Uganda Nutrition Action Plan II

1.1 Why invest in nutrition................................................................................................................................1

1.2 Global, continental and national frameworks context . ...........................................................................3

1.2.1 Global nutrition commitments and initiatives........................................................................................................ 3

1.2.2 Continental and regional frameworks context. .................................................................................................... 4 1.2.3 National legal, policy and planning frameworks context. .................................................................................. 4

1.3 Programme achievements and challenges ...............................................................................................5

1.4 Contextual challenges ................................................................................................................................6

1.5 Opportunities to harness . ..........................................................................................................................7

1.6 The process of developing the ‘Uganda Nutrition Action Plan’...............................................................7 Nutrition Situational Analysis. .......................................................................................8

2.1 Undernutrition . ...........................................................................................................................................8 2.1.1 Prevalence of stunting in children under five years of age................................................................................ 8

2.1.2 Prevalence of low birth weight (<2500g) . ........................................................................................................... 10

2.1.3 Prevalence of wasting in children aged 0-5 years............................................................................................. 10

2.1.5 Prevalence of anaemia in women of reproductive age.................................................................................... 12

2.2 Overweight, obesity and diet-related non-communicable diseases (NCD)..........................................13

2.2.1 Prevalence of overweight in children under five years of age . ........................................................................... 13 2.2.2 and 2.2.4 Proportion of overweight and obesity in adult women aged 18+ years.............................................. 13 2.2.3 and 2.2.5 Proportion in overweight and obesity among adult men aged 18+ years. .......................................... 13 2.2.6 and 2.2.7 Prevalence of overweight and obesity in adolescents and adolescent girls . ................................... 13 2.2.8 and 2.2.9 Age-standardized prevalence of raised blood glucose/diabetes and blood pressure among persons aged 18+ years. ........................................................................................................................................................ 14

2.3 Determinants of nutrition status . ............................................................................................................15

2.3.1 Maternal, infant and young child feeding practices. ........................................................................................ 15 2.3.3 Access to and utilization of maternal and child health services .................................................................... 17

2.3.4 Early childhood development (ECD). .................................................................................................................... 18

2.3.5 Food production, access and utilization . ............................................................................................................ 19

2.3.6 Water sanitation and hygiene (WASH). ............................................................................................................... 22

2.3.7 Nutrition-enabling environment . .......................................................................................................................... 23

2.4 Government commitment to address malnutrition ...............................................................................24 ‘UNAP II’ Strategic Direction. .......................................................................................25

3.1 ‘UNAP II’ theory of change........................................................................................................................25

3.2 Vision..........................................................................................................................................................27

3.3 Goal.............................................................................................................................................................27 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

3.4 Objectives ..................................................................................................................................................27

3.5 Strategies and priority actions . ...............................................................................................................28

3.6 ‘UNAP II’ alignment with ‘NDP III’............................................................................................................33

3.7 Implementation principles .......................................................................................................................33

3.8 Targeting ....................................................................................................................................................34 ‘UNAP II’ Implementation and Coordination Arrangements.....................................35

4.1 National coordination structures and platforms ...................................................................................37

4.2 National level Scaling Up Nutrition (SUN) Networks............................................................................38

4.3 Roles of MDAs in the coordination of the implementation of ‘UNAP II’...............................................39

4.4 Specific roles of Parliament, Cabinet and UNAP-implementing MDAs . ..............................................39

4.5 Sub-national level coordination. ..............................................................................................................42 Financing and Resource Mobilization. ........................................................................44 5.1 Estimated financial requirements for implementing ‘UNAP II’. ............................................................44

5.2 Generation of indicative costs for ‘UNAP II’............................................................................................47

5.3 Resource mobilization...............................................................................................................................47 Monitoring, Evaluation, Accountability and Learning (MEAL)..................................48

6.1 Overview of the ‘UNAP II’ MEAL framework ..........................................................................................48

6.2 Primary and intermediate outcomes of the ‘UNAP II’. ...........................................................................49

6.3 ‘UNAP II’ MEAL arrangements. ................................................................................................................50

6.4 Learning......................................................................................................................................................50

6.5 Risks and mitigation measures. ...............................................................................................................51 Annexes. ........................................................................................................................53 Annexe 1: Evolution of global and African nutrition commitments and initiatives .....................................54 Annexe 2: ‘UNAP II’ implementation matrix 2020/21-2024/2025....................................................................56 Annexe 3: ‘UNAP II’ MEAL framework 2020/21-2024/25 aligned with ‘NDP III’, SDGs and SUN MEAL frameworks .....................................................................................................................................75 Annexe 4: ‘UNAP II’ rollout and implementation road map 2020/21-2024/2025...........................................82 Annexe 5: Information on outstanding ‘UNAP II’ implementation components..........................................84 References. ....................................................................................................................86 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 11 LIST OF TABLES TABLE 1: UNAP II alignment with NDPII...........................................................................................................33 TABLE 1: Summary of ‘UNAP II’ five-year indicative costs by objective and strategy.................................45 TABLE 1: Risk prioritization matrix....................................................................................................................51 TABLE 1: Risk identification, prioritization and mitigation plan for ‘UNAP II’...............................................52 TABLE 1: Five essential components for the successful implementation of ‘UNAP II’. ...............................84 LIST OF FIGURES FIGURE 1: Map of Uganda showing Uganda Demographic and Health Survey (UDHS) sub-regions in which Uganda Nutrition Action Plan (UNAP) programming is based FIGURE 2: Nutrition and the Sustainable Development Goals. .......................................................................3 FIGURE 3: Distribution of stunting in children under five years old by region in Uganda. ...........................9 FIGURE 4: Percentage of children under five years old with wasting............................................................10 FIGURE 5: Percentage of children under five years old with any anaemia. .................................................. 11 FIGURE 6: Percentage of women of reproductive age with any anaemia.....................................................12 FIGURE 7: S‘UNAP II’ Theory of Change ........................................................................................................26 FIGURE 8: Schematic presentation of ‘UNAP II’ multi-sectoral coordination framework at the national and sub-national levels. ............................................................................................................................................36 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Acronyms ALN African Leaders for Nutrition HCDP Human Capital Development Initiative Programme AMIS Agricultural Market HMIS Health Management Information System Information System ARIN Academia and Research ICN International Conference on Institutions Network Nutrition ARNS Africa Regional Nutrition ICSCN Implementation Coordination Strategy Steering Committee on Nutrition AU African Union IECD Integrated early childhood BMI Body mass index development CESCR Committee on Economic, ITN Insecticide-treated net Social and Cultural Rights KCCA Kampala Capital City Authority CFS Committee for World Food Security KCCA-DNCC Kampala Capital City Authority District Nutrition Coordination COHA Cost of hunger in Africa Committee COVID-19 Coronavirus disease LBW Low birth weight CBO Community-based LF Lead farmer organization LLG Lower local government CDO Community development officer LGs Local governments CSOs Civil society organizations M&E Monitoring and evaluation DD Dietary diversity MAAIF Ministry of Agriculture, Animal DDPs District development plans Industry and Fisheries DNCC District Nutrition Coordination MAD Minimum acceptable diet Committee MDAs Ministries, departments and DLG District local government agencies DPs Development partners MDA NCC Ministries, department and agencies Nutrition DRNCDs Diet-related Coordination Committee non-communicable diseases MDD Minimum diet diversity EAC East Africa Community MDNCC Municipal Division Nutrition EAPA FSN Eastern African Parliamentary Coordination Committee Alliance for Food Security and Nutrition MEAL Monitoring, evaluation, accountability and learning ECD Early childhood development MIYCAN Maternal, infant, young child FAL Functional adult literacy and adolescent nutrition FAO Food and Agriculture MNCC Municipality Nutrition Organization Coordination Committee FEWSNET Famine Early Warning MoES Ministry of Education and Systems Network Sports GBV Gender-based violence MoFPED Ministry of Finance, Planning GHI Global Hunger Index and Economic Development GDP Gross domestic product MoGLSD Ministry of Gender, Labour and Social Development GLOPAN Global Panel on Agriculture and Food Systems for MoH Ministry of Health Nutrition MoLG Ministry of Local Government GNR Global Nutrition Report MoPS Ministry of Public Service UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 MoSTI Ministry of Science, RDI Required dietary intake Technology and Innovation RHF Recommended homemade MoTIC Ministry of Trade Industry and fluids Cooperatives RI Regional initiative MoWE Ministry of Water and SBCC Social behaviour change Environment communication MSMEs Micro, small and medium SBN SUN Business Network enterprises SCI Strategic coordination and MSNTCC Multi-Sectoral Nutrition implementation Technical Coordination Committee SDG Sustainable Development Goal MTEF Mid-Term Expenditure Framework SDPs Sector development plan N4G Nutrition for growth SNCC Sub county Nutrition Coordination Committee NCC Nutrition Coordination Committee SOFA State of food and agriculture NCD Non-communicable diseases SUN Scaling Up Nutrition NDP III National Development Plan TNCC Town Council Nutrition (Third) Coordination Committee NDPG Nutrition Development Partner TPC Technical Planning Group Committees NEPAD New Partnership for Africa’s UBOS Uganda Bureau of Statistics Development UDHS Uganda Demographic and NGO Non-governmental Health Survey organization UGX Uganda Shilling NIPN National Information Platform UNAP I Uganda Nutrition Action Plan for Nutrition (First) NNF National Nutrition Forum UNAP II Uganda Nutrition Action Plan NNP National Nutrition Policy (Second) NPA National Planning Authority UNECA United Nations Economic Commission for Africa NRM National Resistance Movement UNICEF United Nations Children’s Fund OPM Office of the Prime Minister UNPS Uganda National Planning ORS Oral rehydration salts Survey ORT Oral rehydration therapy UNSCN United Nations System PCC Policy Coordination Standing Committee on Committee Nutrition PCCN Policy Coordination UNREACH United Nations Renewed Committee on Nutrition Efforts Against Child Hunger PDC Parish Development and undernutrition Committee UWEP Uganda Women PG Parental group Entrepreneurship Programme PIAP Programme implementation USAID United States Agency for action plan International Development P/WNCC Parish/Ward Nutrition VIP Ventilated improved pit Coordination Committee (latrines) RCNCC Regional City Nutrition WASH Water, sanitation and hygiene Coordination Committee WFP World Food Programme RCNFP Regional City Nutrition Focal WHA World Health Assembly Person WHO World Health Organization UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 © UNICEF/UN0364229/Adriko Executive Summary This second ‘Uganda Nutrition Action Plan’ (‘UNAP II’) will guide the country in delivering the nutrition aspirations articulated in Uganda Vision 2040 and the third National Development Plan (2020/21-2024/25). The second ‘Uganda Nutrition Action Plan’ 2020/21-2024/25 is anchored on the progress made, challenges encountered, and lessons learnt from the implementation of ‘UNAP I’. As Uganda faces the COVID-19 pandemic, the ‘UNAP II’ presents an inroad into ‘immunizing’ its people through accessible good nutrition and healthy lifestyles for all. The health, safety and well-being of all Ugandans remain a responsibility and top priority of the Ugandan Government. The ‘UNAP II’, alongside other relevant sector strategic plans, will spur on government commitment toward a Uganda that is free of all forms of malnutrition. In light of this, the ‘UNAP II’ defines the strategic direction for the country and sets critical objectives, strategies, priority actions and targets to achieve optimum nutrition for all Ugandans in a sustainable manner that is essential for a healthy and productive life. HIGHLIGHTS OF ‘UNAP II’ VISION, GOAL AND OBJECTIVES The vision of the ‘UNAP II’ is: ‘A well-nourished, healthy and productive population effectively participating in the socio-economic transformation of Uganda.’ The goal is: ‘Improved nutrition status among children under five years, school-age children, adolescents, pregnant and lactating women and other vulnerable groups by 2025.’ The three strategic objectives are: OBJECTIVE 1 OBJECTIVE 2 OBJECTIVE 3 To increase access to To increase access to To strengthen the enabling and utilization of nutrition- and utilization of nutrition- environment for scaling specific services by sensitive services by up nutrition-specific and children under five years of children under five years, nutrition-sensitive services. age, school-age children, school-age children, adolescents, pregnant and adolescents, pregnant and lactating women and other lactating women and other vulnerable groups. vulnerable groups. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 i ACHIEVEMENTS AND CHALLENGES Some significant achievements registered throughout ‘UNAP I’ implementation include: Newborns put to Infants aged 0-5 Child stunting Child wasting the breast within months old who were reduced from reduced from one hour of birth exclusively breastfed 33% to 29% 5% to 4% increased from increased from 53% to 66% 63% to 66% Children aged 6-23 months who achieved Children aged 6-59 minimum diet diversity minimum acceptable months receiving vit. (MDD) being 4+ food diet (MAD) A supplementation groups increased from increased from increased from 12.8% to 30.3% 5.8% to 15% 56.8% to 62% Pregnant women Women of reproductive age who receiving iron and took iron tablets or consumed foods consumed foods folic acid supplemen- syrup for 90+ days rich in vitamin A rich in iron tation increased from increased from increased from improved from 75%to 88% 4% to 23% 61% to 74% 34% to 58% Women who took deworming Children aged 6-59 months medication during pregnancy given deworming medication increased from increased from 50% to 60% 50% to 71% Despite the above achievements, there are several significant challenges, including: Meal frequency among The prevalence of The prevalence of children aged 6-23 anaemia in women anaemia in children months reduced from increased from increased from 45% to 42% 49% to 53% 23% to 32% The status of over- The status of overweight among Obesity among men weight in children adult women increased from increased from under five years of 14.6% to 16.5% 0.2% to 1.2% age increased from while adult overweight while adult obesity in 3%to 4% increased from women increased from 4% to 7.2% 4.2% to 7.2% Coverage of nutrition-specific interventions Inadequate functionality and nutrition-sensitive interventions remained of nutrition coordination below the expected level of 80% structures at all levels. ii UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 STRATEGIES THAT WILL DELIVER THE RESULTS The following strategies will be implemented to realize OBJECTIVE 1 To increase access to and utilization of nutrition-specific services by children under five years of age, school-age children, adolescents, pregnant and lactating women and other vulnerable groups. Strategy 1.1 Promote optimal maternal, infant, Strategy 1.3 Increase coverage of the management young child and adolescent nutrition (MIYCAN) of acute malnutrition in stable and emergency practices in stable and emergency situations. situations. Strategy 1.2 Promote optimal micronutrient intake Strategy 1.4 Integrate nutrition services in among children, adolescent girls and women the prevention, control and management of of reproductive age in stable and emergency infectious diseases and epidemics. situations. Strategy 1.5 Integrate nutrition services in the prevention, control and management of diet-related non-communicable diseases. The following strategies will be implemented to realize OBJECTIVE 2 To increase access to and utilization of nutrition-sensitive services by children under five years, school-age children, adolescents, pregnant and lactating women and other vulnerable groups. Strategy 2.1 Increase the production of diverse, Strategy 2.4 Promote the integration of nutrition safe and nutrient-dense food at the household services in social protection programmes. level from plant, fisheries and animal sources. Strategy 2.5 Promote access to nutrition services Strategy 2.2 Increase access to diverse, safe and through integrated early childhood development nutrient-dense food from plant, fisheries and (ECD) services and quality education and sports. animal sources. Strategy 2.6 Increase access to nutrition-sensitive Strategy 2.3 Increase the utilization of diverse, safe water, sanitation and hygiene (WASH) services. and nutrient-dense food from plant, fisheries and animal sources. Strategy 2.7 Increase the participation of trade, industry and investment actors in scaling up nutrition. The following strategies will be implemented to realize OBJECTIVE 3 To strengthen the enabling environment for scaling up nutrition-specific and nutrition-sensitive services. Strategy 3.1 Strengthen nutrition coordination and Strategy 3.4 Strengthen nutrition advocacy, partnerships at all levels. communication and social mobilization for nutrition. Strategy 3.2 Improve the planning, resource mobilization, financing and tracking of nutrition Strategy 3.5 Strengthen coherent policy, legal and investments. institutional frameworks for nutrition. Strategy 3.3 Strengthen institutional and technical Strategy 3.6 Strengthen and institutionalize capacity for scaling up nutrition actions. nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 iii IMPLEMENTATION AND COORDINATION MODALITIES The ‘UNAP II’ provides a framework for scaling up multi-sectoral implementation of nutrition-specific, nutrition-sensitive and nutrition-enabling environment interventions across state and non-state actors. The coordination framework is at nine levels: Under Scaling Up Nutrition (SUN) arrangements, at the 1. The National Nutrition Forum (NNF). country level, the following 2. Policy Coordination Committee on Nutrition (PCCN). networks exist: 3. Implementation Steering Coordination Committee (ISCC) • SUN Development Partner 4. Multi-Sectoral Nutrition Technical Coordination Committee Group (DPG) Network (MSNTCC). • SUN Civil Society 5. MDA Nutrition Coordination Committee (NCC). Organization (CSO) Network 6. Regional city and district NCCs • SUN Business Network (SBN) 7. City division NCCs, municipal NCCs and regional city division NCCs • SUN Academia and Research Institutions 8. Municipal division NCCs and sub county/town council NCCs Network (ARIN) 9. Parish and ward NCCs TOTAL FINANCING REQUIREMENTS The five-year ‘UNAP II’ total cost is 3.28 trillion Uganda Shillings (UGX). Financing will be a collaboration between the Government of Uganda, development partners, the private sector, communities, CSOs and households. Adequate financing is a crucial prerequisite for successfully implementing priority actions and achieving ‘UNAP II’ goals. KEY EXPECTED PRIMARY OUTCOMES The 14 key expected primary outcomes of implementing the plan are categorized into two groups with expected primary targets under each. 1. Reduced prevalence of undernutrition The expected primary targets on undernutrition are: Reduced prevalence Reduced prevalence Reduced prevalence Reduced prevalence Reduced prevalence of of stunting in children of low birth weight of wasting in children of anaemia in children anaemia in women of aged 0-5 years from (<2500 g) from aged 0-5 years from aged 0-5 years from reproductive age from 29% to 19% 10% to 7% 4% to 3% 53% to 35% 32% to 20% 2. Reduced prevalence of overweight, obesity and diet-related non-communicable disease The expected primary targets on overweight, obesity and diet-related non-communicable disease (NCD) are: Reduced prevalence of Reduced proportion of Reduced proportion of Reduced proportion of Reduced proportion overweight in children overweight adult women overweight adult men obesity in adult women of obesity in adult men aged 0-5 years from aged 18+ years from aged 18+ years from aged 18+ years from aged 18+ years from 4% to 3% 16.5% to 12.5% 7.7% to 3.7% 7.2% to 5.2% 1.2% to 0.4% Reduced proportion Proportion of obesity Reduced age-standardized prevalence Reduced age-standardized prev- of overweight in in adolescent girls of raised blood glucose/diabetes alence of raised blood pressure adolescents from maintained at among persons aged 18+ years from among persons aged 18+ years from 10% to 6% 1% 3.3% to 2.1% 24% to 20% iv UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 © UNICEF/UN08811/Ose CHAPTER ONE Introduction The second ‘Uganda Nutrition Action Plan’ (‘UNAP II’) (2020/21-2024/25) outlines strategies to address the nutrition needs of all population groups in Uganda with a particular focus on children under five years, school-age children, adolescents, pregnant and lactating women and other vulnerable groups. The plan has been developed in the context of existing nutrition legal and policy frameworks and initiatives at the global, regional and national level. The Constitution of the Republic of Uganda underscores an individual’s right to health, food security, and nutrition to ensure a healthy and well-nourished Ugandan society. All relevant ministries, departments and agencies (MDAs) are required to set minimum standards and develop poli- cies that ensure optimal nutrition. The ‘UNAP II’ provides guidance to all key stakeholders in fulfilling their responsibilities and commitments to ensuring a well-nourished population.

1.1 WHY INVEST IN NUTRITION Good nutrition is a catalyst for social and economic transformation and human development. The United Nations System Standing Committee on Nutrition (UNSCN) (2017) states that since good nutrition (as opposed to malnutrition) is a human right, it is a moral imperative to work towards the elimination of malnutrition, considering current knowledge, techniques and means of mobilization and communication. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 1 Nutrition is essential, especially the first 1,000 days from conception to two Good nutrition years. Poor nutrition causes irreversible cognitive and physical damage, is a human with consequences for individuals, households, communities and the right and the nation. According to the ‘Global Nutrition Report’ (GNR) (2018), malnutri- foundation of tion is responsible for more ill-health than any other cause; therefore, good well-being health is impossible without good nutrition. The same report highlights that undernutrition can be attributed to approximately 45 per cent of deaths United Nations System among children under five, mainly in low and middle-income countries Standing Committee on Nutrition (UNSCN), 2017 (including Uganda). Furthermore, the health consequences of overweight and obesity contribute to an estimated 4 million deaths (7.1 per cent of all deaths) and 120 million healthy years of life lost (disability-adjusted life years) across the global population. Every man, woman and child has the The ‘Cost of Hunger in Africa’ (COHA) study in Uganda (2013) established right to adequate that malnutrition is associated with 15 per cent of all under-five mortalities, food and nutrition which represented over 19,000 child deaths in 2009. The total losses in productivity attributed to childhood malnutrition were estimated at approx- Committee on Economic, Social and Cultural Rights imately UGX 1.9 trillion (US$899 million), which represented 5.7 per cent (CESCR) (1999) of the nation’s gross domestic product (GDP). In terms of education, the report highlighted that 7 per cent of all grade repetitions in school are asso- ciated with a higher incidence experienced by stunted children. One dollar According to the ‘COHA’ Uganda report, improved nutrition in Uganda from invested 2013 to 2025 would: in nutrition • Save more than 101,000 infants’ lives by improving breastfeeding gives a rate of practices. return of US$16 • Save more than 60,000 children’s lives by decreasing vitamin A (GNR, 2015) deficiency. • Save approximately 119,000 children’s lives by preventing stunting. • Save approximately 26,000 infants’ lives by reducing low birth weight. • Save approximately 20,000 infants’ and 7,000 mothers’ lives by decreasing maternal anaemia. NUTRITION IS ONE OF THE BEST • Prevent permanent brain damage in about 236,000 children and increase the average child’s intelligence quotient by up to 13.5 points DRIVERS OF by preventing iodine deficiency. DEVELOPMENT: IT SPARKS A • Result in earlier school enrolment, children staying in school longer, and better performance in school. VIRTUOUS CYCLE OF SOCIO- By 2025, this would total 19.8 million equivalent school years of learning ECONOMIC gained, lead to economic gains through increased productivity exceeding IMPROVEMENTS, UGX 4.3 trillion (US$1.7 billion) by 2025 and lead to improvement in the SUCH AS health and family planning sectors. Since health, family planning and nutri- tion are synergistic, investing in any one sector alone will not lead to the INCREASING same return as investing in all of them. ACCESS TO EDUCATION AND The benefits of investing in nutrition far outweigh the costs, making it one EMPLOYMENT.” of the ‘smartest investments’ for Uganda’s economic development and Kofi Annan, former UN prosperity. Therefore, reducing the causes and effects of malnutrition is Secretary-General (2018) requisite for achieving the nation’s Sustainable Development Goals (SDGs) and Uganda’s Vision 2040. 2 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 The figure below further illustrates how nutrition is essential for the success of all the SDGs (see Figure 2). FIGURE 2 NUTRITION AND THE SUSTAINABLE DEVELOPMENT GOALS 17 01 Being poor limits the ability of individuals - to access adequate food a $16 return in economic growth 16 02 - Agriculture and food security are conerstones of nutrition 03 15 Up to 45% of deaths in children under 5 are Soil degredation threaten caused by undernutrition our ability to grow food Achieving the SDGs 13 04 Climate change may Learning and focusing in reduce food production school is difficult without and cause water scarity a sufficient diet 12 05 Tackling resource use and When women control the family degradation is key for sharing income, children’s health and nut- ring resources and improving rition improve at a greater rate access to quality food 08 06 High levels of malnutrition Access to safe water and in some countries may sanitation is an absolute result in an 11% loss to GDP prerequisite for butrition

1.2 GLOBAL, CONTINENTAL AND NATIONAL FRAMEWORKS CONTEXT

1.2.1 Global nutrition commitments and initiatives The ‘UNAP II’ has been designed with a global • Nutrition for Growth Summit, 2013 outlook. The critical international nutrition decla- • Committee on World Food Security (CFS), 2013 rations, commitments and initiatives informing it include: • The Global Panel on Agriculture and Food Systems for Nutrition (GLOPAN), 2013 • Lancet Series on Maternal Child and Nutrition, 2013 • Global Nutrition Reports (GNR) • Scaling up Nutrition (SUN) Movement, 2010 • 2nd International Conference on Nutrition (ICN), 2015 • The 1,000 Days Initiative, 2010 • Rome Declaration and Framework for • The United Nations General Assembly on Nutrition, 2014 Non-Communicable Diseases, 2011 • Sustainable Development Goals, 2015 • New Alliance for Food Security and Nutrition for sustained agriculture-led growth in Africa • United Nations Decade of Action on Nutrition, and Asia launched in G8 Summit, 2012 2016-2025 • World Health Assembly Resolution, 2012 Annexe 1.1 attached provides the sequence and evolution of some of the key global commitments and initiatives. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 3

1.2.2 Continental and regional frameworks context The ‘UNAP II’ has also been designed with a continental and regional outlook. The key regional and conti- nental nutrition declarations, commitments and initiatives informing the plan include: • African Union (AU) Agenda, 2063. • Maputo Declaration, 2003. • Grow Africa Initiative (AU and New Partnership for Africa’s Development (NEPAD)), 2011. • Malabo Declaration, 2014. • Malabo Declaration on Nutrition, 2015. • Africa Regional Nutrition Strategy (ARNS), 2015-2025. • Food and Agriculture Organization of the United Nations (FAO) Regional Initiative (RI) on Africa’s Commitment to End Hunger by 2025. • East and Southern Africa Regional Civil Society Nutrition Network, 2017. • African Leaders for Nutrition Initiative (ALN), 2018. • African Development Bank’s Multi-Sectoral Nutrition Action Plan (2018-2025). • East Africa Community (EAC) Food and Nutrition Security Strategy (2018-2022). • EAC Food and Nutrition Security Action Plan (2018-2023). • Eastern African Parliamentary Alliance for Food Security and Nutrition (EAPA FSN), 2019. Annexe 1.2 attached provides detail of the Africa regional development agenda relevant to nutrition program- ming.

