Zimbabwe National Nutrition Strategy, 2014-2018

(I) Zimbabwe National Nutrition Strategy, 2014 -2018 (ii) Zimbabwe National Nutrition Strategy, 2014 -2018 ACRONYMS ARI Acute Respiratory Infection ARNS African Regional Nutrition Strategy BF Behaviour Change Communication BFHI Baby Friendly BMFHI Baby - Friendly Hospital Initiative BMI Baby and Mother Friendly Hospital Initiative CAADP Comprehensive African Agriculture Development Program CHW Community Health Worker cIYCF Community Infant and Young Child Feeding cMAM Community - based Management of Acute Malnutrition Dps Development Partners DPT Vaccine against diphtheria, pertussis (whooping cough), and tetanus DRM Disease Related Malnutrition EBF Exclusive Breastfeeding ECD Early Childhood Development EH Environmental Health EHTs Environmental Health Technician ENA Essential Nutrition Actions EPI Expanded Programme on Immunization FNC Food and Nutrition Council FNSAG Food and Nutrition Security Advisory Group FNSCs Food and Nutrition Security Committees FNSP Food and Nutrition Security Policy GAIN Global Alliance for Improved Nutrition GAM Global Acute Malnutrition GDP Gross Domestic Product GMP Growth Monitoring and Promotion GNP Gross National Product GOZ Government of Zimbabwe HDDS Household Dietary Diversity Score H.E His Excellency HFSS Health Facility Systems Strengthening HIV Human Immunodeficiency Virus HMIS Health Management Information System IDD Iodine Deficiency Disorder IMAM Integrated Management of Acute Malnutrition IMCI Integrated Management of Childhood Illness ITNs Insecticide Treated Nets IYCF Infant and Young Child Feeding KABP Knowledge, Attitudes, Beliefs, and Practices KRAs Key Result Areas TABLE OF CONTENTS (iv) Zimbabwe National Nutrition Strategy, 2014 -2018 ACRONYMS……………………………………………………………………… (ii) FOREWORD…………………………………………………………………….... 1 PREFACE…………………………………………………………………………. 3 EXECUTIVE SUMMARY………………………………………………………... 5 STRUCTURE OF THE NATIONAL NUTRITION STRATEGY ……………… 8 INTRODUCTION…………………………………………………………………. 17 VISION, MISSION AND GUIDING PRINCIPLES……………………………. 23 ENVIRONMENTAL SCAN……………………………………………………… 26 KEY RESULT AREAS…………………………………………………………... 34 CLIENT NEEDS AND PROBLEM ANALYSIS……………………………….. 37 STAKEHOLDER ANALYSIS…………………………………………………… 40 POLICY REQUIREMENTS……………………………………………………... 41 GOALS……………………………………………………………………………. 42 STRATEGIES, ASSUMPTIONS AND RISKS………………………………... 44 IMPLEMENTATION PLAN……………………………………………………… 54 STRATEGIC RESULTS CHAIN AND MONITORING AND EVALUATION FRAMEWORK…………................................................................................ 58 RESOURCE REQUIREMENTS………………………………………………... 65 ANNEX 1 GLOSSARY OF TERMS………………………………………... 68 ANNEX 2 REFERENCES…………………………………………………… 75 ANNEX 3 DETAILED ACTIVITIES, ANNUAL OUTPUT TARGETS AND COSTS……………………………………………………… 78 1 Zimbabwe National Nutrition Strategy, 2014 -2018 On 16 May 2013, His Excellency the President Cde. R. G. Mugabe launched the Food and Nutrition Security Policy (FNSP) of Zimbabwe whose goal is to “promote and ensure adequate food and nutrition security for all people at all times in Zimbabwe, particularly amongst the most vulnerable and in line with our cultural norms and values and the concept of rebuilding and maintaining family dignity”. Food and nutrition security exists when all people, at all times have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs for a healthy and productive life. On the other hand, food and nutrition insecurity leads to the vicious cycle of malnutrition, increased susceptibility to disease, impaired mental and physical development, reduced productivity and poverty, resulting in compromised respectability an dignity. Zimbabwe faces a growing level of chronic malnutrition which is exacerbated by food insecurity and deepening poverty. This challenge is certainly beyond the capacity of a single sector or agency to address, hence requires multi-sectoral interventions. To this end, the Government of Zimbabwe (GOZ) has developed a National Nutrition Strategy (NNS) 2014-2018 whose main objective is to implement Commitment V (5) of the Food and Nutrition Security Policy. Commitment V (5) of the FNSP states that the GOZ is committed to ensuring nutrition security for all through the implementation of evidence based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation. Indeed, these efforts are in line with the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (Zim Asset) which has identified Food Security and Nutrition as one of the Four Clusters and pillars for implementation in the next five years. The Food and Nutrition Security Policy and its implementation matrix provide a holistic framework in which the National Nutrition Strategy will address the challenges of malnutrition in a multi- sectoral manner. Further, the reconstitution of the Food and Nutrition Security multi stakeholders Committees at the National Provincial, District and Ward level will buttress the implementation of the National Nutrition Strategy. FOREWORD FOREWORD Zimbabwe National Nutrition Strategy, 2014 -2018 2 The implementation of the Strategy will require the participation and involvement of stakeholders at all levels from the community to the national level, including the public sector (Line Ministries, Agencies and Local Government Authorities); higher learning and training institutions, professional bodies, private sector, development partners, civil society, the media and the community at large. Addressing issues of nutrition security remains top on the agenda of Government, and as such the Government of Zimbabwe shall assume primary responsibility for resource mobilisation funding the strategy and delivering targets set while development partners will complement Government efforts. The Ministry of Health and Child Care’s National Nutrition Department shall spearhead the implementation of the strategy with the Food and Nutrition Council maintaining its coordination role of multiple stakeholders. Government sincerely appreciates and acknowledges all the support rendered by various stakeholders. Hon. E. D. Mnangagwa Vice President of the Rebuplic of Zimbabwe PREFACE Zimbabwe National Nutrition Strategy, 2014 -2018 3 Malnutrition is one of the most serious health problems affecting infants, children and women of reproductive age in Zimbabwe. Despite progress to date, millions of children and women in Zimbabwe continue to suffer from one or more forms of under nutrition, including low birth weight, stunting, anaemia, underweight, wasting, Vitamin A deficiency, and Iodine deficiency disorders. Scientific evidence has shown that chronic under nutrition of a child below the age of 2 years leads to irreversible long term effects. Malnutrition increases the likelihood of Non-Communicable Diseases (NCDs) in latter life, such as, cancer, diabetes and cardiovascular disease. Such non-communicable diseases cause the death of 8 million people in developing countries before they reach 60 years of age. Poor nutrition affects the performance of children in school; it affects economic productivity in adults, thereby affecting overall productivity of a nation. It is undebatable that addressing malnutrition brings considerable economic and social benefits as it reduces mobility and mortality; leads to resource savings in health; improves education outcomes; enhances productivity and increases incomes. Improved nutrition will contribute to six of the Millennium Development Goals (MDGs) including goals for the eradication of extreme poverty and hunger, reduction of child mortality and improved maternal health. It is therefore imperative that efforts to prevent malnutrition are redoubled so that women and children are protected from detrimental effects of being malnourished. To this end, the Government of Zimbabwe, has developed a National Nutrition Strategy (NNS) 2014-2018 whose Vision is “a Zimbabwe free from hunger and malnutrition”, and its Mission is to: “implement evidence based nutrition interventions that are integrated within a broad multi-sectoral collaboration framework”. The National Nutrition Strategy is in line with and will contribute to the Food and Nutrition Security Policy and its Implementation Matrix. The NNS identifies that maternal malnutrition from conception, during pregnancy and through lactation and particularly maternal short stature and iron deficiency anaemia are associated with increased risk of stillbirths, miscarriages, low birth weight, maternal and infant mortality. Maternal overweight and obesity are associated with maternal morbidity, pre-term birth and increased risk of infant death. In addition, maternal micronutrient deficiencies are associated with low birth weight in infants and increased risk of maternal morbidity and mortality. PREFACE Zimbabwe National Nutrition Strategy, 2014 -2018 4 The MOHCC adopts essential nutrition actions for improving maternal, newborn, infant and young child nutrition and health at health facility and community levels. This set of high impact nutrition interventions includes maternal iron, folate, Vitamin A, iodine and calcium supplementation, use of Insecticide Treated Nets (ITNs), family planning and adequate birth spacing, and nutritional care and support for pregnant and lactating women in emergencies. The MOHCC, health facility and community based service delivery platforms adopts this standard maternal nutrition package and implements it at scale, as a proven strategy to decrease under-nutrition during pregnancy and lactation as well as have positive nutrition outcomes for the infant. The NNS also adopts appropriate infant and young child feeding practices that contribute to improvements in early childhood nutrition, reduces under-nutrition, and also contributes to improved health outcomes in children. Additionally, strengthening clinical nutrition services in prevention and management of non-communicable diseases, HIV/AIDS and related opportunistic infections and promotion of healthy lifestyles as a preventive measure has been incorporated into the NNS. Apart from this, ensuring that nutrition surveillance systems provide timely, complete and accurate information on the nutritional status of all people is a priority for the NND. Research that informs the development of high impact strategies needed for the reduction of prominent nutrition problems in the country is given prominence in the NNS. The NNS also strengthens advocacy to ensure that the evidence obtained from research and evaluation of nutrition programmes is used to sensitize decision makers in government, stakeholders and funders. The MOHCC shall lead the implementation of strategies in collaboration with other ministries, seizing on the coordination efforts of the Food and Nutrition Council by bringing in other development partners, non-governmental organisations (local and international), the private sector, and UN agencies and communities to comprehensively address malnutrition problems. The private sector's role in food fortification and developing the value chain for nutritious foods is supported, so is capacity building of community level structures and systems for sustaining government and development partner efforts in addressing the aforesaid nutrition challenges. Facilitation of behaviour change to improve nutrition practices of children and the adult population is a key area of investment of the strategy. The MOHCC shall take advantage of available platforms for collaborative work in reducing all forms of malnutrition, utilising international and national laws, policies and proven- international and local best practices to improve the nutritional status of the citizens of the county. Zimbabwe remains committed to intensifying its efforts at addressing nutrition in the context of the broader regional and global initiatives and commitments under the Scale-Up Nutrition (SUN) Movement. Dr P. D. Parirenyatwa (Senator) Minister of Health and Child Care Zimbabwe National Nutrition Strategy, 2014 -2018 EXECUTIVE SUMMARY BACKGROUND The Zimbabwe National Nutrition Strategy (NNS) for 2014 to 2018 was developed following a wide consultative process of all stakeholders to food and nutrition issues in government, the private sector, non-governmental organisations (NGO), the UN, community-based organisations and the community at large. The first objective of the strategy is to operationalize Commitment V of the Food and Nutrition Security Policy which states that the Government of Zimbabwe (GOZ) is committed to ensuring nutrition security for all through the implementation of evidence-based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation. The second objective is to contribute towards making further progress against the other Scaling up Nutrition (SUN) targets. Over the last 30 years, Zimbabwe made remarkable progress in reducing both underweight and wasting in children under the age of five years. Multi-sectoral approaches involving the Ministry of Agriculture, Health and others were important in ensuring the successes. Nevertheless the prevalence of underweight has continued to be 10% or above (10% in 1999, 13% in 2005, 10% in 2010/11,11% in 2012) according to various sources including the ZDHS 2010/11 and the Micronutrient Survey of 2012 and not meeting the MDG 2015 target of reducing it by half. Moreover, the high prevalence of stunting in children under-five years of age remains Zimbabwe's top nutrition challenge. In 2010, 32% of children below five years were found stunted (ZDHS, 2010/11). In addition, the results of the MNS, 2012 indicate a slight improvement to 30%. However, the prevalence of stunting (of 30% on average, 33% in male children and above 40% in some districts) remains at an unacceptably high level, with significant social and economic consequences on the country. Currently, an estimated 161,105 children die before their fifth birthday (under-five mortality rate (U5MR) of 84/1000) according to UNICEF Information by country, 2011. Although the causal factors are many, malnutrition is one of the leading underlying causes of under-five deaths. Prevalence of micronutrient deficiencies is high across all age groups of the Zimbabwean population. Vitamin A deficiency affects 19% of under-fives, 25% of children living with HIV, 23% of women (15-49 years of age) and 27% of rural women (MNS, 2012). It also affects 35.8% of pre-school children and 20% of pregnant women according to the WHO 1999. About 58% of pre-school children are also anaemic (Hb<11 g/dl), together with 47% of pregnant women (ZDHS, 2005-06), and iodine deficiency affects all population groups, with recent studies showing that one-out-of every six school children is iodine deficient (15.5%) (MoHCW and UNICEF, 2009). The main causal factors of the above situation in Zimbabwe are summarized below: 1) Inadequate knowledge and practices regarding appropriate and healthy diets for children and adults, especially among mothers and caregivers of children in the first 1,000 days of their life; 2) Weak value chain for nutrient-dense foods (processed and unprocessed); 5 3) Weak coordination and inadequate resourcing of nutrition interventions in the country resulting in service coverage that is below scale, comprehensiveness and quality recommended for high impact interventions; 4) Inadequate knowledge and practices in relation to water, sanitation and hygiene (WASH) and other pro-health seeking behaviours (such as immunisation, family planning and malaria control), especially among mothers and caregivers of children under the age of five years; 5) Absence of tailored nutrition services to meet needs of adolescents and adults outside the scope of regular maternal and child nutrition services; 6) Weak capacity of systems for delivery of community-based nutrition services; 7) Nutrition-blind social protection and other sectoral services; and 8) Inadequate information to guide the design of relevant nutrition interventions, and assessment of progress made by on-going nutrition services within the Zimbabwean context. The consequences of nutritional deficiencies and disorders are significant; so are the benefits of investing in efforts to address them. There is strong international evidence that eliminating under nutrition saves lives, prevents more than one-third of child deaths per year, and reduces the burden of disability for children under five by more than half according to Black R. E. et al. The evidence from recent World Bank studies also shows that tackling under-nutrition will result in significant economic benefits both now and in the long term. Productivity in agriculture, industry and other sectors will increase due to better health of the working population and this will contribute to an increase in gross national product (GNP) of between 2% and 8% in Africa (and potentially further up to 11% in high burden countries). These studies also show that reducing stunting will result in school attainment being increased by at least one year. The combination of higher levels of education and improved health of the workforce will result in an increase in lifetime wages of between 5% and 50%, hence a reduction in poverty. Children who are not stunted are 33% more likely to escape poverty as adults. Stunted mothers are three times more likely to have malnourished infants. In addition, women who are well nourished as girls are 10% more likely to own their own business when they become adults. The negative effects of under-nutrition are compounded by those of overweight and obesity which are rising in Zimbabwe contributing to an increase in incidence of chronic and non-communicable diseases (NCDs). In Zimbabwe, 10.6% of the population is obese and the problem is worse among women in urban areas where 41% are overweight or obese, compared with 26% of rural women (ZDHS 2010/11). In Zimbabwe, obesity worsens with higher income levels. Obesity among people in the highest income quintile is four times that for the lowest quintile. The human and economic consequences of the current micronutrient deficiencies in the Zimbabwean population are grave. About 7,700 children and mothers are dying every year due to micronutrient deficiency (iron, vitamin A, zinc, and folic acid). Cognitive growth losses in children will debilitate about 900,000 of the current population of under-fives resulting in future productivity deficits equivalent to USD16 million in annual GDP. In adults, productivity performance deficit is estimated to affect more Zimbabwe National Nutrition Strategy, 2014 -2018 6 Zimbabwe National Nutrition Strategy, 2014 -2018 STRUCTURE OF THE NATIONAL NUTRITION STRATEGY The structure and content of the NNS follows the GOZ results-based management (RBM) template for strategic planning released in 2010. The strategy is presented in 16 chapters based on this. The first chapter is the introductory one followed by subsequent NNS chapters with the vision; mission; guiding principles; terms of reference for the NND; functions of the NND; an environmental scan; key result areas (KRAs) together with their impact and weighting; responsible institutions; client needs, problems and causes; stakeholder analysis; policy requirements (internal and external); goals of the NNS; main strategies, assumptions and risks for each KRA of the strategy; the strategic results chain highlighting the description of the result, the indicators to be used for performance measurement and aspects to be measured, annual targets for impact and outcome indicators and allowable deviations from the set milestones; the monitoring and evaluation framework; and lastly the magnitude and type of resources required to successfully implement the strategy. The NNS will guide individual sectors in mainstreaming nutrition into the sector plans which will be developed and or reviewed in due course. Notably the NNS is not a road map for a single ministry or department since it is multi-sectoral in nature. However, it is a given that the main driver of the strategy will be the MOHCC through the NND. In light of this, the NNS was developed using a highly participatory bottom-up process involving all sectors starting in June 2013 and ending in December 2013. VISION AND MISSION A vision of “a Zimbabwe free from hunger and malnutrition” and a mission to “implement evidence based nutrition interventions that are integrated within a broad multi-sectoral collaboration framework” serve as the NNS' fundamental guides in establishment of the country's strategic objectives. To this end, the NNS emphasises prevention of malnutrition especially focusing on addressing stunting during the first 1,000 days of life together with a broader mandate to address malnutrition problems affecting the other age-groups of children 2 years and above, adolescents and adults, both females and males, rural and urban, poor and wealthy. At programme execution level, the NNS is designed to address stunting, infant and young child malnutrition, nutrition-related non-communicable diseases, and micronutrient deficiencies in children and adults by solving eight main causal factors contributing to these problems, using high impact interventions informed by the UNICEF conceptual framework for nutrition. GUIDING PRINCIPLES OF THE NATIONAL NUTRITION STRATEGY Ten guiding principles inform the implementation conundrum of the strategy namely: Guiding Principle 1: Nutrition is a basic human right and will be safeguarded for all age groups and social and economic strata. 8 Guiding Principle 2: Evidence-based programming: The NNS will prioritise investments in proven and universally accepted high-impact nutrition interventions to maximise results from limited resources. Evidence generation on barriers to the uptake of optimal maternal and child nutrition behaviours will be a top priority. Guiding Principle 3: Collaborative and coordinated action across multiple sectors: The NNS strengthens collaboration across sectors, minimises duplication, and fosters collective accountability towards a shared goal of nutrition security for all. Guiding Principle 4: Community empowerment and participation: Communities as rights holders should be empowered to identify, prioritise and respond to their nutrition challenges, barriers and bottlenecks. Support of government and development partners is required to enhance these community led initiatives by addressing barriers at household, community, district and national levels. Guiding Principle 5: Overcoming barriers to the uptake of optimal maternal and child nutrition behaviours: Addressing knowledge gaps and promoting sustainable nutrition social behaviour change will remain a core cross-cutting strategy for the NNS. Guiding Principle 6: Life-cycle approach: The NNS recognises that key nutritional impact towards reducing stunting is achieved by interventions reaching children in their first 1,000 days of life. However, broader public health nutrition interventions should be provided throughout the life-cycle, tailored to specific needs at each stage, in order to ensure nutrition security for all. Guiding Principle 7: Continuum of care: Health facility based services alone are not adequate to address nutrition security. Therefore the NNS recognises the need for nutrition services to be provided in an integrated manner that links health facility care and support with community based nutrition services. Guiding Principle 8: Ensuring equity and inclusiveness: The NNS ensures that nutrition needs of the whole populace are addressed, and no part of the population is left out as a result of religion, poverty, gender, age, race, geographical location or political orientation. Guiding Principle 9: Emergency preparedness and risk mitigation are central to nutrition security: The NNS recognises the role and impact of climate change related disasters on nutrition security and incorporates strategies that ensure early warning, emergency preparedness and risk mitigation. Guiding Principle 10: Good governance for nutrition security: The NNS defines clear roles and responsibilities and fosters accountability of multi-sectoral actors at various levels from national down to community level. LEGISLATIVE, POLICY AND INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION To complement and deepen commitment to these guiding principles is a comprehensive legislative and policy framework that conforms to international, regional, national and sub-national contexts in food and nutrition security and related matters. Zimbabwe National Nutrition Strategy, 2014 -2018 9 Nationally, the Zimbabwe Agenda for Socio Economic Transformation (ZimAsset) is a government driven economic blue print with a cluster-based thrust in four thematic areas of food and nutrition security; social services and poverty eradication; infrastructure and utilities and value addition and beneficiation. As an all-encompassing policy, ZimAsset has mandates for each cluster to have policies, strategies with a monitoring and evaluation framework complete with outcome and impact indicators that conforms to the GOZ's RBM system. The Food and Nutrition Security Cluster has among many policies the FNSP, with GOZ backed commitments to Policy Analysis and Advice; Agriculture and Food Security; Social Assistance and Social Protection; Food Safety and Standards; Nutrition Security; Food and Nutrition Security Information; and Enhancing and Strengthening National Capacity for Food and Nutrition Security. The NFNSP fosters a multi-sectoral approach to solving food and nutrition security problems in the country. The coordination mechanism to achieve results, has a national and sub-national structure on food and nutrition that reaches up to the ward level. At national level, the Office of The President and Cabinet (OPC) is at the helm of the food and nutrition security implementation framework. The Cabinet Committee on Food and Nutrition Security chaired by the Honourable Vice-President reports to the Cabinet and below the Cabinet Committee on Food and Nutrition Security is the Working Party of Permanent Secretaries that is chaired by the Deputy Chief Secretary and involves 17 critical ministries. Below the WPPS is the FNC which coordinates the Zimbabwe Vulnerability Assessment Committee (ZIMVAC) and the Food and Nutrition Security Advisory Group (FNSAG) and these bodies are composed of government, NGOs and the UN partners at different levels of responsibility. Below this level is the National Food and Nutrition Security Committees (NFNSC/ PFNSC/ DFNSC/ WFNSC) with structures at provincial, district and ward levels. All the sub-national structures interact with development committees at both provincial and district level to discharge the mandate of the food and nutrition security implementation matrix. Not withstanding the policy and legislative framework as put forth by ZimAsset, FNSP and other relevant legislation and policy pronouncements the NNS is bound by, there are several hurdles to the smooth implementation of the strategy. The less conducive macroeconomic environment characterised by deflation, low foreign direct investment, high unemployment rate, depressed economic growth figures and changing climatic conditions negatively impacting on food and nutrition security are prominent examples. KEY RESULT AREAS GOALS AND STRATEGIES The content of the strategy is 6 KRAs and 19 goals, 66 strategies and several specific activities under each KRA and Strategy. High impact interventions as mentioned in the Lancet 2013 series and Copenhagen Consensus are at the core of the strategy and, along with local evidence on what works, have guided prioritisation of interventions in the NNS (2014-2018). 1) KRA 1 Adolescent and Maternal Nutrition Services a. Goal 1: Coverage of health and community nutrition services for adolescents increased to 50% by 2018 b. Goal 2: Standard maternal health and nutrition package scaled up to 90% coverage by 2018 Zimbabwe National Nutrition Strategy, 2014 -2018 10 c. Goal 3: 50% of women of reproductive age have positive support from spouses and communities for decisions on maternal health, nutrition, healthy lifestyles and safe living environment by 2018. 2) KRA2: Infant and Young Child Nutrition a. Goal 4: All health institutions provide the standard IYCF package (BMFHI, BF, CF, multiple micronutrient supplementation and fortification, dietary diversification, disease prevention and management, nutrition interventions in emergencies, feeding behaviours and stimulation, PMTCT, WASH and IMAM) by 2018 b. Goal 5: Community IYCF counseling package increased from 44% to 100% of districts and in at least 90% of the wards by 2018 c. Goal 6:Coverage of growth monitoring and promotion for under-fives increased from 2 districts to 20 districts by 2016 and to 40 districts by 2018 and covering 5 wards per district by 2018 3) KRA3 Clinical Nutrition Services a. Goal 7: To increase the proportion of the adult population practicing at least one or a combination of the top 5 healthy lifestyles to 40% by 2018 b. Goal 8: Proportion of health facilities (central, provincial, mission and district hospitals) providing quality nutrition services for communicable (schistosomiasis, HIV, malaria, soil transmitted helminthes) and non-communicable diseases increased to 75% by 2018. c. Goal 9: 30% of institutions adopt national food service and nutrition guidelines by 2018. 4) KRA4 Enhancing the Quality of Nutrition Information Systems and Effectiveness of Advocacy a. Goal 10: Timely availability of relevant nutrition information that incorporates disaster risk reduction at all levels adequate for disaster preparedness planning and nutrition programming by 2018. 5) KRA 5 Strengthening Multi-sectoral Coordination and Collaboration for Integrated Nutrition Response a. Goal 11:80% of women of reproductive age have the capacity to safely provide for their food, health and nutrition security using appropriate technologies b. Goal 12: Coverage of health and community nutrition services for school children increased to 50% by 2018 c. Goal 13: All provinces and districts have Food and Nutrition Security Committees that are fully discharging their terms of reference by 2014, 50% of ward level committees functioning by 2018 d. Goal 14: To increase the proportion of households consuming safe and acceptable diets all year round to at least 80% by 2018 e. Goal 15: Scale up evidence-based nutrition sensitive interventions in social protection services to 80% coverage by 2018 Zimbabwe National Nutrition Strategy, 2014 -2018 11 f. Goal 16: At least 50% of community based health workers promote WASH related behaviour change whilst integrating nutrition messaging by 2018 g. Goal 17: To ensure that at least 50% of imported and locally produced foods are evaluated for safety by 2018. 