National Nutrition Monitoring and Evaluation Framework 2013

Ministry of Health REPUBLIC OF KENYA National Nutrition Monitoring and Evaluation Framework 2013 REPUBLIC OF KENYA Ministry of Health National Nutrition Monitoring and Evaluation Framework Ministry of Health iii FOREWORD The National Nutrition Monitoring & Evaluation framework is an important document that will guide the monitoring and evaluation of activities of the nutrition sector in the country. This framework aims at consolidating nutrition data and information from various sources such as the DHIS and nutrition surveys and assessments. Through this document it is expected that counties and stakeholders in the nutrition sector will utilize information in planning and coordination of the nutrition activities so that prudent use of resources is done for optimal results. The development of the Monitoring and Evaluation Framework has been done through a consultative process of all the stakeholders in the nutrition sector. The framework is based on the various documents in the health sector namely: The National Food and Nutrition Security Policy, Health Information Systems Policy, Kenya Health Sector Strategic Plan III and the Kenya National Nutrition Action Plan 2012- 2017. The expected output of the framework is to monitor implementation of nutrition activities in the country as we integrate efforts towards reduction of malnutrition. The framework will provide a benchmark for planning, budgeting, reporting and re-strategizing of nutrition interventions for counties and the country to ensure sharing and scaling up of best practices. It is hoped that the users will find this document useful and I encourage them to provide feedback periodically to inform its updating and revision. Dr. S. K. Sharif MBS, MBChB, M.Med. DLSTMH, MSc. Director of Public Health and Sanitation National Nutrition Monitoring and Evaluation Frameworkiv ACKNOWLEDGEMENTS The Division of Nutrition is very grateful to all those who have contributed to this framework which will guide the data collection, data quality, analysis and use and reporting of nutrition information for improved programming. I am particularly grateful to the Division of Nutrition (DON) and the Division of Health Information Systems staff who have worked tirelessly in developing this Country framework which is the first initiative towards improving monitoring and evaluation of nutrition progress in Kenya for the period 2012-2017. We are also grateful for the technical support from our partners and the various nutrition sector technical forums towards the finalization of this Monitoring and Evaluation framework namely: 1. UNICEF Kenya Country Office 2. USAID –MCHIP 3. Action Contre la Faim (ACF), 4. African Population Health and Research Centre (APHRC), 5. Save the children UK, 6. Micronutrient Initiative, 7. Kenya Medical Research institute (KEMRI), 8. Nutrition Information Technical Working Group (NITWG), 9. Nutrition Technical Forum (NTF), 10. National Micronutrient Deficiency Control Committee (NMDCC) and 11. Nutrition Interagency Coordinating Committee (NICC). The Monitoring and evaluation framework has been developed and printed with funding from USAID-MCHIP and UNICEF Kenya Country office. Terry Wefwafwa HSC, Head, Division of Nutrition Ministry of Health Ministry of Health v CONTENTS FOREWORD iii ACKNOWLEDGEMENTS iv LIST OF TABLES vii LIST OF FIGURES viii LIST OF ABBREVIATIONS ix DEFINITIONS OF TERMS xii CHAPTER 1: INTRODUCTION 1 1.1 National Nutrition Status 1 1.2 Division of Nutrition 2 1.2.1 Vision and Mission of the Division of Nutrition 3 1.3 The National Nutrition Action Plan 4 1.4 Status of monitoring and evaluation for Nutrition in Kenya 5 CHAPTER 2: DEVELOPMENT OF THE NATIONAL NUTRITION MONITORING AND EVALUATION FRAMEWORK 7 2.1 Rationale 7 2.2 Goal and Objectives 7 2.3 Guiding Principles 8 2.4 Basic Concepts of Monitoring and Evaluation 8 2.5 Sources of Nutrition Information 9 2.6 Monitoring 10 National Nutrition Monitoring and Evaluation Frameworkvi 2.7 Evaluation 12 2.8 Reporting 13 2.9 Data Analysis and Use 15 CHAPTER 3: NATIONAL NUTRITION M&E FRAMEWORK IN KENYA 16 CHAPTER 4: IMPLEMENTATION STRATEGY FOR THE M&E FRAMEWORK 27 4.1 Roles and responsibilities of stakeholders 27 4.2 Capacity Strengthening for M&E 30 4.3 Data Quality Assurance 31 4.4 Updating of the Framework 32 4.5 Funding of the M&E system 32 REFERENCES 33 Appendix 1: Indicator compendium 34 Appendix 2: Targets for common indicators as set out in the National nutrition action plan 2012 to 2017 36 Appendix 3: Formats for presenting reports for Annual Operations Plans 48 Appendix 4: Activity matrix for National Nutrition Action Plan 2012-2017 49 Appendix 5: Conceptual framework on the causes of under nutrition 58 Appendix 6: Thresholds for nutrition indicators 59 Appendix 7: List of contributors 60 Ministry of Health vii LIST OF TABLES Table 1: Framework for monitoring and evaluation of the Kenya Nutrition Action Plan, 2012 to 2017 16 Table 2: Framework for monitoring and evaluation of the Kenya Nutrition Action Plan, 2012 to 2017 by strategic objective 17 Table 3: Summary of the roles and responsibility in nutrition M&E at various administrative levels 30 National Nutrition Monitoring and Evaluation Frameworkviii LIST OF FIGURES Figure 1: Conceptual framework for coordination of nutrition activities 3 Figure 2: The basic monitoring and evaluation framework 9 Figure 3: Nutrition programs data sources 9 Ministry of Health ix LIST OF ABBREVIATIONS ACSM Advocacy, Communication and Social Mobilization. BCC Behaviour Change Communication BFCI Baby Friendly Community Initiative CHANIS Child Health and Nutrition Information System CHEW Community Health Extension Worker CHMT County Health Management Teams CHW Community Health Workers CNO County Nutrition Officer COTU Central Organization of Trade Unions CWC Child Welfare Clinic DHIS District Health Information System DHMT District Health Management Team DHS Demographic and Health Survey DNO District Nutrition Officer DON Division of Nutrition DPHN District Public Health Nurse DPHO District Public Health Officer DQAs Data Quality Assurance DVI Division of Vaccine and Immunization ECDs Early Childhood Development Centres FKE Federation of Kenyan Employers FSNP Food and Nutrition Security Policy FSNS Food and Nutrition Security Strategy GAIN Global Alliance for Improved Nutrition GAM Global Acute Malnutrition HF Health Facility HIS Health Information System National Nutrition Monitoring and Evaluation Frameworkx HRIO Health Records and Information Officer IDD Iodine Deficiency Disorders IEC Information, Education and Communication IMAM Integrated Management of Acute Malnutrition IR Immediate Results IYC Infant and Young Child IYCN Infant and Young Children Nutrition KAP Knowledge Attitude and Practices KARI Kenya Agricultural Research Institute. KDHS Kenya Demographics and Health survey KEMRI Kenya Medical Research Institute KHIBS Kenya Household Income and Budget Survey KNBS Kenya National Bureau of Statistics KSPA Kenya Service Provision Assessment LBW Low Birth Weight MCH Maternal and Child Health Clinic M&E Monitoring and Evaluation MEASURE Monitoring Evaluation and Use of Results MI Micro-nutrient Initiative MICS Multiple Indicator Cluster Survey MOH Ministry of Health MOPHS Ministry of Public Health and Sanitation MUAC Middle Upper Arm Circumference MTEF Medium Term Expenditure Framework NCPD National Centre for Population and Development. NGO Non-Governmental Organization NHSSP National Health Sector Strategic Plan NICC Nutrition Inter-agency Coordinating Committee NITWG Nutrition Information Technical Working Group Ministry of Health xi NMDCC National Micro-nutrient Deficiency Control Committee NNAP National Nutrition Action Plan NTF Nutrition Technical Forum NIS Nutrition Information Systems OTC Outpatient Therapeutic Centre OTP Outpatient Therapeutic program PMTCT Prevention of Mother to Child Transmission PNOs Provincial Nutrition Officer SAM Severe Acute Malnutrition SC Stabilization Centres SD Standard Deviation SFP Supplementary Feeding Programme ToR Terms of Reference TOT Training of Trainers TWG Technical Working Group UNICEF United Nations Children Fund WFP World Food Program WRA Women of Reproductive Age National Nutrition Monitoring and Evaluation Frameworkxii DEFINITIONS OF TERMS Monitoring is the periodic oversight of the implementation of an activity which seeks to establish the extent to which input deliveries, work schedules, other required actions and targeted outputs are proceeding according to plan, so that timely action can be taken to correct any deficiencies detected. Evaluation is the process to determine as systematically and objectively as possible, the relevance, effectiveness, efficiency and impact of activities in light of specified objectives. Evaluation typically includes measures both at the beginning, midway and at the end of a program and when possible includes a control or comparison group to help determine whether change in outcome results from program activities themselves and not from other influences outside the program. It involves collection of information about programme activities, characteristics, and outcomes that determine the merit or worth of a specific programme. Inputs refer to resources invested in the programme and will include financial, technological and human resources in a program. Processes These are activities carried out to achieve the program objectives. Monitoring of these activities will show what has been done and how well and timely it has been done based on the work plans for the objectives. Output -These refer to the results achieved at the program level or simply program products. Output may be in three forms: numbers of activities conducted in each functional area such as training; service output which measures adequacy of services delivery system in terms of access, quality of care or program image; and service utilization that measures the extent to which the services are being used. Outcome -This refers to the changes observed at the population level among members of the target population as a result of a given program or intervention. There are two types of outcome namely: (a) Effects - which is short - to medium range (e.g., 2-5 years) change in behaviour promoted by programme (b) Impact - which are changes that occur over long-term Development partners -These are agencies who invest resources in nutrition activities in the country. The investment is in the form of technical assistance, funding, commodities and logistical support. Examples of development partners in the nutrition sector include; ECHO, DFID, UNICEF, WFP, GAIN, Micronutrient initiative etc. Ministry of Health xiii Implementing partners -These are agencies or institutions that are involved in supporting or implementing activities in specific target areas of the National Health Sector Strategic Plan (NHSSP) and Annual Work Plan (AWP). These include civil societies and Private sector. Stakeholders refers to a group of agencies or persons with a similar interest in a particular field e.g. nutrition. Indicator - A measure of change, progress or state. Research - Refers to the generation of knowledge that can be used to prevent disease, promote, restore, maintain, protect and improve the population’s development and well-being. Surveys - Periodic, focused assessments that collect health data from a population. Surveys are used to assess the perceptions, behaviour, knowledge, attitudes and infection status of targeted populations. Good surveys utilize well tested and validated instruments administered to representative populations of interest. All surveys assessing similar information should adopt the same sampling design and instruments to assure some level of consistency and ability to monitor trends. Surveillance - Ongoing, systematic collection, collation, analysis and interpretation and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Relevance - Only data that meets the information needs is collected, to inform project management and decision making. Data captured should be used for the purposes for which it is collected. Validity - Data use should be able to measure the changes being tracked. Data should be recorded and used in compliance with relevant requirements, including the correct application of any rules or definitions. This will ensure consistency between periods and with similar activities. Where proxy data is used to compensate for an absence of actual data, activities must consider how well this data is able to satisfy the intended purpose. Accuracy - Data should represent the actual population and their situation. Data should be sufficiently accurate for its intended purposes, representing clearly and in sufficient detail the interaction provided at the point of activity. Completeness - Data requirements should be clearly specified based on the information needs of the activities and data collection processes matched to these requirements. National Nutrition Monitoring and Evaluation Frameworkxiv Reliable - Data should be verifiable, producing the same results when used repeatedly to measure the same thing over time. Data should reflect stable and consistent data collection processes across collection points and over time, whether using manual or computer-based systems, or a combination. Timeliness - Data should be captured as quickly as possible after the event or activity and must be available for the intended use within a reasonable period. Data must be available quickly and frequently enough to support information needs and to influence the appropriate level of service or management decisions. Ministry of Health 1 1.1 National Nutrition Status Causes of malnutrition are multi-factorial and can be divided into immediate, underlying and basic based on UNICEF’s 2006 conceptual framework (Appendix 5). According to the 2008 Kenya Demographic and Health Survey (KDHS), the level of chronic malnutrition for children aged below 5 years was 35% while children who had severe chronic malnutrition was 14%. Acute malnutrition was reported at 7% while severe acute malnutrition was at 2%. Underweight children were 16% while severe underweight was 4%. Malnutrition affects all wealth quintiles (KDHS, 2008). Based on various surveys, the level of micro-nutrient deficiencies (vitamin A, iron, iodine) is similarly high 1leading to disorders such as iodine deficiency disorders and anaemia. These deficiencies are preventable if the population has adequate diet that is sufficiently and appropriately diversified accompanied by nutrition intervention of supplementation and food fortification. In addition to the persistent deficiencies of under nutrition, the Division takes cognizant of the current emergence of non-communicable disease of main concern being cancer and cardiovascular disease. According to the last KDHS 2008-2009, overweight/obesity among women of reproductive age (WRA) was 25% with Nairobi Province having the highest rate of 41%. Infant and Young Child feeding practices remain poor to attain optimal nutritional status. Exclusive breastfeeding rates of infants up to the age of 6 months increased from 13% (KDHS, 2003) to 32% (KDHS, 2008) but more needs to be done to improve these rates. Breastfeeding within one hour of birth stands at 58%. Further optimal complementary feeding at 6 months has been hampered by inadequate caring practices, food insecurity and poverty and was rated at 38% (KDHS, 2008). 1 The last micronutrient survey was done in 1999 and will be updated once the results of the 2011 surveys are out. National Nutrition Monitoring and Evaluation Framework2 Challenges faced by the Division of Nutrition in addressing the nutrition problems include inadequate investment in financial and human resources and insufficient information due partly to ineffective/insufficient monitoring and evaluation processes to guide planning and decision making. The Division of Nutrition (DON) is working in partnership with other departments in the Ministry of Health, other government ministries, civil societies, development and implementing partners to promote health and nutrition among the Kenyan population. 