1.2.3 National legal, policy and planning frameworks context The ‘UNAP II’ has been designed with a legal, policy and planning frameworks outlook. Nationally, the Constitution of the Republic of Uganda (1995) recognizes the right to food. Objective XXII of the Constitu- tion requires the State to take appropriate steps to encourage people to grow and store adequate food. It also requires the State to establish national food reserves and to promote proper nutrition through mass education and other means to build a healthy state. In addition, the government has several sector policies and legal frameworks that guide the scaling up of nutrition. These include: • The Education Act, 2008. • National Trade Policy, 2007. • Second National Health Policy, 2010. • The National Community Development Policy for Uganda, 2015. • The National Extension Policy, 2016. • The National Integrated Early Childhood Development Policy, 2016. • The Social Protection Policy, 2015. • National Integrated Early Childhood Development Policy, 2016. • The Uganda Vision 2040. • Third ‘National Development Plan’ (‘NDP III’). 4 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

1.3 PROGRAMME ACHIEVEMENTS AND CHALLENGES Some significant achievements registered throughout ‘UNAP I’ implementation include: Child stunting Child wasting Newborns put to Infants aged 0-5 reduced from reduced from the breast within months old who were 33% to 29% 5% to 4% one hour of birth exclusively breastfed increased from increased from 53% to 66% 63% to 66% Children aged 6-23 months who achieved Children aged 6-59 minimum diet diversity minimum acceptable months receiving vit. (MDD) being 4+ food diet (MAD) A supplementation groups increased from increased from increased from 12.8% to 30.3% 5.8% to 15% 56.8% to 62% Pregnant women Women of reproductive age who receiving iron and took iron tablets or consumed foods consumed foods folic acid supplemen- syrup for 90+ days rich in vitamin A rich in iron tation increased from increased from increased from improved from 75%to 88% 4% to 23% 61% to 74% 34% to 58% Women who took deworming Children aged 6-59 months medication during pregnancy given deworming medication increased from increased from 50% to 60% 50% to 71% Despite the above achievements, there are several significant challenges, including: Meal frequency among The prevalence of The prevalence of children aged 6-23 anaemia in women anaemia in children months reduced from increased from increased from 45% to 42% 49% to 53% 23% to 32% The status of over- The status of overweight among Obesity among men weight in children adult women increased from increased from under five years of 14.6% to 16.5% 0.2% to 1.2% age increased from while adult overweight while adult obesity in 3%to 4% increased from women increased from 4% to 7.2% 4.2% to 7.2% Coverage of nutrition-specific interventions Inadequate functionality and nutrition-sensitive interventions remained of nutrition coordination below the expected level of 80% structures at all levels. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 5

1.4 CONTEXTUAL CHALLENGES There are societal and contextual issues that continue to inhibit good nutrition in Uganda. They include the following, among others: • Entrenched cultural and social norm and economic conditions which negatively affect feeding practices and lifestyle choices. • Low literacy levels and ignorance leading to low utilization of nutrition-specific and nutrition-sensitive services by communities. • Inadequate participation of women in development and income-generating activities. • Poverty, low household income and limited access to social protection programmes and support networks. • Frequent climatic shocks in regions such as Karamoja limits agricultural productivity leading to low household income. • The increasing trend of urbanization and change in diets and lifestyle is a risk factor for overweight and obesity. • Infrastructural, technological, trade and marketing barriers that negatively affect the production and consumption of nutrient-dense foods. 6 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 There are also governance issues that affect the implementation of nutrition interventions in Uganda. These include: Limited functional capacity among nutrition stakeholders to plan for and implement nutrition. The ‘NDP II’ identified the need for capacity strengthening for nutrition. Planning, budgeting and resource mobilization challenges. The government has identified nutrition as a priority thematic cross-cutting issue impacting planning, budgeting and implementation. Challenges of behaviour change, advocacy and social mobilization for nutrition. Whereas the Consti- tution of the Republic of Uganda, under the directive principle of state policy number XXII, emphasizes proper nutrition through mass education, changing mindsets is still a challenge. Monitoring, evaluation, accountability and learning deficiencies: The national planning frameworks, including the NDP, provide indicators and targets for nutrition. However, tracking these indicators and linking them to nutrition programming is still a challenge at the sector and local government level. Analysis was carried out as part of developing ‘UNAP II’, which has informed its strategic direction, form, and content.

1.5 OPPORTUNITIES TO HARNESS The ‘UNAP II’ presents an opportunity to: • Fulfil government commitment to nutrition as stipulated in the National Constitution of 1995, Vision 2040 and ‘NDP III’. • Sustain political will to prioritize and scale up nutrition, with reference to H.E. the President’s initiative on healthy eating and lifestyles. • Continue promoting nutrition as a cross-cutting priority issue per the NDP planning circular call and the budget speech 19/20 and 20/21. • Align with global trends, e.g. SDGs, Nutrition for Growth (N4G) and the SUN movement, as well as south to south cooperation and coordination.

1.6 THE PROCESS OF DEVELOPING THE ‘UGANDA NUTRITION ACTION PLAN’ The process of developing the ‘Uganda Nutrition Action Plan II’ involved the following activities: 1. Identification of ‘UNAP II’ technical assistance needs. 2. Approval of terms of reference and recruitment of technical assistance provider. 3. Inception and consultations at the national and lower local government (LLG) level. 4. Consensus building on draft ‘UNAP II’. 5. Stakeholder engagement and gathering of feedback on the ‘UNAP II’ draft. 6. Content finalization and validation workshop. 7. Detailed revision of ‘UNAP II’. 8. Multi-sectoral Nutrition Technical Coordination Committee validation, incorporating final comments from MDAs and non-state actors. 9. Presentation to heads of departments at OPM. 10. Final approval by Policy Coordination Committee (PCC) on 22 September 2020. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 7 DIABETES UNDERNUTRITION PREGNANT CHILDREN NUTRITION FOOD SAFETY BREASTFEEDING OVERWEIGHT FEEDING PRACTICES MATERNAL UGANDA WASTING OBESITY STUNTING ANAEMIA FEEDING PRACTICES SITUATION UNDER 5 DIETARY DIVERSITY DIVERSITY ADOLESCENT NUTRITION UNDERWEIGHT NEWBORN LOW BIRTH WEIGHT WASH WOMEN HEALTH MEAL FREQUENCY MINIMUM ACCEPTABLE DIET MALNUTRITION FOOD SECURITY DIET-RELATED MEAL FREQUENCY, STUNTING CHAPTER TWO Nutrition Situational Analysis

2.1 UNDERNUTRITION The indicators of undernutrition of focus under the ‘UNAP II’ are:

2.1.1 Prevalence of stunting in children aged 0-5 years.

2.1.2 Prevalence of low birth weight (<2500 g). 2.1.3 Prevalence of wasting in children aged 0-5 years.

2.1.4 Prevalence of anaemia in children aged 0-5 years. 2.1.5 Prevalence of anaemia in women of reproductive age. The following paragraphs describe the status, trends and patterns of the five indicators for undernutrition.

2.1.1 Prevalence of stunting in children under five years of age The prevalence of stunting in children under five years of age reduced from 33 per cent in 2011 to 29 per cent in 2016. There was a reduction in the prevalence of child stunting from 45 per cent in 2000 to 29 per cent in 2016. According to the World Health Organization (WHO) classification, Uganda moved from very high to high severity of stunting by dropping below the 30 per cent prevalence threshold. Based on the Uganda National Panel Survey (UNPS) of 2020, Uganda achieved a National Development Plan (II) target of reducing the prevalence of child stunting from 29 per cent in 2016 to 25 per cent in 2020. Findings from the UDHS 2020/21 will further validate this result. 8 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Despite the progress on stunting, more improve- The prevalence of stunting among ment is needed to achieve a classification of children increases in the first year of age medium stunting severity (<20 per cent) and to and peaks at 37% among children meet the World Health Assembly (WHA) target aged 18-35 months. of reducing the absolute number of stunted chil- dren by 40 per cent by 2025. There is substantial Children in rural areas are more likely to economic disparity, with the prevalence of stunting be stunted than children in urban areas. in each of the poorest three wealth quintiles nearly 30% double that of the richest quintile. There is regional RURAL variability in stunting; the prevalence was generally 24% highest in the areas that had the highest poverty URBAN (see Figure 3). Children whose mothers are overweight or obese are It is important to note that out of 15 sub-regions, less likely to be stunted than children whose mothers 13 have a prevalence of child stunting higher than have a normal body mass index (BMI) or are thin. acceptable levels. This calls for a national effect to scale actions to address stunting in all sub-regions. 23% 29% 34% OBESE NORMAL THIN It is also important to note that four in every ten MOTHER BMI MOTHER children born to mothers with no education are stunted, compared to one in every ten children born by educated mothers, per the Uganda Demographic The proportion of children who are stunted and Health Survey (UDHS) 2016. decreases with increasing mother’s education. FIGURE 3 DISTRIBUTION OF STUNTING IN CHILDREN UNDER FIVE YEARS OLD BY REGION IN UGANDA KARAMOJA 35.2% ACHOLI 30.6% WESTNILE 33.9% LANGO 22.3% BUNYORO 34.5% TESO 14.8% BUGISU TORO 35.9% 40.6% BUKEDEA KAMPALA 22.8% 18.1% BUSOGA 29.0% ANKOLE 29.3% NORTH CENTRAL Serious: 30% - 39% 28.1% Poor: 20% - 29% KIGEZI SOUTH CENTRAL Acceptable: <20% 30.8% 26.5% Source: UNICEF, 2021 This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 9

2.1.2 Prevalence of low birth weight (<2500g) Prevalence of low birth weight (LBW) (<2500 g) remained at 10 per cent. Birth weight is an important indi- cator when assessing a child’s health for early exposure to childhood morbidity and mortality. It is usually an outcome of intrauterine growth retardation and/or preterm birth. Low birth weight is not only strongly associated with increased risk of fetal and neonatal mortality and morbidity, but also with increased risk of inhibited growth, poor cognitive development, and chronic diseases later in life.

2.1.3 Prevalence of wasting in children aged 0-5 years The prevalence of wasting among children aged 0-5 years remains an issue in two sub-regions of Karamoja and West Nile, where the prevalence of wasting increased over 10 per cent in 2016 (see Figure 4). The cause of the recent increase in acute malnutrition in the two regions is associated with poverty and frequent climatic shocks. FIGURE 4 PERCENTAGE OF CHILDREN UNDER FIVE YEARS OLD WITH WASTING KARAMOJA 10.0% ACHOLI 3.9% WESTNILE 10.4% LANGO 5.0% BUNYORO 2.3% TESO 2.2% BUGISU TORO 5.0% 3.4% BUKEDEA KAMPALA 2.8% 3.9% BUSOGA 3.6% ANKOLE 1.8% NORTH CENTRAL High 2.3% Medium KIGEZI SOUTH CENTRAL Low 3.7% 1.1% Source: UNICEF, 2021 This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. 10 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.1.2 Prevalence of anaemia in children aged 0-5 years FIGURE 5 PERCENTAGE OF CHILDREN UNDER FIVE YEARS OLD WITH ANY ANAEMIA KARAMOJA 68% ACHOLI 71% WESTNILE 56% LANGO 61% BUNYORO 55% TESO 59% BUGISU TORO 48% 45% BUKEDEA KAMPALA 48% 51% BUSOGA 65% ANKOLE 31% - 40% 31% NORTH CENTRAL 55% 41% - 50% 51% - 60% KIGEZI SOUTH CENTRAL 32% 53% 61% - 71% Source: UNICEF, 2021 This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. The prevalence of anaemia among children aged 6-59 Prevalence of anaemia aged months dropped sharply from 73 per cent in 2006 to 49 per 6-59 months cent in 2011, before increasing again to 53 per cent in 2016. 2006 This prevalence is well above the WHO cut-off to define a 2011 2016 serious public health problem (≥40 per cent). The prevalence of anaemia in Uganda is higher among younger children 73% 49% 53% (aged 6-23 months) than older children (aged 24-59 months), with a peak prevalence of 78 per cent among children aged The prevalence of anaemia is higher 9-11 months. This can be associated with poor complemen- in rural areas than in urban tary feeding practices. The prevalence of anaemia is higher in rural areas than in urban areas. There is regional variation in the prevalence of anaemia; 71 per cent of children in the 54% 48% Acholi region are anaemic, compared with 32 per cent of children in the Kigezi region and 31 per cent of children in the Ankole region. The prevalence of anaemia in children aged RURAL URBAN 6-59 months’ decreases with an increase in the mother’s education and household wealth. It is important to note that all sub-regions have a prevalence of child anaemia higher than acceptable levels. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 11

2.1.5 Prevalence of anaemia in women of reproductive age One-third (32 per cent) of women aged 15-49 years have some URGENT ACTION IS NEEDED TO ADDRESS degree of anaemia. The proportion of women aged 15-49 years ANAEMIA AND CHILD STUNTING. with any degree of anaemia rose from 23 per cent in 2011 to 32 per cent in 2016. Of the 15 sub-regions, two sub-regions have a mild public health importance prevalence of anaemia of 13 out of 15 17 per cent and 18 per cent in Kigezi and Bukedi, respectively. sub-regions Eleven sub-regions are classified as having moderate public have a prevalence of child health importance of anaemia prevalence of 41 per cent and 47 per cent in Busoga and Acholi, respectively. Pregnant (38 per stunting higher than 20% cent) and breastfeeding women (34 per cent) are more likely to be anaemic than women who are neither pregnant nor breast- All the 15 feeding (30 per cent). Pregnant women have a lower prevalence sub-regions of mild anaemia (19 per cent) than women who are breast- feeding (29 per cent) and those who are neither pregnant nor have a level of anaemia breastfeeding (25 per cent); however, they have a higher preva- among children and women lence of moderate anaemia (18 per cent) than other women (4-5 of reproductive age that are per cent). The prevalence of anaemia decreases with increasing a public health concern. wealth, from 41 per cent among women in the lowest wealth quintile to 25 per cent among women in the highest quintile. FIGURE 6 PERCENTAGE OF WOMEN OF REPRODUCTIVE AGE WITH ANY ANAEMIA KARAMOJA 32.0% ACHOLI 47.1% WESTNILE 39.6% LANGO 39.4% BUNYORO 32.1% TESO 31.9% BUGISU TORO 34.6% 29.4% BUKEDI KAMPALA 17.7% 25.2% BUSOGA ANKOLE 41.0% 27.5% NORTH CENTRAL 31.6% Severe public health problem KIGEZI SOUTH CENTRAL Moderate public health problem 16.9% 27.6% Mild public health problem Source: UNICEF, 2021 This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. 12 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.2 OVERWEIGHT, OBESITY AND DIET-RELATED NON-COMMUNICABLE DISEASES (NCD) The indicators of concern under ‘UNAP II’ are: 2.2.1 Prevalence of overweight in children under five years of age.

2.2.2 Proportion of overweight women aged 18+ years.

2.2.3 Proportion of overweight men aged 18+ years.

2.2.4 Proportion of obesity in women aged 18+ years.

2.2.5 Proportion of obesity in men aged 18+ years.

2.2.6 Proportion of overweight in adolescents.

2.2.7 Proportion of obesity in adolescent girls.

2.2.8 Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years.

2.2.9 Age-standardized prevalence of blood pressure among persons aged 18+ years.

2.2.1 Prevalence of overweight in children under five years of age At 3.7 per cent, the prevalence of child overweight is not a critical public health issue at the national level. However, there was a slight increase in child overweight from 2011 to 2016, which is a signal that it could escalate if unchecked. 2.2.2 and 2.2.4 Proportion of overweight and obesity in adult women aged 18+ years The proportion of women who are overweight or obese has increased in the same period, from 17 per cent in 2006 to 19 per cent in 2011 and 24 per cent in 2016. The proportion of women of normal weight declines with age, from 76 per cent among those aged 15-19 years to 58 per cent among those aged 40-49 years. Women aged 15-19 years are more likely (13 per cent) to be thin compared to older women (7-8 per cent). The proportion of women who are overweight or obese increases with age, from 11 per cent among those aged 15-19 to 34 per cent among those aged 40-49 years. One in three (34 per cent) of urban women are overweight or obese compared with one in five (20 per cent) rural women. The proportion of women who are overweight or obese increases with increasing education and wealth. For example, 8 per cent of women in the lowest wealth quintile are overweight or obese, compared with 42 per cent of women in the highest wealth quintile. 2.2.3 and 2.2.5 Proportion in overweight and obesity among adult men aged 18+ years Nine per cent of adult men aged 18+ years are overweight or obese. Similar proportions of urban (76 per cent) and rural (78 per cent) men have a normal BMI. However, more rural (16 per cent) than urban (7 per cent) men are thin and more urban (16 per cent) than rural (6 per cent) men are overweight or obese. One in five men who have more than secondary education (19 per cent) and who are in the highest wealth quintile (21 per cent) are overweight or obese. 2.2.6 and 2.2.7 Prevalence of overweight and obesity in adolescents and adolescent girls The adolescence stage is the second-fastest development stage of the human body after infancy. The development during this stage requires increases the nutrient requirements of the body. However, over nutrition in adolescents has the same implication on non- communicable diseases in adolescence as in childhood. The Uganda National Panel Survey (UNPS) 2019/2020 provide information on the body mass index (BMI) for adolescents (10-19 years). BMI in adolescents helps in the assessment of the future risk of some poor health conditions such as high blood pressure, diabetes, and hypertension. Overall, the Survey revealed that 2.9% of adolescents are overweight. Among adolescent girls, obesity was at 0.5%. The UDHS 2021 will provide a clear picture once conducted UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 13 2.2.8 and 2.2.9 Age-standardized prevalence of raised blood glucose/diabetes and blood pressure among persons aged 18+ years The age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years was at 3.3 per cent in 2014. The age-standardized prevalence of raised blood pressure among persons aged 18+ years was 24 per cent in 2014. Obesity and excessive energy intake are known major causes of hyperten- sion. Consequently, hypertension/raised blood pressure can partly be an indirect measure of the popula- tion’s nutrition status or secondary consequences of malnutrition. The UNPS data showed that 6.5% of the adult women affecting all regions of the country. The proportion of women with a raised blood pressure in the central region was 7.2% while the northern region had the highest proportion of women with raised blood pressure despite having least proportion of women that were obese. Available data from the UNPS 2020 indicate that raised blood pressure among men was at 8% with the northern region having the highest proportion of men with a raised blood pressure. The UNPS 2020 report indicated that the proportion of raised blood pressure was continently higher in men compared to women. This is despite the proportions of obesity and overweight being much higher among men than women. The proportion of men with raised blood pressure was higher than the national proportion of both men and women with raised blood pressure. Raised blood pressure was much higher in men aged 60 years and above. There is a double burden of malnutrition. Amidst the high prevalence of stunting and anaemia in children and women, there is also overweight in children under five years of age, overweight among adult women and men, and adult obesity among men and women are on the increase. © UNICEF/UN0357075/Kabuye 14 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.3 DETERMINANTS OF NUTRITION STATUS Nutrition status results from a complex set of multiple and interacting factors at different levels and across the various sectors. This challenge, therefore, calls for a multi-sectoral approach to address the causes of malnutrition at all levels. The ‘UNAP II’ categorizes determents of nutrition status outcomes into three broad categories: 1. Immediate determinants, namely inadequate dietary intake, disease burden and physical inactivity. 2. Underlying determinants, including poor water, sanitation, hygiene and food safety; inadequate access and utilization of health services; inadequate care and feeding practices and behaviour; insufficient supply and access to healthy, nutritious, safe foods and sedentary lifestyle and behaviours. 3. Basic determinants comprising of socio-cultural, economic, political and contextual factors which negatively influence communities and households to access adequate resources. These include legislation and regulatory factors, rapid urbanization, climate change and gender inequity, among others. The following areas are significant in determining nutrition status. 2.3.1 Maternal, infant and young child feeding practices. 2.3.2 Childhood diseases. 2.3.3 Access to and utilization of maternal and child health services.

2.3.4 Early childhood development. 2.3.5 Food production, access and utilization.

2.3.6 Water, sanitation and hygiene.

2.3.1 Maternal, infant and young child feeding practices. According to the UDHS, 2016, 66 per cent of newborns started breastfeeding within one hour. There was regional variation in breastfeeding initiation; 93 per cent of children in the Karamoja region start breastfeeding within one hour of birth, compared with 50 per cent of children in the Bukedi region. The percentage of children who start breastfeeding within one hour of birth decreases as the mother’s educa- tion increases. This calls for appropriate messages to mothers, including the educated. The percentage of children under six months of age exclusively breastfed remained above 60 per cent from 2000 to 2016. Exclusive breastfeeding declines with age, from 83 per cent among children aged 0-1 months to 69 per cent among those aged 2-3 months and 43 per cent among those aged 4-5 months. The proportion of children who are breastfeeding and consuming complementary foods first increases with age (peaking at 87 per cent among children aged 9-11 months) and then falls among children aged 12-23 months (as older children stop breastfeeding). The median duration of breastfeeding among children born in the three years before the 2016 UDHS is 19.8 months, and half of all children stopped breastfeeding before 20 months. Children in rural areas breastfeed for longer (20.4 months) than children in urban areas (17.8 months). Children in the lowest wealth quintile breastfeed for longer (21.2 months) than children in the highest wealth quintile (17.2 months). The findings above show that various contextual issues affect optimal breastfeeding practices, especially continued breastfeeding up to 2 years. Intervention is needed to make exclusive breastfeeding during the first six months of life the norm for infant feeding. The proportion of children aged 6-23 months who received the minimum number of meals remained low in 2016, at 42 per cent. Similarly, only three in ten (30 per cent) of children aged 6-23 months were fed accord- ing to the required minimum dietary diversity. The proportion of children receiving the minimum acceptable diet (those achieving minimum meal frequency and minimum dietary diversity) was alarmingly low, at UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 15 15 per cent. There is regional variation in the proportion SUMMARY of children aged 6-23 months receiving the minimum acceptable diet, from 3 per cent in the Acholi region to During the period 2011-2016, there was 27 per cent in the Ankole region (UDHS, 2016). The pro- an increase in the percentage of: portion of children aged 6-23 months receiving the mini- mum acceptable diet rises with increasing mother’s edu- newborns put to the breast cation, from 10 per cent among children whose mothers within one hour of birth from have no education to 26 per cent among children whose mothers have more than secondary education. 53% to 66% infants aged 0-5 months It is evident that minimum meal frequency and minimum old who were exclusively dietary diversity are major contributors to sub-optimal infant and young child feeding practices and malnutrition breastfed from in Uganda. ‘NDP III’, sector development plans (SDPs) 63% to 66% and district development plans (DDPs) should prioritize support to interventions that target improving comple- mentary feeding such as social behaviour communica- children aged 6-23 months tion and the promotion of region-specific recipes for who received a minimum complementary foods. ‘UNAP II’ has also created viable diet diversity (MDD) of 4+ linkages and complementary actions so that diverse, food groups from safe and nutrient-dense food is sustainably produced, accessed and consumed. 12.8% to 30.3% Among last-born children aged 6-23 months, nearly children aged 6-23 months 7 in 10 (67 per cent) ate foods rich in vitamin A, and 4 who achieved minimum in 10 (40 per cent) ate foods rich in iron. Rural children acceptable diet (MAD) from are less likely (38 per cent) to have eaten iron-rich foods 5.8% to 15% than urban children (47 per cent). While 86 per cent of women took iron supplements at least once during their most recent pregnancy, only 23 per cent took them for Despite this notable increase, this 90 days or more. One in 10 women (12 per cent) took no coverage is far below the iron supplements. Six in 10 (60 per cent) women took expected coverage of 80% deworming medication during their most recent preg- nancy. © UNICEF/UNI366319/Sibiloni 16 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.3.2 Childhood diseases Frequent infections precipitate undernutrition by leading to loss of appetite, increased metabolic rate, increased nutrient requirements and loss of nutrients. On the other hand, undernutrition causes a reduction of the body’s ability to fight infections, which worsens their severity. Consequently, infections can cause undernutrition and undernutrition can increase the severity of infections. Child health and survival services can help improve nutrition outcomes through appropriate interventions to prevent childhood illnesses. The burden of disease, especially among children under five, remains high in Uganda. The common childhood illnesses in Uganda are acute respiratory infection, fever, and diarrhoea. Fever is a symptom of malaria but is also associated with other childhood illnesses that may contribute to high levels of malnutrition, morbidity, and mortality in young children. One-third (33 per cent) of children under five years had a fever in the two weeks preceding the UDHS 2016 survey. The prevalence of fever is highest among children in Busoga (66 per cent) and Teso (59 per cent) regions and lowest in the Bunyoro region (11 per cent). Twenty per cent of children under five years of age suffer from diarrhoea. The preva- lence of diarrhoea rises after age six months, from 19 per cent among children under age six months to 39 per cent among those aged 6-11 months, when complementary foods and other liquids are introduced. The prevalence remains high (31 per cent) at age 12-23 months when children begin to walk and are at an increased risk of contamination from the environment, though declines thereafter. The percentage of children with diarrhoea is highest in Teso (29 per cent) and Busoga (27 per cent) regions and lowest in the Bunyoro region (10 per cent). Interventions to address the three common childhood illnesses in Uganda are expected to improve children’s health in Uganda and, consequently, their nutrition status. Therefore, the integration of appropriate nutrition practices in the prevention, control and management of infectious has been prioritized in this action plan.

2.3.3 Access to and utilization of maternal and child health services Pregnant women should increase their intake of iron and reduce parasites to prevent anaemia. In 2016, while 88 per cent of women took iron supplements at least once during their pregnancy, only 23 per cent took them for 90 days or more. Sixty per cent took intestinal parasite medication at least once. In Uganda, 78 per cent of women with a live birth in the two years before the UDHS survey reported taking one or more doses of fansidar during their last pregnancy, while 46 per cent reported taking two or more doses, and 17 per cent reported taking three or more doses. The proportion of women with a live birth in the two years before the survey who took three or more doses of fansidar during their last pregnancy increased from 6 per cent in 2006 to 17 per cent in 2009, reduced to 10 per cent in 2011, grew to 28 per cent in 2014- 15, and decreased to 17 per cent in 2016. In 2016, 62 per cent of children under five years slept underneath an insecticide-treated net (ITN) the night before the survey, and 75 per cent of children under five years in households with at least one ITN slept under an ITN. Similarly, 64 per cent of pregnant women aged 15-49 slept under an ITN, and close to 79 per cent in households with at least one ITN slept under an ITN. The proportion of children under five years who slept under an ITN was 43 per cent in 2011 and 62 per cent in 2016. A similar trend is observed among pregnant women, with an increase from 47 per cent in 2011 to 64 per cent in 2016. The proportion of children aged 6-59 months receiving vitamin A supplementation increased from 56.8 per cent to 62 per cent. Fifty-five per cent of children aged 12-23 months received all basic vaccinations at any time before the survey. In comparison, 49 per cent received the basic vaccinations by the appropriate age of 12 months, and 1 per cent received no vaccinations at all. The percentage of children aged 12-23 months who have received all basic vaccinations ranges from 45 per cent in the Busoga region to 73 per cent in the Karamoja region. As noted, fever is a symptom of malaria but is also associated with other childhood illnesses. About 20 per cent of children under five years had a diarrhoeal episode. Children with diarrhoea are given increased fluids or a fluid made from a packet of oral rehydration salts (ORS) or government-recommended homemade UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 17 fluids (RHF). Fifty-five per cent of children with diarrhoea received some form of oral rehydration therapy (ORT) such as ORS, recommended homemade fluids, or increased fluids. Nineteen per cent of children received antibiotics, and 40 per cent were given zinc, which can reduce the duration and severity of diar- rhoea. Nearly one in five (19 per cent) children with diarrhoea did not receive any treatment. The proportion of children with diarrhoea who received no treatment increased from 14 per cent in 2011 to 19 per cent in 2016. Male children are more likely (58 per cent) to receive ORT than female children (52 per cent). The proportion of children receiving ORT is higher in urban areas (61 per cent) than in rural areas (54 per cent). Children in the Karamoja region are more likely to receive ORT (84 per cent) than children in other regions. Only about one-third of children in Teso (34 per cent) and Ankole (37 per cent) regions received ORT.

