Uganda Nutrition Action Plan 2011-2016

UGANDA NUTRITION ACTION PL 2 0 1 1 – 2 0 1 Scaling Up Multi -Sectoral Eff orts to Establish a Stron Nutriti on Foundati on for Uganda’s Development AN 6 g THE REPUBLIC OF UGANDA . THE REPUBLIC OF UGANDA UGANDA NUTRITION ACTION PLAN 2 0 1 1 – 2 0 1 6 Scaling Up Multi -Sectoral Eff orts to Establish a Strong Nutriti on Foundati on for Uganda’s Development All rights reserved. The Government of Uganda encourages the reproducti on and disseminati on of material in this informati on product. Non-commercial uses will be authorised free of charge, upon request. Reproducti on for resale or other commercial purposes, including educati onal purposes, may incur fees. © Government of Uganda 2011 Design & Layout: CSR Design, +256712669649, csrdesignltd@gmail.com iEND MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Table of Contents Foreword iii Statement of Commitment v Acronyms and Abbreviati ons vii Executi ve Summary ix PART I: OVERVIEW 1 1. Introducti on 1 2. Policy Context 5 3. Situati on and Problem Analysis 6 3.1 Causes of High Rates of Malnutriti on in Uganda 7 3.2 Consequences of High Rates of Malnutriti on in Uganda 10 PART II: THE STRATEGIC DIRECTION 14 4. Acti on Plan Target Groups and Broad Strategies 14 4.1 Target Groups 14 4.2 Broad Strategies to Reduce Malnutriti on in the Plan Period (2011–2016) 14 5. Goal, Objecti ves, Strategic Interventi ons, and Core Projects 16 5.1 Goal 16 5.2 Objecti ves, Strategies, and Strategic Interventi ons 17 5.3 Priority Investment Areas 21 PART III: IMPLEMENTATION, FINANCING, AND MONITORING AND EVALUATION FRAMEWORKS 23 6. Implementati on Framework 23 6.1 Insti tuti onal Arrangements 23 6.2 Co-ordinati on Arrangements 24 6.3 Implementati on Strategy 25 6.4 Prerequisites for Implementati on 25 7. Financing Framework 26 7.1 Government of Uganda 26 7.2 Development Partners 26 7.3 Public-Private Partnerships 27 8. Monitoring and Evaluati on Framework 29 ii END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 LIST OF FIGURES Figure 1. Malnutriti on’s Impact on Producti vity during the Life Cycle and across Generati ons 2 Figure 2. Prevalence of Stunti ng, Underweight, and Wasti ng among Young Children in Uganda, by Age in Months 3 Figure 3. Nati onal Trends in the Prevalence of Malnutriti on among Children under 5 7 Figure 4. The Causes of Young Child Malnutriti on in Uganda 9 LIST OF TABLES Table 1. Gap Analysis for Scaling Up Nutriti on Interventi ons in Uganda 11 Table 2. Key Nutriti on Outcome Indicators 16 Table 3. Summary of 5-Year UNAP Implementati on Cost Matrix 28 Table 4. Key Outcome Indicators and Annual Targets 30 ANNEXES ANNEX I: Implementati on Matrix 31 ANNEX II: Implementati on Cost Matrix 45 ANNEX III: Reviewed Documents 53 ANNEX IV: List of UNAP Technical Committ ee Members 55 iiiEND MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Foreword We have made progress in reducing poverty over the years. However, malnutriti on sti ll ravages our country. Malnutriti on aff ects millions of Ugandans in various ways, but it is parti cularly devastati ng to women, babies, and children. Malnutriti on also impairs educati onal achievements and economic producti vity, costi ng the government and families enormous amounts of money to treat related illnesses. Adequate nutriti on is a prerequisite for human development and socioeconomic well-being. The Government of Uganda is committ ed to fulfi lling the consti tuti onal obligati on of ensuring food and nutriti on security for all Ugandans. This 5-year Uganda Nutriti on Acti on Plan (UNAP) is thus an important step as it provides the framework for addressing nutriti on issues in the country sequenti ally to develop strong and quality human capital that will propel socioeconomic transformati on. The UNAP has been formulated within the context of the Nati onal Development Plan (NDP), which is the overall vision for Uganda: transforming Uganda into a modern and prosperous country. The goal of this plan is to improve the nutriti on status of all Ugandans, with special emphasis on women of reproducti ve age, infants, and young children. Diff erent forms of malnutriti on aff ect diff erent groups of people in Uganda. However, it is during the ‘window of opportunity’—the 1,000 days from concepti on through the child’s second birthday —that the greatest returns to eff ecti ve acti on to prevent malnutriti on are realised. The plan is intended to reduce the magnitude of malnutriti on in Uganda and its impact on the individual, the household, the community, and the nati on at large. It will sti mulate the nati on toward the achievement of acceptable levels of nutriti on security, especially for women of reproducti ve age, infants, young children, and other vulnerable groups. I am pleased that the factors that have led to the persistent and someti mes worsening malnutriti on and poor health of our people have been identi fi ed and documented. Malnutriti on contributes to poor health, aggravates disease, and reduces producti vity while compounding poverty and its aft er-eff ects. These are interrelated factors, which call for multi -disciplinary approaches. Eff ecti ve intra- and inter-sectoral linkages must be put in place to promote co ordinati on and resource uti lisati on. The UNAP, therefore, calls for scaling up multi -sectoral interventi ons, placing more emphasis on community-based initi ati ves that have been proved to yield cost-eff ecti ve results, and targeti ng areas and groups with the highest levels of malnutriti on. Investi ng in the fi ght against malnutriti on will not only save lives but will also yield high economic returns for Uganda: Every 1,000 shillings we invest in nutriti on results in economic benefi ts at least six ti mes more. These gains mainly benefi t the poor and most disadvantaged, as they spend less money on treati ng malnutriti on-related diseases and increase their producti vity, reaping sustainable socioeconomic benefi ts. iv END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Fortunately, malnutriti on does not require ‘space science’ knowledge, but it does require informati on. District medical offi cers and others concerned need to inform families, through all appropriate media, that a human being needs the following basic nutrients: proteins for body building, carbohydrates for energy, and fats for body insulati on, as well as energy, minerals (iron, zinc, calcium, potassium, phosphorus, iodine, etc.), and vitamins (A, B, C, D, E, etc.). Along with proteins, minerals are important for body building and for co-ordinati on of body functi ons; so are vitamins. I extend my sincere appreciati on to all those who contributed to the development of this plan. Members of the Nutriti on Technical Committ ee and Nutriti on Forum are commended for a job well done. The donor community is appreciated for its support. I cannot overemphasise the role played by the Nati onal Planning Authority in co-ordinati ng the development of this plan. All these actors truly deserve our recogniti on and grati tude. Now, as Ugandans, we must all do whatever is possible in the fi ght against malnutriti on. So, I call upon all those concerned to support the quick enactment of the Food and Nutriti on Bill. This bill will establish a legal insti tuti on to co-ordinate diff erent nutriti on partners, ensure accountability in reaching the objecti ves of both the NDP and UNAP, and increase commitment of resources and experti se to scale up high-impact programmes and policies to improve nutriti on in our country. Since nutriti on is a cross-cutti ng issue with economic, socio-cultural, politi cal, and biomedical dimensions, it is imperati ve that all sectors of the economy play their roles to achieve the goal and objecti ves of this plan. I therefore call upon the Ministers of Agriculture, Animal Industry and Fisheries; Health; Trade and Cooperati ves; Educati on and Sports; Gender, Labour and Social Development; the General Public; Local Government; and the Private Sector, Civil Society and Faith-Based Organizati ons, as well as development partners, to support the implementati on of this acti on plan and align their programmes to it for a united response. We must act now: Our acti ons will send a message to the Ugandan people and the world that Uganda will not look on while its people are ravaged by malnutriti on. Truly, the price of malnutriti on in Uganda today and in the future is too high to ignore. For God and My Country Yoweri Kaguta Museveni President of the Republic of Uganda 29 September 2011 vEND MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Statement of Commitment Following upon the statement made at the United Nati ons General Assembly in September 2010 in New York by the Minister of Foreign Aff airs, Hon. Sam Kuteesa, in which Uganda committ ed itself to tackling the crisis of malnutriti on in the country, a concerted eff ort was set in moti on to respond to the hitherto persistent malnutriti on problem in the country. The eff ort was led by the Nati onal Planning Authority and was aimed at developing a concrete acti on plan with measurable and ti me-bound interventi ons. We, as a government, found the high malnutriti on rates reported in various surveys over the years completely unacceptable. We all supported the new resolve to prioriti se eradicati on of malnutriti on from Uganda as one of the most viable strategies for achieving the Millennium Development Goals. The rati onale for this strategy is that nutriti on forms the basis for most other areas of human development. Conversely, malnutriti on undermines an enti re person’s life. We have therefore adopted the Scaling Up Nutriti on (SUN) strategy of focused interventi ons covering the 1,000-day window of opportunity directed at women in the reproducti ve age bracket, newborns, and young children under the age of 2 years. To add technical content to this expression of politi cal will, a Multi -Sectoral Technical Committ ee was set up to conceptualise and draft this acti on plan. The membership of the committ ee included experts on nutriti on from several sectors of government, academic insti tuti ons, non governmental organisati ons (NGOs), and several internati onal organisati ons working in Uganda. Staff members of the Nati onal Planning Authority provided acti ve and ti mely secretariat services for the committ ee. A comprehensive draft of the Uganda Nati onal Acti on Plan (UNAP) for use in stakeholder consultati ons was completed in early December 2010. Separate structured consultati ons were held with several stakeholder groups, including senior government offi cials, representati ves of local government, the private sector, civil society organisati ons, and development partners, between December 2010 and June 2011. The draft UNAP was also formally submitt ed for review to all of the ministries that will be involved in the implementati on of the acti on plan. Comments and suggesti ons submitt ed through all of these reviews and consultati ons were incorporated by the technical committ ee into this fi nal version of the UNAP. cabinet, under the chairmanship of H. E. the President, Yoweri Kaguta Museveni, adopted the plan on Wednesday, 28 September 2011. Sincere grati tude is due to the individuals and insti tuti ons that played a leading role in the draft ing of the UNAP. Notably, the government wishes to recognise offi cers from the ministries of Agriculture, Animal Industry and Fisheries; Health; and Educati on and Sports; and the Nati onal Planning Authority who parti cipated in the technical committ ee. We also wish to recognise the specifi c technical or fi nancial contributi ons to the UNAP formulati on process made by experts and partners from Makerere and Kyambogo universiti es, the Uganda Nati onal Academy of Sciences, the Food and Nutriti on Technical Assistance II Project, the World Food Programme, vi END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 the Internati onal Food Policy Research Insti tute, World Vision, the World Health Organisati on (WHO), UNICEF, the Food and Agriculture Organizati on,the Intergovernmental Authority for Development, and the United States Agency for Internati onal Development. The process was rigorous, and the development of the UNAP would not have been possible without the combined and unti ring eff orts of these individuals and organisati ons. Although formal responsibility for improving nutriti on in Uganda is mandated to the Ministry of Agriculture, Animal Industry and Fisheries and the Ministry of Health, successfully addressing the problem of malnutriti on necessarily requires the engagement of several other sectors in a joint eff ort. Ensuring that all Ugandans are well nourished and able to live long, healthy, acti ve, and creati ve lives requires that every Ugandan has access to a high-quality and suffi cient diet, good health services, clean water, adequate sanitati on, and, perhaps most importantly, proper knowledge on how to provide for the nutriti onal needs of themselves and those that they care of. All of these services are needed for the nutriti onal security of Ugandans. The responsibiliti es for the provision of public services related to all of these key determinants of improved nutriti on span a wide range of ministries within government. Addressing malnutriti on in Uganda therefore requires a multi -sectoral commitment across all of government. Consequently, we the undersigned commit ourselves and the ministries we lead to do everything necessary to support the implementati on of this nutriti on acti on plan. We undertake to promote the provision of the required human, fi nancial, and other resources that may be necessary to achieve the objecti ves of this plan. We recognise that by ensuring that the mothers of Uganda and the children that they bear and care for are well nourished, we are establishing the best foundati on for Uganda’s development. We acknowledge our responsibility to the people of Uganda to see that this foundati on is solid. A Uganda in which all its citi zens are well nourished is a legacy of which we can all be proud. Rt Hon Henry Muganwa-Kajura 2nd Deputy Prime Minister & Minister of Public Service Hon Tress Bucyanayandi Minister of Agriculture, Animal Industry & Fisheries Hon Dr D Christi ne Ondoa Minister of Health Hon Lt Jessica Alupo Epel Minister of Educati on and Sports Hon Amelia Anne Kyambadde Minister of Trade and Cooperati ves Hon Syda Bbumba Minister of Gender, Labour and Social Development Hon Adolf Mwesige Minister of Local Government Hon Marti a Kasaija Minister of State, Finance, Planning and Economic Development (Planning) Holding the Portf olio of Minister of Finance, Planning and Economic Development …………………… …………………… …………………… …………………… …………………… …………………… …………………… ……………………. ………………………………………………………………………………………………………………………………………………………… ……… …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… ……… ……………… …………………………………………………………………………………………………… ……………………… … ………………………………………… ……………………………………………………………… ……………………. viiEND MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Acronyms and Abbreviati ons BMI Body mass index CAADP Comprehensive Africa Agriculture Development Programme CSO Civil Society Organisati on FNC Food and Nutriti on Council HIV Human Immunodefi ciency Virus M&E Monitoring and evaluati on MAAIF Ministry of Agriculture, Animal Industry and Fisheries MEMD Ministry of Energy and Mineral Development MFPED Ministry of Finance, Planning and Economic Development MGLSD Ministry of Gender, Labour and Social Development MOES Ministry of Educati on and Sports MOH Ministry of Health MOICT Ministry of Informati on, Communicati on, and Technology MOLG Ministry of Local Government MTC Ministry of Trade and Cooperati ves MWE Ministry of Water and Environment NDP Nati onal Development Plan, 2010–2015 NGO Non-governmental Organisati on NPA Nati onal Planning Authority OPM Offi ce of the Prime Minister SUN Scaling Up Nutriti on UDHS Uganda Demographic and Health Survey UFNP Uganda Food and Nutriti on Policy UNAP Uganda Nutriti on Acti on Plan WHO World Health Organisati on Exchange rate (August 2011): UShs 2,600 = US$1 viii