, and procure, deliver, and distribute. Provide integrated MNCH services and immunizations. Manage, store, and inspect inventories (iron, vitamin A, deworming tablets, vitamin and mineral powder, zinc, vitamin B1, and so forth). 6. Deworming 7. Provide oral rehydration salts (ORS) and achieve full coverage, promote the consumption of iodized salts and micronutrient fortified food: Procure, deliver, and distribute potassium iodate, basic diagnostic equipment, and the necessary chemicals, improve inspection and M&E systems, and declare ID eradication in 2020. 8. Promote exclusive breastfeeding for the first six months of life and promote counseling for infant and child care. 9. Supplement food for pregnant and breastfeeding women. 10. Supplement food for children under the age of two years. 11. Improve food quality and safety. 12. Control severe acute malnutrition, provide therapeutic food for treatment at health service facilities and in communities. 13. Bring about a change in practices – nutrition education with the participation of multiple stakeholders. 14. Strengthen clean water systems in households, communities, health service facilities, and schools. 18. Promote income generating activities, such as the cultivation of crops, NTFPs, and traditional medicines and foods, to build household incomes. 4 interventions of the education sector 19. Provide food in schools. 20. Promote vegetable gardens in schools. 21. Integrate nutrition into curricula. 22. Distribute deworming tablets and iron supplements in schools. 14 4.1 Strategic Direction 1: Address immediate causes This Strategic Direction specifies SOs aimed at solving problems at the level of the individual with respect to food intake and methods for controlling food-, water-, and vector-borne diseases, including infectious diseases, in order to ensure the consumption of nutritious and safe foods, which bring about good health and nutrition. This Strategic Direction is composed of 2 SOs: SO1: Improve nutrient intake. SO2: Prevent water-, food-, and vector-borne diseases. SO1: Improve nutrient intake This SO focuses on food intake which is sufficient in terms of both variety and quantity in order to prevent and solve the problem of malnutrition in CU5s, pregnant, postpartum, and breastfeeding women, and WRA. Interventions necessary to achieving this SO comprise the supplementing of food and micronutrients, the provision of food in schools, micronutrient fortification, the promotion of [exclusive] breastfeeding, infant and child care, and the prevention and treatment of CU5 malnutrition. SO2: Prevent water-, food-, and vector-borne diseases This SO aims to prevent and reduce water-, food-, and vector-borne diseases, including infectious diseases, such as ARI, diarrhea, measles, parasitic diseases, HIV/AIDS, and symptoms associated with diseases which can lead to injury and/or death. The interventions necessary to achieving this SO comprise deworming, improving food quality and safety, promoting immunization, preventing and controlling diarrhea, preventing malaria and dengue fever, and preventing and controlling HIV/AIDS and tuberculosis related malnutrition. 4.2 Strategic Direction 2: Address underlying causes This Strategic Direction concerns food security and aims to bring about the availability of sufficient nutritious food as a means of solving the problem of food insecurity at household and community level, to improve environments, and to improve the quality of health services. This Strategic Direction involves increasing the production of a variety of foods in households and schools, access to food, the provision of food in schools, mother and child interventions, and improving clean water [systems and practices], sanitation, and environments while improving access to health services. This Strategic Direction is composed of 5 SOs: SO3: Produce food so that it is available for consumption. SO4: Improve access to nutritious food. SO5: Improve mother and child care practices. SO6: Improve clean water [systems and practices], sanitation, and environments. SO7: Improve access to health services. 15 4.2.1 SO3: Produce food so that it is available for consumption The problem of malnutrition mostly arises in remote rural areas and is due to low agricultural yields and the high risk of natural disasters owing to climate change. This SO specifies interventions aimed at expanding and focusing on the agricultural production of a diverse range of nutritious and safe foods for households, communities, and schools and providing the necessary equipment and infrastructure to facilitate agricultural production. 4.2.2 SO4: Improve access to nutritious food This SO is composed of food access interventions which require the involvement of multiple sectors, such as road construction, transportation, service connections, and markets, but must focus on safe food storage and processing in order to ensure food is available for consumption all year round, which is a means of promoting activities which generate incomes through the cultivation of crops, NTFPs, and traditional foods in order that households may build an income with the main emphasis being placed on women. 4.2.3 SO5: Improve mother and child care practices This SO is composed of interventions aimed at providing education on health and nutrition in order to bring about a change in practices using the mass media, networks and mass organizations, such as the Lao Women’s Union, FP services, and other networks, and publicity campaigns focused on mobilizing communities to take responsibility for interventions on NFS, safe foods, and sanitation with a focus on giving them the courage to pass on what they know and promote correct practices in order to reduce the prevalence of beliefs, traditions, and customs which influence incorrect nutritional practices, such as food restrictions and taboos and so forth. It also focuses on the specific health care needs of WRA, pregnant and breastfeeding women, and infant, child, student, and youth care. 4.2.4 SO6: Improve clean water [systems and practices], sanitation, and environments This SO is composed of interventions which focus on providing clean water systems, toilets, sanitation, household water treatment (HWT), and environmental hygiene in order to enhance the capacities of communities to use, manage, and maintain [these systems and practices] at household, community, school, and health care facility levels. It also aims to promote environmental health impact assessments (HIAs) and adjustments to cope with climate change. It focuses on facilitating and supporting the adoption and implementation of legislation which relates to environmental hygiene in both the State and private sectors so as to ensure the protection of environments and the effects they have on health, which in turn have repercussions on NFS. 4.2.5 SO7: Improve access to health services This SO focuses on improving access to health and nutrition services by integrating nutrition services into MNCH services to form a regular comprehensive service at fixed and mobile health service facilities in communities and on promoting village health volunteers (VHVs), birth assistants, village LWU units, village doctors, and 16 village health committees (VHCs) to take responsibility for the implementation of NFS interventions in their communities through the adoption of the policy for free birth assistance and free CU5 medical treatment. 4.3 Strategic Direction 3: Address basic causes This Strategic Direction is focused on improving institutions and human resources in order to ensure that NFS interventions go ahead smoothly, systematically, consistently, and in a sustainable manner through increased cooperation and coordination between sectors at each level and to ensure that the NNS is adopted into the budget plans of each sector for each period. It also aims to improve nutrition, health education, food security and safety systems, strengthen institutions and human resources, improve M&E and information systems in terms of both quality and quantity, and encourage domestic and external development partners and the private sector to support NNS implementation and invest more in NFS interventions. Strategic Direction 4 is composed of 4 SOs: SO8: Improve institutions and coordination. SO9: Improve human capacities SO10: Increase the quantity and quality of information SO11: Increase investments in nutrition 4.3.1 SO8: Improve institutions and coordination This SO emphasizes the development and improvement of policies, legislation, and working frameworks which relate to NFS with a focus on increasing management for the strengthening of institutions with respect to NFS, improving the nutrition network at each level and health education so that education on nutrition may be provided and food quality analyses strengthened. It also aims to raise the capacity of the agricultural technical service network in order to meet the needs of communities with regard to seed production and rearing of livestock so as to ensure sustainable improvements to NFS systems at each level; and aims to improve coordination mechanisms in multiple sectors at each level from central through to local levels so that [the interventions] go ahead smoothly and consistently through the use of discussions, planning, reporting, and information exchanges. 4.3.2 SO9: Improve human capacities This SO is focused on domestic and overseas short- and long-term capacity building for personnel (managers, specialists, and community networks in the relevant sectors) at all levels in the management and implementation of the NFS interventions and on integrating topics on nutrition into nursing and bachelor’s and master’s degree curricula and other programs at the University of Health Sciences (UHS) and public health management school It also aims to review and develop the integration of topics on nutrition, sanitation, household cultivation, livestock raising, and other such topics into the curricula of the ordinary education system, teaching training institutes, and non-formal education (NFE). 