2.3.4 Early childhood development (ECD) Organized early childhood education programmes are important to facilitate children’s cognitive develop- ment and prepare them for formal primary education. In Uganda, 37 per cent of youngest children aged 36-59 months living with their mother attend organized early childhood education programmes. Children born to mothers with more than secondary education (80 per cent), those from households in the highest wealth quintile (66 per cent), those living in urban areas (55 per cent), and those aged 48-59 months (47 per cent) are more likely to attend early childhood education. Children from Karamoja (13 per cent) and Teso (17 per cent) regions are less likely to participate in early childhood education than children from other regions. Inadequate care for children: Children under five years should be in the care and guidance of responsible adults. Nearly 37 per cent of youngest children under five years living with their mother received inade- quate care for at least one hour in the week preceding the survey. Twenty-three per cent spent at least one hour entirely alone. Twenty-eight per cent spent at least one hour in the care of another child younger than ten years of age. Early child development index: Sixty-three per cent of youngest children aged 36-59 months living with their mother are developmentally on track according to the early child development index. Ninety-one per cent of children are on track in the physical development domain, 86 per cent in the learning domain, 68 per cent in the social-emotional domain, though only 26 per cent in the literacy-numeracy domain. The propor- tion of children who are developmentally on track is highest in Ankole (84 per cent) and South Central (82 per cent) regions. The proportion is lowest in Lango (42 per cent), Teso (42 per cent), and Karamoja (43 per cent) regions. Children who are attending early childhood education are more likely to be developmentally on track (82 per cent) than those who are not attending (53 per cent). The percentage of children who are developmentally on track in at least three of the four domains rises with increasing mother’s education, from 57 per cent among children whose mothers have no formal education to 87 per cent among children whose mothers have more than secondary education. © UNICEF/UN0412384/Kabuye 18 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.3.5 Food production, access and utilization

2.3.5.1 Factors affecting food security in Uganda The following factors affect food production, access and utilization of food in Uganda. Low agricultural production and productivity: Low productivity in agriculture is often the result of erratic weather patterns characterized by severe and frequent droughts and floods. Nearly 90 per cent of households reported reductions in food production due to weather-related shocks, with minimal variation across regions (Uganda National Panel Survey (UNPS) 2013/14). Other factors are low access to extension services, low adoption of agricultural enhancing technologies, poor quality inputs on the market, the prevalence of pests and disease epidemics, limited access to agricultural financing, insecure land tenure systems, inefficient output and a limited market. In addition, low productivity results from food losses and wastage along the value chain due to poor handling practices, inappropriate storage methods and low storage capacity. Informal trade across borders: Uganda is the largest informal supplier of grains in the East Africa region, contributing to more than 70 per cent of regional consumption. It is recognized that the informal grain trade between Uganda and her neighbours is around five times higher than that of the formal grain trade. This, therefore, demonstrates the dominance of informal trade in the region, which in turn limits value addition and food income. In addition, the unregulated cross border food trade has encouraged the inflow of foreign traders who purchase food from the gardens exposing households to food insecurity as they are tempted to sell almost everything. The lack of food distribution and redistribution systems also fails to leverage food surplus in one region to cater for scarcity in another region. Untapped potential for irrigation: Currently, Uganda’s ratio of cultivated area under irrigation to the irrigation potential is only 0.5%. The comfort of receiving rains to sustain two cropping seasons in a year has provided little impetus to government to invest extensively in irrigation. Little attention has been accorded to technological and human capacity development in irrigation. Despite the advantages that the country holds in the ease of undertaking irrigation development, the potential has not been harnessed. Uganda’s rain-fed agriculture has progressively been constrained by frequent threats of, and actual occurrence of, droughts and floods affecting efforts for increased production, fight against hunger and poverty. Uganda’s vulnerability to climate change is exacerbated by a rapidly growing population, a factor that has increased pressure on natural resources (mainly wetlands and forest covers) leading to environmental degradation (Ministry of Water and Environment, National Irrigation Policy, Republic of Uganda, Kampala, 2018. Limiting land tenure system: The constraints related to the land tenure system, such as insecurity of land tenure, unequal access to land, fragmented land and lack of mechanisms to transfer rights and consolidate plots, have resulted in under-developed agriculture, high landlessness and food insecurity, as well as degrading natural resources in most parts of the country. Low household incomes, especially in rural areas: Low household incomes impact food security and exacerbate hunger in both rural and urban households, with a more significant impact on those classified as rural low-income. The lower the household income, the higher the proportion of household expenditure on food, implying higher vulnerability to food insecurity. The average share of food in total household expenditures was in the range of 55 per cent to 61 per cent over the 2009/10-2013/14 period, implying medium vulnerability to food insecurity (UNPS, 2013/14). Low food safety: The enforcement of standards on food handling and hygiene is limited, leading to unsafe food production, processing, packaging, marketing, sale and consumption practices. At the production level, food is contaminated by chemicals and aflatoxins; at the processing level, by old machines and unhygienic processing practices; and, at the consumption level, through unhygienic food preparation practices. The household environment in which food is prepared must be clean, safe, and free from disease causative agents. However, most of the Ugandan population live in unhealthy environments with limited access to sanitation facilities and poor hygiene. In 2016, 22 per cent of households (9 per cent urban and 26 per cent UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 19 rural) still had an unimproved water source. Furthermore, only 19 per cent of households had an improved toilet facility, and 44 per cent had a handwashing facility with soap and water. (UDHS, 2016). These poor sanitation conditions affect food safety through contamination and food poisoning, leading to diarrhoeal diseases and other intestinal infections. This situation is compounded with a weak government health inspection function due to limited human, logistical and financial resources. Food loss and waste: According to the State of Food and Agriculture (SOFA) report ‘Food loss and wastage reduction’ (Food and Agriculture Organization, 2019), globally, around 14 per cent of food produced is lost from the post-harvest stage. Roughly one-third of the edible parts of food produced for human consumption gets lost or wasted globally, which is about 1.3 billion tons per year. By category, this includes 45 per cent of all fruit and vegetables, 35 per cent of fish and seafood, 30 per cent of cereals, 20 per cent of dairy products and 20 per cent of meat. In Uganda, high food losses are a result of poor post-harvest handling practices (inadequate drying and high moisture content at time of storage), insufficient and inappro- priate storage facilities, limited value-addition, filth and contamination, inadequate marketing systems, damage by insects, rodents and other pests and infestation by micro-organisms especially fungus that leads to aflatoxin. Food losses contribute to and exacerbate hunger situations, poverty and food insecurity. Currently, annual post-harvest loss stands at 17.6 per cent for about 2.8 million metric tons, 12.4 per cent for about 214,000 metric tons(MT) and 13.5 per cent for 230,000MT of maize, millet and rice produced in the country, respectively (FAO, 2020). If markets are not properly organized, the losses in mangoes, oranges and pawpaw crops could reach 80 per cent of total production. Livestock post-harvest losses: These occur mainly in milk due to a lack of cold storage and primary processing equipment. Losses from beef and fish also happen due to a lack of cold storage facilities. Honey losses occur mainly due to poor harvesting technologies and skills, leading to 20 per cent of the would-be honey being left in combs. Food storage and reserve infrastructure: Food reserve infrastructure is critical in minimizing food losses, wastage and enhancing safety. However, Uganda lacks a national food reserve system, further exposing the country to food and nutrition insecurity risks. The few available reserves1 are small and are mainly private sector owned. At the household level, the traditional food reserve mechanisms are also non-existent.

2.3.5.2 Hunger In Uganda, hunger is a national concern, with rural areas experiencing severe hunger more than urban areas. As of January 2017,2 an estimated 10.9 million people were experiencing acute food insecurity, of which 1.6 million were in crisis, reflecting a high magnitude of hunger. Severely affected districts in 2017 were Isingiro, Butaleja and Kasese. A similar situation was experienced in Namutumba district in 2015, where children died of malnutrition following a prolonged drought. The situation of school feeding also portrays severe hunger, given that about 66 per cent of school-going children do not access school meals (UNPS, 2018). The ‘Cost of Hunger in Africa’ study in Uganda estimated an annual cost associated with childhood undernutrition and hunger at an equivalent of 5.6 per cent of the gross domestic product (World Food Programme (WFP), United Nations Economic Commission for Africa (UNECA) & African Union Commission, 2013). Uganda’s ranking on the Global Hunger Index (GHI) remains low and lags behind other sub-Saharan African countries. Nonetheless, the country registered progress in reducing its GHI score, from 38.9 in 2000 to 30.6 in 2019 (Concern Worldwide and Welt Hunger Hilfe, 2020). Despite the progress, the depth of hunger in Uganda remains serious, with 41.0 per cent of the population undernourished (Concern Worldwide and Welt Hunger Hilfe, 2020). The situation may be worse following the COVID-19 pandemic that reached Uganda in March 2020. 1 Those operated by Uganda Grain Council and those established with support from World Food Programme (WFP) in specific districts 2 Integrated Food Security Phase Classification (IPC) report, 2017 20 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 In the same way, nearly 1.4 million refugees and asylum-seekers, including 867,000 South Sudanese and 403,000 Congolese nationals, were sheltering in Uganda as of January 2020. It is worth noting that many refugee households in Uganda rely on food assistance to meet their daily food needs. According to the Famine Early Warning Systems Network (FEWS NET), without sustained assistance during the COVID-19 pandemic phase, refugees in Uganda were likely to face acute food insecurity crisis levels (USAID, 2020). Hunger and nutrition insecurity among school-going children is high, especially in rural areas, with the northern and western regions being the most affected. Only 34 per cent of primary and secondary school children receive meals while at school. Urban children (41 per cent) are more likely to receive a school meal than their rural counterparts (32 per cent). The problem is more pronounced in northern (14.8 per cent) and western (14.4 per cent) regions. The Education Act vests the responsibility of school feeding to parents and guardians; however, the majority do not fulfil their obligations. Estimates based on the Integrated Phase Classification (IPC) on food security by the Uganda IPC Technical Working Group (2017) show that the national food secure population declined from 83 per cent in July 2016 to 69 per cent in January 2017. The decreasing proportion of food secure Ugandans may be attributed to disease, disasters and erratic weather conditions. The rural areas, which are the food producers, are increas- ingly becoming food insecure and more hunger-stricken due to selling off most of the food produced. This is a reversing trend since in the period (2002/3-2005/6). Individual residents in urban areas had a higher prevalence of food insecurity and hunger than their rural counterparts (Ssewanyana and Kasirye, 2010). Essentially, food security encompasses four dimensions: food availability, economic and physical access to food, food utilization and stability over time (FAO 1996). Analysis of country reports and food projections reveals that Uganda has significant gaps in its food requirements. Most gaps in food production relate to staples, including rice, millet, sorghum and wheat, with a gap of -1,017,142 metric tons. Milk and milk prod- ucts have similar shortages. The most significant shortages are in fish and meat, with gaps of -547,317 and -544,504 metric tons, respectively. High prevalence of undernourishment in the country: Overall, the prevalence of undernourishment (reflecting the share of the population with insufficient caloric intake below 2,200 kcal) remains high, with nearly 40 per cent of individuals in Uganda classified as undernourished, and 16 per cent of the households chronically undernourished, with only 4 per cent of the household’s food secure for the period 2009/10- 2015/2016. Over 64 per cent of Ugandans cannot afford the desired three meals per day (UBOS & ICF, 2018). This implies that Ugandans only consume 1,860 kcal a day and cannot consume the minimum required dietary intake for light physical activity, which is 2,200 kcal per day. The intake is lower in the rural areas with an average of 1,814 kcal in 2009/10 to 1,841 kcal in 2015/16 compared to the urban areas at 1,956 kcal in 2009/10 2,030 kcal in the same year. The prevalence of undernourishment is highest in the western region and lowest in the northern region. Specifically, there is a drastic decline in caloric intake per person per day in the eastern region, from 1,913 kcal in 2009/10 to 1,692 kcal in 2015/16, and caloric deficiency increased from 33.2 per cent in 2009/10 to 45.8 per cent in 2015/16. This may be attributed to the unguided commercialization of agriculture in the region, with an increased focus on cash crops at the cost of food production. The prevalence of undernourishment is highest among the poor. The wealthiest 20 per cent of the population can meet the required dietary intake, while the poorest 20 per cent have the highest levels of undernourishment. Overall, there is an urgent need to focus on the food intake of the poorest households if Uganda is to meet the required targets for ensuring access to food to all Ugandans all year round. Low dietary diversity (DD) scores: The DD scores remain below the standard average of 9.23, although some improvements have been registered. However, households in the northern and eastern regions that are more food insecure have higher food diversification than the central and western, which are more food secure. This reflects cultural differences in food consumption and nutrition knowledge gaps. 3 Based on the USAID framework for household dietary diversity score (HDDS) for measurement of household food access, the “average HDDS in the richest 33 percent of households can serve as a guide for setting the target level of HDDS” (Swindale and Bilinsky, 2006); from the UNPS, the average HDDS for this group was estimated at 9.2. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 21 Low nutritional quality of foods consumed in the country: The most consumed foods in Uganda are staples (cereals, roots, tubers and matooke), which are typically relatively cheap. However, generally, they are also low in nutritional density due to low protein and micronutrient deficiencies, except beans and ground nuts. The contribution of staples to caloric intake remains high at over 60 per cent of the daily caloric intake. Consequently, micronutrient deficiencies are common. According to UDHS 2016, it is estimated that the anaemia levels increased from 49 per cent to 53 per cent among children aged 6-59 months and 33 per cent of women of reproductive age (UBOS & ICF, 2018). vitamin A deficiency affects one out of five young children and women of reproductive age, resulting in impaired resistance to infection and consequently higher levels of illness and mortality, as well as potentially severe eye problems. The prevalence of zinc deficiency ranges from 20 per cent to 70 per cent in young children and 20 per cent to 30 per cent in adults. Zinc deficiency results in poor growth, reduced resistance to infectious diseases, and increased incidence of stillbirths. Therefore, both dietary quantity and quality remain critical challenges in ensuring that all Ugandans are hunger-free and nutrition secure. The essential protein foods such as meat, fish, poultry, eggs, milk and milk products constitute a low proportion of children’s diets. There is notably low consumption of dairy products since 2006, with only 3 per cent of children aged 6-23 months consuming milk and milk products in 2016. The consumption of fortified foods was less than one per cent in 2016. Therefore, a lot needs to be done to improve children’s diets, especially with nutrient-rich foods.

2.3.6 Water sanitation and hygiene (WASH)

2.3.6.1 Drinking water sources and treatment Improved drinking water sources include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells, springs, and rainwater. Households that use bottled water for drinking are classified as using an improved source only if the water they use for cooking and handwashing comes from an improved source. Just over three quarters (78 per cent) of households in Uganda have access to an improved source of drinking water. Access to improved water sources is more predominant in urban (91 per cent) than rural (74 per cent) households. About half (52 per cent) of households use an appropriate water treatment method. The most commonly used method is boiling (47 per cent of households) and more urban households (70 per cent) than rural households (39 per cent) reported boiling their water. More than half of households in rural areas (54 per cent) do not treat their drinking water at all. More than half (55 per cent) of rural households spend at least 30 minutes (round trip) to fetch drinking water, as compared with 23 per cent of urban households. More than half of urban households (54 per cent) use piped water for drinking; 23 per cent have water piped into their dwelling/yard, 18 per cent use water piped to a neighbour, and 13 per cent use a public tap/standpipe. On the other hand, rural households rely mainly on tube wells or boreholes (45 per cent) or an unimproved source (26 per cent). Sixty-seven per cent of households in Uganda reported having water with no interrup- tion of at least a single day. Urban households (50 per cent) are more likely than rural households (24 per cent) to report water as unavailable for at least one day. The proportion of households using an improved source of drinking water increased steadily from 2011 (70 per cent) to 2016 (78 per cent).

2.3.6.2 Sanitation Improved toilet facilities include any non-shared toilet of the following types: flush/pour toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; pit latrines with slabs and composting toilets. About two in ten households (19 per cent) in Uganda use improved toilet facilities. This is a slight improvement from 15 per cent in 2011. Urban households are more prone to use shared facil- ities (46 per cent) than rural households (11 per cent). More than half of households in Uganda (55 per cent) use unimproved toilet facilities, with nearly two-thirds (65 per cent) of rural households and one quarter (25 per cent) of urban households using such facilities. 22 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

2.3.6.3 Handwashing Fifty-nine per cent of household members most often wash their hands. Among households in which a place for handwashing exists, 44 per cent had soap and water, 32 per cent had water, but no soap, and 21 per cent had no water, no soap and no other cleansing agent.

2.3.7 Nutrition-enabling environment There are governance issues that affect the implementation of nutrition interventions in Uganda. The func- tionality of Nutrition Coordination Committees (NCC) at UNAP-implementing MDAs not yet at optimal levels. The functionality status of 120 district local government (DLG) NCCs is unknown. For the 26 DLGs whose status has been determined, the functionality is not yet at an optimal level. Despite joining the SUN movement in 2011, which requires the establishment of country-level SUN networks, the Business Network, Academia and Research Institute Network and Civil Society Network s not yet established. Despite its establishment, the functionality index of the Nutrition Development Partners Groups Network has never been determined. The following measures of enabling environment for nutrition are general not yet optimal at all levels of UNAP implementation: • Nutrition coordination and partnerships. • Nutrition planning, resource mobilization, financing and tracking. • Institutional and technical capacity for nutrition. • Nutrition advocacy, communication and social mobilization. • Legislation and policy and planning frameworks for nutrition. • Nutrition evidence and knowledge management for effective decision-making. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 23

2.4 GOVERNMENT COMMITMENT TO ADDRESS MALNUTRITION Uganda was one of the ‘early riser’ Scaling up Nutrition (SUN) countries that declared its commitment to nutrition in response to the call to action when it joined the Movement in 2011. Uganda adopted the SUN Movement’s multi-sectoral coordination mechanism and established a multi-sectoral coordination mecha- nism under the OPM. Being a member of the SUN Movement, Uganda galvanized other initiatives such as the United Nations Renewed Efforts Against Child Hunger and undernutrition (UN REACH) initiative at the country level. The ‘UNAP II’ further highlight the global SUN Movement aspirations. Eliminating malnutrition in all its forms is critical in breaking the intergenerational cycle of poverty that propels underdevelopment. Uganda is a signatory of key global and regional initiatives aimed at addressing malnutrition in all its forms. The country has demonstrated commitment to alleviating malnutrition by: 1. Positioning nutrition in the Constitution of the Republic of Uganda 1995, Vision 2040, and ‘NDP III’ (2020/21-2024/25). 2. Developing and implementing ‘Uganda Nutrition Action Plan’ (UNAP) as the country’s strategic and common results framework to enhance mainstreaming nutrition in sector policies, strategies and action for scaling up nutrition in Uganda. 3. Joining the Scaling Up Nutrition (SUN) Movement in 2011 and committing to SUN principles. 4. Committing to achieving World Health Assembly (WHA) nutrition targets, Sustainable Development Goals (SDGs) and the Second International Conference on Nutrition (ICN) Framework for Action, among others. 5. Embracing multi-sectoral and multi-stakeholder approaches to nutrition programming and coordination under OPM. 6. Rolling out the ‘Presidential Initiative on Healthy Eating and Healthy Lifestyles’ (July 2019). H.E President Yoweri Museveni launched the initiative with the following objectives: • Promote healthy eating and lifestyle practices in households and communities. • Raise public awareness about malnutrition and its consequences. • Advocate for engagement and involvement of public and private sectors, civil society and other stakeholders in promoting healthy diets and lifestyles. 24 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 © UNICEF/UNI194160/Ose CHAPTER THREE ‘UNAP II’ Strategic Direction

3.1 ‘UNAP II’ THEORY OF CHANGE The ‘UNAP II’ theory of change (see Figure 7) below has been informed by the Lancet framework for actions to achieve optimum foetal and child nutrition and development. In addition to nutrition-specific, nutrition-sensitive and enabling environment strategies, the ‘UNAP II’ theory of change acknowledges the current situation and assumptions that must hold true for its goal to be achieved. The ‘UNAP II’ builds on the gains attained under the ‘UNAP I’. Its scope includes diet-related non-communicable diseases (overnu- trition), undernutrition among women, children and all vulnerable groups of the population. To effectively scale up nutrition actions and promote the wellbeing of Ugandans, particularly in light of the COVID-19 pandemic, a mix of nutrition-specific and nutrition-sensitive strategies is required. Additionally, further effort is needed to strengthen the enabling environment. It is important to note that enabling envi- ronment strategies play a catalytic role in promoting nutrition-specific and nutrition-sensitive actions. Such methods include enhancing nutrition governance, ensuring coherent policy, legal and institutional frame- works, and strengthening the use of nutrition information, data, and evidence for effective decision-making, ‘UNAP II’ will ensure that viable linkages between nutrition-specific and nutrition-sensitive strategies are established, since nutrition-sensitive approaches act as delivery platforms for increased coverage of nutri- tion-specific interventions. Promotion of the production of, access to and utilization of diverse, safe, nutri- ent-dense food through agricultural and social protection strategies, coupled with the advancement of MIYCAN practices, will lead to improved dietary diversity and micronutrient intake. Integration of essential nutrition actions in preventing and managing infectious and non-communicable diseases and increased access to WASH services will reduce disease burden. ‘UNAP Il’ outputs will be achieved with the assumption that quality nutrition information, sufficient finances and an adequate, skilled human resource base will be available, leading to increased coverage of quality nutrition services. It is also assumed that adequate support for the target groups will lead to a change in behaviours and practices, resulting in the continued utilization of nutrition services. Sustained achievement of primary ‘UNAP II’ intermediate outcomes will lead to improved nutrition status among children under five years of age, school-age children, adolescents, pregnant and lactating women and other vulnerable groups by 2025 (see Figure 7). UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 25 FIGURE 7 ‘UNAP II’ THEORY OF CHANGE ASSUMPTIONS • Quality nutrition information will contribute to design • Enabling environment will lead to • Adequate support to the target groups will of impactful interventions increased coverage of nutrition actions lead to change in behaviours and practices • Sufficient resources to scale up nutrition sensitive • Target cimmunities demans, access • The COVID-19 pandemic does not stop and nutrition specific actions will be available and utilize interventions service delivery CURRENT SITUATION STRATEGIES INTERMEDIATE OUTCOMES PRIMARY OUTCOMES Inadequate access to and utilization of Increase access to and utilization of nutrition Increased access to and utilization of nutrition specific • Reduction in the prevalence of nutrition specific services: MIYCAN, specific services: MIYCAN, micronutrient intake, services: stunting, wasting and overweight in micronutrient intake, acute malnutrition, acute malnutrition management, nutrition in • Improved MIYCAN practices and behaviours children under five years of age nutrition in infectious diseases and nutrition in infectious diseases and and nutrition in diet • Optimal intake of micronutrients of concern • Reduction in prevalence of anemia in diet related and non-communicable diseases related and non-communicale diseases children 0-5 years and in women of • Increased coverage of management acute malnutrition reproductive age • Nutrition integrated in maternal and child health services • Reduction in prevalence of overweight Inadequate access to and utilization of Increase access to and utilization of nutrition • Nutrition integrated in diet related and non-communicale adult women and men aged 18+ years nutrition sensitive services: sensitive services: Promote production, diseases • Reduction in prevalence of obesity in • Production, access and utilization of access and utilization of diverse, safe and adult women and men aged 18+ years diverse, safe and nutrient dense crop, nutrient dense crop, fisheries and animal Increased access to and utilization of nutrition sensitive foods services ie: • Reduction in prevalence of fisheries and animal foods overweight and obesity in adolescents • Nutrition services in: Social Protection Integrate Nutrition services in: Social • Increased production, access and utilization of safe, Protection and SGBV programmes; Early diverse and nutrient dense plant, fisheries and animal • Reduction in prevalence of raised and SGBV programmes; Early Childhood Childhood Development (IECD) services, and source food. blood glucose/diabetes among Development (IECD) services, and quality quality education and sports; Water Sanitation persons aged 18+ years education and sports; Water Sanitation • Increased access to: nutrition sensitive social and Hygiene (WASH) services and Trade, and Hygiene (WASH) services and Trade, protection and GBV programmes; Improved nutrition • Reduction in prevalence of low birth Industry and Investments Industry and Investments for efficient and quality education and sports; access weight (<2500g) to nutrition sensitive Water Sanitation and Hygiene • Reduction in prevalence of raised Inadequate Nutrition enabling environment Strengthen the enabling environment for (WASH) services and Increased Trade, Industry and blood pressure among persons 18+ nutrition Investments in scaling up nutrition years • Nutrition coordination and partnerships; Nutrition financing and tracking; • Nutrition coordination and partnerships; instituitional and technical capacity for Nutrition financing and tracking; Strengthen the enabling environment for nutrition nutrition; Nutrition advocacy, instituitional and technical capacity for • Strengthened nutrition coordination and partnerships at all levels; communication and social mobilization; nutrition; Nutrition advocacy, communication Legislation and policy and planning and social mobilization; Legislation and • Improved planning resource mobilization, financing and tracking of nutrition investments; frameworks for nutrition; policy and planning frameworks for nutrition; • Strengthened instituitional and technical capacity for nutrition; Nutrition advocacy, communication • Nutrition evidence and knowledge • Nutrition evidence and knowledge and social mobilization; Legislation and policy and planning frameworks for nutrition; management management • Nutrition evidence and knowledge management STRENGTHEN PARTNERSHIPS COORDINATION SCALE UP PRODUCTIVE POPULATION NUTRIENT-DENSE FOOD SOCIAL PROTECTION PROGRAMMES WELL-NOURISHED NUTRIENT-DENSE FOOD PLANT VULNERABLE GROUPS NUTRITION-SENSITIVE SCHOOL-AGE UNDER 5 YEARS NUTRITION ADOLESCENTS HEALTHY ANIMAL SOURCES QUALITY EDUCATION NUTRITION-SPECIFIC COMMUNICATION & SOCIAL MOBILIZATION CONTROL MICRONUTRIENT INTAKE EARLY CHILDHOOD DEVELOPMENT MATERNAL MALNUTRITION DIET-RELATED PRODUCTIVE POPULATION PREVENTION VULNERABLE GROUPS WATER, SANITATION AND HYGIENE MICRONUTRIENT INTAKE UNDER 5 YEARS ANIMAL SOURCES REPRODUCTIVE AGE NUTRIENT-DENSE FOOD FISHERIES LACTATING WOMEN UNDER 5 MICRONUTRIENT