6) KRA6 Capacity Development for Nutrition Service Delivery and Resource Mobilization a. Goal 18:To ensure that the National Nutrition Department has a critical mass of staff with the ability, tools, supportive supervision and resources to integrate nutrition into other sectors b. Goal 19: To increase resource allocation to nutrition to 1% of GDP per year by 2018. Overall, the KRAs, goals, strategies, activities, indicators and performance targets for the NNS reflect the emphasis that has been put in comprehensively addressing the multiple nutrition-related problems according to the key result areas 1-6. The NNS identifies that maternal malnutrition from conception, during pregnancy and through lactation and particularly maternal short stature and iron deficiency anaemia are associated with increased risk of stillbirths, miscarriages, low birth-weight, maternal and infant mortality. Nutritional status of a mother at conception clearly determines the size of and growth of the foetus (Kramer and Kakuma, 2003). Maternal overweight and obesity are associated with maternal morbidity, pre-term birth and increased risk of infant death. Also maternal micronutrient deficiencies are associated with low birth weight in infants and increased risk for maternal morbidity and mortality. The Lancet series 2013 clearly identifies the need to address the nutritional needs of a woman from conception through the second birthday of her child in order to promote good nutrition outcomes for both mother and infant. The WHO has identified essential nutrition actions for improving maternal, newborn, infant and young child nutrition and health at health facility and community levels. This set of high impact nutrition interventions includes maternal iron, folate, Vitamin A, iodine and calcium supplementation, use of ITNs, family planning and adequate birth spacing, and nutritional care and support for pregnant and lactating women in emergencies and to be implemented at scale at health facility and community levels for maximum effect. The NNS, therefore, adopts this standard maternal nutrition package for implementation through health facility and community platforms. Primary focus is on preventive strategies, like capacitating community and health facility workers to deliver the standard adolescent and maternal nutrition package, promoting nutrition education through the school curriculum, using community platforms to promote behaviour change on reproductive and sexual health and nutrition, and strengthening planning and management of adolescent and maternal nutrition programmes. Zimbabwe National Nutrition Strategy, 2014 -2018 12 IMPLEMENTATION PLAN Short to medium term mobilisation of resources for nutrition, institutional strengthening of the NND and other agencies responsible for implementation of the NNS has been prioritised. Additionally, recruitment of staff, strengthening of nutrition-related training programmes for health professionals and procurement and distribution of complementary job aids and working tools is top on the priority list. Priority focus in the short term is on children under the age of two years. This will be achieved through strengthening adolescent and maternal nutrition and community IYCF services. Other key areas identified include development and dissemination of information, education and communication materials, effective delivery of IMAM services, micronutrient supplements to adolescent girls, de worming; micronutrient supplementation to women aged 15 - 49 years, pregnant women and women post-partum and supplementary feeding for pregnant and lactating women with acute malnutrition. Implementation of the national food fortification strategy will be prioritised within the first 2 years as this is also essential for reducing anaemia in children under the age of five. Other short to medium term interventions prioritised include: Promotion of BCC on maternal and adolescent health, SRH, hygiene and nutrition targeting adolescents using community platforms and addressing the gap observed in adolescent nutrition services which are either absent or have very limited coverage. Generating evidence for strengthening nutrition programming, strengthening coordination of the multi-sectoral collaboration and coordination approach, and development, printing and dissemination of policies, standards and implementation guidelines. Development of a BCC strategy on healthy lifestyles, reviewing and updating IEC/BCC materials on healthy life styles, promoting social behavioural change on healthy lifestyles using various types of mass media, carrying out social outreach activities and development of a protocol on prevention and management of NCDs. In the long term focus is given to: Strengthening the multi-sectoral approach including development of nutrition social marketing tools for the school environment, Strengthening the integration of nutrition into education, social protection, agriculture and health Integration of nutrition into water, sanitation and hygiene promotion activities is considered paramount but not a short term undertaking. Strengthening of the national system for promoting food safety, post-harvest handling to increase shelf life and food safety of harvested foods will be on-going. Advocacy for increased production of small live-stock, aquaculture and apiculture and consumption of animal source protein foods, Research and development of improved varieties of bio-fortified seeds, and awareness promotion and demand creation for nutritious foods, with an emphasis on production, processing, preservation, storage and preparation of a more diverse food basket. Zimbabwe National Nutrition Strategy, 2014 -2018 13 The NNS also promotes the integration of nutrition into social protection from a longer term perspective. Integration of nutrition education and BCC into all social assistance programmes shall be part of the NNS. Other long term strategic interventions include integrating nutrition sensitive DRM into sector programmes and budgets, integrating nutrition indicators into targeting, monitoring and evaluation systems for social protection programmes, and provision of timely social safety nets in emergencies and crisis situations that meet universally accepted minimum standards and national food and nutrition standards MONITORING AND EVALUATION Core indicators at impact levels like proportion of under-fives who are stunted by age group (stunting expected to be reduced by 1% annually), proportion of low birth-weight babies, incidence of type II diabetes and hypertension among adults, infant mortality rate (IMR), maternal mortality ratio and child mortality rate will be used to assess the impact of the strategy. Outcome indicators will be the following: rates of exclusive breastfeeding, dietary diversity rates for different age categories, proportion of under-fives with underweight wasting categorised according to different ages of children and adults, proportion of obese and overweight individuals categorised from children to adults, proportion of under-fives, school going age children and women of child bearing age with anaemia, proportion of women of child bearing age and children below five years with vitamin A deficiency and proportion of relevant groups with urine iodine concentrations below 50µg/L. Other areas with outcome indicators relate to improvement in information systems, improvement of quality of diets in institutions of special care, improvement in hygiene practices at household levels and the proportion of GDP allocated to nutrition. Additionally, levels of increasing dietary diversity, capacity of Food and Nutrition Security Committees strengthened, proportion of budget allocated to nutrition expected to increase. The NNS M&E plan is linked to the RBM, a GOZ planning, monitoring and evaluation template through which the country's programmes are implemented and monitored. ZimAsset targets and indicators will also be part of the M&E plan. M&E Systems will be a central part of strategy implementation and tracking of results achieved. Routine administrative data collection systems will collect data on reach and coverage of nutrition services and the outcomes will be assessed through the national food consumption and ZimVAC surveys while impacts on nutrition and health status of the population will be assessed through national surveys such as the ZDHS, National Micronutrient Surveys, and National Nutrition Surveys. Nutrition indicators that have been proposed in this strategy will track results in each target group of the population covered by the strategy and will assess knowledge, behaviour change, nutrition practices, outcomes and impacts. Core indicators with a common definition and method of data collection and analysis (and interpretation) will be used to harmonize tracking of results, they will be used by each and every programme, project or intervention designed to address food and nutrition insecurity in any part of the country, regardless of its size. Additionally, some research like the cost of hunger will be commissioned and the results will be jointly used to assess the potential economic impact of the strategy and lobbying for resources. Baseline Zimbabwe National Nutrition Strategy, 2014 -2018 14 data will be established for each indicator proposed in the impact and outcome plans of the M&E system for the Strategy. Day by day activities will be monitored for alignment with the strategy, and for comprehensiveness and quality of service delivery by the National Technical Working Group (NTWG) on Nutrition and the Food and Nutrition Security Committees from national right up to community level. Citizen feedback on satisfaction with the food and nutrition services rendered will be commissioned from time to time to check on appropriateness of service coverage, quantity and quality. COST ESTIMATE The total budget of the strategy is estimated at USD599.6 million and the resources are allocated to: 1) Direct health and nutrition interventions proven to reduce stunting in under-fives by about one third if implemented at scale; 2) Critical activities such as nutrition information systems, human resources for nutrition service management and coordination, and resource mobilisation; and 3) Strengthening the multi-sectoral interventions that complement direct health and nutrition interventions. More specifically, adolescent and maternal nutrition interventions are allocated10%, IYCF – 16%, promotion of healthy lifestyles – 5%, quality information systems and advocacy - 1%, resource mobilisation - 1%, human resource costs towards filling of (district nutritionists' posts, dieticians posts, on the job training of staff and nutritionists positions across sectors) – 0.2% and anthropometric equipment – 0.2%, health and community nutrition services for school children - 10%, integrating nutrition and scaling up nutrition-sensitive interventions in social protection with a focus on strengthening disaster risk management and resilience capacities of vulnerable populations - 47%, promotion of dietary diversity at the household level - 5.6%, ensuring safety of imported and local produced foods - 3.2%, empowering women of reproductive health age to have the capacity to safely provide for their food, health and nutrition security using appropriate technologies - 0.5%, among others. FINANCING THE STRATEGY The GOZ assumes primary responsibility for resource mobilisation, funding the strategy and delivering targets set while development partners will complement government efforts. Budgeting for fiscal resource allocation, planning and implementation of strategies under each goal will be done by line ministries tasks in close collaboration with international cooperating partners, the UN agencies, NGOs, entities and the private sector. Each line ministry will also coordinate implementation and review of the specific strategies foreseen under its mandate and in collaboration and with the active engagement of all relevant stakeholders who will also be invited to support the efforts with resources. Planning and review of progress will be jointly done between ministries and partners. Overall direction and support in resource mobilisation and tracking, and strategy implementation will be provided by the MOHCC, through the NND. Zimbabwe National Nutrition Strategy, 2014 -2018 15 CONCLUSION The NNS shall be a five year roadmap for resolving mounting nutrition problems in Zimbabwe while taking advantage of programmes and strategies proven to have the highest impact in improving the nutritional status of all of the country's citizens especially the vulnerable ones. The approach shall be multi-sectoral and resources shall primarily be mobilised by the GOZ and development partners coming in to plug funding gaps. Zimbabwe National Nutrition Strategy, 2014 -2018 16 1 INTRODUCTION 1.1 Global nutrition situation Globally, Scaling-Up Nutrition (SUN) has taken centre-stage in development efforts to promote child survival, human capital development and economic growth. Worldwide, 10.6 million children below 5 1 years of age die every year . Two-thirds of the childhood deaths occur during infancy, with slightly more than one third taking place during the first month of life and closely associated with the high maternal mortality rate. About 45% of all child deaths beyond infancy are closely associated with 2 nutrition-related causes . Stunting, severe wasting and intra-uterine growth retardation are the major contributors to child mortality, accounting for about 2.3 million deaths of under-fives annually (The Lancet Series, 2013). About 43% of all deaths among under-fives occur in Africa (Black et. al., 2008). Under-nutrition is also the number one cause of morbidity for all age groups, accounting for 11% of the 3 disease burden . With regard to maternal mortality, iron deficiency is the leading cause, contributing 20% of the estimated 536,000 deaths (WHO, 2005 statistics). 1.2 Nutrition progress and challenges in Zimbabwe Over the last 30 years, Zimbabwe made remarkable progress in reducing both underweight and wasting in children under the age of five years. In the 1980s, concerted efforts were made to identify undernourished children and target them with food assistance. In the 1990s, a transition was made from food aid to community-based nutrition programmes with strong coordination between health and 4 agriculture to promote sustainability of the nutrition impact. Early success was recorded in reducing underweight prevalence in under-fives through the multi-sectoral coordination approach. The close partnership between health and agriculture, which was forged through the mechanism of the District Food and Nutrition Management Teams and a strong involvement of village health workers,was instrumental in significantly reducing the prevalence of underweight and wasting in under-fives.That Zimbabwe accomplished what few other African countries were able to after Independence is evidence that Zimbabwe can tackle its most pressing nutrition problems. Nevertheless, reducing the prevalence of under-weight in under-fives by half by the year 2015 in line with MDG Target No. 1, has remained elusive, with the rate even temporarily rising from 10% in 1999, to 13% in 2005, declining back to 10% in 2010 (ZDHS, 2010/11), then rising slightly again to 11% (according to the Micronutrient Survey (MNS) carried out in 2012). Moreover, the high prevalence of stunting in children under-five years of age remains Zimbabwe's top nutrition challenge. In 2010, one in every three children (32%) was found to be stunted (ZDHS, 2010/11), and this situation has not improved in the last decade. Results of the MNS, 2012 indicate a slight improvement to 30%. The prevalence of stunting (of 30% on average, 33% in male children and above 40% in some districts) remains at an unacceptably high level, with significant social and economic consequences on the country. Currently, an estimated 161,105 children die before their fifth birthday (under-five mortality 5 rate (U5MR) of 84/1000) . Although the causal factors are many, malnutrition is one of the leading underlying causes of under-five deaths. Prevalence of micronutrient deficiencies is high across all age groups of the Zimbabwean population. Vitamin A deficiency affects 19% of under-fives, 25% of 1 The Lancet Series on Nutrition, 2008, Executive Summary. 2 The Lancet Series on Nutrition, 2013 (Executive Summary) indicates that the causes include foetal growth restriction (among children <1 month), stunting (1-59 months), under-weight (1-59 months), wasting (1-59 months), severe wasting (1-59 months), zinc deficiency (12-59 months), Vitamin A deficiency (6-59 months), and sub-optimal breastfeeding (0-23 months). 3 The Lancet Series on Nutrition, 2008. 4 Zimbabwe IYCF Programme Review, 2012. 5 UNICEF, 2011, Information by Country: Zimbabwe Statistics, DHS, 2010/11. 17 children living with HIV, 23% of women (15-49 years of age) and 27% of rural women (MNS, 2012). It 6. also affects 35.8% of pre-school children and 20% of pregnant women About 58% of pre-school children are also anaemic (Hb<11 g/dl), together with 47% of pregnant women (ZDHS (2005-06)), and iodine deficiency affects all population groups, with recent studies showing that one-out-of every 7 six school children is iodine deficient (15.5%)(MoHCW and UNICEF (2009)) . There are eight main causal factors contributing to the above situation and these are: 1. Inadequate knowledge and practices regarding appropriate and healthy diets for children and adults, especially among mothers and caregivers of children in the first 1,000 days of their life; 2. Weak value chain for nutrient-dense foods (processed and unprocessed); 3. Weak coordination and inadequate resourcing of nutrition interventions in the country resulting in service coverage that is below scale, comprehensiveness and quality recommended for high impact interventions; 4. Inadequate knowledge and practices in relation to water, sanitation and hygiene (WASH) and other pro-health seeking behaviours (such as immunisation, family planning and malaria control), especially among mothers and caregivers of children under the age of five years; 5. Absence of tailored nutrition services to meet needs of adolescents, and adults outside the scope of regular maternal and child nutrition services; 6. Weak capacity of systems for delivery of community-based nutrition services; 7. Nutrition-blind social protection and other sectoral services; and 8. Inadequate information to inform design of relevant nutrition interventions, and assessment of progress made by on-going nutrition services within the Zimbabwe context. 1.1 Consequences of under-nutrition and benefits of investing in nutrition The consequences of nutritional deficiencies and disorders are significant; so are the benefits of investing in efforts to address them. There is strong international evidence that eliminating under nutrition saves lives, prevents more than one-third of child deaths per year, and reduces the burden of 8 disability for children under five by more than half . The evidence from recent World Bank studies also shows that tackling under-nutrition will result in significant economic benefits both now and in the long term. Productivity in agriculture, industry and other sectors will increase due to better health of the working population (less down time due to illness and higher work efficiency due to stronger and larger bodies) and this will contribute to an increase in gross national product (GNP) of between 2% and 8% 9 in Africa (and potentially further up to 11% in high burden countries) . These studies also show that 10 reducing stunting will result in school attainment being increased by at least one year . The combination of higher levels of education and improved health of the workforce will result in an increase in lifetime wages of between 5% and 50%, hence a reduction in poverty. Children who are not stunted are 33% more likely to escape poverty as adults. Stunted mothers are three times more likely 6 WHO (1999). 7 Although iodine deficiency affects the entire population, and one of the most important target groups is pregnant women, school-children are assessed because they are a convenient sample and act as a proxy for other groups. 8 Black R.E. et. Al, 2008, Maternal and child under-nutrition: global and regional exposures and health consequences, The Lancet Series on Nutrition 2008. 9 The World Bank, 2006, The World Bank: Repositioning nutrition as central to development. A strategy for large-scale action. Washington DC. 10 Sources: a) DIFD 2013, Business Proposition - Nutrition for Growth, for Discussion, May 2013; b) Alderman H, Hoddinott J, Kinsey B. Long term consequences of early childhood malnutrition. Oxf Econ Pap 2006; 58: 450–74; c) Daniels MC, Adair LS. Growth in young Filipino children predicts schooling trajectories through high school. J Nutr 2004; 134: 1439–46. (d)Maluccio JA, Hoddinott J, Behrman JR, Martorell R, QuisumbingA.R. The impact of nutrition during early childhood on education among Guatemalan adults. Middlebury College Economics Discussion Paper number 06-14. Middlebury College, VT, 2006. 11 Leary S, Fall C, Osmond C, et al. Geographical variation in relationships between parental body size and offspring phenotype at birth. ActaObstetGynecolScand 2006; 85: 1066–79. 18 11 to have malnourished infants . In addition, women who are well nourished as girls are 10% more likely 12 to own their own business when they become adults . The negative effects of under-nutrition are compounded by those of overweight and obesity which are rising not only in Zimbabwe but globally, contributing to an increase in incidence of chronic and non-communicable diseases (NCDs). In Zimbabwe, 10.6% of the population is obese and the problem is worst among women in urban areas 13 where 41% are overweight or obese, compared with 26 % of rural women (ZDHS 2010/11) . In Zimbabwe, obesity worsens with higher income levels. Obesity among people in the highest income quintile is four times that for the lowest quintile. The human and economic consequences of the current micronutrient deficiencies in the Zimbabwean population are grave. About 7,700 children and mothers are dying every year due to micronutrient 14. deficiency (iron, vitamin A, zinc, and folic acid) Cognitive growth losses in children will debilitate about 900,000 of the current population of under-fives resulting in future productivity deficits equivalent to USD16 million in annual GDP. In adults, productivity performance deficit is estimated to affect more than 500,000 workers, resulting in an estimated GDP deficit of USD43 million annually. Micronutrient deficiencies are also contributing to higher morbidity that is preventable, for instance about 3.5 million more cases of diarrhoea, acute respiratory infections, low birth weight and birth defects which are estimated to cost the health system and families an additional USD4 million per annum. 1.1 On-going efforts to address malnutrition in Zimbabwe In Zimbabwe, attaining the goal of food and nutrition security has been given high priority on the country's development agenda. On May 16, 2013, the Food and Nutrition Security Policy: Promoting Food and Nutrition Security in Zimbabwe in the Context of Economic Growth and Development (FNSP) was officially launched by the His Excellency, President Robert Gabriel Mugabe. The policy 15 expresses a shared vision and seven commitments for accelerated action by the government, to improve national and household level food security, improve the quality of diets, ensure food safety, improve nutrition for adolescents, pregnant women and young children and reduce stunting. A multi sectoral approach in addressing the goal of reducing under-nutrition is critical and requires multiple actors which include government, civil society, development agencies, as well as public-private partnerships. The special place for business and science in addressing specific nutritional problems and developing and scaling up interventions to strengthen the food system and enable the healthy growth of young children is also fostered by the policy. 1.1 Commitments by the government and global community towards addressing malnutrition Addressing nutrition has also become a major global development objective. Zimbabwe's progress on policy on food and nutrition security is in pursuit of its commitmentsas an “early riser” under the global Scaling-Up Nutrition (SUN) Movement. The SUN Movement has developed a Framework and a road map towards the prioritization of food and nutrition security in national programmes and advocates for national governments to be the main investors. The SUN Movement is based on common principles bringing together the entire spectrum of actors globally whose work affects nutrition. It has a clear focus on improving nutrition during the critical first 1,000 days of life from minus 9 months to 24 months of age and advocates for intensification and scale-up of proven high impact interventions aimed at reducing the prevalence of stunting, anaemia and low-birth 12 DIFD 2013, Business Proposition - Nutrition for Growth, for Discussion, May 2013. 13 The MNS 2012 found that for women aged 15-49years: 5.4% were thin; 59.1% had normal weight; 22.2% were overweight; and 13.4% were obese. 14 The human and economic losses presented here are based on “Initial Findings of Consultant Mission to Support Development of Zimbabwe National Fortification Strategy” commissioned by UNICEF and the National Nutrition Department, Ministry of Health and Child Care in 2013. 15 The commitments are on: I) Policy Analysis and Advice; II) Agriculture and Food Security; III) Social Assistance and Social Protection; IV) Food Safety and Standards; V) Nutrition Security; VI) Food and Nutrition Security Information; and VII) Enhancing and Strengthening National Capacity for Food and Nutrition Security. 19 weight. Commitment V of the Food and Nutrition Security Policy puts emphasis on actions that improve nutrition status during this window of opportunity (first 1,000 days) aimed at stunting reduction. Addressing child and maternal nutrition was also at the top of the agenda for the 2010 MDG Summit. At the current pace of progress in addressing under-weight, Zimbabwe is highly unlikely to achieve the MDG Target of reducing by half the prevalence of under-weight in under-fives by 2015. Furthermore, in June 2013, a new Global Nutrition for Growth (N4G) Compact saw donors pledging £2.7 billion ($4.15 billion) as additional funding to tackle under-nutrition up-to 2020 and 16 governments in developing countries also made commitments . Twenty-two businesses (including those in Southern Africa), also pledged to improve nutrition and, consequently, improve productivity and health of over 927,000 workforce members in more than 80 countries. Zimbabwe has already made progress in the first two of the following three primary areas of performance measurement monitored by the SUN Movement, namely: i) Ensuring the existence of a coherent policy and legal framework for nutrition – a national policy on food and nutrition security has been officially launched, and Food Security & Nutrition, is a pillar in the new economic blueprint Zimbabwe Agenda for Sustainable Socio Economic Transformation (ZimAsset); ii) Bringing people in the same space through multi-stakeholder platforms – multi-sectoral food and nutrition security governance structures have been established from the highest level in Cabinet (Cabinet committee on Food & Nutrition Security) to the community level through the establishment of Food & Nutrition Security Committees at National, Provincial, District and Ward levels. Common results framework for national nutrition plan (aligned programming); this is seen in the multi-sectoral Implementation Matrix of the Food & Nutrition Security Policy and iii) Mobilising and tracking resources with an impact on nutrition. Zimbabwe is yet to cost the national action plan, and begin tracking of investments in food and nutrition security. Zimbabwe realises that progress in scaling up nutrition would be easier if the country had a national strategy to address nutrition, a strategy that would have clear priorities, strong rationale, produced through an inclusive consultative process and is costed. 1.6 The National Nutrition Strategy This National Nutrition Strategy (2014 – 2018) has been developed with two objectives in mind: a) to 17 operationalize Commitment V of the NFNSP and b) to contribute towards making further progress against the other SUN targets. The vision of the NNS is “a Zimbabwe free from hunger and malnutrition”. The mission of the NNS is to “implement evidence- based nutrition interventions that are integrated within a broad multi-sectoral collaboration framework” that emphasises investment in prevention of malnutrition. Whilst the NNS assumes a special focus on addressing stunting (the first 1,000 days), it has a broader mandate to address nutrition-related challenges affecting the other age-groups of children (2 years and above), adolescents and adults, both females 18 and males, rural and urban, poor and wealthier . 16 Zimbabwe's commitment under the Nutrition Global Compact was USD3.04 million. 17 Commitment V states that: The Government of Zimbabwe is committed to ensuring nutrition security for all through the implementation of evidence-based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation. 18 Findings of the DHS, 2010/11 indicate that prevalence of obesity among adult women in urban areas increases with increasing per capita income, with the highest income group having four times higher prevalence than the lowest income quintile. 20 The NNS adopts a life-cycle-based multi-sectoral-integrated programming approach. This shapes the strategies that will be implemented under the six key result areas prioritised for investment. The main interventions prioritised are (i) the strengthening and scaling up of: a) adolescent and maternal nutrition services; b) infant and young child nutrition services; and c) clinical nutrition services; ii) enhancing the quality of nutrition information systems and effectiveness of advocacy; iii) strengthening multi-sectoral coordination and collaboration for integrated nutrition response; and iv) capacity development for nutrition and resource mobilization. The indicators and performance targets for the NNS reflect this orientation as well. The NNS is designed to address stunting, infant and young child malnutrition, nutrition-related non communicable diseases, and micronutrient deficiencies in children and adults by solving eight main causal factors contributing to these problems, using high impact interventions informed by the 19 UNICEF conceptual framework for nutrition . The process of developing the NNS was led by the National Nutrition Department in the Ministry of Health and Child Care, the institution which carries the mandate to coordinate its implementation. The Food and Nutrition Council (FNC) provided the NND with technical guidance and coordination support for the formulation process. The NNS is not a road map for a single ministry or department since it is multi-sectoral in nature, but the main driver of the strategy will be Ministry of Health and Child Care through the NND. In light of this, the NNS was developed using a highly participatory bottom-up process involving all sectors starting in June and ending in December 2013. The process had eleven steps, including community, district, provincial and national consultations. All provinces were consulted through provincial workshops attended by members of the provincial development committee and facilitated by the Food and Nutrition Security Committee at provincial level. In addition, in each province, two district-level workshops and several project site visits to communities were undertaken to ensure that all relevant stakeholders at district and community level contributed. At national level, six thematic workshops, two NNS drafting workshops, one multi-stakeholder validation workshop, one M&E workshop and one costing workshop were organised ensuring maximum stakeholder input at each stage of the formulation process. The thematic workshops were: 1) Health and Nutrition; 2) Food Fortification; 3) Agriculture and Nutrition; 4) Early Warning Food and Nutrition Security Information Systems; 5) Education and Nutrition; and 6) Social Protection and Nutrition. The structural content of the NNS follows the Government of Zimbabwe's results-based management (RBM) template for strategic planning, released in 2010. The Strategy is presented in 16 chapters, including this introductory one. Chapter 2 outlines the vision, Chapter 3 the mission, and Chapter 4 the guiding principles. Chapter 5 presents the Terms of Reference for the National Nutrition Department mandated to coordinate the execution of the NNS while Chapter 6 describes the functions of the NND. An environmental scan is provided in Chapter 7. The Key Result Areas (KRAs) together with their impact weighting and responsible institutions are presented in Chapter 8. Chapter 9 describes the client needs, problems and causes. Chapter 10 presents the stakeholder analysis. Policy requirements (external and internal) for the NNS are listed in Chapter 11. Goals of the NNS are contained in Chapter 12, whilst the main strategies, assumptions and risks for each KRA of the strategy are described in Chapter 13. Chapter 14 presents the strategic results chain, highlighting the 19 The UNICEF Conceptual Framework of Malnutrition has three types of causes: 1) immediate causes (inadequate dietary intake and disease burden); 2) underlying causes (inadequate access to food, inadequate care for children and women, insufficient health services and unhealthy environment); and 3) basic causes (inadequate resources – human, economic and organisational; political and ideological factors, and economic structures). 21 description of the results, the indicators to be used for performance measurement and what will be measured. The chapter also sets out the annual targets for impact and outcome indicators, and the allowable deviations in performance from the set milestones. Chapter 15 presents the M&E framework, while the last Chapter (16) describes the type and magnitude of resources required to successfully implement the NNS. The NNS will guide individual sectors in mainstreaming nutrition into the sector plans which will be developed and or reviewed in due course. Zimbabwe National Nutrition Strategy, 2014 -2018 22 2 VISION 3 Mission 4 Guiding Principles The vision of the National Nutrition Strategy is “a Zimbabwe free from hunger and malnutrition”. The mission for the NNS is to “implement evidence- based nutrition interventions that are integrated within a broad multi-sectoral collaboration framework”. Guiding Principle 1: Nutrition is a basic human right and will be safeguarded for all age groups and social and economic strata. Guiding Principle 2: Evidence-based programming: The NNS will prioritise investments in proven and universally accepted high-impact nutrition interventions to maximise results from limited resources. Evidence generation on barriers to the uptake of optimal maternal and child nutrition behaviours will be a top priority. Guiding Principle 3: Collaborative and coordinated action across multiple sectors: The NNS strengthens collaboration across sectors, minimises duplication, and fosters collective accountability towards a shared goal of nutrition security for all. Guiding Principle 4: Community empowerment and participation: Communities as rights holders should be empowered to identify, prioritise and respond to their nutrition challenges, barriers and bottlenecks. Support of government and development partners is required to enhance these community-led initiatives by addressing barriers at household, community, district and national levels. Guiding Principle 5:Overcoming barriers to the uptake of optimal maternal and child nutrition behaviours: Addressing knowledge gaps and promoting sustainable nutrition social behaviour change will remain a core cross-cutting strategy for the NNS. Guiding Principle 6: Life-cycle approach: The NNS recognises that key nutritional impact towards reducing stunting is achieved by interventions reaching children in their first 1,000 days of life. However, broader public health nutrition interventions should be provided throughout the life-cycle, tailored to specific needs at each stage, in order to ensure nutrition security for all. Guiding Principle 7: Continuum of care: Health facility based services alone are not adequate to address nutrition security. Therefore the NNS recognises the need for nutrition services to be provided in an integrated manner that links health facility care and support with community based nutrition services. Guiding Principle 8: Ensuring equity and inclusiveness: The NNS ensures that nutrition needs of the whole populace are addressed, and no part of the population is left out as a result of religion, poverty, gender, age, race, geographical location or political orientation. Zimbabwe National Nutrition Strategy, 2014 -2018 23 6 Overall Functions of the National Nutrition Department From the above policy and legislative instruments, the functions of the Ministry of Health and Child Care through the National Nutrition Department consist of the following: 1. Identify core advocacy concerns for the nutrition sector and develop key messages that influence national and sectoral policies, strategies, plans and activities and ensure that nutrition concerns are kept high on the policy agenda. 2. Develop, update and disseminate national nutrition policies and strategic plans in collaboration with the Food and Nutrition Council. 3. Ensure appropriate coordination, liaising and working with relevant counterparts especially within departments of the Ministry of Health and Child Care and partners to promote integration, convergence and effectiveness of nutrition interventions. 4. Advocate for nutrition sensitive programming within the Ministry of Health and Child Care and across sectors. 5. Ensure prioritization of nutrition issues, to substantiate investment and implementation for high impact nutrition interventions. 6. Develop, update and disseminate standards and guidelines based on emerging global and regional evidence. 7. Facilitate and support resource mobilization for nutrition, for interventions within and across sectors. 8. Support capacity development and knowledge sharing of best practices, lessons learned, and research findings, to keep stakeholders at National, Provincial and District levels abreast of new research findings and their implications for the Zimbabwe context. 9. Ensure to the extent possible that sector partners use common standards and tools for information collection/sharing and data management, including in needs assessments and monitoring. 10. Ensure early warning systems and emergency preparedness for nutrition arein place. 11. Identify evidence gaps and research priorities to inform the design of more effective nutrition interventions in the context of Zimbabwe. Zimbabwe National Nutrition Strategy, 2014 -2018 25 7 ENVIRONMENTAL SCAN 7.1 Situation analysis: An overview of Zimbabwe's nutritional status and trends – the main problems In Zimbabwe, approximately one out of every three children under the age of five years (32% according to ZDHS 2010/11, and 30% according to MNS 2012) is stunted. Due to the country's scaling up of the management of acute malnutrition and related livelihood and feeding programmes implemented by partners, the prevalence of acute malnutrition has declined significantly by over 50% 20 over the past decade and only 2.4% of children under five have global acute malnutrition (GAM) 21 which is acceptable according to global thresholds . According to the latest ZDHS of 2010/11, 10% of new-borns have a low birth weight (<2500g). Underweight has declined slightly as compared to the early 90s, but not enough to meet the MDG goal of halving the rate by 2015. The situation of stunting remains at best stagnant (Figure 1). There are also geographic, age, gender and socio economic disparities in nutritional status. Figure 1: Trends in Nutritional Status of Children in Zimbabwe Under Five Years Source: ZDHS, 2010/11. 