1.2 Division of Nutrition The Division of nutrition within the Department of Family Health in the Ministry of Health has five technical units: Maternal, Infant and Young Child Nutrition; Micro-nutrient Deficiency Prevention and Control; Food Security and Emergency Nutrition; Healthy Diets and Wellness and Research Monitoring and Evaluation (RM&E).The RM&E arm ensures that programme activities at the DON are tracked and assessed. This framework is essential in order to carry out monitoring and evaluation of national nutrition activities systematically in line with the National Nutrition Action Plan 2012 to 2017. It equally serves as a plan for monitoring and evaluation and clarifies: 1. What is to be monitored and evaluated, 2. The activities needed to monitor and evaluate, 3. Who is responsible for monitoring and evaluation of activities, 4. When monitoring and evaluation activities are planned (timing), 5. How monitoring and evaluation are carried out (methods) and 6. What resources are required and where they are committed. Essentially, this framework gives the Division of Nutrition an opportunity to develop a data base of nutrition activities. Ministry of Health 3 Figure 1: Conceptual framework for coordination of nutrition activities 1.2.1 Vision and Mission of the Division of Nutrition Vision To have a nation that is free from malnutrition and diet related diseases and conditions Mission To provide leadership and participate in the provision of high quality nutrition services that are equitable, responsive, accessible and accountable to all Kenyans Mandate • Policy formulation, standards development and strategic planning • Provision of nutrition services Research Monitoring & Evaluation Commitee Maternal, infant and young child program National infant and young child steering committee Maternal &IYCN working group Urban WG Supplementation sub committee Obesity WG Capacity development WG National food fortification Alliance Dietary diversity working group Nutrition Information WG Response advisory WG Micronutrient deficiency control program National micronutrient control council Healthy Diets & lifestyles programme Healthy Diets & lifestyles steering committee Food security and Emergency Nutrition Nutrition technical forum MONITORING AND EVALUATION AND RESEARCH ADVOCACY & COMMUNICATION wORkING GROUp NATIONAL INTER-AGENCY COORDINATING COMMITEE National Nutrition Monitoring and Evaluation Framework4 • Coordination and resource mobilization • Nutrition assessments and surveillance • Capacity strengthening of health and other workers on food nutrition • Creation of awareness to the public on food and nutrition • Procurement and distribution of equipment and supplies for nutrition service delivery • Food and nutrition operations research • Administration of the scheme of service for nutrition officers and assistants • Monitoring and evaluation of nutrition programmes • Advocacy Essential monitoring and evaluation of the national nutrition programme remains an important function of the Division of Nutrition in assessing progress made towards achieving the set objectives and targets as stipulated in the Kenya Health Sector Strategic Plan II (KHSSP III) and the National Nutrition Action Plan 2012-2017 (NNAP). 1.3 The National Nutrition Action Plan The National Nutrition Action Plan 2012-2017 (NNAP) is guided by the Food and Nutrition Security Policy (FNSP, 2012) and Food and Nutrition Security Strategy (FSNS, draft 2008). The NNAP is as a result of nutrition situation analysis and extensive consultations with nutrition stakeholders. The purpose of the NNAP is to provide a framework for coordinating implementation of nutrition interventions by the government and nutrition stakeholders for maximum impact at all levels. The priority nutrition areas spelt out in the FSNS provided a conceptual guide to the development of the National Nutrition Action Plan, which further identified strategic objectives each with corresponding activities and expected outcomes outlined as follows: i. To improve the nutritional status of women of reproductive age (15-49 years) ii. To improve the nutrition status of children under five years of age. iii. To reduce the prevalence of micronutrient deficiencies in the population iv. To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies v. To improve access to curative nutrition services Ministry of Health 5 vi. To improve prevention, management and control of diet related non communicable diseases vii. To improve nutrition in schools, private and public institutions viii.To improve knowledge, attitudes and practices on optimal nutrition among the population ix. To strengthen nutrition surveillance, monitoring and evaluation systems x. To enhance evidence-based decision making through operations research xi. To strengthen coordination and partnerships among the key nutrition actors xii. The above strategic objectives from NNAP will form the pillars of M&E framework 1.4 Status of monitoring and evaluation for Nutrition in Kenya The nutrition sector M&E is built on the existing infrastructure that collects, collates and analyses surveillance and service delivery data from various Service Delivery Points (SDP) in the country. There are 3 main categories of data being collected on a monthly basis through the District Health Information System (DHIS) that monitor the nutrition programs. These are: • Child Health and Nutrition Information System (CHANIS)2 for children 0 to 59 months. • Micronutrient supplementation data (Vitamin A, Iron and Folate) for children 6 to 59 months and pregnant women. • Integrated Management of Acute Malnutrition (IMAM) program for children above 6 months with acute malnutrition, pregnant and lactating women. Other nutrition data periodically collected in sentinel sites and districts for monitoring purposes include the Long Rains Assessment (LRA)3, Short Rains Assessment (SRA) and small emergency assessments. This data is analyzed, shared and used for decision making in planning appropriate interventions. Nutrition outcome and impact indicators are monitored through the Kenya Demographic and Health Survey (KDHS), Multiple Indicator Cluster survey (MICS) and Kenya Household Income and Budget Survey (KHIBS). Challenges in monitoring and evaluation of activities in the country include limited capacity to collect, analyze and disseminate nutrition data; though all facilities are required to report on vitamin A data, only immunizing facilities are providing reports; data submitted usually 2 CHANIS – From DHIS 3 National Drought Management Authority National Nutrition Monitoring and Evaluation Framework6 excludes vitamin A used for therapeutic purposes and vitamin A supplements given during mass immunization campaigns. Report completeness and timeliness is relatively low with completeness of CHANIS data at 60%4 which further constrain the quality of data and decision making. These challenges facing M&E of nutrition activities necessitates the need for developing an M&E framework to provide strategic information and a robust evaluation of programme effects on the population. 4 HIS data 2011 Ministry of Health 7 2.1 Rationale Kenya has numerous nutrition stakeholders including government ministries, development agencies, implementing partners, private and public teaching and research institutions, nutrition working groups and professional associations, and the private sector. However, even with many players in nutrition, limited impact, including impact from implementation of high impact nutrition interventions, has been realized. This, in part, is attributed to challenges arising from coordination of the nutrition programmes in different sectors, the short-term nature of interventions which mainly target emergency situations and the lack of holistic programming leading to interventions with limited scope and impact. These issues call for sector-wide approaches to nutrition programming in the country in order to meet the millennium development goals (MDGs). The main purpose of the M&E framework is to ensure continuous tracking of progress, document lessons learned and replicate best practices of nutrition interventions as outlined in the National Nutrition Action Plan 2012-2017. Monitoring and evaluation will be an integral part of all aspects of the nutrition intervention programs. The framework is aligned to the Health Information System (HIS) with focus on strengthening nutrition indicators and systems. 2.2 Goal and Objectives 2.2.1 Goal The M&E framework will guide and provide quality information for effective planning, decision making, monitoring and evaluation of nutrition interventions in the country. National Nutrition Monitoring and Evaluation Framework8 2.2.2 Objectives • To provide guidelines on data collection, reporting, feedback and use for the nutrition program • To monitor and evaluate quality of nutrition data and activities • To promote data use at all levels to inform decision making and nutrition programming • To produce and disseminate program implementation reports at all levels • To monitor the health sector’s response to nutrition • To contribute towards strengthening of the nutrition information component of health systems • To develop a supervisory framework to facilitate high quality data collection, collation, analysis, reporting and use at all levels. • To provide a framework for the systematic linkage of nutrition and food security indicators at National and County level. 2.3 Guiding Principles The M&E framework is guided by the following principles: 1. Three Ones Principle; • One national coordinating authority, with a broad based multi-sector mandate • One agreed comprehensive national nutrition plan of action • One agreed country level nutrition monitoring and evaluation framework 2. Mainstreaming of M&E in all nutrition interventions at all levels. 3. Integration of nutrition indicators into DHIS. 4. Decentralization, analysis and storage of data at the operational level. 2.4 Basic Concepts of Monitoring and Evaluation This logical framework identifies and illustrates the linear relationships flowing from program inputs, processes, outputs, outcomes and impacts. Inputs or resources affect processes or activities which produce immediate results or outputs, ultimately leading to long term or broad results, or outcomes and impacts. Indicators are used to measure performance of a program at different levels. Inputs, processes and outputs are regularly monitored while outcomes and impact are periodically assessed either through surveys or evaluations. The nutrition program has adopted the basic M & E framework as illustrated in Figure 2. Ministry of Health 9 Figure 2: The basic monitoring and evaluation framework 2.5 Sources of Nutrition Information The nutrition programme draws data and information from several direct sources as well as from other information systems within and outside the health sector (Figure 3). The information sources are categorized as follows: 1. Government- DHIS, KDHS, KSPA, MICS, KIHBS, KNBS 2. Research institutions e.g. KEMRI, NCPD, Universities, KARI 3. Programs e.g. implementing and development partners. Figure 3: Nutrition programs data sources National Nutrition Monitoring and Evaluation Framework10 2.6 Monitoring Routine data will be used to track nutrition programme performance. Supplementary data for instance for stock monitoring of supplies may be collected for interventions that do not necessarily have data collected on routine basis. Such data may be collected monthly quarterly or annually depending on project and or programme requirements and to complement the routine data. Monitoring data is collected through the following systems: 2.6.1 Health Information System The DHIS is the routine source of health facility service statistics where DON will get required data and/or information directly. The HIS relies on HWs at facility level to collect patient data and HIS staff to aggregate the data and report it on standardized forms. Key nutrition indicators will be collected at various levels and stored directly in the DHIS database (Appendix 1). The data for these indicators needs to be captured on the Monthly Summary Forms. In the nutrition program, some of the routine data collected through HIS for monitoring of activities are: Exclusive breastfeeding, initiation of breastfeeding within one hour of delivery, normal growth, underweight, stunting and wasting in children, Integrated Management of Acute Malnutrition (IMAM) performance, iron folate supplementation in pregnant women and vitamin A supplementation. The HIS also maintains information on types of services provided at health facilities which is important for several DON core indicators. 2.6.2 Kenya Service Provision Assessment (KSPA) The KSPA is a nationally representative facility survey that collects information on the health system in Kenya. The Health Systems Assessment (HSA) process allows systematic and rapid assessment of the national health system and provides policymakers and program managers with information on how to strengthen the health system. The approach provides a comprehensive assessment of key health systems functions, organized around six technical modules: governance, health financing, health service delivery, human resources, medical products management, and health information systems (Luoma et al., 2010) The National Coordinating Agency for Planning and Development and MOPHS/NASCOP are responsible for conducting the KSPA. The KSPA has been conducted thrice in Kenya: 1999, 2004 and 2009. Ministry of Health 11 2.6.3 Monitoring CODE violations of breast milk substitutes International Baby Food Action Network (IBFAN) helped develop the International Code of Marketing of Breast milk Substitutes. In Kenya, Monitoring CODE violations of breast milk substitutes is based on the Breast Milk Substitutes (Regulation and Control) Act of 2012. The Act provides for appropriate marketing and distribution of breast milk substitutes, for safe and adequate nutrition for infants by promotion of breastfeeding and proper use of breast milk substitutes, where necessary. Monitoring reports on CODE violations of breast milk substitutes will be collected at the district level, health facility and commercial outlets and submitted to the County and Division of Nutrition on a quarterly basis. 2.6.4 Monitoring of complementary foods The Kenya Bureau of Standards (KEBS) is responsible for ensuring quality and safety of complementary foods at the processing and manufacturing level in accordance to the standard Act CAP 496 of the Laws of Kenya. The department of Food safety in collaboration with KEBS and DON will continually do market surveillance of complementary foods. Such data will be collected on a quarterly basis for analysis and action. 2.6.5 Monitoring of fortified foods Data on fortified foods is useful in estimating the number of people consuming foods fortified with essential micronutrients. Fortified foods monitoring at production level is conducted quarterly by industries that deal with salt, flour, edible oils, fat and sugar. KEBS conducts external monitoring to ensure that the foods are fortified to the recommended standard. Retail monitoring of fortified foods will be done by the Division of Food Safety and Quality to ensure that foods imported and produced locally in retail outlets are fortified with the required micronutrients. The successful implementation of the universal salt iodization in Kenya as a strategy to eliminate Iodine Deficiency Disorders requires consistent monitoring to maintain the over 90% coverage. Monitoring of salt iodization will be done annually at the household level. Salt iodization is conducted in schools by the DON in collaboration with the Public Health Department to determine levels of iodine in household salts in communities. The Division will also participate in the iodization monitoring at the industry and retail level in order to ensure that salt available to consumers conforms to the national standards on salt iodization. National Nutrition Monitoring and Evaluation Framework12 2.6.6 Support supervision visits Technical quarterly support supervision visits will be conducted to assess program implementation to inform decision and planning. The support supervision visits will be done by the program managers and officers at the DON to the counties and districts. This will also be enhanced and supported by the technical working groups at the DON to ensure adequate feedback and support. 