17 4.3.3 SO10: Improve the quantity and quality of information This SO aims to improve NFS information systems, nutrition surveillance systems, and scientific research for the M&E of the outcomes of NFS implementation with a focus on ensuring its integration into the indicators used in the strategies, planning, and targets of each sector by improving vertical monitoring and reporting mechanisms within each relevant sector and the horizontal coordination of nutrition committees at each level. It also aims to build a master plan for joint NFS education, research, and assessment, the arrangement of priorities, M&E, and surveillance for use in the improvement of policies, strategies, programs, planning, and projects for each period. 4.3.4 SO11: Increase investments in nutrition This SO emphasizes support and increased investment into NFS and food safety interventions and the integration of NFS into the five-year plans of each sector and the 8 th Five-Year NSEDP (2016-2020). It also aims to prioritize investment into NFS areas, such as the promotion of micronutrient fortification and clean domestic and external agriculture, including that of business people, the private sector, markets and so forth. It also aims to promote private sector participation and support for NFS interventions. 4.4 Strategic Direction 4: Linkages This Strategic Direction emphasizes ensuring linkages with other stakeholders who affect the NFS interventions indirectly. The detailed plans and budgets shall be specified in the programs of the relevant sectors for each period. This Strategic Direction comprises land allocation improvement, energy and mines, water resources and the environment, climate change – natural disasters, telecommunications and transportation systems, human rights, gender roles, and poverty reduction. It also emphasizes MNCH and immunization, the integrated management of childhood illness (IMCI), the control of non-communicable diseases, such as diabetes and cardiovascular diseases and of communicable diseases, including diarrhea, malaria, dengue fever, ARI, tuberculosis, and the prevention of mother-to-child transmission (PMCT) and HIV/AIDS as specified in SO2. 18 Part 5 Capital Mobilization, Implementation, and M&E 5.1 Capital Mobilization This NNS is in harmony and consistent with the directions of the GoL. In order for it to succeed, an estimated budget of 411,352,576 US dollars will be required from 2016 until 2020. The GoL is fully committed to solving the vast problems and challenges connected with nutrition and shall approve the most generous GoL budgets possible for this issue. The GoL will, however, need and request domestic and external assistance in the form of resources focused on ensuring united support to be used transparently and accountably in order that the strategic targets for nutrition may be achieved as efficiently and effectively as possible. 5.2 Implementation 5.2.1 Management structure The NNS represents a direction to be adopted for the implementation of the NFS interventions under NNC guidance and aims to improve coordination mechanisms between multiple stakeholders so that [the strategy] may proceed smoothly at all levels and there may be more cooperation from domestic and external development partners. A) High level leadership The GoL has made decisive efforts to solving the problem of nutrition by setting up the NNC on 31 July 2013 pursuant to Prime Minister’s Decision 73/PM. This committee is presided over by three Deputy Prime Ministers – the Minister of Health, the Minister of Planning and Investment, and the Minister of Agriculture and Forestry – and composed of deputy ministers and the deputy leaders of the relevant equivalent organizations. The NNC Secretariat was also established to take a leadership role for the committee and is headed by the Deputy Minister of Health with three Deputy Heads – the Deputy Minister of Agriculture and Forestry, the Deputy Minister of Education and Sports, and the Deputy Minister of Planning and Investment. This committee is responsible for reporting and deciding on high level decisions and policies, specifying the main strategies, and ensuring the performance of the obligations of each stakeholder participating in NFS affairs. B) National level coordination mechanisms The coordination mechanisms for NNS implementation were developed by the NNC Secretariat Office (SSO), which is located within the MOH in the Department of Hygiene and Health Promotion (DHHP), with the National Nutrition Center acting as the central hub for coordination. Technical nutrition teams have been set up from multiple relevant domestic sectors and foreign stakeholders. The main team has representatives from five ministries – the MOH, the Ministry of Agriculture and Forestry (MOFA), the Ministry of Education and Sports (MOES), the Ministry of Planning and Investment (MPI), and the National Committee for Rural Development and Poverty Eradication and this team has the duties of research and consultation, providing directions for solving problems relating to nutrition, coordination between 19 the various sectors and stakeholders, including domestic and international development partners, such as SUN, monitoring implementation progress, and resolving technical NFS problems. C) Provincial and district level coordination Secretariats to Provincial Nutrition Committees (PNCs) have been set up headed by the Directors of the Provincial Health Departments (PHDs) so that they may facilitate multi-sectoral coordination within their provinces and provide the necessary leadership and support to their districts. Offices for these Secretariats have been set up within the PHDs and act as a hub for coordination, planning, and reporting on the NFS interventions vertically and horizontally at provincial level. D) Coordination with development partners External development partners, donors, the United Nations (UN), and non governmental organizations (NGOs) have the obligation to support the GoL with NNS implementation. Development partners provide support in improving the multi sectoral coordination framework in order to facilitate increased NFS support and assistance for vulnerable communities, households, and individuals so that they may gain access and optimal benefits consistently with GoL policies. 5.2.2 Implementation methods This strategy is focused on the various interventions specified in the National Nutrition Plan of Action, which ensures that the various sectors integrate these into their planning for each period. It also ensures the focused implementation of the Priority 1 interventions and quantitatively and qualitatively improves the implementation of existing interventions by evaluating the outcomes yielded during three periods: the Short-Term Period (2016-2018); the Medium-Term Period (2016 2020); and the Long-Term Period (2016-2025). In order to achieve the outcomes for each period, implementation must take place as follows: 1) Multi-sectoral strategic methods and planning must be applied and include common priorities targets, and schedules for the implementation of the 29 interventions with urgent focus being placed on the 22 priority interventions in areas of high malnutrition rates, areas of food insecurity, poor localities, and those of GoL focus with emphasis placed on the rapid and sustainable reduction of chronic malnutrition. 2) The quality of existing NFS service provision must be improved nationwide. 3) It must be ensured that the NNS is incorporated as a component of the 8 th Five-Year NSEDP (2016-2020) and the NNSPA into the annual work plans (AWPs) of the relevant sectors in order to focus on sustainability and ensure that the support of development partners proceeds in accordance with the NNSPA. 20 4) Coordination mechanisms for planning, implementation, management and M&E must be improved at each level within the various sectors and between sectors and development partners. 5) The use of domestic human resources must be promoted for the management and implementation of the nutrition interventions in order to raise the capacities of these human resources to achieve sustainability. 6) Local communities must be strengthened through active participation including taking of responsibility in planning, playing a role in deciding on solutions to problems and implementing the NFE interventions using initiatives taken by village committees and LWU units with regular provincial and district level oversight. 7) Cultural values and traditional customs which boost the consumption of nutritious foods and their processing must be preserved. 8) The environment must be protected in order to avoid negative impacts which could affect NFS interventions in the long-term. 5.3 M&E In order to ensure the assessment and measurement of the impact of the implementation of the interventions specified for each period efficiently and effectively, there must be surveillance systems, progress monitoring, scientific research, surveys, and information reporting and management systems along with the development and implementation of united multi-sectoral plans which cover the main NNS indicators and targets. Capacity building must also take place for persons participating in data collection, analysis, reporting, and information dissemination with a focus placed on ensuring accuracy, clarity, and keeping the data up to date so that this data may act as a reference for policy formation and mobilizing funding from central level government and donors. This strategy has been approved by all the relevant ministries and development partners and there is a strong belief that its implementation shall result in positive changes concerning NFS in the LPDR. 21 References 1. Lao Statistical Indicators Survey (LSIS), 2011-2012. Stunting refers to low height for age. 2. Grantham-McGregor et al. Development potential in the first five years for children in developing countries. Lancet 2007. 3. Black et al, Maternal and Child Malnutrition and Overweight Status in Low Income and Middle-Income Countries, Lancet 2013 4. https://sustainabledevelopment.un.org/sdgsproposal.html (accessible in April 2015) 5. https://extranet.who.int./nutrition/gina/sites/default/files/LAO%202008%20Na tional%20Nutrition&20Policy.pdf 6. http://www.fao.org/3/a-at539e.pdf 7. Vos et al, 2012 8. NERI/UNICEF 2013 9. National Nutrition Strategy and Plan of Action 2010-2015 10. WHO 2000, Number of children aged 8-12 years with a urinary iodine concentration < 100ug/L 11. 