20 Having a z-score of <-2SD weight for height of with presence of bilateral pitting oedema 21 Commonly used threshholds for GAM are:<5% = acceptable; 5% to 9.9% = poor; 10% to 14.9% = serious and >15% = critical 26 Zimbabwe is experiencing a double burden of malnutrition with steadily rising rates of obesity in women which in 2010 stood at 40.5% in urban areas and 25.5% in rural areas (ZDHS, 2010/11) and a high rate of stunting prevalence in under-fives. In 2010, a total of 33% of children living in rural areas were stunted, versus 28% of children in urban areas (ZDHS, 2010/11). Thirty percentage or more of children are stunted in all provinces except Bulawayo (26%) and Harare (29 %). Stunting steadily decreases as the level a of mother's education increases, from a high of 41% among children of mothers with no education to a low of 19% among children of mothers with more than secondary education (NNS 2010). Stunting is also higher in boys (36%) than in girls (28%). While stunting prevalence according to the latest MIMS 2009 is higher among the poor in Zimbabwe at 33%, wealth doesn't necessarily protect children from stunting as almost one in five (19%) of children in the highest wealth quintile is stunted. This suggests that, in the current context in Zimbabwe, adequate income doesn't necessarily guarantee adequate nutrition. Across all wealth quintiles, stunting has generally increased over the past two decades (Figure 2) although there are signs that stunting prevalence in under-fives may have started to decline as the results of the MNS 2012 indicate a modest decline to 30% in 2012. According to the 2010/11 ZDHS, stunting is lower amongst the 0-6 month's age group and increases sharply from around 8 months to a peak at around 50% in the 24 months age group then gradually decreases and levels off at around 15% by age 59 months. Worth noting is the 10% stunting prevalence at birth which indicates that some children are born already stunted. This reflects a need for maternal, pre-pregnancy and adolescent nutrition interventions. The sharp increase in prevalence in stunting from 6 months is likely due to inappropriate complementary feeding and care practices for this age group. The latest MNS 2012, shows that child care practices especially in relation to breastfeeding are improving compared to findings of the ZDHS and the National Nutrition Survey (NNS) both conducted in 2010. However, more work is still required. At the time of the MNS 2012, 76%of children 0 – 23 months were still breastfeeding, 32%of children below six months of age were reported to be exclusively breastfed and the median duration of any breastfeeding was 9 months. Figure 2: Stunting trends by age group Zimbabwe National Nutrition Strategy, 2014 -2018 27 Figure 3: Adequacy of diets for infants Source:MNS, 2012 The ZDHS 2010/11 observed that based on the mean body mass index (BMI), 7.1% of women in Zimbabwe were underweight whereas 31.3% of women 15-49 years of age were overweight and 10.6% were obese. Obesity is steadily rising in women and rates are currently at 40.5% in urban areas and 25.5% in rural areas (ZDHS, 2010/11). Results of the latest MNS 2012 indicate that prevalence of obesity among women in the age-group 15-49 years stood at 13.4% and it is higher than the average for the entire population. About one in five women aged 15-49 years was overweight (MNS 2012). Findings of the latest MNS 2012 indicate that 72% of children 6 – 59 months are iron deficient. Thirty one percent of the children 6 – 24 months have anaemia, 24% have iron deficiency anaemia (IDA), 48% have iron deficiency without anaemia and 8% have anaemia without iron deficiency.Among the children with anaemia, 67% had iron deficiency. Other recent studies have confirmed that more than half (56%) of Zimbabwean children aged 6 – 59 months are anaemic while 28% of women and 14% of men are anaemic (Table 1). Anaemia prevalence is very high among young children affecting (71% for children aged 6-9 months, and 74% for age group 9-18 months), and among pregnant women (32%) according to ZDHS 2010/ 11. In 2012, the national micronutrient survey included biomarkers of iron and vitamin A. The table below indicates the most recent data available on micronutrient status. Zimbabwe National Nutrition Strategy, 2014 -2018 28 Table 1: Prevalence of Micronutrient Deficiencies by Age Group Indicator Status Source Prevalence of iron deficiency among children 6 – 59 months 72% MNS 2012 Prevalence of anaemia among children 6 – 59 months 31% MNS 2012 Prevalence of iron deficiency anaemia (IDA) among children 6-59months 24% MNS 2012 Prevalence of iron deficiency without anaemia in children 6-59months 48% MNS 2012 Prevalence of anaemiawithout iron deficiency among children 6-59months 8% MNS 2012 Proportion of children who had anaemia, who had iron deficiency 6-59months 67% MNS 2012 Prevalence of vitamin A deficiency (RBP < 0.825 µmol/l) among children 6-59 months 19% MNS 2012 Prevalence of vitamin A deficiency (RBP < 0.825 µmol/l) among children 6 -59 months living with HIV 25% MNS 2012 Prevalence of vitamin A deficiency (RBP < 0.825 µmol/l) among children 6 -59 months living in rural areas 24% MNS 2012 Prevalence of vitamin A deficiency (RBP < 0.825 µmol/l) among children 6 -59 months living in urban areas 9% MNS 2012 Prevalence of vitamin A deficiency among pre -school children (serum retinol < 0.70 µmol/l) 35.8% WHO 1999 Prevalence of vitamin A deficiency among women 15-49 years 23% MNS 2012 Prevalence of vitamin A deficiency among pregnant women (serum retinol < 0.70 µmol/l) 20% WHO 1999 Prevalence of anaemia among pre-school children (Hb<11 g/dl) 56% ZDHS(2010/11) Prevalence of iron deficiency in women 15-49 years 61% MNS 2012 Prevalence of iron deficiency in non-pregnant women 15-49 years 62% MNS 2012 Prevalence of iron deficiency in pregnant women 15-49 years 54% MNS 2012 Prevalence of anaemia in women 15-49 years 26% MNS 2012 Prevalence of iron deficiency among women with anaemia aged 15-49 years 67% MNS 2012 Proportion of non-pregnant women with anaemia 26% MNS 2012 Proportion of pregnant women with anaemia 19% MNS 2012 Prevalence of anaemia among pregnant women (Hb<12 g/dl) 32% ZDHS (2010/11) Prevalence of anaemia among women (Hb<12 g/dl) 28% ZDHS (2010/11) Median urinary iodine concentration among children 5-12 years 113 µg/L MNS 2012 Median urinary iodine concentration among non-pregnant women 15-49 years 116 µg/L MNS 2012 Prevalence of iodine deficiency among school-aged children (urinary iodine < 100 µg/L) 15.5% MoHCW& UNICEF (2009) While the coverage of iodized salt is high, estimated at 88% of households (ZDHS, 2011) there appears to be inconsistency between coverage and use of the iodised salt as 16% of school children are iodine deficient. Currently, there are no statistics on nutritional status of adolescents and the elderly. Data on men is limited with the 2010/11ZDHS measuring BMI and anaemia. 7.2 SWOT analysis The strengths, weaknesses, opportunities and threats of past, on-going and future interventions and institutional arrangements for implementation of nutrition programmes in Zimbabwe are summarised in Table 2. Strengths Weaknesses 1. Existence of a common results framework for addressing food and nutrition insecurity( e.g., the FNSP Implementation matrix) 2. Strong political will and commitment for food and nutrition 3. Availability of nutritionists across the country up to district level 4. Well trained technical levels 1. Inadequate resources 2. Brain drain 3. Ability to attract and retain nutritionists 4. Quality of nutrition information management systems 5. Low number of medical nutrition therapy guidelines and training 6. Lack of dieticians at all levels Opportunities Threats 1. High level recognition of the role of nutrition in development and a correspondingly supportive high level political establishment 2. Presence of a multi - sectoral collaborative platform for coordination of food and nutrition security issues 3. Repository of evidence and information on best practices in nutrition intervention programmes the worldwide 4. Improved efficiency and room for improvement 5. Sub-national coordination and governance structures in place(Food and Nutrition Security Committees up to ward level) 1. Inadequate long term financing 2. Climate change and food insecurity 3. Competing program mes and resources needed to support food and nutrition security programming 4. Lack of capacity of translating the simple concept of food and nutrition security to t he community 5. Strong cultural & religious beliefs hindering adoption of appropriate feeding practices Table 2: SWOT Analysis Zimbabwe National Nutrition Strategy, 2014 -2018 29 7.3 Political, economic, social, technological, environmental, and governance (PESTEG) analysis 7.3.1 Political analysis Currently the political environment is stable following the general harmonised elections of 2013 which were closely followed by the government of Zimbabwe outlining its strategic plans for national development priorities. After inauguration, the GOZ proposed the Zimbabwe Agenda for Sustainable 22 Socio-economic Transformation (ZimAsset) 'in pursuit of accelerated growth and wealth creation ” for a five year period running from October 2013 to December 2018. Included in the five clusters to spearhead the objectives of the programme is the Food Security and Nutrition Cluster. To complement the food and nutrition security cluster, the GOZ has a Food and Nutrition Security Policy meant to promote food and nutrition security in the context of economic growth and th development in Zimbabwe. This policy was launched on the 16 of May 2013 by H.E. the President of Zimbabwe and takes cognisance of the inter-sectoral nature of food and nutrition security issues. The main objective of the policy is to “promote and ensure food and nutrition security for all people at all 23 times and particularly among the most vulnerable... ” The policy intends to achieve its other aims and objectives along with other global, regional and local strategies such as the African Regional Nutrition Strategy (ARNS), Comprehensive African Agriculture Development Programme (CAADP), SUN Movement and the MDGs. Further to the political will shown by the GOZ through the launch of the Food and Nutrition Security Policy, the policy is underpinned by eight principles and the GOZ has made seven Commitments to these. The Commitments ensure the presence of the right socio-economic policy instruments, food 2 security, social assistance, food safety and standards and nutrition security . Additionally the four core Commitments (food security, social assistance, food safety and standards and nutrition security) cover the continuum from availability, to access and utilisation. The rest of the commitments cover capacity development and information systems, including assessment, analysis and early warning and disaster risk reduction. In order to give full meaning to these Commitments, the GOZ has an implementation and coordination structure for the Food and Nutrition Security Policy that involves all ministries at the ministerial, permanent secretary and director levels. These structures confirm the unequivocal commitment of the government regarding food and nutrition security issues at the highest level. 7.3.2 Economic analysis Zimbabwe experienced a deterioration of the socio-economic environment which accelerated from the year 2000 onwards and resulted in a decline in industrial capacity utilisation to a level less than 1 10%. The gross domestic product was reduced by 50% in 2008 . The deep social and economic crisis that ensued was also characterised by hyperinflation which depleted stocks in the food chain and household assets, and together severely affected food and nutrition security of the whole country and 22 ZimAsset Document – October 2013. 23 Food and Nutrition Security Policy for Zimbabwe - Preface Signed by H.E. the President of Zimbabwe, May 2013. 30 more so for the vulnerable groups. Following the stabilisation of the economy through the introduction of a multi-currency system, the resulting single digit inflation and GDP growth of between 4% and 10% has been maintained. The stable macro-economic environment creates conditions conducive to promotion of better health and nutrition. Improved health and nutrition status has been linked with increased productivity and 24 economic growth . Poverty and poor nutrition and health are inextricably linked and the economic performance of any given country or community will be on a development path if good nutrition and health are maintained. With this background, government has put in place a new economic development blue print, the ZimAsset, complemented by an existing results-based system that seeks to optimise utilisation of allocated resources in the public sector. Ministries and their departments are to be re-oriented to formulate policies and programmes guided by the results based management system which focuses on clear organisational visions, missions, values, key results areas, goals and objectives which are translated into a results framework of outcomes, outputs, strategies and resources. The RBM system has guided the structure and content of this National Nutrition Strategy. 7.3.3 Social analysis The socio-economic challenges the country experienced since the year 2000 resulted in the deterioration of social services such as quality of health and education service delivery and failure to meet the millennium development goal (MDG) targets. In particular, the third commitment of the national Food and Nutrition Policy states that GOZ is committed to ensuring that where social protection including social assistance programmes are implemented, food and nutrition security 25 needs of the most vulnerable should be met . Further, the policy's implementation matrix's other strategic objectives aim to ensure that social and cultural factors affecting food and nutrition security strategies are systematically recognised and reflected including distinguishing the different roles and responsibilities that men, women, siblings 26. and the elderly have in food and nutrition security The Food and Nutrition Security Policy's thrust is in the backdrop of several social and cultural barriers that are unfavourable to the achievement of food and nutrition security objectives. Some practices that are mainly influenced by socio-cultural beliefs include low rates of early initiation of breastfeeding (65%), early introduction of pre-lacteal feeding (13%) and low average duration of breastfeeding (17.8 months). Other IYCF indicators among children 6 months to 23 months are as follows – minimum dietary diversity – 24%, minimum meal frequency – 45% and minimum acceptable diet is 11%. These percentages are unacceptably low and can only be improved through a multi-sectoral intervention including the social protection sector. 24 H. Alderman et al. Health, Human Capital and economic Growth – PAHO, August 2003. 25 National Food and Nutrition Security Policy – 2013. 26 Implementation Plan/ Matrix of the Food and Nutrition Security Policy of Zimbabwe – November 2012. 31 7.3.4 Technological analysis Zimbabwe has a food and nutrition security information system which is currently undergoing improvements that will enable data to be collected, analysed, disseminated and utilised at local level, whilst contributing to the national system. Zimbabwe also has a working health management information system. The system is currently undergoing modifications that will enable it to accommodate more nutrition information. The changes have provided an opportune moment for the addition of a standard set of indicators into the routine data collection system with a view to monitor food and nutrition related indicators. Some of the major nutrition problems can best be solved through comprehensive food and nutrition security interventions adapted to local conditions, with community participation including male and other opinion leaders or significant others' involvement. Interventions such as food fortification will help with the prevention of problems like iron deficiency anaemia, iodine deficiency disorders, vitamin and other micronutrient deficiencies of public health significance. Other strategies and innovations need to be adopted that address food and nutrition security throughout the spectrum from production, processing and preservation, storage, consumption and utilisation. All this needs to be considered in the context of available technological capacities. 7.3.5 Environmental analysis/ climatic conditions Zimbabwe experiences moderate to severe drought conditions regularly. These conditions have an impact on food and nutrition insecurity and are made worse by climate change that has become a regular phenomenon in many places of the world. Additionally, natural disasters and man-made disasters have also increased the chances of food and nutrition insecurity. There are a number of measures to mitigate these problems such as disaster risk reduction, early warning systems, development of drought resistant crops such as small grains. These strategies have been developed to increase community resilience to shocks through supporting agro-based sustainability programmes targeted at ecologically fragile regions of the country. 7.3.6 Governance analysis The launch of the Food and Nutrition Security Policy in May 2013 was followed by the resuscitation, capacitation and strengthening of food and Nutrition Security Committees (FNSCs) whose structures have representation at national, provincial, district and ward levels. The National Food and Nutrition Security Committee (NFNSC) is the national body responsible for the coordination of all the FNSCs.These FNSCs spearhead the multi sectoral and broad-based coordination of food and nutrition security issues - a cornerstone of the governance structure of food and nutrition in Zimbabwe. The Food and Nutrition Council is the convenor of platforms for discussion of key issues on food and nutrition security and coordinates stakeholders in this field. At national level, there are supporting coordinating structures such as the Food and Nutrition Security Advisory Group (FNSAG) which is Zimbabwe National Nutrition Strategy, 2014 -2018 32 composed of senior officials of UN agencies and corresponding heads for NGOs and government departments. The FNSAG provides strategic guidance to the FNC and assists with resource mobilisation. The Zimbabwe Vulnerability Assessment Committee (ZimVAC), as a technical committee coordinated by the FNC, is responsible for collecting, analysing and reporting on inter-sectoral information pertaining to food and nutrition security. The above is the complete governance structure for food and nutrition security in the country. This governance structure also interacts with other development-related coordination platforms such as the provincial and district development councils. Together they coordinate the various issues related to food and nutrition security in Zimbabwe. Zimbabwe National Nutrition Strategy, 2014 -2018 33 8 KEY RESULT AREAS 8.1 Prioritising the Main Areas of Investment to Achieve Results for Nutrition The NNS prioritises interventions that are informed by global best practice in terms of “what works for nutrition”. Resources for investing in nutrition are scarce and need to be carefully targeted to areas that will produce the highest positive results during the fairly limited period of implementation of the strategy i.e. 5 years. Specific attention is given to addressing the most pressing needs in three priority areas of investment which are affecting national development, namely: maternal under-nutrition, stunting in children under the age of two years and anaemia in both children and women of child bearing age. At least 43% of the estimated resource requirements will be spent on strategies to 27 address these challenges . Based on a) the 2013 Lancet Series on Nutrition which provided a wealth of information on global evidence on what works and at what scale, b) the experience of countries in the region with a wide menu of strategies to address nutrition, and most importantly c) local experience in Zimbabwe, the NNS identifies six main areas of investment towards securing nutrition for all in Zimbabwe in the five year period (2014-2018). These are: a) enhancing the quality of nutrition services (to all target groups using the life-cycle approach); b) behavioural change communication/legislations for optimal nutrition; c) coordination and mainstreaming of nutrition into other sectors; d) technical capacity building of health professionals; e) advocacy and resource mobilization; and f) research and M&E. Figure 3: Malnutrition conceptual framework Source: Lancet, 2013. 27 A third of the budget for nutrition-sensitive social protection is estimated to go towards interventions that address challenges in these three areas. 34 The Key Result Areas are drawn from the menu of high impact interventions highlighted in the Lancet Series (2013) which fall within 3 broad types of investments: a) nutrition-specific programmes and approaches which address the immediate causes of malnutrition; b) nutrition-sensitive interventions and programmes which address the underlying causes, and c) interventions to build an enabling environment for nutrition by addressing the basic causes of malnutrition (Figure 3). The prioritised areas of investment will achieve results in six key areas, which are: 1. Improved adolescent and maternal nutrition; 2. Infant and young child nutrition; 3. Strengthened clinical nutrition services; 4. Quality nutrition information systems and advocacy; 5. Strengthened multi-sectoral coordination and collaboration for integrated nutrition response; and 6. Capacity development for nutrition service delivery and resource mobilization. The intervention packages proposed under each of these KRAs are tailored to the specific context of Zimbabwe. Locally, the interventions are consistent with the priorities already identified in the FNSP Implementation Matrix. Globally, they are also consistent with the “Copenhagen Consensus” best buys in development. While there has been good evidence on 'what needs to happen', the main gap has been in the limited evidence on 'how to scale up the proven interventions in a cost effective and sustainable way in a country like Zimbabwe'. To inform the second part, the country's past experience has been a valuable source of guidance. An understanding of the prevailing PESTEG environment within which the NNS will be implemented has also been important. Furthermore, a strong element of operational research has being included as a critical element of evidence generation on efficacy of specific aspects of the interventions and in tracking overall implementation and performance as part of the broader monitoring and evaluation framework of the strategy and sufficient resources have been earmarked to evidence generation on “best scaling up approaches” to specifically address this observed gap. More details on the key result areas impact weightings, and references to sectoral, national and global strategies is presented below. 8.2 Key Result Areas for the National Nutrition Strategy The Key Result Areas of the NNS, the weights attached to them in terms of their relative contribution to the planned outcomes and impacts, responsible departments and reference to national plans and global goals are summarized in Table 3. Zimbabwe National Nutrition Strategy, 2014 -2018 35 Table 3: Key Result Areas, Linkages with National and Global Objectives and Responsible Departments 28 KRA 1: Improving the health status of the population, KRA 2: Improving the quality of care. KRA 3: Health Systems Strengthening. 29 ZimAsset – Reference to the Food and Nutrition Security Cluster N o . K e y R e s u lt A re a W e ig h t R e s p o n s ib le D e p a rt m e n t/ s S e c to r K R A R e fe re n c e N a ti o n a l K R A R e fe re n c e M D G R e fe re n c e K R A 1 Im p ro v e d a d o le s c e n t a n d m a te rn a l n u tr it io n 2 5 % M O H C C ( R e p ro d u c ti v e h e a lt h , E P I, N u tr it io n , Q u a lit y, H e a lt h P ro m o ti o n , A ID S / T B E p id e m io lo g y, & D is e a s e s u rv e ill a n c e ) M o W A G C D M in is tr ie s o f P ri m a ry & S e c o n d a ry E d u c a ti o n N G O s L o c a l a u th o ri ti e s N a ti o n a l H e a lt h S tr a te g ic P la n M O H C C ( K R A 1 , 2 a n d 3 )2 8 Z im A s s e t2 9 F o o d a n d N u tr it io n S e c u ri ty P o lic y 1 . P o v e rt y 2 . Im p ro v e M a te rn a l H e a lt h 3 . P ro m o te g e n d e r e q u a lit y a n d e m p o w e r w o m e n K R A 2 In fa n t a n d Y o u n g C h ild N u tr it io n 2 5 % M O H C C ( R e p ro d u c ti v e h e a lt h , E P I, N u tr it io n , Q u a lit y, H e a lt h P ro m o ti o n , A ID S /T B ,E p id e m io lo g y, N C D , R e h a b ili ta ti o n & D is e a s e s u rv e ill a n c e , h e a lt h p ro m o ti o n ) M o W A G C D M in is tr ie s o f P ri m a ry & S e c o n d a ry E d u c a ti o n N G O s L o c a l a u th o ri ti e s U N p a rt n e rs N a ti o n a l H e a lt h S tr a te g ic P la n – M O H C C H e a lt h T ra n s it io n F u n d Z im A s s e t N a ti o n a l F o o d a n d N u tr it io n S e c u ri ty E ra d ic a te E x tr e m e P o v e rt y R e d u c e c h ild m o rt a lit y K R A 3 S tr e n g th e n in g c lin ic a l n u tr it io n s e rv ic e s 1 5 % M O H C C ( R e p ro d u c ti v e h e a lt h , E P I, N u tr it io n , Q u a lit y, H e a lt h P ro m o ti o n , A ID S /T B ,E p id e m io lo g y & D is e a s e s u rv e ill a n c e , h e a lt h p ro m o ti o n ) M o W A G C D M in is tr ie s o f P ri m a ry & S e c o n d a ry E d u c a ti o n N G O s M A M ID L o c a l a u th o ri ti e s U N p a rt n e rs N a ti o n a l H e a lt h S tr a te g ic P la n M O H C C Z im A s s e t N a ti o n a l F o o d a n d N u tr it io n S e c u ri ty E ra d ic a te E x tr e m e P o v e rt y Im p ro v e M a te rn a l H e a lt h R e d u c e c h ild m o rt a lit y P ro m o te g e n d e r e q u a lit y a n d e m p o w e r w o m e n K R A 4 Q u a lit y n u tr it io n in fo rm a ti o n s y s te m s a n d a d v o c a c y 1 0 % M O H C C ( R e p ro d u c ti v e h e a lt h , E P I, N u tr it io n , Q u a lit y, A ID S /T B , E p id e m io lo g y , N C D , R e h a b ili ta ti o n & D is e a s e s u rv e ill a n c e , h e a lt h p ro m o ti o n ) M o W A G C D M in is tr ie s o f P ri m a ry & S e c o n d a ry E d u c a ti o n F N C N G O s L o c a l a u th o ri ti e s U N p a rt n e rs N a ti o n a l H e a lt h S tr a te g ic P la n M O H C C Z im A s s e t N a ti o n a l F o o d a n d N u tr it io n S e c u ri ty D e v e lo p a g lo b a l p a rt n e rs h ip fo r d e v e lo p m e n t K R A 5 S tr e n g th e n in g m u lt i s e c to ra l c o o rd in a ti o n a n d c o lla b o ra ti o n f o r in te g ra te d n u tr it io n re s p o n s e 1 5 % M O H C C ( R e p ro d u c t iv e h e a lt h , E P I, N u tr it io n , Q u a lit y, A ID S /T B , E p id e m io lo g y, N C D , R e h a b ili ta ti o n & D is e a s e s u rv e ill a n c e , h e a lt h p ro m o ti o n ) M o W A G C D M A M ID F N C M in is tr ie s o f P ri m a ry & S e c o n d a ry E d u c a ti o n N G O s M o L G P W N H M o P S L S W L o c a l a u th o ri ti e s U N p a rt n e rs N a ti o n a l H e a lt h S tr a te g ic P la n M O H C C Z im A s s e t N a ti o n a l F o o d a n d N u tr it io n S e c u ri ty D e v e lo p a g lo b a l p a rt n e rs h ip fo r d e v e lo p m e n t K R A 6 C a p a c it y d e v e lo p m e n t fo r N u tr it io n a n d R e s o u rc e M o b ili z a ti o n 1 0 % M O H C C ( R e p ro d u c ti v e h e a lt h , E P I, N u tr it io n , Q u a lit y, A ID S /T B , E p id e m io lo g y, N C D , R e h a b ili ta ti o n & D is e a s e s u rv e ill a n c e , h e a lt h p ro m o ti o n ) F N C N G O s L o c a l a u th o ri ti e s U N p a rt n e rs N a ti o n a l H e a lt h S tr a te g ic P la n M O H C C Z im A s s e t N a ti o n a l F o o d a n d N u tr it io n S e c u ri ty D e v e lo p a g lo b a l p a rt n e rs h ip fo r d e v e lo p m e n t 36 Problems: Poor suckling reflex Low birth weight Early Introduction of pre-lacteal feeds Birthing complications Early introduction of solids Congenital deformities Poor hygiene & environments Causes: Birth asphyxia Poor adolescent and maternal nutrition Poor health status Cultural beliefs Poor knowledge of recommended IYCF practices Poor positioning and attachment Mixed messages for IYCF in the context of HIV Poor decision making power of women over infant feeding practices Needs: Continued breast feeding Timely introduction of solids Appropriate complementary feeding Active responsive feeding Growth monitoring and screening for early detection and treatment of acute malnutrition Immunisation De-worming Safe water and sanitation facilities Optimal care practices Extent: 10.6% severe stunting 27.2% moderate stunting 1.3% severe wasting 5.2% moderate wasting 2.2% severe underweight 10.4% moderate underweight 79.2% receiving breast milk, milk or milk products 23.5% (34.2% urban, 19.2% rural, 15.2% mom primary ed, 26.7% mom secondary ed.) receiving 4+ food groups 45.2% receiving minimum meal frequency 87.0% continued breastfeeding at one year 20% continued breastfeeding at 2 years 86% received timely introduction of solid, semi-solid or soft foods (6 8months) 69.3% received measles vaccination 55.6% received all basic vaccinations 73.8% received the same amounts of liquids during diarrhoea as usual 62.7% received the same amount of food during diarrhoea as usual Problems: Non-availability of nutritious and diverse diets at household level Short duration of breast feeding/ premature weaning Incorrect and inadequate feeding during and after illness Early introduction of complementary feeds Poor stimulation Inadequate supplies for treatment of acute malnutrition Poor management of childhood illnesses (diarrhoea, malaria and ARI) Barriers to immunisation against childhood illnesses due to religious and cultural beliefs Causes: Only 11% meet the minimum standards with respect to all 3 of IYCF practices Poor quality of complementary foods Poor health seeking behaviours Poor care practices Poor household food security Poor decision making power of women over infant feeding practices Unsupportive environment Children 6 - < 24 months 24 months – 59 months 5 years to 14 years 15 years to 24 years 3 4 5 6 Needs: Diversified diet Immunisation Growth monitoring and screening for early detection and treatment of acute malnutrition Safe water and improved hygiene and sanitation ECD facilities De-worming Management of early childhood illnesses Problems: Poor diet quality at household level Childhood illnesses Inadequate access to ECD facilities Inadequate care by mothers and other care givers Non- availability of medical supplies at health facilities to treat common childhood illnesses Poor water and sanitation facilities Extent: Appropriate indicators will be included in the next rounds of relevant national surveys to establish extent of needs. Needs: Diversified diet Food supplements Obesity prevention Safe water and improved hygiene and sanitation Basic education facilities De-worming Management of common illnesses Good agricultural practices Problems: Poor diet quality at household level Common illnesses Inadequate access to basic education Inadequate care by duty bearers Non- availability of medical supplies at health facilities to treat common illnesses Child abuse Early pregnancies Needs: Continued diversified diet Iron supplements for adolescent girls Screening for obesity Safe water and improved hygiene and sanitation Continuing education facilities Management of common illnesses HIV prevention SRH education (HIV/AIDS, STIs, early pregnancies) Problems: Unavailability of diversified diets at household level Common illnesses Inadequate access to secondary and tertiary education Inadequate care by duty bearers Non- availability of medical supplies at health facilities to treat common illnesses Child abuse Early pregnancies Lack of SRH education External Clients Needs/Problems Characteristics/ Extent Zimbabwe National Nutrition Strategy, 2014 -2018 38 Needs: Information on appropriate diets and healthy life styles Continuing SRH Education Sport and recreation facilities Vocational skills for active employment Orientation of male involvement in child care Wellness centres HIV/AIDS prevention services Male involvement in family planning Problems: Alcohol and substance abuse Unemployment HIV/AIDS, STIs Obesity Poor health seeking behaviour Needs: Micronutrient supplements Safe water and improved hygiene and sanitation facilities Diversified diet Dental care Wellness awareness, counselling and screening services Mineral supplements (Calcium) Access to health care facilities Problems Post menopause effects Affordability of supplements NCDs HIV/ AIDS, STIs Dental and optical problems Limited livelihood options External Clients Needs/Problems Characteristics/ Extent Men 15 – 49 years Elderly women above 49 years Elderly (men above 65 and women above 49 years) Household indicators 7 8 9 Needs: Safe water and improved hygiene and sanitation facilities Diversified diet Dental care Wellness awareness, counselling and screening services Problems NCDs HIV/ AIDS, STIs Dental and optical problems Limited livelihood options Access to health care facilities Exclusion from mainstream health programmes Needs: Safe water and improved hygiene and sanitation facilities Access to health care facilities Adequate shelter Diversified diet Management of common illnesses Sources of livelihoods Problems: Limited livelihoods options Unavailability of diversified diets at household level Common illnesses Non- availability of medical supplies at health facilities to treat common illnesses Climate change adverse impacts Zimbabwe National Nutrition Strategy, 2014 -2018 39 10 STAKEHOLDER ANALYSIS This section provides an overview of the stakeholders that will be involved in the implementation of the NNS as well as their expectations from the implementation of this strategy. They include oversight bodies set up by the Government as part of the Food and Nutrition Security Policy: the Food and Nutrition Council for policy coordination, monitoring, and advisory support, the 17 sector ministries that will implement specific aspects of the NNS through the multi-sectoral collaboration and coordination approach, United Nations agencies, civil society organisations, the private sector and bilateral and multi-lateral funding partners (Table 5). Communities and individuals that will benefit from the NNS are also important stakeholders in the implementation of the strategy. Table 5: Stakeholder demands, expectations and characteristics External Demands/expectations Characteristics/ Extent 1. Policy oversight OPC Working party of Permanent Secretaries Clear information on the situation on the ground Clear strategies on how best to solve problems Fulfilment of basic human rights 40% 40% 20% 2. Food and Nutrition Council Strong institutional capacity Collaboration from implementing partners and relevant sector ministries 50% 50% 3. The 17 sector ministries (Health and Child Care, Agriculture, Social Welfare, Education, e.t.c.) Strong institutional capacity Supporting Policy in relevant sector ministries Adequate human resources Clear, up-to-date and widely disseminated National Nutrition Guidelines 40% 20% 20% 20% 4. UN, Civil Society Supporting policy environment Motivated and skilled government employees Less red tape 60% 40% 20% 5. Donors, Private sector Clear accountability mechanisms Adequate and accurate baseline data Tangible and sustainable impact/results 50% 20% 30% INTERNAL Demands/expectations Characteristics/ Extent 1. Staff from the 17 sector ministries Mentoring/supportive supervision Capacity development Opportunities for cross fertilisation from other sectors and internationally Appreciation of importance of role played/recognition 25% 25% 25% 25% 2. Communities Recognition of their own priorities and needs Respect for their own background knowledge and experience Fulfilment of rights (access to health, food, e.t.c.) Full involvement in own development (planning, implementation, monitoring, evaluation) 25% 25% 25% 25% Zimbabwe National Nutrition Strategy, 2014 -2018 40 11 POLICY REQUIREMENTS Whilst the NNS will serve as the main driver of nutrition interventions, it has not been designed, and will not be implemented, in a vacuum. Zimbabwe's FNSP provides the overarching framework from which the NNS is drawn. The targets set in the NNS are drawn from and harmonized with those already set in national and global policies, strategies and agreements. These targets are consistent with the MDGs, the post-MDG Agenda and the World Health Assembly targets. The NNS recognizes the existence and importance of development partners, Paris Declaration Principles on Aid Effectiveness and the post-Busan Global Partnership as a guiding policy framework for the relationship between Zimbabwe and her DPs, let alone with non-state actors (private sector and civil society). Recognition is also made of the fact that many other relevant national policies and strategies exist and are being implemented over the same period of the NNPSP, some that operationalize specific aspects of the NNS whilst others complement it by addressing other critical factors that determine the health and nutrition of the population but some of which have not been included in the NNS since they are best addressed by other sectors (see Box 2 for the typology of policies, strategies and other national documents linked to the NNS). Box 2: National Policies, Strategies and Guiding Documents relevant for the NNS External ZimAsset, 2013 Zimbabwe National Strategic Plan (ZNASP) 2006 National Food and Nutrition Security Policy 2012 Mid-Term Plan 2011 Comprehensive African Agriculture Development Programme (CAADP) Strategic Grain Reserve (AGR) Policy Comprehensive Agriculture Policy Draft Comprehensive African Agriculture Development Programme (CAADP) ZNASP for education of girls, orphans and vulnerable children Internal Infant and Young Child Feeding Policy 2013 National Health Strategy for Zimbabwe (2009-2013) PMTCT & Paediatric HIV Prevention, Treatment & Care National Plan 2011 Reproductive Health Policy and Maternal and Neonatal Health Road Map 2007 – 2015 Zimbabwe National Nutrition Strategy, 2014 -2018 41 12 GOALS The NNS seeks to achieve 19 goals which have been drawn up using the life-cycle approach (Table 6). At each stage of the life cycle, at least one goal is set corresponding to the needs at that level. Each goal is given a weighting relative to the other goals. The weight is based on the importance of the goal in the achievement of the overall vision of the NNS and to some extent the resource allocation. Table 6: Goals of the National Nutrition Strategy, relative Weighting and Responsible Departments No. Goals Weight-age30 Responsible Department/s KRA Ref. G1 Coverage of health and community nutrition services for adolescents increased to 50% by 2018 10% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/T B, Epidemiology & Disease surveillance) MoWAGCD Min Primary & Secondary Education UN Agencies MCHIP USAID NGOs Local authorities KRA 1 G2 Standard maternal health and nutrition package scaled up to 90% coverage 10% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB, Epidemiology & Disease surveillance) KRA1 G3 50% of women of reproductive age have positive support from spouses and communities for decisions on maternal health, nutrition, healthy lifestyles and safe living environment by 2018 5% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB, Epidemiology & Disease surveillance) MAMID Min Women Affairs, Gender & community development KRA 1 G4 All health institutions provide the standard IYCF package (BMFHI, BF, CF, multiple micronu trient supplementation and fortification, dietary diversification, disease prevention and management, nutrition interventions in emergencies, feeding behaviours and stimulation, PMTCT, WASH, IMAM ) by 2018 10% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB, Epidemiology & Disease surveillance) KRA2 G5 Community IYCF counseling package increased from 44% to 100%of districts and in at least 90% of the wards by 2018 10% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB, Epidemiology & Disease surveillance, Environmental Health, Health Promotion) KRA2 G6 Coverage of growth monitoring and promotion for under-fives increased from 2 districts to 20 districts by 2016 and to 40 districts by 2018 and covering 5 wards per district 31 5% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) KRA2 G7 To increase the proportion of adult population practicing at least one or a combination of the top 5 healthy lifestyles (in relation to consumption of alcohol, fats, and salts; tobacco use, and physical activity) to 40% by 2018 5% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) Private Sector KRA3 30 Impact weighting refers to the contribution of the Goal to the desired impact of the Strategy. It may guide res ource allocation but does not strictly refer to resource allocation as allocation of resources is dependent upon the nature of actual activities envisaged and their coverage. 