2.7 Evaluation Most of the programmes in the Division of Nutrition are on-going hence the M&E system developed will accommodate periodic assessments in on-going interventions. Baselines will be developed from the existing routine data and disaggregated to County level. However, for new interventions in their formative stages, baseline surveys will be conducted. Impact evaluation will be conducted where possible along with the national health and demographic surveys while other national studies specific to identified objectives e.g. MICS will be explored as possible avenues to evaluate other indicators of national interest. Evaluations conducted at the division will require their methodologies to be approved by the research monitoring and evaluation committee, the relevant working group and the Ethical research committee (KEMRI) if need be before implementation to ensure compliance and protection of the study subjects. 2.7.1 Kenya Demographic and Health Survey (KDHS) The DHS is a nationally representative household survey that is the source of impact and outcome indicators e.g. stunting, wasting, underweight, child nutrition practices and maternal nutrition and obesity. If changes are made to the indicators in the matrix in future, these will also have to change accordingly. The Kenya National Bureau of Statistics (KNBS) is responsible for conducting the survey every 5 years. The DHS has been standardized and has been conducted in over 70 countries for cross-national comparison. The DHS has been conducted five times in Kenya (1987, 1993, 1998, 2003 and 2008) offering trends of various indicators over time. 2.7.2 Multiple Indicator Cluster Surveys (MICS) This is a household survey initiative that was developed by UNICEF to assist countries in collecting and analyzing data in order to fill data gaps for monitoring the situation of children and women. MICS has enabled many countries to produce statistically sound and internationally comparable estimates of a range of indicators in the areas of child mortality, nutrition, child health, environment, reproductive health, education, child protection and HIV/AIDS. In the estimates Ministry of Health 13 of nutrition status the focus of MICS is on: Underweight, stunting, wasting, breastfeeding, salt iodization, vitamin A and low birth weight indicators. MICS findings are used extensively as a basis for policy decisions and programme interventions, and for the purpose of resource allocation and influencing public opinion on the situation of children and women. 2.7.3 Kenya Integrated Household Budget Survey (KIHBS) KIHBS is designed to provide indicators necessary for measuring, monitoring and analyzing living standards and poverty in Kenya (KNBS, 2007). The survey is also aimed at providing data on socio-economic aspects of the Kenyan population including education, nutrition, health, energy, housing, water and sanitation. KIHBS is sometimes integrated into other national surveys such as KDHS. Data from these surveys is normally available according to KNBS time lines. 2.7.4 National Micronutrients survey This survey is to be conducted every 5 years to determine deficiency levels of micronutrients of public health importance so that appropriate intervention can be put in place. 2.7.5 Other nutrition surveys Some surveys conducted periodically to inform nutrition programming include; Sentinel (Malnutrition) surveys conducted to determine GAM, SAM and MAM rates and the SRA and LRA, occasionally conducted by partners and MOH in selected ASAL districts. Based on need during the implementation of nutrition interventions special evaluations will also be conducted by external evaluators to provide an external independent and objective assessment of programs on behalf of DON. 2.8 Reporting Reporting of service delivery activities to the Division of Nutrition is on a monthly basis from the facility, districts and county levels (Figure 4). The reports are sent to the higher level through the DHIS and constitute service delivery statistics on nutrition HIS indicators in micro-nutrient supplementation (Vitamin A, Iron and Folate), CHANIS and IMAM. Reporting of implementation of activities at the national level will be done on a quarterly basis and will be based on the reporting format in Appendix 3. The reports will be structured so as to capture all the requirements of the National Nutrition Action Plan and annual plans. Progress implementation reports will also be shared in the relevant committees and Technical Working Groups (TWGs) within the nutrition sector. Each unit head will be expected to provide a detailed report as per the reporting format every quarter to the monitoring and evaluation unit National Nutrition Monitoring and Evaluation Framework14 for documentation and input into the quarterly, semi-annual and annual reports. The quarterly reports will also be supported by data from the program indicators as captured through the DHIS on a monthly basis. The data will be analyzed by comparing achievement against the set targets or baselines (MDGs targets, NHSSP targets and Nutrition Action Plan targets) as well as with international standards e.g. SPHERE standards and MOH guidelines/standards. Key Feedback: Forward transmission: Figure 4: National HIS Data flow/transmission National Level Dissemination to partners, Donors and Stakeholders County Level partners, Donors and Stakeholders Sub County/District Level partners, Donors and Stakeholders Health facilities: Dispensaries, Health Centres, Hospitals Community Level Ministry of Health 15 2.9 Data Analysis and Use Nutrition data collected through routine system and through evaluations and assessments will be analyzed for use in decision making at all levels of the health system. Analysis will involve systematic data quality assessment and if necessary adjustment. The analyses will be transparent and in line with national data analysis standards. Identifying and accounting for biases because of incomplete reporting, inaccuracies and non-representatives are essential and will greatly enhance the credibility of the results for users. Analysis will be done by comparing achievements against the targets in the Annual Work Plan, KHSSP III and the Nutrition Action Plan 2012-2017. Analysis will also compare achievements and international standards and thresholds (Appendix 6) e.g. sphere standards for the emergency nutrition. Analysis will also be done by looking at the implementation of activities in the nutrition action plan to determine whether progress is being made or not. Data analysis will also compare trends of the nutrition situation and interventions at various levels. Nutrition information analysis will be complemented by more complex analyses that provide estimates of the burden of malnutrition, nutrition service coverage, trends in nutrition indicators, and health system performance. Use of nutrition research as well as qualitative data gathered through systematic processes of analysing nutrition systems characteristics and changes. Analyzed information will be disseminated through technical forums and meetings, bulletins, quarterly and annual reports and the nutrition website. To ensure effective dissemination the use of graphs, bar charts and maps will be employed. Analyzed nutrition information is anticipated to enhance: • Information use for planning, • Re-strategizing, • Forming conclusions and anticipating problems, • Replicating best practices, • Accountability, • Advocacy and • Documentation of lessons learnt. National Nutrition Monitoring and Evaluation Framework16 The goal of the Monitoring and Evaluation Framework is to ensure a systematic monitoring and evaluation of nutrition sector activities in Kenya in line with the strategic objectives as derived from the National Nutrition Action Plan 2012-2017 (Appendix 4): Tables 1 and 2 illustrate the key indicators for activities in the National Nutrition Action Plan 2012 – 2017. Table 1: Framework for monitoring and evaluation of the Kenya Nutrition Action Plan, 2012 to 2017 Goal Impact Indicators Data source Frequency Responsible To have reduced morbidity and mortality caused by malnutrition and diet related diseases by 2017. Proportion of children under five years who are stunted. KDHS, Annually in SMART nutrition surveys in some selected ASAL districts 5 years and annually DON/KNBS/Implement ing partners Proportion of children under-five who are under weight. KDHS, Annually in SMART nutrition surveys in some selected ASAL districts 5 years and annually DON/KNBS/Implement ing partners % of children exclusively breastfeeding in the first 6 months KDHS/ MICS 2-5 years DON/KNBS % of population with micro nutrient deficiencies KNMS 5 years DON/KNBS/KEMRI Proportion of households consuming iodized salts MICs/KNMS Annually/ 5years DON/KNBS/KEMRI % of pregnant women who are anaemic KNMS/DHIS 5 years/annu ally DON/KNBS/KEMRI % of children under five who are Vitamin A deficient. KNMS 5 years DON/KNBS/KEMRI Under five years death rate KDHS, Annually in SMART nutrition surveys in some selected ASAL districts/ MICs 5 years and annually DON/KNBS/Implement ing partners/UNICEF Populations Crude Death Rate KDHS, SMART nutrition surveys in some selected ASAL districts/MICs 5 years and annually DON/KNBS/Implement ing partners/UNICEF Ministry of Health 17 Table 2: Framework for monitoring and evaluation of the Kenya Nutrition Action Plan, 2012 to 2017 by strategic objective Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 1: To improve the nutritional status of women of reproductive age (15-49 years) Inputs Amount of funds available for maternal nutrition. Program reports Annually DON/Development partners Amount of micronutrients purchased for supplementation (iron, folic acid, vitamin A) Type and quantities of anthropometric equipment purchased for assessing nutritional status of women Training manuals and guidelines developed. Outputs Number of WRA supplemented with iron and folic acid for at least 90 days during the last pregnancy. Surveys/KDHS Annually/5years DON – MIYCN/M&E Units Number of lactating mothers supplemented with vitamins A within 4 weeks of delivery PNC registers Monthly DON – MIYCN/M&E units % of pregnant and lactating women with MUAC < 21 CM receiving supplementary food. DHIS Monthly DRH/DON – MIYCN/ M&E units % of pregnant women whose weight is monitored. DHIS Monthly DRH/DON – MIYCN/ M&E units Number of Health workers and CHWs trained on Maternal nutrition Activity reports Quarterly DON Proportion of health facilities with nutrition commodities and equipment for maternal nutrition interventions Activity reports Quarterly DON Number of maternal guidelines disseminated DHIS Monthly DON Outcomes Proportion of WRA admitted in the therapeutic program Activity reports Annually DON Proportion of infants with birth weight above 2500 grams Activity reports Annually DON Proportion of women 15-49 years supplemented with Iron folate Activity reports Annually DON National Nutrition Monitoring and Evaluation Framework18 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 2: To improve the nutrition status of children under five years of age Input Amounts of funds available Program reports Annually DON/Development partnersNumber of nutritionist available IYCN/BFHI guidelines developed IYCN commodities available Output Number of children 0 to 6 months of age on exclusive breastfeeding DHIS/KDHS/surveys Monthly / annually/ 5 years DON/HIS/KNBS/ IMPLEMENTING PARTNRES Number of Health facilities certified as Baby Friendly Activity reports Annually DON Number of community units that are implementing Baby Friendly Community Initiative (BFCI) Activity reports Annually DON Number of infants who are breastfed within one hour of birth DHIS/KDHS/Surveys Monthly / annually/ 5 years DON/HIS/KNBS/ IMPLEMENTING PARTNRES Number of companies / suppliers complying with the CODE of marketing breast milk substitutes Activity reports Annually DON – IYCN Number of Public sector/ agencies/companies which support breastfeeding in the workplace Activity reports Annually DON – IYCN Number of health workers trained in IYCN Activity reports Annually DON – IYCN Number of children 6 to 24 months of age having adequate dietary diversity, appropriate feeding frequency and continued breast feeding. Survey reports Annually DON –IYCN Number of ACSM materials produced and distributed to health facilities and communities Activity reports Annually DON - AYCN Number of health facilities equipped with anthropometric equipment. Activity reports Annually DON Number of children < 5 years screened at community level and referred for nutrition management. Activity reports Monthly DON Number of children under 5 admitted in the therapeutic feeding program. DHIS/Surveys Monthly/annually DON Number of children aged 6-59 months receiving Vitamin A supplements DHIS/activity reports Monthly DON Number of children < 5 years whose growth is monitored DHIS Monthly DON % of children aged under 5 years with diarrhoea who are treated with zinc supplements Activity reports/surveys monthly DON/ implementing partners % of children aged 6-59months receiving multiple micronutrient powders as per the recommended dose Activity reports Quarterly DON MIYCN/ DON emergency/Implementing partners Ministry of Health 19 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 3: To reduce the prevalence of micronutrient deficiencies in the population Inputs Amount of funds available for micronutrient program. Program reports Annually DON/Development partners/ Implementing partners Review policy to include use of CHWs in delivery of micronutrient supplements. Program reports Annually DON/Development partners/ Implementing partners Training manuals developed Program reports Annually DON/Development partners/ Implementing partners Micronutrient guidelines developed Program reports Annually DON/Development partners/ Implementing partners Outputs Number of health workers trained on micronutrient deficiency control Training reports Quarterly DON/Implementing partners Number of community health workers trained on micronutrient deficiency prevention and control. Training reports Quarterly DON/Implementing partners Number of foods fortified by product and by industry Activity reports Quarterly DON Amount in metric tonnes of fortified food vehicle. Activity reports Monthly DON/Industry Number of micronutrient nutrition intervention campaigns launched. Activity reports Quarterly DON Number of health facilities experiencing no stock outs of micronutrient supplements Stock Management reports Quarterly DON Number of industries certified by KEBS as meeting the recommended fortification standards. Activity reports Quarterly KEBS/DON Percentage of households consuming Iodized salt. Assessment reports Annually DON Outcome Proportion of population with micronutrient deficiencies Survey reports KNMDC 5 Years DON/KEMRI/MI Proportion of population reached with messages on fortified foods. Activity reports Quarterly DON/GAIN Number of industries fortifying food products Activity reports Quarterly DON/GAIN Proportion of population consuming fortified foods Activity reports 2-5years DON/Industries/GAIN National Nutrition Monitoring and Evaluation Framework20 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 4: To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies Inputs Available funding for emergency activities Program reports Quarterly/ Annually DON/Development partners/ Implementing