2002-2003 Lao Expenditure and Consumption Survey (LECS) 12. 2006 national nutrition or data from the MCH survey (MICS 2006) 13. 2013 Water and Sanitation Program (WSP) Report 14. Decision 73/PM, dated 31 July 2013, on the Appointment of the National Nutrition Committee; 15. The economic consequences of malnutrition in Lao PDR: A Damage Assessment Report NERI and Unicef 2013. 16. Vision to 2030 and Ten-Year Health Development Strategy (2016-2025); 17. Summary of the Implementation of the 7 th Five-Year Health Development Plan (2011-2015) and Directions and D ut ies for the 8 th Five-Year Health Development Plan (2016-2020); 18. 2010-2015 Nati on al Nutrition Strategy an d Plan of Action https://sustainabledevelopment.un.org/sdgsproposal.html https://extranet.who.int./nutrition/gina/sites/default/files/LAO%202008%20National%20Nutrition&20Policy.pdf https://extranet.who.int./nutrition/gina/sites/default/files/LAO%202008%20National%20Nutrition&20Policy.pdf http://www.fao.org/3/a-at539e.pdf 22 Appendices Definitions  Nutrition shall r efer to the “ co nsumption of nutritional and safe food to enable physical growth a nd balance and to enhance mental development” (Law on Food, Article 4).  Malnutrition shall include both undernutrition and overnutrition. Undernutrition shall refer to a caloric, protein, and/or micronutrient intake which is insufficient for the physical growth or which the body is unable to utilize due to a given disease. Overnutrition shall refer to a caloric intake which is in excess of the needs of the body.  Food Security shall refer to a sufficient and complete availability of food (in terms of quantity, quality, safety, and socio-cultural acceptability) which is accessible and sufficient for the use and benefit of all persons in a region at all times and locations in order that they may have strong health.  The first 1,000 days of life shall commence at conception and end at the age of two years. 23 Ministries and organizations which participated in forming the national policies and NNSPA Ministry of Health Ministry of Agriculture and Forestry Ministry of Education and Sport Ministry of Planning and Investment Ministry of Finance Government’s Office Ministry of Industry and Trade National Committee for Rural Development and poverty Eradication Ministry of Foreign Affaire Ministry of Information, Culture and Tourism Ministry of Labour and Social Welfare Ministry of Public Security Ministry of National Resource and Environment MCH committee Ministry of Science and Technology Provincial, district, village cluster, and village authorities Mass organizations: Central Lao Federation of Trade Unions (LFTU) Central Lao Front for National Construction (LFNC) Central Lao Revolutionary Youth Union (LRYU) Central LWU Development Partner UNICEF, EU, FAO,WFP,UN network, MQSUN, SUN-CSA,WHO and other development partners 24 Acronyms ANC Ante Natal Care ARI Acute Respiratory Infection AWP Annual Work Plan(s) BMI Body Mass Index BFHI Baby Friendly Hospital Initiative CCT Conditional Cash Transfers CED Chronic Energy Deficiency CEFDAW Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) CFSVA Comprehensive Food Security and Vulnerability Assessment CMR Child Mortality Rate CU5 CU5 Years CRC Convention on the Right of the Child DHHP Department of Hygiene and Prevention EIA Environmental Impact Assessment EPI Expanded Programme of Immunization FCT Food Composition Tables FIVIMS Food Insecurity and Venerability Information and Mapping System FP Family Planning GAP Good Agricultural Practices GHP Good Hygiene Practices GMP Good Manufacturing Practices GoL Government of Laos HACCP Hazard Analysis and Critical Control Points HIA Health Impact Assessment HIV/AIDS Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome HWT Household Water Treatment ICESCR International Covenant on Economic, Social and Cultural Rights IDA Iron Deficiency Anaemia ID Iodine Deficiency IMR Infant Mortality Rate IMCI Integrated Management of Childhood Illness IPM Integrated Pest Management IYCF Infant and Young Child Feeding JICA Japan International Cooperation Agency LECS Lao Expenditure Consumption Survey LNHS Lao National Health Survey LPDR Lao People’s Democratic Republic LRHS Lao Reproductive Health Survey LWU Lao Women’s Union MAF Ministry of Agriculture and Forestry MCH Maternal and Child Health MDG Millennium Development Goal 25 MICS3NNS Multiple Indicator Cluster Survey 3 and National Nutrition Survey MIC Ministry of Commerce and Industry MMR Maternal Mortality Rate MNCH Maternal, Neonatal and Child Health MOES Ministry of Education and Sport MOH Ministry of Health MPI Ministry of Planning and Investment M&E Monitoring and Evaluation MR Mortality Rate NCMC National Commission for Mother and Child NCNRCD Non Communicable Nutrition Related Chronic Diseases NFS Nutrition and Food Security NHS National Health Survey NIPH National Institute of Public Health NIEC Nutrition Information, Education and Communication NGOs Non-Governmental Organization NME National Monitoring and Evaluation NNC National Nutrition Committee (responsible to manage the NNP and coordinate partners in the NNSPA) NNP National Nutrition Policy NNS National Nutrition Secretariat NNSPA National Nutrition Strategy for 2016 to 2025 and Plan of Action for 2016-2020 NSEDP The 8 th National Socio-Economic Development Plan 2016-2020 NSEDS National Economic and Social Development Strategy to 2025 NTFP Non-Timber Forest Products ORT Oral Rehydration Therapy PM Prime Minister PEM Protein Energy Malnutrition PHC Primary Health Care PHCR Poverty Head Count Ration PMCT Prevention of Mother to Child Transmission POU Point of Use REACH Renew Effort Against Child Hunger RDA Recommended Dietary Allowances RH Reproductive Health SAC School attendance children SC Steering Committee SIA Social Impact Assessment SO Strategic Objective SSO National Nutrition Secretariat Support Office STH Soil Transmitted Helminths UIE Urine Iodine Excretion UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund U5MR Under-five Mortality Rate USI Universal Salt Iodization 26 VAD Vitamin A Deficiency VAM Vulnerability Analysis and Mapping VAS Vitamin A Supplement VHW Village Health Worker VNV Village Nutrition Volunteer WHO World Health Organization WFP World Food Programme WRA Women of Reproductive Age 1 Lao People’s Democratic Republic Peace Independence Democracy Unity Prosperity National Plan of Action on Nutrition 2016-2020 2 Contents 1. Part 1 Summary of Plan of Action and Budgets 3 2. Part 2 Implementation Framework 8 3. Part 3 2016-2020 NPAN in Detail 9 3 Part I Summary of Plan of Action and Budgets The development of the 2016-2020 National Plan of Action on Nutrition (NPAN) was based on the National Nutrition Strategy (NNS). The first part of the NPAN will be arranged so as to maintain full consistency with the NNS. The NPAN aims to provide a detailed explanation of the interventions to be implemented, the stakeholders responsible, the implementation timeframe, the expectations of the donors and development partners providing funding, and the expected budget requirements. The NPAN consists of three parts, the first of which will give an overall summary of the plan of action and the budgets, the second presenting an implementation framework, and the third presenting in detail its intended implementation from 2016 through to 2020. Figure 1: Bar chart of interventions separated by sector 29 22 7 10 4 4 4 0 5 10 15 20 25 30 T o ta l P ri o ri ty 1 P ri o ri ty 2 H e a lt h M u lt i s e c to ra l A g ri c u lt u re E d u c a ti o n 4 Table 1: Overall plan of action and budgets Total number of interventions 29 Multi-sectoral 4 Health sector 10 Agriculture sector 4 Education sector 4 Strategic Objectives (SOs) 11 Activities 145 Priorities Number of Priority 1 interventions 22 Number of Priority 2 interventions 7 Priority 1 Interventions Total Cost (USD) SO PI 4 Multi-sectoral SO8,SO9,SO11 1 Promote capacity building in organizations in order to ensure nutrition and food security (NFS) efficiently and effectively. 22,326,117 SO8 2 Improve multi-sectoral NFS management and coordination systems. 2,490,000 SO10 3 Improve nutrition surveillance data systems, conduct scientific research, and perform monitoring and evaluation (M&E) of NNSPA implementation and adoption. 7,041,158 SO11 4 Increase NFS support and investment. 585,000 Total multi-sectoral budget 32,442,275 10 Health sector SO1 5 Provide micronutrients, vitamins, and multi-micronutrient powder (MNP). Create an overall needs plan for all products and medicines related to nutrition. Procure, deliver, and distribute. Integrated MNCH services, immunizations, storage management and inventory inspections and reporting (iron, vitamin A, deworming tablets, MNP, zinc, vitamin B1, and others). 17,668,203 SO2 6 Deworming 3,225,728 SO1 7 Provide iodized salt, achieving full coverage. Promote the consumption of iodized salt and micronutrient fortified foods. Procure, deliver, and distribute potassium iodate, basic testing equipment, and the necessary chemicals. Improve monitoring systems. Inspect quality. Evaluate and declare the eradication of iodine deficiency by 2020. 2,628,587 SO1 8 Promote exclusive breastfeeding for children from birth up until the age of six months and promote counseling for infant and child care. 60,212,971 SO1 9 Food supplements for pregnant and breastfeeding women. 33,543,106 5 SO1 10 Food supplements for children under the age of two years. 7,537,609 SO2 11 Improve food quality and safety. 1,047,124 SO1 12 Control severe malnutrition, to include the provision of therapeutic food supplements for treatment at medical treatment facilities and in communities. 9,960,797 SO5 13 Bring about a change in practices related to nutrition through multi-stakeholder participation. 24,339,071 SO6 14 Strengthen clean water systems in health centers, communities, households, and schools. 14,270,118 Total health sector budget 174,433,284 4 agriculture sector budgets SO1,SO9,SO10 15 Increase the cultivation of crops of high nutritional value and high nutrient levels. 