3.2 VISION OBJECTIVE 1 A well-nourished, healthy and productive population To increase access to and utilization of effectively participating in the socio-economic trans- nutrition-specific services by children formation of Uganda. under five years of age, school-age children, adolescents, pregnant and lactating women and other vulnerable

3.3 GOAL groups. Improve nutrition status among children under 5 years, school age children, adolescents, pregnant and lactating women and other vulnerable groups OBJECTIVE 2 by 2025; To increase access to and utilization of nutrition-sensitive services by children under five years, school-age children,

3.4 OBJECTIVES adolescents, pregnant and lactating The ‘UNAP II’ objectives are based on a holistic women and other vulnerable groups. approach to nutrition, taking into account all-encom- passing global contemporary trends and demands. These include SUN, 2030 Agenda and SDGs, as well OBJECTIVE 3 as the Vision 2040 aspirations operationalized in the ‘NDP III’. The focus areas are nutrition specific, To strengthen the enabling environment nutrition sensitive and enabling environment. The for scaling up nutrition-specific and spirit of the objectives is to uphold a multi-sectoral nutrition-sensitive services. approach to nutrition. Over the period 2020-2025, ‘UNAP II’ seeks: UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 27

3.5 STRATEGIES AND PRIORITY ACTIONS OBJECTIVE 1 To increase access to and utilization of nutrition-specific services by children under five years of age, adolescent girls, pregnant and lactating women and older persons. STRATEGY PRIORITY ACTIONS Strategy 1.1: Promote optimal 1. Promote exclusive breastfeeding for infants aged 0-5 months. maternal, infant, young child 2. Promote complementary feeding for children aged 6-23 months. and adolescent nutrition 3. Promote and support growth promotion and monitoring services practices in emergencies at health facilities and in communities. and stable situations. Strategy 1.2: Promote optimal 1. Provide routine vitamin A supplementation to all children aged micronutrient intake among 0-5 years during integrated child health days. children, adolescent girls 2. Educate and provide for all pregnant women attending antenatal and women of reproductive care to uptake iron and folate supplementation. age in stable and emergency 3. Promote consumption of fortified foods especially in schools situations. with focus on beans, rice, sweat potatoes, cooking oil, maize. 4. Promote and enforce mandatory consumption of safe and fortified foods in schools 5. Promote and support food fortification for specified foods Strategy 1.3: Increase coverage 1. Integrate routine screening and timely management of severe of the management of acute and moderate acute malnutrition into routine health and health malnutrition in stable and services in refugee settlements, host communities and other emergency situations. areas. Strategy 1.4: Integrate nutrition 1. Increase access to immunization against childhood diseases. services in the prevention, 2. Promote de-worming medications targeting children 1-14 years control and management receiving at least two doses per year. of infectious diseases and 3. Reduce the burden of communicable diseases, focusing on high epidemics. burden diseases (malaria and diarrhoea) related to malnutrition through the primary health care approach. Strategy 1.5: Integrate nutrition 1. Have a national physical exercise day. services in the prevention, 2. Conduct sensitization of employers and workers on workplace control and management physical activities for staff. of diet-related non- 3. Assess workers and employees for body mass index. communicable diseases. 4. Assess workers and employees for diabetes and hypertension. 5. Procure nutrition assessment and health fitness equipment. 6. Develop social behaviour change communication on feeding habits and behaviours. 7. Sensitize households and communities on healthy eating and lifestyle. 8. Engage with public and private sectors, civil society and other stakeholders to promote healthy diets and lifestyles. 28 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 OBJECTIVE 2 To increase access to and utilization of nutrition-sensitive services by children under five years, school-age children, adolescent girls, pregnant and lactating women and other vulnerable groups. STRATEGY PRIORITY ACTIONS Strategy 2.1: Increase 1. Support access to improved technologies, including climate-smart ones, the production of to increase diverse, safe, nutrition enhancing crop and animal products. diverse, safe and 2. Scale up research about the popularity and accessibility of indigenous nutrient-dense food and non-indigenous nutrition-enhancing seed and stock. at the household level 3. Design and streamline mechanisms for improved farmer access to from plant, fisheries indigenous and non-indigenous nutrition-enhancing seed and stock and animal sources. varieties. 4. Support the production of nutrient-dense indigenous and underutilized plant, fisheries and animal resources. 5. Increase the production of biofortified foods. 6. Establish community structures for delivering nutrition-sensitive agriculture services through the primary school system. 7. Strengthen linkages between community health worker’s services and farming communities. 8. Enhance nutrition services delivered through primary schools, parental groups (PGs) and lead farmers (LFs). 9. Strengthen linkages between agricultural extension services and primary schools to deliver multi-sectoral food and nutrition-security actions. 10. Strengthen the capacity of health, agriculture and education ministries to deliver multi-sectoral food and nutrition-security actions. Strategy 2.2: Increase 1. Support the scale-up of value addition, agro-processing and marketing access to diverse, safe of diverse, safe, nutrient-dense foods, including indigenous and and nutrient-dense underutilized food resources. food from plant, 2. Build capacity of farmers on postharvest handling technologies and fisheries and animal value addition. sources 3. Support on-farm agricultural enterprise mixes to ensure stable, diversified food access. 4. Provide timely early warnings systems to ensure stable access to food, including the Integrated Phase Classification System. Strategy 2.3: Increase 1. Integrate nutrition and home economics in agricultural research and the utilization of extension. diverse, safe and 2. Support investment in technologies and infrastructure development for nutrient-dense food food safety along the agricultural value chain. from plant, fisheries 3. Intensify awareness on benefits of consuming safe and nutrition-dense and animal sources. foods, including fortified (bio and industrial), indigenous and underutilized food resources. 4. Develop national food-based dietary guidelines and food composition tables. 5. Establish and operationalize a functional food safety index-tracking system along the agricultural value chains.. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 29 STRATEGY PRIORITY ACTIONS Strategy 2.4: Promote 1. Implement the 15-household model for social-economic empowerment. the integration of 2. Mainstream nutrition interventions into social protection programmes nutrition services and humanitarian assistance safety net programmes. in social protection programmes. 3. Implement income-generating activities targeting poor and vulnerable households and communities. 4. Support initiatives that create an enabling environment for women to participate in development activities. Strategy 2.5: Promote 1. Register all ECD centres in accordance with the Ugandan Basic access to nutrition Requirements and Minimum Standards (BRMS). services through 2. Sensitize private players to spread ECD centres to under-served areas. integrated early childhood development 3. Increase access to ECD services for children aged 0-8 years. (ECD) services and 4. Promote and enforce mandatory consumption of safe and fortified foods quality education and in schools. sports. 5. Mobilize parents to provide meals to school-going children. 6. Promote the establishment of school gardens Strategy 2.6: Increase 1. Increase access to inclusive, safe water supply in rural areas. access to nutrition-sen- 2. Increase access to inclusive sanitation and hygiene services in rural areas. sitive water, sanitation and hygiene (WASH) 3. Increase access to inclusive, safe water supply in urban areas. services. 4. Increase access to inclusive sanitation and hygiene services in urban areas. 5. Provide support to improve WASH services in institutions. 6. Improve nutrition and food safety with emphasis on children under five years and school-going children. Strategy 2.7: Increase 1. Build capacity of local industries to adopt appropriate technologies for the participation of industrial food fortification. trade, industry and 2. Support industrial uptake and value addition of bio-fortified plants. investment actors in scaling up nutrition. 3. Enforce surveillance for compliance with the mandatory food fortification regulation. 4. Build capacity of micro, small and medium enterprises (MSMEs) in the food sector with compliance to quality and standards. 5. Support traders and processors of foods to form viable cooperatives. 6. Mitigate non-tariff barriers that affect food and nutrition. 30 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 OBJECTIVE 3 To strengthen the enabling environment for scaling up nutrition-specific and nutrition-sensitive services. STRATEGY PRIORITY ACTIONS Strategy 3.1: 1. Conduct comprehensive nutrition stakeholder and action mapping at MDA Strengthen levels. nutrition 2. Conduct comprehensive nutrition stakeholder and action mapping at local coordination and government levels. partnerships at all levels. 3. Establish and support the functionality of Nutrition Coordination Committees (NCCs) at the national and MDA level. 4. Establish and support the functionality of NCCs at local government levels. 5. Establish and support the functionality of all SUN networks with a focus on SUN business, academia and CSO networks. 6. Support joint annual SUN Movement assessments and other relevant joint nutrition programme reviews. Strategy 3.2: 1. Develop nutrition action plans (districts, regional cities, municipalities, municipal Improve the divisions, and town councils) aligned to ‘UNAP II’ and ‘NDP III’ programme planning, resource implementation action plans (PIAPs). mobilization, 2. Develop joint annual nutrition work plans (districts, regional cities, municipalities, financing and municipal divisions, and town councils) aligned to the ‘UNAP II’ implementation tracking of nutrition matrix. investments. 3. Develop nutrition action plans for Kampala Capital City Authority (KCCA) and its five divisions aligned to ‘UNAP II’ and ‘NDP III’ PIAPs. 4. Develop joint annual nutrition work plans for KCCA and its five divisions aligned to the ‘UNAP II’ implementation matrix. 5. Develop joint annual nutrition work plans and action plans for UNAP- implementing MDAs aligned to the ‘UNAP II’ implementation matrix. 6. Undertake expenditure reviews for nutrition. 7. Develop an investment case for nutrition in Uganda. 8. Conduct detailed costing of ‘UNAP II’. 9. Develop and implement resource mobilization and tracking plan for nutrition aligned to ‘UNAP II’. Strategy 3.3: 1. Conduct nutrition capacity assessments among UNAP-implementing MDAs. Strengthen 2. Conduct nutrition capacity assessments among DLGs and regional cities. institutional and technical capacity 3. Develop nutrition capacity development framework for UNAP-implementing for scaling up MDAs. nutrition actions. 4. Develop nutrition capacity development framework for DLGs and regional cities. 5. Implement the nutrition capacity development framework for UNAP- implementing MDAs. 6. Implement the nutrition capacity development framework for DLGs and regional cities. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 31 STRATEGY PRIORITY ACTIONS Strategy 3.4: 1. Develop a nutrition advocacy communication strategy fully aligned with the Strengthen ‘UNAP II’ strategic direction. nutrition advocacy, 2. Develop and implement a regional-specific nutrition advocacy and communication communication campaign. and social 3. Mobilize and institute high-level nutrition advocates to actively advance the mobilization for nutrition agenda at national and sub-national levels. nutrition. 4. Develop nutrition advocacy briefs and technical briefs for use at national and sub-national levels. 5. Develop nutrition commitments scorecards at national and MDAs levels. 6. Develop nutrition commitments scorecards targeting districts and regional cities. 7. Build capacity of community-based structures such as functional adult literacy (FAL) groups, Parish Development Committees (PDCs), community resource persons, and community-based informal groups to trigger and deliver community-based advocacy, social mobilization and behavioural change communication on nutrition interventions. 8. Undertake campaigns to reduce teenage pregnancy, gender-based violence (GBV) and other harmful practices that result in malnutrition. Strategy 3.5: 1. Conduct regulatory impact assessment for the National Nutrition Policy. Strengthen 2. Finalize the National Nutrition Policy (NNP). coherent 3. Develop the national food fortification policy and law. policy, legal 4. Develop standards and guidelines for child care facilities at formal workplaces and institutional frameworks for 5. Develop and implement employment regulations related to breastfeeding and nutrition. childcare facilities at workplaces. 6. Amend the Employment Act to provide for childcare facilities at workplaces. 7. Develop legislature and regulation to regulate the production and consumption of sweetened beverages 8. Develop the public food procurement policy for schools and institutions. 9. Strengthen and develop school feeding programmes policy. 10. Conduct a detailed review and revision of existing policies and pending legislation, regulations and standards across relevant sectors. 11. Advocate for coordinated enforcement of relevant legislation at all levels. Strategy 3.6: 1. Design and implement a monitoring, evaluation, accountability and learning Strengthen and (MEAL) plan for ‘UNAP II’. institutionalize 2. Strengthen and scale up early warning systems, survey and surveillance on food nutrition evidence and nutrition from community to national levels. and knowledge 3. Develop, disseminate and enhance the use of evidence-based nutrition management knowledge products at all levels. along with a 4. Implement sector-specific research and assessment plans for ‘UNAP II’. multi-sectoral nutrition 5. Create capacity within national institutions to operate and maintain the National information system Information Platform for Nutrition (NIPN). for effective 6. Strengthen capacity to track progress in meeting national objectives to prevent decision making. malnutrition and monitor nutrition investments. 7. Build the capacity of government staff to make better use of evidence and data to design and implement nutrition-related policies and programmes. 32 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

3.6 ‘UNAP II’ ALIGNMENT WITH ‘NDP III’ TABLE 1 UNAP II ALIGNMENT WITH NDPII ‘NDP III’ PROGRAMME ‘UNAP II’ MDA 01. Agro-Industrialisation Strategy 2.1 Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) 06. Natural Resource, Environment, Strategy 2.6 Ministry of Water and Environment Climate Change, Land and Water (MoWE) Resources Management 12. Human Capital Development Strategy 1.1-1.5; 2.7 Ministry of Education and Sports (MoES) Strategy 2.4; 2.5; 2.6 Ministry of Health (MoH) 13. Technology Transfer and Strategy 2.1; 2.2; 2.7 Ministry of Science, Technology and Development Innovation (MoSTI) 14. Public Sector Transformation Strategy 3.3 Ministry of Public Service (MoPS) 15. Community Mobilisation and Strategy 2.4; 2.5; 3.4 Ministry of Gender, Labour and Social Minuet Change Development (MoGLSD) 17. Regional Balanced Development Strategy 2.1; 2.2; 2.7 Ministry of Gender, Labour and Social Development 18. Development Plan Strategy 3.1-3.6 Ministry of Finance, Planning and Implementation Economic Development (MoFPED)

3.7 IMPLEMENTATION PRINCIPLES While espousing the implementation of ‘UNAP II’, the following principles will be applied by all actors. Ensuring community participation: Community participation will be strengthened to address local nutrition challenges by including community members in assessing the extent of challenges, analysing causes and finding solutions. This principle is in line with the government’s thinking of using parish development committees. The ‘UNAP II’ coordination structures have fully taken care of this arrangement by providing terms of reference for the Parish Nutrition Coordination Committee in all parishes. Strengthening community-based nutrition programming: The ‘UNAP II’ will emphasise mainstreaming and strengthening nutrition actions through community-based nutrition programmes that reduce food insecurity and consumption of poorly diversified diets. The Parish Model approach will facilitate the implementation of the UNAP strategic direction at community levels. Strengthening effective coordination mechanism in line with ‘NDP III’ planning framework: It is important to note that the ‘UNAP II’ has been developed at a time when the Ugandan Government has approved the ‘NDP III’ 2020/21-2014/25, which includes multi-sectoral and programme-based implementation. Like the ‘UNAP’ approach, the ‘NDP III’ programme approach focuses on the delivery of common results; strengthening the alignment of planning and budgeting frameworks; enhancing synergies among sectors and other actors to minimise silo approach to implementation and providing a coordinated framework for implementation, monitoring, reporting and evaluation of common results. Deliberate targeting for vulnerable population groups and regions with the highest number and prevalence of malnutrition: Nutrition priority actions, especially for sustaining proper care for nutritionally vulnerable groups, shall be integrated with emergency response systems and addressed in a coordinated manner. Particular groups, especially farmers, typically sell off the most nutritious foods for cash and remain with less healthy foods for their children. Unfortunately, their earned income from the sale of nutritious foods is rarely used to buy a suitable variety of foods, and so ultimately, their children are exposed to undernutrition. Evidence from the UDHS 2016 indicates that regions such as Tooro with high food production per capita is the same region with the highest prevalence of child stunting. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 33 Improving nutrition knowledge and skills: Training in community nutrition is to be provided to health workers, agriculture extension workers, community development workers and functional adult literacy workers using a standardized training manual developed by UNAP-implementing MDAs. Adequate technical and material support for carrying out nutrition interventions will be provided to all service providers. Attention shall also be given to strengthening higher learning institutions participating in pre-and in-service training in multi-sectoral nutrition relevant disciplines for high-level multi-sectoral nutrition programming training.

3.8 TARGETING Although nutrition is important for all demographics, there are primary target groups upon which focus must be put during ‘UNAP II’ implementation. Critical among the target groups are: Pregnant and lactating women: Malnutrition during pregnancy poses a high risk for both the mother and the unborn child. In particular, iodine deficiency in early pregnancy can cause stillbirth and other pregnancy- related complications. If a foetus is born malnourished, this can cause irreversible defects. Similarly, iron deficiency anaemia during pregnancy can increase the risk of maternal mortality and significantly contribute to low birth weight. Infants and children under five years of age: In most low-income countries, including Uganda, growth faltering begins in the mother’s womb. The damage caused by poor nutrition in the womb or the first years of life will be a burden that a child must bear for the rest of his/her life. Rarely does a child who is stunted at the age of two catch up with the mental and physical growth of his/her peers. The child becomes permanently stunted if malnutrition is not averted at this early age. People living with HIV/AIDS: People living with HIV/AIDS are particularly vulnerable to malnutrition. Opportunistic infections reduce appetite and thus lower food intake, further exacerbating the illness and the progression towards AIDS. Therefore, sensitising and educating people living with HIV/AIDS on the importance of maintaining nutrition is vital. Displaced population groups: Population groups who are displaced due to either natural or man-made calamities are usually at risk of being malnourished. Food insecure households: Food insecure households are vulnerable to overt hidden malnutrition. In these conditions, children and mothers are the most vulnerable groups and should receive special attention. Other population groups: The elderly, prisoners, students in boarding schools, children in orphanages and hospital in-patients, as well as other population groups who are exposed to malnutrition, must receive adequate attention during this action plan implementation. 34 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 © UNICEF/UNI353032/Abdul CHAPTER FOUR ‘UNAP II’ Implementation and Coordination Arrangements The ‘UNAP II’ coordination structure is derived from the Institutional Framework for Coordination (National Coordination Policy, 2016). Figure 8 describes a schematic presentation of the ‘UNAP II’ multi-sectoral coordination framework at the national and sub-national levels. The ‘UNAP II’ remains the strategic frame- work for SUN in Uganda, based on a multi-sectoral approach and multi-stakeholder engagement as clari- fied in the implementation matrix. Line MDAs required to plan and budget for nutrition programming and implementation include OPM, MoH, MAAIF, Ministry of Trade Industry and Cooperatives (MoTIC), MoES, MoWE, MoLG, MoGLSD, MoFPED, National Planning Authority (NPA), UBOS, KCCA, LGs and MoSTI. Implementing actors include development partners, CSOs, those in academia and the private sector. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 35 FIGURE 8 SCHEMATIC PRESENTATION OF ‘UNAP II’ MULTI-SECTORAL COORDINATION FRAMEWORK AT THE NATIONAL AND SUB-NATIONAL LEVELS Policy Coordination Committee on Nutrition (PCCN) Uganda Nutrition Action Plan (UNAP) Implementation Coordination Steering Committee on Nutrition ICSCN) Multi-Sectoral Nutrition Technichal Cordination Committee (MSNTCC) UNAP MDA (MOH, MAAIF, MoLG, MoES, Secrerariat - Office the Prime Minister (OPM SUN Networks (NDPG, CSOs, Academic MoGLSD, MoWE, KCCA, MoSTI, UBOS, NPA, and Research, Food Systems Business) MoFPED) Nutrtion Coordination Committee Ministry of Local Government Regional City/District Nutrition Coordination Committee (RCNCC/DNCC) Local Government Level Municipal Nutrition Coordination Committee (MNCC) Division Nutrition Coordination Committee (DiNCC) Sub-county/Town Council NCC Ward Nutrition Coordination Commitee (WNCC) Parish NCC Effective coordination is a critical component of nutrition improvement as it creates the necessary enabling environment for harmonization, scale-up, mutual accountability and sustainability of nutrition actions. The UNAP coordination framework is at nine levels: v) MDA Nutrition Coordination Committees (NCC) each chaired by respective permanent i) The National Nutrition Forum convened by the secretaries or executive directors in MoH, RT Hon Prime Minister MAAIF and KCCA. ii) Policy Coordination Committee on Nutrition vi) Regional city and district NCCs chaired by the chaired by the Right Honourable Hon Prime City Clerk and Chief Administrative Officer Minister. (CAO), respectively. iii) iImplementation Coordination Steering vii) City division NCC; municipal NCCs and regional Committee on Nutrition chaired by the city division NCCs chaired by town clerks. Permanent Secretary Office the Prime Minister. viii) Municipal division NCCs, sub county/town iv) Multi-Sectoral Nutrition Technical Coordi- council NCCs chaired by Senior Assistant Town nation Committee chaired by the Permanent Clerk and Senior Assistant Secretary. Secretary, Office of the Prime Minister. ix) Chairperson LCII chairs the PMC while the Parish Chief is the focal person. Under Scaling Up Nutrition arrangements, NDPG, CSO, Academia, and Business and Research Networks are at the country level. 36 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

4.1 NATIONAL COORDINATION STRUCTURES AND PLATFORMS The National Nutrition Forum: The National Nutrition Forum (NNF) is the apex tier of engagement on nutrition by all stakeholders. Every two and a half years, the NNF is covenanted by the Right Honourable Prime Minister to take stock of the implementation of the halfway period for the UNAP. The NNF brings together all heads of government departments and agencies, ambassadors, development partners, the private sector, civil society organizations and academia under the chairmanship of the Prime Minister. The NNF event is preceded by a technical review meeting that focuses on reviewing the progress in implementing the ‘Uganda Nutrition Action Plan’. Terms of reference for networks detailing the membership, roles and responsibilities, chair, secretariat, frequency of meetings and manner of call, as well as a functionality assessment tool, have been developed as part of the supporting tools for ‘UNAP II’. The Policy Coordination Committee on Nutrition (PCCN): This is composed of Cabinet Ministers from MoH; MoES; MAAIF; MoGLSD; MoLG; MoWE; MoTIC; MoFPED; MoSTI; KCAA, and Chairpersons of UBOS and NPA. The Rt Hon. Prime Minister chairs the PCCN. The Implementation Coordination Steering Committee on Nutrition (ICSCN): This is composed of Permanent Secretaries from MoH; MoES; MAAIF; MoGLSD; MoLG; MoWE; MoTIC; MoFPED; MoSTI and Executive Directors of KCCA, UBOS and NPA. The ICSCN is chaired by the Permanent Secretary, Office of the Prime Minister. The Multi-Sectoral Nutrition Technical Coordination Committee (MSNTCC): This is composed of focal persons drawn from the UNAP implementing MDA of MoH; MoES; MAAIF; MoGLSD; MoLG; MoWE; MoTIC; MoFPED; MoSTI, and Executive Directors of KCCA, UBOS and NPA. Membership of MSNTCC also includes representatives of the SUN CSO Network, NDPG Network, SUN Business Network and SUN Academia and Research Institute. The MSNTCC is chaired by the Permanent Secretary, Office of the Prime Minister. The MSNTCC is held quarterly to mainly discuss the progress of UNAP quarterly and annual work plan implementation and reports to the ICSCN. Department of Strategic Coordination and Implementation (SCI): This is composed of the secretary to the PCCN, ICSCN and the MSNTCC. The SCI performs the key function of overall policy analysis and day to day coordination for the UNAP on behalf of the Ugandan Government. The role of the SCI as the UNAP Secretariat is to: • prepare reports on operations of the MSTNCC per the existing government of Uganda reporting arrangements/structures. • provide supervision and mentorship in the area of nutrition governance to the MDAs. • support the MDAs to prepare annual nutrition work plans derived from the ‘UNAP II’ five-year implementation matrix to facilitate its implementation at the MDA level. • facilitate the committee to undertake regular support supervision visits to implementation sites for programmes to MDAs. • prepare quarterly progress reports on UNAP implementation and contribute to the ‘UNAP II’ nutrition advocacy agenda, knowledge-sharing and learning events and visits. Ministries Department and Agencies Nutrition Coordination Committee (MDA NCC): This consists of members from the MoH; MoES; MAAIF; MoGLSD; MoLG; MoWE; MoTIC; MoFPED; MoSTI: KCCA, UBOS and NPA. MDA NCC members are drawn from the directorates/departments/divisions/programmes within the MDA to reflect multi-sectoral programming. Nutrition implementing partners supporting relevant ministries are members of the MDA NCC. The MDA NCC is chaired by the Permanent Secretary and Executive Director for KCCA, UBOS and NPA. The committee meetings are held quarterly and report to the MSNTCC through the UNAP Secretariat. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 37 © UNICEF/UNI138663/Nakibuuka Kampala Capital City Authority Nutrition Coordination Committee (KCCA NCC): During the implementation of ‘UNAP I’, Kampala Capital City Authority was left behind in the coordination structures. However, UNAP interventions were being implemented in the city. It is important to note that despite being at the acceptable level of child stunting in 2016, KCCA registered an increase in child stunting from 14 per cent in 2011 to 18 per cent in 2016. In addition, problems of overweight, obesity, poor dietary and lifestyle behaviours are on the increase in Kampala City and its surrounding urban areas. Although KCCA operates as an MDA for which coordination structure is already provided (see organogram), the ‘UNAP II’ coordination structure deliberately provides for KCCA and its five divisions to facilitate and fast track the coordination and implementation of nutrition programming in the KCCA as a matter of urgency. The coordination of UNAP implementation in KCCA is cognizant of the KCCA Act 2010 with its amendments (2019). The KCCA NCC members are drawn from Directorates of Administration and Human Resources Management; Treasury Services; Engineering and Technical Services; Public Health and Environment; Education and Social Services; Legal Affairs; Revenue Collection; Gender, Community Services and Production and Internal Audit. The nutrition committee is chaired by Kampala City Authority Executive Director and reports to MSNTC through the UNAP Secretariat.