31 G8 Proportion of health facilities (central, provincial, mission and district hospitals) providing quality nutrition services for communicable (schistosomiasis, HIV, malaria, soil transmitted helminthes) and non communicable diseases increased to 75% by 2018 5% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) KRA3 G9 30% of institutions adopt national food service and nutrition guidelines by 2018 5% MOHCC(Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) Education Social Welfare Prisons KRA3 G10 Timely availability of relevant nutrition information that incorporates disaster risk reduction at all levels adequate for disaster preparedness planning and nutrition programming 10% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) FNC Local Government KRA4 G11 80% of women of reproductive age have the capacity to safely provide for their food, health and nutrition security using appropriate technologies by 2018 2% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/ TB Epidemiology &Disease surveillance)MoAMID MoWAGCD MoPSLSW NGOs KRA1 G12 Coverage of health and community nutrition services for school children increased to 50% by 2018 3% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) Ministry of Primary & Secondary Education Ministry of Higher and Tertiary Education KRA5 G13 All provinces and districts have food and nutrition security committees that are fully discharging their terms of reference by 2014, 50% of ward level committees functioning by 2018 2% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) FNC KRA5 Although growth monitoring promotion is not an evidenced intervention of infant and young child nutrition it is considered necessary for informing programming such as nutrition counselling of mothers and caregivers.42 No. Goals Responsible Department/s KRA Ref. Weight-age G14 To increase the proportion of households consuming safe and acceptable diets all year round to at least 80% by 2018 2% MoAMID MOHCC (Nutrition, Health Promotion, Environmental Health) KRA5 G15 Scale up evidence-based nutrition sensitive interventions in social protection services to 80% coverage by 2018 2% MoPSLSW MOHCC (Nutrition) FNC KRA5 G16 At least 50% of community based health workers promote WASH related behaviour change whilst integrating nutrition messaging by 2018 2% MOHCC(Reproductive health, EPI, Nutrition, Quality, AIDS/TB,Epidemiology & Disease surveillance, Environmental Health, Health Promotion) KRA5 G17 By 2018 ensure that at least 50% of imported and locally produced foods are evaluated for safety 2% MOHCC(Nutrition, Environmental Health, Health Promotion) MoAMID KRA5 G18 By 2018 the national nutrition department has a critical mass of staff with the ability, tools, supportive supervision and resources to integrate nutrition into other sectors 5% MOHCC(Nutrition, Environmental Health, Health Promotion) KRA6 G19 To increase resource allocation to nutrition to 1% of GDP per year by 2018. 5% MOHCC(Nutrition, Environmental Health, Health Promotion) FNC Ministry of Finance KRA6 Zimbabwe National Nutrition Strategy, 2014 -2018 43 13 STRATEGIES, ASSUMPTIONS AND RISKS In this section the NNS describes what needs to be done to achieve the above stated goals, and the justification for such strategies. How it will be done will be elaborated in a separate document on the implementation plan. The implementation plan will articulate concrete activities and outputs to be achieved each year over the 5-year period for the Strategy together with “how much it will cost”. Responsibility for implementation is provided in the section on institutional arrangements. Detailed activities, their timing, annual output targets and annual cost estimates are contained in an Excel spreadsheet for ease of tracking the milestones and budget. An extract of the information in presented in Annex 1. A strong emphasis of the NNS strategies is on prevention which is allocated 89% of the resource envelope. 13.1 KRA 1: Improved Quality of Adolescent and Maternal Nutrition Services Adolescent and Maternal nutrition services Bearing in mind that there are no specific adolescent nutrition programmes in Zimbabwe, the NNS seeks to improve their nutritional status, nutrition and preventive health knowledge and access to education. The growth rate of adolescents is second only to that of the first year of life. Their nutrient requirements are higher than any other time during the lifecycle. Nutrition needs of adolescents tend to double during growth spurts and when reaching puberty. Nutrition is also important during this time to help prevent adult diet-related chronic diseases, such as cardiovascular disease, cancer, and osteoporosis. Adolescents are also sensitive about their body structure at this stage.In addition, adolescents are involved in a lot of physical activity during sports at school, increasing their nutrition requirements. The NNS identifies the maternal nutrition period as nutrition for a woman, from conception, during pregnancy and through lactation. Maternal malnutrition particularly maternal short stature and iron deficiency anemia are associated with increased risk for stillbirths, miscarriages, low birth weight, maternal and infant mortality. Nutritional status of a mother at conception clearly determines size of and growth of the fetus(Kramer and Kakuma, 2003). Maternal overweight and obesity are associated with maternal morbidity, pre-term birth and increased risk for infant death (Sheiner E, Levy A, Katz M, et. al., 2005). Maternal micronutrient deficiencies are also associated with low birth weight in infants and increased risk for maternal morbidity and mortality. The Lancet series 2013 clearly identifies the need to address nutritional needs of a woman from conception through the second birthday of her child in order to promote good nutrition outcomes for both mother and infant. The World Health Organization has identified essential nutrition actions for improving maternal, newborn, infant and young child nutrition and health at health facility and community levels. This set of high impact nutrition interventions includes maternal iron, folate, Vitamin A, iodine and calcium supplementation, use of ITNs, family planning and adequate birth spacing, and nutritional care and support for pregnant and lactating women in emergencies (ENA2013). When implemented at scale at health facility and community levels, this standard maternal nutrition package has been proven to decrease under nutrition during pregnancy and lactation as well as have positive nutrition outcomes for the infant. The NNS, therefore, adopts this standard maternal nutrition package for implementation through health Zimbabwe National Nutrition Strategy, 2014 -2018 44 facility and community platforms. Primary focus is on preventive strategies, including among others capacitating community and health facility workers to deliver the standard adolescent and maternal nutrition package, promoting nutrition education through the school curriculum, using community platforms to promote behaviour change on reproductive and sexual health and nutrition, and strengthening planning and management of adolescent and maternal nutrition programmes. The specific strategies under KRA 1 are summarized in Table 7 No. Strategy Assumptions Risks Key Result Area 1: Improved quality of adolescent and maternal nutrition services G1 Coverage of health and community nutrition services for adolescents increased to 50% by 2018 Equip community health workers with skills and knowledge on maternal and adolescent nutrition service delivery Ability to integrate nutrition skills building into Reproductive health services, EPI & Antenatal care Adequate staffing at health facilities at all levels Health workers are willing to become role models within their communities Integration occurs in documents, and guidelines, but is not implemented Review and update school curriculum to incorporate adolescent and maternal nutrition Ministry of Primary and Secondary Education is inclusive of Ministry of Health and Child Care in Curriculum Review process Teachers willing to adapt weekly teaching plans to align with new curriculum Teaching aids are adequate to support teaching of nutrition in the new curriculum New nutrition and health updates are disseminated timely to teachers Teachers may not have adequate knowledge and skills on nutrition to effectively teach what is in the curriculum Promote behaviour change communication on maternal and adolescent health, SRH, hygiene and nutrition targeting adolescents using community platforms (such as the youth friendly corners approach) Community based platforms exist in every community Adolescent girls are fully participating in available community based platforms (e.g., youth friendly corners) SRH platform may not be an accepted platform for health and nutrition education Table 7: Main Strategies, Assumptions and Risks for Key Result Area 1 G2 Standard maternal health and nutrition package scaled up to 90% coverage Equip health facility and community-based health workers with skills and knowledge to deliver the standard package of maternal health and nutrition services (including family planning and adequate birth spacing) Ability to integrate nutrition skills building into reproductive health services Adequate staffing at health facilities at all levels Lack of documentation on nutrition services delivered Staff rotation at referral hospitals moves trained personnel to non nutrition related services Promotion of family-focused and evidence based behaviour change communication on appropriate adolescent, maternal and child care practices Population targeted with BCC has an environment conducive to changing behaviour and are willing to change Lack of funding Ensure availability of standardised anthropometric equipment and supplies for delivery of adolescent, maternal and child nutrition care services through health facilities Adequate skilled staffing to take care of other competing tasks and to release time for nutrition services Non-availability of funds to procure equipment Promotion of healthy eating for optimal weight management before and during pregnancy (to prevent obesity and under-weight) Staff available for counselling at health facility and community levels Marketing for profit at the expense of the population’s health Promoting the distribution and consumption of micronutrient supplements and fortified foods through community-based channels (pharmacies, schools and community health workers) targeting women and infants Mechanisms will be put in place to ensure adequate and appropriate monitoring and documentation of coverage and quality of services Low community acceptance Build capacity of national and district programme managers in effective planning, implementation, monitoring and management focusing on increasing quality and coverage of effective interventions for adolescent and maternal health and nutrition Information, resources and motivation are adequate for effective interventions High attrition Zimbabwe National Nutrition Strategy, 2014 -2018 45 G3 50% of pregnant and lactating women receive positive support from spouses and communities for decisions on maternal health, nutrition, healthy lifestyles and safe living environment by 2018 Promote behaviour change communication on decisions on maternal health, nutrition, healthy lifestyles and safe living environment targeting men, community and religious leaders and all other influential structures Positive behaviour change communication support from the spouses and community for decisions on maternal health, nutrition, health lifestyles and safe living environment Inadequate resources to support the behaviour change 13.2 Key Result Area 2: Infant and Young Child Nutrition Inappropriate infant and young child feeding practices contribute to under-nutrition. Improving feeding of children below 2 years of age can lead to significant reductions in malnutrition rates. Improvements in early childhood nutrition also contribute to improved health outcomes in later life (The Lancet Series, 2008). A review of child survival interventions in 42 countries revealed that promotion, support and protection of exclusive breastfeeding for the first six months of a child's life prevents 19% of all deaths under 5 years in countries with a high child mortality rate (WHO, 2001). The review also showed that continued breastfeeding up to two years with appropriate introduction of solid/semi-solid foods at six months (complementary feeding) contributes to a 6% reduction in child mortality (Jones G et.al. 2004, How many child deaths can we prevent this year? Lancet, 2004, 362:65–71).According to the ZDHS of 2010/11, only 11% of Zimbabwean children in the age group 6-23 months meet the minimum standards with respect to three recommended IYCF feeding practices (that is, children fed with breast milk or milk products; 4+ food groups, and the minimum meal frequency). This evidence supports the strong focus on infant and young child nutrition in the NNS. Table 8 shows the proposed strategies under Key Result Area 2 which covers IYCF which also emphasizes preventive measures. No. Strategy Assumptions Risks Key Result Area 2: Infant and Young Child Nutrition G4 All health institutions provide the standard IYCF package (BMFHI, BF, CF, multiple micronutrient supplementation and fortification, dietary diversification, disease prevention and management, nutrition interventions in emergencies, feeding behaviours and stimulation, PMTCT, WASH), IMAM by 2018 Integrate nutrition into pre-service curricula for health professionals Time, tools and guidelines are available for the trained cadres to discharge their duties related to proven high impact IYCF interventions Presence of community demand for the standard IYCF package High attrition rate of trained cadres in IYCF standard packages Changes in priority arising from outbreak of diseases/ epidemic situations Develop capacity of institutions and communities to provide comprehensive IYCF services Strategies for demand stimulation are effective in encouraging positive health seeking behaviour and uptake of improved/ recommended IYCF services Presence of barriers like transport, religious beliefs from accessing the services Strengthen the provision of supportive supervision to ensure quality service delivery on IYCF The existence of a legal framework for enforcement of supervisor observations and recommended follow-up actions Low staff motivation for quality service delivery Promote, protect and support optimal feeding practices at health facility level (including review of labour regulations) The community see benefits in changing feeding practices and are willing to take-up the services Cultural and religious barriers Access to the health facility (transport etc) G5 Community IYCF counselling package increased from 44% to 75% of districts with coverage of at least 90% of the wards by 2018 Empower community development structures to provide quality IYCF services Communities actively take-up IYCF services and community structures prioritise these as their needs for child survival Competing needs in the community could ‘crowd out’ IYCF package delivery Enforcement of the Code on marketing of breast-milk substitutes and the statutory instrument to protect and to promote breastfeeding All retail shops are aware and comply with the Code of Marketing of Breast milk Substitutes Police force is supportive of EH practitioners in enforcement and are capacitated to complement their actions Profit prioritised ahead of compliance with the code Corruption hinders enforcement Table 8: Main Strategies, Assumptions and Risks for Key Result Area 2 G6 Coverage of growth monitoring and promotion for under fives increased from 2 districts to 20 districts by 2016 and to 40 districts by 2018 and covering 5 wards per district Build capacity of community cadres (CHWs, EHTs, extension workers, community development workers) and development structures to improve early detection of malnutrition cases and provide appropriate counselling & referral services (skills and equipment) Communities are willing and able to bring their children for growth monitoring Availability of treatment after screening Community volunteer fatigue High attrition rate of community volunteers Breakdown and non replacement of GMP equipment Zimbabwe National Nutrition Strategy, 2014 -2018 46 13.3 Key Result Area 3: Strengthening Clinical Nutrition Services Currently, there is no information available regarding nutrition services for hospitals, schools, institutional feeding including prisons, orphanages, military and police camps and other institutions. Improved nutrition in schools and other institutions is expected to contribute to the overall national efforts of promoting optimal nutrition. Clinical nutrition services have a role to play in prevention and management of non-communicable diseases, HIV/AIDS and related opportunistic infections. The NNS incorporates strengthening of clinical nutrition services to address promotion of healthy lifestyles as a preventive measure as well as management of nutrition related diseases and specific strategies are presented in Table 9. Table 9: Main Strategies, Assumptions and Risks for Key Result Area 3 No. Strategy Assumptions Risks Key Result Area 3: Strengthening clinical nutrition services G7 To increase the proportion of adult population practicing at least one or a combination of the top 5 healthy lifestyles (in relation to consumption of alcohol, fats, and salts; tobacco use, and physical activity) to 40% by 2018 Promote social and behaviour change communication on healthy lifestyles (diversified diets -including consumption of at least 5 servings of fruits and vegetables decreased consumption of sugary beverages, intake of<400mg of sodium per day,physical exercise of recommended duration) using multi-media channels Willingness of target audience to adopt healthy lifestyles Proposed alternative foods are available, affordable and accessible The social and economic costs of adopting a healthy lifestyle may not be affordable Promote health screening and wellness days through various community based platforms such as pharmacies, workplaces and faith based organizations All platforms willing and able to take-up the health screening and wellness days initiative Prioritisation of curative over preventive services Generate information on food consumption patterns, obesity, overweight and key drivers of adult lifestyles (physical activity, alcohol and other substance abuse, diets, eating habits) to inform behaviour change communication strategies There is demand and appreciation for evidence The socio-economic cost of behaviour change will be prohibitive G8 Proportion of health facilities (central, provincial, mission and district hospitals) providing quality nutrition services for communicable (schistosomiasis, HIV, malaria, soil transmitted helminthes) and non communicable diseases increased to 75% by 2018 Promote the establishment of wellness clinics with adequate equipment for screening and treatment of NCDs Communities attend well-ness clinics once they are established Low motivation of the health workers Strengthen the knowledge and skills of health workers for the prevention and management of NCDs Complementary supplies for service delivery are available High staff attrition rate Effective monitoring of prevalence of nutrition related NCD risk factors (overweight, obesity, abnormal lipids, raised blood sugar)and supportive supervision of services delivered by wellness clinics The existence of a legal framework for enforcement of supervisor observations and recommended follow-up actions Low staff motivation for quality service delivery Management of moderate and severe acute malnutrition in PLWHA Capacity and commitment for national response exist Shortage of health workers Raise awareness of Under 2 malnutrition as risk factor for NCDs in health facility departments and communities Health workers are able to prioritise and set aside sufficient time to actively screen and counsel clients and their work in this regard is recognised and appreciated Low motivation G9 30% of institutions adopt national food service and nutrition guidelines by 2018 Ensure nutrition services and education are implemented through institutions of special care(such as hospitals, prisons, orphanages) to promote the reinforcement of nutrition practices Institutions of special care have the requisite capacity to implement the national food services and nutrition guidelines Lack of resources 13.4 KRA 4: Quality nutrition information systems and advocacy Ensuring that nutrition surveillance systems provide timely, complete and accurate information on the nutritional status of all people (especially the vulnerable ones) is a priority for the NND. Research (including operational research) on nutrition interventions that informs the high impact strategies needed for the reduction of prominent nutrition problems in the country is much needed, as well as monitoring and evaluation of nutrition programmes. There is also a need to strengthen advocacy to ensure that the evidence obtained from research and evaluation of nutrition programmes is used to sensitize decision makers in government, stakeholders and funders. Specific strategies to strengthen the quality of information systems, key assumptions and the likely risks are presented in Table 10. Zimbabwe National Nutrition Strategy, 2014 -2018 47 Table 10: Main Strategies, Assumptions and Risks for Key Result Area 4 No. Strategy Assumptions Risks KRA 4: Quality nutrition information systems and advocacy G10 Timely availability of relevant nutrition information that incorporates disaster risk reduction at all levels adequate for disaster preparedness planning and nutrition programming Ensure nutrition indicators are integrated into the national Health Information System Utilisation of nutrition information generated Low capacity for response Strengthening coordination of nutrition surveillance activities andtimely information sharing (subcommittee, indicators, integrated operational plan, nutrition surveillance guidelines) Extra resources will be mobilised for an effective response Competing priorities Strengthen monitoring and evaluation of nutrition programmes The existence of a legal framework for enforcement monitoring and evaluation recommendations Low staff motivation Ensure availability of functional equipment for monitoring nutrition trends in Zimbabwe Skills and knowledge for use of the equipment is adequate at all levels Equipment is safely stored and maintained High attrition rate Build capacity of FNSCs in early warning and disaster risk management 100% resuscitation of FNSCs Competing tasks from sector responsibilities Operational research to identify context specific drivers of stunting and possible interventions that address the causal factors of malnutrition Capacity and commitment for national response exist Buy-in from relevant institutions to conduct operational research Shortage of resources 13.5 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response The causes of malnutrition in a population are many and often interlinked. The immediate causes are related to nutrient intake and to health. The underlying causes are embedded in the household and community level context in which under-nutrition occurs, including poor access to food at household level, poor care for women and children and poor health environment. The basic causes of malnutrition are rooted in institutional, political and economic issues such as poverty, economic growth, governance and use and control of natural resources and the environment. Addressing nutrition challenges therefore calls for collaboration across sectors. Acceleration of progress in nutrition will require effective, large-scale nutrition-sensitive programmes that address key underlying determinants of nutrition and enhance the coverage and effectiveness of nutrition-specific interventions (Lancet, 2013). According to the World Bank, 2013, multi-sectoral actions can strengthen nutritional outcomes in three main ways; (a) by accelerating action on determinants of under-nutrition, (b) by integrating nutrition considerations into programmes in other sectors which may be substantially larger in scale; and (c) by increasing policy coherence through government-wide attention to policies or strategies and trade-offs, which may have positive or unintended negative consequences on nutrition. The key sectors for maximizing nutrition impacts are health, agriculture and food security, social protection (especially social safety nets), education (especially girl's education), water and sanitation and the private sector(Ruel, 2008). While strong evidence exists for inter-sectoral collaboration across sectors for improved nutrition, little evidence exists demonstrating the success of multi-sectoral projects improving nutrition outcomes. Experience and evidence exists that points to thinking and planning multi-sectorally, with sector specific actions tailored to specific contexts, objectives and sectoral operating environments (World Bank, 2013). In this Key result area the NNS strategy will strengthen the capacity of Food and Nutrition Security Committees to enable them to coordinate and monitor nutrition activities at all levels. Through the agriculture sector, food based approaches to ensuring dietary diversity for good nutrition will be promoted, coupled with post harvest management for year round availability of safe nutritious food. Through the social assistance programmes, nutrition will be well integrated into the design and implementation of social protection programmes informed by evidence based vulnerability and food and nutrition assessment results. The NNS will also promote continued education of the girl child and women empowerment for improved nutrition outcomes. Zimbabwe National Nutrition Strategy, 2014 -2018 48 Improving Nutrition in Water and Sanitation Water and sanitation services are an essential part of the National Nutrition Strategy. According to the 2010/11 ZDHS, “Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among young children. Exposure to diarrhoea-causing agents is frequently related to the use of contaminated water and to unhygienic practices in food preparation and disposal of excreta.” Clean water is essential to the preparation of food that is safe to eat. Hand washing at critical times, e.g. before eating and after using the toilet is an essential part of decreasing diarrhoea and improving nutritional status. The ZDHS 2010/11 found that diarrhoea is more prevalent among children living in households without improved sources of drinking water. Similarly, the prevalence of diarrhoea is higher in children living in rural areas and also in households with unimproved, shared sanitation facilities. Care needs to be taken during the period of introduction of complementary foods as incidences of diarrhoea among children aged 6 to 11 months increases drastically after the exclusive breastfeeding period. Continued and sustained education on proper hygiene practices has the potential to both prevent and decrease rates of malnutrition in Zimbabwe. Improving nutrition of school-age children Nutrition interventions for school-age children have been prioritized for inclusion in the National • Nutrition Strategy in recognition of the central role the school curriculum plays in promoting nutrition knowledge and behaviour change, on the one hand, and the contribution of the education sector to sustainable, longer-term and equitable reduction in under-nutrition on the other. The package of nutrition interventions that has been prioritized for implementation as part of the NNS encompasses the following: • Integrating nutrition into the basic education curriculum, covering essential topics such as nutrition and growth, family planning, pregnancy and infant feeding, and hygiene promotion; • Teacher training on curriculum enhanced by integrating nutrition; • Promoting enrolment and improving attendance, especially of girls in schools with curriculum strengthened in relation to nutrition, and supporting their joining of school health and nutrition clubs; • Strengthening school health and nutrition management, which includes incorporation of health and nutrition services into school calendars; these include immunization, de-worming, family planning, school feeding in locations vulnerable to household food insecurity during emergencies, and increasing access to improved sanitation facilities; • Promoting social behaviour change in nutrition and WASH through establishment and capacitation of school health and agriculture clubs; • Promoting healthy lifestyles directly (through dietary diversification as part of practical lessons on agriculture and home economics, and physical activity as part of extra-curricular activities); and • Strengthening community-based health and nutrition clubs led by children that promote appropriate nutrition practices at the household and local levels targeting out-of-school children. Zimbabwe National Nutrition Strategy, 2014 -2018 49 Global evidence confirms that improvements in women's education are linked to better nutritional outcomes for their children. Under-nutrition is significantly less among children born to mothers with secondary education. For example, the risk of stunting has been found to be about 2.5 times lower in Burundi, half in Lagos and more than 4 times lower in Niger when the mother attended secondary school compared with no schooling. This is achieved in three main ways: a) by improving child care practices through improved access to information (better literacy); b) strengthening economic prospects of educated women (employment opportunities); and c) delaying the first pregnancy (schools protect adolescents from early marriages). Food Safety Food safety and standards are critical for protection of the food supply in Zimbabwe. The NNS recognizes the role that food safety and standards have for the prevention of malnutrition in Zimbabwe. It is with this understanding that the NNS incorporates priority actions such as updating laws to control the safe production, processing and distribution of safe foods within the country and from outside, investment in food safety testing equipment to be used at main border posts and within the country in order to avoid sub-standard foods from coming into the country as this compromises the safety of foods distributed and consumed, ensuring that all ports of entry are manned by trained personnel to monitor food imports are a priority. Social Protection The deliberate integration of food and nutrition security indicators into social protection programmes needs to be an integral part of the Social Protection agenda in the country. Among many social protection programmes like the harmonized social cash transfer system and treasury supported social welfare grants for instance, there is a general lack of integration of nutrition into social protection services to address nutrition needs for infants, young children, adolescents and women of