44,861,691 SO3, SO9 16 Produce and promote animal meat which has protein for household consumption (for example, poultry, fish, and other aquatic life). In doing so, provide the necessary materials, equipment, and infrastructure (for example: small-scale irrigation systems, agricultural service units, and so forth). 49,495,786 SO9 17 Build facilities to cater for post-harvest produce (including food dehydrators and food storage facilities) and apply technology in the processing and preservation of food so that it may remain safe and nutritious in order to ensure food security all year round. 22,045,506 SO2, SO10 18 Promote income generating activities, such as the cultivation of crops, non-timber forest products (NTFPs), and traditional medicines and foods to build household incomes. 27,787,148 Total agriculture sector budget 144,190,131 4 education sector budgets SO1,SO9,SO10 19 Provide food in schools. 45,270,054 SO3,SO9,SO10 20 Promote vegetable gardens in schools. 6,879,550 SO4, SO9 21 Integrate nutrition into curricula. 7,758,000 SO2,SO9, O10 22 Distribute deworming tablets and iron supplements in schools. 153,000 Total education sector budget 60,060,604 Priority 2 Interventions SO2 23 Promote immunizations (based on the Expanded Program on Immunization (EPI). SO2 24 Prevent and control diarrhea. SO2 25 Prevent malaria and dengue fever (based on the Five-Year Strategic Plan to Combat Malaria and Dengue Fever). 6 SO2 26 Prevent and control malnutrition associated with HIV/AIDS and tuberculosis (based on the Five-Year Plan to Combat AIDS). SO5 27 Family planning (FP) (based on the Five-Year Mother and Child Plan). SO7 28 Improve access to health and nutrition services. SO6 29 Promote health impact assessments (HIAs) and adapt to climate change. 226,280 Total Priority 2 budget 226,280 Health sector 174,659,565 Multiple relevant stakeholder 32,442,275 Agriculture 144,190,131 Education 60,060,604 GRAND TOTAL 411,352,576 7 Strategic Objectives (SOs) Interventions Total cost Total Priority 1 Strategic Direction 1: Address immediate causes SO1: Improve nutrient intake. 7 7 169,705,697 SO2: Prevent water-, food-, and vector-borne diseases. 7 3 4,425,852 Strategic Direction 2: Address underlying causes. SO3: Produce food so that it is available for consumption. 3 3 32,340,042 SO4: Improve access to nutritious food. 2 2 23,585,148 SO5: Improve mother and child care practices. 2 1 24,339,071 SO6: Improve clean water [systems and practices], sanitation, and environments. 2 1 14,496,398 SO7: Improve access to health and nutrition services. 1 N/A 1 N/A 1 Strategic Direction 3: Address basic causes. SO8: Improve institutions and coordination. 2 2 6,064,481 SO9: Improve human capacities. 1 1 100,598,734 SO10: Increase the quantity and quality of information. 1 1 31,645,858 SO11: Increase investments in nutrition. 1 1 4,151,293 Strategic Direction 4: Linkages with other stakeholders GRAND TOTAL 29 22 411,352,576 1 N/A Budget to be calculated in accordance with relevant program(s) 8 Part 2 Implementation Framework This is the main part of the NPAN and consists of twelve columns, each column detailed as follows: Column 1: SO number Column 2: The intervention number Column 3: Activity number Column 4: Area of implementation and intervention Column 5: Target group Columns 6&7: Outcomes and coverage indicators (current and 2020 forecasts) Column 8: Intervention priority Column 9: Evaluation period Column 10: Total expected budget requirement for 2016-2020 (five years) Column 11: Main government sectors responsible Column 12: Main development partners responsible Figure 1: NPAN framework structure 1 2 3 4 5 6 7 8 9 10 11 12 S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator Priority Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 Provide micronutrients, vitamins, MNP, zinc, vitamin B1). Create an overall needs plan for all medicinal products related to nutrition. Procure, deliver, and distribute. Integrated MNCH services, immunizations, storage management and inventory inspections and reporting $17,668,203 Indicator 1: % of children aged 6-59 months suffering from anemia (Hb<11g/dL) Source: 2014 survey 41% 30% MOH UNICEF Indicator 2: Vitamin A distribution coverage among children aged 6-59 months Source: 2012 LSIS 59% >80% MOH UNICEF Indicator 3: % of under-5 children (CU5s) with low blood retinol levels Source: 2006 NNS 45% 10% MOH UNICEF Indicator 4: % of women aged 15-49 years suffering from iron deficiency (serum ferritin < 15μg/L) Source: 2006 MICS III 22%* 15% MOH UNICEF Indicator 5: % of women of reproductive age (WRA) suffering from anemia (Hb < 12g/dL) Source: 2006 MICS III 36%* 23% MOH UNICEF Indicator 6: % of pregnant women (or postpartum women) receiving at least 90 iron-folic acid (IFA)tablets Source: 2012 LSIS 25% 75% MOH UNICEF Indicator 7: % of pregnant women suffering from anemia No data No data 30% MOH UNICEF 1 5 5.1 Develop and improve national instruments for the provision of the necessary micronutrients – deworming tablets, vitamins A and B1, iron, zinc, and MNP, and so forth and create annual needs plans. Overall population No data 80% 1 Short-term (2016 2018) $1,678,25 MOH WHO 1 5 5.2 Procure iron for pregnant women to take 1 tablet daily for a period of six months – the 2 nd and 3 rd trimesters (180 tablets) and for three months postpartum (90 tablets). Distribute these via both fixed and mobile service units by integrating the process into MNCH services, including periods during which health promotion campaigns are taking place in communities. 1. Priority: Pregnant and three month postpartum women 80% 1 Short-term (2016 2018) $2,051,107 MOH UNICEF, WHO The development partners will be reviewed annually as appropriate while we are all well aware that there is also participation from government organizations and non governmental organizations (NGOs) Each row specifies clearly and in detail the overall responsibilities for the implementation of the interventions (including the coverage targets and indicators to measure the outcomes achieved within the timeframe). 9 Part 3 2016-2020 NPAN in Detail SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 5 Provide micronutrients, vitamins, and MNP. Create an overall needs plan for all products and medicines related to nutrition. Procure, deliver, and distribute. Integrated MNCH services, immunizations, storage management and inventory inspections and reporting (iron, vitamin A, deworming tablets, MNP, zinc, vitamin B1, and others). $17,668,203 Indicator 1: % of children aged 6-59 months suffering from anemia (Hb<11g/dL) Source: 2014 survey 41% 30% MOH UNICEF Indicator 2: Vitamin A distribution coverage among children aged 6-59 months Source: 2012 LSIS 59% >80% MOH UNICEF Indicator 3: % of under-5 children (CU5s) with low blood retinol levels Source: 2006 NNS 45% 10% MOH UNICEF Indicator 4: % of women aged 15-49 years suffering from iron deficiency (serum ferritin < 15μg/L) Source: 2006 MICS III 22%* 15% MOH UNICEF Indicator 5: % of women of reproductive age (WRA) suffering from anemia (Hb < 12g/dL) Source: 2006 MICS III 36%* 23% MOH UNICEF Indicator 6: % of pregnant women (or postpartum women) receiving at least 90 iron-folic acid (IFA) tablets Source: 2012 LSIS 25% 75% MOH UNICEF Indicator 7: % of pregnant women suffering from anemia No data No data 30% MOH UNICEF 1 5 5.1 Develop and improve national instruments for the provision of the necessary micronutrients – deworming tablets, vitamins A and B1, iron, zinc, and MNP, and so forth and create annual needs plans. Overall population No data 80% 1 ST(16-18) $1,678,255 MOH UNICEF ,WHO 1 5 5.2 Procure iron supplements for pregnant women to take 1 1. Priority: No data 80% 1 ST(16-18) $2,051,107 MOH UNICEF, 10 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners tablet daily for a period of six months – the 2 nd and 3 rd trimesters (180 tablets) and for three months postpartum (90 tablets). Distribute these via both fixed and mobile service units by integrating the process into MNCH services, including periods during which health promotion campaigns are taking place in communities. Pregnant and three-month postpartum women WHO, JICA 1 5 5.3 Procure iron supplements for WRA aged 12-25 years in vulnerable areas for them to take one tablet daily. Create needs plans, procure, deliver, and distribute in communities and schools. Create summary reports. Women aged 12-25 years No data 80% 1 ST(16-18) $981,084 MOH WHO 1 5 5.4 Procure vitamin B1 supplements for pregnant women during the six months of their 2 nd and 3 rd trimesters and 3 months postpartum in vulnerable areas. Create needs plans, procure, deliver, and distribute via both fixed and mobile service units and also periods during which health promotion campaigns are taking place in communities. Pregnant and postpartum women No data 80%** 1 ST(16-18) $7,833,142 MOH UNICEF, WHO 1 5 5.5 Procure vitamin A supplements for CU5s, distribute micronutrients, MNP, and other necessary supplements. Distribute via both fixed and mobile service units and integrate the process into MNCH services, also using health promotion campaigns taking place in communities, for distribution. Children aged 6 59 months 59% >80%** 1 ST(16-18) $1,951,678 MOH UNICEF, WHO 1 5 5.6 Provide MNP to be mixed into food processed in households. Children aged 6 23 months 1% 25% 1 ST(16-18) $4,838,924 MOH UNICEF 1 5 5.7 Deliver vitamins and MNP – iron supplements, vitamin A, deworming tablets, MNP, zinc supplements, and vitamin B1 – from central through to provincial levels Medical staff N/A N/A 1 ST(16-18) $59,166 MOH UNICEF, WHO 1 5 5.8 Deliver vitamins and MNP – iron supplements, vitamin A, deworming tablets, MNP, zinc supplements, and vitamin B1 – from provincial through to district levels Medical staff N/A N/A 1 ST(16-18) $31,356 MOH UNICEF, WHO 11 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 7 Provide iodized salt, achieving full coverage. Promote the consumption of iodized salt and micronutrient fortified food. Procure, deliver, and distribute potassium iodate, basic testing equipment, and the necessary chemicals. Improve monitoring, quality inspection, and evaluation and declare the eradication