4.2 NATIONAL LEVEL SCALING UP NUTRITION (SUN) NETWORKS SUN Development Partners Group (NDPG) Network: Members shall be drawn from development partners involved in financing and supporting nutrition-specific and nutrition-sensitive programmes in Uganda. The Network will meet quarterly and reports to MSNTC through the UNAP Secretariat. SUN Business Network (SBN): Members shall be drawn from registered business associations, corporate bodies, public-sector agencies involved in the food trade, food transportation, food processing and food and nutrition advisory services for nutrition-specific and nutrition-sensitive actions. The SBN meets quarterly and reports to MSNTC through the UNAP Secretariat. SUN Civil Society Organizations (CSO) Network: Members shall be drawn from the entire active member CSOs (including international CSOs) implementing nutrition actions. The CSO Network meets quarterly and reports to MSNTC through the UNAP Secretariat. SUN Academia and Research Institutions Network (ARIN): Members shall be drawn from academic and research institutions working in Uganda that offer Bachelors or advanced degrees in human nutrition, health, food security and other relevant biological sciences in the field of nutrition. All such institutions must be accredited by the National Council of Higher Education, approved by the National Council of Science and Technology or should be registered as non-profit organisations and have ethical clearance from an accredited Ethics Committee or Ethical Review Board. The Network will meet quarterly and reports to MSNTC through the UNAP Secretariat. 38 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

4.3 ROLES OF MDAS IN THE COORDINATION OF THE IMPLEMENTATION OF ‘UNAP II’ The ‘UNAP II’ implementation matrix (see Annexe 2) provides for MDA specific outputs and their respective indicators to facilitate regular monitoring and evaluation (M&E) of MDA progress of ‘UNAP II’ implementation (quarterly, bi-annually and annually). It is expected that individual UNAP-implementing MDAs will quality assure nutrition priority actions within their mandates as detailed in the ‘UNAP II’ implementation matrix. Implementation of enabling environment actions takes place at the following levels: • Policy Coordination Committee. • Implementation Coordination Steering Committee. • Multi-Sectoral Nutrition Technical Coordination Committee. • Kampala City Authority Nutrition Coordination Committee. • MDA Nutrition Coordination Committee. • SUN Networks (NDPG, CSOs, Academia, Business and Research). OPM will mainly provide technical support in the coordination of national-level actions. In contrast, MoLG will particularly support the strengthening of enabling environment actions and implementation at LG levels of Regional City and District NCC; Municipal NCC; Division NCC; Sub-county/Town Council NCC and Parish NCC. Actual delivery of services will take place at household and community levels. The MDA Nutrition Coordination Committees will regularly undertake support supervision to these sub-national structures to strengthen nutrition governance and technical capacity for nutrition programming and subsequently provide updates to the MSNTC through established reporting arrangements. Based on these implementation arrangements, the UNAP-implementing MDAs need to ensure that priority actions in the ‘UNAP II’ are implanted under respective strategies at regional cities, district municipal, division, sub county, town council wards, parish, village and household levels through existing established technical coordination committees. This will mean that technical capacity in nutrition programming at all levels is assured. It is important to note that the Nutrition Coordination Committee roles are specifically for implementing objective three of the ‘UNAP II’, that is, strengthening the enabling environment for scaling up nutrition-specific and nutrition-sensitive interventions. The UNAP established coordination structures are sub-committees of the Technical Planning Committees (TPCs), and it is expected that the technical quality assurance task is at the technical committee level.

4.4 SPECIFIC ROLES OF PARLIAMENT, CABINET AND UNAP- IMPLEMENTING MDAS The Ugandan Parliament is the highest legislative body in Uganda. It is expected that Parliament will debate and enact relevant laws to create an enabling environment for nutrition programming. The parlia- ment will also allocate appropriate resources to UNAP-implementing MDAs and ensure transparent and accountable spending of allocated funds. Engaging Members of Parliament about nutrition is important in ensuring that they champion and effectively legislate nutrition relevant bills for enactment into Acts of Parliament. The Cabinet, as the highest policy-making organ of the Ugandan Government, will, in the context of nutri- tion programming, ensure that nutrition relevant policies and planning frameworks are in place to allow effective implementation of nutrition programmes. The Ministry of Health will provide quality assurance in these strategies: Strategy 1.1: Promote optimal maternal, infant, young child and adolescent nutrition (MIYCAN) practices in stable and emergency situations. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 39 Strategy 1.2: Promote optimal micronutrient intake among children, adolescent girls and women of reproductive age in stable and emergency situations. Strategy 1.3: Increase coverage of the management of acute malnutrition in stable and emergency situations. Strategy 1.4: Integrate nutrition services in the prevention, control and management of infectious diseases and epidemics. Strategy 1.5: Integrate nutrition services in the prevention, control and management of diet-related non-communicable diseases. In addition, through the MDA NCC, MoH will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) will provide quality assurance in these strategies: Strategy 2.1: Increase the production of diverse, safe and nutrient-dense food at the household level from plant, fisheries and animal sources. Strategy 2.2: Increase access to diverse, safe and nutrient-dense food from plant, fisheries and animal sources. Strategy 2.3: Increase the utilization of diverse, safe and nutrient-dense food from plant, fisheries and animal sources. In addition, through the MDA NCC, MAAIF will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.2: Improve the planning, resource mobilization, financing and tracking of nutrition investments. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. The Ministry of Gender, Labour and Social Development (MoGLSD) will provide quality assurance in this strategy: Strategy 2.4: Promote the integration of nutrition services in social protection programmes. In addition, through the MDA NCC, MoGLSD will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.2: Improve the planning, resource mobilization, financing and tracking of nutrition investments. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. 40 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. Ministry of Education and Sports (MoES) will provide quality assurance in this strategy: Strategy 2.5: Promote access to nutrition services through integrated early childhood development (ECD) services and quality education and sports. In addition, through the MDA NCC MoES will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.2: Improve the planning, resource mobilization, financing and tracking of nutrition investments. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. Ministry of Water and the Environment (MoWE) will provide quality assurance in this strategy: Strategy 2.6: Increase access to nutrition-sensitive water, sanitation and hygiene (WASH) services. In addition, through the MDA NCC MoWE will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.2: Improve the planning, resource mobilization, financing and tracking of nutrition investments. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. Ministry of Trade Industry and Cooperatives (MoTIC) will provide quality assurance in this strategy: Strategy 2.7: Increase the participation of trade, industry and investment actors in scaling up nutrition. In addition, through the MDA NCC MoTIC will support these strategies: Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. Strategy 3.5: Strengthen coherent policy, legal and institutional frameworks for nutrition. Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral nutrition information system for effective decision making. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 41

4.5 SUB-NATIONAL LEVEL COORDINATION Coordination of nutrition programming at the sub-national level will be effected through the following government entities: regional cities; district local governments; Kampala City divisions; regional city divi- sions; municipalities; municipality divisions; town councils; sub counties; wards and parishes. The roles and responsibilities of these NCCs are: • advocacy, planning, budgeting, and resource mobilisation • coordination and partnerships • nutrition behaviour change communication and social mobilisation • system capacity building and strengthening of nutrition interventions • policy implementation and dissemination • monitoring, evaluation, accountability and learning about the implementation of the ‘UNAP II’ in the respective entity levels. Terms of reference and a functionality assessment tool for each NCC have been developed as part of ‘UNAP II’. Regional City Nutrition Coordination Committee (RCNCC): RCNCC members shall be drawn from the following departments: Administration, Human Resources, Finance, Planning, Health Services, Production, Works, Natural Resources, Education, Community Based Services and Commercial Services Development. The City Clerk chairs the RCNCC. Of the RCNCC members from the Regional City Departments, the Technical Planning Committee (TPC) assigns/designates a Regional City Nutrition Focal Person (RCNFP). The committee meetings are held quarterly, and the RCNCC reports to the TPC. District Nutrition Coordination Committee (DNCC): DNCC members shall be drawn from the following departments: Administration, Human Resources, Finance, Planning, Health Services, Production, Works, Natural Resources, Education, Community Based Services and Commercial Services Development. The Chief Administrative Officer (CAO) chairs the DNCC. The committee meetings are held quarterly, and the DNCC reports to the TPC. Under the Local Government Act, 1997, with its amendments, district local governments and the regional cities fall under the Ministry of Local Government implementation coordination arrangements. Kampala Capital City Authority District Nutrition Coordination Committee (KCCA-DNCC): KCCA-NDCC m-embers shall be drawn from the following focus areas: Education services, Medical operations, Veterinary services, Revenue collection, Gender, Production and marketing, Physical planning, Law enforcement, Human Resource, Division clerk, Environmental and sanitation. The Town Clerk chairs the KCCA-DNCC. The committee meetings are held quarterly, and KCCA-DNCC reports to the TPC. Municipality Nutrition Coordination Committee (MNCC): MNCC members shall be drawn from the following departments: Administration, Finance and Planning, Human Resource, Works, Environmental Management, Physical Planning, Education, Production Unit, Community-Based Services, Trade, Industry and Local Economic Development and Public Health. The Town Clerk chairs the MNCC. The committee meetings are held quarterly, and the MNCC reports to the TPC. Municipal Division Nutrition Coordination Committee (MDNCC): MDNCC members are drawn from the following departments: Administration, Finance, Health, Production, and Community-Based Services like Senior Assistant Town Clerk, Assistant Town Clerk, Treasurer, Community Development Officer, Principal Town Agent, Assistant Treasurer and Law Enforcement Officer. The Senior Assistant Town Clerk chairs the MDNCC. 42 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Town Council Nutrition Coordination Committee (TNCC): TNCC members are drawn from the following departments: Administration, Finance and Planning, Works, Production Unit, Community-Based Services, Trade, Industry, Local Economic Development and Public Health. The Principal Township Officer (who is head of the Town Council) chairs the TNCC. The committee meetings are held quarterly, and the TNCC reports to the TPC. Sub county Nutrition Coordination Committee (SNCC): SNCC members are drawn from the following departments: Administration (including parish chiefs), Finance, Health, Production, Community-Based Services. In addition, the Health Centre III In-charge and the Health Assistant should be included as SNCC members. The Senior Assistant Secretary/Sub-county Chief chairs the SNCC. The committee meetings are held quarterly, and the SNCC reports to the TPC. Parish/Ward Nutrition Coordination Committee (P/WNCC): Members of the Parish Development Committee established as per the MoLG Parish Development Committee (PDC) Guidelines (2020) will constitute the Parish Nutrition Coordination Committee. The PDC (which at the same time will work as the PNCC) is composed as follows: LCII Chairperson; Parish Chief; Members of the parish executives holding the following portfolios; Sec. Production, Sec. Information, Sec. Prodn & Env, Representatives of the special interest group in the executive (Youth, PWD, Women); CSOs, NGOs, CBOs; Opinion Leaders (Male and Female) such as retired civil servants; Business/Private Sector Representatives and Chairpersons LC1 in the Parish. PDCs will be strengthened to effectively oversee planning, implementation and monitoring of nutrition actions at the Parish level. ‘UNAP II’ will support actions aimed at re-activating dormant PDCs and establishment in areas where they are non-existent. The Parish Chief/Ward Administrator/Town Agent chairs the P/WNCC. The committee meetings are held quarterly, and the P/WNCC reports to the TPC. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 43 CHAPTER FIVE Financing and Resource Mobilization

5.1 ESTIMATED FINANCIAL REQUIREMENTS FOR IMPLEMENTING ‘UNAP II’ The total indicative financial resource requirement is UGX 3,287.315 billion (UGX 3.28 trillion) for the entire period of five years, distributed as follows: Nutrition-specific interventions: 33% Nutrition- UGX 1,721.08 billion sensitive Nutrition-sensitive interventions: 52% Nutrition- UGX 1,072.4904 billion specific Enabling environment interventions: UGX 493.745 billion 15% Enabling environment The ‘UNAP II’ Theory of Change recognizes the need for adequate financial resources as a key prerequisite for successfully implementing priority actions and achieving the ‘UNAP II’ goal. ‘UNAP II’ strategies and priority actions are spread across government ministries departments and agencies, namely, OPM, MoH; MoES; MAAIF; MoGLSD; MoLG; MoWE; MoTIC; MoFPED; MoSTI, KCCA, UBOS and NPA. This implies that each of the MDAs together with stakeholders supporting them, have a role in financing ‘UNAP II’. The table below summarizes the estimated cost of implementing the 18 ‘UNAP II’ strategies and achieving results over the 2020-2025 period (see Table 2). 44 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 TABLE 2 SUMMARY OF ‘UNAP II’ FIVE-YEAR INDICATIVE COSTS BY OBJECTIVE AND STRATEGY OBJECTIVE 1 To increase access to and utilization of nutrition-specific services by children under five years of age, school-age children, adolescents, pregnant and lactating women and other vulnerable groups. SN STRATEGY INDICATIVE COST LEAD PARTNERSHIPS (UGX BILLIONS) MDA 1 Strategy 1.1: Promote optimal maternal, infant, 1,586.71 MoH MAAIF, MoSTI young child and adolescent nutrition (MIYCAN) MoTIC, practices in stable and emergency situations. development partners (DPs), CSOs 2 Strategy 1.2: Promote optimal micronutrient intake 21.4 MoH MAAIF, MoSTI among children, adolescent girls and women MoTIC, DPs, of reproductive age in stable and emergency CSOs situations. 3 Strategy 1.3: Increase coverage of the management 106.47 MoH MoSTI, DPs, of acute malnutrition in stable and emergency CSOs, private situations. sector 4 Strategy 1.4: Integrate nutrition services in the - MoH MoWE, DPs, prevention, control and management of infectious CSOs, private diseases and epidemics. sector 5 Strategy 1.5: Integrate nutrition services in the 6.5 MoH MAAIF, MoTIC, prevention, control and management of diet-related DPs, CSOs, non-communicable diseases. private sector SUBTOTAL FOR OBJECTIVE 1 1,721.08 OBJECTIVE 2 To increase access to and utilization of nutrition-sensitive services by children under five years, school-age children, adolescents, pregnant and lactating women and other vulnerable groups. SN STRATEGY INDICATIVE COST LEAD PARTNERSHIPS (UGX BILLIONS) MDA 6 Strategy 2.1: Increase the production of diverse, 482.0664 MAAIF MoWE, MoSTI, safe and nutrient-dense food at the household level DPs, CSOs, from plant, fisheries and animal sources. private sector 7 Strategy 2.2: Increase access to diverse, safe and 115.8 MAAIF MoTIC, MoSTI, nutrient-dense food from plant, fisheries and animal DPs, CSOs, sources. private sector 8 Strategy 2.3: Increase the utilization of diverse, safe 111.889 MAAIF MoH, MoSTI DPs, and nutrient-dense food from plant, fisheries and CSOs, private animal sources. sector 9 Strategy 2.4: Promote the integration of nutrition 220.55 MoGLSD MoH, MoFPED, services in social protection programmes. DPs, CSOs 10 Strategy 2.5: Promote access to nutrition services 47.51 MoES, MoH, MAAIF, through integrated early childhood development MoGLSD DPs, CSOs (ECD) services and quality education and sports. 11 Strategy 2.6: Increase access to nutrition-sensitive 76.2 MoWE MoH, DPs, CSOs, water, sanitation and hygiene (WASH) services. private sector 12 Strategy 2.7: Increase the participation of trade, 18.475 MoTIC MAAIF, MoH, industry and investment actors in scaling up MoFPED DPs, nutrition. CSOs, private sector SUBTOTAL FOR OBJECTIVE 2 1,072.4904 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 45 OBJECTIVE 3 To strengthen the enabling environment for scaling up nutrition-specific and nutrition-sensitive services. SN STRATEGY INDICATIVE COST LEAD PARTNERSHIPS (UGX BILLIONS) MDA 13 Strategy 3.1: Strengthen nutrition coordination and 24.462 All UNAP All line ministries, partnerships at all levels. MDAs DPs, CSOs 14 Strategy 3.2: Improve the planning, resource 36.823 All UNAP All line ministries, mobilization, financing and tracking of nutrition MDAs DPs, CSOs, investments. private sector 15 Strategy 3.3: Strengthen institutional and technical 44.69 All UNAP All line ministries, capacity for scaling up nutrition actions. MDAs DPs, CSOs, private sector 16 Strategy 3.4: Strengthen nutrition advocacy, 183.51 All UNAP All line ministries, communication and social mobilization for nutrition. MDAs DPs, CSOs, private sector 17 Strategy 3.5: Strengthen coherent policy, legal and 59.68 All UNAP All line ministries, institutional frameworks for nutrition. MDAs DPs, CSOs, private sector 18 Strategy 3.6: Strengthen and institutionalize 144.58 All UNAP All line ministries, nutrition evidence and knowledge management MDAs DPs, CSOs along with a multi-sectoral nutrition information system for effective decision making. SUBTOTAL FOR OBJECTIVE 3 493.745 GRAND TOTAL 3,287.315 The Uganda central and local governments, with support from development partners, civil society organi- zations, the private sector, academia and research institutions and other stakeholders supporting nutrition in Uganda, will finance ‘UNAP II’. Effective coordination, clarity of accountabilities, capacity to complement and leverage resources is vital in ensuring that ‘UNAP II’ is adequately financed. The ‘UNAP II’ implemen- tation matrix in Annexe 2 defines sector/ministry priority actions, outputs and performance indicators. The matrix is helpful in the process of estimating financial requirements to implement ‘UNAP II’. It is important to note that the estimated figures summarized in Table 2 are only indicative of the resource requirements to implement ‘UNAP II’. Also, most capital project costs already indicated in the various ‘NDP III’ PIAPs relevant to ‘UNAP II’ have been excluded in the indicative cost of ‘UNAP II’, but the activities under such costs have been maintained. Implementation of such activities, especially in the Ministry of Water and Environment, contribute to improved nutrition outcomes. © UNICEF/UN0364207/Adriko 46 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

5.2 GENERATION OF INDICATIVE COSTS FOR ‘UNAP II’ The indicative figures in Table 2 were arrived at based on existing budget provisions and extrapolated over the implementation period and the nutrition expenditure review. They will guide the costing of work plans for each of the strategies. The projected resources for ‘UNAP II’ include resources already available in the ‘NDP III’ PIAPs Mid-Term Expenditure Framework (MTEF) for line MDAs and ongoing projects and programmes. Implementation will be mainstreamed in relevant UNAP MDA work plans and budgets gener- ated from the ‘NDP III’ Programme PIAPs for Agro-Industrialization, Human Capital Development, Commu- nity Mobilization and Mindset Change. ‘UNAP II’ strategies and priority actions fall into three categories from the cost estimation lens: i) Nutrition actions that already have an indicative figure provided under the ‘NDP III’ PIAPs or MDA work plans. ii) Existing nutrition actions of capital nature such as water and sanitation infrastructure costs under MoWE; infrastructure costs under MAAIF and MoTIC such as agro-processing industries construction; activities already at MDA level which are aggregated in nature, such as disease prevention costs under MoH that contribute to nutrition outcomes, without necessarily being included in the ‘UNAP II’ cost estimate iii) New nutrition-specific, nutrition-sensitive and enabling environment actions that have not been costed given any cost in the existing government and non-Government plans and yet are a priority in realised of the desired ‘UNAP II’ targets. Categorization of strategies and priority actions (as indicated above) helped conduct a targeted review of existing information sources and generate indicative costs. The following data sources were used to come up with ‘UNAP II’ cost estimates: • ‘NDP III’ Programme Implementation Action Plans for (1) Agro-industrialization (2) Human Capital Development and (3) Community Mobilization and Mindset Change guided the generation of indicative costs for strategies 2.4 to 2.7. • MIYCAN Action Plan 2020-2025 by MoH guided the generation of indicative cost for strategies 1.1 and 1.2. • Integrated Management of Acute Malnutrition by MoH guided the indicative figure for strategy 1.3. • Mainstream MoH budgets related to its core functions of disease prevention and control guided the generation of indicative costs for strategy 1.4. • MAAIF Strategic Plan for 2020/21-2024/25 guided the generation of indicative costs for strategy 2.1 to 2.3. • Uganda Multi-Sectoral Food Security and Nutrition Project Document provided additional indicative costs for strategy 2.1. Note: Accurate projections require comprehensive nutrition expenditure review and activity-based costing. In addition to the ongoing nutrition expenditure review, the development of investment case for detailed nutrition costing and consequent development of nutrition resource mobilization and tracking plan has been identified as a priority activity in the ‘UNAP II’ implementation roadmap.

5.3 RESOURCE MOBILIZATION Developing a plan for resource mobilization and tracking has been included as a critical activity in the ‘UNAP II’ implementation roadmap. The estimated costs of implementing ‘UNAP II’ actions and the ongoing nutri- tion expenditure review will provide crucial information for the development of ‘UNAP II’ resource mobiliza- tion and tracking plan. The plan will ensure systematic and sustained financing of nutrition actions. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 47 © UNICEF/UN0368341/Emorut CHAPTER SIX Monitoring, Evaluation, Accountability and Learning (MEAL)

6.1 OVERVIEW OF THE ‘UNAP II’ MEAL FRAMEWORK ‘UNAP II’ recognizes the importance of tracking and evaluating the performance of various targets. In addi- tion to tracking programme implementation and performance, ‘UNAP II’ will also track resources and build an evidence base for timely decision making, accountability and learning both at the national and sub-national level. The MEAL framework is also helpful in aligning stakeholders’ commitments, enhancing evidence- based policy dialogue and retaining institutional memory. The ‘UNAP II’ MEAL framework is aligned with the ‘NDP III’ monitoring and evaluation framework, ‘NDP III’ PIAPs, SDGs, World Health Assembly targets and the SUN MEAL framework. The ‘UNAP II’ MEAL framework will be implemented through the MEAL plan. The framework captures the indicators to be monitored at impact and implementation levels as drawn from existing frameworks. The ‘UNAP II’ MEAL framework has been developed to focus on primary and intermediate outcomes while the outputs and their indicators are entailed in the implementation matrix (see Annexe 2). 48 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

6.2 PRIMARY AND INTERMEDIATE OUTCOMES OF THE ‘UNAP II’ The expected primary targets on the reduced prevalence of undernutrition are: Reduced prevalence Reduced prevalence Reduced prevalence Reduced prevalence Reduced prevalence of of stunting in children of low birth weight of wasting in children of anaemia in children anaemia in women of aged 0-5 years from (<2500 g) from aged 0-5 years from aged 0-5 years from reproductive age from 29% to 19% 10% to 7% 4% to 3% 53% to 35% 32% to 20% The expected primary targets on the reduced prevalence of overweight, obesity and diet-related non-communicable disease are: Reduced prevalence of Reduced proportion of Reduced proportion of Reduced proportion of Reduced proportion overweight in children overweight adult women overweight adult men obesity in adult women of obesity in adult men aged 0-5 years from aged 18+ years from aged 18+ years from aged 18+ years from aged 18+ years from 4% to 3% 16.5% to 12.5% 7.7% to 3.7% 7.2% to 5.2% 1.2% to 0.4% Reduced proportion Proportion of obesity Reduced age-standardized prevalence Reduced age-standardized prev- of overweight in in adolescent girls of raised blood glucose/diabetes alence of raised blood pressure adolescents from maintained at among persons aged 18+ years from among persons aged 18+ years from 10% to 6% 1% 3.3% to 2.1% 24% to 20% The nutrition-specific intermediate outcomes are: Outcome 1.1: Improved maternal, infant, young child and adolescent nutrition (MIYCAN) practices in stable and emergency situations. Outcome 1.2: Optimal uptake of micronutrients of concern among children, adolescent girls and women of reproductive age in stable and emergency situations. Outcome 1.3: Increased coverage of the management of acute malnutrition in stable and emergency situations. Outcome 1.4: Nutrition services fully integrated in the prevention, control and management of infectious diseases and epidemics. Outcome 1.5: Nutrition services fully integrated in the prevention, control and management of diet-related non-communicable diseases. The nutrition-sensitive intermediate outcomes are: Outcome 2.1: Increased production of diverse, safe and nutrient-dense food at the household level from plant, fisheries and animal sources. Outcome 2.2: Increased access to diverse, safe and nutrient-dense food from plant, fisheries and animal sources. Outcome 2.3: Improved utilization of diverse, safe and nutrient-dense food from plant, fisheries and animal sources. Outcome 2.4: Increased access to nutrition-sensitive services in social protection programmes. Outcome 2.5: Increased access to nutrition services through integrated early childhood development (IECD) services and quality education and sports Outcome 2.6: Increased access to nutrition-sensitive water, sanitation and hygiene (WASH) services. Outcome 2.7: Increased participation of trade, industry and investment actors in scaling up nutrition. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 49 The enabling environment intermediate outcomes are: Outcome 3.1: Strengthened nutrition coordination and partnerships at all levels. Outcome 3.2: Improved planning, resource mobilization, financing and tracking of nutrition investments. Outcome 3.3: Strengthened institutional and technical capacity for scaling up nutrition actions. Outcome 3.4: Strengthened nutrition advocacy, communication and social mobilization for nutrition. Outcome 3.5: Coherent policy, legal and institutional frameworks for nutrition. Outcome 3.6: Improved nutrition evidence and knowledge management along with multi-sectoral nutrition information system for effective decision making:

6.3 ‘UNAP II’ MEAL ARRANGEMENTS In collaboration with line ministries and relevant stakeholders, OPM will monitor and evaluate progress towards achievement of ‘UNAP II’ outcomes at output, objective and goal levels using the set indicators as detailed in the implementation matrix and MEAL framework (Annexe 2 and 3, respectively). In addition to routine monitoring, a systematic mid-term review and summative evaluation will be conducted. Uganda National Planning Survey (UNPS), Health Management Information System (HMIS), Agricultural Market Information System (AMIS) and other existing systems will be used to collect routine data. It will be collated in the national nutrition information platform/database to facilitate ‘UNAP II’ implementation monitoring. Quarterly and annual monitoring, reporting and reviews ‘UNAP II’ implementation matrix in Annexe 2 will guide quarterly work planning, budgeting, implemen- tation and reporting in each MDA through output indicators provided. The work plans will detail planned activities under each priority action, expected outputs, output indicator, annual target, timeframe, activity location and activity cost per strategy. It is important to note that the outputs provided in the implementa- tion matrix are for priority actions at the strategic level. Therefore, lower level outputs may be included in the annual work plans related to the activity implementation under the respective priority action. From the annual work plan, quarterly and annual reports will be generated to track ‘UNAP II’ implementa- tion on a more regular basis. Quarterly reports will act as a key source of information for the annual nutrition review in each MDA. The annual reports will provide information on the following topics: achievement of relevant intermediate outcomes, achievement of commitments in line with nutrition scorecard, variance and remedial measures, lessons learned, risks analysis and mitigation measures, among others. Mid-term review and summative evaluation The mid-term review will assess progress and changes in the nutrition context and recommend amenable revisions to strategic objectives and priority actions in response to the changing context. End-term eval- uation criteria will highlight the impact, effectiveness, efficiency, sustainability and relevance of nutrition actions and cross-cutting issues. SUN joint annual assessments, panel surveys, DHS surveys, nutrition surveys, sectoral administrative assessments, thematic research and other assessments will provide addi- tional information.