partnersCommodities procured for emergency activities. National nutrition commodities monitoring plan developed Policy and guidelines reviewed IEC materials developed Outputs Number of counties with emergency nutrition response plans Activity reports Annually DON/Development partners/ Implementing partners Number of counties reporting on a timely basis on nutrition surveillance indicators Activity reports Monthly DON Number of counties holding regular coordination meetings. Activity reports Quarterly DON Number of facilities experiencing no stock outs of essential nutrition commodities Stock Management reports Monthly DON Number of health facilities offering the essential nutrition services package. Activity reports Monthly DON Number of health workers trained on essential nutrition services package. Training reports Quarterly DON Number of counties mobilizing resources for nutrition emergency response Activity reports Quarterly DON Number of counties meeting the SPHERE standards on IMAM and national targets on IFE Activity reports Quarterly DON Number of counties implementing the National Nutrition Commodities Monitoring plan Stock Management reports Quarterly DON Outcomes Proportion of health facilities offering essential emergency nutrition services package. Activity reports Quarterly DON Proportion of vulnerable populations who access essential emergency nutrition services Activity reports/DHIS Monthly DON Proportions of vulnerable populations who recover. Activity reports/DHIS Monthly DON/implementing partners Ministry of Health 21 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 5: To improve access to quality curative nutrition services Inputs Review the clinical nutrition guideline Program reports Quarterly/ Annually DON/Development partners/ implementing partners Available funds for curative nutrition services Program reports Quarterly/ Annually DON/Development partners/ implementing partners Procure supplies and equipment for curative nutrition services Program reports Quarterly/ Annually DON/Development partners/ implementing partners Outputs Number of clinical nutrition guidelines disseminated Activity reports Quarterly DON Number of health workers trained on curative nutrition services Training reports Quarterly DON Number of counties integrating the standards of nutritional care into the county development plans Activity reports Annually DON/Development partners/ implementing partners Number of health facilities with no stock outs of commodities for curative nutrition services Stock management reports Quarterly DON Outcomes Proportion of facilities offering curative nutrition services Activity reports Annually DON Proportion of population admitted with clinical malnutrition KDHS/MICS 3-5 Years DON/ Development partners/ implementing partners Proportion of counties integrating nutrition activities in the development plans. Activity reports Annually DON/Development partners/ implementing partners National Nutrition Monitoring and Evaluation Framework22 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 6: Halt and reverse the prevalence of diet related non communicable diseases Input Human, financial resources, training manuals and guidelines Program reports Quarterly/ Annually DON/Development partners/ implementing partners Available funding for diet related non communicable diseases Program reports Quarterly/ Annually DON/Development partners/ implementing partners Healthy diets and lifestyles strategy developed Program reports Quarterly/ Annually DON/Development partners/ implementing partners Diet related non communicable diseases guidelines developed Program reports Quarterly/ Annually DON/Development partners/ implementing partners Diet related non communicable diseases training manuals developed Program reports Quarterly/ Annually DON/Development partners/ implementing partners Outputs Number of health workers trained on healthy diets and physical activity. Training reports Quarterly DON Number of guidelines distributed to health facilities. Activity reports Quarterly DON Number of healthy diets and lifestyle strategy forums held for dissemination. Activity reports Quarterly DON % of population screened for diet related non communicable diseases. Activity reports Quarterly DON Number of CHWs trained on healthy diets and lifestyles. Training reports Quarterly DON Outcome Proportion population with incidences of diet related non communicable diseases Activity reports Annually DON % of population who have adopted healthy diets and physical activity. Activity reports Annually DON Ministry of Health 23 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 7: To improve nutrition in schools, private and public institutions Input Guidelines and strategy for nutrition improvement in schools, private and public institutions reviewed. Program reports Annually DON/Development partners Financial and human resources available for institutional nutritional activities Program reports Annually DON/Development partners IEC materials developed Program reports Annually DON/Development partners Outputs Situation analysis report on school/ institutional feeding conducted , documented and disseminated Activity reports Annually DON/Ministry of education/Ministry of Interior and Coordination of National Government Number of guidelines for school/institutional feeding reviewed and disseminated Activity reports Annually DON/Ministry of education/Ministry of Interior and Coordination of National Government Number of schools and institutions mainstreaming basic nutrition in their operations Activity reports Annually DON/Ministry of education/Ministry of Interior and Coordination of National Government Number of schools and institutions integrating nutrition interventions in their programmes Activity reports Annually DON/Ministry of education/Ministry of Interior and Coordination of National Government Number of stakeholders’ meetings discussing sustainable institutional feeding programme Activity reports Annually DON/Ministry of education/Ministry of Interior and Coordination of National Government Outcomes Proportion of schools and institution integrating nutrition interventions in their programs. Activity reports Annually DON/Ministry of Education/Ministry of Interior and Coordination of National Government Proportions of counties monitoring nutrition interventions in schools and institutions. Activity reports Annually DON/Ministry of Education/Ministry of Interior and Coordination of National Government National Nutrition Monitoring and Evaluation Framework24 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 8: To improve knowledge, attitudes and practices on optimal nutrition among the population Input Amount of financial resources available Program reports Annually DON/Development partners/ Implementing partnersIEC materials for improvement of knowledge attitude and practice for optimal nutrition developed Strategy and Guidelines developed for improvement of knowledge attitude and practice for optimal nutrition developed Output Number of formative and periodic studies conducted to assess KAP Activity reports Quarterly DON Number of Counties implementing Nutrition Advocacy Communication and Social Mobilisation (ACSM) strategy Activity reports Quarterly DON Number and type of nutrition IEC/BCC materials disseminated. Activity reports Quarterly DON Number of service providers trained on nutrition communication and advocacy skills in every county Training reports Quarterly DON Number and type of nutrition communication materials disseminated at all levels Activity reports Quarterly DON Number of counties marking Nutrition Days (World Breastfeeding Week, African Food and Nutrition Security Day, Iodine Deficiency Disorders Day, Malezi Bora, etc) Activity reports Quarterly DON Number of nutrition messages disseminated by media houses (Nationally, county) Activity reports Quarterly DON Outcome Proportion of Counties implementing nutrition ACSM strategy Activity reports Annually DON Proportion of population with improved nutrition knowledge attitudes and practices Activity reports Annually DON Proportion of counties marking nutrition days Activity reports Annually DON Ministry of Health 25 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 9: To strengthen nutrition surveillance, monitoring and evaluation systems Input Procure data management equipment Program reports Annually DON/Development partners/ implementing partners Print nutrition monitoring and reporting tools Program reports Annually DON/Development partners/ implementing partners Develop training manuals for management of nutrition information Program reports Annually DON/Development partners/ implementing partners Develop the nutrition monitoring and evaluation framework Program reports 5 years DON/Development partners/ implementing partners Outputs Number of health facilities and programs submitting timely, accurate and complete nutrition data to the central level. Activity reports Quarterly DON Number of core nutrition indicators integrated in DHIS, NMEF, MTEF planning and budgeting framework. Activity reports Annually DON Number of health facilities with nutrition data quality audit conducted. Activity reports Quarterly DON/implementing partners Number of nutrition progress reports, surveillance reports and bulletins produced and disseminated. Activity reports Monthly/ Quarterly DON Number of sensitization meetings on nutrition information management. Activity reports Quarterly DON Number of Feedback forums held on nutrition information. Activity reports Monthly/ Quarterly DON Number of data management equipment procured and distributed. Activity reports Annually DON Number of health facilities reporting through the national reporting system Activity reports Monthly DON Outcomes Proportion of counties with improved reporting, evaluation and documentation of nutrition intervention and programs Activity reports Annually DON National Nutrition Monitoring and Evaluation Framework26 Strategic objective areas performance Indicators Data source Frequency Responsible Strategic objective 10: To enhance evidence-based decision making through operations research Input Nutrition Research, Monitoring and Evaluation committee established Program reports Annually DON/KEMRI /Development partners/ implementing partners Funding available for operational research on nutrition Program reports Annually DON/KEMRI/ /Development partners/ implementing partners Outputs Nutrition Research Coordinating Committee established and executing its appropriate mandate Activity reports Annually DON/KEMRI/Development partners/ implementing partners Number of research coordinating committee meetings held. Activity reports Quarterly/Annually DON/KEMRI/Development partners/ implementing partners Number of nutrition priority research studies conducted and disseminated among relevant nutrition stakeholders Activity reports Quarterly / biannually/ Annually DON/KEMRI/Development partners/ implementing partners Annual work plan informed by evidence from operational research. Activity reports Annually DON/KEMRI//Development partners/ implementing partners Number of best-practices tested and recommended for replication Activity reports Annually DON/KEMRI//Development partners/ implementing partners Outcomes Number of operational research results presented Activity reports Annually DON/KEMRI/Development partners/ implementing partners Number of publications resulting from surveys Activity reports Annually DON/KEMRI/Development partners/ implementing partners Number of abstracts presented at scientific conferences Activity reports Annually DON/KEMRI/Development partners/ implementing partners Strategic objective11: To strengthen coordination and partnerships among the key nutrition actors Inputs Available funding for nutrition coordination and partnership activities Activity reports Annually DON/ Development partners/ implementing partners TORs for coordination forums at national, county and district level developed Activity reports Annually DON/ Development partners/ implementing partners Output Number of Nutrition Coordination meetings held at national, county and district levels. Activity reports Monthly/Quarterly DON/Development partners/ implementing partners Number of partners/ stakeholders participating in nutrition coordination forums at all levels Activity reports Monthly/Quarterly DON/Development partners/ implementing partners Amount of funding allocated to nutrition services at national and county level. Activity reports Annually DON/Development partners/ implementing partners Outcomes Proportion of counties with joint coordination forums at all levels Activity reports Quarterly /Annually DON/Development partners/ implementing partners Proportion of funding allocated to nutrition activities by government and partners in the health budget. Activity reports Annually DON/Development partners/ implementing partners Ministry of Health 27 The implementation of M&E framework will be spearheaded by the Ministry of Health in collaboration with development partners and stakeholders at all levels. This will ensure successful implementation of M&E system in the Division of Nutrition. 4.1 Roles and responsibilities of stakeholders 4.1.1 Role of DON The DON main role and responsibilities will be to develop standards and guidelines for M&E of nutrition project and programmes in the country. Specifically, the responsibilities of the DON will be: 1. Overall management and ensuring implementation of the M&E Framework 2. Development of M&E implementation plan 3. Development of M&E operational manual (Laying out M&E Systems) 4. Dissemination of M&E Framework to all stakeholders 5. Capacity building for NIS sub-systems 6. Resource mobilization (financial and technical) for M&E activities 7. Utilize the reports from M&E systems and research to guide programme interventions and decision making 8. Analysis of data and preparation of national M&E reports 9. Ensuring quality control in M&E systems 10. Building strong institutional collaboration/relationships critical for the success of M&E National Nutrition Monitoring and Evaluation Framework28 4.1.2 Role of implementers The implementers are agencies/institutions that are involved in supporting or implementing nutrition activities in specific target areas of the NHSSP and annual work plan. These include: line Ministries, Civil Societies and Private sector organizations. The implementers will be reporting through relevant Monitoring System on programmatic activities. Where an implementer is responsible for a particular programme/ project for example in the case of blanket supplementary feeding program (BSFP), the implementer will coordinate development of the required standard tools, capacity building, quality control in the system and management of the data in collaboration with the DON - MOH. Specifically, the implementers will be responsible for: 1. Monitoring and evaluating their activities 2. Using existing systems/developing M&E sub systems that utilize existing structures at all levels of HIS 3. Mainstreaming M&E for nutrition in their M&E systems 4. Utilization of the data collected for decision making within the institution 5. Submit reports to DON for all Nutrition aspects which they are implementing 4.1.3 Role of Line Ministries/ Institutions and Agencies The role of line ministries and agencies will be to monitor nutrition related indicators and activities that fall in their dockets. This is particularly important in monitoring interventions that require multi-sector approach. For example, stunting requires monitoring of the food security situation in the country. The agencies will also be important in information sharing of nutrition related data and information in their interventions. 