END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 ixEND MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Executi ve Summary Nutriti on plays a crucial role in the socioeconomic development of any country. Malnutriti on accounts for about 35 percent of deaths among children under 5 years old around the world. Stunti ng, severe wasti ng, and intrauterine growth retardati on are the major contributors to child mortality, accounti ng for about 2 million deaths annually. Malnutriti on is the major cause of morbidity for all age groups, accounti ng for 11 percent of the disease burden globally. In additi on, iron defi ciency is the leading cause of maternal mortality, accounti ng for 20 percent of the esti mated 536,000 deaths worldwide. About 43 percent of all deaths among children under 5 occur in Africa. According to the Uganda Demographic and Health Survey (UDHS), 19 percent of the Ugandan populati on was malnourished in 2006, and 38 percent of children under 5 were stunted. This prevalence means that about 2.3 million young children in Uganda today are chronically malnourished. In additi on, 16 percent of children under 5 are underweight while 6 percent are wasted, and 12 percent of women are malnourished. The current levels of malnutriti on in Uganda are unacceptable. Therefore, nutriti on warrants greater investment and commitment for Uganda to realise its full development potenti al. Such an investment is a necessary prerequisite for further progress on the Millennium Development Goals and att ainment of the Nati onal Development Plan (NDP) objecti ves. While there has been some reducti on in the prevalence of child malnutriti on in Uganda over the past 15 years, the change has been slow. Child malnutriti on in Uganda remains largely a ‘hidden problem’; micronutrient defi ciencies are similarly diffi cult to detect. Malnutriti on remains one of Uganda’s most fundamental challenges for human welfare and economic growth. The ulti mate goal of the Uganda Nutriti on Acti on Plan (UNAP) is to reduce levels of malnutriti on among women of reproducti ve age, infants, and young children through 2016; ensuring that all Ugandans are properly nourished will enable them to live healthy and producti ve lives. However, it is parti cularly at the start of the life cycle where we must work together to ensure that all Ugandans are properly nourished. To att ain this, women of reproducti ve age must receive proper nutriti on so that when they are pregnant they are able to properly nourish their children from the ti me of concepti on unti l those children begin complementary feeding. Interventi ons to prevent malnutriti on have the greatest benefi t during these 1,000 days. Only by doing this will Uganda have in place the nutriti onal foundati on of an intelligent, creati ve, and healthy populati on from which to build a bett er and more prosperous future. This is why the UNAP focuses on young children and mothers and seeks to scale up eff orts to ensure that all Ugandan children are properly nourished from the day they are conceived. Improving young child and maternal nutriti on in Uganda through 2016 will have the following benefi ts:  Reduce the number of maternal deaths by more than 6,000 and child deaths by more than 16,000 every year x END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016  Increase nati onal economic producti vity, both physical and intellectual, by about UShs 130 billion per year at present value  Provide a strong return on public investment: For every UShs 1,000 invested, about UShs 6,000 worth of increased producti vity will result from reduced child stunti ng, improved maternal health, enhanced micronutrient intake, and improved nutriti on care Investi ng in nutriti on makes economic sense, and the economic benefi ts far outweigh the investments required for scaling up nutriti on programmes. The poor state of nutriti on in Uganda highlights the need for strategic interventi ons to enable government at various levels to meet its obligati ons toward the many malnourished Ugandans. It is in view of comprehensively addressing these problems that the UNAP has been formulated as a guide for acti on for the Uganda Food and Nutriti on Policy (UFNP) that was approved by government in 2003. The UNAP presents the agenda of acti on that the Government of Uganda will pursue to fulfi l legally binding nati onal, regional, and internati onal obligati ons to reduce and eliminate malnutriti on. The design of the UNAP was guided by several concerns. These include vulnerability and gap analyses, att enti on to human rights and gender diff erences, decentralisati on, and the cross sectoral nature of eff ecti ve measures that can redress malnutriti on. Nutriti on issues are cross cutti ng, and with no strong sectoral advocates for nutriti on, it can easily be ignored or addressed in an unco-ordinated manner. Many of the acti ons that are needed to address malnutriti on are already within the mandates of the various sectors, most notably agriculture, health, trade, gender and social development, water and environment, and educati on. It is criti cal that these sectors undertake the nutriti on-related acti viti es for which they are responsible and are held accountable for doing so. The UNAP seeks to minimise duplicati on of eff ort and confl icts of interest that tend to misdirect scarce public and private resources. 1END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 PART I: OVERVIEW 1. Introducti on Malnutriti on is a major development concern in Uganda, aff ecti ng all regions of the country and most segments of the populati on. The current levels of malnutriti on hinder Uganda’s human, social, and economic development. Although the country has made tremendous progress in economic growth and poverty reducti on over the past 20 years, its progress in reducing malnutriti on remains very slow. The ulti mate objecti ve of the Uganda Nutriti on Acti on Plan (UNAP) is to ensure that all Ugandans are properly nourished so that they can live healthy and producti ve lives. However, it is at the start of life in parti cular that we must work together to ensure that all Ugandans are properly nourished. To att ain this goal, women of reproducti ve age (15–49 years), must receive proper nutriti on so that when they are pregnant, they can properly nourish their children from the ti me of concepti on unti l those children begin complementary feeding. These same women must receive relevant informati on and the health services to properly feed and care for their children so that they grow strong, smart, and healthy. Only by doing this will Uganda have in place the nutriti onal foundati on of an intelligent, creati ve, and healthy populati on from which to build a bett er and more prosperous future. It is for this reason that the UNAP focuses on young children and mothers, both actual and potenti al, and seeks to scale up eff orts to ensure that all Ugandan children are properly nourished from the day they are conceived. According to the three most recent Uganda Demographic and Health Surveys (UDHS), although some nutriti on indicators for young children and their mothers have improved over the past 15 years, the improvement has been minimal. For example, in 1995, 45 percent of children under 5 years old in Uganda were short for their age (stunted); 10 years later, the prevalence of stunted under-5s had fallen to only 39 percent (UDHS 2006). Other indicators have actually worsened over that 15-year period.1 Stunti ng indicates chronic malnutriti on in children; the stunti ng prevalence rate of 39 percent means that about 2.3 million young children in Uganda today are chronically malnourished. As noted, the meagre improvements in ensuring the nutriti onal well-being of Ugandan children stand in stark contrast to the large gains in economic growth and poverty reducti on over this period. Many of the nutriti on problems that women and children experience in Uganda are hidden. Micronutrient defi ciencies are common among both groups. Vitamin A defi ciency aff ects one out of fi ve young children and women of reproducti ve age, resulti ng in impaired resistance to infecti on and consequently higher levels of illness and mortality, as well as potenti ally severe eye problems. 1 See the UDHS and FHI 360/FANTA-2, 2010, The Analysis of the Nutriti on Situati on in Uganda, htt p://www. fantaproject.org/downloads/pdfs/Uganda NSA May2010.pdf. 2 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016  Iron-defi ciency anaemia aff ects three-quarters of children 6–59 months old and half of women of reproducti ve age. Anaemia in women leads to chronic fati gue and impairs producti vity, earnings, and caregiving abiliti es. Pregnancy complicati ons, premature birth, low birth weight, and even maternal mortality all arise from iron defi ciencies in women. In children, anaemia leads to a signifi cant slowdown in cogniti ve development, decreased physical acti vity, and reduced resistance to disease. The prevalence of zinc defi ciency ranges from 20 percent to 70 percent in young children and 20 percent to 30 percent in adults. Zinc defi ciency results in poor growth, reduced resistance to infecti ous diseases, and increased incidence of sti llbirths. Figure 1. Malnutriti on’s Impact on Producti vity during the Life Cycle and across Generati ons2 Malnutriti on among Uganda’s young children and mothers has signifi cant economic costs for the malnourished individuals, their households and communiti es, and the nati on as a whole. These costs stem from the need to deal with an increased disease burden and other physical and mental problems related to malnutriti on and the enormous reducti ons in human potenti al and economic producti vity throughout life caused by hunger and malnutriti on. As shown in Figure 1, malnourished children suff er from irreparable stunted physical growth. Hungry children make poor students and are prone to drop out of the educati onal system. Hungry and malnourished adults are unable to be fully producti ve workers and are more likely to be ill, increasing the strain on oft en overburdened health systems. Malnourished, stunted women give birth to low birth weight babies, transferring the broad economic disadvantages of malnutriti on in their own lives to the next generati on. The aggregate costs of malnutriti on at the nati onal level impose a heavy burden on eff orts to foster sustained economic growth and improved general welfare. 2 Adapted from the United Nati ons Administrati ve Committ ee on Coordinati on/Sub-Committ ee on Nutriti on (ACC/SCN) (2000), 4th Report on the World Nutriti on Situati on, Geneva: ACC/SCN in collaborati on with the Internati onal Food Policy Research Insti tute (IFPRI). Reduced physical labour capacity, OLDER PEOPLE Malnourished BABY Low birth weight CHILD Stunted ADOLESCENT Stunted WOMAN Malnourished PREGNANCY Low weight gain Inadequate food, health, and care Reduced capacity to care for child Higher mortality rate Impaired mental development Increased risk of adult chronic disease Inadequate catch-up growth Untimely / inadequate feeding Frequent infections Inadequate food, health, and care Reduced mental capacity Inadequate food, health, and care Inadequate food, health, and care Higher maternal mortality Inadequate foetal nutrition Inadequate infant nutrition lower educational attainment, restricted economic potential, shortened life Reduced physical labour capacity, lower educational attainment 3END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 The principal points of interventi on to break this cycle of malnutriti on are: Address the nutriti onal needs of the young child from concepti on through about 24 months  Ensure the nutriti onal well-being of the mother of the child even before she becomes pregnant For young children, the period from concepti on to their second birthday is characterised as the 1,000 days of opportunity to eff ecti vely and sustainably address malnutriti on. Interventi ons to prevent malnutriti on have the greatest benefi t during these 1,000 days. Interventi ons aft er the second birthday can make a diff erence but oft en cannot undo the damage done by malnutriti on during the fi rst 1,000 days. This is seen in Figure 2, which shows that the percentage of young children in Uganda who are stunted increases sharply from 6 months up to 2 years, with a parti cularly steep rise from the ages of 6 to 18 months. Relati vely litt le change, positi ve or negati ve, is seen in the general nutriti onal conditi on of children aft er age 2 years. For these reasons, the objecti ve of the UNAP is to stop the rapid rise in levels of chronic malnutriti on among children in their fi rst 2 years of life. Figure 2. Prevalence of Stunti ng, Underweight, and Wasti ng among Young Children in Uganda, by Age in Months Beyond the young child, acti on also is needed to address maternal nutriti on needs so that children are properly nourished from concepti on. Healthy, well-nourished mothers are considerably more likely to give birth to and be able to nurture and raise healthy children. While women who are pregnant or caring for an infant must receive a range of nutriti on-related services and informati on, adolescent girls (10–14 years) will also be targeted under the UNAP. Ensuring the proper nutriti on of these future mothers will result in their experiencing pregnancies and Pe rc en t 60 50 40 30 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 Age (months) Stunted Underweight The window of opportunity outside the womb 4 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 deliveries that are less prone to problems and giving birth to healthier babies who have a good birth weight. Hence, the focus of the UNAP includes both the children and the mothers of today and of the future. The Government of Uganda is committ ed to achieving its development objecti ves set out in the 2010–2015 Nati onal Development Plan (NDP)—Uganda’s master development framework— which are also consistent with the internati onal Millennium Development Goals. In the NDP, the commitment was made to signifi cantly reduce the levels of malnutriti on in the Ugandan populati on in the next 5 years and beyond. The NDP’s theme of ‘Growth, Employment, and Socioeconomic Transformati on for Prosperity’ cannot be achieved if the populati on is unhealthy and if children and women conti nue to face problems related to malnutriti on. In additi on, Uganda cannot achieve its objecti ves of reducing the high rates of infant, child, and maternal mortality. (Most of the deaths are directly att ributed to preventable diseases, such as pneumonia, diarrhoea, and malaria. Malnutriti on is the underlying cause of death in nearly 60 percent and 25 percent of infant and maternal deaths, respecti vely.) Over the next 5 years, the UNAP’s goal is to focus public resources and nati onal eff orts to bring about sharp improvements in nutriti on among young children and women of reproducti ve age by scaling up the implementati on of a package of proven and cost-eff ecti ve interventi ons. The UNAP focuses on young children and their mothers to operati onalise the nutriti on component of the NDP, as well as the Uganda Food and Nutriti on Policy (UFNP) and the draft Uganda Food and Nutriti on Strategy. The UNAP will also foster acti on to address sectoral prioriti es, such as those laid out in the Health Sector Strategic and Investment Plan and the Agricultural Sector Development Strategy and Investment Plan. Improving young child and maternal nutriti on in Uganda over the next 5 years will have the following outcomes. • Every year the number of maternal deaths will be reduced by more than 6,000 and the number of child deaths will be reduced by more than 16,000. • Nati onal economic producti vity, in terms of both physical and intellectual output, will be increased by an esti mated UShs 130 billion per year at present value. • There will be a strong return on public investment: For every UShs 1,000 invested, about UShs 6,000 worth of increased producti vity will result from reduced child stunti ng, improved maternal health, enhanced micronutrient intake, and improved nutriti on