6.4 LEARNING ‘UNAP II’ will encourage continuous improvement of processes and outcomes through learning. This will involve evidence-based contextual assessment and analysis of successes, challenges, and opportunities to pinpoint aspects that influence the achievement of results. Plans will be put in place to ensure systematic formal and informal learning, experience sharing and reflection involving all stakeholders. The MEAL plan will put in place systems for continuous documentation and dissemination of lessons learnt. 50 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25

6.5 RISKS AND MITIGATION MEASURES ‘UNAP II’ will strive to identify and manage risks that may affect smooth implementation and achievement of results. The aim is to maximize opportunities and reduce threats to the achievement of ‘UNAP II’ objec- tives. This involves identifying and analysing risks through the systematic use of available information to determine the likelihood of specified events. It also determines the magnitude and consequences of risks and prioritizes risks from the most critical to least critical. Risk mitigation consists of coming up with strat- egies to reduce the likelihood that a risk event will occur and reducing the effect of a risk event if it does occur. Various risks are anticipated during the course of ‘UNAP II’ implementation. Therefore, it is vital to prioritize risks based on the likelihood of occurrence and impact using the risk prioritization matrix below (see Table 3). TABLE 3 RISK PRIORITIZATION MATRIX LIKELIHOOD OF OCCURRENCE CONSEQUENCE/IMPACT High Medium Low High 5 4 3 Medium 4 3 2 Low 3 2 1 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 51 TABLE 4 RISK IDENTIFICATION, PRIORITIZATION AND MITIGATION PLAN FOR ‘UNAP II’ IDENTIFIED RISK EVENT RISK CONSEQUENCE LIKELIHOOD OF RISK IMPACT / RISK MITIGATION STRATEGY RESPONSIBILITY OCCURRENCE CONSEQUENCE Limited integration of nutrition into Low coverage of Medium High • Continuously monitor and report on integration • OPM • Line ministries ongoing health, agriculture, education, nutrition programmes and implementation convergence for nutrition • LLGs • NDPGs social protection WASH, trade and leading to low actions • Implementing partners industry and other programmes performance • Ensure effective nutrition multi-sectoral nutrition coordination and linkage Inadequate institutional and technical Poor performance in Medium High • Conduct capacity assessment and use findings • OPM • Line ministries capacity to implement, monitor and meeting ‘UNAP II’ to develop and implement capacity development • NDPGs evaluate ‘UNAP II’ objectives framework for ‘UNAP II’ • Implementing partners Inadequate funding of ‘UNAP II’ Slow down or halt in High High • Develop and implement a robust resource • OPM • MoFPED activities implementation nutrition mobilisation and tracking plan for nutrition • LLGs • NDPGs actions • Champion integration of nutrition to relevant • Line ministries ongoing sector programmes • Implementing partners Low enforcement of relevant nutrition Limited compliance High High • Include monitoring of enforcement and • OPM regulations (e.g. mandatory food leading to missed compliance as part of the M&E framework • Line ministries fortification, food safety, marketing opportunities in of breast milk substitutes, maternity improving nutrition protection) Occurrence of natural disasters, e.g. Disruption of service Medium High • Develop contingency plans and integrate early • OPM • Line ministries floods, drought, landslides, earthquakes delivery and limited warning and action monitoring in the M&E • LLGs • NDPGs and disease outbreaks such as Ebola access by populations system • Implementing partners Fading of the current political will and Inadequate funding and Low Medium • Ensure sustained engagement of political • OPM • Line ministries Government commitment to address support to effectively leaders and key stakeholders • Line ministries malnutrition implement ‘UNAP II’ • Use nutrition commitments scorecard to • LLGs • NDPGs monitor commitments and advocate for • Implementing partners sustained support The continued influx of refugees Pressure on current High High • Collaborate with other sectors in monitoring the • OPM • Line ministries nutrition interventions situation and developing contingency plans • LLGs • NDPGs and programmes • Explore other mechanisms such as reserve • Implementing partners funds which can be activated in case of emergencies COVID-19 The coronavirus High High • To improve nutrition, the Ugandan Government • OPM • Line ministries pandemic has brought will aggressively implement programmes to • LLGs • NDPGs to the forefront the need ensure adequate sensitization and awareness • Implementing partners to ensure adequate food of all Ugandans on the benefits out of good security and nutrition nutrition for their health and wellbeing UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 52 53 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Annexes Annexe 1: Evolution of global and African nutrition commitments and initiatives ...... 54 Annexe 2: ‘UNAP II’ implementation matrix 2020/21-2024/2025..................................... 56 Annexe 3: ‘UNAP II’ MEAL framework 2020/21-2024/25 aligned with ‘NDP III’, SDGs and SUN MEALframeworks ................................................................. 75 Annexe 4: ‘UNAP II’ rollout and implementation road map 2020/21-2024/2025............ 82 Annexe 5: Information on outstanding ‘UNAP II’ implementation components........... 84 Annexe 1 EVOLUTION OF GLOBAL AND AFRICAN NUTRITION COMMITMENTS AND INITIATIVES Annexe 1.1: Global commitments and initiatives Lancet Series on Maternal Child and Nutrition 2008 Committee for World Food Security and Nutrition (later updated in 2013) (CFS, 2013); which incorporated the United National System Standing Committee on Nutrition Scaling up Nutrition (SUN) Movement launched (UNSCN) in 2010 Launch of the Global Panel on Agriculture and Food 1,000 Days Initiative (2010), which promotes Systems for Nutrition (GLOPAN) (2013) targeting effective actions and investments to improve nutrition in the first 1,000 days of life Global Nutrition Reports; the first one was launched (from a woman’s pregnancy through her child’s in 2014, and they are produced annually. They second birthday) track commitments and progress, actions and accountability at the global and national level United Nations General Assembly on Non-Communicable Diseases (2011) Second International Conference on Nutrition (2015) Rome Declaration and Framework for Nutrition; New Alliance for Food Security and Nutrition for underlined the need to address the impact of sustained agriculture-led growth in Africa and climate change and other environmental factors Asia launched in G8 Summit (2012) on food security and nutrition World Health Assembly Resolution (2012); Sustainable Development Goals (2015); these include 65.6 endorsed the WHO Comprehensive 17 goals and 169 targets of which SDG 2 focuses Implementation Plan for maternal, infant on ending hunger, achieving food security and and young child nutrition and outlined global improved nutrition nutrition targets for 2025 UN Decade of Action on Nutrition (2016-2025); follow Nutrition for Growth Summit (2013); which up of the second International Conference on capitalized on the political engagement during Nutrition (ICN 2) and a powerful tool for achieving the London Summer Olympics the WHA and NCD targets it serves as a major driving force for achieving the SDGs As per Annexe 1.2 below, more recent initiatives offer a significant opportunity for Uganda to demonstrate nutrition leadership in the region by aligning its priorities with these plans. These include the African Devel- opment Bank’s (AFDB) Africa Leaders for Nutrition (ALN) initiative, AFDB Multi-Sectoral Nutrition Action Plan, East Africa Community Food and Nutrition Security Strategy and Action Plan (2018).

Annexe 1.2: Evolution of regional (African) nutrition declarations, commitments and initiatives4 African Union (AU) Agenda, 2063 This is a strategic Maputo Declaration, 2003 This contains a framework for the socio-economic transformation commitment to allocating at least 10 per cent of of the African continent over the next 50 years. national budgetary resources to agriculture and It builds on and seeks to accelerate past and rural development policy implementation within existing continental initiatives for growth and five years. sustainable development. It prioritizes the goal of healthy and well-nourished citizens with Grow Africa Initiative (AU & NEPAD), 2011 It works the strategy of reducing maternal and child to increase private sector investment in malnutrition. agriculture and accelerate the execution 4 Adapted from the ‘East African Food and Nutrition Security Strategy 2018-2022’ 54 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 and impact of investment commitments. Uganda’s Civil Society for Nutrition Network was Opportunities to integrate nutrition into not involved at the time; however, through ‘UNAP agricultural initiatives through this initiative are II’, there will be greater emphasis on civil society abounding. engagement. Malabo Declaration, 2014 This aims to transform African Leaders for Nutrition Initiative (ALN), 2018 Africa’s agriculture for shared prosperity and The ALN initiative was endorsed by the Assembly improved livelihoods through harnessing of Heads of State and Governments of the African opportunities for inclusive growth and sustainable Union (AU) at the 30th ordinary AU Summit, held development opportunities. in Addis Ababa, Ethiopia, on 31 January 2018. It is led by the President of the African Development Malabo Declaration on Nutrition, 2015 It includes a Bank and Global Panel on Agriculture and commitment to increased investment in nutrition Food Systems for Nutrition, Panel Member Dr to end all forms of malnutrition as articulated in Akinwunmi Adesina. ALN launched a ‘Continental the SDGs. Nutrition Accountability Scorecard’ in 2019 to support greater advocacy and accountability Africa Regional Nutrition Strategy (ARNS), 2015-2025 for nutrition investments in Africa. ARNS 2015-2025 is the extension of the ARNS 2005-2015. It is an update of the nutrition African Development Bank’s Multi-sectoral Nutrition situation in Africa based on lessons learnt during Action Plan, 2018-2025 The Action Plan aims to the implementation of the ARNS 2005-2015. catalyze nutrition-smart investments to support a It outlines the specific role of the AU in the 40 per cent stunting reduction in Africa by 2025. elimination of hunger and malnutrition. It is based on the AU 2014-2017 Strategic Plan and reflects East Africa Community (EAC) Food and Nutrition the recently initiated AU Agenda 2063, which Security Strategy (FNSS), 2018-2022 articulates the continent’s longer-term vision. This is hinged on the EAC Food and Nutrition Security Policy goal, which is ‘to attain food FAO Regional Initiative (RI) on Africa’s Commitment and nutrition security for all the people of East to End Hunger by 2025 This was established in 2014 African Community throughout their life cycle, for as a response to the UN Secretary General’s their health and social and economic wellbeing.’ Zero Hunger Challenge. It assists countries, and The EAC FNSS and FNSP aim to provide a regional economic communities, strengthen their unified approach to implementing, coordinating, systems and capacities to deliver programmes and monitoring the food and nutrition security that contribute to eradicating hunger and programs at the national and regional levels. A malnutrition. clear objective on nutrition has been included to improve access and utilization of nutritious, East and Southern Africa Regional Civil diverse and safe food by 2022. Society Nutrition Network, 2017 In June 2017, representatives of nine Civil Society Alliances EAC Food and Nutrition Security Action Plan (FNSP), (CSAs) on nutrition in East and Southern 2018-2023 Africa, namely Kenya, Madagascar, Malawi, Eastern African Parliamentary Alliance for Food Mozambique, Rwanda, South Sudan, Tanzania, Security and Nutrition (EAPA FSN), 2019 Zimbabwe and Zambia, resolved to establish During their First Annual Meeting from 15 to 17 this network. It exists to strengthen coordination April 2019 in Arusha, Tanzania, members of the for joint advocacy by the national CSAs, support newly-formed ‘Eastern African Parliamentary regional advocacy and help meet the critical Alliance for Food Security and Nutrition (EAPA need for media engagement and communication FSN)’ committed to leveraging their critical role as support to position nutrition as a crucial legislators to promote the right to food. development issue in the region. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 55