reproductive age in difficult circumstances; lack of nutrition education and behaviour change communication within all social assistance programmes and lack of integration of nutrition into targeting, monitoring and evaluation systems for social protection programmes. With this background there is need for: 1) accommodation of nutrition indicators for instance in targeting of the vulnerable in the communities using nutrition sensitive programming for social protection; 2) provision of timely food assistance in emergency situations (adequate for the nutrition requirements of the different population groups); 3) assisting vulnerable populations prepare for emergency by re-establishing livelihoods after-shocks; and 4) providing a consistent adequate cash transfer to ultra-poor households for them to meet their needs for a healthy productive life. Zimbabwe National Nutrition Strategy, 2014 -2018 50 11: Main Strategies, Assumptions and Risks for Key Result Area 5 No. Strategy Assumptions Risks KRA 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response G11 80% of women of reproductive age have the capacity to safely provide for their food, health and nutrition security using appropriate technologies by 2018 Target women for livelihood projects that use labour-saving technologies to improve their decision-making power in relation to access to reproductive health services, nutrition,purchasing, occupational health Proportion of women willing and able to participate in livelihoods projects is adequate Environment is conducive for viability of projects Participation leads to true empowerment and decision making in the home as opposed to gender conflicts and violence Participation may compromise time for child care and personal health and nutrition Nutrition education on safe use of irrigation to prevent malaria, schistosomiasis and any other water-borne diseases MOHCC and MAMID work together effectively on prevention and treatment of water borne diseases Community may not accept messages on treatment and prevention of water borne diseases G12 Coverage of health and community nutrition services for school children increased to 50% by 2018 Knowledge and skills development for education managers, school health coordinators, teachers (pre-service and in service)and SDC members on health and nutrition Skills acquired are successfully aligned with already existing teaching plans High attrition Nutrition integrated into the basic education curriculum, covering essential topics such as nutrition and growth, family planning, pregnancy and infant feeding, and hygiene promotion Availability of teachers, textbooks and teaching aids in schools to give adequate attention to nutrition in the classroom Attendance and appreciation of nutrition among school children is high Low motivation amongst teachers Promotion of continuing girls education focusing on school retention and completion of education by orphans and other vulnerable children in a bid to break cycles of poverty Willingness and motivation between parents and girls to complete secondary education Low accessibility to schools by girls Lack of resources for parents to support completion of secondary education Promotion of Peer Education on Health and Nutrition in all schools by Q4, 2015 Willingness of pupils to participate in clubs Retention of peer educators Inadequate parental and school support for activities of Health and Nutrition clubs G13 All provinces and districts have Food and Nutrition Security Committees that are fully discharging their terms of reference by 2014, 50% of ward level committees functioning by 2018 Capacity development of FNSCs on their core mandates Line ministries have filled their positions for effective multi-sectoral collaboration in Food and Nutrition Security Committee activities Competing priorities among Food and Nutrition Security Committee members G14 To increase the proportion of households consuming safe and acceptable diets all year round to at least 80% by 2018 Promote crop diversification including adoption of bio-fortified crops rich in iron, zinc and vitamin A Acceptance of bio-fortified seeds among communities Unfavourable climate and environmental conditions Promote improved post-harvest handling, processing, storage and value-addition to increase shelf-life and food safety of harvested foods Willingness of target groups to shift to improved technologies High cost of some of the technologies may hinder adoption Promote production and availability of small live-stock, aquaculture and apiculture and consumption of animal source protein foods Availability of technical expertise to promote the enterprises at household level Unfavourable climate and agro-ecological conditions Promote research and development of improved varieties of bio-fortified seeds Availability of technical expertise to conduct research in bio-fortification Failure of bio-fortification trials due to unfavourable weather and pests Promote awareness of and demand for nutritious food, with an emphasis on production, processing, preservation, storage and preparation of diverse foods Availability of appropriate technologies for each stage of the food value chain Food commodity price fluctuations Promote consumer awareness, demand for, and market availability of fortified staple foods Acceptance of fortified foods by households Households do not appreciate nutritional value of fortified foods Zimbabwe National Nutrition Strategy, 2014 -2018 51 The main strategies for KRA 5 as well as the assumptions and risks are summarised in Table 11. G15 Scale up evidence based nutrition sensitive interventions in social protection services to 80% coverage Provision of conditional cash transfers to non labour constrained vulnerable households under the food poverty line to increase utilisation of health services by pregnant and lactating women and children under-five Providing a consistent adequate nutritionally sensitive unconditional social cash transfer to ultra-poor labour constrained households for them to meet their needs for a healthy, productive life Health services can cope with increased demand by pregnant and lactating women and children under-five The case load of the target groups below the food poverty line does not exceed the resource base Religious and cultural norms are a barrier to conditionality Integration of nutrition into social protection is not perceived as expensive and unnecessarily delaying delivery of social assistance to vulnerable groups Ensure that nutrition education and behaviour change communication are integral parts of all social assistance programmes Implementing partners have the capacity to deliver a comprehensive package which includes BCC on nutrition Socio-cultural and religious practices may hinder behaviour change among target groups Empower communities through productive asset creation and information to build a culture of safety and resilience to disasters Communities are willing to take ownership of their food and nutrition security and are willing to work to create assets that benefit them Untimely availability of labour and complementary resources for the work Integrate DRM into sector programmes and budgets 33 (supportive policy, legal and institutional frameworks for DRM; early warning information, social behaviour change towards a culture of safety and resilience; integrating DRM into sector programmes; and DRM capacity building at all levels) Institutions for DRM exist, Draft DRM policy and strategy are finalised, resource allocation to early warning information system remains a priority Resistance by sectors to address DRM issues for lack of technical capacity and funds Integrate nutrition indicators into targeting, monitoring and evaluation systems for social protection programmes Social services officers can be capacitated to integrate nutrition into their day to day work 33 This includes disaster risk prevention, preparedness and response. Provision of timely social safety nets in emergencies and crisis situations that meet universally accepted minimum standards and national food and nutrition standards (where applicable The perceived cost of targeting might discourage the use of nutrition indicators as targeting criteria Nutrition indicators may contradict with community targeting and create conflict Climate change-induced shocks may increase the frequency and severity of emergencies The social sector has adequate capacity to implement and coordinate emergency response initiatives G16 At least 50% of community based health workers promote WASH related behaviour change whilst integrating nutrition messaging by 2018 Integrate nutrition into PHHE delivered through the community health club approach Community health clubs are revived and functional Volunteer fatigue Capacitate WASH committees at all levels on nutrition and WASH linkages Functional, revived and pro-active WASH committees Lack of resources Lack of commitment by WASH committees Competing priorities Integrate nutrition into PHHE delivered through the community health club approach There are programmes that provide complementary resources for community based workers to deliver WASH promotion Too many competing priorities dependent on the same cadres G17 By 2018 ensure that at least 50% of imported and locally produced foods are evaluated for safety All ports of entry capacitated with port health officers Availability of skilled people who can be recruited and deployed as port health officers Resources available to provide the officers with relevant, state-of-the art equipment Low motivation of port health officers Corruption Harmonisation of regulations related to importation of foods among ZIMRA, MOHCC, MAMID (veterinarians) and SAZ to meet International Standards Availability of key people and willingness to collaborate between the various government agencies. The reviewed and updated legislation and regulations are effectively used to monitor and ensure food safety Turnover of key people may derail process in harmonisation. Legislation review processes might take long. Provide low cost food safety rapid test kits used at ports of entry and market places Political will, commitment and resource mobilisation and allocation towards low cost rapid test kits Sensitivity and specificity of test-kits maybe compromised Capacitate (with skills, equipment and supplies) existing Government Analyst laboratory Availability of utilities (water and electricity) to support efficient functioning of laboratories Low motivation of laboratory technicians Conduct operational research on pesticide residue and aflatoxins and GMOs in household diets Capacitate the National Environmental Health Department to effectively implement and monitor the above mentioned strategies Availability of expertise to conduct research Capacity created will be effectively utilised and can be retained Lack of resources to support research activities Resources to ensure knowledge and skills and equipment provided are not effectively utilised and maintained 52 14 IMPLEMENTATION PLAN The NNS is only effective when implemented. It is a large programme with many strategies under each goal and several sub-activities under each strategy. The financial resources and capacity of institutions responsible of implementing these activities are not adequate to enable simultaneous implementation of all the identified activities. Therefore, the strategy identifies immediate short term actions and those to be implemented in the medium term (see Annex 1). 14.1 Short term strategic activities (Years 1 to 3) Nutrition is under-funded at the moment, and no meaningful progress can be achieved in the implementation of the strategy without a significant improvement in resources and capacity. The mobilisation of resources for nutrition together with institutional strengthening of the National Nutrition Department and various state and non-state entities, agencies and structures responsible for implementation of the NNS has been given high priority. This includes recruitment of staff, strengthening of nutrition-related training programmes for health professionals (e.g., nutritionists, dieticians, nurses, doctors, and other relevant health professionals), and procurement and distribution of complementary job aids and working tools (e.g., anthropometric equipment, and NCD screening and treatment equipment). In addition, the number 1 nutrition challenge for Zimbabwe is reducing stunting in under-fives. Addressing this problem is a top priority of the strategy with Year 1 and 2 activities focusing specifically on addressing stunting in children under the age of two years by strengthening adolescent and maternal nutrition, and community IYCF services, especially capacity for face-to-face nutrition counselling of pregnant and lactating mothers and caregivers of children under the age of two years (but also reaching out to children in the age group 24-59 months), development and dissemination of information, education and communication materials and boosting supplies such as therapeutic foods for effective delivery of IMAM services, micronutrient supplements to 400,000 adolescent girls (as future mothers), supplies for deworming (adolescents, mothers, school children), iron and folate supplements to 420,000 women aged 15 - 49 years, calcium supplements to 300,000 pregnant women and vitamin A supplements for 300,000 women post-partum, supplementary feeding for 60,000 pregnant and lactating women with acute malnutrition, and supplements to 500,000 anaemic women of child-bearing age. Finalisation and implementation of the national Food Fortification Strategy is given high priority and will be done in the first two years of the strategic plan. This will include specific technical support and leveraging of financial support for the private sector companies that deal with fortification 'vehicles' (i.e. processed food commodities like sugar, oil and wheat flour) prioritised by Zimbabwe for industrial fortification to improve the supply of micronutrients through the value chain. Production of fortified processed foods will continue though throughout the five years of the strategy and the volumes of industrially fortified commodities will grow with time as demand for these grows. Support for these activities will be in the form of resources for start-up costs (including equipment and training of staff) for millers, bakers, oil processing firms and sugar companies and recurrent costs in the form of the supply of micronutrients required. Zimbabwe National Nutrition Strategy, 2014 -2018 54 Promotion of behaviour change communication on maternal and adolescent health, SRH, hygiene and nutrition targeting adolescents using community platforms (such as the youth friendly corners approach) is given priority to start in the first year and will continue throughout the tenure of the NNS. The special focus on adolescents is in recognition of the need to catch future mothers young, as this is important for addressing stunting in the first 1,000 days. It also addresses the gap observed in adolescent nutrition services which are either absent or have very limited coverage. The development of an enabling environment (governance for nutrition) has also been prioritised for strengthening in the first two years of the NNS with high priority being accorded to generating evidence for strengthening nutrition programming, strengthening coordination of the multi-sectoral collaboration and coordination approach, and development, printing and dissemination of policies, standards and implementation guidelines. The component on evidence generation includes: (a) strengthening of the nutrition surveillance system, the food security and disaster preparedness early warning information system; (b) commissioning of two important surveys (food consumption survey and a KABP survey on adolescents and maternal nutrition); and (c) launching of an operational research on exclusive breastfeeding. In relation to standards and guidelines, the NNS prioritises development of maternal and adolescent nutrition guidelines, the review and updating of community IYCF guidelines and manuals based on new evidence from national, regional and global research, updating of the school health manual, and development of national food service and nutrition guidelines, nutrition surveillance guidelines, and guidelines on peer health and nutrition education clubs. Dissemination of these guidelines and provision of support for their use is also given high priority attention. Identification and training of community cadres (2,180 in total) in early detection of malnutrition cases, provision of appropriate counselling and referral will be an on-going activity until full coverage is reached, but even beyond this point in order to cater for natural attrition of these community volunteers. All trainings therefore are treated as longer term undertakings but starting in the first year of the plan. They will not be phased out, though scale of training may be reduced with time when critical mass is reached. Strategic activities to address the growing problem of nutrition-related NCDs are important and have been programmed mainly as medium-to-longer term priorities (3-5 years) but there are routine and on-going activities that are urgent and will be continued from Year 1. What will be begin in the short term (Years 1 and 2) is the development of a behavioural change communication strategy on healthy lifestyles, reviewing and updating IEC/BCC materials on healthy life styles, promoting social behavioural change on healthy lifestyles using various types of mass media, carrying out social outreach activities such as road shows, awareness campaigns, commemorations, agriculture shows, community theatres, radio listening clubs, community films in 30 districts, development of a protocol on prevention and management of NCDs. BCC will remain an important on-going activity till the final year of the NNS. 14.2 Medium-to-long term strategic activities (Years 4 and 5) Most of the strategic activities that are started in the first two years and continue to be needed will continue throughout the duration of the NNS. In the medium term, the focus will be on strengthening Zimbabwe National Nutrition Strategy, 2014 -2018 55 the multi-sectoral approach including development of nutrition social marketing tools for the school environment, strengthening the integration of nutrition into education, social protection, agriculture and health. These are longer term undertakings as they require, in the case of basic education and agricultural extension training, a review of the curriculum, the formation of school based peer education groups, finalisation of a BCC strategy, preparation of the BCC tools and materials and training of educators. Incorporating nutrition into the basic education curriculum will also require the promotion of school gardening with cooking demonstrations and nutrition education. These will be done mostly in years 3-5. Trainings that require a ToT approach, such as the BMFHI, and those that are routine and continuous, such as pre-service and in-service training of health professionals, may start in the first two years but will continue and be expanded in the medium to longer term as more resources become available, and the demand for such human resources grows with increased coverage of nutrition services. Many of the capacity building activities related to infrastructure and introduction of new national events for addressing the issue of nutrition-related NCDs will come mostly in years 3-5. These include equipping and upgrading of 400 pharmacies, workplaces and faith based organisations, conducting quarterly health screening and wellness days in all 89 districts in the country and bi-annual NCD screening (for controlling diabetes, hypertension, overweight and obesity) at 8,112 schools. Other medium-to-longer term activities include identification and equipping of 400 health facilities and 200 wellness clinics, and capacity building of 600 health workers (training on prevention and management of NCDS). Building the capacity of FNSCs on early warning and disaster risk management, as part of the broader goal of ensuring timely availability of relevant nutrition information that incorporates disaster risk reduction at all levels, is included in the strategy and its implementation will start at the national level and cascade down to provincial, district and ward level. The trainings at ward level will take place at the earliest possible time after completing that at the district and higher levels. The NNS supports strengthening of health services, agriculture and social protection programming to address nutrition. Integration of nutrition into water, sanitation and hygiene promotion activities is considered paramount but not a short term undertaking. So is the strengthening of the national system for promoting food safety (regulations and mechanisms for enforcement of these laws) will be on going into years 3, 4, 5 and beyond this strategy. In relation to food safety, the NNS focuses on strengthening staffing in terms of numbers and skills and their capacity in terms of equipment and supplies to test imported and locally traded foods for compliance with minimum food safety standards. Promotion of improved post-harvest handling (processing, storage and value addition) to increase shelf life and food safety of harvested foods will be on-going throughout the five years of the strategy. The NNS also advocates for increased production of small live-stock, aquaculture and apiculture and consumption of animal source protein foods, research and development of improved varieties of bio fortified seeds, and awareness promotion and demand creation for nutritious foods, with an emphasis on production, processing, preservation, storage and preparation of a more diverse food basket. These activities together with awareness promotion and demand creation for increased consumption of fortified staple foods are long term in nature. Zimbabwe National Nutrition Strategy, 2014 -2018 56 The NNS also promotes the integration of nutrition into social protection from a longer term perspective. Provision of conditional cash transfers to non-labour constrained vulnerable households under the food poverty line is advocated for to increase utilization of health services by pregnant and lactating women and children under-five. In addition, the provision of a consistent adequate nutritionally sensitive unconditional social cash transfer to ultra-poor labour constrained households is supported in order to help them meet their needs for a healthy productive life. Activities to integrate nutrition education and behaviour change communication into all social assistance programmes are promulgated in the NNS. Focus is also put on promoting the empowerment of communities through productive asset creation and information to build a culture of safety and resilience to disasters. Other long term strategic interventions include integrating nutrition sensitive DRM into sector programmes and budgets, integrating nutrition indicators into targeting, monitoring and evaluation systems for social protection programmes, and provision of timely social safety nets in emergencies and crisis situations that meet universally accepted minimum standards and national food and nutrition standards (where applicable). Zimbabwe National Nutrition Strategy, 2014 -2018 57 15 STRATEGIC RESULTS CHAIN AND MONITORING AND EVALUATION FRAMEWORK 15.1 Strategic Results Chain The impact plan is presented in Table 13 and focuses on higher level results achievable through the implementation not only of the NNS, but other on-going development initiatives that have the potential to make a positive impact on the identified indicators. The indicators focus on maternal, infant and child mortality and higher level nutrition indicators such as stunting and the proportion of new born babies with low birth weights. In terms of the outcomes plan, these are more directly linked to the implementation of the NNS itself and these focus on behaviour change related outcomes and indicators of transitory under-nutrition (see Table 14). With the successful implementation of the NNS, the coverage and quality of nutrition services are expected to improve resulting in reduction in prevalence of stunting, nutrition-related NCDs, and mortality (maternal, infant and child). The stated outcomes and impacts will be confirmed through periodic impact assessments in the course of the plan most of which will be informed by data collected through national surveys and a few complementary ones that will also capture baseline information for indicators that are outside the existing national surveys. Zimbabwe National Nutrition Strategy, 2014 -2018 58 Table 13: Impact Indicators, Baseline Values, Targets and Allowable Variance 15.2 Impact Plan R e d u ct io n o n n u tr it io n re la te d N C D s (c a rd io va sc u la r d is e a se s, d ia b e te s, h y p e rt e n si o n , ca n ce r) i n a d u lt s P re va le n ce o f N C D s (c a rd io va sc u la r d is e a se s, d ia b e te s, h y p e rt e n si o n , ca n ce r in a d u lt s) % o f a d u lt s w it h Ty p e 2 D ia b e te s N C D s ri sk fa ct o r su rv e il la n c e 1 0 % 2 0 0 5 9 .7 9 .5 9 8 .5 8 % ± 1 % 7 ,8 ,9 3 % o f a d u lt s w it h H y p e rt e n si o n N C D S r is k fa ct o r su rv e il la n c e 2 7 % 2 0 0 5 2 6 % 2 5 % 2 4 % 2 3 % 2 2 % ± 5 % 7 ,8 ,9 3 In ci d e n ce o f Ty p e 2 D ia b e te s a m o n g a d u lt s N u m b e r o f n e w Ty p e 2 D ia b e te s a m o n g a d u lt s N H M IS T B C T B C T B C T B C T B C T B C T B C T B C 7 ,8 ,9 3 ,6 In ci d en ce o f H yp er te n si o n am o n g ad u lt s N u m b er o f n ew H yp er te n si o n ca se s am o n g ad u lt s p er ye ar N H M IS TB C TB C TB C TB C TB C TB C TB C TB C 7 ,8 ,9 3 ,6 Im p ro ve m at er n al n u tr it io n P ro p o rt io n o f lo w b ir th w ei gh t b ab ie s Pe rc en ta ge o f b ab ie s b o rn w it h w ei gh t le ss t h an 2 .5 kg ZD H S 9 .5 % 2 0 1 0 /1 1 9 .2 5 % 9 .0 0 % 8 .7 5 % 8 .5 0 % 8 .3 0 % ±1 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 Im p ro ve d m a te rn a l o u tc o m e s M a te rn a l m o rt a li ty r a ti o N u m b e r o f m a te rn a l d e a th s/ 1 0 0 ,0 0 0 l iv e b ir th s Z D H S 9 6 0 2 0 1 0 /1 1 9 0 0 8 4 0 7 7 0 6 9 0 6 0 0 ± 1 0 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 Im p ro ve d i n fa n t su rv iv a l In fa n t m o rt a li ty ra te N u m b e r o f in fa n t d e a th s/ 1 0 0 0 l iv e b ir th s Z D H S 5 7 2 0 1 0 /1 1 5 2 4 7 4 2 3 7 3 1 ± 1 0 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 Im p ro ve d c h il d su rv iv a l C h il d m o rt a li ty ra te N u m b e r o f u n d e r fi ve c h il d d e a th s/ 1 0 0 0 l iv e b ir th s Z D H S 8 4 2 0 1 0 /1 1 7 8 7 0 6 2 5 4 4 6 ± 1 0 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 R e d u ce d st u n ti n g l e ve ls P ro p o rt io n o f U n d e r 5 s w h o a re s tu n te d b y a g e g ro u p % o f ch il d re n 0 5 m o n th s < 2 z s co re Z D H S 9 .8 2 0 1 0 /1 1 8 .8 7 .8 6 .8 5 .8 4 .8 ± 4 2 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 % o f ch il d re n 6 2 3 m o n th s < 2 z s co re Z D H S 2 9 2 0 1 0 /1 1 2 8 2 7 2 6 2 5 2 4 ± 8 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 % o f ch il d re n 2 4 5 9 m o n th s < 2 z s co re Z D H S 3 8 2 0 1 0 /1 1 3 7 3 6 3 5 3 4 3 3 ± 6 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 % o f ch il d re n 6 5 9 m o n th s < 2 z s co re Z D H S 3 2 2 0 1 0 /1 1 3 1 3 0 2 9 2 8 2 7 ± 7 % 1 ,2 ,3 ,4 ,5 ,6 ,7 ,9 ,1 1 , 1 2 ,1 3 ,1 4 ,1 5 ,1 6 ,1 7 , 1 8 ,1 9 1 ,2 ,3 ,4 , 5 ,6 Im p a ct D e sc ri p ti o n Im p a ct In d ic a to r M e a su re m e n t U n it (e .g ., % , n o ., e tc .) B a se li n e Ta rg e t a / A ll o w a b le V a ri a n ce R e f. KRA Ref. D a ta S o u rc e B a se li n e B a se li n e P e ri o d 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 G o a l Zimbabwe National Nutrition Strategy, 2014 -2018 59 15.3 Outcome Plan Table 14: Outcome Indicators, Baseline Values, Targets and Allowable Variance Proportion of Under 5s with underweight % of Under 5s weight for age <-2 z score ZDHS 9.70% 2010/11 9.00% 8.00% 7.00% 6.00% 5% ±30% 2,3,4,5,6,1 3, 14,15, 16,18,19 1,2,5,6 Proportion of Under 5s with wasting % of Under 5s weight for height < -2 z score ZDHS 3% 2010/11 3% 2.70% 2.50% 2.20% 2% ±25% 2,3,4,5,6,1 3, 14,15, 16,18,19 1,2,5,6 Proportion of Under 5s with obesity % of Under 5s > weight for length +2 z-scores Impact Ref. Outcome Indicator Measurement Unit (e.g., %, no., etc Baseline Target Allowable Variance Goal Ref. KRA Ref.Data Source Baseline Baseline Period 2014 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Outcome Description 1: Improved nutritional status ZDHS 5.50% 2010/11 5% 4.50% 4% 3.50% 3% ±33% 2,3,4,5,6,1 3, 14,15, 16,18,19 1,2,5,6 Proportion of school age children (5-12yrs) with obesity % of children weight for length (5-12yrs) >2 z score TBC No data TBC TBC TBC TBC TBC TBC TBC 1,12,13, 14,15, 16,18,19 1,5,6 Proportion of adolescents with obesity (female 15 19 years) % of adolescents BMI >29.9 ZDHS 1.70% 2010/11 1.60% 1.40% 1.20% 1% 0.80% ±25% 1,12,13, 14,15, 16,18,19 1,5,6 Proportion of adolescents with obesity (male 15-19 years) % of adolescents BMI >29.9 ZDHS 0.20% 2010/11 0.20% 0.15% 0.10% 0.07% 0.05% ±30% 1,12,13, 14,15, 16,18,19 1,5,6 Proportion of female adolescents underweight (15-19 years) % of adolescents BMI < 18.5 ZDHS 13.50% 2010/11 13% 12% 11% 10% 9% ±11% 1,12,13, 14,15, 16,18,19 1,5,6 Proportion of male adolescents underweight (15-19 years) % of adolescents BMI < 18.5 ZDHS 34.70% 2010/11 34% 32% 30% 28% 25% ±12% 1,12,13, 14,15, 16,17,18,1 9 1,5,6 Proportion of women of child bearing age (15-49 years) underweight % of women of child bearing age BMI < 18.5 ZDHS 7.1 2010/11 7% 6.80% 6.50% 6% 5% ±30% 1,12,13,14, 15, 16, 17 18,19 1,5,6 Proportion of women of child bearing age (15-49 years) with obesity % of women of child bearing age BMI >29.9 ZDHS 10.60% 2010/11 10% 9% 8% 7% 5% ±20% 1,12,13,14, 15, 16, 17 18,19 1,5,6 Proportion of adult men (15-49) with obesity % of men with BMI >29.9 ZDHS 1.80% 2010/11 1.80% 1.70% 1.70% 1.60% 1.50% ±7% 1,12,13,14, 15, 16, 17 18,19 1,5,6 Proportion of males 6-14 years of age that are overweight and obese % of women with BMI >=25.0 ZDHS No data TBC TBC TBC TBC TBC TBC TBC 1,12 1,5 Proportion of females 6 14 years of age that are overweight and obese % of women with BMI >=25.0 ZDHS 12.60% 2010/11 12% 11% 10% 9% 7% ±29% 1,12 1,5 Proportion of females 20 29 years of age that are overweight and obese % of women with BMI >=25.0 ZDHS 26.80% 2010/11 26% 25% 23% 22% 20% ±10% 2,7,8,11,14 ,15,18,19 1,3,5.6 Proportion of females 30 39 years of age that are overweight and obese % of women with BMI >=25.0 ZDHS 41.50% 2010/11 40% 38% 35% 32% 30% ±13% 2,7,8,11,14 ,15,18,19 1,3,5,6 Proportion of females 40 49 years of age that are overweight and obese % of women with BMI >=25.0 ZDHS 50.50% 2010/11 49% 47% 45% 43% 40% ±7.5% 2,7,8,11,14 ,15,18,19 1,3,5,6 Proportion of females 50 54 years of age that are overweight and obese % of women with BMI >=25.5 TBC no data TBC TBC TBC TBC TBC TBC TBC 2,7,8,11,14 ,15,18,19 1,3,5,6 Proportion of males 6-14 years of age that are overweight and obese % of men with BMI >=25.5 TBC no data TBC TBC TBC TBC TBC TBC TBC 1,12 1,5 Proportion of males 15-19 years of age that are overweight % of men with BMI >=25.5 ZDHS 1% 2010/11 1% 1% 1% 1% 1% ±0% 1,12 1,5 Proportion of males 20-29 years of age that are overweight and obese % of men with BMI >=25.5 ZDHS 6% 2010/11 6% 5.50% 5.00% 4.00% 3.00% ±33% 2,7,8,11,14 ,15,18,19 1,3,5.6 Proportion of males 30-39 years of age that are overweight and obese % of men with BMI >=25.5 ZDHS 15.10% 2010/11 15% 14% 13% 12% 10% ±20% 2,7,8,11,14 ,15,18,19 1,3,5.6 Proportion of males 40-49 years of age that are overweight and obese % of men with BMI >=25.5 ZDHS 19% 2010/11 19% 18% 17% 16% 15% ±6% 2,7,8,11,14 ,15,18,19 1,3,5.6 Males 50-54 years overweight and obese % of men with BMI >=25.5 ZDHS 19.70% 2010/11 19% 18% 17% 16% 15% ±6% 2,7,8,11,14 ,15,18,19 1,3,5.6 Outcome Description 2: Improved micronutrient status in adolescents and women of child bearing age Proportion of Under 5s with Vitamin A deficiency % of Under 5s with Vitamin A deficiency (retinol binding protein) NMNS 19% 2012 19% 18% 17% 15% 13% ±11% 2,3,4,5,6,1 3, 14,15, 16,18,19 1,2,5,6 Proportion of Under 5s with Anemia % of Under 5s with Hgb< 110g/L ZDHS, 2010/11 56.00% ZDHS, 2010/11 50% 48% 45% 40% 30% ±33% 2,3,4,5,6,1 3, 14,15, 16,18,19 1,2,5,6 Proportion of school going age children (6 14 years) % of school going age children (6-14 years) IDD Sentinel 15.5% (6 14years, 2009 10% 8% 7% 6% 5% ±60% 1,12 1,5 with iodine deficiency with Iodine deficiency (<100µg/l) Surveillance <100µg/L) Zimbabwe National Nutrition Strategy, 2014 -2018 60 Proportion of pregnant and non-pregnant women of age 15-49 years with urinary iodine <100µg/l % of women of child bearing with urinary iodine <100µg/l NMNS To be confirmed (results available Q1, 2014) 2012 NMS, 2012 NMS, 2012 NMS, 2012 NMS, 2012 NMS, 2012 TBC 1,2,3,9,11, 12,13,14,1 5,18,19 1,2,3,5 ,6 Proportion of school going age children (6-14 years) with urinary iodine <50µg/l % of school going age children with urinary iodine <50µg/l IDD Sentinel Surveillance 3.00% 2009 3% 3% 3% 3% 3% ±0% 1,12 1,5 Median urinary iodine levels in school going age children (6-14 years) urinary iodine level measured in µg/l IDD Sentinel Surveillance 185µg/L 2009 185 185 185 185 185 +7.5% or 46% 1,12 1,5 Median urinary iodine levels in non-pregnant women 15-49 years urinary iodine level measured in µg/l NMNS 116 µg/L 2012 mainta in mainta in mainta in mainta in mainta in maintain 1,2,3,9,11, 12,13,14,1 5,18,19 1,2,3,5 ,6 Proportion of households consuming salt with iodine above 15 ppm % of households consuming salt with iodine content above 15 ppm ZDHS 94.00% 2010/11 75% 80% 85% 88% 90% ±10% 1,2,3,7,11, 15 1,3,5 Proportion of households consuming adequately iodized salt % of households consuming salt with iodine content (between 15 ppm and 55 ppm) IDD Sentinel Surveillance 61.70% 2009 71% 77% 83% 89% 95% ±5% 1,2,3,7,11, 15 1,3,5 Outcome Description 3: Improved infant & young child feeding practices Proportion of infants 0-5 months exclusively breastfed % of infants 0-5 months exclusively breastfed ZDHS 31% 10/11 33% 35% 39% 44% 50% ±10% 2,3,4,5,6 1,2 Proportion of children born in the past 24 hours who were put to the breast within 1 hour of birth %of children born in the past 24 months who were put to the breast within 1 hour of birth ZDHS 65% 182 8/11 66 70 75 81 90 ±11% 2,3,4,5,6 1,2 Proportion of infants & children 6-23 months meeting minimum acceptable diet % of infants & children 6 23 months meeting minimum acceptable diet ZDHS 11% 2010/11 11 12 13 14 15 ±3.33% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Impact Ref. Outcome Indicator Measurement Unit (e.g., %, no., etc Baseline Target Allowable Variance Goal Ref. KRA Ref.Data Source Baseline Baseline Period 2014 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Outcome Description 1: Improved nutritional status Proportion of school going age children (6-14 years) with anemia % of school going age (6 14 years) with Hgb< 115g/L NMS, 1999 18.1% (6 11years) and 27.4% (12 14 years) NMS 1999 18% 17% 17% 16% 15% ±11% 1,12 1,5 Proportion of women of children bearing age with vitamin A deficiency % of women of children bearing with vitamin A deficiency NMNS 23% 2012 23% 22% 20% 17% 14% ±13% 1,2,3,9,11, 13,14,15,1 8,19 1,2,3,5 ,6 % of women of child Proportion of women of child bearing with anemia bearing with Hgb<120g/L (non-pregnant) and <110g/L (pregnant) ZDHS, 2010/11 28.00% ZDHS 2010/11 27% 25% 23% 21% 20% ±10% 1,2,3,9,11, 13,14,15,1 8,19 1,2,3,5 ,6 Proportion of men 15-54 years with anemia % of adult men with Hgb<130g/L ZDHS, 2010/11 14.00% ZDHS 2010/11 12% 