of iodine deficiency by 2020. $2,628,587 Indicator 1: % of households consuming iodized salt Source: 2006 MICS 89% >90% MOH UNICEF Indicator 2: % of children enrolled in schools with urinary iodine excretion (UIE) levels of under 100μg/L Source: 2012 LSIS 27% 13% Health UNICEF 1 7 7.1 Improve the revolving fund scheme for the procurement, delivery, and distribution of potassium iodate to salt factories and improve monitoring and reporting systems. Lao Salt Producers’ Group 1 ST(16-18) $126,434 Industry and Commerce UNICEF, USAID 1 7 7.2 Procure, deliver, and distribute the necessary testing equipment and chemicals for salt factories and customs checkpoints and improve monitoring and reporting systems. Lao Salt Producers’ Group 1 ST(16-18) $395,990 MOH UNICEF, USAID 1 7 7.3 Disseminate and effectively enforce the regulations and laws for the promotion of iodized salt General public 1 ST(16-18) $593,985 MOH UNICEF, USAID 1 7 7.4 Review and improve measures and the implementation of external quality testing systems to enhance the production, transportation, and distribution of iodized salt General public 1 ST(16-18) $84,855 MOH UNICEF, USAID 1 7 7.5 Implement the internal quality testing systems of salt factories and related sectors so that such systems are stronger and to ensure the production, transportation, and distribution of iodized salt and test salt iodine levels on a regular basis. Lao Salt Producers’ Group 1 ST(16-18) $565,700 MOH / Industry and Commerce UNICEF, USAID 1 7 7.6 Implement processes and declare the country free of General public 1 ST(16-18) $424,275 MOH UNICEF, 12 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners iodine deficiency. USAID 1 7 7.7 Survey the situation with regard to iodized saltavailability and iodine deficiency in pregnant women and students. Pregnant women and primary schoolchildren 1 ST(16-18) $200,000 MOH UNICEF, USAID 1 7 7.8 Develop a working framework along with relevant legislation concerning micronutrient fortified food General public 1 ST(16-18) $237,347 MOH UNICEF, USAID 1 8 Promote exclusive breastfeeding for the first six months of life and promote counseling for infant and child care. $60,212,971 Indicator 1: % of children exclusively breastfed for the first six months of life Source: 2012 LSIS 40% 50% MOH UNICEF Indicator 2: % of children who breastfeed within the first hour after birth Source: 2012 LSIS 39% 50% MOH UNICEF Indicator 2: % of children aged 6-23 months who receive complementary foods Source: 2012 LSIS 70% 95% MOH UNICEF Indicator 3: % of children aged 6-23 months who receive at least three meals a day of complementary foods. Source: 2012 LSIS 37% >80% MOH UNICEF Indicator 4: % of children aged 6-23 months who receive a variety of complementary foods Source: 2012 LSIS 16% >50% MOH UNICEF 1 8 8.1 Improve and enforce legislation concerning the marketing of breast milk substitutes and food for infants and children The entire population N/A N/A 1 LT(16-25) $49,620,814 MOH UNICEF, WHO 1 8 8.2 Create and implement plans to promote exclusive breastfeeding for children from birth up to the age of six months and promote counseling for infant and child care. Mothers with children < two years No data 80% 1 LT(16-25) $5,770,142 MOH UNICEF, WHO 1 8 8.3 Procure and provide basic equipment and vehicles for service units to use in their operations to promote exclusive breastfeeding and to promote counseling for infant and child care and for the monitoring of child growth. 1% 1% 1 ST(16-18) $865,913 MOH UNICEF, WHO 13 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 8 8.4 Procure and provide food processing equipment for communities and service facilities for use in their promotion of breastfeeding and provision of counseling for infant and child care. 0% 0% 1 ST(16-18) $3,956,102 MOH UNICEF, WHO 1 8 8.5 Improve hospital conditions with respect to mothers and children and transform such work into one of the hospital health services which is to see improved conditions while also improving M&E systems. Hospitals 18% 60% 1 LT(16-25) Associated with SO1, Activity 9.1 MOH UNICEF, WHO 1 8 8.6 Train medical staff at all levels, including village doctors, village health volunteers (VHVs), and village Lao Women’s Union (LWU) units so that they promote breastfeeding and provide counseling on infant and child care. Perform regular M&E. Medical staff, VHVs, and village LWU units 1 LT(16-25) Associated with SO1, Activity 9.1 MOH UNICEF, WHO 1 9 Food supplements for pregnant and breastfeeding women $33,543,106 Indicator 1: % of pregnant and breastfeeding women receiving food supplements Pregnant and breastfeeding women in vulnerable areas No data >75% WFP 1 9 9.1 Provision of food supplements to pregnant and breastfeeding women when receiving prenatal care, childbirth services, postpartum checkups, and immunizations in vulnerable areas 1 LT(16-25) $33,543,106 MOH WFP 1 12 Control severe acute malnutrition, provide therapeutic food for treatment at health service facilities and in communities. $9,960,767 Indicator 1: % of CU5s suffering from moderate acute malnutrition Source: 2012 LSIS 6.0% 5.0% MOH WHO Indicator 2: % of CU5s suffering from severe acute malnutrition (SAM) Source: 2012 LSIS 1.4% 1.0% MOH WHO 14 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 12 12.1 Review and improve instruments to control cases of severe and moderate acute malnutrition. CU5s Not improved Improved 1 ST(16-18) $839,128 MOH WHO 1 12 12.2 Ensure consistent implementation nationwide of the identification of children suffering from acute malnutrition. Monitor the growth of CU5s and refer children consistently with the instructions for case management. CU5s 0% 80% 1 ST(16-18) $16,519 MOH WFP 1 12 12.3 Treat and manage all cases of acute malnutrition in communities. Cases of children suffering from SAM are to be referred to medical units with the necessary facilities. CU5s 1 ST(16-18) $3,394,201 MOH WFP 1 12 12.4 Treat and manage cases of SAM in medical treatment facilities and follow up. CU5s 1% (SAM CU5s) 45% 1 ST (16-18) $5,710,919 MOH WFP 1 12 12.5 Provide nutritional food supplements (give things which are enticing to eat and provide food to treat cases of acute malnutrition in children aged 6-59 months). Children aged 6 59 months suffering from malnutrition 0% 20% 1 ST(16-18) Associated with Activities 10.1 MOH WFP 1 12 12.6 Provision of food in emergency situations Areas affected by natural disasters 0% 100% 1 ST(16-18) Associated with Activity 10.1 MOH WFP 1 10 Food supplements for children under the age of two years $7,537,609 Indicator 1: % of children < two years receiving food supplements None 0% WFP Indicator 2: Chronic malnutrition rate (stunting: below height standards) in CU5s 44% 34% WFP Indicator 3: Rate of malnutrition of the type that results in CU5s being underweight 27% 17% WFP Indicator 4: % of overweight CU5s 2% ≤2% WFP 15 SO 1: Improve Nutrient Intake S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 1 10 10.1 Provision of food supplements to children aged 6-23 months Children aged 6 23 months 0% 80% 1 LT(16-25) $7,537,609 WFP 1 19 Provision of food in schools $38,154,454 Indicator 1: % of schools (kindergartens, primary, secondary) in poor districts where food is provided in schools Kindergartens and primary and secondary schools in poor districts 20% 50% Indicator 2: % of girl and boy students with access to nutritious food at schools on at least 80% of the days on which they attend Girl and boy students at the target schools 40% 100% 1 19 19.5 Provision of food in 2,349 target schools in 2,326 villages, exclusive of schools in focus areas 2,349 schools 1 LT(16-25) $27,976,017 IEC, DPPE, MOH, MAF provinces, districts, schools, GoL, students WFP, CRS, EDF 1 19 19.6 Provision of food in 517 schools exclusively in 64 focus points in 56 districts 517 schools 0% 0% 1 LT(16-25) $10,178,438 IEC, DPPE, MOH, MAF provinces, districts, schools, GoL, students WFP, CRS, EDF 16 SO2: Prevent water-, food-, and vector-borne diseases S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 2 Deworming $3,225,728 Indicator 1: % of children aged 12-59 months who have received deworming tablets Source: 2014 HMIS 90% >95% MOH UNICEF 2 6 6.1 Launch a national process for consistent deworming (in place of mobilization of the public to distribute deworming tablets in their own communities) Children aged 15 years, primary schoolchildren, and WRA 94% 95% 1 MT(16-20) $1,398,546 MOH EU, UNICEF, USAID 2 6 6.2 Procure and provide deworming tablets to CU5s, distributing them via both fixed and mobile service facilities by integrating them into MNCH services, including periods during which health promotion campaigns are taking place in communities Children aged 15 years, primary schoolchildren, and WRA 0% 0% 1 MT(16-20) $282,017 MOH EU, UNICEF, USAID 2 6 6.3 Procure deworming tablets for women in their 2 nd and 3 rd trimesters of pregnancy and postpartum (in vulnerable areas): Create needs plans, procure, deliver, and distribute these along with iron supplements at both fixed and mobile service facilities and integrate this into MNCH services in communities. Create summary reports. Women in their 2 nd and 3 rd trimesters of pregnancy and postpartum women 0% 0% 1 MT(16-20) $1,545,165 MOH EU, UNICEF, USAID 2 22 Distribution of deworming tablets and iron supplements in schools $153,000 Indicator 1: % of schools distributing deworming tablets and iron supplements on a weekly basis Target schools 75% MOES Indicator 2: % of schools receiving deworming tablets and iron supplements on a weekly basis in time [for them to be distributed on schedule] Target schools 100% MOES Indicator 3: % of students receiving deworming tablets Primary and lower secondary students 100% MOES 17 SO2: Prevent water-, food-, and vector-borne diseases S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners Indicator 4: % of secondary school girls receiving iron supplements Secondary students 100% MOES 2 22 22.2 Distribution of deworming tables and iron supplements to primary and lower-secondary students 1 MT(16-20) $153,000 DPPE, secondary schools, UNICEF 7 Improve food quality and safety. $1,047,124 Indicator 1: New cases of food-borne diseases MOH FAO 2 11 