Annexe 2 ‘UNAP II’ IMPLEMENTATION MATRIX 2020/21-2024/2025 The implementation matrix details the priority actions, outputs, output indicators, estimated cost, the lead MDA and the relevant ‘NDP III’ (2020/21-2024/25) PIAP alignment. From this matrix, each implementing entity, for example, MDA and local governments, will develop annual work plans implanted with activities to deliver the expected outputs. ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT OBJECTIVE 3 To increase access to and utilization of nutrition-specific services by children under five years of age, school-age children, adolescents, pregnant and lactating women and other vulnerable groups Strategy 1.1: Promote optimal maternal, infant, young child and adolescent nutrition (MIYCAN) practices in stable and 1,586.71 MoH Human Capital emergency situations. Development Programme (HCDP) Objective 1 Outcome 1.1: Improved maternal, infant, young child and adolescent nutrition (MIYCAN) practices in stable and emergency situations. Promote exclusive breastfeeding for Baby-friendly initiatives in health facilities, Proportion of health facilities certified 706.44 MoH HCDP Objective 1; infants aged 0-5 months communities and workplaces scaled up as baby-friendly Intervention 1.2 Number of exclusive breastfeeding MoH HCDP Objective 1; promotion activities Intervention 1.2 Increased number of breastfeeding Percentage of workplaces with MoH HCDP Objective 1; corners in public and private institutions breastfeeding corners Intervention 1.2 and workplaces established Increased number of commercial Percentage of commercial outlets and MoH HCDP Objective 1; outlets and health facilities monitored health facilities monitored conforming Intervention 1.2 conforming to the code of marketing to the code of marketing Increased number of breastfeeding Proportion of breastfeeding mothers MoH HCDP Objective 1; mothers sensitized on optimal sensitized on exclusive breastfeeding Intervention 1.2 breastfeeding and complementary practices by peer mothers feeding practices by peer mothers Promote complementary feeding for Peer mothers trained to mobilize Proportion of peer mothers trained to 880.27 MoH HCDP Objective 1; children aged 6-23 months and sensitize breastfeeding mothers mobilize and sensitize breastfeeding Intervention 1.2 to adopt optimal breastfeeding and mothers on optimal breastfeeding and complementary feeding practices complementary feeding practices UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 56 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Promote and support growth Increased number of children aged 0-5 Proportion of children aged 0-5 years MoH HCDP Objective 1; promotion and monitoring services at years reached with growth promotion reached with GMP services at health Intervention 1.2 health facilities and in communities and monitoring services at health facilities facilities and community Proportion of children aged 0-5 years MoH HCDP Objective 1; reached with GMP services at the Intervention 1.2 community level Strategy 1.2: Promote optimal micronutrient intake among children, adolescent girls and women of reproductive age in 21.4 MoH HCDP Objective 1; stable and emergency situations. Intervention 1.2 Outcome 1.2: Optimal uptake of micronutrients of concern among children, adolescent girls and women of reproductive age in stable and emergency situations. Provide routine vitamin A Increased number of children under five vitamin A second dose coverage for 11.4 MoH HCDP Objective 1; supplementation to children aged 0-5 years receiving vitamin A second dose children under five years (percentage) Intervention 1.2 years during integrated child health days Educate and provide for all pregnant Increased number of pregnant women Percentage of pregnant women 10.0 MoH HCDP Objective 1; women attending antenatal receiving iron and folate supplement receiving iron and folate supplement Intervention 1.2 care to uptake iron and folate supplementation Strategy 1.3: Increase coverage of the management of acute malnutrition in stable and emergency situations. 106.470 MoH HCDP Objective 4 Outcome 1.3: Increased coverage of the management of acute malnutrition in stable and emergency situations. Integrate routine screening and Availability and supply of essential Supply documents indicating 106.470 MoH HCDP Objective 4; timely management of severe and nutrition commodities and logistics for availability and supply of essential Intervention 4.1 moderate acute malnutrition into the management of acute malnutrition nutrition commodities and logistics for routine health and health services streamlined the management of acute malnutrition in refugee settlements, host Nutrition assessment, counselling and Proportion individuals (per age MoH HCDP Objective 4; communities and other areas support at health faculty and community category) accessing nutrition Intervention 4.1 levels scaled up assessment and screening services Referral systems for the management of Percentage of individuals identified MoH HCDP Objective 4; acute malnutrition strengthen with malnutrition and referred for Intervention 4.1 treatment Increased number of health facilities Proportion of facilities providing IMAM MoH HCDP Objective 4; providing IMAM services services Intervention 4.1 Increased number of malnourished Percentage of malnourished individuals MoH HCDP Objective 4; individuals receiving IMAM services receiving IMAM services Intervention 4.1 Increased number of malnourished Proportion of malnourished clients MoH HCDP Objective 4; clients linked to support services at the linked to support services at the Intervention 4.1 community level community level UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 57 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 1.4: Integrate nutrition services in the prevention, control and management of infectious diseases and epidemics. Part of MoH MoH HCDP Objective 4 budgets Outcome 1.4: Nutrition services fully integrated in the prevention, control and management of infectious diseases and epidemics. Increase access to immunization Communities mobilized to increase Proportion of villages mobilized to Part of MoH MoH HCDP Objective 4; against childhood diseases uptake for child immunization services increase uptake for child immunization budgets Intervention 4.1 services Increased number of 1-year-old children Proportion of 1-year-old children who Part of MoH MoH HCDP Objective 4; who have received the appropriate doses have received the appropriate doses budgets Intervention 4.1 of the recommended vaccines of the recommended vaccines in the national schedule Promote de-worming medications Increased number of children above 1-4 Proportion of children aged 1-4 years Part of MoH MoH HCDP Objective 4; targeting children above 1-14 years years receiving at least two doses of receiving two doses of deworming budgets Intervention 4.1 receiving at least two doses per year deworming medication per year medication per year Increased number of children aged 5- 14 Proportion of children aged 5-14 years Part of MoH MoH HCDP Objective 4; years receiving two doses of deworming receiving two doses of deworming budgets Intervention 4.1 medication per year medication per year Reduce the burden of communicable Strengthened community-based Percentage of the population with Part of MoH MoH HCDP Objective 4; diseases, focusing on high burden behavioural change actions to harness knowledge, utilize and practice correct budgets Intervention 4.1 diseases (malaria and diarrhoea) and sustain positive malaria practices malaria prevention, control and related to malnutrition through the among children aged 0-5 years, pregnant management measures primary health care approach and lactating women Percentage of primary health care Part of MoH MoH HCDP Objective 4; programmes integrating nutrition budgets Intervention 4.1 actions Strengthened community-based Percentage of the population with Part of MoH MoH HCDP Objective 4; behavioural change actions to harness knowledge, utilize and practice correct budgets Intervention 4.1 and sustain positive diarrhoea practices diarrhoea prevention, control and among children aged 0-5 years management measures for children aged 0-5 years UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 58 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 1.5: Integrate nutrition services in the prevention, control and management of diet-related non-communicable 6.5 MoH HCDP Objective 4. diseases. Part of MoH NCD activities Outcome 1.5: Nutrition services fully integrated in the prevention, control and management of diet-related non-communicable diseases. Have a national physical exercise day National physical exercise day held National physical exercise day in place Part of MoH NCD MoH HCDP Objective 4; activities Intervention 4.12 Conduct sensitization of employers Employers and workers sensitized on Number of workplaces with physical Part of MoH NCD MoH HCDP Objective 4; and workers on workplace physical workplace physical activities exercise initiatives activities Intervention 4.12 activities for staff Physical fitness increased Part of MoH NCD MoH HCDP Objective 4; activities Intervention 4.12 Assess workers and employees for Workers assessed for body mass index Proportion of workers and employees Part of MoH NCD MoH HCDP Objective 4; body mass index (BMI) assessed for BMI activities Intervention 4.12 Assess workers and employees for Workers assessed for diabetes and Proportion of workers assessed for Part of MoH NCD MoH HCDP Objective 4; diabetes and hypertension hypertension diabetes activities Intervention 4.12 Proportion of workers assessed for Part of MoH NCD MoH HCDP Objective 4; hypertension activities Intervention 4.12 Procure nutrition assessment and Nutrition assessment and health fitness Proportion of households and Part of MoH NCD MoH HCDP Objective 4; health fitness equipment equipment procured communities sensitized on healthy activities Intervention 4.12 eating and lifestyle Develop social behaviour change Social behaviour change communication Proportion of healthcare 6.5 MoH HCDP Objective 4; communication on feeding habits on feeding habits and behaviours providers trained on diet-related Intervention 4.10 and behaviours. non-communicable diseases (DRNCDs) at all levels Sensitize households and Increased number of households and Proportion of households and MoH communities on healthy eating and communities sensitized on healthy communities sensitized on healthy lifestyle eating and lifestyle eating and lifestyle Engage with public and private Increased number of healthcare Proportion of public and private MoH sectors, civil society and other providers trained on healthy diets and sectors, civil society and other stakeholders in the promotion of lifestyles stakeholders engaged in promoting healthy diets and lifestyles healthy diets and lifestyles UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 59 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT OBJECTIVE 2 To increase access to and utilization of nutrition-sensitive services by children under five years, school-age children, adolescent girls, pregnant and lactating women and other vulnerable groups. Strategy 2.1: Increase the production of diverse, safe and nutrient-dense food at the household level from plant, fisheries 482.0664 MAAIF Agro- and animal sources. industrialization Programme Objective 1 Outcome 2.1: Increased production of diverse, safe and nutrient-dense food at the household level from plant, fisheries and animal sources. Support access to improved Increase access to improved Percentage of the districts including 80.18 MAAIF Agro- technologies, including climate-smart technologies urban centres in Uganda having access industrialization ones, to increase diverse, safe, to a package of nutrition-sensitive Programme nutrition enhancing crop and animal technologies along the entire value Objective 1 products chain Scale up research about the 100 MAAIF Agro- popularity of and access to industrialization indigenous and non-indigenous Programme nutrition-enhancing seed and stock Objective 1 Design and streamline mechanisms Increase access to indigenous and none Percentage of districts having 1.6 MAAIF Agro- for improved farmer access to indigenous nutrition enhancing seed and established multiplication centres industrialization indigenous and non-indigenous stock for biofortified and indigenous crop nutrition-enhancing seed and stock varieties varieties Support the production of nutrient- 20.15 MAAIF Agro- dense indigenous and underutilized industrialization plant, fisheries and animal resources Programme Objective 1 Increase the production of Increased production of biofortified foods Proportion of farming households 203.85 MAAIF Agro- biofortified foods intensified producing biofortified foods industrialization Programme Objective 1 Establish community structures Community structures for delivering Number of structures delivering 5.52 MoES HCDP Objective 1 for delivering nutrition-sensitive nutrition-sensitive agriculture services nutrition services established at the agriculture services through the established community level primary school system Strengthen linkages between Linkages between community Proportion of village health teams 8.7216 MoES HCDP Objective 1 community health worker’s services health workers services and farming participating in the delivery of nutrition- and farming communities communities established sensitive agriculture services UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 60 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Enhance nutrition services delivered Nutrition services delivered through Proportion of primary schools, PGs and 47.84 MoES HCDP Objective 1 through primary schools, parental primary schools, PGs and LFs LFs delivering nutrition services groups (PGs) and lead farmers (LFs) Strengthen linkages between Linkages between agricultural Proportion of primary school 6.8448 MAAIF HCDP Objective 1 agricultural extension services and extension services and primary schools backstopped by agriculture extension primary schools to deliver multi- strengthened to deliver multi-sectoral officers staff to deliver multi-sectoral sectoral food and nutrition-security food and nutrition security actions food and nutrition security actions actions Strengthen the capacity of health, Increased number of health, agriculture Proportion of health, agriculture and 7.36 MAAIF HCDP Objective 1 agriculture and education ministries and education personnel trained to education personnel trained to deliver to deliver multi-sectoral food and deliver multi-sectoral food and nutrition multi-sectoral food and nutrition nutrition-security actions security actions security actions Strategy 2.2: Increase access to diverse, safe and nutrient-dense food from plant, fisheries and animal sources. 115.8 MAAIF Agro- industrialization Programme Objective 2 Outcome 2.2: Increased access to diverse, safe and nutrient-dense food from plant, fisheries and animal sources. Support the scale-up of value Small scale cottage industries Percentage of districts with cottage 94.47 MAAIF Agro- addition, agro-processing and established industries following GMP industrialization marketing of diverse, safe, nutrient- Programme dense foods, including indigenous Objective 3 and underutilized food resources Build capacity of farmers on Farmers trained on postharvest handling Number of farmers trained on 3.25 MAAIF Agro- postharvest handling technologies technologies and value addition postharvest handling and value industrialization and value addition addition Programme Objective 2 Support on-farm agricultural On-farm agriculture enterprises Percentage of districts supported with 5.03 MAAIF Agro- enterprise mixes to ensure stable, supported for stable access to diversified on-farm agriculture enterprises for industrialization diversified food access foods stable access to diversified foods Programme Objective 1 Number of farmers supported with Agro- on-farm agriculture enterprises for industrialization stable access to diversified foods Programme Objective 1 Provide timely early warnings Timely early warning systems for food E-based early warning system in place 13.05 MAAIF Agro- systems to ensure stable access to security and nutrition established industrialization food, including the Integrated Phase Programme Classification System Objective 1 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 61 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 2.3: Increase the utilization of diverse, safe and nutrient-dense food from plant, fisheries and animal sources. 111. 889 MAAIF HCDP Objective 1; Intervention 1.2c Outcome 2.3: Improved utilization of diverse, safe and nutrient-dense food from plant, fisheries and animal sources. Integrate nutrition and home Nutrition and home economics Guidelines, handbooks and 3.6 MAAIF Agro- economics in agricultural research integrated into agriculture research and information, education and industrialization and extension extension commmunication m materials on Programme nutrition-sensitive extension services Objective 1 in place Support investment in technologies Technologies and infrastructure for food Number and type of technologies 59.25 MAAIF Agro- and infrastructure development for safety along the value chain developed developed /infrastructure in place industrialization food safety along the agricultural Programme value chain Objective 1 Number of technology implementation 10 MoSTI action plans Intensify awareness on benefits Communities sensitized on the benefits Number of households sensitized on 13.02 MAAIF HCDP Objective 1 of consuming safe and nutrition- of consuming diverse, safe nutrient- the benefits of consuming diverse, dense foods, including fortified dense crop, fish and animal products safe nutrient-dense crop, fish and (bio and industrial), indigenous and animal product underutilized food resources Extension officers sensitized trained on Number of extension officers HCDP Objective 1 the benefits of consuming diverse, safe sensitized trained on the benefits of nutrient-dense crop, fish and animal consuming diverse, safe nutrient- products dense crop, fish and animal products Develop national food-based dietary National food composition tables National food composition tables in 15.919 MAAIF HCDP Objective 1 guidelines and food composition developed place tables National food-based dietary guidelines National food-based dietary guidelines HCDP Objective 1 developed in place Establish and operationalize a A functional food safety index-tracking A functional food safety index-tracking 10.1 MAAIF HCDP Objective 1 functional food safety index-tracking system established system operational system along the agricultural value chains UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 62 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 2.4: Promote the integration of nutrition services in social protection programmes. 220.55 MoGLSD HCDP Objective 5 Outcome 2.4: Increased access to nutrition-sensitive services in social protection programmes. Mainstream nutrition interventions A program aimed at promoting Number of households benefiting from 220.55 MoGLSD Community into social protection programmes household engagement in improving village savings and loan associations Mobilization and and humanitarian assistance safety household income implemented investment clubs Mindset Change net programmes Programme Objective 1 The village cluster household model Proportion of households benefitting MoGLSD expanded to undertake five investments, from one time investments e.g. (water point, agricultural inputs, livelihood support) Mainstream nutrition interventions Increased number of vulnerable Proportion of vulnerable populations MoGLSD HCDP Objective 5 into social protection programmes populations covered by nutrition- covered by nutrition-sensitive and humanitarian assistance safety sensitive social protection programmes social protection programmes and net programmes and humanitarian assistance safety net humanitarian assistance safety net programmes. programmes. Implement income-generating Increased number of poor and vulnerable Proportion of poor and vulnerable MoGLSD HCDP Objective 5 activities targeting poor and households and communities engaging households and engaging in income- vulnerable households and in income-generating activities generating activities communities Support initiatives that create an Increased number of women Proportion of women of women MoGLSD HCDP Objective 5 enabling environment for women to participating in development participating in development participate in development activities initiatives such as the Uganda Women initiatives such as the Uganda Women Entrepreneurship Programme fund Entrepreneurship Programme fund Strategy 2.5: Promote access to nutrition services through integrated early childhood development (ECD) services and 47.51 MoES and HCDP objective 1 quality education and sports. MoGLSD Outcome 2.5: Increased access to nutrition services through integrated early childhood development (ECD) services and quality education and sports. Register all ECD centres in ECD centres registered Percentage of ECD centres registered 2 MoES HCDP objective 1 accordance with the Ugandan Basic Requirements and Minimum Standards Sensitize private players to spread 0.15 MoES HCDP Objective 1 ECD centres to under-served areas UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 63 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Increase access to ECD services Integrated ECD service delivery Proportion of children aged 0-8 years 14.1 MoGLSD HCDP Objective 1 for children aged 0-8 years framework rolled out accessing ECD services The national integrated communication 14.1 MoGLSD HCDP Objective 1 and advocacy strategy rolled out Delivery of integrated ECD services in 1.16 MoGLSD HCDP Objective 1 local governments monitored Promote and enforce mandatory Nutritious meals provided at schools Number of schools (primary and 10 MoES HCDP Objective 1; consumption of safe and fortified secondary) providing safe and fortified Intervention:1.2b foods in schools foods to children Mobilize parents to provide meals to Parents mobilized to provide a hot Percentage of day school-going 2 MoES HCDP Objective 1 school going children healthy meal to their school-going children having at least a healthy children during school days hot meal a day Promote the establishment of Schools gardens established Proportion of schools with school 4 MoES HCDP Objective 4; schools gardens gardens established Intervention 4.15 Strategy 2.6: Increase access to nutrition-sensitive water, sanitation and hygiene (WASH) services. 76.2 for social MoWE HCDP objective 4; behaviour change Intervention 4.5 communication on WASH; capital costs in MoWE budgets Outcome 2.6: Increased access to nutrition-sensitive water, sanitation and hygiene (WASH) services. Increase access to inclusive, safe Piped water systems constructed in rural Percentage of people accessing Imbedded in MoWE MoWE HCDP objective 4; water supply in rural areas areas safe and clean water sources in capital projects Intervention 4.5 Solar/wind-powered water supply rural areas Imbedded in MoWE MoWE HCDP objective 4; systems constructed in rural areas capital projects Intervention 4.5 New point water sources constructed in Imbedded in MoWE MoWE HCDP objective 4; rural areas capital projects Intervention 4.5 Improved water point per village Percentage of villages with access Imbedded in MoWE MoWE HCDP objective 4; constructed in rural areas to safe and clean water supply capital projects Intervention 4.5 Communal or institutional rainwater Imbedded in MoWE MoWE HCDP objective 4; harvesting systems provided in rural capital projects Intervention 4.5 areas UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 64 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Increase access to inclusive Increased number of villages Percentage of population with access Imbedded in MoWE MoWE HCDP objective 4; sanitation and hygiene services in reached with social behaviour change to basic sanitation capital projects Intervention 4.5 rural areas communication for construction and use of improved sanitation facilities Increased number of villages in districts Percentage of population using safely Imbedded in MoWE MoWE HCDP objective 4; promoting faecal sludge management in managed sanitation services capital projects Intervention 4.5 rural areas Increased number of households Percentage of population with 10 MoWE HCDP objective 4; reached with social behaviour handwashing facilities with soap and Intervention 4.5 change communication for the use of water at home handwashing with water, investment in public handwashing facilities in rural areas Increase access to inclusive, safe Increased number of new piped water Percentage of the urban population Imbedded in MoWE MoWE HCDP objective 4; water supply in urban areas supply systems using regional and within access of an improved water capital projects Intervention 4.5 integrated national approaches in small source (200 m) towns constructed Increased number of pro-poor public Number of people having access to Imbedded in MoWE MoWE HCDP objective 4; stand posts in small towns pro-poor facilities capital projects Intervention 4.5 Increased number of household Percentage of population using safely Imbedded in MoWE MoWE HCDP objective 4; connection in small towns (number) managed drinking water services capital projects Intervention 4.5 located on-premises Increase access to inclusive Increased number of urban centres Percentage of population with access 10.8 MoWE HCDP objective 4; sanitation and hygiene services in reached with social behaviour change to basic sanitation in urban areas Intervention 4.5 urban areas communication (SBCC) for construction and use of improved sanitation facilities Increased number of urban centres with Percentage of population using safely Imbedded in MoWE MoWE HCDP objective 4; faecal sludge management processes, managed sanitation services capital projects Intervention 4.5 transport and appropriate sewerage infrastructure constructed Increased number of urban centres Percentage of population with 20.2 MoWE HCDP objective 4; reached with SBCC for handwashing handwashing facilities with soap and Intervention 4.5 with water, investment in public water at home in urban areas handwashing facilities UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 65 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Provide support to improve WASH Increased institutions (schools, prisons, Percentage of institutions with an Imbedded in MoWE MoWE HCDP objective 4; services in institutions barracks, religious establishment, improved water source capital projects Intervention 4.5 health facilities, etc.) with water supply infrastructure constructed or extended Increased number of schools reached Percentage of pupils enrolled in 20.2 MoWE HCDP objective 4; with SBCC for the use of sanitation schools provided with basic sanitation Intervention 4.5 facilities and handwashing with water and handwashing facilities Improve nutrition and food safety Increased number of household Number of households use of safe 15 MoWE HCDP objective 4; with emphasis on children under five sensitized, monitor and evaluated for water with a deliberate focus on Intervention 4.5 years and school-going children water usage and handwashing practices nutrition and food safety with particular focus on nutrition and food safety Strategy 2.7: Increase the participation of trade, industry and investment actors in scaling up nutrition. 18.475 MoTIC and Agro- industrialization MoSTI Programme Objective 2 and 3 Outcome 2.7: Increased trade, industry and investments in scaling up nutrition. Build capacity of local industries to Increased availability of fortified foods on Proportion of industries supplying 14 MoTIC Agro- adopt appropriate technologies for the market fortified foods on the market industrialization industrial food fortification. Programme Objective 2 and 3 Increased support to research and Types and number of new biofortified MoSTI Agro- development to biofortified products products supported through research industrialization and development Programme Objective 2 and 3 Increased awareness created on Number of awareness campaigns MoSTI Agro- biofortification and its importance to created on biofortification and its industrialization human nutrition importance to human nutrition Programme Objective 2 and 3 Support industrial uptake and value Increased value addition of nutritious Proportion of value-added nutritious 1.2 MoTIC Agro- addition of biofortified plants foods foods industrialization Programme Objective 2 and 3 Enforce surveillance for compliance Increased number of industries Proportion of industries complying 0.75 MoTIC Agro- with the mandatory food fortification complying with the fortification of wheat with the fortification of wheat flour, industrialization regulation flour, maize flour, edible oil enforcement maize flour, edible oil enforcement Programme Objective 2 and 3 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 66 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Build capacity of micro, small and Increased number of MSMEs in the food Proportion of MSMEs in the food 1.25 MoTIC Agro- medium enterprises (MSMEs) in system availing fortified foods on the system availing fortified foods on the industrialization the food sector with compliance to market market Programme quality and standards Objective 2 and 3 Support traders and processors of Increased number of traders and Proportion of traders and processors 0.675 MoTIC Agro- foods to form viable cooperatives processors of foods forming viable of foods forming viable cooperatives industrialization cooperatives for trading quality nutritious for trading quality nutritious foods Programme foods Objective 4 Mitigate non-tariff barriers that affect Decreased non-tariff barriers that affect Proportion of non-tariff barriers that 0.6 MoTIC Increase market food and nutrition food and nutrition mitigated affect food and nutrition that have access and been mitigated competitiveness of agricultural products in domestic and international markets UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 67 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT OBJECTIVE 3 To strengthen the enabling environment for scaling up nutrition-specific and nutrition-sensitive services Strategy 3.1: Strengthen nutrition coordination and partnerships at all levels. 24.462 UNAP HCDP Objective 1; MDAs Intervention 1.2a Outcome 3.1: Strengthened nutrition coordination and partnerships at all levels. Conduct comprehensive nutrition Comprehensive nutrition stakeholder Nutrition stakeholder and action 0.6 OPM HCDP Objective 1; stakeholder and action mapping at and action mapping at national and MDA mapping at MDA levels Intervention 1.2a MDA levels levels conducted Conduct comprehensive nutrition Comprehensive nutrition stakeholder Nutrition stakeholder and action 4.95 MoLG HCDP Objective 1; stakeholder and action mapping at and action mapping at local government mapping at local government levels Intervention 1.2a local government levels levels conducted regularly Establish and support the Multi-sectoral Nutrition Technical Overall functionality score of the 1.962 OPM HCDP Objective 1; functionality of Nutrition Coordination Coordination Committee (MSNTCC) is MSNTCC Intervention 1.2a Committees (NCCs) at the national fully established and fully-functional and MDA level Existence of nutrition coordination Functionality index of individual UNAP HCDP Objective 1; committees in all UNAP-implementing MDAs NCCs MDAs Intervention 1.2a MDAs Establish and support the Existence of nutrition coordination Functionality index of local 16 MoLG HCDP Objective 1; functionality of NCCs at local committees at all levels of local government level NCCs Intervention 1.2a government levels governments Establish and support the SUN Business Network is fully SUN Business Network functionality 0.9 MoTIC HCDP Objective 1; functionality of all SUN networks established and fully-functional index Intervention 1.2a with a focus on SUN business, academia and CSO networks. SUN Civil Society Organisation Network SUN CSO network functionality MOGLSD HCDP Objective 1; (CSO) is fully established and fully- index Intervention 1.2a functional SUN Academic and Research Institutions SUN ARI network functionality MoES HCDP Objective 1; Network (ARIN) is fully established and index Intervention 1.2a fully-functional SUN Development Partners Group (DPG) SUN DPG Network functionality OPM HCDP Objective 1; is fully established and fully-functional index Intervention 1.2a Support joint annual SUN Movement Joint annual SUN Movement SUN Movement processes score 0.050 OPM HCDP Objective 1; assessments and other relevant joint assessments (and other joint nutrition Intervention 1.2a nutrition programme reviews programme reviews) conducted UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 68 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 3.2: Improve the planning, resource mobilization, financing and tracking of nutrition investments. 36.823 UNAP HCDP Objective 1; MDAs Intervention 1.2a Outcome 3.2: Improved planning, resource mobilization, financing and tracking of nutrition investments. Develop nutrition action plans Nutrition action plans (district, regional Proportion of LGs with nutrition 24.45 MoLG HCDP Objective 1; (districts, regional cities, cities, municipalities, municipal divisions, action plans (district, regional cities, Intervention 1.2a municipalities, municipal divisions, and town councils) developed municipalities, municipal divisions, and town councils) aligned to and town councils) in place for ‘UNAP II’ and ‘NDP III’ programme implementation implementation action plans (PIAPs). Develop joint annual nutrition work Joint annual nutrition work plans (district, Proportion of LGs with approved MoLG HCDP Objective 1; plans (districts, regional cities, regional cities, municipalities, municipal joint annual nutrition work plans for Intervention 1.2a municipalities, municipal divisions, divisions, and town councils) developed implementation and town councils) aligned to the ‘UNAP II’ implementation matrix Develop nutrition action plans for Nutrition action plans for KCCA and the Nutrition action plans for KCCA KCCA HCDP Objective 1; Kampala Capital City Authority five divisions developed and the five divisions in place for Intervention 1.2a (KCCA) and its five divisions aligned implementation to ‘UNAP II’ and ‘NDP III’ PIAPs Develop joint annual nutrition Joint annual nutrition work plans for Joint annual nutrition work plans for KCCA HCDP Objective 1; work plans for KCCA and its five KCCA and the five divisions developed KCCA and the five divisions in place Intervention 1.2a divisions aligned to the ‘UNAP II’ for implementation implementation matrix Develop joint annual nutrition work Joint annual nutrition work plans for Proportion of MDAs with annual OPM, all HCDP Objective 1; plans for UNAP-implementing UNAP-implementing MDAs developed nutrition work plans (UNAP- UNAP Intervention 1.2a MDAs aligned to the ‘UNAP II’ implementing MDAs) in place for MDAs implementation matrix implementation Undertake expenditure reviews for Nutrition expenditure review finalized Nutrition expenditure review report in 2.298 OPM, all HCDP Objective 1; nutrition and report disseminated place UNAP Intervention 1.2a MDAs Develop an investment case for Nutrition investment case developed and Nutrition investment case in place for 1.880 OPM HCDP Objective 1; nutrition in Uganda disseminated use in resource mobilization Intervention 1.2a Conduct detailed costing of ‘UNAP II’ Finalize detailed costing of ‘UNAP II’ Report indicating costs per priority 2.45 OPM HCDP Objective 1; action in the ‘UNAP II’ Intervention 1.2a Develop and implement resource Resource mobilization and tracking plan Resource mobilization and tracking 5.745 OPM, all HCDP Objective 1; mobilization and tracking plan for for nutrition developed plan in place UNAP Intervention 1.2a nutrition aligned to ‘UNAP II’ MDAs UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 69 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 3.3: Strengthen institutional and technical capacity for scaling up nutrition actions. 44.69 UNAP HCDP Objective 1; MDAs Intervention 1.2a Outcome 3.3: Strengthened institutional and technical capacity for scaling up nutrition actions. Conduct nutrition capacity Nutrition capacity gaps identified UNAP- implementing MDAs nutrition 0.401 UNAP HCDP Objective 1; assessments among UNAP- and prioritized for action by UNAP- capacity assessment report MDAs Intervention 1.2a implementing MDAs implementing MDAs Conduct nutrition capacity Nutrition capacity gaps identified and DLGs and regional cities nutrition 1.0 MoLG HCDP Objective 1; assessments among DLGs and prioritized for action by DLGs and capacity assessment report Intervention 1.2a regional cities regional cities Develop nutrition capacity All UNAP-implementing MDAs and Nutrition capacity development 0.9 All UNAP HCDP Objective 1; development framework for UNAP- partners integrate nutrition capacity framework for UNAP-implementing MDAs Intervention 1.2a implementing MDAs development activities in annual work MDAs plans and budgets Develop nutrition capacity All DLGs, regional cities and partners Nutrition capacity development 3 MoLG HCDP Objective 1; development framework for DLGs integrate nutrition capacity development framework for DLGs and regional cities Intervention 1.2a and regional cities activities in annual work plans and budgets Implement the nutrition capacity The nutrition capacity development plan Status of implementation of the 9.389 All UNAP HCDP Objective 1; development framework for UNAP- is fully implemented by all MDAs and nutrition capacity development MDAs Intervention 1.2a implementing MDAs implementing partners framework for UNAP-implementing MDAs Implement the nutrition capacity The nutrition capacity development plan Status of implementation for the 30 MoLG HCDP Objective 1; development framework for DLGs is fully implemented by all DLGs and nutrition capacity development Intervention 1.2a and regional cities regional cities and their implementing framework for DLGs and regional cities partners Strategy 3.4: Strengthen nutrition advocacy, communication and social mobilization for nutrition. 183.51 All UNAP HCDP Objective 1; MDAs Intervention 1.2a Outcome 3.4: Strengthened nutrition advocacy, communication and social mobilization for nutrition. Develop a nutrition advocacy Nutrition advocacy and communications Nutrition advocacy and 0.6 OPM HCDP Objective 1; communication strategy fully aligned strategy fully aligned with the ‘UNAP II’ communications strategy fully aligned Intervention 1.2a with the ‘UNAP II’ strategic direction strategic direction developed with the ‘UNAP II’ strategic direction Training packages for the NACSII Training packages for the NACSII OPM HCDP Objective 1; developed strategy developed Intervention 1.2a Develop and implement a regional- Sub-regional context NACSII Number of sub-regional context 2.0 OPM/ HCDP Objective 1; specific nutrition advocacy and implementation framework developed NACSII implementation framework in all UNAP Intervention 1.2a communication campaign and implemented place MDAs UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 70 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Mobilize and institute high-level High-level nutrition advocates instituted Number of high-level nutrition 1.05 OPM/ HCDP Objective 1; nutrition advocates to actively at the national level and actively advocates instituted all UNAP Intervention 1.2a advance the nutrition agenda at advancing the nutrition agenda MDAs national and sub-national levels Develop nutrition advocacy briefs Nutrition advocacy briefs and technical Number of nutrition advocacy briefs/ 0.9 MoLG HCDP Objective 1; and technical briefs for use at briefs are harmonized and used. technical briefs Intervention 1.2a national and sub-national levels Develop nutrition commitments Advocacy and SBCC campaign Number MDAs with scorecards 0.4 OPM/ HCDP Objective 1; scorecards at national and MDAs systematically uses scorecards at for nutrition advocacy and SBCC all UNAP Intervention 1.2a levels national and MDAs levels campaigns MDAs Develop nutrition commitments Advocacy and SBCC campaign Number of districts and regional cities 0.6 MoLG HCDP Objective 1; scorecards targeting districts and systematically uses scorecards at with scorecards for nutrition advocacy Intervention 1.2a regional cities national and MDAs levels at districts and and SBCC campaigns regional cities level Build capacity of community-based Capacity of community-based structures Number of community engagement 175.46 MoGLSD Community structures such as functional built to deliver advocacy, social dialogues for advocacy, social Mobilization and adult literacy (FAL) groups, Parish mobilization and behavioural change mobilization and behavioural change Mindset change Development Committees (PDCs), communication for nutrition communication for nutrition Programme community resource persons, and Objective 4. community-based informal groups to trigger and deliver community-based advocacy, social mobilization and behavioural change communication on nutrition interventions Undertake campaigns to reduce Campaign to reduce teenage pregnancy, Number of campaigns on teenage 2.5 MoGLSD No objective? teenage pregnancy, GBV and other GBV and other harmful practices that pregnancy, GBV, and other harmful harmful practices that result in result in malnutrition practices that result in malnutrition malnutrition conducted Strategy 3.5: Strengthen coherent policy, legislation and institutional frameworks for scaling up nutrition. 59.68 UNAP HCDP Objective 1; MDAs Intervention 1.2a Outcome 3.5: Coherent policy, legal and institutional frameworks for nutrition. Conduct regulatory impact Regulatory impact assessment for the NNP 0.49 OPM HCDP Objective 1; assessment for the National Nutrition NNP developed Intervention 1.2a Policy (NNP) Finalize the NNP NNP approved OPM HCDP Objective 1; Intervention 1.2a Develop the national food fortification National food fortification policy and law National food fortification policy and 0.45 MoH HCDP Objective 1; policy and law developed law in place Intervention 1.2d UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 71 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Develop standards and guidelines Standards and guidelines for child care Standards and guideline in place 0.6 MoH HCDP Objective 1; for child care facilities at formal facilities at formal workplaces developed for child care facilities at formal Intervention 1.2a workplaces workplaces Develop and implement employment The employment breastfeeding and child The employment breastfeeding and 28.6 MoGLSD HCDP Objective 1; regulations related to breastfeeding care facilities at workplaces regulations child care facilities at workplaces Intervention 1.1 and childcare facilities at workplaces developed regulations in place Amend the Employment Act to Employment Act amended to provide for Presence of the amended 1.2 MoGLSD HCDP Objective 1; provide for child care facilities at child care facilities at workplaces Employment Act that provides for child Intervention 1.2a workplaces care facilities at workplaces Develop legislature and regulation Regulations on sweetened beverages Regulations on sweetened beverages 5.86 MoH HCDP Objective 4; to regulate the production and and alcohol developed and alcohol Intervention 4.10 consumption of sweetened beverages Develop the public food procurement Forum for the development of multi- Public food procurement policy for 0.3 MoES HCDP Objective 4; policy for schools and institutions sectoral teams to develop the schools schools and institutions Intervention 4.10 and institutional policy established Public food procurement policy for schools and institutions developed Strengthen and develop school School feeding programmes policy School feeding programmes policy in 4.2 MoES HCDP Objective 4; feeding programmes policy developed place Intervention 4.10 Community-based school feeding and Community-based school feeding and MoES nutrition guidelines developed nutrition guidelines Standards and quality indicators for Standards and quality indicators for MoES school feeding and nutrition developed school feeding and nutrition Guidelines for school feeding and Guidelines for school feeding and MoES nutrition in Ugandan institutions nutrition in Ugandan institutions developed Teachers’ guide on nutrition and comic Status of implementation of the MoES book implemented Teachers’ guide and comic book Conduct a detailed review and Revised policies, legislations and Proportion of sectors and actors 13.78 UNAP HCDP Objective 1; revision of existing policies and frameworks covering relevant sectors at aligning to relevant policies, MDAs Intervention 1.2a pending legislation, regulations and all levels legislations and frameworks standards across relevant sectors Advocate for coordinated The legal, policy and planning provisions Implementation status of policies, 4.2 UNAP HCDP Objective 1; enforcement of relevant legislation at relevant to nutrition popularized at all legislation, regulations and standards MDAs Intervention 1.2a all levels levels across relevant sectors UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 72 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Strategy 3.6: Strengthen and institutionalize nutrition evidence and knowledge management along with a multi-sectoral 144.58 UNAP HCDP Objective 1; nutrition information system for effective decision making. MDAs Intervention 1.2a Outcome 3.6: Improved nutrition evidence and knowledge management along with multi-sectoral nutrition information system for effective decision making. Design and implement a monitoring, Develop MEAL plan for ‘UNAP II’ MEAL plan for ‘UNAP II’ 45.1 OPM HCDP Objective 1; evaluation, accountability and Intervention 1.2a learning (MEAL) plan for ‘UNAP II’ Develop a MEAL training package for MEAL training package for ‘UNAP II’ OPM HCDP Objective 1; ‘UNAP II’ Intervention 1.2a Conduct training of sectoral planning Proportion of sectoral planning and OPM and HCDP Objective 1; and M&E officers using MEAL training M&E officers trained using MEAL UNAP Intervention 1.2a package training package MDAs Conduct periodic evaluative studies to Number of evaluative studies to OPM and HCDP Objective 1; provide evidence on the effectiveness of provide evidence on the effectiveness UNAP Intervention 1.2a nutrition programmes and interventions of nutrition programmes and MDAs interventions Strengthen and scale up early Nutrition-related surveys and analysis Number of Food Security and Nutrition 52.2 OPM and HCDP Objective 1; warning systems, survey and generated with action support Aseessments data available for UNAP Intervention 1.2a surveillance on food and nutrition programming MDAs from community to national levels Early warning system for food and Number of early warning system for OPM and HCDP Objective 1; nutrition established food and nutrition reports UNAP Intervention 1.2a MDAs Develop, disseminate and enhance Knowledge products for nutrition Number of knowledge products for 14.46 OPM and HCDP Objective 1; the use of evidence-based nutrition developed nutrition developed and disseminated UNAP Intervention 1.2a knowledge products at all levels MDAs Policy dialogue among policymakers Number of policy dialogue among OPM and HCDP Objective 1; for evidence-based decision making for policymakers for evidence-based UNAP Intervention 1.2a nutrition enhanced decision making for nutrition held MDAs Learning and knowledge dissemination Number of learning and knowledge OPM and HCDP Objective 1; for nutrition at different multi-sectoral dissemination for nutrition at different UNAP Intervention 1.2a nutrition committees envisioned under multi-sectoral nutrition committees MDAs the ‘UNAP II’ organized envisioned under the ‘UNAP II’ organized UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 73 ‘UNAP II’ PRIORITY ACTIONS OUTPUTS OUTPUT INDICATORS COST (UGX BILLION) LEAD MDA ‘NDP III’ PIAP ALIGNMENT Implement sector-specific research Partnerships with academic and research Number of partnerships with 22.6 OPM and HCDP Objective 1; and assessment plans for ‘UNAP II’ institutions for conducting research and academic and research institutions for UNAP Intervention 1.2a publication on nutrition established conducting research and publication on MDAs nutrition established Conduct a joint annual nutrition review Number of joint annual nutrition OPM and HCDP Objective 1; reviews conducted and results UNAP Intervention 1.2a disseminated MDAs Conduct an annual conference on Number of annual conferences on OPM and HCDP Objective 1; nutrition research nutrition research conducted UNAP Intervention 1.2a MDAs Research on nutrition-agricultural Number of research on nutrition- OPM and HCDP Objective 1; linkages conducted agricultural linkages conducted UNAP Intervention 1.2a MDAs Create capacity within national Achievement of the implementation Degree of achievement of the 10.22 OPM and HCDP Objective 1; institutions to operate and maintain plans agreed with the NIPN policy implementation plans agreed with UBOS Intervention 1.2a the National Information Platform for advisory committee, according to the key the NIPN policy advisory committee, Nutrition (NIPN) performance indicators and their annual according to the key performance targets indicators and their annual targets Strengthen capacity to track progress Nutrition-specific and nutrition-sensitive Number and quality of nutrition- OPM and HCDP Objective 1; in meeting national objectives to data sets obtained by NIPN specific and nutrition-sensitive data UBOS Intervention 1.2a prevent malnutrition and monitor sets obtained by NIPN nutrition investments Policies that are informed or updated and Number of policies that are informed OPM and HCDP Objective 1; reflect the needs for nutrition, notably for or updated and reflect the needs UBOS Intervention 1.2a vulnerable groups, women, and children for nutrition, notably for vulnerable under five years groups, women, and children under five years Build the capacity of government Increase in the cost-effectiveness of Cost-effectiveness of nutrition-related OPM and HCDP Objective 1; staff to make better use of evidence nutrition-related programmes programmes UBOS Intervention 1.2a and data to design and implement Increase in nutrition-related data from Number of nutrition-related data sets OPM and HCDP Objective 1; nutrition-related policies and nutrition-specific and nutrition-sensitive from nutrition-specific and nutrition- UBOS Intervention 1.2a programmes programmes and sectors sensitive programmes and MDAs Requests for data or information made Number of requests for data or OPM and HCDP Objective 1; to NIPN information made to NIPN UBOS Intervention 1.2a Government staff trained in disciplines Proportion of government staff trained OPM and HCDP Objective 1; that support the work of the NIPN and in disciplines that support the work of UBOS Intervention 1.2a their institutions the NIPN and their institutions UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 74 Annexe 3 ‘UNAP II’ MEAL FRAMEWORK 2020/21-2024/25 ALIGNED WITH ‘NDP III’, SDGS AND SUN MEAL FRAMEWORKS Annexe 3.1: Indicators for primary outcomes (‘UNAP II’ goal level) INDICATOR BASELINE TARGET DATA (%) 2024/2025 (%) SOURCE Prevalence of stunting in children aged 0-5 years 29 (UDHS 2016) 19 UDHS/UBOS Prevalence of low birth weight (<2500 g) 10 (UDHS 2016) 7 UDHS/UBOS Prevalence of wasting in children aged 0-5 years 4 (UDHS 2016) 2 UDHS/UBOS Prevalence of anaemia in children aged 0-5 years 53 (UDHS 2016) 35 UDHS/UBOS Prevalence of anaemia in women of reproductive age 32 (UDHS 2016) 20 UDHS/UBOS Prevalence of overweight in children aged 0-5 years 4 (UDHS 2016) 3 UDHS/UBOS Proportion of overweight adult women aged 18+ years 16.5 (UDHS 2016) 125 UDHS/UBOS Proportion of overweight adult men aged 18+ years 7.7 (UDHS 2016) 3.7 UDHS/UBOS Proportion of obesity in adult women aged 18+ years 7.2 (UDHS 2016) 5.2 UDHS/UBOS Proportion of obesity in adult men aged 18+ years 1.2 (UDHS 2016) 0.4 UDHS/UBOS Proportion of overweight in adolescents 10 (UDHS 2016) 6 UDHS/UBOS Proportion of obesity in adolescent girls 1 (UDHS 2016) 1 UDHS/UBOS Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years 3.3 (MoH 2014) 2.1 UDHS/UBOS Age-standardized prevalence of raised blood pressure among persons aged 18+ years 24 (MoH 2014) 20 UDHS/UBOS UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 75