care; investi ng in nutriti on makes economic sense, with the economic benefi ts far outweighing the investments required for scaling up nutriti on programmes. Factors leading to high levels of malnutriti on in Uganda cut across many sectors. To guide public acti on to address maternal and young child malnutriti on in Uganda, the UNAP recognises that cross-sectoral, inter-agency collaborati on is necessary. This acti on plan prioriti ses multi -sectoral interventi ons that will have the quickest impact on improving key nutriti on indicators. The interventi ons are grouped under fi ve themati c objecti ves: 1. Improve maternal, infant, and young child nutriti on and health to increase the likelihood of healthy pregnancy and infancy and proper physical and mental growth 5END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 2. Increase the target populati ons’ consumpti on of diverse nutriti ous foods by increasing the producti on of and access to micronutrient-rich foods at the household and community levels 3. Miti gate and respond to the impact of acute malnutriti on by providing nutriti on care for children and mothers who are ill and providing nutriti on services in emergencies 4. Strengthen the legal and insti tuti onal frameworks and the capacity to eff ecti vely plan and implement nutriti on programmes in the country 5. Advocate for increased resources for scaling up nutriti on interventi ons to address the needs of young children and mothers and to create awareness among the general populati on of the human, social, and economic costs of malnutriti on. 2. Policy Context This acti on plan to address the nutriti onal needs of young children and women of reproducti ve age in Uganda was developed within the context of a specifi c set of policy and legal frameworks. The Consti tuti on of the Republic of Uganda requires the state to encourage and promote good nutriti on to build a healthy Uganda. It further mandates the Ministry of Health (MOH) and the Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) to set minimum standards and develop relevant policies to ensure provision of quality food and nutriti on services in the country. The NDP has incorporated nutriti on as a cross-cutti ng issue that requires multi -sectoral acti on in at least four key sectors: health; agriculture; educati on; and gender, labour, and social development. This is a clear testi mony to Uganda’s understanding that tackling nutriti on problems will contribute to the att ainment of its broader development goals. Given the historical challenges to cross-sectoral nutriti on programming in Uganda, the UNAP has been designed with the full parti cipati on of all stakeholders involved in nutriti on. Implementati on and monitoring and evaluati on (M&E) of the UNAP will follow a similar approach. Under the joint leadership of MOH and MAAIF in exercising their consti tuti onal mandate, the UFNP was developed in 2003. Thereaft er, a Nati onal Food and Nutriti on Strategy was draft ed, as was a Food and Nutriti on Bill (2008) to put in place statutory regulati ons and insti tuti ons for implementi ng the UFNP, in parti cular the Uganda Food and Nutriti on Council (FNC). The UNAP draws much of its content from these documents in seeking to operati onalise eff orts to eff ecti vely implement the UFNP. At the sectoral level, the Health Sector Strategic and Investment Plan identi fi es nutriti on as part of the Nati onal Minimum Health Care Package for Uganda, while the Agricultural Sector Development Strategy and Investment Plan and the draft Nati onal Agriculture Policy recognise food and nutriti on security as key factors for the country’s social and economic development. Also, nutriti on and food security are central components in the draft School Health Policy, the draft School Feeding Policy Guidelines, and the Nati onal Orphans and Other Vulnerable Children Policy. 6 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 At the internati onal level, the UNAP also builds on several agreements to which Uganda is a signatory. These include: • Internati onal Conference on Nutriti on, 1992 • World Food Summit, 1996 • Declarati on on the Millennium Development Goals, 2000, and the follow-up summit in 2010 • Scaling Up Nutriti on Initi ati ve • Internati onal Covenant on Economic, Social and Cultural Rights • Conventi on on Eliminati on of All Forms of Discriminati on Against Women • Internati onal Health Partnerships and related initi ati ves At the regional level, Uganda adopted the African Regional Nutriti on Strategy of the African Union. The strategy’s main focus is to advocate for renewed commitment to nutriti on, intensify member states’ eff orts to sustainably address malnutriti on in the wake of the worsening nutriti on status of vulnerable groups across Africa, and sti mulate acti ons at nati onal and regional levels that result in improved nutriti on outcomes. (In light of the above, at the 2010 summit of African Union heads of state, hosted by Uganda, member states approved the establishment of an Africa Food and Nutriti on Day to be commemorated each year on 31 October to remind Africa of the constant need to address its nutriti on problems.) Uganda has also adopted the Comprehensive Africa Agriculture Development Programme (CAADP), an African Union-driven initi ati ve for substanti ally improving agricultural producti on. Nutriti on and food security are one of the four pillars of the CAADP. 3. Situati on and Problem Analysis Uganda has made progress in reducing HIV, malaria, and tuberculosis; produces suffi cient food nati onally to meet the needs of its populati on; and has experienced a signifi cant reducti on in poverty levels, from 39 percent in 2002 to 23 percent in 2009–2010. However, the levels of malnutriti on among women and young children have improved only minimally and some indicators, like micronutrient defi ciency, have even worsened over the past two decades. Among children, while there has been some reducti on in the prevalence of malnutriti on in Uganda over the past 15 years (Figure 3), the change is slow. Moreover, child malnutriti on in Uganda remains largely a ‘hidden problem’. Most children aff ected are moderately malnourished, which is diffi cult to identi fy without regular assessment. Micronutrient defi ciencies are similarly diffi cult to detect. 7END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Figure 3. Nati onal Trends in the Prevalence of Malnutriti on among Children under 5 Sources: UDHS 1995, 2001, and 2006 50 45 45 39 22 19 16 7 5 6 WastedUnderweightStunted 40 30 20 10 0 Pe rc en t o f u n d er 5 s 1995 2001 2006 Among women of reproducti ve age, more than 12 percent were found to be underweight in 2006, with a body mass index (BMI) of less than 18.5 kg/m2. Iron-defi ciency anaemia remains the most serious micronutrient defi ciency faced by Ugandan women. In additi on, Uganda is faced with a double burden of malnutriti on—the increasing co-existence of obesity and malnutriti on in communiti es across the country. The 2006 UDHS showed high levels of overweight among women living in urban centres, as well as in many rural areas of Western and Central regions. 3.1 Causes of High Rates of Malnutriti on in Uganda There are several interconnected causes of child malnutriti on in Uganda, as seen in Figure 4, ranging from policy issues to immediate household conditi ons to underlying community and cultural situati ons. The immediate causes of child malnutriti on in Uganda are two-fold: inadequate dietary intake resulti ng from subopti mal maternal and infant feeding practi ces and the high disease burden resulti ng from malaria, diarrhoeal diseases, acute respiratory infecti ons, and worm infestati ons. There are three broad underlying causes of inadequate dietary intake and high disease burden: 1. Household food insecurity (mainly related to poor access to the range of foods needed for a diversifi ed diet). An added element of this is that the foods that households frequently consume are relati vely defi cient in micronutrients. Seasonality in food producti on, variable food prices, and seasonal earning patt erns exacerbate the instability and the poor quality of the diet the household consumes through the year. 2. Inadequate maternal and child care. Care-related constraints lead to both inadequate dietary intake and a high disease burden in young children. These constraints include the heavy workload that women as primary caregivers in the household must shoulder every day. Women do both farm and household chores and might engage in small business 8 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 acti viti es, while also being responsible for the conti nual care of the children and other dependents within the household. Frequent births limit a woman’s ability to properly care for her infant and other young children, while simultaneously regaining her own health. In additi on, social dislocati on in many households and communiti es in Uganda has led to changes in traditi onal gender roles and increased family breakups. These changes tend to worsen the quality of the nutriti on and health care women and young children receive. 3. Poor access to health care and a healthy environment. In far too many cases, young children do not live in a healthy environment with good access to toilets and other sanitati on services, a reliable safe water supply, and eff ecti ve health faciliti es and services, including nutriti on services, such as micronutrient supplementati on and nutriti on educati on. 9END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Figure 4. The Causes of Young Child Malnutriti on in Uganda Malnourished young child Inadequate dietary intake Poor feeding frequency Poor feeding prac ces tly diverse diets Frequent illness Malaria, diarrhoea, infec ons Too early & improper weaning Late seeking of health care Household food insecurity Poor access to divers d foods Low nutrient content of foods; low use of for ed foods Seasonal ctu on in food supply and diet quality Low agricultural p ty Inadequate maternal & child care High daily workload for women Teenage pregnancy and too frequent births Lack of knowledge of good carin Poor access to health care and healthy environment Improper n and hygiene; unsafe water sources Poor food safety Poor access to health care & nutri on support services Livelihoods Limited -farm work opportuni es; capital to develop businesses scarce Poor access to land, inform , & inputs to improve farm produ on In ve farming support services Few adapted tools for produ on Culture, educ on, awareness Maternal educ en limited Tr l may adversely ect maternal & child feeding and health & repro ve care t access to household economic resources by primary caregiver Policies Limited policy guidance to facilitate private sector investment in nutri on Policies and legal instruments lacking for nutri on planning structures and g Mechanisms absent for l and district mu -sectoral coordin on & accountability Financing Earmarked budget alloca s across sectors to scale up hig Admini ve and budgetary g of nutri on in the sectors at na onal and district levels generally unclear Support to sectoral vi es to improve nutri on not considered to be priority expenditure Policy & leadership commitment to improved nutri on Low awareness of the role of nutr on in the l development agenda Poor appreci on of evidence of what n Inadequate human capacity in nutri on policy & programme design and analysis Immediate causes: Underlying causes: Basic causes: 10 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 The nature of the underlying causes of child malnutriti on is largely dependent on how available resources are distributed within Uganda. The availability of nutriti on resources at the household level is linked to a set of basic causes. Basic/root causes are a functi on of how society operates in terms of livelihood opportuniti es and economic structure, the availability of knowledge both through cultural insti tuti ons and formal and informal educati on, politi cal expectati ons and policies, the prioriti es guiding the allocati on of public funding and other resources, and the quality of social and politi cal leadership. It is principally in this area of basic causes that acti on to address child malnutriti on moves from the realm of the individual and household to the politi cal arena and where policy, public administrati on and expenditure, and governance issues come to the fore. One of the important causes of the conti nuing high levels of young child malnutriti on in Uganda is the fact that there is generally litt le awareness that nutriti on is criti cal to the country’s economic development and to eff orts to reduce child and maternal mortality. The inadequate politi cal commitment and public funding for nutriti on have limited the development of policies and legislati on to create the environment for increased investment in nutriti on. In additi on, the lack of politi cal support has hindered the country’s ability to establish the necessary structures for co-ordinati ng acti on to address young child and maternal malnutriti on; to develop an M&E framework to improve these eff orts; and to strengthen human capacity for nutriti on analysis, programme design, and implementati on in Uganda. 3.2 Consequences of High Rates of Malnutriti on in Uganda A. Malnutriti on kills many Ugandans each year. • Low birth weight is rampant in Uganda. More than 16,000 children who were born weighing less than 2.5 kg died in 2009. Other forms of malnutriti on were associated with more than 67,500 child deaths in 2009.3 • Anaemia aff ects 49 percent of women. Without any interventi on, 15,000 mothers will die of anaemia-related causes between 2006 and 2015. One in three of these deaths could be prevented if Uganda doubled its coverage of iron supplementati on among pregnant women. B. Malnutriti on signifi cantly reduces agricultural producti vity. • Uganda’s main employer, the agriculture sector, lost more than US$34 million worth of producti vity in 2009 alone due to iron-defi ciency anaemia in the adult populati on. Other losses to agriculture occurred as a result of ti me lost due to illnesses associated with other types of malnutriti on or ti me lost while dealing with family illnesses or deaths associated with malnutriti on. 3 Data are from PROFILES, a process developed by FHI 360 with USAID funding for nutriti on policy analysis and advocacy that uses spreadsheet models to esti mate the functi onal consequences of malnutriti on. For more informati on, see the Uganda Nutriti on Advocacy Profi les at htt p://www.fantaproject.org/publicati ons/uganda advocacy2010.shtml. 