11% 10% 9% 8% ±25% 1,2,3,9,11, 12,13,14,1 5,18,19 1,2,3,5 ,6 Proportion of pregnant and non-pregnant women of age 15-49 years with urinary iodine <50µg/l % of women of child bearing with urinary iodine <50µg/l NMNS To be confirmed (results available Q1, 2014) 2012 TBC TBC TBC TBC TBC TBC 1,2,3,9,11, 12,13,14,1 5,18,19 1,2,3,5 ,6 Proportion of children 6 23 months who received at least 4 food groups in the last 24 months %of children 6-23 months who received >/=4 food groups in the last 24 months ZDHS 24% 11-Oct 26 29 32 35 40 ±12.5% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of breastfed and non-breastfed children 6-23 months of age who receive solid, semi-solid or soft foods %of breastfed and non breastfed children 6-23 months of age who receive solid, semi-solid or soft foods ZDHS 45% 2010/11 47 50 53 55 60 ±8.3% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of children 6 23 months of age who receive a minimum acceptable diet (apart from breast milk) %of children 6-23 months of age who receive a minimum acceptable diet (apart from breast milk) ZDHS 11% 2010/11 15 19 23 27 30 ±3.33% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of children who consume iron rich or iron fortified foods %of children who consume iron rich or iron fortified foods ZDHS TBC TBC TBC TBC TBC TBC TBC TBC 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of children 12 15 months who were fed breast milk in the past 24 hours %of children 12-15 months who were fed breast milk in the past 24 hours ZDHS 87% 2010/11 88 89 90 92 95% ±3% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Table 14: Outcome Indicators, Baseline Values, Targets and Allowable Variance Zimbabwe National Nutrition Strategy, 2014 -2018 61 Table 14: Outcome Indicators, Baseline Values, Targets and Allowable Variance Impact Ref. Outcome Indicator Measurement Unit (e.g., %, no., etc Baseline Target Allowable Variance Goal Ref. KRA Ref.Data Source Baseline Baseline Period 2014 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Outcome Description 1: Improved nutritional status 2,3,4,5,6,1 1,2,5,6 Duration of breastfeeding Median duration of ZDHS 17.8 2010/11 18 19 20 22 24 ±8% 4,15,18,19 months breastfed months Proportion of children 24 % of children breastfed 2,3,4,5,6,1 1,2,5,6 months of age who are for 24 months ZDHS 20% 2010/11 21 22 23 24 25 ±4% 4,15,18,19 fed breast milk Proportion of infants 6-8 %of infants 6-8 months 2,3,4,5,6,1 1,2,5,6 months of age who of age who received 4,15,18,19 received solids/ semi- solids/ semi-solids or ZDHS 86% 2010/11 87 89 91 93 95 ±5.5% solids or soft foods in the soft foods in the past 24 past 24 hours hours Outcome Description 4: Improved Quality of Diets & lifestyles Proportion of children & adults consuming at least 5 servings of fruits & vegetables per day % of population consuming at least 5 servings of fruits & vegetables survey (food consumption survey) No data TBC 0 5% 20% 30% 60% ±8% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of adults consuming < 2400mg of Sodium per day % of adults consuming < 2400mg of Sodium per day survey (food consumption survey) No data TBC 0 5 15 30 50 ±20% 2,7,11,13,1 5,18,19 1,3,5,6 Proportion of children & adults consuming < 30% of total calories from fat % of children & adults consuming < 30% of total calories from fat survey (food consumption survey) No data TBC 0 5 15 30 50 ±10% 2,3,4,5,6,1 4,15,18,19 1,2,5,6 Proportion of households with acceptable HDDS % of households with acceptable HDDS RLA 2013 57% Apr 2013 65 78 85 92 95 ±5% 3,8,9,12,13 ,14,15,16,1 7,18 1,3,5 Proportion of households with acceptable food consumption score % of households with acceptable Food Consumption score RLA 2012 60.3 May 2012 70 75 85 90 97 ±2% 3,8,9,16,17 ,18,19 1,3,5 Proportion of adults 18 years or older achieving 150 minutes of moderate to vigorous intensity physical activity weekly % of adults 18 years or older achieving 150 minutes of moderate to vigorous intensity physical activity weekly survey (food consumption survey) No data TBC 10 30 45 55 65 ±23% 1,2,3,7,8 1,3 Proportion of 5-17 years achieving 7 hours of moderate to vigorous intensity physical activity weekly % of 5-17 years achieving 7 hours of moderate to vigorous intensity physical activity weekly survey (food consumption survey) No data TBC 20 40 60 80 100 ±10% 1,2,3,7,8,1 2 1,3,5 Proportion of women beneficiaries targeted for nutrition sensitive agriculture programmes % of women beneficiaries targeted for nutrition sensitive agriculture programmes TBC No data TBC 10 15 20 27 33 ±21% 2,11,14 1,5 Proportion of health facilities screening for NCDs % of health facilities screening for NCDs TBC No data TBC 15 30 45 60 75 ±7% 7,8,9 3 Outcome Description 5: Improvement of the quality of diets in institutions of special care Proportion of institutions that are implementing national dietary guidelines (schools, orphanages and rehabilitation centers, prisons and hospitals) %of institutions by category (schools, orphanages, rehabilitation centers, prisons and hospitals) complying with national dietary guidelines Institutional Survey No data TBC 10% 30% 60% 80% 100% ±10% 9 3 Outcome Description 6: Improvement of hygiene practices at household level Prevalence of diarrhoea among children 0-59 months %of children who experienced diarrhea in the 2 week period preceding the survey ZDHS No data TBC TBC TBC TBC TBC TBC TBC 1,2,3,4,5, 11, 16, 17 1, 2, 5 Proportion of households with hand-washing places where water and soap or other washing agents are present % of households with hand-washing places where water and soap or other washing agents are present MICS No data TBC TBC TBC TBC TBC TBC TBC 1,2,3,4,5, 11, 16, 17 1, 2, 5 Outcome Description 7: Improved nutrition information systems Proportion of health facilities submitting the core nutrition indicators % of routine data reports submitted on time HMIS TBC Oct 2013 70 80 90 95 100 ±10% 7,11 1,2,4 Proportion of routine data submitted with completeness % of routine data submitted with completeness HMIS 93 Dec 2013 100 100 100 100 100 ±10% 7,11, 1,2,4 Proportion of districts with growth monitoring % of under-fives attending growth monitoring HMIS 50 Dec 2013 60 70 80 80 80 ±10% 6 2 Outcome Description 8: Adequate resource allocation for nutrition services Proportion of national budget allocated for nutrition % of health budget allocated for nutrition National Budget Statement <0.02 Dec 2013 0.1% 0.5% 1% 1.50% 2% ±20% 19 6 Budget allocation for nutrition expressed as share of GDP Nutrition budget expressed as percentage of GDP National Budget Statement <0.1 2013 0.1% 0.20% 0.40% 0.60% 0.80% ±20% 19 6 Zimbabwe National Nutrition Strategy, 2014 -2018 62 15.4 Output Plan The output plan is compiled in a separate Ms Excel document on the costing of the strategy. 15.5 Monitoring and Evaluation As part of a Government-wide initiative, the Ministry of Health and Child Care has introduced the Results Based Management System, which has guided the development of this Strategic Plan. The RBM system requires that key result areas, goals, strategies, and strategic activities be formulated being linked to the vision and mission of the Strategic Plan, which in turn should be linked to the overall national policy or strategy driving development for the five year period. In addition, the results framework of the Strategic Plan should be specified including specific indicators for tracking progress at impact, outcome and output level, and the annual milestones for each of the above results. These are presented in this Chapter as impact plan, outcome plan and output plan. The output plan is linked to the strategic activities for each strategy and they are detailed in a costing template used for costing the strategy (Annex 1). From the several indicators stated in the impact and outcome plans, a smaller set of core indicators for the monitoring of the Strategy will be identified and will be included in the staff performance management system and corporate governance structures of the Ministry of Health and Child Care to support the implementation process. Some of the indicators will be included in the performance contract for the Permanent Secretary and cascaded to the responsible senior staff (relevant directors and deputy directors) in the various directorates in the Ministry. Senior staff in the NND will also have relevant core indicators included in their performance contracts. The Ministry of Health and Child Care has a planning and M&E department responsible for monitoring the ministry's operations. The NND M&E system which will specifically track the NNS will be harmonised with, and form a sub-set of the ministry-wide M&E system. Tracking of specific results (based on the specific impact and outcome indicators presented above) will be through specific focal points assigned to report on the indicators. Each indicator will have a focal point for data collection, analysis and reporting. The expanded M&E matrix is provided in a separate Ms Excel spreadsheet, and it shows for each indicator, the frequency of reporting on the indicator, the unit of analysis (either national, provincial, district) and other forms of disaggregation (sex, age, etc) necessary when reporting on the indicator. Many of the impact and outcome indicators are tracked as part of monitoring the overall 5 year national development blueprint, the ZimAsset, and the health strategic plan. They are included in national surveys conducted by ZIMSTAT, the National Statistical Agency, or are reported through the Health Management Information System (HMIS), or the nutrition surveillance system, or the ZimVAC process. They are therefore reported quarterly (if part of HMIS), biannually and annually (e.g., if part of nutrition surveillance or ZimVAC process), biennially (e.g., if part of other special annual surveys like the NMNS, and the IDD Sentinel Surveillance), five-yearly (e.g., if reported through the ZDHS), or once every ten years in the event of them being only tracked through the more expensive national nutrition surveys or micronutrient surveys. Indicators that are new and have not been part of any Zimbabwe National Nutrition Strategy, 2014 -2018 63 existing M&E system will be tracked through new surveys as outlined in section 14.1 on issues relating to strengthening nutrition governance. The new surveys include the food consumption survey, the operational research on exclusive breastfeeding, the KABP on maternal and adolescent nutrition, among others. The National Working Group on Nutrition will play a critical role in objective assessment of progress achieved in the implementation of the NNS and its results. Joint annual reviews of the strategy will be conducted involving the Ministry of Health and Child Care, FNC, the Ministry of Finance, other key sector ministries, development partners, NGOs, the academia and the private sector. Periodically, the National Nutrition Working Group will meet to discuss lessons learned and emerging best practices being informed by results of nutrition surveillance, routine collection of administrative data via the HMIS, national surveys, location specific research conducted by members of the Working Group, Evaluations of Nutrition Programmes, and the operational research which will be commissioned as an integral part of the NNS M&E framework. The Ministry of Health will appoint a specific interdepartmental committee to spearhead its efforts to monitor the National Nutrition Strategy. It will draw from the departments within the Ministry and from the other six key sector ministries (these are agriculture, social protection, water, basic education, higher education, and women and gender). Furthermore, the implementation of the National Nutrition Strategy will be done through the institutional structures created for monitoring the National Food and Nutrition Security Policy. In this regard, the Food and Nutrition Security Committees, the parliamentary bodies, the inter-ministerial working party of officials and Cabinet will periodically review the progress of implementation of the NNS. They will monitor results achieved and identify solutions for challenges that may require attention. Zimbabwe National Nutrition Strategy, 2014 -2018 64 16 RESOURCE REQUIREMENTS 16.1 Plan Cost The estimated total cost of the strategic plan is US$599.6 million spread over a five year period (see budget breakdown by goal in Table 15). The cost is based on marginal costing which means the amount is over and above the current allocations for salaries and other programme management costs provided to the sectors involved in the implementation of the nutrition interventions. Adolescent and maternal nutrition key result area will absorb 10% of the budget. Infant and young child nutrition interventions will cost 16% of the budget. Promotion of healthy lifestyle will require 5% of the resources. A further 1% will go to quality information systems and advocacy. Sixty-seven percent of the budget is required for strengthening multi-sectoral nutrition interventions, including strengthening the coordination of the multi-sector approach. Out of this, US$30.7 million (5% of total NNS budget) will be required to support implementation of the industrial food fortification strategies. Resource mobilization and institutional strengthening, especially of the National Nutrition Department, will require the balance of 1%. Of the total NNS resource requirements, the first and second year will each absorb US$96 million rd (i.e., 16% of total budget per year). Twenty-two percent of the resources are required in the 3 year, th 24% in the 4 year and 23% in the final year. 16.2 Operational Cost All the resources except the 1% required for resource mobilization and institutional strengthening will be for operational costs. 16.3 Human Resources The additional human resources costs are estimated at US$1,072,000 (0.2%) and this amount will be spent on: ∑Recruitment of 1 national nutrition manager per year starting in 2015; ∑Recruitment of 4 focal nutritionists, one each for Agriculture, Social Protection, Education and Women and Gender in 2016; ∑Mobilisation of 1 community based nutrition volunteer per village for 70% of wards by 2015; ∑Recruitment of 10 district nutritionists to fill vacant posts by 2015; ∑Recruitment of 10 provincial hospital dieticians by 2017; and ∑On the job training of staff on RBM, nutrition financial tracking tool, and research and data management. 16.4 Materials and equipment The procurement of anthropometric equipment, and food safety testing equipment will require a budget of US$1.067 million (0.2% of total budget), and US$14 million (2.3%), respectively. Start-up Zimbabwe National Nutrition Strategy, 2014 -2018 65 equipment for the industrial fortification of staple food commodities is estimated to cost US$1.838 million (0.3% of total budget). Nutrition supplies will cost a total of US$81 million (14% of the budget). Social protection assistance is estimated to cost a total of US$280 million (47% of the budget). This is consistent with the special attention that the Food and Nutrition Security Policy gives assisting vulnerable groups as part of measures to prevent hunger and malnutrition. 16.5 Space Requirements The budget does not include any construction of offices or new buildings but establishment of demonstration sites for bio-fortification. 16.6 Financing Strategy The Government of Zimbabwe shall assume primary responsibility for resource mobilisation, funding the strategy and delivering the targets set and development partners will complement government efforts. The responsibility for budgeting for fiscal resource allocation will lie with the respective line ministries tasked with the mandate to lead planning and implementation of strategies under each goal. The resource planning, mobilisation and allocation will be done in close collaboration with international cooperating partners, the UN agencies, NGOs, other non-government entities and the private sector. Each goal has a sector ministry that will lead on resource mobilisation and tracking. Each line ministry will also coordinate implementation and review of the specific strategies foreseen under its mandate. Implementation of the strategy will be done collaboratively and with the active engagement of all relevant stakeholders who will also be invited to support the efforts with resources and will participate in joint planning and review of progress. Overall direction and support in resource mobilisation and tracking, and strategy implementation will be provided by the Ministry of Health and Child Care, through the National Nutrition Department. Zimbabwe National Nutrition Strategy, 2014 -2018 66 Table 15: Estimated Plan Cost and Breakdown by Cost, Component and Year K e y R e su lt A re a s a n d G o a ls E st im a te d C o st p e r Y e a r, U S D To ta l C o st , U S D P e rc e n t 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 G o a l K R A K e y R e su lt A re a 1 : Im p ro v e d q u a li ty o f a d o le sc e n t a n d m a te rn a l n u tr it io n se rv ic e s 1 3 ,4 5 6 ,8 1 5 1 2 ,2 8 7 ,2 6 3 1 1 ,9 3 1 ,9 7 9 1 2 ,1 5 5 ,9 7 9 1 2 ,3 4 9 ,9 7 9 6 2 ,1 8 2 ,0 1 5 1 0 % G o a l 1 : C o v e ra g e o f h e a lt h a n d c o m m u n it y n u tr it io n s e rv ic e s fo r a d o le sc e n ts in cr e a se d f ro m X % t o 5 0 % b y 2 0 1 8 2 ,5 6 7 ,4 4 3 1 ,8 8 7 ,6 0 0 1 ,7 0 8 ,0 0 0 1 ,9 3 2 ,0 0 0 2 ,1 5 6 ,0 0 0 1 0 ,2 5 1 ,0 4 3 1 .7 % G o a l 2 : S ta n d a rd m a te rn a l h e a lt h a n d n u tr it io n p a ck a g e s ca le d u p f ro m X % t o 9 0 % c o v e ra g e 1 0 ,2 6 8 ,9 8 6 9 ,3 1 0 ,4 7 7 9 ,2 6 3 ,9 7 9 9 ,2 6 3 ,9 7 9 9 ,2 3 3 ,9 7 9 4 7 ,3 4 1 ,4 0 0 7 .9 % G o a l 3 : 5 0 % o f p re g n a n t a n d l a ct a ti n g w o m e n r e ce iv e p o si ti v e s u p p o rt f ro m sp o u se s a n d c o m m u n it ie s fo r d e ci si o n s o n m a te rn a l h e a lt h , n u tr it io n , h e a lt h y li fe st y le s a n d s a fe l iv in g e n v ir o n m e n t b y 2 0 1 8 6 2 0 ,3 8 6 1 ,0 8 9 ,1 8 6 9 6 0 ,0 0 0 9 6 0 ,0 0 0 9 6 0 ,0 0 0 4 ,5 8 9 ,5 7 2 0 .8 % K e y R e su lt A re a 2 : In fa n t a n d Y o u n g C h il d N u tr it io n 2 2 ,9 5 8 ,7 4 8 1 4 ,5 0 0 ,0 9 3 21 ,0 2 6 ,9 3 9 1 8 ,2 2 4 ,2 3 9 1 8 ,2 7 4 ,7 4 7 9 4 ,9 8 4 ,7 6 5 1 6 % G o a l 4 : A ll h e a lt h i n st it u ti o n s p ro v id e t h e s ta n d a rd I Y C F p a ck a g e ( B M F H I, B F, C F, m u lt ip le m ic ro n u tr ie n t su p p le m e n ta ti o n a n d f o rt if ic a ti o n , d ie ta ry d iv e rs if ic a ti o n , d is e a se p re v e n ti o n a n d m a n a g e m e n t, n u tr it io n i n te rv e n ti o n s in e m e rg e n ci e s, fe e d in g b e h a v io u rs a n d s ti m u la ti o n , P M T C T, W A S H ) a n d I M A M b y 2 0 1 8 1 6 ,8 9 3 ,1 9 3 7 ,8 7 5 ,5 8 8 7 ,7 7 1 ,8 2 8 7 ,7 7 1 ,7 2 8 7 ,7 7 1 ,7 2 8 4 8 ,0 8 4 ,0 6 6 8 .0 % G o a l 5 : C o m m u n it y I Y C F c o u n se ll in g p a ck a g e i n cr e a se d f ro m 4 4 % t o 1 0 0 % o f d is tr ic ts w it h c o v e ra g e o f a t le a st 9 0 % o f th e w a rd s b y 2 0 1 8 5 ,5 8 8 ,4 8 0 6 ,6 0 9 ,2 8 0 13 ,2 3 9 ,8 8 6 1 0 ,4 3 7 ,2 8 6 1 0 ,4 8 7 ,7 9 4 4 6 ,3 6 2 ,7 2 4 7 .7 % G o a l 6 : C o v e ra g e o f g ro w th m o n it o ri n g a n d p ro m o ti o n f o r u n d e r fi v e s in cr e a se d fr o m 2 d is tr ic ts t o 2 0 d is tr ic ts b y 2 0 1 6 a n d t o 4 0 d is tr ic ts b y 2 0 1 8 a n d c o v e ri n g 5 w a rd s p e r d is tr ic t 4 7 7 ,0 7 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 5 3 7 ,9 7 5 0 .1 % K e y R e su lt A re a 3 : P ro m o ti n g H e a lt h y L if e st y le s 8 2 6 ,0 8 6 2 ,3 8 7 ,8 2 7 7 ,7 6 0 ,5 5 2 9 ,0 7 7 ,5 4 8 9 ,0 5 8 ,3 0 9 2 9 ,1 1 0 ,3 2 3 5 % G o a l 7 : To i n cr e a se t h e p ro p o rt io n o f a d u lt p o p u la ti o n p ra ct ic in g a t le a st o n e o r a co m b in a ti o n o f th e t o p 5 h e a lt h y l if e st y le s to 4 0 % b y 2 0 1 8 1 0 5 ,2 0 0 2 8 0 ,0 4 1 4 ,9 3 8 ,5 7 9 5 ,5 9 3 ,3 1 6 5 ,5 6 5 ,9 4 6 1 6 ,4 8 3 ,0 8 2 2 .7 % G o a l 8 : P ro p o rt io n o f h e a lt h f a ci li ti e s (c e n tr a l, p ro v in ci a l, m is si o n a n d d is tr ic t h o sp it a ls ) p ro v id in g q u a li ty n u tr it io n s e rv ic e s fo r co m m u n ic a b le ( sc h is to so m ia si s, H IV , m a la ri a , so il t ra n sm it te d h e lm in th e s) a n d n o n c o m m u n ic a b le d is e a se s in cr e a se d t o 7 5 % b y 2 0 1 8 7 ,2 5 4 8 1 ,6 5 4 9 0 9 ,4 4 1 1 ,3 8 3 ,7 5 9 1 ,3 9 1 ,7 7 2 3 ,7 7 3 ,8 8 1 0 .6 % G o a l 9 : 3 0 % o f in st it u ti o n s a d o p t n a ti o n a l fo o d s e rv ic e a n d n u tr it io n g u id e li n e s b y 2 0 1 8 7 1 3 ,6 3 2 2 ,0 2 6 ,1 3 2 1 ,9 1 2 ,5 3 2 2 ,1 0 0 ,4 7 3 2 ,1 0 0 ,5 9 1 8 ,8 5 3 ,3 6 0 1 .5 % K e y R e su lt A re a 4 : Q u a li ty n u tr it io n i n fo rm a ti o n s y st e m s a n d a d v o ca cy 4 ,2 4 0 ,6 3 0 2 ,3 1 1 ,9 3 5 9 9 8 ,7 8 3 9 9 8 ,7 8 3 9 9 8 ,7 8 3 6 ,8 6 8 ,8 1 5 1 % G 1 0 : T im e ly a v a il a b il it y o f re le v a n t n u tr it io n i n fo rm a ti o n t h a t in co rp o ra te s d is a st e r ri sk r e d u ct io n a t a ll l e v e ls a d e q u a te f o r d is a st e r p re p a re d n e ss p la n n in g a n d n u tr it io n p ro g ra m m in g 4 ,2 4 0 ,6 3 0 2 ,3 1 1 ,9 3 5 9 9 8 ,7 8 3 9 9 8 ,7 8 3 9 9 8 ,7 8 3 6 ,8 6 8 ,8 1 5 1 .1 % K e y R e su lt A re a 5 : S tr e n g th e n in g m u lt i se ct o ra l co o rd in a ti o n a n d co ll a b o ra ti o n fo r in te g ra te d n u tr it io n r e sp o n se 5 3 ,3 7 3 ,1 1 7 6 2 ,5 4 5 ,2 7 1 8 8 ,4 4 2 ,2 4 1 1 0 3 ,9 9 5 ,2 7 1 9 4 ,3 1 4 ,9 9 1 4 0 2 ,7 2 2 ,8 2 9 6 7 % G o a l 1 1 : 8 0 % o f w o m e n o f re p ro d u ct iv e a g e h a v e t h e c a p a ci ty t o s a fe ly p ro v id e fo r th e ir f o o d , h e a lt h a n d n u tr it io n s e cu ri ty u si n g a p p ro p ri a te t e ch n o lo g ie s b y 2 0 1 8 5 7 9 ,4 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 2 ,7 5 0 ,6 0 0 0 .5 % G o a l 1 2 : C o v e ra g e o f h e a lt h a n d c o m m u n it y n u tr it io n s e rv ic e s fo r sc h o o l ch il d re n i n cr e a se d t o 5 0 % b y 2 0 1 8 9 ,1 5 6 ,6 4 0 9 ,6 2 6 ,6 4 0 1 5 ,6 3 3 ,2 7 0 1 7 ,5 8 1 ,8 8 0 7 ,8 8 1 ,6 0 0 5 9 ,7 5 1 ,9 3 0 1 0 .0 % G o a l 1 3 : A ll p ro v in ce s a n d d is tr ic ts h a v e F o o d a n d N u tr it io n S e cu ri ty C o m m it te e s th a t a re f u ll y d is ch a rg in g t h e ir t e rm s o f re fe re n ce b y 2 0 1 4 , 5 0 % o f w a rd l e v e l co m m it te e s fu n ct io n in g b y 2 0 1 8 3 3 3 ,3 7 5 4 7 9 ,0 3 0 3 5 8 ,8 4 0 3 5 8 ,8 4 0 3 5 8 ,8 4 0 1 ,8 8 8 ,9 2 5 0 .3 % G o a l 1 4 : To i n cr e a se t h e p ro p o rt io n o f h o u se h o ld s co n su m in g s a fe a n d a cc e p ta b le d ie ts a ll y e a r ro u n d t o a t le a st 8 0 % b y 2 0 1 8 8 ,8 7 1 ,2 2 7 6 ,2 9 4 ,9 3 7 6 ,2 1 0 ,4 8 7 6 ,1 8 1 ,7 8 7 6 ,1 8 1 ,7 8 7 3 3 ,6 9 1 ,0 2 4 5 .6 % G o a l 1 5 : S ca le u p e vi d e n ce b a se d n u tr it io n s e n si ti ve in te rv e n ti o n s in s o ci a l p ro te ct io n s e rv ic e s to 8 0 % co ve ra g e b y 2 0 1 8 2 3 ,4 1 3 ,3 5 0 4 3 ,3 5 2 ,4 6 4 6 3 ,3 9 6 ,8 6 4 7 7 ,3 4 6 ,8 6 4 7 7 ,3 6 6 ,8 6 4 2 8 5 ,1 0 5 ,6 4 5 4 7 .6 % G o a l 1 6 : A t le a st 5 0 % o f co m m u n it y b a se d h e a lt h w o rk e rs p ro m o te W A S H re la te d b e h a vi o u r ch a n g e w h il st in te g ra ti n g n u tr it io n m e ss a g in g b y 2 0 1 8 5 9 ,8 7 5 1 6 3 ,4 5 0 2 2 3 ,3 2 5 0 .0 % G o a l 1 7 : B y 2 0 1 8 e n su re t h a t a t le a st 5 0 % o f im p o rt e d a n d lo ca ll y p ro d u ce d fo o d s a re e va lu a te d f o r sa fe ty 1 0 ,9 5 9 ,2 5 0 2 ,0 8 5 ,9 5 0 2 ,2 9 9 ,9 8 0 1 ,9 8 3 ,1 0 0 1 ,9 8 3 ,1 0 0 1 9 ,3 1 1 ,3 8 0 3 .2 % K e y R e su lt A re a 6 : R e so u rc e M o b il is a ti o n a n d c a p a ci ty d e ve lo p m e n t fo r N u tr it io n 7 6 3 ,7 3 0 1 ,5 7 7 ,0 7 1 9 0 7 ,9 4 0 2 1 5 ,0 2 0 2 2 6 ,9 4 0 3 ,6 9 0 ,7 0 1 1 % G o a l 1 8 : B y 2 0 1 8 t h e N a ti o n a l N u tr it io n D e p a rt m e n t h a s a c ri ti ca l m a ss o f st a ff w it h t h e a b il it y, t o o ls , su p p o rt iv e s u p e rv is io n a n d r e so u rc e s to in te g ra te n u tr it io n in to o th e r se ct o rs 1 3 0 ,0 8 0 3 2 2 ,8 1 7 1 5 8 ,7 6 0 1 3 2 ,1 2 0 1 4 4 ,0 4 0 8 8 7 ,8 1 7 0 .1 % G o a l 1 9 : To in cr e a se r e so u rc e a ll o ca ti o n t o n u tr it io n t o 1 % o f G D P b y 2 0 1 8 . (T o b e d is cu ss e d f u rt h e r a ft e r co st in g ) 6 3 3 ,6 5 0 1 ,2 5 4 ,2 5 4 7 4 9 ,1 8 0 8 2 ,9 0 0 8 2 ,9 0 0 2 ,8 0 2 ,8 8 4 0 .5 % G ra n d T o ta l b y Y e a r 9 5 ,6 1 9 ,1 2 7 9 5 ,6 0 9 ,4 5 9 1 3 1 ,0 6 8 ,4 3 3 1 4 4 ,6 6 6 ,8 4 0 1 3 5 ,2 2 3 ,7 4 9 5 9 9 ,5 5 9 ,4 4 9 1 0 0 % Zimbabwe National Nutrition Strategy, 2014 -2018 67 ANNEX 1: GLOSSARY OF TERMS Acute malnutrition (wasting): Low weight-for-height defined as more than 2 standard deviations(SD) below the mean of the sex-specific reference data. Wasting is usually the result of a recent shock such as lack of calories and nutrients and/or illness, and is strongly linked to mortality. Adequate Intake (AI): Recommendations for nutrient intake when insufficient information is available to establish a recommended dietary allowance (RDA). Also are based on observed or experimentally determined estimates of the average nutrient intake that appears to maintain a defined nutritional state in a specific population. Adequately iodized salt: Salt containing l5-40 parts per million of iodine. At the population level, household access to iodized salt should be greater than 90 percent, constituting universal salt iodization Anaemia: The condition of having a haemoglobin concentration below a specified cut-off point, which can change according to age, gender, physiological status, smoking habits, and altitude at which the population being assessed lives. The World Health Organization (WHO) defines anaemia in children under five years of age and pregnant women as a haemoglobin concentration <110g/1 at sea level. Although the primary cause of anaemia worldwide is iron deficiency, it often coexists with a number of other anaemia causes, including malaria and other parasitic infections; acute and chronic infections that result in inflammation and haemorrhages; deficiencies in other vitamins and minerals, especially folate, vitamin B and vitamin A; and genetically inherited traits, such as thalassemia Bio-fortification: The development of micronutrient-dense staple crop varieties using traditional breeding practices or biotechnology. Body Mass Index (BMI): A measure of body fatness, calculated as weight (kg) divided by the square of height (m2). A BMI of <18.5 is considered underweight, >25 signifies overweight, and >30 signifies obesity. Although BMI is a good measure for determining a range of acceptable weights, it does not take into consideration some important factors, such as body build, i.e., relative contributions of fat, muscle, and bone to weight. Breast-milk substitute: Any food marketed or otherwise represented as a partial or total replacement for breast-milk, whether or not suitable for that purpose. Childhood obesity: Weight-for-height that is >2 SD (see Over-nutrition). Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. Zimbabwe National Nutrition Strategy, 2014 -2018 68 Chronic malnutrition (stunting): Low height-for-age, defined as more than 2 SD below the mean of the sex-specific reference data. Stunting is the cumulative effect of long-term deficits in food intake, poor caring practices, and illness. Colostrum: The first fluid secreted by the breast during late pregnancy and the first few days after birth. This thick fluid is rich in immune factors and protein. Community-Based Management of Acute Malnutrition (CMAM): The management of acute malnutrition through (a) in-patient care for children with severe acute malnutrition with medical complications and infants under six-months of age with visible signs of severe acute malnutrition; (b) outpatient care for children with severe acute malnutrition; and (c) community outreach. Community nutrition programme: A community-based programme intended to prevent growth faltering, control morbidity, and improve survival of children by promoting breastfeeding, providing education and counselling on optimal feeding practices, preventing diarrheal disease, and monitoring and promoting growth. Complementary feeding practices: A set of 10 practices recommended for caregivers to implement from 6 to 24 months, at which point breast milk and/or breast milk substitutes alone are no longer sufficient to meet the nutritional needs of growing infants. Poor breastfeeding and complementary feeding practices, coupled with high rates of infectious disease, are the principal proximate causes of malnutrition during the first two years of life. Complementary food: Any food, whether manufactured or locally prepared, suitable as a complement to breast-milk or to infant formula, when either becomes insufficient to satisfy the nutritional requirements of the infant (at about 6 months of age). Conditional Cash Transfer (CCT): A social safety net programme aimed at reducing both present and future poverty by linking a targeted transfer of cash to compliance with a pre-specified investment, usually in child education or health. Cretinism: The stunting of body growth and poor mental development in the offspring that result from inadequate maternal intake of iodine during pregnancy. Demographic targeting: A targeting method in which eligibility is based on age. Diarrhoea: The passage of three or more loose or liquid stools per day or more frequently than is normal for the individual. Diarrhoea is usually a symptom of gastrointestinal infection, which can be caused by a variety of viral and parasitic organisms. Severe diarrhoea leads to fluid loss and plays a particularly important role in nutrition and growth faltering, perhaps because of its association with mal-absorption of nutrients and appetite suppression. The adjusted odds of stunting at 24 months of age increase by 5 percent with each episode of diarrhoea in the first 24 months of life. Zimbabwe National Nutrition Strategy, 2014 -2018 69 Dietary Diversity: The number of food groups consumed over a given period of time. Household level dietary diversity can be used as an indicator of household food security, and individual-level dietary diversity is an indicator of diet quality for an individual (typically measured for women or young children) Early initiation of breastfeeding: Initiation of breastfeeding within one hour of birth. As a public health statistic, it is measured as the proportion of children born in the past 24 months who were put to the breast within one hour of birth. Exclusive Breastfeeding (EBF): The feeding of an infant only with breastmilk from his/her mother or a wet nurse, or expressed breastmilk, and no other liquids or solids except vitamins, mineral supplements, or medicines in drop or syrup form. Food-based transfer/food-based safety net programme: A food-based safety net programme intended to support food consumption. It differs from other safety net programmes in that it is tied to food either directly or through cash-like instruments (food stamps, coupons) that may be used to purchase food. Food fortification: The addition of one or more micronutrients (vitamins and minerals) to a food during processing. Ideally, food fortification provides a public health benefit with minimal risks to health in the population. Food-For-Work Programmes (FFW): This type of programme provides food rations in exchange for a given amount of work done or a stipulated wage rate. FFW programmes have long been used to protect households against the decline in purchasing power that often accompanies seasonal unemployment, climate-induced famine, or other periodic disruptions by providing them with employment. Food security: According to the UN, food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritional food to meet their dietary needs and food preferences for an active and healthy life. The concept of food security includes the pillars of food availability, access, utilization, and stability/vulnerability Fortified Blended Foods (FBF): Blends of partially precooked and milled cereals, soya, beans, or pulses, fortified with micronutrients. Special formulations may contain vegetable oil or milk powder. Corn Soya Blend (CSB) and Wheat Soya Blend (WSB) are often used in emergency food distributions. Global acute malnutrition is weight-for-height of -2 z-scores or more below the median, according to the WHO's child growth standards (moderate and severe wasting) Hidden hunger: Micronutrient malnutrition or vitamin and mineral deficiencies, which can compromise growth, immune function, cognitive development, and reproductive and work capacity. HIV/AIDS: Human immunodeficiency virus (HIV) is a retrovirus that affects cells of the immune system, destroying or impairing their function. As the disease progresses, the immune system becomes weaker, and the person becomes more susceptible to infection. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS) Zimbabwe National Nutrition Strategy, 2014 -2018 70 Home garden / homestead food production: A small plot or plots around the home, managed by household members, where a variety of crops including vegetables, fruits, legumes, tubers, non-food plants, e.g., medicinal herbs, spices, fuel material are grown throughout the year and often livestock and fish are raised, primarily for household consumption. They typically use low-cost inputs and indigenous varieties, as well as local knowledge and practices and community participation. Home gardens have multiple uses, including improving diets within the household, provide inputs for other farm activities, e.g., fodder for animals, provide shade or natural fencing, raise income from the sale of garden produce, and empower women, who most typically manage home gardens. Nutritional impact of home gardening "is increased when combined with nutrition education and linked with other health and development activities in the community Hunger: A feeling of discomfort, illness, weakness, or pain due to prolonged involuntary lack of food that goes beyond the usual uneasy sensation of temporary absence of food in the stomach (Panel to Review the USDA's Measurement of Food Insecurity and Hunger, 2006). The sensation of hunger that results from a lack of food in the stomach is universal, but there are different manifestations and consequences of hunger, including undernourishment, malnutrition, and wasting. Infant and Young Child Feeding (lYCF): Refers to specific recommendations and guiding principles for optimal nutrition, health, and development of children. A set of eight population-level IYCF indicators have been developed to: (i) assess IYCF trends over time; (ii) improve targeting of interventions; and (iii) monitor progress in achieving goals and evaluate the impact of interventions (WHO, 2008). Infant and Young Child Nutrition (lYCN): A term that encompasses all aspects that relate to the nutrition of infants and young children (0 to 24 months). In-kind transfers: The transfer of ownership of a good or asset other than cash, or the provision of a service without any counterpart. International Code on Marketing of Breastmilk Substitutes: A set of recommendations to regulate the marketing of breastmilk substitutes, feeding bottles, and teats. This code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" (Article 1). Intrauterine Growth Retardation (IUGR): The poor growth of a baby while in the womb, which results in birth weight below a given percentile cut-off (typically the 10th percentile) for gestational age. Iodine: An essential component of at least two thyroid hormones that are necessary for skeletal growth and neurological development. Iodine deficiency: The condition resulting when iodine intake falls below recommended levels, tested through median urinary iodine concentration (normal range 100-199 µ?