4.1.4 Role of Development Partners The role of development partners is crucial to developing and supporting the National M&E Framework and the subsequent strengthening of the M&E systems. They will be expected to provide substantive technical and financial support to ensure that the systems are functional. They are expected to ensure that their reporting requirements and formats are in line with the indicators outlined in the M&E framework. They are to synchronize efforts with existing development partners and stakeholder efforts based on an agreed upon one country-level M&E system. In Ministry of Health 29 addition, they will utilize reports from DON in decision making, advocacy and engaging with other partners for resource mobilization. 4.1.5 The Roles of County Health Management Teams and District Health Management Teams With the decentralization strategy in place, the districts and Counties are expected to play a significant role in the provision of technical services and coordination of nutrition activities at those levels. Subsequently, M&E focal persons (County Health Coordinator, County Health Records and Information Officer, County Nutrition Officer, County Public Health Officer and the County Public Health Nurse) at these levels will be responsible for coordinating and supervising the development of district annual reports, bulletins, and special studies, which should be disseminated and circulated to key partners and players at that level for the programs in the their sectors. The data and information at these levels should be used to review trends and progress and identify and resolve problems as they emerge. The information should also be provided to program managers and implementers so as to make informed decisions on the efficiency and effectiveness of their programmes. 4.1.6 The Roles at the Health Facility Level Given that implementation of programmes is undertaken at this level, it is imperative that data collected and reports generated are disseminated and used by the implementers to monitor trends in supply of basic inputs, routine activities, and progress made to make regular adjustments and informed decisions about the program. They will be expected to use this data in making decisions on priority activities to improve access and quality of service delivery. 4.1.7 The roles of the Community Health Units The roles of the community units will be to identify and notify to the health authority of all health and demographic events including nutrition that occurs in the community. These events will be reported through community main actors e.g. the CHWs, teachers and religious leaders through a well-developed reporting guidelines Community Health Information System (CHIS) developed by the Division of Community Health. The roles and responsibilities discussed are summarized in Table 3. National Nutrition Monitoring and Evaluation Framework30 Table 3: Summary of the roles and responsibility in nutrition M&E at various administrative levels Level Responsible Roles DON HRIO/ M&E Officer Coordinate and manage the nutrition M&E System Develop and review nutrition data collection and reporting tools Maintain a functional database within the DON Analyze data Produce information products and disseminate to stakeholders Supervise and ensure data and information use Sensitize on use of data/Information for decision making and planning Utilize data for planning and decision making Coordinate national capacity building for M&E Update and revise DON M&E Plan Initiate and supervise operational research. County County Health Records and Information Officer/ County Nutrition Officer Maintain County database Coordination and management of M&E Receive and compile nutrition data from the districts Forwards nutrition data/information within, up and down (feedback). Sensitize on use of data/information for decision making/planning Utilize data for planning and decision making Train County/districts TOTs on Monitoring & Evaluation Supervise data collection at County level District District Health Records and Information Officer/ District Nutrition Officer Maintain district database Coordinate and manage M&E at the district Receive and compile nutrition data from the facilities and implementing partners Supervise nutrition data collection in facilities Train district data and information focal persons Forward nutrition data/information to the county Give feedback to the health facility and community level Utilize data for planning and decision making Sensitize other actors on use of data/information for decision making and planning Facility Facility In charge/ Nutritionist Collect, compile, analyze and forward data/reports to the district Store data Use data for planning and decision making Community CHEW Collect data from the community Compile and forward data to the district level Receive feedback from the district/province/national level and dissemination to the community 4.2 Capacity Strengthening for M&E Needs assessment for effective implementation of national nutrition programme will be conducted. This will focus on data management, HIS, training of HWs and CHWs, and information technology. Ministry of Health 31 To ensure implementation of the framework the DON technical heads will conduct continuous capacity building in their areas of expertise through the following: 1. Supportive supervision to county, district and facility level. 2. On the job training on technical issues as well as data and information management. 3. Formal trainings using approved curriculums in all the trainings conducted in the division. 4. To further emphasise this, the division through the various technical arms and units will ensure that all trainings conducted shall include a unit on monitoring and evaluation. 4.3 Data Quality Assurance The data quality assurance (DQA) process will strive to ensure nutrition data is accurate, valid, reliable, timely, relevant and complete5. DQA will be conducted in data generation points, district level and county levels on a quarterly basis. Tools and programs for documenting DQA results will be used to ensure targeted support supervision for technical support and action by the relevant levels. The minimum set of indicators for consideration in DQAs will be as stipulated in the nutrition indicator compendium (Appendix 1) and the areas that will be considered for audit will include: 1. Reviewing completeness and accuracy of all indicator source documents for the selected reporting period. 2. Recounting results from source document and comparing the verified numbers to the site reported numbers and explaining discrepancies if any. 3. Cross-checking reported results with other data sources for example comparing routine data with survey data. 4. M&E system Structure, Functions and Capabilities at level being audited. 5. Nutrition Indicators definitions and reporting guidelines. 6. Availability of nutrition data-collection and reporting forms and tools. 5 The definition of Accuracy, Validity, Reliability, Timeliness, Relevance and completeness is in the definition of terms section. National Nutrition Monitoring and Evaluation Framework32 7. Data Management Processes e.g. back up and confidentiality of source documents and registers. 8. Compliance of reporting through the National Reporting System (DHIS). 9. As part of data quality audit all nutrition surveys and assessments in nutrition sector, will be validated by the NITWG to ensure that the methodologies used are of the required standards to give accurate results that can be used to inform planning for interventions. 4.4 Updating of the Framework The life of this framework is 5 years, in line with the NNAP 2012-2017. Regular update of the M&E plan will be done based on modification and/or inclusion of new interventions into the Division of Nutrition. M&E plan will be changed if new interventions to achieve any of the programmes specific objectives are introduced based on the National Nutrition Action Plan. This being the first framework for the DON, a mid-term review of the framework will be done in 2015 to measure progress of its implementation and make necessary amendments. 4.5 Funding of the M&E system The funding of the M&E system will come from the ministry in charge of Health, county governments and partners. To ensure successful monitoring and evaluation of activities, 10% of the total DON budget or any other partner project shall be allocated to monitoring and evaluation activities. This should be emphasized in all proposals/planning and budgeting as a requirement for production of data collection tools, trainings, improvement of computer hardware, development of software for nutrition database, communication and supportive supervision to give on the job technical assistance. To ensure implementation of this requirement, a clause on this condition will be included in any agreement that the division signs with its partners. The DON program will also take advantage of the existing periodic surveys and systems e.g. MICS, KHIBS, DHS, Health facility Assessment survey to include specific programme indicators as defined through the M&E framework. Ministry of Health 33 REFERENCES Luoma, Marc, Julie Doherty, Stephen Muchiri, Tiberius Barasa, Kate Hofler, Lisa Maniscalco, Charles Ouma, Rosalind Kirika and Josephine Maundu: Kenya Health System Assessment 2010. Health Systems 20/20 project Central Bureau of Statistics (CBS) (Kenya), Ministry of Health (Kenya), and ORC Macro, 2004. Kenya Demographic and Health Survey 2003.Calverton, Maryland: CBS, MOH and ORC Macro. Kenya National Bureau of statistics (KNBS) and ICF Macro.2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. National Council for Population and Development (NCPD), Central Bureau of Statistics (CBS) (Office of the Vice President and Ministry of Planning and National Development) [Kenya], and Macro International Inc, (MI). (1999). Kenya Demographic and Health Survey 1998. Calverton, Maryland: NCPD, CBS, and MI. Republic of Kenya: The Second National Health Sector Strategic Plan: 2005-2010. Republic of Kenya: Kenya National Nutrition Action Plan 2012 – 2017 Republic of Kenya: Kenya National Food and Nutrition Security Policy, 2011 Republic of Kenya: National Policy on Infant and Young Child Feeding Practices 2012. Republic of Kenya, National HIV and AIDS Monitoring, Evaluation and Research Framework (2009/10 2012/13) The Sphere Project 2011: Humanitarian Charter and Minimum Standards in Humanitarian Response, 3rd Edition. National Nutrition Monitoring and Evaluation Framework34 APPENDIx 1: INDICATOR COMPENDIUM Indicator Numerator/ denominator Measurement/ calculation Source documents Frequency of data collection 1 Percentage of under-five children who are under weight Number of children under the age of 5 years attending CWC with weight for age below 2 SD No. Underweight/Total weighed in CWC *100 CHANIS tally MOH 704, CHA NIS facility sum mary MOH 711A(fa cility), MOH 711 B(District), MOH 713 monthly Total number of children under 5 years weighed at the CWC 2 Proportion of children under-fives who are stunted Number of children under the age of 5 years attending CWC with height for age below 2 SD No. under- 5s with below -2 SD height for age in CWC/total un der-5s weighed in CWC *100 CHANIS tally MOH 704, CHA NIS facility sum mary MOH 711A(fa cility), MOH 711 B(District) monthly Total number of children under 5 years attending CWC measured 3 Percentage of children under the age of five years who are wasted. Number of under five year old children attending the CWC whose weight-for-height Z-score is below-2SD Number of under five year old children attending the CWC whose weight-for-height Z-score is below-2SD divided by the number of children younger than 5 years attending the CWC screened for wasting./ population surveys multiplied by 100 MOH 713 Periodical ly during SMART surveys and surveillance activities Number of children younger than 5 years attending the CWC screened for wasting/ population surveys 4 Proportion of children 6-59 months receiving at least one dose of Vitamin A supplementation with in six months Number of children 6-59 months who received a dose of Vitamin A within 6 months No. received VAS within 6 months/Total population pro jection of 6-59 Months chil dren*100 MOH 702 tally sheet, mother child booklet and summary sheet MOH 710 Monthly / biannually Total number of children 6-59 months in the catchment area 5 Percentage of pregnant women receiving iron and folate supplements Number of pregnant women who received iron/folate sup plements at ANC during the month No of pregnant women who were supplemented with iron/ folate / total number of preg nant women in the catchment area * 100 ANC register– MOH 405, MOH 711 A, MOH 711 B, MOH 105 Monthly Total number of pregnant women in the catchment area 6 Percentage of children (new cases/re-attend ances) with severe acute malnutrition receiving treatment Number of new children (admitted into OTP or In-pa tient care) with severe acute malnutrition who received treatment at the end of the reporting month Number of new children (ad mitted into OTP or In-patient care) with severe acute malnu trition who received treatment at the end of the reporting month divided by the number of children screened for mal nutrition in the health facility multiplied by 100 MOH 368, MOH 409 and MOH 713 Monthly Number of children screened for malnutrition in the health facility Ministry of Health 35 Indicator Numerator/ denominator Measurement/ calculation Source documents Frequency of data collection 7 Percentage of new cases with moderate malnutri tion receiving treatment Number of new children (ad mitted into SFP) with moder ate acute malnutrition at the end of the reporting month Number of new children (ad mitted into SFP) with moderate acute malnutrition at the end of the reporting month divid ed by the number of children screened for malnutrition in the health facility multiplied by 100 MOH 410 and MOH 713 Monthly Number of children screened for malnutrition in the health facility 8 Percentage of children 1-5 years de-wormed at least twice at health fa cility during the year Number of children 1-5 years de-wormed at health facility at least twice in health facil ities Number of children 1-5 years de-wormed at health facility at least twice in health facilities expressed as a percentage of all children between the age of 5 years attending CWC multi plied by 2 visits per year. MOH 704 and MOH 711 Monthly/ biannual Number of children below 1-5 years attending CWC 9 Percentage of children under 5 years who are attending MCH for growth monitoring for the first time. Number of Children under 5 years who are attending MCH for growth monitoring for the first time Number attending CWC for growth monitoring for new visits/ Population projection of under – 5s in catchment area. *100 CHANIS facility summary MOH 704, MOH 105(district ser vice delivery) Monthly Total number of children under five years old in the catchment area 10 Proportion of infants initiated on breast milk within 1 hour after de livery Number of new infants breastfed within the first hour after birth Number of new infants breast fed within the first hour after birth divided by the number of live births delivered in a health facility multiplied by 100 MOH – Maternity register Monthly Number of live births deliv ered in a health facility 11 Proportion of infants less than 6 months age of age exclusively breastfed Number of infants less than 6 months of age who received only breast milk during the previous day (24hours recall) No. of infants exclusively breastfeed/ total number chil dren less than 6 months *100 CHANIS revised MOH 704,MOH 711 Monthly Total number of infants less than 6 months of age in the MCH clinic National Nutrition Monitoring and Evaluation Framework36 A PP EN D Ix 2 : T A R G ET S FO R C O M M O N I N D IC A TO R S A S SE T O U T IN T H E N A TI O N A L N U TR IT IO N A C TI O N P LA N 2 01 2 TO 2 01 7 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a % o f c hi ld re n < 5 ye ar s w ho a re s tu nt ed 20 08 /9 35 30 25 20 15 14 14 KD H S 20 08 /9 W H O 2 01 0 M D G s ta tu s re po rt 2 01 0: p 9 % o f c hi ld re n < 5 ye ar s w ho a re w as te d 20 08 /9 6 5 4 3. 5 3 2. 