11.1 Develop a working framework and legislation concerning food safety. General public 1 MT(16-20) $419,564 MOH FAO 2 11 11.2 Strengthen the capacity for food and water inspection and analysis (including lab testing) General public 40% 80% 1 MT(16-20) $226,280 MOH FAO 2 11 11.3 Monitor and inspect contaminated food and perform surveillance of food-borne diseases. General public 30% 80% 1 MT(16-20) MOH WHO 2 11 11.4 Boost and provide knowledge on food and water safety. General public 40% 80% 1 ST(16-18) MOH FAO 2 11 11.5 Implement good agricultural practices (GAP), good hygiene practices (GHP), and good manufacturing practices (GMP) in food processing through the provision of hazard analysis critical control point (HACCP) training. Persons engaging in food production and processing 60% 80% 1 ST(16-18) Ministry of Industry and Comerce FAO 2 11 11.6 Build and promote awareness on consumer rights and safe and healthy foods. General public No data 80% 1 ST(16-18) Ministry of Industry and Comerce FAO 2 11 11.7 Inspect the quality of food and food products Producers No data 90% 1 MT(16-20) $226,280 MOH UNICEF 2 11 11.8 Provide training on food safety to medical staff, teachers, and communities. Medical staff, teachers, and communities 1 MT(16-20) $75,000 MOH UNICEF 2 11 11.9 Monitor and inspect food safety in schools. Schools 1 MT(16-20) $50,000 MOH UNICEF 2 11 11.10 Monitor and inspect the safety and hygiene of food sold on roadsides and in restaurants, hotels, stores, markets, and communities. Food sold on roadsides and in restaurants, 1 MT(16-20) $50,000 MOH UNICEF 18 SO2: Prevent water-, food-, and vector-borne diseases S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners hotels, stores, markets, and communities 23 Promote immunizations (refer to EPI sub-program) Indicator 1: % of children < 1 year vaccinated against DPTHepBHIB3 2012 LSIS 51% 95% MOH WHO Indicator 2: % of children < 1 year vaccinated against measles Not available 55% 95% MOH WHO 2 23 23.1 Expansion of mobile immunization units for target populations (including promotion for health and nutrition during the immunization process) Children <1 year and WRA 2 ST(16-18) Based on the EPI program MOH WHO, UNICEF, GAVI, JICA, Lao LUX 2 24 Diarrhea prevention and control Indicator 1: % of CU5s suffering from diarrhea CU5s 12% TBD MOH WHO Indicator 2: % of CU5s suffering from diarrhea who receive oral rehydration therapy (ORT) CU5s 57% 90% MOH WHO 2 24 24.1 Use of education on health and nutrition concerning diarrhea (in association with SO5 and based on the Five-Year MNCH Strategic Plan)* General public 2 LT(16-25) Associated with SO5 and based on the Five-Year MNCH Strategic Plan MOH WHO, UNICEF, JICA, INGOs 2 24 24.2 Promotion of ORT, especially using ORS (based on the Five Year MNCH Strategic Plan) CU5s 2 LT(16-25) Associated with SO5 and based on the Five-Year MNCH Strategic Plan MOH WHO, UNICEF, JICA, INGOs 2 24 24.3 Promotion of the provision of zinc supplements when children CU5s 2 LT (2016- Associated MOH WHO, 19 SO2: Prevent water-, food-, and vector-borne diseases S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners have diarrhea (associated with SO1) 2025) with SO1 UNICEF, JICA, INGOs 2 25 Prevention of malaria and dengue fever (based on the Five Year Strategic Plan to Combat Malaria and Dengue Fever)* Indicator: % of CU5s who slept under insecticide treated mosquito nets last night 2012 LSIS 43% TBD MOH WHO Indicator: % of CU5s who slept under insecticide treated mosquito nets last night 2006 MICS 15% TBS MOH WHO 2 25 25.1 Insecticide treated mosquito nets (provision, promotion, correct use) (based on the Five-Year Strategic Plan to Combat Malaria and Dengue Fever)* Households 81% 81% 2 ST(16-18) Based on the Five Year Strategic Plan to Combat Malaria and Dengue Fever MOH WHO 2 25 25.2 Provide health education and nutrition to support the prevention of malaria and dengue fever (based on the Five-Year Strategic Plan to Combat Malaria and Dengue Fever) The entire population No data TBD 2 ST(16-18) Based on the Five Year Strategic Plan to Combat Malaria and Dengue Fever MOH WHO 2 26 Prevent and control malnutrition associated with HIV/AIDs and tuberculosis (based on the Five-Year Plan to Combat AIDS) Indicator 1: % of pregnant women coming in to receive services Pregnant No data 50% MOH UNICEF 20 SO2: Prevent water-, food-, and vector-borne diseases S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners at prenatal care facilities who are tested for HIV and receive counseling for prevention of mother-to-child transmission (PMCT) women Indicator 2: % of HIV+ pregnant women coming in to receive services and prenatal care facilities who receive medicine HIV+ pregnant women No data 90% MOH UNICEF Indicator 2: % of children born to HIV+ mothers who receive antiretroviral therapy (ARV) HIV+ children No data 100% MOH UNICEF 2 26 26.1 Provide and promote the use of tools to provide nutritional care for persons infected with AIDS / pregnant and breastfeeding women (associated with mother and child subprogram and subprogram to prevent and combat HIV/AIDS)**** Persons infected with AIDS / pregnant and breastfeeding women 2 ST (16-18) Based on Five-Year Plan to combat AIDS MOH WFP 2 26 26.2 Provide counseling on infant feeding for mothers infected with AIDS and children born to infected mothers (associated with mother and child subprogram and subprogram to prevent and combat HIV/AIDS)**** Mothers and WRA infected with AIDS No data 50% 2 ST (16-18) Based on Five-Year Plan to combat AIDS MOH UNICEF 2 26 26.3 Identify, treat, and control cases of malnutrition in children infected with AIDS (associated with mother and child subprogram and subprogram to prevent and combat HIV/AIDS)**** Children infected with AIDS No data 100% 2 ST (16-18) Based on Five-Year Plan to combat AIDS MOH 2 26 26.4 Promote prevention of non-communicable diseases (NCDs): tuberculosis, AIDS, diabetes, cardiovascular diseases (based on program to control NCDs) 2 ST (16-18) Based on Five-Year Plan to combat AIDS MOH 21 SO 3: Produce Food so That It Is Available for Consumption S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 3 15 Increase the cultivation of crops which have high nutritional value. $19,244,923 Indicator 1: Rate of daily consumption of homegrown vegetables and/or purchased vegetables and crops (including vegetable oil) in the target households Target households None 75% 3 15 15.1 Make preparations at community level (including needs assessments). Rural households 75% 1 MT(16-20) $1,074,790 MAF FAO, EU, IFAD 3 15 15.3 Provide cultivars, seedlings, and seeds. Rural households 75% 1 MT(16-20) $5,191,467 MAF FAO, EU, IFAD 3 15 15.4 Provide agricultural tools (including small-scale irrigation systems for vegetable gardens). Rural households 75% 1 MT(16-20) $12,978,667 MAF FAO, EU, IFAD 3 20 Promote vegetable gardens in schools. $462,550 Indicator 1: % of target schools teaching about vegetable gardens Target schools 100% Indicator 2: % of target schools with vegetable gardens Target schools 20% 100% 3 20 20.2 Provide seeds and equipment and implement the operation of vegetable gardens in schools 0% 1 MT(16-20) $462,550 IEC, MAF, MOH, provinces, districts, schools, GoL, students WFP, CRS, EDF, PLAN 3 16 Produce and promote meat protein for household consumption (eg. poultry, fish, and other aquatic life). Provide materials and equipment for production along with the necessary basic infrastructure (eg. small-scale irrigation, agricultural service units, and so forth). $12,632,569 Indicator 1: Rate of daily consumption of household-produced animal protein among all members of the target households Target households None 75% 3 16 16.3 Provide baby poultry and baby fish (3,000 baby fish per household Rural 75% 1 MT(16-20) $12,632,569 MAF FAO, EU, IFAD 22 SO 3: Produce Food so That It Is Available for Consumption S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners at the price of 300 kip per baby fish) and baby frogs (500 baby frogs per household at the price of 500 kip per baby frog). raise crickets at household level (500,000 kip per household). Provide equipment and vaccines for the livestock of the target households. households 23 SO4: Improve Access to Nutritious Food S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 4 17 Build post-harvest facilities (including food dehydrators and food storage facilities) and apply technology to food processing, preservation, and storage so that it remains safe and nutritious as a means of ensuring food availability all year round. $17,095,815 Indicator: Rate of harvest and food processing by target households for all food groups Target households None 75% 4 17 17.1 Techniques for the dehydration of agricultural products. Training in food processing 0% 75% 1 MT(16-20) $5,656,790 MAF FAO, EU, IFAT 4 17 17.2 Provision of equipment for food processing and preservation for villages 0% 75% 1 MT(16-20) $4,949,691 MAF FAO 4 17 17.3 Prevention of food losses and warehouse improvements 0% 75% 1 MT(16-20) $6,489,333 MAF FAO 4 18 Promote income generating activities, such as the cultivation of crops, NTFPs, and traditional medicines and foods, to build household incomes. $6,489,333 Indicator 1: Rate of consumption of food from forests (such as NTFPs, meat, and fish) among the target households (all members) Target households None 50% 4 18 18.4 Create a specific NTFP seed center as a seed provision facility. 