11END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 C. Malnutriti on contributes to poverty in Uganda. • Uganda loses US$310 million worth of producti vity per year due to the high levels of stunti ng, iodine-defi ciency disorders, iron defi ciency, and low birth weight, and malnutriti on contributes to a loss of about 4.1 percent of the gross domesti c product per year. • Malnutriti on is expensive to treat. For instance, treati ng severe acute malnutriti on costs more than US$120 per child. D. Malnutriti on aff ects the educati on and intellectual potenti al of schoolchildren. • Between 2006 and 2015, iodine-defi ciency disorder will cause 19,300 children to be born as creti ns and 543,000 children to be born with mild or moderate mental disabiliti es. • Stunti ng causes children to start school late because they look too small for their age. In 2006, one in four 7-year-olds had not started school, even with the Universal Primary Educati on programme. • Malnutriti on will also be a cause of absenteeism and repeti ti on of school years. As the causes and consequences of malnutriti on are multi -dimensional, eff ecti vely addressing the problem requires an integrated approach with broad cross-sectoral politi cal support. While cross-sectoral co-ordinati on increases the challenges in implementi ng eff ecti ve programmes, these challenges are not insuperable, parti cularly if eff ecti ve leadership is brought to the issue. Table 1 below provides the gap analysis for scaling up public nutriti on acti on in Uganda that was developed through stakeholder consultati ons. This exercise involved comparing recent performance in Uganda in addressing young child and maternal malnutriti on with potenti al and desired performance. Table 1. Gap Analysis for Scaling Up Nutriti on Interventi ons in Uganda Gap Current performance Opportuniti es for improvement Weak advocacy  Limited recogniti on by  Emerging commitment for improving for nutriti on at government and general nutriti on in the country all levels populati on of the centrality  Food and Nutriti on Bill draft ed, awaits of improved nutriti on to enactment by parliament to empower the development FNC  Low prioriti sati on of nutriti on by  Nutriti on is integrated in various policy government and implementers documents, including the Consti tuti on of  Weak leadership for nutriti on Uganda and the NDP across all sectors  Government staff structure that allows for  Limited advocacy skills among strengthening human capacity; for example, nutriti on stakeholders nutriti onists recruited in health system  Lack of commitment to achieve and agricultural extension and community the nati onal nutriti on agenda development offi cers at sub-county levels  No communicati on strategy for  Increasing commitment to nutriti on from nutriti on development partners  Inadequate number of nutriti on acti vists 12 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Gap Current performance Opportuniti es for improvement Weak infra-  Nutriti on inadequately  Nutriti on incorporated in the curricula at structure to mainstreamed into existi ng all educati on levels support quality sectoral programmes  In-service training curriculum now being nutriti on  Poor appreciati on of centrality of reviewed programming nutriti on to development  Nutriti on offi cer posts established at at all levels,  Low recruitment, poor district levels including lack of professional growth  Agriculture, educati on, and gender have equipment and opportuniti es, and poor wide-reaching structural frameworks that skilled human retenti on of nutriti onists due to can be uti lised to fi ll gaps in nutriti on resources low prioriti sati on of nutriti onists experti se as cadres of the civil service  Increasing appreciati on of the role of  Lack of a comprehensive nutriti on as a preventi ve health mechanism nutriti on curriculum and training  Training and informati on, educati on, and plan for in-service capacity communicati on materials on nutriti on in strengthening of personnel who Uganda available for local adaptati on do not specialise in nutriti on  Development partners supporti ve of  Lack of incenti ves for nutriti on capacity strengthening in nutriti on personnel in all sectors Weak co-  Lack of co-ordinati on structure  Presence of Nati onal Planning Authority ordinati on and to link sectors on nutriti on to co-ordinate multi -sectoral eff orts on inadequate programming nutriti on programming and M&E implementati on  Lack of a nati onal nutriti on  Nati onal co-ordinati on forum for nutriti on of policy agenda to act as a reference stakeholders to meet regularly guidelines point for implementers  Several stakeholders strongly committ ed to  Existi ng food and nutriti on support nutriti on initi ati ves policy and other guidelines not  Some nutriti on policies and guidelines adequately implemented and in place for implementati on, including disseminated infant and young child feeding, HIV, food forti fi cati on, and micronutrient supplementati on Weak system  Lack of a nati onal nutriti on  Existi ng and forthcoming survey datasets for informati on database and informati on with nutriti on content management system  Supporti ve development partners and limited  Lack of standardised data  Nati onal nutriti on indicators established. research on collecti on and analyti cal tools  Some surveillance systems for nutriti on changing  Low demand for nutriti on and food security established innovati ons in informati on nutriti on  Weak co-ordinati on, informati on sharing, and adaptati on of promising practi ces  Lack of a nati onal nutriti on research agenda 13END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Gap Current performance Opportuniti es for improvement Low  Curati ve health services seen as  Development partners and government involvement of more important than preventi ve interested in integrati ng nutriti on in communiti es in  Nutriti on acti viti es that oft en community development models nutriti on do not promote community  Role of community appreciated involvement; few good models  Communiti es willing to parti cipate for community engagement  Support for operati onal research available  Inadequate public knowledge on importance of good nutriti on  Few community organisati ons involved in nutriti on  No regular incenti ves in place for community nutriti on volunteers Low coverage  High dependence on  Local producti on of enriched foods of nutriti on development partners increasing services at  Inadequate knowledge about  Commitment by government and all levels, food supplementati on development partners parti cularly  Limited data on nutriti on needs  Increasing interest in the private sector in the private sector 14 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 PART II: THE STRATEGIC DIRECTION 4. Acti on Plan Target Groups and Broad Strategies 4.1 Target Groups As discussed earlier, diff erent forms of malnutriti on aff ect diff erent groups of Ugandans. However, investments in preventi ng malnutriti on yield the greatest returns during the ‘window of opportunity’, the 1,000 days from concepti on through the 9 months of pregnancy to the child’s second birthday. As such, the UNAP, while seeking to address in a substanti ve manner the enti re scope of the malnutriti on problem in Uganda, will focus on infants, young children, and mothers, both women of reproducti ve age and adolescent girls who will become mothers in later years. Uganda has about 2.7 million children under 2 years old, 7.1 million women of reproducti ve age, and 2 million adolescent girls. These groups account for about 37 percent of Uganda’s total populati on. Eff ecti vely addressing the nutriti onal needs of infants and young children will arrest a lifeti me of problems that malnourished children face and will reduce the burdens they impose on the household, the community, and the nati on. The nutriti onal conditi on of the women who bear these children is equally important, as the health and nutriti onal well-being of the newborn is determined by the health and nutriti onal well-being of its mother. However, these two target groups cannot be served in isolati on. Most causes of malnutriti on are linked to practi ces or access to resources at the household or community level. As a result, the UNAP will directly and indirectly address the nutriti onal needs of all Ugandans, parti cularly the most vulnerable, leading to a sustained decline in the numbers of malnourished Ugandans. 4.2 Broad Strategies to Reduce Malnutriti on in the Plan Period (2011–2016) To eff ecti vely meet the nutriti on needs of the target groups, the UNAP will seek to: 1. Address the multi ple causes of malnutriti on among young children in Uganda. This will be done by building linkages between key sectors in both the public and private arenas. Intra and inter-sectoral linkages, public-private partnerships, co-ordinati on, and collaborati on will be strengthened to facilitate adequate nutriti on advocacy, programming, and M&E. 2. Implement proven high-impact interventi ons in reducing young child and maternal malnutriti on. Most interventi ons will be in the areas of producti on of nutriti ous food, nutriti on care within the household, public health, and livelihood support. 3. Identi fy and implement cost-eff ecti ve nutriti on programme models that are scalable at both district and nati onal levels. Such models will involve behaviour change and social marketi ng, forti fi cati on of common staple foods, use of bio-forti fi ed produce, and 15END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 micronutrient supplementati on programmes, among others. 4. Equip local insti tuti ons to provide leadership and capacity in nutriti on policy and programming. This will include the legal establishment of the FNC and its secretariat. The ability of key public sectors to fi nance nutriti on programmes and research with local or external resources will be strengthened. Policies and incenti ves will be established to enable the private sector and local governments to increase their investments in nutriti on. 5. Plan nutriti on programmes appropriately. Whenever possible, the programmes will be planned, managed, and implemented at community and local government levels in a cross-sectoral manner. The UNAP will target geographic areas where young child and mothers are most vulnerable to malnutriti on. The UNAP will therefore focus on the following four broad acti on areas: 1. Promoti ng key maternal, infant, and young child feeding and nutriti on practi ces to improve awareness and increase targeted healthy feeding behaviours. These include breastf eeding, appropriate complementary feeding, dietary diversifi cati on, and increased coverage of micronutrient supplementati on programmes. 2. Supporti ng households and communiti es to increase access to and consumpti on of diversifi ed foods throughout the year through their own food producti on or purchased food. Complementary programmes will focus on reducing post-harvest losses and spoilage and on addressing issues related to women’s workload within the household. 3. Providing care and support to individuals with severe acute malnutriti on. 4. Mobilising the community to promote the adopti on of healthy nutriti on behaviours, community-based growth monitoring and promoti on, two-way referral of malnourished cases for care at either the community or the health facility level, and increased public awareness of the centrality of nutriti on to community and nati onal development. Appropriate materials and tools will be employed to: 1. Facilitate behaviour change, using nutriti on informati on, educati on, and communicati on materials 2. Provide nutriti on care and support 3. Collect informati on on the nutriti onal conditi on of the target groups and all Ugandans over ti me for analysis and use in programming To support priority nutriti on areas and their complementary acti viti es, key structural functi ons will be invested in insti tuti ons that will be established or strengthened at nati onal, district, sub county, and community levels in both government and private arenas, as provided for in the Food and Nutriti on Policy and the draft Food and Nutriti on Bill. Strengthened links between diff erent levels of nutriti on actors to enable informed and appropriate decisions for co-ordinated nutriti on programming across Uganda will also be an element of the implementati on of the UNAP. 16 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 5. Goal, Objecti ves, Strategic Interventi ons, and Core Projects 5.1 Goal The goal of the UNAP is to reduce malnutriti on levels among women of reproducti ve age, infants, and young children from 2011 through 2016 and beyond. Table 2 lists the key indicators that the UNAP will focus on. Table 2. Key Nutriti on Outcome Indicators Outcome indicator Baseline UNAP target 2016 1 Stunti ng: prevalence in children under 5, % 38 32 2 Underweight: prevalence in children under 5, % 16 10 3 Underweight non-pregnant women 15–49 years old with BMI less than 18.5 kg/m2, % 12 8 4 Iron-defi ciency anemia: prevalence in under-5s, % 73 50 5 Iron-defi ciency anemia: prevalence in women 15–49 years old, % 49 30 6 Vitamin A defi ciency: prevalence in under-5s, % 19 13 7 Vitamin A defi ciency: prevalence in women 15–49 years old, % 20 12 8 Low birth weight: newborns weighing less than 2.5 kg, % 13 9 9 Infants aged under 6 months who were exclusively breastf ed: % 60 75 10 Dietary diversifi cati on index: percentage of calories consumed from foods other than cereals and starchy roots 57 75 11 Calorie consumpti on: average daily energy intake per capita, kcal 2,220 2,500 Baseline data obtained from the 2006 UDHS and from FAO 2008. These indicators have been chosen to cover the two principal target groups of the UNAP—young children and women of reproducti ve age—and to consider both calorie and micronutrient consumpti on levels, principally by looking at defi ciencies in consumpti on as evidenced by stunted growth in children and underweight in children and women. Att enti on is also paid to nutriti on in pregnancy (as indicated by the infant’s birth weight), breastf eeding, and dietary diversity. 17END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 5.2 Objecti ves, Strategies, and Strategic Interventi ons To achieve the above goal and to improve the nutriti on status indicators, the following fi ve strategic objecti ves will be pursued through 2016. Objecti ve 1: Improve access to and uti lisati on of services related to maternal, infant, and young child nutriti on. Strategy 1.1: Promote access to and uti lisati on of nutriti on and health services to all women of reproducti ve age, infants, and young children. Interventi ons 1. Promote and support health and nutriti on educati on to increase the level of awareness of good nutriti on. 2. Promote integrati on of nutriti on services in all routi ne and outreach health services and programmes targeti ng children and mothers. 3. Manage nutriti on for sick children, pregnant women, lactati ng mothers, and other women of reproducti ve age. 4. Integrate management of severe and moderate acute malnutriti on into routi ne health services. 5. Promote uti lisati on of antenatal and post-natal care services among all pregnant women and lactati ng mothers. 6. Promote and support breastf eeding policies, programmes, and initi ati ves. 7. Promote and support appropriate complementary feeding practi ces. 8. Support and scale up community-based nutriti on initi ati ves. 9. Promote proper food handling, hygiene, and sanitati on through increased knowledge, use of safe water, and hand-washing practi ces at the household level. Strategy 1.2: Address gender and socio-cultural issues that aff ect maternal, infant, and young child nutriti on. Interventi ons 1. Promote male involvement in family health services and in food security and nutriti on programmes. 2. Advocate and seek soluti ons for reducing workload for all women, especially pregnant women and lactati ng mothers. 3. Address detrimental food taboos and norms that impair the nutriti on of women, infants, and young children. 18 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Objecti ve 2: Enhance consumpti on of diverse diets. Strategy 2.1: Increase access to and use of diverse nutriti ous foods at the household level. Interventi ons 1. Promote producti on and consumpti on of diversifi ed nutriti ous foods at the household and community levels. 2. Advocate for and support integrati on of nutriti on in agricultural programmes at the nati onal and local government levels. 3. Increase consumpti on of both raw and processed nutriti ous foods. 4. Promote and support local food processing and value additi on at the household and community levels. 5. Promote and support the uti lisati on of safe labour-saving technologies at the household and community levels. 6. Support the on-farm enterprise mix to promote stable diversifi ed food producti on. 7. Promote producti on and consumpti on of indigenous foods to enhance dietary diversifi cati on. 8. Promote positi ve indigenous dietary practi ces. Strategy 2.2: Enhance post-harvest handling, storage, and uti lisati on of nutriti ous foods at the household and farm levels. Interventi ons 1. Promote and support adopti on of post-harvest handling and storage technologies at the household and community levels. 2. Provide an enabling environment to the private sector to manufacture, market, and distribute appropriate post-harvest handling and storage technologies. Strategy 2.3: Promote the consumpti on of nutrient-enhanced foods. Interventi ons 1. Promote producti on of forti fi ed common staples by local manufacturers. 