2 KD H S U nd er w ei gh t l ev el s am on g ch ild re n < 5 ye ar s 20 08 /9 16 15 13 .5 12 11 .5 10 .5 10 KD H S C hi ld re n < 5 ye ar s w ith ob es ity 20 08 /9 22 22 21 .8 21 .6 21 .3 21 .0 19 .5 KD H S Iro n de fic ie nc y am on g ch ild re n < 5 ye ar s 19 99 69 50 45 40 35 30 25 M I S ur ve y * Ta rg et s to b e se t b as ed o n fin di ng s of p ro po se d M I s ur ve y of 2 01 1 Vi ta m in A d efi ci en cy am on g ch ild re n< 5 ye ar s 19 99 84 .4 60 50 40 30 20 15 M I s ur ve ys * Ta rg et s to b e se t b as ed o n fin di ng s of p ro po se d M I s ur ve y of 2 01 1 Zi nc d efi ci en cy a m on g ch ild re n< 5 ye ar s 19 99 51 45 40 35 * 30 25 20 M I s ur ve ys * Ta rg et s to b e se t b as ed o n fin di ng s of p ro po se d M I s ur ve y of 2 01 1 % o f h ea lth fa ci lit ie s th at a re B FH I c er tifi ed C ar ry o ut ba se lin e as se ss m en t Se t b as el in e va lu e ba se d on th e as se ss m en t 8 12 16 20 24 28 Pe rio di ca l n ut rit io n as se ss m en ts . IY C F dr af t s tr at eg y (2 01 1 20 15 ) Ministry of Health 37 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a % c om m un ity u ni ts th at a re im pl em en t in g BF C I C ar ry o ut ba se lin e as se ss m en t ba se lin e va lu e ba se d on th e as se ss m en t 8% 12 % 16 % 20 % 24 % 28 % Pe rio di ca l n ut rit io n as se ss m en ts % o f i nf an ts in iti at ed o n b re as tf ee di ng w ith in o ne h ou r o f bi rt h 20 08 /0 9 58 64 66 68 70 72 74 Pe rio di ca l n ut rit io n as se ss m en ts ; KD H S % o f c hi ld re n un de r si x m on th s on e xc lu si ve b re as tf ee di ng 20 08 /0 9 32 41 44 47 50 53 56 Pe rio di ca l n ut rit io n as se ss m en ts KD H S % o f c hi ld re n (6 8 ) m on th s) w ho a re in tr od uc ed to co m pl em en ta ry fo od s 20 08 /0 9 83 .9 88 89 .7 91 .4 93 .1 94 .8 96 .5 Pe rio di ca l n ut rit io n as se ss m en ts % o f c hi ld re n 6 to 23 m on th s co ns um in g 3+ o r 4 + fo od gr ou ps in a d ay (d ie ta ry d iv er si ty ) 20 08 /0 9 39 49 .5 53 56 .5 60 63 .5 67 Pe rio di ca l n ut rit io n as se ss m en ts KD H S % o f c hi ld re n co nt in ue d w ith b re as tf ee d in g up to 2 4 m on th s 20 08 /0 9 Pe rio di ca l n ut rit io n as se ss m en ts National Nutrition Monitoring and Evaluation Framework38 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a % o f c hi ld re n un de r fiv e ye ar s w ho se gr ow th is tr ac ke d by he al th fa ci lit ie s C ar ry o ut as se ss m en t t o de te rm in e ba se lin e Se t b as el in e va lu e fr om as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et H ea lth fa ci lit ie s tr ac k g ro w th of 1 5 % o f t he un de r fi ve c hi l dr en Se t A W P ta rg et to w ar ds ye ar 2 01 7 ta rg et H ea lth fa ci lit ie s tr ac k g ro w th of 1 8 % o f t he un de r fi ve c hi l dr en Pe rio di ca l n ut rit io n as se ss m en ts % o f t ra in ed fa ci l ity a nd c om m un i ty b as ed h ea lth w or ke rs s en si tiz in g w om en o n op tim al in fa nt a nd y ou ng ch ild n ut rit io n C ar ry o ut ba se lin e si tu at io n as se ss m en t Se t b as el in e va lu e fr om as se ss m en t 15 % 0 f h ea lth w or ke rs tr ai ne d an d se ns iti zi ng w om en o n op ti m al IY C N 17 % 0 f h ea lth w or ke rs tr ai ne d an d se ns iti zi ng w om en o n op ti m al IY C N Pe rio di ca l n ut rit io n as se ss m en ts KD H S % o f w om en w ho ad op t op tim al in fa nt an d yo un g ch ild re n nu tr iti on p ra ct ic es 10 % o f w om en a do pt in g op tim al IY C N pr ac tic es 13 % o f w om en a do pt in g op tim al IY C N pr ac tic es Pe rio di ca l n ut rit io n as se ss m en ts KD H S Pr op or tio n of e m pl oy in g ag en ci es th at su pp or t b re as tf ee d in g at w or k pl ac es O pe n in ve nt or y of KE PS A , F KE an d C O TU m em be r 30 % o f K EP SA , F KE a nd C O TU m em be rs su pp or t b re as t fe ed in g at w or k pl ac e 35 % of K EP SA an d C O TU m em be rs s up po rt br ea st fe ed in g at w or k pl ac e Pe rio di ca l n ut rit io n as se ss m en ts % o f h ea lth fa ci lit ie s co m pl yi ng w ith I YC N gu id el in es C ar ry o ut ba se lin e si tu at io n as se ss m en t Se t b as el in e va lu e fr om as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et 20 % o f h ea lth fa ci lit ie s co m pl yi ng w ith IY C N g ui de lin es Se t A W P ta rg et to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 25 % o f h ea lth fa ci lit ie s co m pl yi ng w ith IY C N g ui de lin es Pe rio di ca l n ut rit io n as se ss m en t KD H S % o f c hi ld re n ag ed 6 59 m on th s re ce iv in g vi ta m in A s up pl e m en ts tw ic e ye ar ly 20 08 /0 9 62 71 74 77 80 83 86 Pe rio di ca l n ut rit io n as se ss m en t KD H S % o f c hi ld re n un de r 5 ye ar s ol d w ith d i ar rh oe a tr ea te d w ith zi nc s up pl em en ts 20 08 /0 9 0. 2 20 60 80 80 80 80 Pe rio di ca l n ut rit io n as se ss m en ts Ministry of Health 39 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a Pr op or tio n of fi rm s co m pl yi ng w ith th e C od e of m ar ke tin g br ea st m ilk s ub st i tu te s O pe n in ve nt or y of fi rm s m ar ke tin g br ea st m ilk su bs tit ut es Se t b as el in e va lu e fr om in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et 25 % o f t he fir m s m ar ke tin g m ilk s ub st i tu te s co m pl y w ith C od e on m ar ke tin g su b st itu te s Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 30 % o f t he fir m s m ar ke tin g m ilk s ub st itu te s co m pl y w ith C od e on m ar ke tin g su bs ti tu te s Pe rio di ca l n ut rit io n as se ss m en t KD H S % o f < 5 y ea r c hi l dr en s cr ee ne d at co m m un ity le ve l a nd re fe rr ed fo r n ut rit io n m an ag em en t C ar ry o ut ba se lin e as se ss m en t Es ta bl is h ba se lin e va l ue fr om th e as se ss m en t 10 % o f un de r fiv e ch ild re n sc re en ed a nd re fe rr ed fo r nu tr iti on m an ag em en t Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 13 % o f un de r fiv e ch ild re n sc re en ed a nd re fe rr ed fo r nu tr iti on m an ag em en t Pe rio di ca l n ut rit io n as se ss m en ts Vi ta m in A d efi ci en cy am on g w om en 19 99 51 40 35 30 25 20 15 M I S ur ve y Iro n de fic ie nc y 19 99 55 50 *4 5 *4 0 *3 5 *3 0 *2 5 M I S ur ve y Io di ne d efi ci en cy 19 99 6 5 4 3 2 2 1 M I S ur ve y O be si ty a m on g w om en 20 08 /9 25 KD H S Zi nc d efi ci en cy a m on g w om en 19 99 52 47 42 37 32 27 15 M I S ur ve y Pr op or tio n of pr eg na nt w om en w ho t ak e iro n an d fo la te s up pl em en ts fo r a t l ea st 9 0 da ys 20 08 /9 3 50 60 70 75 80 80 Pe rio di ca l n ut rit io n as se ss m en ts % o f H IV p os iti ve m ot he rs re ce iv in g su pp le m en ta ry fo od C ar ry o ut ba se lin e as se ss m en t in 2 01 1 Es ta bl is h ba se lin e va lu e fr om th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et 10 % o f H IV po si tiv e m ot he rs re ce iv in g su pp le m en ta ry fo od s Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 15 % o f H IV po si tiv e m ot he rs re ce iv in g su pp le m en ta ry fo od s Pe rio di ca l n ut rit io n as se ss m en ts % o f H IV p os iti ve m ot he rs c ou ns el le d an d w ho a do pt g oo d nu tr iti on p ra ct ic es O pe n in ve nt io n of H IV p os iti ve m ot he r w ho a re co un se lle d an d ad op t go od nu tr iti on pr ac tic es in 20 11 Es ta bl is h ba se lin e va lu e fr om in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et 10 % o f H IV po si tiv e m ot he rs co un se lle d an d ha vi ng pr ac tic ed g oo d nu tr iti on in th e la st s ix m on th s pr ec ed in g as se ss m en t Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 15 % o f H IV po si tiv e m ot he rs co un se lle d an d ha vi ng pr ac tic ed g oo d nu tr iti on in th e la st s ix m on th s pr ec ed in g as se ss m en t Pe rio di ca l n ut rit io n as se ss m en ts National Nutrition Monitoring and Evaluation Framework40 % o f p re gn an t a nd la ct at in g m ot he rs w ith M U A C < 21 cm re ce iv in g su pp le m en ta ry fo od C on du ct ba se lin e as se ss m en t Es ta bl is h ba se lin e va lu e fr om th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng ye ar 2 01 5 ta rg et 12 % o f pr eg na nt an d la ct at in g m ot he rs (M U A C < 21 cm ) ha vi ng re ce iv ed su pp le m en ta ry fo od fo r t he la st s ix m on th s pr ec ed in g th e as se ss m en t Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 12 % o f pr eg na nt an d la ct at in g m ot he rs (M U A C < 21 cm ) ha vi ng re ce iv ed su pp le m en ta ry fo od fo r t he la st s ix m on th s pr ec ed in g th e as se ss m en t Pe rio di ca l n ut rit io n as se ss m en ts O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a % o f p eo pl e w ho ad op t p os iti ve nu tr iti on p ra ct ic es C on du ct ba se lin e as se ss m en t to d et er m in e KA P on nu tr iti on Se t nu tr iti on KA P ba se lin e va lu e fr om th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 3% o f t he po pu la tio n ad op t po si tiv e nu tr iti on pr ac tic es Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 4% o f t he po pu la tio n ad op t p os iti ve nu tr iti on pr ac tic es KD H S N um be r o f n ut rit io n se rv ic e pr ov id er s tr ai ne d an d ca rr yi ng ou t n ut rit io n IE C / BC C a nd a dv oc ac y ac tiv iti es C on du ct in ve nt or y of n ut rit io n se rv ic e pr ov id er s tr ai ne d an d ca rr yi ng o ut nu tr iti on IE C /B C C ac tiv iti es Se t b as el in e va lu e fr om in ve nt or y 15 % nu tr iti on se rv ic e pr ov id er s tr ai ne d an d ca rr yi ng ou t I EC / BC C ac tiv iti es 20 % n ut rit io n se rv ic e pr ov id er s tr ai ne d an d ca rr yi ng o ut IE C /B C C ac tiv iti es Pe rio di ca l nu tr iti on s ur ve ys Ministry of Health 41 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta r g et 20 16 /1 7 Ta rg et So ur ce o f d at a Re vi ew ed n at io na l nu tr iti on M & E fra m ew or k in p la ce Fu lly f un ct io na l M & E fra m ew or k is in p la ce Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s C or e nu tr iti on in di ca to rs in te gr at ed in to H M IS /K N BS /M EF V i si on 2 03 0. C or e n u tr iti on in di ca to rs in id en tifi ed na tio na l M & E sy s te m s Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s Su rv ei lla nc e gu id el in es de ve lo pe d & di ss em in at ed A ll su rv ei lla nc e gu id el in es de ve lo pe d Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s G ui de lin es o n va li da tio n, d is se m in at io n an d ut ili za tio n of su rv ei lla nc e re su lts in pl ac e A ll gu id el in es in p la ce Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s A fu nc tio na l M & E w eb si te in p la ce Fu nc tio na l M & E w eb si te in p la ce Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s N um be r o f t oo ls d e si gn ed a nd u til iz ed A ll ta rg et to ol s de ve lo pe d an d be in g us ed Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s N um be r o f n ut rit io n m an ag er s an d se rv ic e pr ov id er s tr ai ne d an d us in g M & E to ol s O pe n in ve nt or y of nu tr iti on m an ag er s an d se rv ic e pr ov id er s w ho w ill u se th e M & E to ol s Se t t he ba se lin e fr om th e in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 7% o f t he nu tr iti on m an ag er s an d se rv ic e pr ov id er s us in g th e M & E to ol s Se t A W P ta r ge ts to w ar ds ac hi ev in g ye ar 20 17 ta rg et 10 % o f t he nu tr iti on m an ag er s an d se rv ic e pr ov id er s us in g th e M & E to ol s Pr og ra m m e im pl em en ta tio n Pr og re ss re po rt s National Nutrition Monitoring and Evaluation Framework42 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a N um be r o f p up ils an d in m at es in in st i tu tio ns w ho re ce iv e nu tri tio na lly a de qu at e m ea ls Ca rry o ut b as e lin e as se ss m en t to e st ab lis h cu r re nt p ris on a nd pu pi l p op ul at io n Se t b as el in e va lu e ba se d on b as el in e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 5% o f p up ils an d in m at es in in st itu tio ns e ac h re ce iv e nu tri tio na lly ad eq ua te m ea ls at al l t im es Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 10 % o f p up ils an d in m at es in in st itu tio ns ea ch re ce iv e nu tri tio na lly ad eq ua te m ea ls at a ll tim es KD H S, Pe rio di ca l nu tri tio n as se ss m en ts Te ac he rs p re s er vi ce cu rri cu lu m w ith b as ic nu tri tio n co m po ne nt Te ac he rs pr e se rv ic e Cu rri cu lu m w ith b as ic nu tri tio n co m po ne nt in p la ce Pe rio di ca l nu tri tio n as se ss m en t N um be r o f E CD ce nt re s ca rry in g ou t gr ow th m on ito rin g Ca rry o ut b as e lin e as se ss m en t Se t b as el in e va lu e ba se d on b as el in e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 7 % o f E CD c en tre s ca rry in g ou t gr ow th m on ito rin g Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 10 % o f E CD ce nt re s ca rry in g ou t g ro w th m on ito rin g KD H S, Pe rio di ca l nu tri tio n as se ss m en ts O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a N um be r o f fu nc tio na l n ut rit io n co or di na tin g co m m itt ee s in p la ce an d ex ec ut in g th ei r m an da te O pe n in ve nt io n of n ut rit io n co or di na tin g co m m itt ee a nd ex ec ut in g th ei r m an da te Se t b as el in e ba se d on th e in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 75 % o f co or di na tin g co m m itt ee s in p la ce a nd ex ec ut in g th ei r m an da te Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 10 0% o f co m m itt ee s in p la ce a nd ex ec ut in g th ei r m an da te Pr og ra m m e pr og re ss im pl em en ta tio n re po rt s Ministry of Health 43 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a A m ou nt o f d iff er en t ki nd s of re so ur ce s (fu nd s* a nd h um an ) av ai la bl e fo r im pl em en ta tio n of th e Pl an o f A ct io n O pe n in ve nt or y of re so ur ce s (h um an a nd fin an ci al ) go in g to w ar ds im pl em en ta tio n of A ct io n Pl an Se t b as el in e ba se d on th e in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 75 % o f t he re so ur ce s ne ed ed av ai la bl e fo r im pl em en ta tio n of th e Pl an o f A ct io n Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 85 % o f t he re so ur ce s ne ed ed av ai la bl e fo r im pl em en ta tio n of th e Pl an o f A ct io n Pr og ra m m e pr og re ss im pl em en ta tio n re po rt s * re fe r t o th e bu dg et o f t he Pl an o f A ct io n N um be r o f nu tr iti on n et w or ks es ta bl is he d at na tio na l a nd c ou nt y le ve ls C on du ct ra pi d as se ss m en t t o de te rm in e st at us of n et w or ks Es ta bl is h th e ba se lin e fr om as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 75 % o f t he ta rg et n ut rit io n ne tw or ks to h av e be en fo rm ed at n at io na l a nd co un ty le ve ls Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 2 01 7 ta rg et 85 % o f t he ta rg et n ut rit io n ne tw or ks to ha ve b ee n fo rm ed a t na tio na l a nd co un ty le ve ls Pr og ra m m e pr og re ss im pl em en ta tio n re po rt s National Nutrition Monitoring and Evaluation Framework44 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a N um be r an d ty pe of n ut rit io n pr io rit y re se ar ch st ud ie s co nd uc te d an d di ss em in at ed am on g re le va nt nu tr iti on st ak eh ol de rs C ar ry o ut as se ss m en t to d et er m in e ba se lin e si tu at io n Se t b as el in e va lu e ba se d on as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 20 15 ta rg et Re se ar ch ca rr ie d ou t o n 40 % o f p rio rit y nu tr iti on a re as an d th e fin di ng s di ss em in at ed am on g nu tr iti on st ak eh ol de rs Se t A W P ta rg et to w ar ds ac hi ev in g ye ar 20 17 ta rg et Re se ar ch ca rr ie d ou t on 6 0% of p rio rit y nu tr iti on ar ea s an d th e fin di ng s di ss em in at ed am on g nu tr iti on st ak eh ol de rs Pe rio di ca l n ut rit io n pr og ra m m e as se ss m en ts N um be r o f in st itu tio ns us in g ev id en ce ba se d da ta fo r d ec is io n m ak in g an d pr og ra m m in g on n ut rit io n C ar ry o ut as se ss m en t to d et er m in e ba se lin e si tu at io n Se t b as