/I). Iodine Deficiency Disorders (IDD): All of the consequences of iodine deficiency in a population that can be prevented by ensuring that the population has an adequate intake of iodine. IDD can affect children at any stage of rapid growth, with the greatest negative impacts on cognitive development occurring during pregnancy. Symptoms range from mild impairment of brain development and subtle degrees of brain damage, goitre, hypothyroidism, reproductive disorders (spontaneous abortion, stillbirth, congenital abnormalities, perinatal mortality) to its most severe form, cretinism. Iodine deficiency is the primary cause of preventable mental retardation and brain damage in the world Iron: A key building block of haemoglobin, which plays a central role in oxygen transport throughout the body. Zimbabwe National Nutrition Strategy, 2014 -2018 71 Iron deficiency: The most common nutritional deficiency in the world, resulting from insufficient iron in the body due to inadequate consumption of bioavailable iron, blood loss, or unmet increased iron requirements due to infection, pregnancy, rapid growth, dietary habits, or any combination of these. Iron Deficiency Anemia (lDA): The condition in which the body does not have enough healthy red blood cells due to a deficiency in iron. Iron deficiency (above) and iron deficiency anaemia are associated with foetal and child growth failure, compromised cognitive development in young children, lowered physical activity and labour productivity in adults, and increased maternal morbidity and mortality. Women and young children are the most vulnerable to IDA, which increases the risk of haemorrhage and sepsis during childbirth, and is implicated in 20 percent of maternal deaths. Furthermore, children with IDA suffer from infections, weakened immunity, learning disabilities, impaired physical development, and in severe cases, death Lipid-Based Nutrient Supplements (LNS): Refers generically to a range of fortified, lipid-based products (including RUTF, and other highly concentrated supplements used for "point-of-use" fortification) used for the prevention and treatment of acute malnutrition. LNS typically contain milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients, and provide 120 to 250 kcal/day. Low Birth Weight (LBW): A birth weight of less than 2,500g. At the population level, the proportion of infants with a low birth weight often serves as an indicator of a multifaceted public health problem that includes long-term maternal malnutrition, ill health, hard work, and poor health care in pregnancy Malnutrition: an abnormal physiological condition caused by deficiencies, excesses or imbalances in energy, protein and/or other nutrients. Mid-Upper Arm Circumference (MUAC): The circumference of the upper arm measured at the mid point between the tip of the acromial process (shoulder) and the tip of the olecranon process (elbow). Micronutrient(s): Vitamins and minerals that are needed in small amounts by the body to produce enzymes, hormones, and other substances essential for proper growth and development. Iodine, vitamin A, iron, and zinc are the most important in terms of prevalence and severity; deficiencies are a major threat to the health and development of populations worldwide, particularly children and pregnant women in low-income countries. Micronutrient deficiency(ies): Deficiencies in one or more essential vitamin or mineral, often caused by disease and/or lack of access and/or consumption of micronutrient-rich foods such as fruit, vegetables, animal products, and fortified foods. Micronutrient deficiencies increase the severity and risk of dying from infectious disease such as diarrhoea, measles, malaria, and pneumonia. More than two billion people in the world are estimated to be deficient in iodine, vitamin A, iron, or zinc. Multiple micronutrient powder: A tasteless powder that comes in the form of individual sachets, containing the recommended daily intake of 16 vitamins and minerals for one person. They can be sprinkled into home-prepared food after cooking or just before eating. Moderate malnutrition: Weight-for-age between -2 and -3 z-scores below the mean of sex-specific reference data (moderate underweight). Moderate Acute Malnutrition (MAM): Weight-for-height between -2 and -3 standard deviations below the mean of sex-specific reference data (moderate wasting). Non-Agricultural GDP/worker: The difference between the total national and agricultural GDP divided by the difference between total national and agricultural employment. Zimbabwe National Nutrition Strategy, 2014 -2018 72 Nutrition security: The ongoing access to the basic elements of good nutrition, i.e., a balanced diet, safe environment, clean water, and adequate health care (preventive and curative) for all people, and the knowledge needed to care for and ensure a healthy and active life for all household members. Obesity: A condition characterized by excess body fat, defined as a BMI of 30 or more. Oral Rehydration Solution/Salts (ORS): A liquid electrolyte solution that is used for the management of diarrhoea among children. ORS is typically distributed in ready-to-use sachets that are added to one litre of clean water. Over-nutrition: A state in which nutritional intake greatly exceeds nutritional need. Over-nutrition manifests itself as overweight (BMI~25) and obesity (BMI~30). In children, over nutrition is defined as weight-for-height >2 SD (>2 SD is overweight and >3 SD is obese). Overweight: A condition characterized by excess body fat, defined as a BMI between 25 and 30kg/m2. Protein-Energy Malnutrition (PEM): A condition resulting from insufficient consumption of energy and protein, resulting in wasting. Public works: Social protection programmes where income support for the poor is given in the form of wages (in either cash or food) in exchange for work effort. These programmes typically provide short-term employment at low wages for unskilled and semiskilled workers on labour-intensive projects such as road construction and maintenance, irrigation infrastructure, reforestation, and soil conservation. They are generally seen as a means of providing income support to the poor in critical times rather than as a way of getting the unemployed back into the labour market. Ready-to-use Supplementary Food (RUSF): A high-energy nutrition supplement that is particularly suited as a nutritional support in emergency situations or in the context of nutritional programmes for the prevention or treatment of moderate malnutrition and deficiency-related illnesses. Ready-to-use Therapeutic Food (RUTF): A high energy and protein ready-to-eat food with added electrolytes, vitamins and minerals, specifically designed to treat SAM in the rehabilitation phase. RUTF is typically oil- and/or peanut-based; it does not have to be mixed with water so is microbiologically safe and enables outpatient treatment. Severe Acute Malnutrition (SAM): Weight-for-height more than 3 standard deviations below the mean of sex-specific reference data (severe wasting). Social protection: The set of public interventions aimed at supporting the poorer and more vulnerable members of society, as well as helping individuals, families, and communities manage risk. Social protection includes safety nets (social assistance), social insurance, labour market policies, social funds, and social services. Social Safety Net (SSN): Non-contributory transfer programmes targeted in some manner to the poor and those vulnerable to poverty and shocks-analogous to the U.S. term "welfare" and the European term "social assistance." Stunting (chronic malnutrition): Low height-for-age, defined as more than 2 SD below the mean of the sex-specific reference data. Stunting is the cumulative effect of long-term deficits in food intake, poor caring practices, and/or illness. Supplementary feeding programmes: A direct transfer of food to target households or individuals, most commonly maternal and child feeding and school feeding. The food may be prepared and eaten on- site or given as a dry ration to take home. Supplementary feeding is often provided as an incentive for participation in public services such as primary health care and education. Zimbabwe National Nutrition Strategy, 2014 -2018 73 Unconditional Cash Transfer (UCT): A social safety net programme aimed at reducing both present and future poverty through a transfer of cash to vulnerable and specifically targeted populations Undernourished: A person whose usual food consumption, expressed in terms of dietary energy (kcal), is below the energy requirement norm. The prevalence of undernourishment in a specified population is sometimes used as a measure of food deprivation. This term is not to be confused with under-nutrition. Under-nutrition: when the body contains lower than normal amounts of one or more nutrients, i.e. deficiencies in macro-nutrients (food) and/or micronutrients. Under-nutrition encompasses stunting, wasting and deficiencies of essential vitamins and minerals (collectively referred to as micronutrients). Underweight: Low weight-for-age defined as more than 2 SD below the mean of the sex-specific reference data. Vitamin A: An essential micronutrient that plays an essential role in vision and immune response. Vitamin A Deficiency (VAD): The condition resulting when vitamin A intake falls below recommended levels. Vitamin A deficiency may be exacerbated by high rates of infection, and greatly increases the risk that a child may die from diseases such as measles, diarrhoea, and acute respiratory infections, and is the leading cause of childhood blindness. Vitamin A deficiency compromises the immune systems of approximately 40 percent of the developing world's children under five and leads to the deaths of as many as one million young children each year. Wasting (acute malnutrition): Low weight-for-height defined as more than 2 SD below the mean of the sex-specific reference data. Wasting is the result of a recent shock such as lack of calories and nutrients and/or illness, and is linked strongly to mortality. Weather-index insurance: A product designed to provide compensation to farmers when specific weather events are insufficient (rainfall) or destructive (cyclones, floods) for farmers to grow and optimize their yields. Weather index insurance does not measure changes in yields; rather it measures changes in weather, assuming that if the weather is poor, the farmers' yields will be too. Window of opportunity: The period between conception and age two when irreversible damage caused by malnutrition can and should be prevented. Zinc: An essential micronutrient that plays a critical role in the structure of cell membranes and in the function of immune cells. Zinc deficiency: The condition resulting when zinc intake falls below recommended levels. Zinc deficiency is associated with growth retardation, mal-absorption syndromes, foetal loss, neonatal death, and congenital abnormalities. Zinc supplementation reduces the duration and intensity of diarrheal illness and reduces clinical disease caused by acute respiratory infections and malaria Zimbabwe National Nutrition Strategy, 2014 -2018 74 ANNEX 2: REFERENCES Alderman H, Hoddinott J, Kinsey B. Long term consequences of early childhood malnutrition.Oxf Econ Pap 2006; 58: 450–74 Black R.E. et. Al, Maternal and child under-nutrition: global and regional exposures and health consequences, The Lancet Series on Nutrition 2008. CIDA, 2013, Prevention and Treatment of HIV and Under-nutrition in Infants and young children: Innovation in Integrated Service Delivery Daniels M.C., Adair LS.Growth in young Filipino children predicts schooling trajectories through high school. J Nutr 2004; 134: 1439–46 DFID 2013, Business Proposition - Nutrition for Growth, for Discussion, May 2013. FAO, Institute of Hunger Studies (IEH), 2012, A comparative Study on Institutional Frameworks for Food Security and Nutrition at National Level. FNC, National Food and Nutrition Security Policy 2013 Food and Nutrition Council, 2012, Implementation Plan/Matrix for the Food and Nutrition Security Policy for Zimbabwe Food and Nutrition Council, UNICEF, 2009, National Nutrition Surveillance Assessments (NANSA) Government of Zambia, 2012, Tackling Maternal and Child Under-nutrition in Zambia Government of Zimbabwe, Food and Nutrition Security Policy for Zimbabwe - Preface, May 2013 Government of Zimbabwe, Implementation Plan/ Matrix of the Food and Nutrition Security of Zimbabwe – November 2012 Government of Zimbabwe, Mid-Team Plan 2011 Government of Zimbabwe, Strategic Grain Reserve (AGR) Policy Government of Zimbabwe, ZimAsset Document – October 2013 H. Alderman et al. Health, 2008, Human Capital and economic Growth – PAHO, August 2008 Jones G et.al. 2004, How many child deaths can we prevent this year? Lancet, 2004, 362:65–71 Kramer M.S., and Kakuma R., 2003, Energy and protein intake in pregnancy.Cochraine Database System Review, 2003: 4; CD000032 th Landell Mills Development Consultants, European Union, 2013, 12 EDF Formulation of Smallholder Irrigation Support Programme in Zimbabwe Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; 2005 Zimbabwe National Nutrition Strategy, 2014 -2018 75 Leary S, Fall C, Osmond C, et al. Geographical variation in relationships between parental body size and offspring phenotype at birth. ActaObstetGynecolScand 2006; 85: 1066–79 Maluccio JA, Hoddinott J, Behrman JR, Martorell R, Quisumbing A.R. The impact of nutrition during early childhood on education among Guatemalan adults. Middlebury College Economics Discussion Paper number 06-14. Middlebury College, VT, 2006 Ministry of Health and Child Care, Infant and Young Child Feeding Policy 2013 Ministry of Health and Child Care, Zimbabwe IYCF Programme Review, 2012 Ministry of Health and Child Care, ZNASP for education of girls, orphans and vulnerable children Ministry of Health and Child Welfare, 2012, Zimbabwe National Integrated Health Facility Assessment Ministry of Lands and Agriculture, Zimbabwe, 2013 Comprehensive Agriculture Policy Draft MoHCC, National Health Strategy for Zimbabwe (2009-2013) MoHCC, PMTCT & Paediatric HIV Prevention, Treatment & Care National Plan 2011 MoHCC, Reproductive Health Policy and Maternal and Neonatal Health Road Map 2007 – 2015 MoHCW& UNICEF (2009) NEPAD, Comprehensive African Agriculture Development Programme (CAADP) Ruel, 2008. Op cit. Sheiner E, Levy A, Katz M, et al, 2005. Op cit. Stang J, Story M. eds. Guidelines for adolescent nutrition services. Minneapolis, MN: Center for Disease Control The Government of Ethiopia, 2012, Accelerating reductions in under-nutrition in Ethiopia The Republic of Uganda: Office of the Prime Minister, 2012, National Policy on Public Sector Monitoring and Evaluation The UNICEF Conceptual Framework of Malnutrition The World Bank, 2006, The World Bank: Repositioning nutrition as central to development. A strategy for large-scale action. Washington DC U.S. Government Initiative, 2011, Tanzania FY 2011-2015 Multi-Year Strategy UNICEF, 2011, Information by Country: Zimbabwe Statistics, ZDHS, 2010/11 UNICEF, 2013, The Human And Economic Losses Presented Here Are Based On “Initial Findings of Consultant Mission to Support Development of Zimbabwe National Fortification Strategy” commissioned by UNICEF and the National Nutrition Department, Ministry of Health and Child Care in 2013 Zimbabwe National Nutrition Strategy, 2014 -2018 76 UNICEF, UNICEF and Global Strategy on Infant and Young Child Feeding (GSIYCF) Understanding the Past – Planning the Future. WHO, 2005 statistics World Health Organisation, 2013, Essential Nutrition Actions: Improving maternal, new born, infant and young child health and nutrition www.thelancelet.com, 2013, http:dx.doi.org/10.1016/S0140-6726(13)60996-4 ZIMSTAT, 2013, Poverty and Poverty Datum Line Analysis in Zimbabwe 2011/12 ZIMSTAT, ZDHS, 2010/11 ZIMSTAT, MIMS 2009 Zimbabwe National Nutrition Strategy, 2014 -2018 77 ANNEX 3: DETAILED ACTIVITIES, ANNUAL OUTPUT TARGETS AND COSTS Key Result Area 1: Improved quality of adolescent and maternal nutrition services G o a l 1 : C o v e ra g e o f h e a lt h a n d c o m m u n it y n u tr it io n s e rv ic e s fo r a d o le sc e n ts i n cr e a se d f ro m X % t o 5 0 % b y 2 0 1 8 2 ,5 6 7 ,4 4 3 1 ,8 8 7 ,6 0 0 1 ,7 0 8 ,0 0 0 1 ,9 3 2 ,0 0 0 2 ,1 5 6 ,0 0 0 1 0 ,2 5 1 ,0 4 3 S tr a te g y 1 : E q u ip h e a lt h w o rk e rs w it h s k il ls a n d k n o w le d g e o n a d o le sc e n t n u tr it io n s e rv ic e d e li ve ry S tr a te g ic A ct iv it y 1 D e ve lo p & d is se m in a te a d o le sc e n t n u tr it io n g u id e li n e s to a ll p ro v in ce s a n d d is tr ic ts 1 1 A d o le sc e n t n u tr it io n g u id e li n e s d e ve lo p e d a n d d is se m in a te d t o a ll d is tr ic ts 1 0 0 ,0 0 0 1 0 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 1 0 0 ,0 0 0 S tr a te g ic A ct iv it y 2 Tr a in a t le a st o n e h e a lt h w o rk e r p e r p ri m a ry h e a lt h ca re , 5 p e r d is tr ic t a n d p ro v in ci a l h o sp it a l a n d 1 0 p e r ce n tr a l h o sp it a l o n a d o le sc e n t n u tr it io n 3 9 0 3 9 0 3 9 0 3 9 0 3 9 0 1 ,9 5 0 S tr a te g ic A ct iv it y 3 C o n d u ct q u a rt e rl y m e n to ri n g & s u p e rv is io n o f a ll h e a lt h fa ci li ti e s 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 3 0 ,0 0 0 M e n to ri n g a n d su p p o rt iv e su p e rv is io n co n d u ct e d 1 8 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 5 ,4 0 0 ,0 0 0 S tr a te g ic A ct iv it y 4 P ro v is io n o f m ic ro n u tr ie n t su p p le m e n ts t o 4 0 0 ,0 0 0 a d o le sc e n t g ir ls 4 0 0 ,0 0 0 4 0 0 ,0 0 0 4 0 0 ,0 0 0 4 0 0 ,0 0 0 4 0 0 ,0 0 0 2, 0 0 0 ,0 0 0 A d o le sc e n t g ir ls p ro v id e d w it h ir o n a n d f o la te su p p le m e n ts 0 2 0 ,0 0 0 2 0 ,0 0 0 2 0 ,0 0 0 2 0 ,0 0 0 2 0 ,0 0 0 1 0 0 ,0 0 0 S tr a te g y 2 : R e v ie w a n d u p d a te s ch o o l cu rr ic u lu m t o i n co rp o ra te a d o le sc e n t a n d m a te rn a l n u tr it io n S tr a te g ic A ct iv it y 1 3 o ff ic e rs p a rt ic ip a te i n w o rk in g s e ss io n s fo r cu rr ic u lu m r e v ie w & a d vo ca te fo r in co rp o ra ti o n o f N u tr it io n in to t h e P ri m a ry & S e co n d a ry E d u ca ti o n c u rr ic u lu m 1 1 C u rr ic u lu m u p d a te d 1 9 ,9 8 0 1 9 ,9 8 0 1 9 ,9 8 0 S tr a te g ic A ct iv it y 2 D e ve lo p n u tr it io n s o ci a l m a rk e ti n g t o o ls f o r th e s ch o o l e n v ir o n m e n t 1 1 S o ci a l m a rk e ti n g to o ls d e ve lo p e d a n d d is se m in a te d 4 0 ,4 0 0 4 0 ,4 0 0 4 0 ,4 0 0 S tr a te g ic A ct iv it y 3 P a rt ic ip a te i n u p d a ti n g t h e sc h o o l h e a lt h m a n u a l 1 1 S ch o o l h e a lt h m a n u a l u p d a te d 2 1 ,1 9 0 2 1 ,1 9 0 2 1 ,1 9 0 S tr a te g ic A ct iv it y 4 Im p le m e n t sc h o o l g a rd e n in g w it h c o o k in g d e m o n st ra ti o n s a n d n u tr it io n e d u ca ti o n i n 1 5 0 sc h o o ls 5 0 1 0 0 1 5 0 3 0 0 S ch o o l g a rd e n in g p ro je ct im p le m e n te d 4 ,4 8 0 2 2 4 ,0 0 0 4 4 8 ,0 0 0 6 7 2 ,0 0 0 1 ,3 4 4 ,0 0 0 Zimbabwe National Nutrition Strategy, 2014 -2018 78 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 C o n d u ct K A B P s u rv e y o n a d o le sc e n ts a n d m a te rn a l n u tr it io n 1 1 K A B P s u rv e y re p o rt 4 0 6 ,5 7 3 4 0 6 ,5 7 3 4 0 6 ,5 7 3 D e ve lo p & d is se m in a te B C C st ra te g y to c o m m u n ic a te n u tr it io n m e ss a ge s to a d o le sc e n ts a n d w o m e n o f ch ild b e a ri n g a ge 1 1 B C C s tr a te g y in p la ce 9 1 ,7 0 0 9 1 ,7 0 0 9 1 ,7 0 0 Id e n ti fy & c a p a ci ta te a t le a st 2 co m m u n it y b a se d y o u th ch a m p io n s p e r w a rd in 3 0 d is tr ic ts t o c o m m u n ic at e n u tr it io n m e ss a ge s a s p e r B C C st ra te g y 8 0 0 8 0 0 1 ,6 0 0 Yo u th c h a m p io n s tr a in e d 2 5 2 2 0 1 ,8 0 0 2 0 1 ,8 0 0 4 0 3 ,6 0 0 Yo u th c h a m p io n s co n d u ct p e e r su p p o rt g ro u p s in a t le a st 9 0 % of w a rd s in 3 0 d is tr ic ts 8 0 0 8 0 0 8 0 0 8 0 0 8 0 0 4 ,0 0 0 P e e r su p p o rt g ro u p s e st a b lis h e d 2 4 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 9 6 0 ,0 0 0 E q u ip a t le a st 2 le a d m o th e r p e r w a rd t o p ro vi d e f a m ily fo cu se d n u tr it io n c o u n se lin g a n d im p le m e n t B C C s tr a te g y 8 0 0 8 0 0 Le a d m o th e rs tr a in e d 2 5 2 2 0 1 ,8 0 0 2 0 1 ,8 0 0 4 0 3 ,6 0 0 Le a d m o th e rs p ro vi d e n u tr it io n c o u n se lli n g a n d im p le m e n t B C C s tr a te g y in a t le a st 9 0 % o f w a rd s in 3 0 d is tr ic ts 8 0 0 8 0 0 8 0 0 8 0 0 8 0 0 4 ,0 0 0 2 4 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 1 9 2 ,0 0 0 9 6 0 ,0 0 0 G o a l 2 : S ta n d a rd m a te rn a l h e a lt h a n d n u tr it io n p a ck a g e s ca le d u p f ro m X % t o 9 0 % c o ve ra g e 1 0 ,2 6 8 ,9 8 6 9 ,3 1 0 ,4 7 7 9 ,2 6 3 ,9 7 9 9 ,2 6 3 ,9 7 9 9 ,2 3 3 ,9 7 9 4 7 ,3 4 1 ,4 0 0 St ra te g y 1 : E q u ip h e a lt h f a ci lit y a n d c o m m u n it y b a se d h e a lt h w o rk e rs w it h s ki lls a n d k n o w le d ge t o d e liv e r th e s ta n d a rd p a ck a ge o f m a te rn a l h e a lt h a n d n u tr it io n s e rv ic e s (i n c lu d in g f a m ily p la n n in g a n d a d e q u a te b ir th s p a ci n g ) U p d a te n u tr it io n c o m p o n e n t fo r p re s e rv ic e t ra in in g o f n u rs e s a n d d o ct o rs 1 1 C u rr ic u lu m u p d a te d D e ve lo p & d is se m in a te m a te rn a l a n d a d o le sc e n t n u tr it io n g u id e lin e s & j o b a id e s to a ll h e a lt h f a ci lit ie s 1 1 G u id e lin e s d e ve lo p e d a n d d is se m in a te d 1 0 0 ,0 0 0 1 0 0 ,0 0 0 1 0 0 ,0 0 0 Key Result Area 1: Improved quality of adolescent and maternal nutrition services Zimbabwe National Nutrition Strategy, 2014 -2018 79 St ra te g y 3 : P ro m o te b e h av io u r ch a n ge c o m m u n ic a ti o n o n m a te rn a l a n d a d o le sc e n t h e a lt h , SR H , h yg ie n e a n d n u tr it io n t a rg e ti n g a d o le sc e n ts u si n g c o m m u n it y p la tf o rm s (s u ch a s th e y o u th f ri e n d ly c o rn e rs a p p ro a ch ) S tr a te g ic A ct iv it y 3 O n t h e j o b t ra in in g o n m a te rn a l a n d a d o le sc e n t n u tr it io n g u id e li n e s fo r a t le a st o n e h e a lt h w o rk e r p e r p ri m a ry h e a lt h c a re , 5 p e r d is tr ic t a n d p ro v in ci a l h o sp it a l a n d 1 0 p e r ce n tr a l h o sp it a l 3 9 0 3 9 0 3 9 0 3 9 0 3 9 0 1 ,9 5 0 H e a lt h w o rk e rs tr a in e d 4 8 1 8 ,5 9 9 1 8 ,5 9 9 1 8 ,5 9 9 1 8 ,5 9 9 1 8 ,5 9 9 9 2 ,9 9 6 S tr a te g ic A ct iv it y 4 Im p le m e n t m a te rn a l d e w o rm in g i n 8 h ig h p re va le n ce d is tr ic ts 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 2 0 0 ,0 0 0 P re g n a n t w o m e n d e w o rm e d 0 8 ,0 0 0 8 ,0 0 0 8 ,0 0 0 8 ,0 0 0 8 ,0 0 0 4 0 ,0 0 0 S tr a te g ic A ct iv it y 5 C o n d u ct q u a rt e rl y m e n to ri n g & s u p e rv is io n o f a ll h e a lt h fa ci li ti e s 1 ,5 0 0 1 ,5 0 0 1 ,5 0 0 1 ,5 0 0 1 ,5 0 0 7 ,5 0 0 M e n to ri n g a n d su p p o rt iv e su p e rv is io n r e p o rt 7 2 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 1 ,0 8 0 ,0 0 0 5 ,4 0 0 ,0 0 0 S tr a te g y 2 : P ro m o te f a m il y fo cu se d a n d e v id e n ce b a se d b e h a v io u r ch a n g e c o m m u n ic a ti o n o n a p p ro p ri a te a d o le sc e n t, m a te rn a l a n d c h il d c a re p ra ct ic e s S tr a te g ic A ct iv it y 1 C o n d u ct K A B P s u rv e y o n m a te rn a l n u tr it io n 1 1 K A B P s u rv e y re p o rt S tr a te g ic A ct iv it y 2 D e ve lo p & i m p le m e n t B C C st ra te g y i n 3 0 d is tr ic ts B C C s tr a te g y i n p la ce S tr a te g ic A ct iv it y 3 E q u ip a t le a st o n e l e a d m o th e r p e r w a rd t o p ro v id e f a m il y fo cu se d n u tr it io n c o u n se li n g a n d i m p le m e n t B C C s tr a te g y Le a d m o th e rs tr a in e d i n m a te rn a l n u tr it io n S tr a te g ic A ct iv it y 4 Le a d m o th e rs p ro v id e n u tr it io n c o u n se ll in g a n d im p le m e n t B C C s tr a te g y i n a t le a st 9 0 % o f w a rd s in 3 0 d is tr ic ts Fa m il ie s co u n se ll e d o n n u tr it io n S tr a te g y 3 : E n su re a va il a b il it y o f st a n d a rd is e d a n th ro p o m e tr ic e q u ip m e n t a n d s u p p li e s fo r d e li ve ry o f a d o le sc e n t, m a te rn a l a n d c h il d n u tr it io n c a re s e rv ic e s th ro u g h h e a lt h f a ci li ti e s S tr a te g ic A ct iv it y 1 P ro cu re a n d d is tr ib u te st a n d a rd iz e d a n th ro p o m e tr ic e q u ip m e n t (s ca le s, h e ig h t b o a rd s a n d M U A C t a p e s, ca li b ra ti o n w e ig h ts , 1 p e r p ri m a ry h e a lt h c e n tr e , 5 p e r d is tr ic t, 1 0 p e r p ro v in ci a l a n d ce n tr a l h o sp it a ls ) 1 1 E q u ip m e n t p ro cu re d 4 7 6 ,3 5 7 4 7 6 ,3 5 7 4 7 6 ,3 5 7 S tr a te g ic A ct iv it y 2 Tr a in a t le a st o n e h e a lt h w o rk e r p e r p ri m a ry h e a lt h ca re , 5 p e r d is tr ic t a n d p ro v in ci a l h o sp it a l a n d 1 0 p e r ce n tr a l h o sp it a l o n e q u ip m e n t ca li b ra ti o n & m a in te n a n ce 9 7 5 9 7 5 1 ,9 5 0 H e a lt h w o rk e rs tr a in e d 4 8 4 6 ,4 9 8 4 6 ,4 9 8 9 2 ,9 9 6 S tr a te g ic A ct iv it y 3 P ro cu re m e n t & P ro v is io n o f ir o n a n d f o la te , su p p le m e n ts to 4 2 0 0 0 0 w o m e n a g e d 1 5 4 9 y e a rs 4 2 0 ,0 0 0 4 2 0 ,0 0 0 4 2 0 ,0 0 0 4 2 0 ,0 0 0 4 2 0 ,0 0 0 2 ,1 0 0 ,0 0 0 Ir o n a n d f o la te p ro v id e d t o a n a e m ic w o m e n o f ch il d b e a ri n g a g e 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 1 0 5 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 Key Result Area 1: Improved quality of adolescent and maternal nutrition services Zimbabwe National Nutrition Strategy, 2014 -2018 80 Key Result Area 1: Improved quality of adolescent and maternal nutrition services St ra te g ic A ct iv it y 1 P ro vi d e a t le a st f o u r n u tr it io n co u n se lin g s e ss io n s at h e a lt h fa ci lit y a n d c o m m u n it y le ve ls to 1 ,4 0 0 ,0 0 0 .0 0 w o m e n o f ch ild b e a ri n g a ge b e fo re a n d d u ri n g p re g n a n cy 1 5 0 ,0 0 0 1 5 0 ,0 0 0 1 5 0 ,0 0 0 1 5 0 ,0 0 0 1 5 0 ,0 0 0 7 5 0 ,0 0 0 W o m e n o f ch ild b e a ri n g a ge co u n se lle d 1 2 1 ,8 0 0 ,0 0 0 1 ,8 0 0 ,0 0 0 1 ,8 0 0 ,0 0 0 1 ,8 0 0 ,0 0 0 1 ,8 0 0 ,0 0 0 9 ,0 0 0 ,0 0 0 St ra te g ic A ct iv it y 2 D e ve lo p a n d d is se m in at e st a n d a rd iz e d I E C m at e ri a ls t o 1 6 0 0 h e a lt h f a ci lit ie s 3, 0 0 0 3 ,0 0 0 3 ,0 0 0 3 ,0 0 0 3 ,0 0 0 1 5 ,0 0 0 IE C m at e ri a l d e ve lo p e d a n d d is se m in at e d 1 3 3 9 ,0 0 0 3 9 ,0 0 0 3 9 ,0 0 0 3 9 ,0 0 0 3 9 ,0 0 0 1 9 5 ,0 0 0 St ra te g ic A ct iv it y 3 Su p p le m e n ta ry f e e d in g f o r 6 0 ,0 0 0 p re g n a n t a n d la ct at in g w o m e n w it h a cu te m a ln u tr it io n 6 0 ,0 0 0 6 0 ,0 0 0 6 0 ,0 0 0 6 0 ,0 0 0 6 0 ,0 0 0 3 0 0 ,0 0 0 Su p p le m e n ta ry fe e d in g p ro vi d e d 6 1 3 ,6 7 2 ,0 0 0 3 ,6 7 2 ,0 0 0 3 ,6 7 2 ,0 0 0 3 ,6 7 2 ,0 0 0 3 ,6 7 2 ,0 0 0 1 8 ,3 6 0 ,0 0 0 St ra te g ic A ct iv it y 4 D e ve lo p a n d im p le m e n t a d vo ca cy c a le n d a r fo r m o n th ly m a ss m e d ia c a m p a ig n s o n n u tr it io n f o r th e f a m ily 9 9 9 9 9 4 5 M e d ia c a m p a ig n s co n d u ct e d 4 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 1 8 0 ,0 0 0 St ra te g y 5 : P ro m o te t h e d is tr ib u ti o n a n d c o n su m p ti o n o f m ic ro n u tr ie n t su p p le m e n ts a n d c o n su m p ti o n o f fo rt if ie d f o o d s th ro u g h c o m m u n it y b a se d c h a n n e ls ( p h a rm a ci e s, s ch o o ls a n d co m m u n it y h e a lt h w o rk e rs ) ta rg e ti n g w o m e n a n d in fa n ts St ra te g ic A ct iv it y 1 D e ve lo p m e n t a n d d is se m in at io n o f m ic ro n u tr ie n t fo rt if ic at io n a n d su p p le m e n ta ti o n I E C m at e ri a ls 5, 0 0 0 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 2 5 ,0 0 0 Fo rt if ic at io n a n d su p p le m e n ta ti o n IE C m at e ri a ls d e ve lo p e d a n d d is se m in at e d 1 2 5 8 ,9 0 0 5 8 ,9 0 0 5 8 ,9 0 0 5 8 ,9 0 0 5 8 ,9 0 0 2 9 4 ,5 0 0 St ra te gy 4 : P ro m ot e he al th y ea tin g fo r o pt im al w ei gh t m an ag em en t b ef or e an d du rin g pr eg na nc y (t o pr ev en t o be sit y an d un de r w ei gh t) St ra te g ic A ct iv it y 2 D is tr ib u te p o in t o f u se su p p le m e n ts t o 5 0 0 ,0 0 0 a n a e m ic w o m e n o f ch ild b e a ri n g a ge 4 2 0 ,0 0 0 42 0 ,0 0 0 4 2 0 ,0 0 0 4 2 0 ,0 0 0 4 2 0 ,0 0 0 2 ,1 0 0 ,0 0 0 Su p p le m e n ts d is tr ib u te d 5 2 ,2 6 8 ,0 0 0 2 ,2 6 8 ,0 0 0 2 ,2 6 8 ,0 0 0 2 ,2 6 8 ,0 0 0 2 ,2 6 8 ,0 0 0 1 1 ,3 4 0 ,0 0 0 St ra te g ic A ct iv it y 3 Im p le m e n t Fo o d F o rt if ic a ti o n St ra te g y A w a re n e ss ca m p a ig n s co n d u ct e d St ra te g y 6 : B u ild c a p a ci ty o f n a ti o n a l a n d d is tr ic t p ro g ra m m e m a n a ge rs in e ff e ct iv e p la n n in g , im p le m e n ta ti o n , m o n it o ri n g a n d m a n a ge m e n t fo cu si n g o n in cr e a si n g q u a lit y a n d c o ve ra ge o f e ff e ct iv e in te rv e n ti o n s fo r a d o le sc e n t a n d m a te rn a l h e a lt h a n d n u tr it io n St ra te g ic A ct iv it y 1 Tr a in 2 4 0 d is tr ic t le ve l s ta ff (D M O s, D N O s, D N ) o n m a te rn a l & a d o le sc e n t n u tr it io n p ro g ra m m e p la n n in g & m a n a ge m e n t 2 4 0 2 4 0 D is tr ic t m a n a ge rs tr a in e d 5 8 3 1 3 9 ,8 0 0 1 3 9 ,8 0 0 St ra te g ic A ct iv it y 2 R o u ti n e ly c o lle ct a n d r e p o rt d a ta o n a d o le sc e n t a n d m a te rn a l a n e m ia , u n d e rw e ig h t a n d o b e si ty 1, 6 0 0 1 ,6 0 0 D a ta c o lle ct e d a n d r e p o rt s su b m it te d 1 5 1 2 4 2 ,3 5 3 2 4 2 ,3 5 3 St ra te g ic A ct iv it y 3 C o n d u ct m o n th ly c o o rd in a ti o n m e e ti n g s fo r 1 1 d is tr ic t o ff ic e rs in 6 0 d is tr ic ts a n d q u a rt e rl y p ro vi n ci a l m e e ti n g s fo r 8 p ro vi n ci a l o ff ic e rs in 1 0 p ro vi n ce s 4, 8 0 0 4 ,8 0 0 4 ,8 0 0 4 ,8 0 0 4 ,8 0 0 2 4 ,0 0 0 M o n th ly co o rd in a ti o n m e e ti n g s co n d u ct e d 3 7 1 7 8 ,0 0 0 1 7 8 ,0 0 0 1 7 8 ,0 0 0 1 7 8 ,0 0 0 1 7 8 ,0 0 0 8 9 0 ,0 0 0 St ra te g ic A ct iv it y 4 P re se n t a d o le sc e n t a n d m a te rn a l n u tr it io n d a ta a n d p ro g re ss a t q u a rt e rl y a n d a n n u a l r e vi e w m e e ti n g s 5 5 5 5 5 2 5 R e p o rt s su b m it te d a n d p re se n te d a t q u a rt e rl y a n d b ia n n u a l r e vi e w m e e ti n g s G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 81 Key Result Area 1: Improved quality of adolescent and maternal nutrition services G o a l 3 : 5 0 % o f p re g n a n t a n d l a ct a ti n g w o m e n r e ce iv e p o si ti v e s u p p o rt f ro m s p o u se s a n d c o m m u n it ie s fo r d e ci si o n s o n m a te rn a l h e a lt h , n u tr it io n , h e a lt h y li fe st y le s a n d s a fe l iv in g e n v ir o n m e n t b y 2 0 1 8 6 2 0 ,3 8 6 1 ,0 8 9 ,1 8 6 9 6 0 ,0 0 0 9 6 0 ,0 0 0 9 6 0 ,0 0 0 4 ,5 8 9 ,5 7 2 S tr a te g y 1 : P ro m o te b e h a v io u r ch a n g e c o m m u n ic a ti o n o n d e ci si o n s o n m a te rn a l h e a lt h , n u tr it io n , h e a lt h y l if e st y le s a n d s a fe l i v in g e n v ir o n m e n t ta rg e ti n g m e n , co m m u n it y a n d r e li g io u s le a d e rs a n d a ll o th e r in fl u e n ti a l st ru ct u re s S tr a te g ic A ct iv it y 1 D e ve lo p m a le f ri e n d ly co m m u n ic a ti o n p a ck a g e 1 1 C o m m u n ic a ti o n p a ck a g e d e ve lo p e d 1 1 ,2 0 0 1 1 ,2 0 0 1 1 ,2 0 0 S tr a te g ic A ct iv it y 2 Id e n ti fy a t le a st o n e m a le ch a m p io n f o r n u tr it io n & im p le m e n t m a le s u p p o rt g ro u p s in 7 0 % o f th e w a rd s in 3 0 d is tr ic ts 3 0 1 3 0 1 6 0 2 M a le c h a m p io n s id e n ti fi e d a n d tr a in e d 4 2 9 1 2 9 ,1 8 6 1 2 9 ,1 8 6 2 5 8 ,3 7 2 S tr a te g ic A ct iv it y 3 C o n d u ct b i a n n u a l ro a d s h o w s o n n u tr it io n i n 3 0 d is tr ic ts 3 0 6 0 6 0 6 0 6 0 2 7 0 R o a d s h o w s co n d u ct e d 1 6 ,0 0 0 4 8 0 ,0 0 0 9 6 0 ,0 0 0 9 6 0 ,0 0 0 9 6 0 ,0 0 0 9 6 0 ,0 0 0 4 ,3 2 0 ,0 0 0 S u b T o ta l K R A 1 I m p ro v e d q u a li ty o f a d o le sc e n t a n d m a te rn a l n u tr it io n s e rv ic e s 1 3 ,4 5 6 ,8 1 5 1 2 ,2 8 7 ,2 6 3 1 1 ,9 3 1 ,9 7 9 1 2 ,1 5 5 ,9 7 9 1 2 ,3 4 9 ,9 7 9 6 2 ,1 8 2 ,0 1 5 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 G o a l 4 : A ll h e a lt h i n st it u ti o n s p ro v id e t h e s ta n d a rd I Y C F p a ck a g e ( B M F H I, B F, C F, m u lt ip le m ic ro n u tr ie n t su p p l e m e n ta ti o n a n d f o rt if ic a ti o n , d ie ta ry d iv e rs if ic a ti o n , d is e a se p re v e n ti o n a n d m a n a g e m e n t, n u tr it io n i n te rv e n ti o n s in e m e rg e n ci e s, f e e d in g b e h a v io u rs a n d s ti m u la ti o n , P M T C T, W A S H ) a n d I M A M b y 2 0 1 8 1 6 ,8 9 3 ,1 9 3 7 ,8 7 5 ,5 8 8 7 ,7 7 1 ,8 2 8 7 ,7 7 1 ,7 2 8 7 ,7 7 1 ,7 2 8 4 8 ,0 8 4 ,0 6 6 S tr a te g y 1 : In te g ra te n u tr it io n i n to p re s e rv ic e c u rr ic u la f o r h e a lt h p ro fe ss io n a ls S tr a te g ic A ct iv it y 1 S ta ke h o ld e r se n si ti za ti o n on in te g ra ti o n o f n u tr it io n i n to p re se rv ic e o f h e a lt h p ro fe ss io n a l (N u rs e s, d o ct o rs , E H T, H P O , P C C , V H W s) cu rr ic u la b y Q 2 2 0 1 4 1 1 S e n si ti sa ti o n m e e ti n g s h e ld 8 5 0 8 5 0 8 5 0 S tr a te g ic A ct iv it y 2 R e v ie w c u rr ic u lu m f o r d if fe re n t h e a lt h p ro fe ss io n a ls t o i d e n ti fy g a p s a n d o p p o rt u n it ie s to i n te g ra te n u tr it io n b y 2 0 1 4 Q 2 1 1 C u rr ic u la re v ie w re p o rt a n d c o u rs e o u tl in e s 1 7 2 2 5 1 7 ,2 2 5 1 7 ,2 2 5 S tr a te g ic A ct iv it y 3 S u p p o rt t h e r o le o u t o f th e n e w cu rr ic u la ( e q u ip m e n t b y Q 4 2 0 1 4 ) a n d p ri n ti n g a n n u a ll y 1 1 1 1 1 5 Tr a in in g k it s in a ll tr a in in g s ch o o ls 3 1 ,2 2 5 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0 5 1 ,2 2 5 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 82 K e y R e s u lt A re a 2 : In fa n t a n d Y o u n g C h il d N u tr it io n S tr a te g ic A ct iv it y 1 R e v ie w a n d u p d a te g u id e li n e s a n d m a n u a ls b a se d o n n e w e v id e n ce fr o m n a ti o n a l, r e g io n a l a n d g lo b a l re se a rc h b y Q 3 2 0 1 5 a n d d is tr ib u te b y Q 2 2 0 1 6 , C H C p ri n te d a n n u a ll y fo r 1 5 0 0 0 0 n e w b o rn c h il d re n 1 1 G u id e li n e s u p d a te d a n d C H C p ri n te d 1 0 3 8 6 0 2 7 ,0 0 0 1 3 0 ,8 6 0 2 7 ,0 0 0 2 7 ,0 0 0 2 7 ,0 0 0 2 3 8 ,8 6 0 S tr a te g ic A ct iv it y 2 D e ve lo p a c h e ck li st o n re q u ir e m e n ts t o p ro v id e co m p re h e n si ve I Y C F s e rv ic e s b y 2 0 1 4 a n d r e v ie w i n Q 2 2 0 1 6 1 1 2 C o m p re h e n si ve ch e ck li st 1 0 0 1 0 0 1 0 0 2 0 0 S tr a te g ic A ct iv it y 3 P ro cu re a n d d is tr ib u te m ic ro n u tr ie n t su p p le m e n ts (v it a m in A a n d z in c fo r d ia rr h o e a l d is e a se s) a n n u a ll y 1 1 1 1 1 5 A ll h e a lt h f a ci li ti e s w it h m ic ro n u tr ie n ts 5 1 5 1 7 4 .8 5 1 5 ,1 7 5 5 1 5 ,1 7 5 5 1 5 ,1 7 5 5 1 5 ,1 7 5 5 1 5 ,1 7 5 2 ,5 7 5 ,8 7 4 S tr a te g ic A ct iv it y 4 P ro cu re a n d d is tr ib u te a n th ro p o m e tr ic e q u ip m e n t to a ss e ss a ll u n d e r 5 s b y 2 0 1 4 1 1 A ll h e a lt h a ct iv it ie s w it h a n th ro p o m e tr ic e q u ip m e n t 1 1 1 6 2 9 8 5 1 1 ,1 6 2 ,9 8 5 1 1 ,1 6 2 ,9 8 5 S tr a te g ic A ct iv it y 5 P ro cu re a n d d is tr ib u te I M A M co m m o d it ie s (S A M ) b ia n n u a ll y 1 1 1 1 1 5 A ll h e a lt h f a