2. Promote producti on of bio-forti fi ed varieti es. 3. Promote consumpti on of nutrient-enhanced foods through increased awareness of their benefi ts. 4. Support local producti on of ready-to-use therapeuti c and complementary foods. 19END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Objecti ve 3: Protect households from the impact of shocks and other vulnerabiliti es that aff ect their nutriti onal status. Strategy 3.1: Develop preparedness plans for shocks. Interventi ons 1. Strengthen and scale up early warning systems on food and nutriti on informati on from the community to the nati onal level. 2. Support and promote urban farming to serve the most vulnerable households in urban areas. 3. Develop, promote, and implement in a ti mely fashion a comprehensive package of nutriti on services and food items to provide during emergencies and recovery periods. 4. Make integrati on of nutriti on in all disaster management programmes mandatory. 5. Promote and support diversifi ed producti on of drought-resistant crops, including vegetables, and raising of animals tolerant to heat stress at the household and community levels. 6. Carry out sensiti sati on programmes for communiti es to raise their awareness of preventi on, miti gati on, and response to risks of malnutriti on during shocks. Strategy 3.2: Promote social protecti on interventi ons for improved nutriti on. Interventi ons 1. Provide social transfers to and support livelihoods for the most vulnerable households and communiti es. 2. Develop and implement programmes for special social assistance and for livelihood promoti on and protecti on in areas with high levels of malnutriti on. 3. Advocate for and promote school feeding programmes. 4. Manage cases of severe acute malnutriti on by integrati ng care into routi ne health services and providing follow-up support and monitoring at the household and community levels. 5. Promote social protecti on interventi ons for improved nutriti on. Objecti ve 4: Strengthen the policy, legal, and insti tuti onal frameworks and the capacity to eff ecti vely plan, implement, monitor, and evaluate nutriti on programmes. Strategy 4.1: Strengthen the policy and legal frameworks for co-ordinati ng, planning, and monitoring nutriti on acti viti es. Interventi ons 1. Fast-track enactment of the Food and Nutriti on Bill, which will provide the statutory mechanism for establishing the FNC and its secretariat. 20 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 2. Revitalise and legalise the functi onality of the FNC and establish its secretariat/co ordinati ng unit. 3. Review the UFNP to integrate emerging issues. 4. Revise the draft Uganda Food and Nutriti on Strategy to align it with the prevailing nati onal, regional, and global nutriti on agenda and disseminate the strategy widely. 5. Advocate for the enactment of by-laws and ordinances that promote nutriti on and food security at district and sub-county levels. 6. Integrate nutriti on issues into plans and budgets at all levels of government by mainstreaming nutriti on and creati ng vote functi ons for nutriti on. 7. Support the development of nutriti on curricula for all levels of educati on and training. 8. Advocate for the establishment of lower- and middle-cadre nutriti on courses in the educati on structure. 9. Review and integrate nutriti on issues in the existi ng curricula of formal and non-formal educati on and in pre- and in-service training. Strategy 4.2: Strengthen and harmonise the insti tuti onal framework for nutriti on from the local to the central government level. Interventi ons 1. Review Uganda’s current insti tuti onal framework for nutriti on and implement a suitable one. 2. Establish an interim multi -sectoral co-ordinati on mechanism for nutriti on programming and M&E. 3. Strengthen insti tuti onal capacity for nutriti on programming at all levels in all sectors. Strategy 4.3: Strengthen human resource capacity to plan, implement, monitor, and evaluate food and nutriti on programmes in the country. Interventi ons 1. Design and implement a capacity-strengthening plan for nutriti on programming at the nati onal, local government, and community levels. 2. Establish a food and nutriti on M&E system for tracking performance of nutriti on indicators and for ti mely decision making. 3. Conduct a nati onal food and nutriti on survey to establish up-to-date nutriti on baseline monitoring indicators. 4. Conduct periodic district-level food and nutriti on surveys in vulnerable areas and among vulnerable populati ons. 5. Undertake mid-term and end-of-term impact evaluati ons of the UNAP. 6. Strengthen district-level food and nutriti on surveillance systems. 21END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Strategy 4.4: Enhance operati onal research for nutriti on. Interventi ons 1. Conduct formati ve research studies on best practi ces for nutriti on. 2. Research, document, and disseminate fi ndings on positi ve indigenous dietary practi ces. 3. Compile food compositi on data for all foods consumed in Uganda. 4. Identi fy and conduct research relevant to scaling up food and nutriti on interventi ons. 5. Collate and share research fi ndings and best practi ces for scaling up food and nutriti on interventi ons in Uganda. Objecti ve 5: Create awareness of and maintain nati onal interest in and commitment to improving and supporti ng nutriti on programmes in the country. Strategy 5.1: Increase awareness of and commitment to addressing nutriti on issues in the country. Interventi ons 1. Develop and implement a nutriti on communicati on strategy. 2. Produce annual policy statements and periodic policy briefs on the nati onal food security and nutriti on situati on. 3. Commemorate nutriti on-related events and take advantage of other opportuniti es to raise the profi le of nutriti on. Strategy 5.2: Advocate for increased commitment to improving nutriti on outcomes. Interventi ons 1. Develop and implement a nutriti on communicati on strategy. 2. Develop and implement a comprehensive and sustainable nutriti on advocacy plan. 3. Produce and publish an annual report on the state of Uganda’s food security and nutriti on situati on. 5.3 Priority Investment Areas A. Scale up cost-effective community-based initiatives that emphasise prevention and control of malnutrition. Key areas of focus will include growth monitoring and promotion, Community-Based Management of Acute Malnutrition, initiatives to promote baby-friendly hospitals and communities, food fortification, and increased production of bio-fortified staple food crops. B. Establish an enabling legal environment and strong institutional capacity and mechanisms to implement the UNAP at all levels. Critical areas of focus under this investment area will include fast-tracking the Food and Nutrition Bill, strengthening 22 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 human resource capacity for nutritional assessment and programming, and establishing institutional structures for nutrition programme implementation and co-ordination at both national and decentralised levels. C. Strengthen food security and nutrition safety nets at national and decentralised levels. This includes the establishment of a national food and nutrition information system. D. Conduct operational research in nutrition to inform implementation and monitoring of UNAP progress. The activities under this investment area include research on improved community- and household-level food processing for value addition, improved post-harvest handling and storage of food crops, community-based school feeding pilot programmes, and investigation and demonstration of labour-saving technologies for women with young children. 23END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 PART III: IMPLEMENTATION, FINANCING, AND MONITORING AND EVALUATION FRAMEWORKS 6. Implementati on Framework This secti on of the UNAP provides an overview of how the plan will be implemented and co-ordinated at the nati onal and local government levels to achieve its goal and objecti ves. Nutriti on is a multi -sectoral issue that is best addressed through a well-co-ordinated, multi sectoral approach. Thus, this implementati on framework aims to support nutriti on stakeholders at all levels and sectors in the country to successfully operati onalise the UNAP. The lack of an insti tuti onalised co-ordinati ng mechanism for nutriti on has been one of the main contributors to the ineff ecti veness of past interventi ons. Inadequate co-ordinati on of the planning and implementati on of nutriti on programmes and projects oft en resulted in duplicati on of services and programmes without proper equitable distributi on and convergence of resources. Nutriti on interventi ons have been implemented mostly as verti cal projects with litt le human capacity, technical competence development, and numbers in the public sector. The UNAP seeks to address this gap and emphasises the need to establish new insti tuti onal arrangements and to strengthen existi ng ones to adequately provide policy directi on, co ordinate and harmonise nutriti on programming, and conduct M&E in the country. 6.1 Insti tuti onal Arrangements The UNAP specifi cally recognises the urgent need to establish and strengthen the insti tuti onal structure for nati onal-level co-ordinati on by legally establishing the FNC and its secretariat in the Offi ce of the Prime Minister (OPM) as proposed in the draft Food and Nutriti on Bill. Assisted by its secretariat, the council will be responsible for providing policy directi on, guidance, and oversight, as well as nati onal co-ordinati on of the implementati on, monitoring, and evaluati on of the UNAP and other nutriti on programmes in the country. Specifi cally the FNC, assisted by its secretariat, will: • Co-ordinate joint planning and review with other ministries and departments as well as development partners, civil society, the private sector, and academia • Monitor and evaluate the nati onal nutriti on response in the country • Mobilise resources and support for nutriti on response • Provide nati onal standards and norms for nutriti on • Advocate for the development of nutriti on structures and adequate resource allocati on • Lobby for the establishment of a consolidated nutriti on fund by development partners • Facilitate cross-sector collaborati on and work with higher-level committ ees (in the cabinet and parliament) and the Multi -Sectoral Technical Committ ee on Nutriti on. 24 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 6.2 Co-ordinati on Arrangements The UNAP further recognises the need to establish, strengthen, and support nutriti on co ordinati on structures at both nati onal and local government levels and to strengthen sector specifi c capacity at all levels to eff ecti vely implement nutriti on programmes. A. Nati onal Co-ordinati on Policy Co-ordinati on. Policy co-ordinati on will be done through three enti ti es: a cabinet sub committ ee, the FNC, and the Parliamentary Sub-Committ ee on Nutriti on. The cabinet sub committ ee will meet bi-annually to review progress on key nutriti on indicators in the country and to provide policy directi on. The FNC, which will include key line ministers and permanent secretaries, will meet quarterly to review progress on performance of key nutriti on indicators, to analyse budget performance of nutriti on programmes, to analyse the constraints to implementati on, and to provide strategic directi on. Recommendati ons from the cabinet sub committ ee and the FNC will be fed into the Parliamentary Sub-Committ ee on Nutriti on, which will approve the key policy and fi nancial decisions, and then to the Nutriti on Multi -Sectoral Technical Committ ee (see below) for implementati on of decisions. Technical Co-ordinati on. Technical co-ordinati on of nutriti on will be done through the Nutriti on Multi -Sectoral Technical Committ ee, which will comprise key technical experts from the government, development partners, the private sector, academia, and civil society. The committ ee, whose establishment and terms of reference will be defi ned during the plan period, will be led by the FNC chairperson and co-ordinated by the head of the secretariat. Unti l the FNC and its secretariat are established, the Nati onal Planning Authority (NPA) , in line with its mandate to co-ordinate and harmonise nati onal development planning, monitoring, and evaluati on, will carry out this role. The NPA will also work with other stakeholders to ensure that the proposed insti tuti onal structures are established as soon as possible. Nutriti on Development Partners Committ ee. The Nutriti on Development Partners Committ ee will be responsible for promoti ng and identi fying funding resources for the nutriti on agenda in Uganda; promoti ng joint resource mobilisati on, allocati on, and support; responding to the proposed development partners’ consolidated nutriti on fund; and providing policy guidance on the alignment of nutriti on programmes to the Millennium Development Goals and the nutriti on commitments of the United Nati ons Development Agency Fund and other internati onal organisati ons. This committ ee will be composed of representati ves of nutriti on development partners and will feed into the policy and technical co-ordinati on committ ees. The Uganda Nutriti on Co-ordinati on Forum. The Uganda Nutriti on Co-ordinati on Forum, which will be inaugurated in the plan period, will meet bi-annually to review implementati on of the UNAP and to provide advice and advocacy for nutriti on. Chaired by the NPA, the Co-ordinati on Forum will comprise all key nati onal and local nutriti on stakeholders, including heads of the principal government departments and agencies and representati ves of the private sector, 25END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 non-governmental organisati ons (NGOs), and civil society organisati ons (CSOs) involved in implementi ng programmes under the UNAP. B. Decentralised Co-ordinati on Sector-Level Co-ordinati on Committ ees. At the sector level, the various ministries, departments, and agencies will form committ ees that will co-ordinate nutriti on programmes and support implementati on by central government departments, local governments, the private sector, academia, and civil society. These committ ees will also ensure joint planning and budgeti ng for nutriti on acti viti es within each sector, prepare quarterly monitoring reports to submit to the secretariat (or NPA in the interim), and provide technical guidance to stakeholders and service providers in each sector. Nutriti on focal persons in each sector will co-ordinate nutriti on acti viti es within their area of responsibility. District-Level Co-ordinati on Committ ee. The District Nutriti on Co-ordinati on Committ ee, which will be composed of representati ves from key sector departments, CSOs, the private sector, and academia, will provide technical advice to the district technical planning committ ees and subsequently to the district council. The committ ee will also monitor and evaluate nutriti on acti viti es, carrying out reviews and providing technical advice to the lower-local government levels. Nutriti on focal persons/offi cers in local governments and at the community level will co ordinate nutriti on acti viti es within their area of responsibility. 