Annexe 3.2: Indicators for intermediate outcomes (‘UNAP II’ objective level) INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA Outcome 1.1: Improved maternal, infant, young child and adolescent nutrition (MIYCAN) practices in stable and emergency situations 1.1.1 Proportion of health facilities that are baby-friendly hospital No data 80 Health Management Ministry of Health initiative certified. Information System (HMIS) (MoH) 1.1.2 Percentage of newborns put to the breast within one hour 66 80 Uganda National Panel MoH of birth. Survey (UNPS)/Uganda Demographic and Health Survey (UDHS) 1.1.3 Percentage of infants aged 0-5 months old who were 66 80 MoH MoH exclusively breastfed. 1.1.4 Proportion of mothers of children aged 0-23 months who have No data 80 UNPS/UDHS MoH received counselling, support or messages on optimal breastfeeding at least once in the last year. 1.1.5 Proportion of children aged 6-23 months who receive a 30 40 UNPS/UDHS MoH minimum diet diversity (MDD). 1.1.6 Proportion of children aged 6-23 months who receive a 42 60 UNPS/UDHS MoH minimum meal frequency (MMF). 1.1.7 Proportion of children aged 6-23 months who achieve 15 40 UNPS/UDHS MoH minimum acceptable diet (MAD). 1.1.8 Prevalence of women of reproductive age (WRA) consuming 16 (UNPS 2019) 40 UNPS/UDHS MoH a minimum diet diversity. Outcome 1.2: Optimal uptake of micronutrients of concern among children, adolescent girls and women of reproductive age in stable and emergency situations. 1.2.1 Proportion of children aged 6-59 months receiving vitamin A 62 80 HMIS/UNPS/UDHS MoH supplementation. 1.2.2 Proportion of pregnant women receiving iron and folic acid 23 80 HMIS/UNPS/UDHS MoH supplementation. 1.2.3 Proportion of schools (primary and secondary) providing safe No data 60 Education Management Ministry of Education and fortified foods to children. Information System/UNPS/ and Sports (MoES) UDHS Outcome 1.3: Increased coverage of the management of acute malnutrition in stable and emergency situations. 1.3.1 Proportion of children aged 6-59 months with severe acute No data 60 HMIS/UNPS/UDHS MoH malnutrition admitted for treatment. Outcome 1.4: Nutrition services fully integrated in the prevention, control and management of infectious diseases and epidemics. 1.4.1 Proportion of children under five years old with diarrhoea 30 (UDHS 2016) 80 UNPS/UDHS MoH (in last two weeks) receiving oral rehydration salts (ORS) and zinc. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 76 INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA 1.4.2 Proportion of children aged 12-59 months receiving at least one dose 60 80 UNPS/UDHS MoH of deworming medication. 1.4.3 Percentage of children 0-5 years old who slept under an 62 (UDHS 2016) UNPS/UDHS MoH insecticide-treated mosquito net. 1.4.4 Prevalence of malaria in children under five years. 30 10 UNPS/UDHS MoH 1.4.5 Proportion of 1-year-old children who have received the appropriate 55 80 UNPS/UDHS MoH doses of the recommended vaccines in the national schedule. 1.4.6 Prevalence of diarrhoea in children under five years. 20 10 UNPS/UDHS MoH Outcome 1.5: Nutrition services fully integrated in the prevention, control and management of diet-related non-communicable diseases. 1.5.1 Percentage of adults considered physically inactive. 4.3 0 UNPS/UDHS MoH 1.5.2 Proportion of workplaces with health and wellness programme. 20 45 UNPS/UDHS MoH 1.5.3 Age-standardized prevalence of persons (aged 18+ years) consuming No data 20% increase UNPS/UDHS MoH less than five total servings (400 grams) of fruit and vegetables per day. from baseline 1.5.4 Age-standardized mean population intake of salt (sodium chloride) per No data 20% increase UNPS/UDHS MoH day in grams in persons aged 18+ years. from baseline Outcome 2.1: Increased production of diverse, safe and nutrient-dense food at the household level from plant, fisheries and animal sources. 2.1.1 Percentage increase in the production volumes of priority food 3.8% annual 6% annual MAAIF, Uganda Bureau Ministry of Agriculture, commodities. increment increment of Statistics (UBOS) Animal Industry and Fisheries (MAAIF) 2.1.2 Proportion of households dependent on subsistence agriculture 68 (2017/18) 55 MAAIF, UBOS MAAIF as a main source of livelihood. 2.1.3 Percentage increase in production volumes of biofortified - 30% MAAIF, UBOS MAAIF staple food commodities. 2.1.4 Proportion of households chronically undernourished. 16 8 UNPS MAAIF UDHS, Food and Agriculture Organization of the United Nations (FAO) 2.1.5 Population experiencing acute food insecurity (millions). 10.9 (2017) 5.5 Integrated Phase MAAIF Classification, UNPS, Uganda National Household Survey (UNHS) 2.1.6 Proportion of households that are food secure. 69 (2017/18) 89.84 UNPS, UNHS MAAIF 2.1.7 Post-harvest losses for priority commodities (percentage). 37 (2017/18) 15 UNPS, UNHS MAAIF UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 77 INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA 2.1.8 The total amount of fruit and vegetables and derived products (in 397 (2013) 400 UNPS, UNHS MAAIF grams) available for human consumption during the reference period. (expressed in per capita terms). 2.1.9 Fortification status of fortifiable food vehicles (including salt, Sustain salt, improve Salt, vegetable oil, UNPS, UNHS Ministry of Trade vegetable oil, wheat flour, maize flour, rice, sugar, fish/soy sauce) oil/wheat (2016) wheat flour, maize Industry and based on information about coverage and compliance. flour, rice, sugar, Cooperatives (MoTIC) fish/soy sauce 2.1.10 Share of total household expenditure on food and non-alcoholic 43% 37% UNHS 2016/17 MAAIF beverages. 2.1.11 Percentage of the population able to meet the required 60% 65% UNPS, UDHS, MAAIF daily dietary intake. UNHS 2.1.12 Percentage of calories from non-staples in the food supply. 60% (2016) 50% UNPS MAAIF 2.1.13 Percentage of undernourishment (share of the population 40% (2016) 30 UNPS MAAIF with insufficient caloric intake below 2,200 kcal). UDHS, FAO 2.1.14 Percentage of households suffering a reduction in food 90% 40% UNPS, UNHS MAAIF production due to weather shocks. 2.1.15 Prevalence of persons aged 18+ years consuming less than 14 20 UDHS MAAIF 400 grams of fruit and vegetables per day. (2016) 2.1.16 Dietary diversity score. 4.1 (2014) 6.1 UNPS MAAIF 2.1.17 Percentage of households that have suffered a reduction - 25% IPS, UNPS, UNHS MAAIF in food access due to major emergencies. Outcome 2.4: Increased access to nutrition-sensitive services in social protection programmes. 2.4.1 Percentage of households participating in public development 60 (2017/18) 90 Sector reports Ministry of Gender, initiatives. Labour and Social Development (MoGLSD) 2.4.2 Percentage of vulnerable and marginalized persons empowered. 1.5% (2017/18) 10% Sector reports MoGLSD 2.4.3 Proportion of households participating in saving schemes. 10 (2017/18) 60 Sector reports MoGLSD 2.4.4 Percentage of smallholder farmers covered by social assistance - 30% Education Sector MoGLSD and social protection programmes. Strategic Plan reports Outcome 2.5: Increased access to nutrition services through integrated early childhood development (ECD) services and quality education and sports. 2.5.1 Percentage of youngest children aged 36-59 months 30% (UDHS 2016) 60% UNPS/UDHS MoES attending organised early childhood education programmes. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 78 INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA 2.5.2 Proportion of children aged 36-59 months who are developmentally 63 80 UNPS/UDHS MoES on track in at least three of the following domains: literacy-numeracy, physical development, social-emotional development and learning. 2.5.3 Percentage of school-going children having meals at schools. 34% (2016) 54% UNPS/UDHS MoES Outcome 2.6: Increased access to nutrition-sensitive water, sanitation and hygiene (WASH) services. 2.6.1 Proportion of rural households with access to a safe water supply. 73 (2017/18) 85 Sector/UNPS/UDHS Ministry of Water and Environment (MoWE) 2.6.2 Proportion of urban households with access to a safe water supply. 74 (2017/18) 100 Sector/UNPS/UDHS MoWE 2.6.3 Proportion of rural households with access to improved toilets. 19 (2017/18) 45 Sector/UNPS/UDHS MoWE 2.6.4 Proportion of urban households with access to Improved 34 (2017/18) 50 Sector/UNPS/UDHS MoWE handwashing facility. Outcome 2.7: Increased trade, industry and investments in scaling up nutrition. 2.7.1 Percentage increase in production volumes of industrial-fortified - 15% MoTIC/UBOS MoTIC staple food commodities. 2.7.2 Percentage of food losses across the food value chain. 37% 15% UBOS MoTIC 2.7.3 Proportion of foods and feeds conforming to aflatoxin standards - 80 UBOS, UNBS, MAAIF MoTIC (percentage). 2.7.4 Percentage of certified food products on the market. - 50% NBS, MTIC MoTIC 2.7.5 Percentage of food-based MSMEs in food processing and - 30% UBOS, MTIC MoTIC value addition. Outcome 3.1: Strengthened nutrition coordination and partnerships at all levels. 3.1.1 Functionality score of the Multi-sectoral Nutrition Technical No data 80 Nutrition governance Office of the Prime Coordination Committee. assessment reports Minister (OPM) 3.1.2 Functionality score of SUN networks. No data 80 Nutrition governance OPM assessment reports 3.1.3 Functionality index of MDAs nutrition coordination committees. No data 80 Nutrition governance OPM assessment reports 3.1.4 Functionality index of local government nutrition coordination No data 80 Nutrition governance Ministry of Local committees. assessment reports Government (MoLG) 3.1.5 SUN business network functionality index. No data 80 Nutrition governance MoTIC assessment reports 3.1.6 SUN civil society network functionality index. No data 80 Nutrition governance MoGLSD assessment reports UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 79 INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA 3.1.7 SUN academic and research institutions network functionality index. No data 80 Nutrition governance MoES assessment reports 3.1.8 NDPG functionality index. No data 80 Nutrition governance OPM assessment reports Outcome 3.2: Improved planning, resource mobilization, financing and tracking of nutrition investments. 3.2.1 Level of alignment between the annual budgets and the No data 80 Annual review reports OPM ‘NDP III’ at the national and programme level. 3.2.2 Level of alignment between the annual budgets and the No data 80 Annual review reports MoLG nutrition action plans at the district level. 3.2.3 National budget spending for nutrition-budget analysis completeness. Report in place Tracking tool Annual review reports OPM updated annually 3.2.4 Total nutrition expenditures. UGX 2,218 billion UGX 3,284 billion Annual review reports OPM (NER 2020) 3.2.5 Percentage of total government spending on essential No data 3% Annual review reports OPM services: education, health and social protection. Outcome 3.3: Strengthened institutional and technical capacity for scaling up nutrition actions. 3.3.1 Status of implementation of the nutrition capacity No data 80 Annual review reports UNAP MDAs development framework for UNAP-implementing MDAs. 3.3.2 Status of implementation for the nutrition capacity No data 80 Annual review reports MoLG development framework for DLGs and regional cities. 3.3.3 Proportion of public service health professionals trained in No data 80 Annual review reports MoH nutrition services delivery. 3.3.4 Proportion of public non-health professionals trained in No data 80 Annual review reports UNAP MDAs nutrition services delivery. Outcome 3.4: Strengthened nutrition advocacy, communication and social mobilization for nutrition. 3.4.1 Level of alignment of the nutrition advocacy communication No data 80 Annual review reports OPM strategy with ‘UNAP II’. 3.4.2 Level of implementation of sub regional context nutrition No data 80 Annual review reports OPM advocacy and communication strategy. 3.4.3 Implementation status of the nutrition advocacy and No data 80 Annual review reports OPM communication strategy for ‘UNAP II’. 3.4.4 Mobilization of high-level advocates (champions, No data 80 Annual review reports OPM parliamentarians, media). UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 80 INTERMEDIATE OUTCOME INDICATORS BASELINE TARGET 2024/2025 DATA SOURCE IMPLEMENTING MDA 3.4.5 Implementation of status scorecards for nutrition advocacy No data 80 Annual review reports All UNAP MDAs and social behaviour change communication (SBCC) campaigns at national/MDA levels. 3.4.6 Implementation status scorecards for nutrition advocacy No data 80 Annual review reports MoLG and SBCC campaigns at district/regional cities level. Outcome 3.5: Coherent policy, legal and institutional frameworks for nutrition. 3.5.1 Status of implementation of nutrition-relevant policies and No data 80 Annual review reports All UNAP MDAs legal frameworks. 3.5.2 Level of constitutional protection of the right to food (high, medium- High (2003) High Annual reports OPM high, medium, low). 3.5.3 Presence of legal documentation indicating standardized fortification Yes Yes Annual reports MoTIC levels of the food vehicle in question with one or more priority nutrients. 3.5.4 Presence of legal documentation that has the effect of Yes (Salt, wheat, Yes (Salt, wheat, Annual reports MoTIC mandating fortification of the food vehicle in question with one maize, oil) (2016) maize, oil) or more priority micronutrients. 3.5.5 Presence of legal documentation indicating standardized Yes (salt, wheat, Yes (Salt, wheat, Annual reports MoTIC fortification levels of the food vehicle in question, but does not have legal maize, oil) (2016) maize, oil) documentation that has the effect of mandating fortification. 3.5.6 Presence of policies to reduce the impact of marketing of foods and No (2016) Yes Annual reports MoH non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt on children. 3.5.7 Presence of maternity protection law/regulations in line with No (2011) Yes Annual reports MoGLSD the International Labour Organization Maternity Protection Convention, 2000 (No. 183) and Recommendation No.191. 3.5.8 Presence of legislation/regulation fully implementing the International Full Full Annual reports MoH Code of Marketing of Breastmilk Substitutes (resolution WHA34.22) and subsequent relevant resolutions adopted by the World Health Assembly. 3.5.9 Percentage of local governments with enacted by-laws and No data 30% Annual review reports MoLG ordinances on nutrition. Outcome 3.6: Improved nutrition evidence and knowledge management along with multi-sectoral nutrition information system for effective decision making. 3.6.1 Level of achievement of ‘UNAP II’ targets. No data 100 Annual reports OPM 3.6.2 Proportion of ‘UNAP II’ baseline indicators up-to-date No data 80 Annual reports OPM and updated. UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 81

Annexe 4 ‘UNAP II’ ROLLOUT AND IMPLEMENTATION ROAD MAP 2020/21-2024/2025 ACTIVITY TIME FRAME OUTPUT RESPONSIBILITY POTENTIAL PARTNERSHIPS 2020/21 2021/22 2022/23 2023/24 2024/25 1 Production of a simplified reader- 2,000 copies printed and OPM UNAP Secretariat UNICEF, USAID, DFID, EU, friendly version of ‘UNAP II’ and circulated WHO, FAO and CSOs the Nutrition policy 2 High-level launch of ‘UNAP II’ Government and OPM ‘UNAP II’ UNICEF, USAID, DFID, EU, at the national level non-governmental leaders are Secretariat WHO, FAO and CSOs aware of ‘UNAP II’ and commit to supporting its implementation 3 Finalise and disseminate standard National and LLG actors are OPM UNAP Secretariat UNICEF, USAID, DFID, EU, operating procedures for nutrition sensitized on the standard WHO, FAO and CSOs coordination structures aligned to operating procedures nutrition ‘UNAP II’ 4 Conduct a stakeholders mapping A catalogue of ‘UNAP II’ OPM UNAP Secretariat UNICEF, EU and CSOs and capacity assessment and stakeholders, Geographic and line ministries design a capacity development Information System maps, framework capacity gaps and a capacity development 5 Support the establishment Functional DNCCs and SNCCs in MoLG NDPG and implementing and functionality of nutrition all districts CSO partners coordination structures at DLGs, and LLG level 6 Develop and roll out MEAL Functional MEAL plan supported OPM UNAP Secretariat NDPG and implementing system for ‘UNAP II’ by stakeholders at all levels and line ministries CSO partners 7 Finalise nutrition expenditure Functional resource mobilization OPM UNAP Secretariat NDPG and implementing review and tracking plan for ‘UNAP II’ and line ministries CSO partners with clear commitments and accountabilities 8 Conduct detailed costing of Costing of ‘UNAP II’ and OPM UNAP Secretariat NDPG and implementing ‘UNAP II’ and resource resource mobilization, and line ministries CSO partners mobilization, financing and financing and tracking plan tracking plan for ‘UNAP II’ for ‘UNAP II’ developed UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 82 ACTIVITY TIME FRAME OUTPUT RESPONSIBILITY POTENTIAL PARTNERSHIPS 2020/21 2021/22 2022/23 2023/24 2024/25 9 Develop nutrition investment Nutrition investment case OPM UNAP Secretariat NDPG and implementing case developed and line ministries CSO partners 10 Develop the NACS strategy for Revised NACS OPM UNAP Secretariat NDPG and implementing ‘UNAP II’ and disseminate it at and line ministries CSO partners the national and LLG level 11 Training packages for NACSII Training packages for OPM UNAP Secretariat NDPG and implementing developed NACSII developed and line ministries CSO partners 12 Provide technical support to 146 DNAPs produced OPM and relevant Implementing partner LLGs to develop nutrition line ministries CSOs action plans aligned to ‘UNAP II’ 13 Conduct sensitization/ Oriented and sensitized MoLG NDPG and implementing orientation/dissemination DNCCs CSO partners workshops and ‘UNAP II’ at national the national level and in LLGs 14 Orient all district local councils DNAPs are aligned to the MoLG NDPG and implementing (V and III) on ‘UNAP II’ and DDPs and allocated funds CSO partners DNAPs in the district budget 15 Provide technical and advisory SUN networks are OPM UNAP Secretariat NDPGs, implementing support to SUN networks established and are partners/CSOs functional 16 Conduct annual national Progress reports on OPM UNAP Secretariat NDPGs, implementing ‘UNAP II’ progress review fora ‘UNAP II’ implementation partners/CSOs 17 Conduct annual sub-regional Progress reports on MoLG NDPGs, implementing ‘UNAP II’ progress ‘UNAP II’ implementation partners/CSOs review fora 18 Conduct annual national Progress reports and OPM and relevant NDPGs, implementing nutrition reviews renewed stakeholder line ministries partners/CSOs commitments 19 Midterm evaluation and Summative evaluation OPM UNAP Secretariat NDPGs, implementing review of ‘UNAP II’ report SUN Coordinator partners/CSOs 20 Summative evaluation for Summative evaluation OPM UNAP Secretariat NDPGs, implementing ‘UNAP II’ report SUN Coordinator partners/CSOs UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 83

Annexe 5 INFORMATION ON OUTSTANDING ‘UNAP II’ IMPLEMENTATION COMPONENTS Background Nutrition stakeholders agreed in July 2019 to focus on clarifying the ‘UNAP II’ strategic direction, implemen- tation and coordination framework and M&E framework, with other detailed components to be developed after the ‘UNAP II’ is validated. This was informed due to the fact that ‘UNAP II’ has delayed for more than two years, and there was a high risk of missing out on key developments such as integrating nutrition in the ‘National Development Plan III’. Furthermore, mobilization of financial resources and technical support to cover the five components listed below would have taken more than 12 months. The table below describes the five components that are important in ensuring successful implementation of ‘UNAP II’, together with the indicative timelines it will take to develop each component5. These activities are already part of the ‘UNAP II’ implementation matrix and road map. TABLE 5 FIVE ESSENTIAL COMPONENTS FOR THE SUCCESSFUL IMPLEMENTATION OF ‘UNAP II’ COMPONENT ESTIMATED TIMELINE 1 Comprehensive nutrition expenditure review, costing of ‘UNAP II’, development Ten months of nutrition investment case and development of nutrition resource mobilization and tracking plan. 2 Multi-sectoral MEAL system for ‘UNAP II’ (MEAL plan, MEAL tools, capacity Seven months building plan for MEAL, indicator dashboard, nutrition repository etc.). 3 Institutional and technical capacity assessment and development of capacity Nine months development framework for nutrition. 4 Development of multi-sectoral nutrition advocacy, communication and social Six months mobilization plan. 5 Development of common results, accountability and coordination plan Five months (including a nutrition commitments scorecard). It is important to note that components one (supported by UNICEF) and two (supported by the EU under the NIPN project) already have partial financial and technical support, and have started. This will save a considerable amount of time, but it is essential to be mindful that a component will be implementable only when developed in full. For example, comprehensive expenditure review will be impactful if followed by costing and development of resource mobilization and tracking plan. This implies that fundraising should continue until funding to cover the entire component is secured. Some components, such as components two and five, are interrelated, thus developing them at the same time will save time and resources. Coherence across the five components is also vital. OPM and key actors should therefore ensure effective coordination, information sharing and learning across the five compo- nents. 5 Covers period of time from recruitment of technical assistance to finalization of each component. 84 UGANDA NUTRITION ACTION PLAN II | 2020/21 – 2024/25 Below are general details indicative/rough costs estimates (in USD) for each of the five components. COMPONENT UNIT UNIT COST DAYS TOTAL (USD) 1. Comprehensive nutrition expenditure review, costing of ‘UNAP II’, development of nutrition investment case and development of nutrition resource mobilization and tracking plan.6 Lead consultant 1 550 40 22,000 Sub-consultants 3 400 30 36,000 Consultation, review and validation work- 4 25,000 100,000 shops Travel, accommodation, communication, Lump sum 15,000 15,000 stationery and other costs TOTAL 163,000 2. Multi-sectoral MEAL system for ‘UNAP II’ (MEAL plan, MEAL tools, capacity building plan for MEAL, indicator dashboard, nutrition repository etc.)7 Lead consultant 1 500 40 20,000 Sub-consultant 1 350 40 14,000 Consultation, review and validation 3 20,000 60,000 workshops Travel, accommodation, communication, Lump sum 10,000 10,000 stationery and other costs TOTAL 104,000 3. Institutional and technical capacity assessment and development of capacity development framework for nutrition Lead consultant 1 650 40 26,000 Sub-consultants 3 400 35 42,000 Consultation, review and validation 3 25,000 75,000 workshops Travel, accommodation, communication, Lump sum 20,000 20,000 stationery and other costs TOTAL 163,000 4. Development of multi-sectoral nutrition advocacy, communication and social mobilization plan Lead consultant 1 450 35 15,750 Sub-consultant 1 350 35 12,250 Consultation, review and validation 4 30,000 120,000 workshops including pre-testing Communication, stationery, transportation Lump sum 15,000 15,000 and other costs TOTAL 163,000 5. Development of common results, accountability and coordination plan (including a nutrition commitments scorecard) Lead consultant 1 500 25 20,000 Sub-consultant 1 350 25 Consultation, review and validation 1 350 80,000 workshops Communication, stationery, transportation Lump sum 2,500 2,500 and other costs TOTAL 102,500 GRAND TOTAL 465,500 6 Estimated costs are exclusive financial and technical support for nutrition expenditure review and development of investment case for nutrition by UNICEF. 7 Estimated costs are exclusive of exclusive ongoing financial and technical support by NIPN project. 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