el in e va lu e ba se d on as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 20 15 ta rg et 45 % o f in st itu tio ns m ak e de ci si on s on n ut rit io n pr og ra m m in g ba se d on in fo rm at io n fr om n ut rit io n op er at io ns re se ar ch Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 55 % o f in st itu tio ns m ak e de ci si on s on n ut rit io n pr og ra m m in g ba se d on in fo rm at io n fr om n ut rit io n op er at io ns re se ar ch KD H S Pe rio di ca l n ut rit io n pr og ra m m e as se ss m en ts N um be r o f nu tr iti on ba se d de ci si on s m ad e by ag en ci es u si ng in fo rm at io n ge ne ra te d th ro ug h op er at io ns re se ar ch C ar ry o ut as se ss m en t to d et er m in e ba se lin e si tu at io n on ke y nu tr iti on de ci si on s m ad e Se t b as el in e va lu e ba se d on as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 20 15 ta rg et 45 % o f nu tr iti on b as ed de ci si on s m ad e by a ge nc ie s ar e in fo rm ed by fi nd in gs of n ut rit io n op er at io ns re se ar ch Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 15 ta rg et 65 % o f nu tr iti on ba se d de ci si on s m ad e by ag en ci es a re in fo rm ed by fi nd in gs of n ut rit io n op er at io ns re se ar ch KD H S Pe rio di ca l n ut rit io n pr og ra m m e as se ss m en ts Ministry of Health 45 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a Re se ar ch co or di na tin g co m m itt ee es ta bl is he d an d ex ec ut in g th ei r m an da te ac co rd in g to te rm s of re fe re nc e C ar ry o ut as se ss m en t on e xi st in g nu tr iti on re se ar ch co or di na tin g co m m itt ee s Se t b as el in e ba se d on as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 20 15 ta rg et 75 % o f f ul ly fu nc tio na l re se ar ch co or di na tin g co m m itt ee s es ta bl is he d Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 15 ta rg et 85 % o f f ul ly fu nc tio na l re se ar ch co or di na tin g co m m itt ee s es ta bl is he d Pr og ra m m e pr og re ss im pl em en ta tio n re po rt s O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a Pr op or tio n of po pu la tio n th at a do pt co ns um pt io n of m ic ro nu tr ie nt ric h fo od s in cl ud in g th e fo rt ifi ed fo od s. C ar ry o ut po pu la tio n –b as ed as se ss m en t to d et er m in e ba se lin e si tu at io n Se t b as el in e va lu e ba se d on th e as se ss m en t re su lts Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et In cr ea se b y 5% of th e po pu la tio n th at c on su m ed m ic ro nu tr ie nt ric h fo od s in cl ud in g fo rt ifi ed fo od s fo r t he la st si x m on th s pr ec ed in g th e ta rg et e va lu at io n su rv ey Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et In cr ea se b y 8% o f t he po pu la tio n th at c on su m ed m ic ro nu tr ie nt ric h fo od s in cl ud in g fo rt ifi ed fo od s fo r t he la st si x m on th s pr ec ed in g th e ta rg et ev al ua tio n su rv ey KD H S. Pe rio di ca l nu tr iti on pr og ra m m e as se ss m en ts N um be r o f in st itu tio ns in co rp or at in g m ic ro nu tr ie nt is su es in th ei r t ra in in g cu rr ic ul a C ar ry o ut as se ss m en t de te rm in e ta rg et n um be r an d ty pe o f in st itu tio ns Se t b as el in e va lu e ba se d on th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 75 % o f t ar ge t tr ai ni ng in st itu tio ns in co rp or at in g m ic ro nu tr ie nt is su es in th ei r cu rr ic ul a Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 85 % o f t ar ge t tr ai ni ng in st itu tio ns in co rp or at in g m ic ro nu tr ie nt is su es in th ei r cu rr ic ul a KD H S, Pe rio di ca l nu tr iti on pr og ra m m e as se ss m en ts National Nutrition Monitoring and Evaluation Framework46 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a Pr op or tio n of s al t m an uf ac tu rin g in du st rie s co m pl yi ng w ith S oP s on sa lt io di za tio n O pe n in ve nt or y of s al t m an uf ac tu rin g in du st rie s Se t b as el in e ba se d on th e in ve nt or y Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 95 % o f t he ex is tin g sa lt m an uf ac tu rin g in du st rie s co m pl y w ith S oP s on s al t io di za tio n Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 10 0% o f t he ex is tin g sa lt m an uf ac tu rin g in du st rie s co m pl y w ith So Ps o n sa lt io di za tio n Pe rio di ca l nu tr iti on pr og ra m m e as se ss m en ts Pr op or tio n of h ou se ho ld s w ith re co m m en de d io di ne c on te nt in th e sa lt C ar ry o ut as se ss m en t o n io di ne c on te nt in s al ts a t ho us e ho ld le ve ls Se t b as el in e va lu e ba se d on th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 95 % o f th e ho us e ho ld s ha vi ng re co m m en de d io di ne c on te nt in th e sa lt Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 10 0% o f th e ho us e ho ld s ha vi ng re co m m en de d io di ne c on te nt in th e sa lt KD H S Pe rio di ca l nu tr iti on pr og ra m m e as se ss m en ts Pr op or tio n of fo rt ifi ed fo od s at th e ho us eh ol d le ve l w ith re co m m en de d co nt en t o f t he fo rt ifi ca nt C ar ry o ut as se ss m en t on c on te nt o f fo rt ifi ca nt s in fo rt ifi ed fo od s av ai la bl e at ho us e ho ld le ve ls Se t b as el in e ba se d on th e as se ss m en t Se t A W P ta rg et s to w ar ds a ch ie vi ng y ea r 2 01 5 ta rg et 95 % o f t he fo rt ifi ed fo od s at h ou se h ol d le ve l t o ha ve re co m m en de d co nt en t o f fo rt ifi ca nt s Se t A W P ta rg et s to w ar ds ac hi ev in g ye ar 20 17 ta rg et 10 0 % o f t he fo rt ifi ed fo od s at h ou se h ol d le ve l t o ha ve re co m m en de d co nt en t o f fo rt ifi ca nt s KD H S, Pe rio di ca l nu tr iti on pr og ra m m e as se ss m en ts N o of tr ai ni ng s fo r h ea lth y di et s an d ph ys ic al ac tiv ity co nd uc te d fo r h ea lth w or ke rs . 2 5 7 9 10 N ut rit io n su rv ei lla nc e m at rix Ministry of Health 47 O ut p ut in d ic at o rs O ut co m e in d ic at o rs B as el in e Ye ar B as el in e Va lu e 20 11 /1 2 Ta rg et 20 12 /1 3 Ta rg et 20 13 /1 4 Ta rg et 20 14 /1 5 Ta rg et 20 15 /1 6 Ta rg et 20 16 /1 7 Ta rg et So ur ce o f d at a Pr op or tio n of po pu la tio n sc re en ed fo r n on co m m un ic ab le di se as es . 5% 7% 10 % 12 % 15 % KD H S Pr op or tio n of p eo pl e w ho se B M I is m on ito re d re gu la rly . 5% 7% 10 % 12 % 15 % KD H S/ nu tr iti on su rv ei lla nc e m at rix Pr op or tio n of C H W s tr ai ne d on h ea lth y di et s an d lif es ty le s. 5% 8% 12 % 17 % 20 % N ut rit io n su rv ei lla nc e Pr op or tio n of po pu la tio n w ho a do pt he al th y di et s an d ph ys ic al ac tiv ity . C on du ct a ba se lin e su rv ey to d et er m in e nu tr iti on K A P Se t a n ut rit io n KA P va lu e fr om th e su rv ey 2% 5% 7% 12 % 15 % KD H S N o te : O ut co m e ta rg et s ar e se t on t he b as is o f e xi st in g in fo rm at io n dr aw n fr om W H O C hi ld G ro w th S ta nd ar ds a s w el l a s an al ys is o f d at a on m al nu tr iti on t re nd s in t he c ou nt ry . F or ou tp ut in di ca to rs , t ar ge t s et tin g is b as ed o n an al ys is o f d at a on G lo ba l M al nu tr iti on tr en ds a s w el l a s th e pe rf or m an ce o f n at io na l n ut rit io n pr og ra m m es . T ar ge t s et tin g ha s al so ta ke n in to c on si de ra tio n in flu en ci ng fa ct or s no ta bl y po lit ic al c om m itm en t, av ai la bi lit y of re so ur ce s an d dr ou gh t, am on g ot he rs National Nutrition Monitoring and Evaluation Framework48 APPENDIx 3: FORMATS FOR PRESENTING REPORTS FOR ANNUAL OPERATIONS PLANS. To ensure consistency and uniformity each unit head within the division of nutrition will be required to report progress of implementation of outputs as stipulated in the annual plans by 15th after the end of every quarter. (These will be in the months of October, January, April and July of every year.) Result area/cohort Output Progress Comments Ministry of Health 49 APPENDIx 4: ACTIVITY MATRIx FOR NATIONAL NUTRITION ACTION PLAN 2012-2017 Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies Strategic Objective 1: To improve the nutritional status of women of reproductive age (15-49 years) % reduction of Vitamin A deficiency among women of reproductive age. % reduction of iron deficiency among women of reproductive age. % reduction of iodine deficiency among women of reproductive age. % reduction of overweight and obesity among women of reproductive age. % reduction of zinc deficiency among women of reproductive age. % of pregnant women who take iron and folic acid supplements for at least 90 days during pregnancy. • Provide IFA supplements to adolescent girls and pregnant women. County MOH MoE, Development , Implementing partners % of pregnant and lactating women with MUAC < 21 cm receiving supplementary food. • Provide supplementary foods to pregnant and lactating women according to the admission criteria on integrated management of acute malnutrition guidelines. County MOH KEMSA, Development , Implementing partners % of pregnant women monitored for their weight. • Conduct routine weight monitoring and appropriate counselling for the pregnant women County MOH Development , Implementing partners Proportion of health facilities with nutrition commodities and equipment for maternal nutrition interventions • Procure and distribute nutritional commodities and equipment to health facilities. National/ County MOH KEMSA, Development , Implementing partners • Conduct nutrition education on healthy dietary practices to Women of reproductive age. County MOH Development , Implementing partners, Media No of maternal nutrition guidelines disseminated in use at county level National MOH Development , Implementing partners, Media • Review, develop, print and disseminate and distribute guidelines National MOH Development , Implementing partners, Media National Nutrition Monitoring and Evaluation Framework50 Strategic objective 3: To reduce the prevalence of micronutrient deficiencies in the population Outcome Indicator Output Indicator Activity Implemen tation level Lead Agency Other Agencies decreased prevalence of micronutrients deficiencies decreased preva lence of Vitamin A deficiency by 5% decreased prev alence of iron deficiency by 10% decreased prev alence of iodine (goitre rate) defi ciency by 1% Increase in the population knowledge on micronutrient deficiency and curative and preventive meas ures # of health workers at all levels trained on pre vention, management and control of micronu trient deficiencies. Review, develop and disseminate national micronutrient deficiency prevention and control strategy and guidelines. National and County MoH NMDCC members Train service providers on micro nutrients deficiency prevention and control strategies including logistic and supply chain man agement County MOH Institutions of Higher Learning, Develop ment , Implementing partners No. of advocacy work shops on micronutrient interventions conducted at all levels No. of micronutrient intervention campaigns (Radio, TV, Community etc) launched. Advocate and create public awareness on food fortification, supplementation and dietary di versification. County MoH KNFFA members, Me dia , Industry Proportion of U5 children who receive multiple micronutrient supplements % U5 children supple mented with vitamin A % of women of repro ductive age supple mented with iron and folic acid Scale up and strengthen the ex isting strategies of micronutrient supplementation at all levels. County MOH CHMT, County Gov ernment, MOA, MOL, MOF, MOW, MoG C&SS, MoE, Develop ment , Implementing partners Procure and distribute micronu trient supplements (VAS, MNPs and IFA). National and County MOH KEMSA, CHMT, County Government, Development , Imple menting partners % of households con suming adequately fortified foods in the country Scale up fortification of widely consumed food stuffs. National / County Kenya National Fortification Alliance MOH, MOT, MOF, Media. % of widely consumed basic commodities which are fortified with necessary micronutri ents No. of private sector actors/industries fortify ing their foods products as per the national guidelines. Monitor the quality of fortified foods regularly at all levels. National and County KEBS MOH, Media. Conduct M&E of micronutrient deficiency prevention and control interventions County KEMRI MOH, CHMT, County Government, Devel opment , Implement ing partners Train CHEWs and CHWs on micro nutrient deficiency prevention and control strategies. County MOH CHMT, County Gov ernment, Academia, Development , Imple menting partners Review of policy to include use of CHWs in delivery of micronutrient supplements. National MOH Academia, Develop ment , Implementing Partners Ministry of Health 51 Strategic objective 4: To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies Outcome Indicator Output Indicator Activity Imple mentation level Lead Agency Other Agencies Improved nutritional status of populations in emergencies. Reduced morbidity and mortality of the affected population Proportion of counties with emergency nutrition response plans Build the capacity of the counties to develop nutrition response plans National and County MOH CHMT, County Government, Academia, Development , Implementing partners Review, develop and disseminate guidelines for disaster preparedness, response and management of nutrition emergencies National and County MOH CHMT, County Government, Academia, Development , Implementing partners Number of counties reporting on a timely basis on nutrition surveillance Conduct nutrition surveillance in emergency affected areas County MoH Implementing partners Number of counties holding regular coordination meetings. Map partners, review and develop TORs County MOH CHMT, County Government, Academia, Development, Implementing partners Hold and document regular joint planning and review meetings County MOH CHMT, County Government, Development , Implementing partners Proportion of facilities experiencing no stock outs of essential nutrition commodities Timely provision of food and non food items County MOH MOF, KEMSA CHMT, County Government, Academia, Development , Implementing partners Proportion of health facilities offering the essential nutrition services package. Scale up delivery of essential nutrition services (High Impact Nutrition Interventions) County MOH MOF, KEMSA, CHMT, County Government, MOF, MOA, MOE, MOW, Development , Implementing partners Number of health workers in emergency districts trained on essential nutrition services package. Capacity strengthening of health workers to provide nutrition care and support at all levels County MOH CHMT, County Government, Academia Development , Implementing partners Proportion of counties mobilizing resources for nutrition emergency response Mobilize resources for emergency response County MOH MOF, CHMT, County Government, MOA, MOE, MOW, Development , Implementing partners Number of counties meeting the SPHERE standards on IMAM and national targets on IFE National nutrition commodities monitoring plan developed and disseminated for use by the counties Develop, disseminate and implement the national monitoring plan for nutrition commodities in emergency National MOH MOF, Development , Implementing partners Proportion of counties implementing the nutrition commodities monitoring plan used during emergencies Monitor food safety of nutrition commodities for use in emergencies County MOH CHMT, County Government, Development , Implementing partners Create public awareness on importance of nutrition in emergencies County MOH CHMT, County Government, Development , Implementing partners, Media Civil Society National Nutrition Monitoring and Evaluation Framework52 Strategic Objective 5: To improve access to quality curative nutrition services Outcome Indicator Output Indicator Activity Implemen tation level Lead Agency Other Agencies Proportion of population accessing curative nutrition services Number of agencies integrating nutritional care standards in their plans Proportion of resources committed to