6.3 Implementati on Strategy The UNAP will be implemented along fi ve main dimensions that are interrelated and mutually reinforcing: 1. Preventi ng and controlling malnutriti on by targeti ng and investi ng in interventi ons that have an impact within the ‘window of opportunity’ (the 1,000 days from concepti on through pregnancy unti l the child’s second birthday) 2. Scaling up community-based initi ati ves that have proven to have a high impact and that are cost-eff ecti ve 3. Comprehensively managing cases of acute and moderate malnutriti on 4. Supporti ng food-based approaches to improve nutriti on that have proven to be sustainable 5. Creati ng an enabling legal environment and building strong insti tuti onal structures and mechanisms and capacity at all levels 6.4 Prerequisites for Implementati on Implementati on of the UNAP will be a shared responsibility of the government, the public sector, the private sector, development partners, NGOs, CSOs, and research insti tuti ons and academia. Successful implementati on of the UNAP will require: • Ownership of the acti on plan by the key government ministries—the MOH; the MAAIF; the Ministry of Educati on and Sports, the Ministry of Water and Environment, the Ministry of Local Government, the Ministry of Gender, Labour and Social Development, and the 26 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Ministry of Trade and Cooperati ves—and support from the Ministry of Finance, Planning and Economic Development, the OPM, and the NPA • Politi cal will and fi nancial commitment at both the nati onal and local government levels • Behaviour change at the nati onal, local, and household levels to promote good nutriti on • Routi ne and eff ecti ve M&E of the implementati on of the UNAP to ensure that the plan is on track • Eff ecti ve co-ordinati on and networking of implementi ng agencies and development partners 7. Financing Framework The budget is the sum of all budget esti mates from the programmes and acti viti es under each objecti ve, representi ng a snapshot of the current nutriti on prioriti es for Uganda. The total cost of the 5-year UNAP is UShs 161,614 million (see Table 3 and Annex II). Financing the UNAP will require a concerted eff ort from the Government of Uganda, development partners, CSOs, and the private sector. However, the major investor in these nutriti on prioriti es will be the Government of Uganda. 7.1 Government of Uganda Uganda’s central and local governments, in alliance with other agencies and development partners, will fi nance the UNAP through focused resource reallocati on within existi ng budgets and through mainstreaming nutriti on in various sector programmes to increase resource availability. This calls for making food security and nutriti on a high priority in nati onal programmes, specifi cally in such sectors as health, agriculture, social development, fi nance, educati on, trade and tourism, and local development. For successful resource mobilisati on, a strong advocacy strategy will be used to demonstrate to sectors and development partners the cost-eff ecti veness of improved investment in nutriti on and the consequences of failing to do so. 7.2 Development Partners The government recognises that the current domesti c budgets will not be able to independently fi nance the UNAP at the level required to sustainably improve the nutriti on indicators. While in the long term the government will seek to fund the UNAP through domesti c revenues, it will conti nue to depend on external resources in the short to medium term, while progressively reducing its reliance on such resources. Opportuniti es for initi al resource mobilisati on will be through such forums as monthly local development partner group meeti ngs. The government will take further advantage of existi ng and new global and regional initi ati ves, including SUN, CAADP, and the United States Agency for Internati onal Development’s Feed the Future, to identi fy potenti al sources for fi nancing the nutriti on programmes. The current support for nutriti on programmes is fragmented and has minimal impact on the nutriti on indicators. Thus, at the nati onal level, advocacy for basket funding for nutriti on programmes from the nati onal nutriti on development partners to maximise nutriti on investments 27END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 will be adopted. This will facilitate a more holisti c approach to nutriti on programming and implementati on, since the tendency is to implement only acti viti es that would have received funding, even when their scope and potenti al impact are limited (e.g., micronutrient programmes have received a lot of funding and yet macronutrient problems remain largely unaddressed). In additi on, some development partners provide support directly to CSOs, NGOs, and some districts outside the government budget. While this arrangement is not discouraged, it will be appropriate to share informati on on the level of support provided and the acti viti es of the UNAP being funded to have an accurate assessment of the impact on the nutriti on indicators. 7.3 Public-Private Partnerships Experience shows that cooperati on between the public and private sectors in the form of public-private partnerships can be a powerful incenti ve for improving the quality and effi ciency of public services and a source of fi nancing for public infrastructure. There will be strategic explorati on of public-private partnerships with the highest cost-eff ecti veness in sustainably addressing malnutriti on in Uganda, especially through the value additi on, energy, and labour saving technologies. Existi ng and available resources for nutriti on within the nati onal budget and from private sector and development partners must be co-ordinated eff ecti vely to maximise impact. In additi on, the government envisions encouraging aff ected communiti es to take ownership of their nutriti on problems. If communiti es recognise how these problems aff ect their development and see that they can help identi fy strategies to address the problems, the community contributi on to nutriti on interventi ons would increase and help sustain acti viti es. 28 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Table 3. Summary of 5-Year UNAP Implementati on Cost Matrix 2011–12 2012–13 UShs (millions) 2013–14 2014–15 2015–16 US$ (thou sands) Percent of total budgetOBJECTIVE TOTAL 1. Improve access to and uti lisati on of services related to maternal, infant, and young child nutriti on 5,087 7,199 10,392 13,399 13,706 49,783 19,147 30.8 2. Enhance consumpti on of diverse diets 1,227 3,777 4,817 5,127 6,777 21,726 8,356 13.4 3. Protect households from the impact of shocks and other vulnerabiliti es that aff ect their nutriti onal status 920 6,920 9,960 13,030 15,080 45,910 17,658 28.4 4. Strengthen the policy, legal, and insti tuti onal frameworks and the capacity to eff ecti vely plan, implement, monitor, and evaluate nutriti on 3,855 6,292 7,729 8,836 8,343 35,055 13,483 21.7 programmes 5. Create awareness of and maintain nati onal interest in and commitment to improving and supporti ng nutriti on programmes in the country 1,595 1,733 1,835 1,938 2,040 45,946 9,140 161,614 3,515 62,159 5.7 100.0TOTAL 12,684 25,921 34,734 42,330 29END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 8. Monitoring and Evaluati on Framework The current M&E system for nutriti on and food security indicators is weak, with minimal and fragmented systems among sectors and development partners. To eff ecti vely track progress of UNAP implementati on and performance of the target outcome and output indicators, a comprehensive and integrated multi -sectoral monitoring system for nutriti on will be developed. An annual multi -sectoral monitoring and reporti ng system will be established with a lead co ordinati ng agency, which will be the NPA in the interim and the FNC once it is legally established. All implementi ng agencies will submit annual reports on the status of implementati on and performance of the target indicators to the co-ordinati ng agency. The agency will then compile the reports to produce an annual report. An annual review meeti ng for the implementi ng agencies and other nutriti on stakeholders will be held. All implementi ng agencies will submit quarterly reports in their themati c areas to the co ordinati ng agency, which will compile them and produce a quarterly report. Quarterly meeti ngs will be held to discuss the reports. During these meeti ngs, appropriate measures to address slow or off -track implementati on will be developed. To evaluate the eff ecti veness and impact of the various programmes and interventi ons and the UNAP overall, evaluati ons and reviews will be conducted annually, at the midpoint (2.5 years), and at the end of the implementati on period (5 years). Table 4 below shows the key outcome indicators and targets that will be monitored during the 5-year plan period. 30 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Table 4. Key Outcome Indicators and Annual Targets No. Outcome indicator Baseline 2012 2013 2014 2015 UNAP Target (2016) 1. Stunti ng: prevalence in under-5s, % 38 1 37 35 34 33 32 2. Underweight: prevalence in under-5s, % 16 1 15 14 12 11 10 3. Underweight non-pregnant women 15–49 years old with BMI less than 18.5 kg/m2, % 12 1 11 10 10 9 8 4. Iron-defi ciency anemia: prevalence in under-5s, % 73 1 68 64 59 54 50 5. Iron-defi ciency anemia: prevalence in women 15–49 years old, % 49 1 45 41 38 34 30 6. Vitamin A defi ciency: prevalence in under-5s, % 19 1 18 17 15 14 13 7. Vitamin A defi ciency: prevalence in women 15–49 years old, % 20 1 18 17 15 14 12 8. Low birth weight: newborns weighing less than 2.5 kg, % 13 1 12 11 11 10 9 9. Exclusive breastf eeding to 6 months: % of infants 60 1 63 66 69 72 75 10. Dietary diversifi cati on index: percentage of calories consumed from foods other than cereals and starchy roots 57 1 61 64 69 71 75 11. Calorie consumpti on: average daily energy intake per capita, kcal 2,220 2 2,276 2,332 2,388 2,444 2,500 1 UDHS 2006 2 FAO 2008 Uganda Nutriti on Acti on Plan 2011-2016 31 END MALNUTRITION NOW ANNEX I: Implementation Matrix Goal: Reduce malnutri tion levels among women of reproduc tive age, infants, and young children from 2011 through 2016 and beyond Interventi ons Expected Outputs Lead Agency Other Parti cipants Objecti ve 1: Improve access to and uti lisati on of services related to maternal, infant, and young child nutriti on. Strategy 1.1: Promote access to and uti lisati on of nutriti on and health services to all women of reproducti ve age, infants, and young children. Promote and support health and nutriti on educati on to increase the level of awareness of good nutriti on.  Increased level of awareness of good nutriti on  Increased access to and uti lisati on of informati on, educati on, and communicati on materials and messages to target benefi ciaries MOH Local governments, MGLSD, MAAIF, MOES, development partners, CSOs, MFPED Promote integrati on of nutriti on services in all routi ne and outreach health services and programmes targeti ng children and mothers.  Growth monitoring and promoti on and other nutriti on services integrated in all routi ne and outreach health services  Increased access to and uti lisati on of nutriti on services MOH Local governments, MGLSD, MAAIF, MOES, development partners, CSOs, MFPED Manage nutriti on for sick children, pregnant women, lactati ng mothers, and other women of reproducti ve age.  Increased access to and intake of nutriti ous foods by sick children, pregnant women, lactati ng mothers, and other women of reproducti ve age MOH Local governments, MGLSD, MAAIF, MOES, MFPED, development partners, CSOs Integrate management of severe and moderate acute malnutriti on into routi ne health services.  Capacity for management of severe and moderate acute malnutriti on enhanced  Centres for management of severe and moderate acute malnutriti on increased within existi ng health faciliti es nati onwide  Cases of severe and moderate acute malnutriti on monitored and followed up on MOH MGLSD, local governments, MOES, MAAIF, MFPED, private sector, development partners, CSOs 32 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Promote uti lisati on of antenatal and post-natal care services among all pregnant women and lactati ng mothers. Promote and support breastf eeding policies, programmes, and initi ati ves. Promote and support appropriate complementary feeding practi ces. Support and scale up community-based nutriti on initi ati ves.  Increased number of mothers att ending antenatal and post-natal care services  Increased number of exclusively breastf ed babies  Increased number of ‘baby-friendly’ workplaces, communiti es, and health faciliti es, both public and private  Increased number of employers and insti tuti ons/agencies implementi ng the maternity and paternity law  Increased use of diversifi ed local foods for complementary feeding  Increased frequency of complementary meals at household level  Increased knowledge among mothers of appropriate complementary feeding practi ces  Increase in number of appropriate complementary feeding practi ces/initi ati ves supported  Increase in number of community-based nutriti on initi ati ves supported  Increased coverage of community-based nutriti on initi ati ves  Increased level of community parti cipati on and involvement in community-based nutriti on programmes MOH MOH MOH MOH/MGLSD/ MAAIF/MOES Local governments, MGLSD, MAAIF, MOES, MFPED, development partners, CSOs, Populati on Secretariat Local governments, MGLSD, MAAIF, MOES, development partners, CSOs Local governments, MGLSD, MAAIF, MOES, MFPED, development partners, CSOs, MOICT Local governments, MAAIF, MOES, MFPED, development partners, CSOs, MOICT Uganda Nutriti on Acti on Plan 2011-2016 33 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Promote proper food handling hygiene, and sanitati on through increased knowledge, use of safe water, and hand-washing practi ces at the household level.  Increased knowledge of proper food handling hygiene and sanitati on  Increase household use of safe water  Increase in hand washing practi ces by households MOH Local governments, MWE, MOES, development partners, CSOs, MFPED, MOICT Strategy 1.2: Address gender and socio-cultural issues that aff ect maternal, infant, and young child nutriti on. Promote male involvement in family health services and in food security and nutriti on programmes.  Increased knowledge among men of family health and nutriti on issues  Increased male involvement in family health, food security, and nutriti on services and programmes MGLSD/MOH/ MAAIF MOH, MAAIF, local governments, MFPED, development partners, CSOs Advocate and seek soluti ons  Increased awareness among husbands and MGLSD/ MOH, local governments, MFPED, for reducing workload for all other family members of benefi ts of reducing MAAIF development partners, CSOs women, especially pregnant women’s workloads women and lactati ng mothers.  Increase in sharing of farm and household work among household members  Increased use of labour-saving technologies at the farm and household levels Address detrimental food taboos and norms that impair the nutriti on of women, infants, and young children.  Increased knowledge on the impact of detrimental food taboos and norms that impair nutriti on  Change in negati ve atti tudes, beliefs, and practi ces related to nutriti on  Increased intake of culturally prohibited foods MAAIF/ MGLSD MOH, local governments, development partners, CSOs 34 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Objecti ve 2: Enhance consumpti on of diverse diets. Strategy 2.1: Increase access to and use of diverse nutriti ous foods at the household level. Promote producti on and  Increased producti on of diversifi ed nutriti ous MAAIF MOH, local governments, MGLSD, MFPED, consumpti on of diversifi ed foods private sector, development partners, CSOs nutriti ous foods at the  Increased consumpti on of diversifi ed nutriti ous household and community foods levels.  Increased provision of appropriate agricultural inputs and services at the household and community levels Advocate for and support  Increased integrati on of nutriti on issues in MAAIF/NPA Private sector, development partners, CSOs, integrati on of nutriti on in agricultural programmes MFPED agricultural programmes at the nati onal and local government levels. Increase consumpti on of both  Increased consumpti on of raw vegetables and MAAIF/MOH MTC, MFPED, private sector, development raw and processed nutriti ous fruits partners foods.  