0% 75% 1 MT (16 20) $6,489,333 MAF FAO 24 SO 5: Improve mother and child care practices S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 5 13 Bring about a change in practices – nutrition education with the participation of multiple stakeholders. $24,339,071 Indicator 1: Based on the indicators stated in the interventions Source: LSIS 27% WHO Indicator 2: % of overweight CU5s Source: LSIS ≤2 WHO 5 13 13.1 Develop and review health education publicity tools and media to bring about a change in practices. These should be in both Lao and local languages and aimed at supporting implementation and give broad support to nutrition or provide support centered around specific focus points. The entire population 1 ST(16-18) $1385,966 MOH, MAF, ES UNICEF, WB, IFAD, WFP, WHO 5 13 13.2 Provide education on nutrition via the mass media and all forms of publicity to bring about a change in practices in order to support implementation and give broad support to nutrition or provide support centered around specific focus points. The entire population 1 ST(16-18) $17,126,914 MOH, MAF, ES UNICEF, WB, IFAD, WFP, WHO 5 13 13.3 Raise awareness in order to bring about a change in practices in order to promote healthy living. The entire population 1 ST(16-18) Associated with SO1 activities 9.1 MOH, MAF, ES UNICEF, WB, IFAD, WFP, WHO 5 13 13.4 Disseminate media on nutrition via mass organizations: the LWU, the Central Lao Front for National Construction (LFNC), and others. The entire population 1 ST(16-18) $5,551,216 MOH, MAF, ES UNICEF, WB, IFAD, WFP, WHO 5 13 13.5 Provide education on hygiene and environmental protection practices (promote toilet use and a reduction in open defecation through community responsibility and promote hand washing with soap). The entire population 1 ST(16-18) $274,976 MOH, MAF, ES UNICEF, WB, IFAD, WFP, WHO 5 27 FP (based on the Strategic Plan for Mothers and CU5s) 5 27 27.1 Education on nutrition, health, and FP, specifically for newly wedded couples (based on the mother and child subprogram)**** Newly wedded couples 40% 80% 2 ST(16-18) Based on the Five-Year Strategic Plan for Mothers and Children MOH UNFPA 25 SO6: Improve clean water [systems and practices], sanitation, and environments S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 6 14 Strengthen clean water systems in households, communities, health service facilities, and schools (based on the Five-Year Plan for Clean Water and Environmental Hygiene) $14,270,118 % of households using household water treatment (HWT) for clean and safe drinking water LSIS 2012 53% 70% MOH UNICEF % of households using clean water sources LSIS 2012 70% 90% MOH WB % of households using toilets LSIS 2012 60% 75% MOH WB % of the population practicing open defecation LSIS 2012 38% 18% % of the population washing their hands with soap WASH TWG 25% 50% MOH UNICEF % of the primary schools using clean water and toilets WASH TWG 52% 65% % of health service facilities using clean water and toilets WASH TWG 75% 80% 6 14 14.1 Manage water in households by promoting the HWT to make water clean and safe and ensure clean water is stored safely in the household. General public 53% 70% 1 LT(16-25) $12,721,715 MOH, NCRDPE, PWT UNICEF, WSP, WHO, INGOs 6 14 14.2 Improve water sources and water supply systems in rural communities. General public 1 LT(16-25) $32,474 MOH, NCRDPE, PWT UNICEF, WSP, WHO, INGOs 6 14 14.3 Improve water supply systems used in health service facilities. General public 1 LT(16-25) $16,833 MOH, NCRDPE, PWT UNICEF, WSP, WHO, INGOs 6 14 14.4 Improve school water supply systems. General public 1 LT(16-25) $20,541 MOH, ES, NCRDPE, PWT UNICEF, WSP, WHO, INGOs 6 14 14.5 Provide health education on sanitation, environmental protection, and the promotion of toilet use. General public 21% (mothers) 75% 1 LT(16-25) Associated with Activity 14.1 MOH, ES, NCRDPE, PWT, MONRE UNICEF, WSP, WHO, INGOs 6 14 14.6 Promote sanitation practices and hand washing with soap. General public 1 LT(16-25) $1,460,299 MOH, ES, NCRDPE, PWT UNICEF, WSP, WHO, INGOs 6 14 14.7 Get communities to take responsibility for themselves with respect to sanitation in order to ensure the eradication of open General public 1 LT(16-25) $18,256 MOH, ES, NCRDPE, UNICEF, WSP,WHO, 26 SO6: Improve clean water [systems and practices], sanitation, and environments S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners defecation. LWU INGOs 6 14 14.8 Provide toilets and water systems for rural communities. General public 1 LT (16-25) Associated with Activity 14.1 MOH, ES, NCRDPE, PWT UNICEF, WSP,WHO, INGOs 6 14 14.9 Provide toilets to health service facilities. General public 1 LT (16-25) Associated with Activity 14.1 MOH, ES, NCRDPE, PWT UNICEF, WSP,WHO, INGOs 6 14 14.10 Provide toilets to schools. General public 50% 1 LT (16-25) Associated with Activity 14.1 MOH, ES, NCRDPE, PWT UNICEF, WSP,WHO, 6 14 14.11 Provide toilets to health service facilities, schools, and poor households. Schools, health service facilities, and poor households None 75% 1 LT (16-25) Associated with Activity 14.1 MOH, ES, NCRDPE UNICEF, WSP,WHO, INGOs 6 29 Promote HIAs and adapt to climate change. $226,280 6 29 29.1 Support the implementation of policies and legislation concerning HIAs for development projects Persons implementing large projects None 100% 2 LT (16-25) $226,280 MOH, NRE, MPWT, IC Private sector, WHO 27 SO7: Improve Access to Health and Nutrition Services S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners 7 28 Improve access to health and nutrition services** 7 28 28.1 Improve the nutrition services regularly integrated into the MNCH services at health services facilities (associated with the primary health care (PHC) subprogram). CU5s and mothers 0.19 TBD 2 LT(16-25) Associated with the PHC subprogram MOH WHO, WB, ADB, JICA, UNFPA, UNICEF 7 28 28.2 Get communities to take responsibility for NFS in their communicates on a regular basis by collaborating with VHVs, birth assistants, the LWU, village doctors, village health committees (VHCs), and so forth (associated with the PHC subprogram) CU5s and WRA 20% 80% 2 LT(16-25) Associated with the PHC subprogram MOH, LWU UN, donors, INGOs 7 28 28.3 Improve mobile health services in their integration of nutrition into their MNCH services and projects to integrate comprehensive services in communities (associated with the mother and child program and the PHC subprogram). CU5s and WRA No data TBD 2 LT(16-25) Associated with the PHC subprogram MOH UN, donors, INGOs 7 28 28.4 Promote the implementation of free childbirth and CU5 medical treatment (based on the mother and child subprogram). Pregnant and postpartum women and CU5s None 80% 2 LT (16-25) Associated with the PHC subprogram MOH WB, WHO, ADB, GAVI, Lao LUX, INGOs ** Associated with budget in others subprogram 28 SO 8: Improve Institutions and Coordination S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners 8 1 Promote capacity building in institutions in order to ensure that NFS is provided efficiently and effectively. $3,574,481 Indicator 1: Number of relevant employees receiving training on nutrition 8 1 1.1 Improve policies, legislation, and working frameworks which constitute nutrition strategies. 1 LT(16-25) $839,128 MOH, MAF, ES, PI UN, donors, IO, INGOs 8 1 1.4 Improve the capacities of institutions to strengthen the nutrition services network at all levels from central through to community levels. 1 LT(16-25) $16,833 MOH, MAF, ES, PI UN, donors, IO, INGOs 8 1 1.5 Strengthen food quality analysis. 1 LT(16-25) $2,097,819 MOH, MAF, ES, PI UN, donors, IO, INGOs 8 1 1.6 Build capacities in institutions which enable them to provide nutrition education and communications to bring about a change in practices 1 LT(16-25) $620,701 MOH, MAF, ES, PI UN, donors, IO, INGOs 8 2 Improve NFS management and coordination across multiple sectors. $2,490,000 Indicator 1: Ensure coordination structures and institutions function to their fullest extent. NSC FAO, UNICEF Indicator 2: Operate a system of annual progress reports on NPAN implementation. NSC FAO, UNICEF Indicator 3: Proportion of target households participating in the implementation of the annual NFS improvement plans of District Agriculture Offices. District Agriculture Offices None 80% 8 2 2.1 Improve multi-sectoral coordination mechanisms for the implementation of NFS activities at each level: Establish and operate provincial, district, and village coordination committees. 1 LT (16-25) $490,000 MONRE, LNCCI FAO, UNICEF 8 2 2.2 Strengthen national level coordination with multiple stakeholders for NFS. 1 LT (16-25) $525,000 MONNRE ,LNCCI FAO, UNICEF 8 2 2.3 Improve domestic-international NFS coordination. 1 LT (16-25) $500,000 MONRE, NCC FAO, UNICEF 8 2 2.4 Micro-planning for multi-stakeholder participatory NFS activities 1 LT (16-25) $520,000 MONRE, NCC FAO, UNICEF 8 2 2.5 Create systems to report on the outcomes achieved from the 1 LT (16-25) $455,000 MONRE FAO, 29 SO 8: Improve Institutions and Coordination S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners implementation of NFS plans to the National Nutrition Committee (NNC) Secretariat and to other sectors. NCC UNICEF 30 SO 9: Improve Human Capacities S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners 1 Improve human capacities $92,840,736 9 1 1.3 Develop capacity building plans for NFS personnel . 0% 0% 1 LT(16-25) $1,578,304 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.7 Provide training for trainers of personnel in all relevant stakeholders, focusing on NFS activities. Relevant personnel 0% 0% 1 ST(16-18) $2,307,603 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.8 Set up short-term training for nutrition administrators and managers from central through to district levels – 2 people per province and 1 person per district. Relevant personnel 0% 0% 1 ST(16-18) $738,239 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.9 Set up short-term training for nutrition service providers and training in the treatment of malnutrition at central-level hospitals through to district hospital 4 people per central hospital, 2 people per provincial hospital, and 1 person per to district hospital. Relevant personnel 0% 100 1 ST(16-18) $254,565 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.10 Set up short-term training to promote nutrition among medical staff and district and health center level, and for staff in multiple sectors – 1 person per district, 1 person per health center, and 1 person per village which lacks road access. Relevant personnel 0% 2,700 people 1 ST(16-18) $3,818,477 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.11 Integrate nutrition into the nursing and bachelor’s degree medical doctor’s curricula along with other faculties of the University of Health Sciences (UHS) and public health management school Relevant personnel 0% 1 ST(16-18) $300,000 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.15 Develop university-level curricula (bachelor’s and