nutrition care services Number of health workers trained on curative nutrition services Number of community individuals and private sector players sensitized on quarterly basis Proportion of health facilities providing curative nutrition services Proportion of facilities experiencing no stock-outs of essential nutrition commodities Reduced inpatient length of stay Review, develop and disseminate national guidelines on nutritional care in the management of common diseases National MOH Development , Implementing partners Mobilize resources for nutritional care and treatment for common diseases National MOH MOF, Development , Implementing partners Train health workers on clinical nutrition management National and County MOH CHMT, County Government, Academia Development , Implementing partners Procure and distribute essential nutrition commodities (micronutrient supplements, therapeutic milks and feeds) and equipments (anthropometric and others) National MOH MOF, KEMSA Development , Implementing partners Develop and disseminate nutrition commodities monitoring plan National MOH KEMSA, Development , Implementing partners National nutrition commodities monitoring plan developed and disseminated for use by the counties Monitor food safety of nutrition commodities National and County MOH KEMSA, CHMT, County Government, Academia Development , Implementing partners Proportion of counties implementing the nutrition commodities monitoring plan Conduct M&E of curative nutrition services County MOH KEMRI, Development , Implementing partners Ministry of Health 53 Strategic objective 6: Halt and reverse the prevalence of diet related non communicable diseases Outcome Indicator Output Indicator Activity Implemen tation level Lead Agency Other Agencies % reduction of incidences of non communicable diseases. % of population screened for non communicable diseases % reduction of population prevalence rates for obesity and overweight. % of population with normal range BMI. % of households consuming diversified diets. Proportion of counties implementing nutrition guidelines on NCDs Proportion of the population who are screened for non-communicable diseases. Proportion of Counties conducting sensitization meetings on healthy diets and physical activity % no. of population whose BMI is monitored regularly Review, develop and disseminate a comprehensive strategy and guidelines for prevention, management and control of diet-related NCDs Health facility/ Community MOH Academia, MOA, Development , Implementing partners Train service providers on prevention, management and control of diet-related NCDs Health facility/ Community MOH Academia, MOA, Development , Implementing partners Create public awareness on the importance of prevention, management and control of diet-related NCDs County Health facility/ MOH Academia, MOA, Media Development, Implementing partners Map partners, review and develop TORs Community MOH CHMT, Academia, Development , Implementing partners Hold and document regular joint planning and review meetings National/ County MOH CHMT, County Governments Development , Implementing partners Conduct M&E of diet related NCDs National/ County MOH KEMRI, Development, Implementing partners Conduct screening for non communicable diseases. County MOH MOE, Development, Implementing partners, Scale up community screening for BMI and waist circumference National/ County MOH MOE, MOGC&SS, Development , Implementing partners, National Nutrition Monitoring and Evaluation Framework54 Strategic objective 7: To improve nutrition in schools, public and private institutions Outcome Indicator Output Indicator Activity Implemen tation level Lead Agency Other Agencies % of pupils in Primary Schools with adequate nutrition status. % population in public institutions with adequate nutrition status Situation analysis on school/ institutional feeding conducted, documented and disseminated • Conduct situation analysis on school/ institutional feeding including the Early Childhood Development Education Centres(ECDE), Daycare centres County MOH MoE, KEMRI, KNBS, Children Department, Development , Implementing partners School/institutional feeding guidelines reviewed and disseminated Proportion of schools and institutions mainstreaming basic nutrition in their operations • Review, develop and disseminate nutrition guidelines for school and other institutions National MOH MoE, Children Department, Development , Implementing partners • Mainstream basic nutrition training in all schools and other institutions National KIE MOH MoE, Children Department, Development , Implementing partners • Implement appropriate nutrition interventions (school meals, micronutrient supplementation, nutrition assessment, de-worming among others) in schools and other institutions County MOE/MOH Children Department, Development , Implementing partners Number of counties holding stakeholders’ meetings on sustainable institutional feeding programmes • Mobilize resources to sustain optimal institutional feeding programmes County MOE MOH, MOF, Children Department, Development , Implementing partners • Integrate nutrition education in school curricula at all levels National KIE MOH MoE, Children Department, Development , Implementing partners Proportion of counties monitoring nutrition interventions in schools and institutions • Conduct M&E of nutrition interventions in schools and other institutions County MOE MOH, Children Department, Development , Implementing partners Ministry of Health 55 Strategic objective 8: To improve nutrition knowledge attitudes and practices among the population Outcome Indicator Output Indicator Activity Implemen tation level Lead Agency Other Agencies % of population adopting healthy diets and lifestyle Formative and periodic assessment reports available and disseminated • Conduct formative and periodic assessments on the status of nutrition knowledge, attitude and practices in the general population National and County MOH KEMRI, KNBS Institutions of Higher Learning, Development , Implementing partners, Proportion of Counties implementing ACSM strategy • Develop, print and disseminate national nutrition advocacy, communication and social mobilization (ACSM) strategy at all levels National MOH Development , Implementing partners Proportion of service providers trained on nutrition communication and advocacy skills • Train service providers on communication and advocacy skills County MOH Development , Implementing partners Number and type of nutrition communication materials developed and disseminated at all levels • Review, develop, print, disseminate and distribute IEC materials National / County MOH Development , Implementing partners Proportion of counties marking Nutrition Days • Mark national/international Nutrition Days (World Breastfeeding Week, African Food and Nutrition Security Day, Iodine Deficiency Disorders Day, Malezi Bora among others) National / County MOH Development , Implementing partners, Media Civil Society Proportion of media houses disseminating nutrition messages • Promote optimal nutrition through all channels of communication at all levels National and County MOH Development , Implementing partners, Media Civil Society National Nutrition Monitoring and Evaluation Framework56 Strategic objective 9: To strengthen the nutrition surveillance, monitoring and evaluation systems % health facilities nationwide conveying accurate and complete monitoring data to central level # Of core nutrition indicators included in HIS, NMEF, MTEF planning and budgeting framework. Coordination and information exchange strengthened among nutrition stakeholders. • Launch and Implement M & E framework for the nutrition sector National MOH KEMRI, KNBS Development , Implementing partners # Core nutrition indicators integrated into HIS, KNBS, NMEF for Vision 2030 • Define and Integrate core Nutrition indicators in HIS/ KNBS/NMEF- VISION 2030 National MOH KEMRI, KNBS Development , Implementing partners Surveillance protocol and reporting formats disseminated and implemented. • Review, develop and disseminate guidelines and tools on surveillance, M&E. National MOH KEMRI, KNBS Development , Implementing partners Surveillance protocol and M&E tools (reporting formats etc.) available online. • Conduct data audits at all levels. National and County MOH KEMRI, KNBS Development , Implementing partners Number of nutrition bulletins disseminated annually # of nutrition stakeholder forum held at county level to support and strengthens feedback mechanisms. • Develop and disseminate quarterly nutrition bulletins. National and County MOH KEMRI Development , Implementing partners • Hold feedback meetings among nutrition stakeholders at all levels National and County MOH Development , Implementing partners • Update and maintain national nutrition website National MOH Development , Implementing partners Number of nutrition M&E tools disseminated • Review, and disseminate Nutrition M&E tools based on new information. National MOH KEMRI Development , Implementing partners Proportion of health facilities reporting quality nutrition data Proportion of counties conducting scheduled support supervision visits Proportion of county health facilities equipped with facilities for data entry and analysis • Train all health managers and service providers on use of DHIS and interpretation of M&E data National / County MOH KEMRI Development , Implementing partners • Conduct support supervision at all level. National / County MOH Development , Implementing partners • Procure and distribute equipment (Computers, printers, copiers, scanners and external hard discs) National and County MOH Development , Implementing partners Ministry of Health 57 Strategic objective 10: To enhance evidence-based decision-making through research Evidence based nutrition interventions planned and programmed Nutrition Research Coordinating Committee established and executing its appropriate mandate • Establish nutrition research committee with clear terms of reference at county level National KEMRI MOH, Development , Implementing partners Number and type of nutrition priority research studies conducted and disseminated among relevant nutrition stakeholders • Conduct need-based research to inform policy, programme design and implementation • Mobilize resources to address critical gaps in nutrition research National KEMRI/ KNBS MOH, MOF, Development , Implementing partners Number of agencies and institutions making decisions based on empirical evidence for nutrition intervention programming and planning • Disseminate research findings to key stakeholders at all levels National / County MOH CHMT, County Government, MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners Number and type of best practices documented and disseminated for evidence based programming Support relevant research institutions (equipment, laboratory supplies and technical support) to conduct nutrition research National MOH MOF, Development , Implementing partners Strategic Objective 11: To Strengthen coordination and partnerships among the key nutrition actors Increased hu man, financial and material resources allocation by government and partners to support nutri tion activities. • Number of inter- and intra-sectoral coordination meetings held at all levels • Map partners, review and develop TORs National and County MOH MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners Number of functional nutri tion coordination committees in place and executing their mandates at all levels Number of new partners sup porting nutrition activities at all levels. Proportion of counties inte grating nutrition priorities in their county plans • Hold and document regular joint planning and review meetings to align the annual nutrition planning process to the nutrition action plan. National / County MOH MOH, MOA, MOL, MOF, MOW, MoG C&SS, MoE, Devel opment , Imple menting partners % of the resource mobilized for nutrition activities from government and partners against the budget activities. • Mobilize financial and human resources for nutrition interventions at all levels National / County MOH CHMT, County Government, MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Im plementing partners National Nutrition Monitoring and Evaluation Framework58 APPENDIx 5: CONCEPTUAL FRAMEWORK ON THE CAUSES OF UNDER NUTRITION (Source: Sphere Project, 2011) Ministry of Health 59 APPENDIx 6: THRESHOLDS FOR NUTRITION INDICATORS Indicators Acceptable Alert Serious Critical Very critical Global acute malnutrition GAM <5% 5 to <10% 10 to <15% or where there is significant increase from baseline/seasonal trends in the last ≥2 yrs 15 to <20% or where there is significant increase from baseline/ seasonal trends in the last ≥2 yrs >/=20% or where there is significant increase from baseline/seasonal trends in the last ≥2 yrs Mean weight for height (WHZ) >-0.04 -0.40 to -0.69 -0.70 to -0.99; >usual /increasing <-1.00; >usual /increasing Severe Acute Malnutrition <3.0% 3.0 – 4.4% 4.5% - 5.4% 5.5 – 6.9% or where there is significant increase from baseline/ seasonal trends in the last ≥2 yrs ≥ 7.0% or where there is significant increase from baseline/seasonal trends in the last ≥2 yrs MUAC children (%<12.5) <5% <5% with increase from seasonal trends 5.0 -9.9% 10.0 – 14.9%, or where there is significant increase from seasonal trends >15%, or where there is significant increase from seasonal trends Adult MUAC – Pregnant and Lactating (%<23.0cm, sphere 04) <9.5% 9.5% - 14.9% 15 – 21.9% 22.0 – 27.9% ≥28% Adult MUAC – Non Pregnant and Non Lactating (%<18.5cm, sphere 04) <0.3% 0.3 - 0.49% 0.5 - 0.69% 0.7 – 1.99% ≥2.0% Non Pregnant maternal Under nutrition BMI<18.5 <10% 10.0 to 19.9% 20.0 to 39.9% >40% Poor HH dietary Diversity (% consuming <4 fdgps)) <5% 5-9.9% 10-24.9% 25-49.9% ≥ 50% Breastfeeding practices : (i)EBF, (ii) Continued BF at 1 yr, (iii)Continued BF at 2 yr reference ≥90% 50-89% 12-49% 0-11% Stunting <10% 10 ‐ <20% 20 ‐ <40% > 40% Vitamin A supplementation coverage : 1 dose in last 6 months ≥95% 80-94.9% <80% Crude death rate/10000/day <0.5 0.5 to <1 1 to <2 include information on the main causes 2 to ≤5 include information on the man causes >5 or doubling of rate from preceding phase. Include main causes Under five years death rates/10000/day <1 1-1.99 2-3.9/10000/ day include main cause 4 to 9.9 or doubling from previous phase, include main cause ≥10 or doubling rate from preceding phase. Include main cause National Nutrition Monitoring and Evaluation Framework60 APPENDIx 7: LIST OF CONTRIBUTORS Name Agency/ Department Dr Annah Wamae Head, Department of Family Health Terry Wefwafwa Head, Division of Nutrition Gladys Mugambi Division of Nutrition Valarie Wambani Division of Nutrition Lucy Gathigi Division of Nutrition Samuel Murage Division of Nutrition James Njiru Division of Nutrition Evelyne Kikechi Division of Nutrition Grace Gichohi Division of Nutrition John Mwai Division of Nutrition Leila Akinyi Division of Nutrition Faith Njoroge Division of Nutrition Nancy Deya Division of Nutrition Sarah Onsase Division of Nutrition Patrick Warutere Division of Health Information systems Samuel Cheburet Division of Health Information systems David Kiongo UNICEF - Consultant Ruth Situma UNICEF Shadrack Oyie UNICEF Kibet Chirchir UNICEF/ DON Edward Kutondo UNICEF Dr. Isaac Malonza USAID/MCHIP Evelyn Matiri USAID/MCHIP Prof. Judith Kimiywe USAID/MCHIP Herbert Kere USAID/MCHIP Rose Mulindi USAID/MCHIP Samuel Kamau Micronutrient Initiative – Consultant Lucy Rowa Micronutrient Initiative Imelda Awino Action Against Hunger Elizabeth Kimani African Population and Health Research Centre Fredrick Wekesah African Population and Health Research Centre Juliana Muiruri Save the Children UK Zipporah Bukania Kenya Medical Research Institute Emily Madete World Food Program Irene M Makori Kenyatta National Hospital Prof. A. O. Makokha Jomo Kenyatta University of Agriculture and Technology Samuel Kirichu Concern Worldwide Ministry of Health REPUBLIC OF KENYA National Nutrition Monitoring and Evaluation Framework 2013