Increased consumpti on of enriched processed foods  Increased consumpti on of forti fi ed foods Promote and support local  Increased processing of nutriti ous foods at the MAAIF/MTC Private sector, development partners, MOH, food processing and value household and community levels MGLSD, MFPED additi on at the household and  Diversifi ed processed food products at the community levels. household and community levels Promote and support the  Increased types of labour-saving technologies at MAAIF/MTC MGLSD, MWE, MEMD, local governments, uti lisati on of safe labour-saving the household and community levels private sector, development partners, CSOs technologies at the household  Increased uti lisati on of labour-saving and community levels. technologies at the household and community levels Support on-farm enterprise mix  Increased number of households and MAAIF Local governments, MGLSD, MTC, MFPED, to promote stable diversifi ed communiti es with stable diversifi ed food private sector, development partners, CSOs food producti on. supplies and incomes Uganda Nutriti on Acti on Plan 2011-2016 35 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Promote producti on and consumpti on of local indigenous foods to enhance dietary diversifi cati on.  Increased producti on and consumpti on of indigenous foods  Increased awareness of the nutriti on value of indigenous foods  Increased exploitati on and uti lisati on of foods from non-conventi onal sources MAAIF MOH, MOES, MWE,MGLSD, development partners, CSOs Promote positi ve indigenous dietary practi ces.  Dietary practi ces related to indigenous foods emphasised in the school curricula and nati onal examinati on  Increased applicati on of dietary practi ces related to indigenous foods at the household and community levels harvest handling, storage, and uti lisation of nutriti MAAIF ous food MOH, MOES, MWE,MGLSD, development partners, CSOs s at the household and farm levels.Strategy 2.2: Enhance post Promote and support adopti on of post-harvest handling and storage technologies at the household and community levels.  Increased awareness and adopti on of appropriate post-harvest handling and storage technologies MAAIF/MOES MOH, MTC, MGLSD, development partners, CSOs Provide an enabling environment to the private sector to manufacture, market, and distribute appropriate post harvest handling and storage technologies.  Clear policy developed to guide and provide incenti ves to small- and medium-scale private sector players  Private players supported to acquire equipment, fi nancial support, and infrastructure  Increase in public-private partnerships for food processing and storage  Affi rmati ve acti on provided for geographically marginalised areas MTC/MTC MAAIF, MOES, development partners, private sector 36 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Strategy 2.3: Promote the consumpti on of nutrient-enhanced foods. Promote producti on of forti fi ed common staples by local manufacturers.  A policy promoti ng forti fi cati on in place  Food forti fi cati on public-private partnerships increased and strengthened  Increased variety of forti fi ed foods  Industries that forti fy foods scaled up nati onwide MOH/MTC Uganda Nati onal Bureau of Standards, NDA, local governments, private sector, development partners, CSOs Promote producti on of bio forti fi ed varieti es.  Policy promoti ng bio-forti fi cati on in place  Increased variety of bio-forti fi ed foods  Bio-forti fi cati on of foods scaled up nati onwide  Food bio-forti fi cati on public-private partnerships increased and strengthened MAAIF/MTC MOH, local governments, private sector, development partners, CSOs Promote consumpti on of nutrient-enhanced foods through increased awareness of their benefi ts.  Increased awareness of the benefi ts of nutrient enhanced foods  Increased consumpti on of forti fi ed foods  Increased adopti on and consumpti on of bio forti fi ed foods MAAIF/MOH/ MTC Private sector, development partners, local governments Support local producti on of ready-to-use therapeuti c and complementary foods.  Policy promoti ng therapeuti c and complementary foods in place  Therapeuti c foods included on the essenti al drugs list  Local industries producing therapeuti c and complementary foods scaled up nati onwide  Public-private partnerships for therapeuti c and complementary foods strengthened MOH/MTC MAAIF, local governments, Ministry of Justi ce and Consti tuti onal Aff airs, private sector, development partners, CSOs, Uganda Nati onal Bureau of Standards Uganda Nutriti on Acti on Plan 2011-2016 37 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Objecti ve 3: Protect households from the impact of shocks and other vulnerabiliti es that aff ect their nutriti onal status. Strategy 3.1: Develop preparedness plans for shocks. Strengthen and scale up early warning systems on food and nutriti on informati on from the community to the nati onal level.  Early warning system in MAAIF strengthened (capacity and equipment)  Nutriti on informati on system in MOH strengthened  Nati onal nutriti on surveillance system established MOH/MAAIF/ FNC OPM, local governments, private sector, development partners, CSOs, academia Support and promote urban farming to serve the most vulnerable households in urban areas.  Urban farming policy developed and operati onalised  Supermarket-linked value chains developed for high-value enterprise in urban and peri-urban areas MAAIF/MTC MOH, local governments, development partners, CSOs, private sector Develop, promote, and implement in a ti mely fashion a comprehensive package of nutriti on services and food items to provide during emergencies and recovery periods.  Comprehensive package of nutriti on services and requirements for emergencies developed  Timely implementati on of comprehensive nutriti on services in emergencies MOH/OPM OPM, MAAIF, private sector, development partners, CSOs Make integrati on of nutriti on in disaster management programmes mandatory.  Capacity of local governments to provide nutriti on services in emergencies strengthened  Nutriti on package integrated in all disaster management programmes MOH/OPM/ MAAIF/MOLG Local governments, MGLSD, MAAIF, private sector, development partners, CSOs 38 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Promote and support diversifi ed producti on of drought-resistant crops, including vegetables, and raising of animals tolerant of heat stress at the household and community levels.  Increased producti on of drought-resistant crops, including vegetables, and raising of animals tolerant of heat stress MAAIF MWE, local governments, MGLSD, private sector, development partners, CSOs Carry out sensiti sati on programmes for communiti es to raise their awareness of preventi on, miti gati on, and response to risks of malnutriti on during shocks.  Increased awareness of proper nutriti on during shocks l protecti on interventions for improved nutri OPM/MOH/ MAAIF ti on. MOH, MWE, MAAIF, MGLSD, local governments, private sector, development partners, CSOs Strategy 3.2: Promote socia Provide social transfers to and support livelihoods for the most vulnerable households and communiti es.  Increase in vulnerable households receiving social transfers (cash, food, agricultural inputs) MGLSD/ MAAIF/OPM MFPED, local governments, OPM, private sector, development partners, CSOs Develop and implement programmes for special social assistance and for livelihood promoti on and protecti on in areas with high levels of malnutriti on.  Special food-based programmes for vulnerable groups in areas with high malnutriti on levels designed and implemented  Increased coverage of livelihood programmes MGLSD/ MAAIF Local governments, OPM, MOH, private sector, development partners, CSOs Advocate for and promote school feeding programmes.  Increased awareness of the benefi ts of nutriti ous school meals on learning outcomes  ‘Homegrown’ school meals provided  Schools supported to provide school meals MOES/MAAIF/ MGLSD MOH, local governments, development partners, CSOs, private sector, MFPED Uganda Nutriti on Acti on Plan 2011-2016 39 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Manage cases of severe acute  Increased number of health faciliti es with MOH CSOs, NGOs, MOES malnutriti on by integrati ng care supplies to manage SAM cases into routi ne health services and  Increased number of communiti es mobilized providing follow-up support and and sensiti zed on SAM management monitoring at the household  Increased number of children screened for SAM and community levels. in the communiti es and referred Promote social protecti on  Increased social protecti on interventi ons for MGLSD MOH, MAAIF, development partners interventi ons for improved improved nutriti on nutriti on. Objecti ve 4: Strengthen the policy, legal, and insti tuti onal frameworks and the capacity to eff ecti vely plan, implement, monitor, and evaluate nutriti on programmes. Strategy 4.1: Strengthen the policy and legal frameworks for co-ordinati ng, planning, and monitoring nutriti on acti viti es. Fast-track the enactment of  Food and Nutriti on Bill enacted NPA/MAAIF MOH, Ministry of Justi ce and Consti tuti onal the Food and Nutriti on Bill, Aff airs, development partners which will provide the statutory mechanism for establishing the FNC and its secretariat. Revitalise and legalise the  FNC functi onal OPM NPA functi onality of the FNC and  FNC secretariat established establish its secretariat/co ordinati ng unit. Review the Food and Nutriti on  Food and Nutriti on Policy revised FNC MOH, MAAIF, NPA, MGLSD, MTC, private Policy to integrate emerging sector, development partners, CSOs issues. 40 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Revise the draft Uganda Food and Nutriti on Strategy to align it with the prevailing nati onal, regional, and global nutriti on agenda and disseminate the strategy widely.  Food and Nutriti on Strategy revised  Food and Nutriti on Strategy disseminated widely FNC secretariat NPA, MTC, local governments, private sector, development partners, CSOs Advocate for the enactment of by-laws and ordinances that promote nutriti on and food security at the district and sub county levels.  By-laws and ordinances that promote nutriti on and food security developed and enacted FNC/MOLG Local governments, MOH, MAAIF, MTC, MOES, CSOs, development partners, MFPED Integrate nutriti on issues into plans and budgets at all levels of government by mainstreaming nutriti on and creati ng vote functi ons for nutriti on.  Vote functi ons for nutriti on established  Nutriti on mainstreamed into sectors and district development plans NPA/MFPED MOH, MAAIF, MTC, MOES, MGLSD, MWE, MOLG, Populati on Secretariat, development partners Support the development of nutriti on curricula for all levels of educati on and training.  Nutriti on curricula in place at all levels of educati on MOES Academia, MOH, MAAIF Advocate for establishment of lower- and middle-cadre nutriti on courses in the educati on structure.  Lower- and middle-cadre nutriti on courses established MOES MOH, MAAIF, academia Review and integrate nutriti on issues in the existi ng curricula of formal and non-formal educati on and in pre- and in service training.  Nutriti on issues integrated in curricula MOES MOH, MAAIF, academia Uganda Nutriti on Acti on Plan 2011-2016 41 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Strategy 4.2: Strengthen and harmonise the insti tuti onal framework for nutriti on from the local to the central government level. Review the country’s current insti tuti onal framework for nutriti on and implement a suitable one.  Current insti tuti onal framework reviewed  Key recommendati ons from the review implemented NPA/OPM MOH, MAAIF, MTC, MOES, MGLSD, MWE, MOLG, Populati on Secretariat, development partners Establish an interim multi sectoral co-ordinati on mechanism for nutriti on programming and M&E.  Multi -sectoral co-ordinati on mechanism in place NPA MOH, MAAIF, MTC, MOES, MGLSD, MWE, MOLG, Populati on Secretariat, development partners, CSOs Strengthen insti tuti onal capacity for nutriti on programming at all levels in all sectors.  Nutriti on focal persons appointed or assigned in key ministries, departments, and agencies and local governments  Nutriti on co-ordinati on structures and committ ees at the nati onal and local government levels established man resource capacity to plan, implement, m FNC secretariat, OPM onitor, and ev MOH, MWE, MAAIF, MOES, MGLSD aluate food and nutriti on programmes Strategy 4.3: Strengthen hu in the country. Design and implement a capacity-strengthening plan for nutriti on programming at the nati onal, local governments, and community levels.  Nutriti on capacity strengthening plan developed  Capacity in nutriti on policy analysis, planning, implementati on, surveillance, and M&E strengthened  Nutriti on capacity of community-based resource persons strengthened FNC secretariat MOH, MAAIF, MTC, MOES, MGLSD, MWE, MOLG, Populati on Secretariat, development partners Establish a food and nutriti on M&E system for tracking performance of nutriti on indicators and for ti mely decision making.  Nati onal food and nutriti on informati on system established  Integrated nutriti on M&E system established  Progress of implementati on and performance of UNAP periodically reported on FNC secretariat MOH, MAAIF, MFPED, MTC, local governments, development partners, MOICT, academia 42 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Conduct a nati onal food and  Baseline food and nutriti on survey conducted FNC MOH, MAAIF, MFPED, MTC, local governments, nutriti on survey to establish secretariat development partners, MOICT, academia up-to-date nutriti on baseline monitoring indicators. Conduct periodic district-level  District specifi c surveys conducted FNC MOH, MAAIF, MFPED, MTC, development food and nutriti on surveys in secretariat/ partners, MOICT, academia vulnerable areas and among local vulnerable populati ons. governments Undertake mid-term and end-  UNAP impact evaluati ons conducted FNC MOH, MAAIF, MFPED, MTC, local governments, of-term impact evaluati ons of secretariat development partners, MOICT, academia the UNAP. Strengthen district-level food  District food and nutriti on surveillance systems FNC Local governments, MOES, MTC, development and nutriti on surveillance established and capacity strengthened secretariat/ partners, CSOs systems. MOH/MAAIF Strategy 4.4: Enhance operati onal research for nutriti on. Conduct formati ve research on  Formati ve research studies on best practi ces for MAAIF/MOH NPA, academia, local governments, best practi ces for nutriti on. nutriti on conducted development partners, CSOs, MFPED Research, document, and  Positi ve indigenous dietary practi ces researched, MAAIF Development partners, academia disseminate fi ndings on positi ve documented, and disseminated indigenous dietary practi ces. Compile food compositi on  Food consumpti on database developed MAAIF Development partners, academia data for all foods consumed in Uganda. Identi fy and conduct research  Research on scaling up food and nutriti on MOH/MAAIF NPA, academia, local governments, relevant to scaling up food and interventi ons conducted development partners nutriti on interventi ons.  