master’s degrees) and an NFS institute. Universities 0% Yes 1 MT(16-20) $385,931 MOH FAO 9 1 1.12 Long-term upgrade of domestic staff in NFS Relevant personnel 0% 30 people 1 LT(16-25) $135,768 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.13 Provide a long-term program to upgrade personnel overseas in NFS. Relevant personnel 0% 20 people 1 LT(16-25) $1,470,921 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 1 1.14 Provide short-term programs to upgrade personnel overseas (study tours, exchanges, seminars, trainings, and conferences). Relevant personnel 1 ST(16-18) $4,195,638 MOH, MAF, ES, PI UN, donors. IO, INGOs 9 19 19.1 Capacity building for management and administration personnel IEC, DPPE, MAF, provinces, disricts, schools, the GoL, and 1 LT(16-25) $6,524,200 MOES WFP, CRS, EDF 31 SO 9: Improve Human Capacities S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners students 9 20 20.1 Strengthen capacities for the creation of vegetable gardens at provincial, district, and school levels (training, study tours of vegetable gardens, and the provision of food in schools). IEC, DPPE, MAF, provinces, districts, schools, the GoL, and students 1 LT (16-25) $6,417,000 MOES WFP, WRS, EDF, PLAN 9 15 15.2 Improve and strengthen agricultural facilities so that they may provide cultivars and seedlings to provide fruit and seeds. Agricultural facilities 75% 1 LT (16-25) $4,828,064 MAF FAO, EU, IFAD 9 15 15.5 Organize training on the cultivation of organic crops and mushrooms in vegetable gardens (including herbs, tools and equipment for this training) and on dealing with pests and provide basic training on nutrition in connection with agriculture. Personnel and villagers 75% 1 MT (16-20) $12,374,228 MAF FAO, EU, IFAD 9 15 15.6 Organize study tours and exchanges on organic cultivation. Personnel and villagers 75% 1 MT (16-20) $3,464,784 MAF FAO, EU, IFAD 9 16 16.2 Raise the capacities of personnel and communities (training in livestock raising, animal husbandry, fish and frog farming, and livestock disease prevention (including the provision of tools related to livestock raising and the prevention of various diseases). Rural households 0% 1 MT (16-20) $7,424,537 MAF FAO, EU, IFAD 9 16 16.7 Strengthen institutions (procure computers, motorcycles, vehicles (automobiles), and desks). Central, provincial, and district levels 1 MT (16-20) $19,086,528 MAF FAO, EU, IFAD 9 17 17.4 The Ministry of Agriculture and Forestry (MAF) shall provide technical support for the agriculture and forestry sector at provincial and district levels. 1 MT (16-20) $4,949,691 MAF FAO, EU, IFAD 9 18 18.2 Organize training for sustainable NTFP management. 1 MT (16-20) $3,959,753 MAF FAO, EU, IFAD 9 18 18.3 Study tours on good NTFP management 1 MT (16-20) $2,969,815 MAF FAO, EU, IFAD 9 18 18.5 Training on microfinance (including small-scale funds for villages) 1 MT (16-20) $5,656,790 MAF FAO, EU, IFAD 9 21 Integrate nutrition into curricula. $7,758,000 32 SO 9: Improve Human Capacities S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Priority Current 2020 Total costs Relevant ministries Development partners Indicator 1: Number of curricula into which the topic of nutrition is integrated in the ordinary education stream, teacher training colleges, and non-formal education (NFE) The ordinary education stream, teacher training colleges, NFE 0% 0% Indicator 2: Number of schools teaching curricula into which nutrition has been integrated. Target schools 20% 50% 9 21 21.1 Review and develop curricula to incorporate nutrition, water, sanitation, and vegetable gardening (in the ordinary education stream, teacher training colleges, and NFE). NCSR, DTT, MAF, MOH, DHE, TVED, colleges, provinces, districts, schools 1 LT(16-25) $1,590,000 MOES 9 21 21.2 Provide training for teachers in the teaching of curricula into which nutrition, water, sanitation, and vegetable gardening have been incorporated (in the ordinary education stream, teacher training colleges, and NFE). NCSR, DTT, MOF, MOH, DHE, TVED, colleges, provinces, districts, schools 1 LT(16-25) $6,168,000 MOES 33 SO10: Improve the Quantity and Quality of Information S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluatio n period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministrie s Development partners 10 3 Improve nutrition surveillance information systems, scientific research, and M&E for the NNSPA $31,645,858 Indicator 1: Nutrition surveillance systems being fully operational No Yes MOH FAO 10 3 3.1 Create NFS surveillance systems (including specific nutrition surveillance, databases, analyses, monitoring, summaries, and reporting) in all sectors within the coverage and indicators specified in the NNSPA. 1 ST(16-18) $3,394,201 MOH WHO, FAO 10 3 3.2 Consistently conduct surveys on the progress shown and the outcomes/indicators and impacts specified above in the NNSPA. 1 MT(16-20) $1,800,000 MOH WHO, FAO 10 3 3.3 Evaluate the work being performed for infant and young child feeding (IYCF) right from the outset of implementation through the micronutrient fortification of foods with support from the private sector for households which have children aged 6-59 months and by developing the State sector; and using plans to expand implementation for households with children aged 6-23 months. 1 MT(16-20) $904,973 MOH WHO, FAO 10 3 3.4 Develop national level NFS research plans involving the relevant sectors. 1 ST(16-18) $600,000 MOH WHO, FAO 10 3 3.5 Disseminate information (including progress made with the implementation and outcomes of surveys) which can form a basis for the scientific research performed during planning / management. 1 ST(16-18) $126,983 MOH FAO 10 3 3.6 Set up systems for reporting to the NNC Secretariat and various sectors on the outcomes achieved during the implementation of NFS plans. 1 LT(16-25) $125,000 NRE, NCC FAO 10 3 3.7 Develop a common result framework. 1 LT(16-25) $90,000 MOH FAO 10 19 19.2 Develop and improve M&E systems. IEC,DPPE, MOH, MAF, provinces, districts, schools, the 1 LT(16-25) $466,400 ES WFP, CRS, EDF 34 SO10: Improve the Quantity and Quality of Information S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluatio n period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministrie s Development partners GoL, and students 10 19 19.3 Data survey on the nutritional status of children in schools IEC,DPPE, MOH, NAF, provinces, districts, schools, the GoL, and students 1 LT(16-25) $75,000 ES WFP, CRS, EDF 10 19 19.4 Impact group-specific assessment of implementation IEC,DPPE, MOH, MAF, provinces, districts, schools, the GoL, and students 1 LT(16-25) $50,000 ES WFP, CRS, EDF 10 22 22.1 Data collection, databases, and request for deworming tablets and iron supplements DPPE, secondary schools,provin ces,districts,an d schools 1 LT(16-25) Associated with SO2, Activity 22.2 ES UNICEF 10 22 22.3 M&E of the taking of deworming tablets and iron supplements by primary and lower-secondary students AF, Department of Secondary Education,pro vinces, districts, and schools 1 LT(16-25) Associated with SO2, Activity 22.2 ES UNICEF 10 15 15.7 Field technical monitoring and support to provide technical support to the agriculture and forestry sector at provincial, district, and village level. Provincial, district, and village agriculture bodies 0% 75% 1 MT (16 20) $4,949,691 AF FAO, EU, IFAD 35 SO10: Improve the Quantity and Quality of Information S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluatio n period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministrie s Development partners 10 16 16.1 Study needs at village level before implementing projects and assessing the final project outcomes. Rural households 1 MT(16-20) $2,206,148 AF FAO, EU, IFAD 10 16 16.4 The MAF shall provide monitoring and technical support for the agriculture sector at provincial, district, and village level. MAF, provinces, districts, and villages 1 MT(16-20) $4,949,691 AF FAO, EU, IFAD 10 16 16.5 District Agriculture and Forestry Offices (DAFOs) shall provide monitoring and support for the implementation of activities in villages (twice monthly). Provincial and district personnel 1 MT(16-20) $3,054,667 MAF FAO, EU, IFAD 10 16 16.6 M&E (extraction of lessons learned, holding of meetings, and follow-up) Central level 1 MT(16-20) $141,646 MAF FAO, EU, IFAD 10 18 18.1 Assessment of the results of needs analyses at village level prior to project implementation 1 MT(16-20) $3,761,765 MAF FAO, EU, IFAD 10 18 18.6 The MAF shall provide technical support to the agriculture sector at provincial and district level. 1 MT(16-20) $4,949,691 MAF FAO, EU, IFAD 36 SO11: Increase Investments in Nutrition S O In te r v e n ti o n A c ti v it y Intervention / activity group Target group Outcome / coverage indicator P r io r it y Evaluation period 2016 – 2020 Main entities responsible* Current 2020 Total costs Relevant ministries Development partners 11 4 Increase support and investment for NFS. $4,151,293 11 1 1.2 Request support from [GoL/Party] leadership and State and private sector, international, and community donors. 1 LT(16-25) $3,566,293 MOH REACH Initiative 11 4 4.1 Increase investment into nutrition and safe food. 1 LT(16-25) $75,000 MOH REACH Initiative 11 4 4.2 Integrate NFS into the 8 th NSEDP (to be included in the monitoring of is the 8 th NSEDP and the 8 th Five-Year Development Plans of the relevant sectors. 1 LT(16-25) $40,000 MOH, MAF, ES, PI, Ministry of Finance (MOF) UNICEF, FAO 11 4 4.3 Prioritize investment into food security. 1 LT(16-25) $50,000 REACH Initiative 11 4 4.4 Mobilize capital domestically and internationally for use in food security. 1 LT(16-25) $70,000 MOH, MAF, ES, PI, MOF REACH Initiative 11 4 4.5 Study the feasibility of special joint NFS investment mechanisms. 1 LT(16-25) $150.000 MOH, MAF, ES, PI, MOF REACH Initiative 11 4 4.6 Promote private businesses, private sector investment, and marketing into food security, including clean food, crop cultivation, and so forth. 1 LT(16-25) $200,000 MOH, MAF, ES, PI, MOF Private sector 37 National Nutrition Strategy to 2025 and Plan of Action 2016-2020 Evolved under Government of Lao PDR By cooperation with FAO, UNICEF, EU, MQSUN ຿ and UN network