Academia supported to conduct applied food and nutriti on research Uganda Nutriti on Acti on Plan 2011-2016 43 END MALNUTRITION NOW Interventi ons Expected Outputs Lead Agency Other Parti cipants Collate and share research  Best practi ces documented, disseminated, and NPA MOH, MAAIF, local governments, MOLG, fi ndings and best practi ces for scaled up MGLSD, MOES, MTC, development partners, scaling up food and nutriti on CSOs, academia interventi ons in Uganda. Objecti ve 5: Create awareness of and maintain nati onal interest in and commitment to improving and supporti ng nutriti on programmes in the country. Strategy 5.1: Increase awareness of and commitment to addressing nutriti on issues in the country. Develop and implement a  Nutriti on communicati on strategy developed Development MOH, MAAIF, CSOs nutriti on communicati on partners strategy. Produce annual policy  Annual policy statements produced MAAIF/MOH NPA, local governments, MOLG, MGLSD, statements and periodic policy  Quarterly policy briefs produced MOES, MTC, development partners, CSOs briefs on the nati onal food security and nutriti on situati on. Commemorate nutriti on-related  Nati onal, regional, and internati onal food and MOH/MAAIF Local governments, MOLG, MGLSD, MOES, events and take advantage of nutriti on events commemorated MTC, development partners, CSOs, MOICT other opportuniti es to raise the profi le of nutriti on. Strategy 5.2: Advocate for increased commitment to improving nutriti on outcomes. Develop and implement a  Printed and disseminated strategy Food and MAAIF, MOH, MOES nutriti on communicati on Nutriti on strategy Secretariat Develop and implement a  Comprehensive nutriti on advocacy plan FNC MOH, MAAIF comprehensive and sustainable developed and implemented nutriti on advocacy plan. 44 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons Expected Outputs Lead Agency Other Parti cipants Produce and publish an annual  Annual report on the state of food security and NPA MOH, MAAIF, local governments, MOLG, report on the state of the food nutriti on produced MGLSD, MOES, MTC, development partners, security and nutriti on situati on CSOs in the country. Uganda Nutriti on Acti on Plan 2011-2016 45 END MALNUTRITION NOW ANNEX II: Implementation Cost Matrix Interventi ons UShs millions 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Objecti ve 1: Improve access to and uti lisati on of services related to maternal, infant, and young child nutriti on. Strategy 1.1: Promote access to and uti lisati on of nutriti on and health services to all women of reproducti ve age, infants, and young children. Promote and support health and nutriti on educati on to increase the level of awareness of good nutriti on. 140 160 180 200 250 930 Promote integrati on of nutriti on services in all routi ne and outreach health services and programmes targeti ng children and women. 200 1,500 3,000 4,500 6,000 15,200 Manage nutriti on for sick children, pregnant women, lactati ng mothers, and other women of reproducti ve age. 1,200 1,000 1,000 1,000 1,000 5,200 Integrate management of severe and moderate acute malnutriti on into routi ne health services. 967 1,047 1,332 1,879 1,596 6,821 Promote uti lisati on of antenatal and post-natal care services among all pregnant women and lactati ng mothers. 400 500 600 700 800 3,000 Promote and support breastf eeding policies, programmes, and initi ati ves. 100 112 100 100 100 512 Promote exclusive breastf eeding. 100 500 1,500 2,000 1,000 5,100 Promote and support appropriate complementary feeding practi ces. 80 120 100 100 100 500 Support and scale up community-based nutriti on programmes. 900 1,140 1,380 1,620 1,860 6,900 Promote proper food handling, hygiene and sanitati on through increased knowledge, use of safe water, and hand-washing practi ces at the household level. 100 120 100 100 100 520 46 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 UShs millions Interventi ons 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Strategy 1.2: Address gender and socio-cultural issues that aff ect maternal, infant, and young child nutriti on. Promote male involvement in family health s and nutriti on programmes. ervices and in food security 500 500 500 500 100 2,100 Advocate and seek soluti ons for reducing workload for all women, especially pregnant women and lactati ng mothers. 200 250 300 350 400 1,500 Address detrimental food taboos and norms that impair the nutriti on of women, infants, and young children. 200 250 300 350 400 1,500 Subtotal – Objecti ve 1 5,087 7,199 10,392 13,399 13,706 49,783 Objecti ve 2: Enhance consumpti on of diverse diets. Strategy 2.1: Increase access to and use of diverse nutriti ous foods and use at the household level. Promote producti on and consumpti on of diversifi ed nutriti ous foods at the household and community levels. 317 657 857 1,057 1,257 4,146 Advocate for and support integrati on of nutriti on services in agricultural programmes the nati onal and local government levels. 60 75 90 105 120 450 Increase consumpti on of both raw and processed nutriti ous foods. 100 200 200 200 200 900 Promote and support local food processing and value additi on at the household and community levels. 100 500 600 700 800 2,700 Promote and support the uti lisati on of safe labour-saving technologies at the household and community levels. 50 100 140 180 1,000 1,470 Support on-farm enterprise mix to promote stable diversifi ed food producti on. 100 100 150 150 200 700 Promote producti on and consumpti on of indigenous foods to enhance dietary diversifi cati on. 60 70 80 90 100 400 Uganda Nutriti on Acti on Plan 2011-2016 47 END MALNUTRITION NOW UShs millions Interventi ons 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Strategy 2.2: Enhance post-harvest handling, storage, and uti lisati on of nutriti ous foods at the household and farm levels. Promote and support adopti on of post-harvest handling and storage technologies at the household and community levels. 60 100 200 300 400 1,060 Provide an enabling environment to the private sector to manufacture, market, and distribute appropriate post-harvest handling and storage technologies. … 400 500 20 20 940 Strategy 2.3: Promote the consumpti on of nutrient-enhanced foods. Promote producti on of forti fi ed common staples by local manufacturers. 100 625 750 875 1,000 3,350 Promote producti on of bio-forti fi ed varieti es. 130 350 500 650 800 2,430 Promote consumpti on of nutrient-enhanced foods through increased awareness of their benefi ts. 20 100 150 100 80 450 Support local producti on of ready-to-use therapeuti c and complementary foods. 130 500 600 700 800 2,730 Subtotal – Objecti ve 2 1,227 3,777 4,817 5,127 6,777 21,726 Objecti ve 3: Protect households from the impact of shocks and other vulnerabiliti es that aff ect their nutriti onal status. Strategy 3.1: Develop preparedness plans for shocks. Strengthen and scale up early warning systems on food and nutriti on informati on from the community to the nati onal level. 100 150 250 300 350 1,150 Support and promote urban farming to serve the most vulnerable households in urban areas. 50 2,100 3,100 4,150 4,150 13,550 Develop, promote, and implement in a ti mely fashion a comprehensive package of nutriti on services and food items to provide during emergencies and recovery periods. 60 120 60 60 60 360 Make integrati on of nutriti on in disaster management programmes mandatory. 40 40 40 40 40 200 48 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 UShs millions Interventi ons 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Promote and support diversifi ed producti on of drought-resistant crops, including vegetables, and raising of animals tolerant of heat stress the 60 40 40 40 40 220 household and community levels. Carry out sensiti sati on programmes for communiti es to raise their awareness of preventi on, miti gati on, and response to risks of 50 80 80 50 50 310 malnutriti on during shocks. Strategy 3.2: Promote social protecti on interventi ons for improved nutriti on. Provide social transfers to and support livelihoods for the most 150 2,000 3,000 4,000 5,000 14,150 vulnerable households and communiti es. Develop and implement programmes for special social assistance and for livelihood promoti on and protecti on in areas with high levels of 350 350 350 350 350 1,750 malnutriti on. Advocate for and promote school feeding programmes. 40 40 40 40 40 200 Manage cases of severe acute malnutriti on by integrati ng care into routi ne health services and providing follow-up support and monitoring at the household and community levels. Promote social protecti on interventi ons for improved nutriti on. 20 2,000 3,000 4,000 5,000 14,020 Subtotal – Objecti ve 3 920 6,920 9,960 13,030 15,080 45,910 Objecti ve 4: Strengthen the policy, legal, and insti tuti onal frameworks and the capacity to eff ecti vely plan, implement, monitor, and evaluate nutriti on programmes. Strategy 4.1: Strengthen the policy and legal frameworks for co-ordinati ng, planning, and monitoring nutriti on acti viti es. Fast-track enactment of the Food and Nutriti on Bill, which will provide 30 30 … … … 60 the statutory mechanism for establishing the FNC and its secretariat. Revitalise and legalise the functi onality of the FNC and establish its 25 25 25 25 25 125 secretariat/co-ordinati ng unit. Review the Food and Nutriti on Policy to integrate emerging issues. … 90 … 110 … 200 Uganda Nutriti on Acti on Plan 2011-2016 49 END MALNUTRITION NOW UShs millions Interventi ons 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Revise the draft Uganda Food and N the prevailing nati onal, regional, and disseminate the strategy widely. utriti on S global nutriti trategy to align it with on agenda and … 90 … 110 … 200 Advocate for enactment of by-laws and ordinances that promote nutriti on and food security at the district and sub-county levels. 50 50 50 50 50 250 Integrate nutriti on issues into plans and budgets at all levels of government by mainstreaming nutriti on and creati ng vote functi ons for nutriti on. 100 120 140 140 120 620 Support the development of nutriti on curricula for all levels of educati on and training. 100 125 150 175 200 750 Advocate for establishment of lower- and middle-cadre nutriti on courses in the educati on structure. 100 125 150 175 200 750 Review and integrate nutriti on issues in the existi ng curricula of formal and non-formal educati on and pre- and in-service training. 100 125 150 175 200 750 Strategy 4.2: Strengthen and harmonise insti tuti onal framework for nutriti on from the local to the central government level. Review the country’s current insti tuti onal framework for nutriti on and implement a suitable one. 60 60 … … … 120 Establish an interim multi -sectoral co-ordinati on mechanism for nutriti on programming and M&E. 20 22 24 26 28 120 Strengthen insti tuti onal capacity for nutriti on programming at all levels in all sectors. 200 400 400 400 400 1,800 Strategy 4.3: Strengthen human resource capacity to plan, implement, monitor, and evaluate food and nutriti on programmes. Design and implement a capacity-strengthening plan for nutriti on programming at the nati onal, local government, and community levels. 50 60 70 80 90 350 Nutriti on human resource capacity strengthening project 50 400 600 800 400 2,250 50 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 Interventi ons UShs millions 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Strategy 4.4: Monitor and evaluate the food and nutriti on situati on to inform policy and programming. Establish a food and nutriti on M&E system for tracking performance of nutriti on indicators and for ti mely decision making. 1,000 1,500 2,000 2,500 2,500 9,500 Conduct a nati onal food and nutriti on survey to establish up-to-date nutriti on baseline monitoring indicators. 500 750 950 700 680 3,580 Conduct periodic district-level food and nutriti on surveys in vulnerable areas and among vulnerable populati ons. 500 750 950 700 680 3,580 Undertake mid-term and end-of-term impact evaluati on of the UNAP. … … … … 100 100 Strengthen district-level food and nutriti on surveillance systems. 50 50 50 50 50 250 Strategy 4.5: Enhance operati onal research for nutriti on. Conduct formati ve research on best practi ces for nutriti on. 300 400 400 500 500 2,100 Research, document, and disseminate dietary practi ces. fi ndings on positi ve indigenous 50 50 50 50 50 250 Compile food compositi on data for all foods consumed in Uganda. 500 1,000 1,500 2,000 2,000 7,000 Identi fy and conduct research relevant to scaling up food and nutriti on interventi ons. 50 50 50 50 50 250 Collate and share research fi ndings and best practi ces for scaling up food and nutriti on interventi ons in Uganda. 20 20 20 20 20 100 Subtotal – Objecti ve 4 3,855 6,292 7,729 8,836 8,343 35,055 Objecti ve 5: Create awareness of and maintain nati onal interest in and commitment to improve and support nutriti on programmes in the country. Strategy 5.1: Increase awareness of and commitment to addressing nutriti on issues in the country. Develop and implement a nutriti on communicati on strategy. 195 200 200 200 200 995 Produce annual policy statements and periodic policy briefs on the nati onal food security and nutriti on situati on. 50 58 65 73 80 325 Uganda Nutriti on Acti on Plan 2011-2016 51 END MALNUTRITION NOW Interventi ons UShs millions 2011–12 2012–13 2013–14 2014–15 2015–16 TOTAL Commemorate nutriti on-related events and take advantage of other advocacy events. 300 375 450 525 600 2,250 Strategy 5.2: Advocate for increased commitment to improving nutriti on outcomes. Develop and implement a nutriti on communicati on strategy. Develop and implement a comprehensive and sustainable nutriti on advocacy plan. 1,000 1,000 1,000 1,000 1,000 5,000 Produce and publish an annual report on the state of the food security and nutriti on situati on in the country. 50 100 120 140 160 570 Subtotal – Objecti ve 5 1,595 1,733 1,835 1,938 2,040 9,140 GRAND TOTAL 12,684 25,921 34,734 42,330 45,946 161,614 52 EN D M A LN U TR IT IO N N O W U g a n d a N u tr iti o n A cti o n P la n 2 01 1– 20 16 53END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 ANNEX III: Reviewed Documents African Union. 2005. Africa Regional Nutriti on Strategy, 2005–2015. Food and Agriculture Organizati on (FAO). 2008. The State of Food Insecurity in the World 2008. Food and Nutriti on Technical Assistance II Project. 2010. Analysis of the Nutriti on Situati on in Uganda. Government of Uganda. 2003. The Uganda Food and Nutriti on Policy. ———. 2004. The Uganda Food and Nutriti on Strategy and Investment Plan. Draft . Horton, S. et al. 2010. Scaling Up Nutriti on Roadmap: What Will It Cost? MOH. 1999. The Health Policy of Uganda. ———. 2010. Health Sector Strategic Plan (HSSP III). Draft . ———. 2010. The Five-Year Maternal, Infant and Young Children Nutriti on Acti on Plan 2010–2015. NPA. 2010. Nati onal Development Plan 2010/11–2014/15. Republic of Malawi. 2007. Nati onal Nutriti on Policy and Strategic Plan 2007–2012. Uganda Bureau of Stati sti cs and Macro Internati onal. 2006. The Uganda Demographic and Health Survey, 2006. Uganda Acti on for Nutriti on. 2010. Malnutriti on – Uganda is paying too high a price. Advocacy briefs. ANNEX III: Reviewed Documents African Union 2005 Africa Regional Nutrition Strategy 2005–2015 54 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 55END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016 ANNEX IV: List of UNAP Technical Committee Members Name Title Organisati on Hon Wilberforce Kisamba-Mugerwa Chairperson Nati onal Planning Authority Prof John Kakitahi Chairperson, Technical Committ ee; Former Deputy Head, Makerere University School of Public Health Makerere University School of Public Health Dr John Ssekamatt e-Ssebuliba Manager, Populati on, Health and Social Development Planning Nati onal Planning Authority Ms Nahalamba Sarah Secretary, Technical Committ ee; Senior Gender and Social Development Offi cer Nati onal Planning Authority Ms Mutabazi Judith Sectoral Policy and Planning Offi cer Nati onal Planning Authority Ms Julia Tagwireyi Senior Nutriti on Advisor to Country Director World Food Programme Mr Geoff rey Ebong Programme & Policy Advisor World Food Programme Dr Robert Mwadime Regional Senior Nutriti on Advisor Food and Nutriti on Technical Assistance II Project Ms Namugumya Brenda Shenute Public Nutriti on Specialist Regional Centre for Quality of Health Care Dr Elizabeth Madraa Stakeholder Ministry of Health Mr Todd Benson Senior Research Fellow Internati onal Food Policy Research Insti tute Ms Agnes Chandia Baku Acti ng Head, Nutriti on Unit Ministry of Health Mr Bambona Alex Head, Home Economics and Nutriti on Secti on Ministry of Agriculture, Animal Industry, and Fisheries Ms Zaam Ssali Programme Offi cer Uganda Nati onal Academy of Sciences Mr Mugisa Tom Technical Offi cer Plan for Modernisati on of Agriculture Ms Daisy Eresu Programme Offi cer Ministry of Agriculture, Animal Industry, and Fisheries Ms Susan Oketcho Nutriti on Focal Person Ministry of Educati on and Sports Ms Lilia Turcan Nutriti on Offi cer United Nati ons Children’s Fund Ms Beatrice Okello Technical Offi cer Food and Agricultural Organisati on Dr Geoff rey Bisoborwa Technical Offi cer World Health Organisati on 56 END MALNUTRITION NOW Uganda Nutriti on Acti on Plan 2011–2016