ci li ti e s w it h I M A M co m m o d it ie s 1 7 7 6 5 5 4 .6 7 1 ,7 7 6 ,5 5 5 1 ,7 7 6 ,5 5 5 1 ,7 7 6 ,5 5 5 1 ,7 7 6 ,5 5 5 1 ,7 7 6 ,5 5 5 8, 8 8 2 ,7 7 3 S tr a te g ic A ct iv it y 6 P ro cu re a n d d is tr ib u te I M A M co m m o d it ie s (M A M ) fr o m 2 0 1 6 t o 2 0 1 8 2 2 2 2 8 C S B i n I M A M f a ci li ti e s 1 2 7 0 5 0 1 .8 5 2 ,5 4 1 ,0 0 4 2 ,5 4 1 ,0 0 4 2 ,5 4 1 ,0 0 4 2 ,5 4 1 ,0 0 4 1 0 ,1 6 4 ,0 1 5 S tr a te g ic A ct iv it y 7 Tr a in 2 4 0 h e a lt h p ro fe ss io n a ls (d o ct o rs , n u rs e s, E H T, H P O ,P C C ) tr a in in g G ro w th m o n it o ri n g , IM A M a n I Y C F o n s k il ls t o d e li ve r th e I Y C F p a ck a g e i n t h re e q u a rt e rs b y 2 0 1 8 a n d t ra in 6 0 T O T o n a ll t h re e p a ck a g e s b y Q 4 2 0 1 8 2 3 3 3 3 1 4 N o o f H e a lt h p ro fe ss io n a ls tr a in e e s 3 7 8 0 0 0 5 9 2 ,0 2 5 1 ,1 3 4 ,0 0 0 1 ,1 3 4 ,0 0 0 1 ,1 3 4 ,0 0 0 1 ,1 3 4 ,0 0 0 5, 1 2 8 ,0 2 5 S tr a te g y 3 : S tr e n g th e n t h e p ro v is io n o f su p p o rt iv e s u p e rv is io n t o e n su re q u a li ty s e rv ic e d e li ve ry o n I Y C F S tr a te g ic A ct iv it y 1 D e ve lo p m e n to ri n g a n d s u p p o rt ch e ck li st w h ic h i s co m p re h e n si ve a n d i n cl u d e s a n a u d it c h e ck li st b y Q 2 2 0 1 4 1 1 M e n to ri n g c h e ck li st a va il a b le 5 6 0 5 6 0 5 6 0 S tr a te g ic A ct iv it y 2 Tr a in 2 4 5 m e n to rs b y Q 3 2 0 1 4 1 1 2 4 5 m e n to rs t ra in e d 8 7 0 7 5 8 7 ,0 7 5 8 7 ,0 7 5 S tr a te g ic C o n d u ct a t le a st 1 m e n to ri n g v is it e a ch q u a rt e r a t e a ch h e a lt h f a ci li ty 1 4 4 4 4 1 7 Q u a rt e rl y v is it s to e a ch h e a lt h f a ci li ty 1 2 5 1 5 0 1 2 5 ,1 5 0 5 0 0 ,6 0 0 5 0 0 ,6 0 0 5 0 0 ,6 0 0 5 0 0 ,6 0 0 2 ,1 2 7 ,5 5 0 Key Result Area 2: Infant and Young Child Nutrition G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 83 S tr a te g y 2 : D e ve lo p c a p a ci ty o f in st it u ti o n s a n d c o m m u n it ie s to p ro v id e c o m p re h e n si ve I Y C F s e rv ic e s G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 S tr a te g y 4 : P ro m o te , p ro te ct a n d s u p p o rt o p ti m a l fe e d in g p ra ct ic e s a t h e a lt h f a ci li ty l e ve l (i n cl u d in g r e v ie w o f la b o u r re g u la ti o n s) S tr a te g ic A ct iv it y 1 C o n d u ct a T ra in e r o f Tr a in e rs o f B M F H I fo r 6 0 T O Ts b y Q 3 2 0 1 4 1 1 6 0 T O T t ra in e d 4 9 3 0 0 4 9 ,3 0 0 4 9 ,3 0 0 S tr a te g ic A ct iv it y 2 C a sc a d e t ra in in g t o a ll h e a lt h fa ci li ti e s (p u b li c, p ri va te a n d m is si o n h o sp it a ls ) in B M F H I a n d a ll to b e c o m p li a n t b y 2 0 1 6 1 1 1 1 1 5 3 0 h e a lt h f a ci li ti e s, 3 0 p ri va te h e a lt h fa ci li ti e s a n d 8 P ro v in ci a l H o sp it a l tr a in e d 1 ,1 4 0 ,2 5 0 7 0 9 ,5 0 0 7 0 9 ,5 0 0 7 0 9 ,5 0 0 7 0 9 ,5 0 0 3 ,9 7 8 ,2 5 0 S tr a te g ic A ct iv it y 3 D e ve lo p I E C m a te ri a l p ro m o ti n g E B F, a p p ro p ri a te c o m p le m e n ta ry fe e d in g o p ti o n s, d ie ta ry d iv e rs if ic a ti o n to s u p p o rt co u n se ll in g o f m o th e rs a t h e a lt h fa ci li ti e s a n n u a ll y 1 1 1 1 1 5 C o m m u n ic a ti o n S tr a te g y f o r E B F, D ie ta ry d iv e rs if ic a ti o n , a p p ro p ri a te co m p le m e n ta ry fe e d in g p ra ct ic e s 4 2 2 8 9 5 4 2 2 ,8 9 5 4 2 2 ,8 9 5 4 2 2 ,8 9 5 4 2 2 ,8 9 5 4 2 2 ,8 9 5 2 ,1 1 4 ,4 7 5 S tr a te g ic A ct iv it y 4 E st a b li sh a n a d h o c g ro u p o f e m in e n t w o m e n p a rl ia m e n ta ri a n s/ p ro fe ss io n a ls a n d su p p o rt iv e m a le p a rt n e rs / p a rl ia m e n ta ri a n s to a d vo ca te f o r a re v ie w o f la b o u r re g u la ti o n s to in cl u d e 6 m o n th m a te rn it y l e a ve fo r b re a st fe e d in g m o th e rs b y 2 0 1 5 4 4 4 4 4 2 0 A d vo ca cy m e e ti n g s h e ld 3 5 0 0 0 1 4 0 ,0 0 0 1 4 0 ,0 0 0 1 4 0 ,0 0 0 1 4 0 ,0 0 0 1 4 0 ,0 0 0 7 0 0 ,0 0 0 S tr a te g ic A ct iv it y 5 O p e ra ti o n a l re se a rc h i n E B F t o in fo rm g u id e li n e s (R A F p ro je ct b y 2 0 1 4 1 1 8 0 4 8 2 4 8 0 4 ,8 2 4 8 0 4 ,8 2 4 G o a l 5 : C o m m u n it y I Y C F c o u n se ll in g p a ck a g e i n cr e a se d f ro m 4 4 % t o 1 0 0 % o f d is tr ic ts w it h c o v e ra g e o f a t le a st 9 0 % o f th e w a rd s b y 2 0 1 8 5 ,5 8 8 ,4 8 0 6 ,6 0 9 ,2 8 0 1 3 ,2 3 9 ,8 8 6 1 0 ,4 3 7 ,2 8 6 1 0 ,4 8 7 ,7 9 4 4 6 ,3 6 2 ,7 2 4 S tr a te g y 1 : E m p o w e r co m m u n it y d e ve lo p m e n t st ru ct u re s to p ro v id e q u a li ty I YC F s e rv ic e s S tr a te g ic A ct iv it y 1 Tr a in 5 2 2 c o m m u n it y b a se d w o rk e rs i n 4 0 u rb a n a n d ru ra ld is tr ic ts o n c IY C Fc o u n se ll in g b y 2 0 1 8 2 4 4 4 4 1 8 C B W t ra in e d i n cI Y C Fc o u n se ll in g 1 2 7 ,6 0 0 1, 0 2 0 ,8 0 0 2 ,0 4 1 ,6 0 0 2 ,0 4 1 ,6 0 0 2 ,0 4 1 ,6 0 0 2 ,0 4 1 ,6 0 0 9 ,1 8 7 ,1 9 8 S tr a te g ic A ct iv it y 2 S u p p o rt 1 6 ,2 0 0 c o m m u n it y b a se d w o rk e rs w it h r e so u rc e s to c a rr y o u t th e ir m a n d a te b y 2 0 1 6 , st a ti o n a ry a n d b a g s @ 1 2 p e r se t p ro v id e d a n n u a ll y 1 1 R e so u rc e s fo r C B W 1 9 4 ,4 0 0 1 9 4 ,4 0 0 2 ,9 9 7 ,0 0 0 1 9 4 ,4 0 0 1 9 4 ,4 0 0 3 ,7 7 4 ,6 0 0 S tr a te g ic A ct iv it y 3 E st a b li sh a t le a st 3 0 co m m u n it y p e e r su p p o rt g ro u p s p e r w a rd i n 2 ,6 4 7 w a rd s b y Q 4 2 0 1 8 2 4 4 4 4 1 8 5 ,2 9 2 p e e r su p p o rt g ro u p s 1 9 1 4 0 0 3 3 ,8 2 8 ,0 0 6 3 ,8 2 8 ,0 0 6 7 ,6 5 6 ,0 1 2 7 ,6 5 6 ,0 1 2 7 ,6 5 6 ,0 1 2 3 0 ,6 2 4 ,0 4 8 Key Result Area 2: Infant and Young Child Nutrition Zimbabwe National Nutrition Strategy, 2014 -2018 84 S tr a te g ic A ct iv it y 1 C o n d u ct 4 a w a re n e ss c a m p a ig n s o n th e c o d e f o r re ta il e rs i n cl u d in g p h a rm a ci e s, m a n u fa ct u re rs a n d t h e p u b li c b y Q 4 2 0 1 6 1 1 1 1 1 5 4 a w a re n e ss ca m p a ig n s 5 2 7 4 0 0 5 2 7 ,4 0 0 5 2 7 ,4 0 0 5 2 7 ,4 0 0 5 2 7 ,4 0 0 5 2 7 ,4 0 0 2 ,6 3 7 ,0 0 0 S tr a te g ic A ct iv it y 2 D e ve lo p a r o b u st i m p le m e n ta ti o n a n d m o n it o ri n g s ys te m o f th e c o d e b y 2 0 1 8 1 1 C o d e i m p le m e n ta ti o n a n d m o n it o ri n g sy st e m 5 0 5 0 8 5 0 ,5 0 8 5 0 ,5 0 8 S tr a te g ic A ct iv it y 3 C o n d u ct a r e fr e sh e r tr a in in g b y ca rr y in g o u t C o d e m o n it o ri n g e xe rc is e s fo r 1 0 P ro v in ci a l n u tr it io n is ts , 6 2 D is tr ic t n u tr it io n is ts a n d 1 ,6 7 4 E H Ts 2 2 2 2 2 10 6 2 d is tr ic ts t ra in e d i n co d e m o n it o ri n g 1 7 ,8 7 4 1 7 ,8 7 4 1 7 ,8 7 4 1 7 ,8 7 4 1 7 ,8 7 4 8 9 ,3 7 0 G o a l 6 : C o v e ra g e o f g ro w th m o n it o ri n g a n d p ro m o ti o n f o r u n d e r f iv e s in cr e a se d f ro m 2 d is tr ic ts t o 2 0 d is tr ic ts b y 2 0 1 6 a n d to 4 0 d is tr ic ts b y 2 0 1 8 a n d co v e ri n g 5 w a rd s p e r d is tr ic t 4 7 7 ,0 7 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 5 3 7 ,9 7 5 S tr a te g y 1 : B u il d c a p a ci ty o f co m m u n it y c a d re s (C H W s, E H Ts , e xt e n si o n w o rk e rs , co m m u n it y d e ve lo p m e n t w o rk e rs ) a n d d e ve lo p m e n t st ru ct u re s to i m p ro ve e a r ly d e te ct io n o f m a ln u tr it io n c a se s a n d p ro v id e a p p ro p ri a te c o u n se li n g & r e fe rr a l se rv ic e s (s k il ls a n d e q u ip m e n t) S tr a te g ic A ct iv it y 1 R e cr u it a c o n su lt a n t to p re p a re tr a in in g m a n u a ls f o r a T ra in e r o f Tr a in e r' s (T O T ) co u rs e o n g ro w th m o n it o ri n g , d e te ct io n o f m a ln u tr it io n c a se s, p ro v id e a p p ro p ri a te c o u n se ll in g a n d re fe rr a l b y 2 0 1 5 1 1 Tr a in in g m a n u a l o n g ro w th m o n it o ri n g , tr a in in g m a n u a ls a n d d e te ct io n o f m a ln u tr it io n a n d re fe rr a l 7 0 0 0 0 7 0 ,0 0 0 7 0 ,0 0 0 S tr a te g ic A ct iv it y 2 Id e n ti fy a n d t ra in 2 1 8 0 co m m u n it y ca d re s in e a rl y d e te ct io n o f m a ln u tr it io n c a se s, p ro v is io n o f a p p ro p ri a te c o u n se ll in g a n d re fe rr a l 1 8 9 6 7 1 7 1 7 1 7 1 2 1 8 0 Tr a in e d C o m m u n it y C a d re s 2 1 5 4 0 7 ,0 7 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 1 5 ,2 2 5 4 6 7 ,9 7 5 S u b T o ta l K R A 2 I n fa n t a n d Y o u n g C h il d N u tr it io n 2 2 ,9 5 8 ,7 4 8 1 4 ,5 0 0 ,0 9 3 2 1 ,0 2 6 ,9 3 9 1 8 ,2 2 4 ,2 3 9 1 8 ,2 7 4 ,7 4 7 9 4 ,9 8 4 ,7 6 5 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 ,0 1 4 2 ,0 1 5 2 ,0 1 6 2 ,0 1 7 2 ,0 1 8 S tr a te g y 1 : B u il d c a p a ci ty o f co m m u n it y c a d re s (C H W s, E H Ts , e x te n si o n w o rk e rs , co m m u n it y d e v e lo p m e n t w o rk e rs ) a n d d e v e lo p m e n t st ru ct u re s to i m p ro v e e a rl y d e te ct io n o f m a ln u tr it io n c a se s a n d p ro v id e a p p ro p ri a te c o u n se li n g & r e fe rr a l se rv ic e s (s k il ls a n d e q u ip m e n t) Key Result Area 2: Infant and Young Child Nutrition Zimbabwe National Nutrition Strategy, 2014 -2018 85 Key Result Area 3: Promoting Healthy Lifestyles G o a l 7 : To i n cr e a se t h e p ro p o rt io n o f th e a d u lt p o p u la ti o n p ra ct ic in g a t le a st o n e o r a c o m b in a ti o n o f th e t o p 5 h e a lt h y t o 4 0 % b y 2 0 1 8 1 0 5 ,2 0 0 2 8 0 ,0 4 1 4 ,9 3 8 ,5 7 9 5 ,5 9 3 ,3 1 6 5 ,5 6 5 ,9 4 6 1 6 ,4 8 3 ,0 8 2 S tr a te g y 1 : P ro m o te s o ci a l a n d b e h a v io u r ch a n g e c o m m u n ic at io n o n h e a lt h y l if e st y le s (d iv e rs if ie d d ie ts in cl u d in g c o n su m p ti o n o f a t le a st 5 s e rv in g s o f fr u it s a n d v e g e ta b le s d e cr e a se d c o n su m p ti o n o f su ga ry b e ve ra g e s, i n ta ke o f < 4 0 0 m g o f so d iu m p e r d a y, p h ys ic a l e xe rc is e o f re co m m e n d e d d u ra ti o n ) u si n g m u lt i m e d ia c h a n n e ls S tr a te g ic A ct iv it y 1 D e ve lo p b e h a v io ra l ch a n g e co m m u n ic a ti o n s tr a te g y o n h e a lt h y li fe st y le s b y Q 1 , 2 0 1 5 7 5 % 2 5 % 1 h e a lt h y l if e st y le s B C C s tr a te g y d e ve lo p e d 1 3 1 ,5 0 0 1 0 5 ,2 0 0 2 6 ,3 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 1 3 1 ,5 0 0 S tr a te g ic A ct iv it y 2 R e v ie w a n d u p d a te I E C /B C C m a te ri a ls o n h e a lt h y l if e s ty le s b y Q 3 , 2 0 1 5 1 .0 0 1 IE C /B C C m a te ri a ls d e ve lo p e d 5 7 ,0 0 0 5 7 ,0 0 0 5 7 ,0 0 0 S tr a te g ic A ct iv it y 3 P ro m o te s o ci a l b e h a v io ra l ch a n g e o n h e a lt h y li fe st y le s u si n g v a ri o u s ty p e s o f m a ss m e d ia s ta rt in g Q 1 , 2 0 1 5 t o 0 .2 0 3 0 % 3 0 % 2 0 % 1 A d u lt s a d o p ti n g h e a lt h y l if e st y le s re a ch e d b y m a ss m e d ia c a m p a ig n s 2 ,7 0 6 5 4 1 8 1 2 8 1 2 5 4 1 2 ,7 0 6 S tr a te g ic A ct iv it y 4 C a rr y o u t so ci a l o u tr e a ch a ct iv it ie s su ch a s ro a d s h o w s, a w a re n e ss ca m p a ig n s, co m m e m o ra ti o n s, a g ri cu lt u re sh o w s, c o m m u n it y t h e a tr e s, r a d io li st e n in g c lu b s, c o m m u n it y f il m s in 3 0 d is tr ic ts b y Q 4 , 2 0 1 8 2 0 % 3 0 % 3 0 % 2 0 % 1 D is tr ic ts w it h so ci a l o u tr e a ch a ct iv it ie s d o n e 4 1 3 ,0 0 0 8 2 ,6 0 0 1 2 3 ,9 0 0 1 2 3 ,9 0 0 8 2 ,6 0 0 4 1 3 ,0 0 0 S tr a te g y 2 : P ro m o te h e a lt h s cr e e n in g a n d w e ll n e ss d a ys t h ro u g h v a ri o u s co m m u n it y b a se d p la tf o rm s su ch a s p h a rm a ci e s, w o rk p la ce s a n d f a it h b a se d o rg a n iz a ti o n s S tr a te g ic A ct iv it y 1 D e ve lo p m e n t o f p ro to co l o n p re ve n ti o n a n d m a n a g e m e n t o f N C D s b y Q 4 2 0 1 5 1 1 p ro to co l o n p re ve n ti o n a n d m a n a g e m e n t o f N C D s d e ve lo p e d 1 1 3 ,6 0 0 1 1 3 ,6 0 0 1 1 3 ,6 0 0 S tr a te g ic A ct iv it y 2 C a p a ci ty b u il d in g o f 6 0 h e a lt h w o rk e rs b y e n d o f 2 0 1 8 2 0 2 0 2 0 6 0 6 0 h e a lt h w o rk e rs tr a in e d o n N C D s 1 4 ,1 7 0 2 8 3 ,4 0 0 2 8 3 ,4 0 0 2 8 3 ,4 0 0 8 5 0 ,2 0 0 S tr a te g ic A ct iv it y 3 E q u ip m e n t u p g ra d e f o r 4 0 0 p h a rm a ci e s, w o rk p la ce s a n d f a it h b a se d o rg a n iz a ti o n s b y Q 4 2 0 1 8 8 0 1 6 0 1 6 0 4 0 0 4 0 0 p h a rm a ci e s w o rk p la ce s ,f a it h b a se d o rg a n is a ti o n s a n d sc h o o ls e q u ip p e d 3 7 4 2 9 ,9 3 8 5 9 ,8 7 5 5 9 ,8 7 5 1 4 9 ,6 8 8 S tr a te g ic A ct iv it y 4 C o n d u ct q u a rt e rl y h e a lt h s cr e e n in g a n d w e ll n e ss d a ys i n a ll 8 9 d is tr ic ts fr o m Q 1 2 0 1 7 t o Q 4 2 0 1 8 4 4 4 5 8 9 q u a rt e rl y w e ll n e ss d a ys a n d h e a lt h sc re e n in g d o n e i n 8 9 d is tr ic ts 1 4 ,2 0 0 6 2 4 ,8 0 0 6 3 9 ,0 0 0 1 ,2 6 3 ,8 0 0 st ra te g ic a ct iv it y 5 B ia n n u a l N C D s sc re e n in g ( D ia b e te s, H y p e rt e n si o n a n d O ve rw e ig h t / o b e si ty ) fo r a ll 8 ,1 1 2 s ch o o ls i n Z im b a b w e f ro m Q 1 , 2 0 1 6 2 ,7 0 4 2 ,7 0 4 2 ,7 0 4 8 1 1 2 sc h o o ls w it h b ia n n u a l sc re e n in g d o n e 1 ,6 6 4 4 ,5 0 0 ,5 2 9 4 ,5 0 0 ,5 2 9 4 ,5 0 0 ,5 2 9 1 3 ,5 0 1 ,5 8 8 Zimbabwe National Nutrition Strategy, 2014 -2018 86 S tr a te g y 3 : G e n e ra te i n fo rm a ti o n o n f o o d c o n su m p ti o n p a tt e rn s, o b e si ty , o ve rw e ig h t a n d k e y d ri ve rs o f a d u lt l if e st y le s (p h ys ic a l a ct iv it y, a lc o h o l a n d o th e r su b st a n ce a b u se , d ie ts , e a ti n g h a b it s) t o i n fo rm b e h a v io u r ch a n g e c o m m u n ic at io n s tr a t e g ie s S tr a te g ic A ct iv it y 1 c o n d u ct a f o o d c o n su m p ti o n su rv e y 1 0 0 % 1 fo o d c o n su m p ti o n su rv e y c o n d u ct e d G o a l 8 : P ro p o rt io n o f h e a lt h f a ci li ti e s (c e n tr a l, p ro v in ci a l, m is si o n a n d d is tr ic t h o sp it a ls ) p ro v id in g q u a li ty n u tr it io n s e rv ic e s fo r co m m u n ic a b le (s ch is to so m ia si s, H IV , m a la ri a , so il t ra n sm it te d h e lm in th e s) a n d n o n c o m m u n ic a b le d is e a se s in cr e a se d t o 7 5 % b y 2 0 1 8 7 ,2 5 4 8 1 ,6 5 4 9 0 9 ,4 4 1 1 ,3 8 3 ,7 5 9 1 ,3 9 1 ,7 7 2 3 ,7 7 3 ,8 8 1 S tr a te g y 1 : P ro m o te t h e e st a b li sh m e n t o f w e ll n e ss c li n ic s w it h a d e q u a te e q u ip m e n t fo r sc re e n in g a n d t re a tm e n t o f N C D s S tr a te g ic A ct iv it y 1 I d e n ti fy s p a ce f o r w e ll n e ss c li n ic s fo r 7 5 % o f d is tr ic ts a n d a ls o p ro v id e s u p p o rt a n d s u p e rv is io n st a rt in g 2 0 1 6 e n d in g 2 0 1 8 2 2 2 2 2 3 6 7 w e ll n e ss c li n ic s e st a b li sh e d 7 ,9 3 4 1 7 4 ,5 5 5 1 7 4 ,5 5 5 1 8 2 ,4 9 0 5 3 1 ,6 0 0 S tr a te g ic A ct iv it y 2 T o e q u ip 4 0 0 h e a lt h f a ci li ti e s th a t is 2 0 0 d is tr ic t, m is si o n , p ro v in ci a l, ce n tr a l in st it u ti o n s a n d 2 0 0 w e ll n e ss c li n ic s b y Q 1 2 0 1 7 t o Q 4 2 0 1 8 2 0 0 2 0 0 4 0 0 4 0 0 h e a lt h fa ci li ti e s e q u ip p e d 1 ,9 3 5 3 8 6 ,9 6 6 3 8 6 ,9 6 6 7 7 3 ,9 3 1 S tr a te g ic A ct iv it y 3 C a p a ci ty b u il d in g o f 6 0 0 h e a lt h w o rk e rs ( tr a in in g o n p re ve n ti o n a n d m a n a g e m e n t o f N C D S ) b y e n d o f 2 0 1 8 2 0 0 2 0 0 2 0 0 6 0 0 6 0 0 h e a lt h w o rk e rs t ra in e d i n N C D m a n a g e m e n t a n d p re ve n ti o n 6 9 0 1 3 8 ,0 0 0 1 3 8 ,0 0 0 1 3 8 ,0 0 0 4 1 4 ,0 0 0 S tr a te g y 2 : S tr e n g th e n t h e k n o w le d g e a n d s k il ls o f h e a lt h w o rk e rs f o r th e p re ve n ti o n a n d m a n a g e m e n t o f N C D s S tr a te g ic A ct iv it y 1 D e ve lo p t ra in in g p ro g ra m m e a n d cu rr ic u lu m a n d t ra in 8 9 d is tr ic ts o n p re ve n ti o n a n d m a n a g e m e n t o f N C D s 2 7 3 1 3 1 8 9 d is tr ic ts t ra in e d o n p re ve n ti o n a n d m a n a g e m e n t o f N C D s 2 1 ,8 3 8 5 8 9 ,6 3 1 6 7 6 ,9 8 4 6 7 6 ,9 8 4 1 ,9 4 3 ,6 0 0 S tr a te g ic A ct iv it y 1 D e si g n a M a n d E f ra m e w o rk a n d sy st e m 0 S tr a te g ic A ct iv it y 2 D e si g n q u a li ty c o n tr o l a n d a ss u ra n ce 0 S tr a te g ic A ct iv it y 3 D e si g n /r e v ie w d a ta m a n a g e m e n t sy st e m s 0 S tr a te g ic A ct iv it y 4 C o n d u ct s u p p o rt a n d s u p e rv is io n 0 S tr a te g y 4 : M a n a g e m e n t o f m o d e ra te a n d s e ve re a cu te m a ln u tr it io n i n P LW H A S tr a te g ic A ct iv it y 1 In te g ra ti o n o f C M A M i n to P LW H A tr a in in g 1 1 P LW H A t ra in in g p a ck a g e in co rp o ra ti n g C M A M 1 7 ,4 0 0 1 7 ,4 0 0 1 7 ,4 0 0 S tr a te g ic A ct iv it y 2 C o n d u ct o n e d a y I n s e rv ic e tr a in in g s fo r 3 p e o p le a t 3 0 % o f th e C M A M c e n te rs r e a ch in g a t o ta l o f 9 2 2 t ra in e e s b y e n d o f 2 0 1 8 . 1 8 4 1 8 4 1 8 4 1 8 4 1 8 6 9 2 2 3 p e o p le a t 3 0 % o f C M A M c e n tr e s tr a in e d 3 9 7 ,2 5 4 7 ,2 5 4 7 ,2 5 4 7 ,2 5 4 7 ,3 3 3 3 6 ,3 5 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Key Result Area 3: Promoting Healthy Lifestyles Zimbabwe National Nutrition Strategy, 2014 -2018 87 S tr a te g y 3 : E ff e ct iv e m o n it o ri n g o f p re va le n ce o f n u tr it io n r e la te d N C D r is k f a ct o rs ( o ve rw e ig h t, o b e si ty , a b n o rm a l li p id s, ra is e d b lo o d s u g a r) a n d s u p p o rt iv e s u p e rv is io n o f se rv ic e s d e li ve re d b y w e ll n e ss c li n ic s Key Result Area 3: Promoting Healthy Lifestyles St ra te gy 5 : R ai se a w ar e n e ss o f U n d e r 2 m al n u tr it io n a s ri sk f ac to r fo r N C D s in h e al th f ac ili ty d e p ar tm e n ts a n d c o m m u n it ie s St ra te gi c A ct iv it y 1 In te gr at e N C D S in to in fa n t an d yo u n g ch ild t ra in in g p ac ka ge a n d d e si gn a n d d e ve lo p IE C /B C C m at e ri al s 1 0 0 % 1 0 0 % N C D s in te gr at e d in to IY C F tr ai n in g p ac ka ge 5 7 ,0 0 0 5 7 ,0 0 0 5 7 ,0 0 0 St ra te gi c A ct iv it y 2 C ar ry o u t so ci al o u tr e ac h a ct iv it ie s su ch a s ro ad s h o w s, a w ar e n e ss ca m p ai gn s, co m m e m o ra ti o n s, ag ri cu lt u re sh o w s, c o m m u n it y th e at re s, r ad io lis te n in g cl u b s, c o m m u n it y fi lm s in 3 0 d is tr ic ts b y Q 4 , 2 0 1 8 1 6 % 2 8 % 2 8 % 2 8 % 1 0 0 % so ci al o u tr e ac h ac ti vi ti e s ac h ie ve d G o a l 9 : 3 0 % o f in st it u ti o n s a d o p t n at io n a l f o o d s e rv ic e a n d n u tr it io n g u id e li n e s b y 2 0 1 8 7 1 3 ,6 3 2 2 ,0 2 6 ,1 3 2 1 ,9 1 2 ,5 3 2 2 ,1 0 0 ,4 7 3 2 ,1 0 0 ,5 9 1 8 ,8 5 3 ,3 6 0 St ra te gy 1 : E n su re n u tr it io n s e rv ic e s an d e d u ca ti o n a re im p le m e n te d t h ro u gh in st it u ti o n s o f sp e ci al c ar e ( su ch a s h o sp it al s, p ri so n s, o rp h an ag e s) t o p ro m o te t h e r e in fo rc e m e n t o f n u tr it io n p ra ct ic e s St ra te g ic A ct iv it y 1 D e ve lo p n a ti o n a l d ie ta ry g u id e lin e s b y Q 4 2 0 1 4 1 1 N a ti o n a l D ie ta ry G u id e lin e s D o cu m e n t 1 1 3 ,6 0 0 1 1 3 ,6 0 0 1 1 3 ,6 0 0 St ra te g ic A ct iv it y 2 Tr a in 1 0 0 0 0 c a rd e rs f ro m in st it u ti o n s o f sp e ci a l c a re f ro m Q 1 2 0 1 5 t o Q 4 2 0 1 8 2 5 0 0 2 5 0 0 2 5 0 0 2 5 0 0 1 0 0 0 0 1 0 0 0 0 c a rd e rs fr o m in st it u ti o n s tr a in e d 5 2 5 1 ,3 1 2 ,5 0 0 1 ,3 1 2 ,5 0 0 1 ,3 1 2 ,5 0 0 1 ,3 1 2 ,5 0 0 5 ,2 5 0 ,0 0 0 St ra te g ic A ct iv it y 3 R e vi e w a n d in co rp o ra te in to p re se rv ic e t ra in in g c u rr ic u lu m f o r ca d re s in vo lv e d i n in st it u ti o n s o f sp e ci a l c a re ( H FS S, n u tr it io n is ts , d ie ti ci a n s, d o ct o rs ) 1 1 P re s e rv ic e cu rr ic u lu m re vi e w e d 1 1 3 ,6 0 0 1 1 3 ,6 0 0 1 1 3 ,6 0 0 St ra te g ic A ct iv it y 4 R e cr u it 2 0 d ie ti ci a n s fo r n a ti o n a l, p ro vi n ci a l a n d c e n tr a l l e ve ls b y Q 4 , 2 0 1 8 4 4 4 4 4 2 0 2 0 d ie ti ci a n s re cr u it e d 8 3 2 3 2 3 2 3 2 3 2 1 6 0 St ra te g ic A ct iv it y 5 B y 2 0 1 8 , e q u ip a ll ce n tr a l a n d p ro vi n ci a l h o sp it a l k it ch e n s w it h a d e q u a te e q u ip m e n t = 9 p ro vi n ci a l a n d 5 c e n tr a l = 1 5 in st it u ti o n s 3 3 3 3 3 1 5 1 5 c e n tr a l a n d p ro vi n ci a l h o sp it a ls e q u ip p e d 2 0 0 ,0 0 0 6 0 0 ,0 0 0 6 0 0 ,0 0 0 6 0 0 ,0 0 0 6 0 0 ,0 0 0 6 0 0 ,0 0 0 3 ,0 0 0 ,0 0 0 St ra te g ic A ct iv it y 6 C o n d u ct s u p p o rt a n d s u p e rv is io n vi si ts in 3 0 % a ll in st it u ti o n s o f sp e ci a l c a re i. e h o sp it a ls , p ri so n s, o rp h a n a ge s, o ld p e o p le h o m e s th a t h av e a d o p te d t h e n a ti o n a l n u tr it io n g u id e lin e s fr o m Q 1 2 0 1 7 to Q 4 2 0 1 8 = 3 1 6 9 in st it u ti o n s 1 5 8 4 1 5 8 5 3 1 6 9 su p p o rt a n d su p e rv is io n vi si ts co n d u ct e d a t 3 1 6 9 in st it u ti o n s 1 1 9 1 8 7 ,9 4 1 1 8 8 ,0 5 9 3 7 6 ,0 0 0 S u b T o ta l K R A 3 P ro m o ti n g H e a lt h y L if e st y le s 8 2 6 ,0 8 6 2 ,3 8 7 ,8 2 7 7 ,7 6 0 ,5 5 2 9 ,0 7 7 ,5 4 8 9 ,0 5 8 ,3 0 9 2 9 ,1 1 0 ,3 2 3 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 88 Key Result Area 4: Quality nutrition information systems and advocacy G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 G 1 0 : T im e ly a v a il a b il it y o f re le v a n t n u tr it io n i n fo rm a ti o n t h a t in co rp o ra te s d is a st e r ri sk r e d u ct io n a t a ll l e v e ls a d e q u a te f o r d is a st e r p re p a re d n e ss p la n n in g a n d n u tr it io n p ro g ra m m in g 4 ,2 4 0 ,6 3 0 2 ,3 1 1 ,9 3 5 9 9 8 ,7 8 3 9 9 8 ,7 8 3 9 9 8 ,7 8 3 6 ,8 6 8 ,8 1 5 S tr a te g y 1 : E n su re n u tr it io n i n d ic a to rs a re in te g ra te d i n to t h e n a ti o n a l H e a lt h I n fo rm a ti o n S ys te m S tr a te g ic A ct iv it y 1 R e v ie w e xi st in g H IS f o r In d ic a to rs 1 1 In d ic a to rs in te g ra te d in to th e H IS 5 0 0 5 0 0 5 0 0 S tr a te g ic A ct iv it y 2 S ta ke h o ld e r co n su lt a ti o n 1 1 S ta ke h o ld e rs C o n su lt e d 1 ,0 0 0 1 ,0 0 0 1 ,0 0 0 S tr a te g ic A ct iv it y 3 P re se n ta ti o n a n d A p p ro va l o f In d ic a to rs t o t h e H M IS t e ch n ic a l g ro u p 1 1 P re se n ta ti o n d o n e t o T e ch n ic a l G ro u p 1 ,0 0 0 1 ,0 0 0 1 ,0 0 0 S tr a te g ic A ct iv it y 4 In te g ra ti o n o f N u tr it io n I n d ic to rs in to t h e N a ti o n a l S ta ti st ic a l Sy st e m b y Q 1 2 0 1 5 1 5 0 0 0 N a ti o n a l S ta ti st ic a l Sy st e m in te g ra ti n g n u tr it io n in d ic a to rs 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 S tr a te g y 2 : S tr e n g th e n in g c o o rd in a ti o n o f n u tr it io n s u rv e il la n ce a ct iv it ie s & t im e ly i n fo rm a ti o n s h a ri n g ( su b co m m it te e , in d ic a to rs , in te g ra te d o p e ra ti o n a l p la n , n u tr it io n s u rv e il la n ce g u id e li n e s) S tr a te g ic A ct iv it y 1 D e ve lo p in g a n d p ri n ti n g o f N u tr it io n s u rv e il la n ce g u id e li n e s b y 2 0 1 4 4 5 0 0 4 5 0 0 N u tr it io n S u rv e il la n ce G u id e li n e s p ro d u ce d 1 0 4 5 ,0 0 0 4 5 ,0 0 0 S tr a te g ic A ct iv it y 2 co n d u ct t ra in in g o n N u tr it io n su rv e il la n ce 3 3 2 2 2 1 2 5 0 8 0 P e o p le tr a in e d 2 9 4 ,9 9 2 8 8 4 ,9 7 5 8 8 4 ,9 7 5 5 8 9 ,9 8 3 5 8 9 ,9 8 3 5 8 9 ,9 8 3 3 ,5 3 9 ,9 0 0 S tr a te g ic A ct iv it y 3 H o ld q u a rt e rl y N u tr it io n su rv e il la n ce m e e ti n g s 8 8 8 8 8 4 0 R e v ie w m e e ti n g s co n d u ct e d 5 1 ,1 0 0 4 0 8 ,8 0 0 4 0 8 ,8 0 0 4 0 8 ,8 0 0 4 0 8 ,8 0 0 4 0 8 ,8 0 0 2 ,0 4 4 ,0 0 0 S tr a te g ic A ct iv it y 1 D e si g n o f M a n d E F ra m e w o rk s a n d Sy st e m s b y 2 0 1 4 1 1 M a n d E F ra m e w o rk D e si g n e d 5 0 0 5 0 0 2 8 0 S tr a te g ic A ct iv it y 2 D e si g n o f Q u a li ty C o n tr o l a n d A ss u ra n ce 1 1 Q u a li ty C o n tr o l a n d A ss u ra n ce d e si g n e d 2, 5 0 0 2 ,5 0 0 2 8 0 S tr a te g ic A ct iv it y 3 D e si g n /R e v ie w o f D a ta M a n a g e m e n t Sy st e m s 1 1 D a ta M a n a g e m e n t Sy st e m r e v ie w e d 5 0 0 5 0 0 2 8 0 S tr a te g ic A ct iv it y 4 S ta ke h o ld e r C o n su lt a ti o n 1 1 C o n su lt a ti o n s D o n e 5 ,0 0 0 5 ,0 0 0 5 6 0 S tr a te g ic A ct iv it y 5 D a ta c o ll e ct io n a n d a n a ly si s 4 4 4 4 4 2 0 M a n d E R e p o rt s 6 6 8 ,2 5 0 2 ,6 7 3 ,0 0 0 S tr a te g y 4 : E n su re a va il a b il it y o f fu n ct io n a l e q u ip m e n t fo r m o n it o ri n g n u tr it io n t re n d s in Z im b a b w e S tr a te g ic A ct iv it y 1 S it u a ti o n a l A ss e ss m e n t S tr a te g ic A ct iv it y 2 E q u ip m e n t u p g ra d e f o r h e a lt h ce n tr e s Zimbabwe National Nutrition Strategy, 2014 -2018 89 S tr a te g y 3 : S tr e n g th e n m o n it o ri n g a n d e va lu a ti o n o f n u tr it io n p ro g ra m m e s Key Result Area 4: Quality nutrition information systems and advocacy G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 St ra te gi c A ct iv it y 3 Eq u ip m e n t u p gr a d e f o r h o sp it a ls St ra te gi c A ct iv it y 1 Tr a in in g o f Tr a in e rs 1 1 T O T d o n e 9 8 ,0 8 0 9 8 ,0 8 0 9 8 ,0 8 0 St ra te gi c A ct iv it y 2 Tr a in in g o f FN SC s (D is tr ic t Le ve l) 1 1 Tr a in in gs D o n e 1 ,0 1 8 ,1 6 0 1 ,0 1 8 ,1 6 0 1 ,0 1 8 ,1 6 0 St ra te gi c A ct iv it y 3 Tr a in in g o f FN SC s (W a rd L e ve l) 0 0 0 0 0 0 Tr a in in gs D o n e St ra te gy 6 : O p e ra ti o n a l r e se a rc h t o id e n ti fy c o n te xt s p e ci fi c d ri ve rs o f st u n ti n g a n d p o ss ib le in te rv e n ti o n s th at a d d re ss t h e c a u sa l f a ct o rs o f m a ln u tr it io n ( in vo lv in g u n iv e rs it y st u d e n ts ) St ra te gi c A ct iv it y 1 C a rr y o u t a s tu d y to id e n ti fy c a su a l fa ct o rs o f st u n ti n g b y 2 0 1 4 1 1 St u d y re p o rt o n ca u sa l f a ct o rs o f st u n ti n g 4 0 ,3 0 0 4 0 ,3 0 0 4 0 ,3 0 0 St ra te gi c A ct iv it y 2 C o n d u ct a F o o d C o n su m p ti o n Su rv e y 1 1 Fo o d C o n su m p ti o n Su rv e y R e p o rt 5 4 ,4 7 6 5 4 ,4 7 6 5 4 ,4 7 6 Su b T o ta l K R A 4 Q u a li ty n u tr it io n in fo rm a ti o n s ys te m s a n d a d vo ca cy 4 ,2 4 0 ,6 3 0 2 ,3 1 1 ,9 3 5 9 9 8 ,7 8 3 9 9 8 ,7 8 3 9 9 8 ,7 8 3 6 ,8 6 8 ,8 1 5 Zimbabwe National Nutrition Strategy, 2014 -2018 90 St ra te gy 5 : B u ild c a p a ci ty o f FN SC s o n e a rl y w a rn in g a n d d is a st e r ri sk m a n a ge m e n t Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 G o a l 1 1 : 8 0 % o f w o m e n o f re p ro d u ct iv e a g e h a v e t h e c a p a ci ty t o s a fe ly p ro v id e fo r th e ir f o o d , h e a lt h a n d n u tr it io n s e cu ri ty u si n g a p p ro p ri a te te ch n o lo g ie s b y 2 0 1 8 5 7 9 ,4 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 5 4 2 ,8 0 0 2 ,7 5 0 ,6 0 0 S tr a te g y 1 : Ta rg e t w o m e n f o r li ve li h o o d p ro je ct s th a t u se l a b o r sa v in g t e ch n o lo g ie s S tr a te g ic A ct iv it y 1 A ss e ss a va il a b le l a b o u r sa v in g te ch n o lo g ie s, t h e ir s u it a b il it y a n d a cc e p ta b il it y t o t h e v a ri o u s n a tu ra l fa rm in g r e g io n s. 1 1 A ss e ss m e n t re p o rt 1 7 ,1 0 0 1 7 ,1 0 0 1 7 ,1 0 0 S tr a te g ic A ct iv it y 2 D is se m in a te r e p o rt o f th e La b o u r S a v in g T e ch n o lo g ie s A ss e ss m e n t to k e y s ta ke h o ld e rs 1 1 D is se m in a ti o n a ct io n p la n 7 ,5 7 5 7 ,5 7 5 7 ,5 7 5 S tr a te g ic A ct iv it y 3 Tr a in 7 2 0 A G R IT E X O ff ic e rs p e r ye a r o n l a b o u r sa v in g te ch n o lo g ie s 7 2 0 7 2 0 7 2 0 7 2 0 7 2 0 3 ,6 0 0 Tr a in e d A G R IT E X O ff ic e r 2 5 8 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 9 2 7 ,0 0 0 S tr a te g ic A ct iv it y 4 E st a b li sh 2 4 d e m o n st ra ti o n p lo ts p e r ye a r o n l a b o u r sa v in g te ch n o lo g ie s 2 4 2 4 2 4 2 4 2 4 1 2 0 D e m o n st ra ti o n p lo t 5 ,0 0 0 1 2 0 ,0 0 0 1 2 0 ,0 0 0 1 2 0 ,0 0 0 1 2 0 ,0 0 0 1 2 0 ,0 0 0 6 0 0 ,0 0 0 S tr a te g ic A ct iv it y 5 E st a b li sh 3 2 0 I S A L G ro u p s fo r w o m e n p e r ye a r 3 2 0 3 2 0 3 2 0 3 2 0 3 2 0 1 ,6 0 0 F u n ct io n a l IS A L G ro u p 5 0 1 6 ,0 0 0 1 6 ,0 0 0 1 6 ,0 0 0 1 6 ,0 0 0 1 6 ,0 0 0 8 0 ,0 0 0 S tr a te g y 2 : N u tr it io n e d u ca ti o n o n s a fe u se o f ir ri g a ti o n w a te r to p re ve n t m a la ri a , sc h is to so m ia si s a n d a n y o th e r w a te r b o rn e d is e a se s S tr a te g ic A ct iv it y 1 D e ve lo p a n u tr it io n p re s e rv ic e tr a in in g m o d u le f o r a g ri cu lt u re co ll e g e s 1 1 P re s e rv ic e N u tr it io n Tr a in in g M o d u le 1 1 ,9 2 5 1 1 ,9 2 5 1 1 ,9 2 5 S tr a te g ic A ct iv it y 2 Tr a in 7 2 0 i n s e rv ic e e xt e n si o n o ff ic e rs e ve ry y e a r o n n u tr it io n e d u ca ti o n a n d s a fe u se o f ir ri g a ti o n w a te r 7 2 0 7 2 0 7 2 0 7 2 0 7 2 0 3 ,6 0 0 Tr a in e d A G R IT E X O ff ic e r 2 5 8 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 9 2 7 ,0 0 0 S tr a te g ic A ct iv it y 3 Tr a in in g 7 2 ,0 0 0 ( 1 0 0 f a rm e rs / e xt e n si o n o ff ic e r) f a rm e rs p e r ye a r o n n u tr it io n e d u ca ti o n a n d sa fe u se o f ir ri g a ti o n w a te r 7 2 ,0 0 0 7 2 ,0 0 0 7 2 ,0 0 0 7 2 ,0 0 0 7 2 ,0 0 0 3 6 0 ,0 0 0 Tr a in e d F a rm e r 1 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 1 8 0 ,0 0 0 G o a l 1 2 : C o v e ra g e o f h e a lt h a n d c o m m u n it y n u tr it io n s e rv ic e s fo r sc h o o l ch il d re n i n cr e a se d t o 5 0 % b y 2 0 1 8 9 ,1 5 6 ,6 4 0 9 ,6 2 6 ,6 4 0 1 5 ,6 3 3 ,2 7 0 1 7 ,5 8 1 ,8 8 0 7 ,8 8 1 ,6 0 0 5 9 ,7 5 1 ,9 3 0 S tr a te g y 1 : K n o w le d g e a n d s k il ls d e ve lo p m e n t fo r E d u ca ti o n m a n a g e rs , sc h o o l h e a lt h C o o rd in a to rs , t e a ch e rs ( p re s e rv ic e a n d i n s e rv ic e )a n d S D C m e m b e rs o n h e a lt h a n d n u tr it io n S tr a te g ic A ct iv it y 1 D e ve lo p a T ra in in g M a n u a l o n H e a lt h a n d N u tr it io n b y Q 3 , 2 0 1 4 1 1 H e a lt h a n d N u tr it io n Tr a in in g M a n u a l 1 2 8 ,1 0 0 1 2 8 ,1 0 0 S tr a te g ic A ct iv it y 2 P ri n t 1 0 0 0 0 0 T ra in in g M a n u a ls o n H e a lt h a n d N u tr it io n b y Q 4 , 2 0 1 5 1 0 0 ,0 0 0 1 0 0 ,0 0 0 1 0 0 0 0 0 t ra in in g m a n u a ls p ri n te d 1 0 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 Zimbabwe National Nutrition Strategy, 2014 -2018 91 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 3 C o n d u ct T ra in in g o f Tr a in e rs a t n a ti o n a l le ve l o n h e a lt h a n d n u tr it io n i n s ch o o ls t a rg e ti n g 1 P e rm a n e n t S e cr e ta ry , 5 P ri n ci p a l D ir e ct o rs , 1 1 H e a d o ff ic e D ir e ct o rs , 1 0 P E D s, 1 4 H e a d o ff ic e D /D ir e ct o rs , 2 0 D /P E D s, 6 O ff ic e rs ( E C D , Le a rn e r W e lf a re , Ju n io r, S e co n d a ry , S p e ci a l n e e d s E d u ca ti o n a n d C u rr ic u lu m D e v p t. ), 5 M O H C C + 1 C o n su lt a n t. To ta l = 7 3 p a rt ic ip a n ts . B y Q 4 2 0 1 4 1 1 E d u ca ti o n M a n a g e rs tr a in e d 8 1 ,8 4 0 8 1 ,8 4 0 8 1 ,8 4 0 S tr a te g ic A ct iv it y 4 C o n d u ct t ra in in g o f tr a in e rs a t P ro v in ci a l le ve l o n h e a lt h a n d n u tr it io n i n s ch o o ls t a rg e ti n g 1 x E C D , 2 xI n sp e ct o r a n d 1 xD E O p e r e a ch o f th e 1 0 P ro v in ce s b y Q 2 2 0 1 5 . 1 0 1 0 1 0 P ro v in ci a l tr a in in g o f tr a in e rs co n d u ct e d 1 9 ,9 5 0 1 9 9 ,5 0 0 1 9 9 ,5 0 0 S tr a te g ic A ct iv it y 5 C a sc a d e t ra in in g a t D is tr ic t le ve l to s ch o o ls i n 8 2 C lu st e rs ( 1 cl u st e r = 1 0 s ch o o ls , 1 s ch o o l h a s 1 H e a d , 1 D /H e a d , 1 S D C , 1 S ch o o l H e a lt h C o o rd in a to r a n d 1 T IC ) b y Q 2 2 0 1 6 4 1 4 1 8 2 82 c lu st e r tr a in in g s co n d u ct e d 2 4 ,6 2 0 1 ,0 0 9 ,4 2 0 1 ,0 0 9 ,4 2 0 2 ,0 1 8 ,8 4 0 S tr a te g ic A ct iv it y 6 R e v ie w S u p e rv is io n To o ls t o in co rp o ra te H e a lt h a n d N u tr it io n a sp e ct s b y Q 3 , 2 0 1 6 1 1 R e v ie w e d S u p e rv is io n T o o l 8 5 0 8 5 0 8 5 0 S tr a te g ic A ct iv it y 7 R e v ie w o f te a ch e r tr a in in g cu rr ic u lu m b y M o H T E T t o r o p e in h e a lt h a n d n u tr it io n b y Q 4 , 2 0 1 4 1 1 Te a ch e r tr a in in g cu rr ic u lu m re v ie w e d 1 8 ,6 0 0 1 8 ,6 0 0 1 8 ,6 0 0 S tr a te g y 2 : N u tr it io n i n te g ra te d in to t h e b a si c e d u ca ti o n c u rr ic u lu m , co ve ri n g e ss e n ti a l to p ic s su ch a s n u tr it io n a n d g ro w th , fa m il y p la n n in g , p re g n a n cy a n d i n fa n t fe e d in g , a n d h yg ie n e p ro m o ti o n S tr a te g ic A ct iv it y 1 C u rr ic u lu m r e v ie w f o r a ll l e ve ls fr o m E C D t o u p d a te a n d in te g ra te H e a lt h a n d N u tr it io n O n g o in g 1 1 2 H o m e E co n o m ic s , S o ci a l S tu d ie s Sy ll a b i fo r ( E C D , G r 1 /2 , Ju n io r C la ss e s) re v ie w e d a n d Fo o d J u n io r a n d "O " le ve l re v ie w e d S tr a te g ic A ct iv it y 2 D e ve lo p in g s y ll a b i b y Q 4 2 0 1 5 1 6 7 Sy ll a b i d e ve lo p e d 4 6 ,5 0 0 4 6 ,5 0 0 2 7 9 ,0 0 0 3 2 5 ,5 0 0 S tr a te g ic A ct iv it y 3 Sy ll a b u s in te rp re ta ti o n b y Q 2 ,2 0 1 6 5 2 7 7 In te rp re te d Sy ll a b i 4 6 ,5 0 0 2 3 2 ,5 0 0 9 3 ,0 0 0 3 2 5 ,5 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 92 S tr a te g ic A ct iv it y 4 Sy ll a b u s In te rp re ta ti o n ca sc a d e d b y Q 4 2 0 1 7 1 8 0 3 9 4 5 7 4 8 2 C lu st e r tr a in in g s fo r 7 sy ll a b i co n d u ct e d 2 4 ,6 2 0 4 ,4 3 1 ,6 0 0 9 ,7 0 0 ,2 8 0 1 4 ,1 3 1 ,8 8 0 S tr a te g ic A ct iv it y 5 E st a b li sh in g n u tr it io n g a rd e n s a t e a ch o f th e 8 1 1 2 sc h o o ls b y Q 4 , 2 0 1 8 1 ,6 2 2 1 ,6 2 2 1 ,6 2 2 1 ,6 2 2 1 ,6 2 2 8 ,1 1 0 N u tr it io n g a rd e n s e st a b li sh e d 2 ,1 0 0 3 ,4 0 6 ,2 0 0 3 ,4 0 6 ,2 0 0 3 ,4 0 6 ,2 0 0 3 ,4 0 6 ,2 0 0 3 ,4 0 6 ,2 0 0 1 7 ,0 3 1 ,0 0 0 S tr a te g y 3 : P ro m o ti o n o f co n ti n u in g g ir ls e d u ca ti o n f o cu si n g o n s ch o o l re te n ti o n a n d c o m p le ti o n o f e d u ca ti o n b y o rp h a n s a n d o th e r v u ln e ra b le c h il d re n i n a b id t o b re a k c yc le s o f p o ve rt y S tr a te g ic A ct iv it y 1 P ro v id in g su st a in a b le S ch o o l b a se d F e e d in g P ro g ra m m e f o r d is a d va n ta g e d l e a rn e rs O n g o in g 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 5 ,0 0 0 ,0 0 0 S ch o o l Fe e d in g P ro g ra m m e 4 4 ,0 0 0 ,0 0 0 4 ,0 0 0 ,0 0 0 4 ,0 0 0 ,0 0 0 4 ,0 0 0 ,0 0 0 4 ,0 0 0 ,0 0 0 2 0 ,0 0 0 ,0 0 0 S tr a te g ic A ct iv it y 2 P ro v is io n o f Li fe S k il ls , S e xu a li ty , H IV a n d A ID S E d u ca ti o n P ro g ra m m e s to e li m in a te d ro p o u ts a n d b re a k c y le s o f p o ve rt y th ro u g h 2 x 1 0 p ro v in ci a l H o li d a y C a m p s p e r ye a r O n g o in g 2 0 2 0 2 0 2 0 2 0 1 0 0 2 0 P ro v in ci a l H o li d a y c a m p s co n d u ct e d p e r ye a r 2 3 ,7 7 0 4 7 5 ,4 0 0 4 7 5 ,4 0 0 4 7 5 ,4 0 0 4 7 5 ,4 0 0 4 7 5 ,4 0 0 2 ,3 7 7 ,0 0 0 S tr a te g ic A ct iv it y 3 E st a b li sh in g P P P in e a ch o f th e 7 3 D is tr ic ts b y b y e n ga g in g w it h lo ca l b u si n e ss e s in t h e co m m u n it y w il li n g t o s u p p o rt O V C O n g o in g 1 4 1 4 1 5 1 5 1 5 7 3 P P P i n 7 3 D is tr ic ts S tr a te g y 4 : P ro m o ti o n o f P e e r E d u ca ti o n o n H e a lt h a n d N u tr it io n i n a ll s ch o o ls b y Q 4 , 2 0 1 5 S tr a te g ic A ct iv it y 1 D e ve lo p g u id e li n e s o n P e e r H e a lt h a n d N u tr it io n E d u ca ti o n C lu b s fo r 8 1 1 2 s ch o o ls b y Q 4 , 2 0 1 5 1 1 P e e r H e a lt h a n d N u tr it io n G u id e li n e s d e ve lo p e d 2 4 ,6 2 0 2 4 ,6 2 0 2 4 ,6 2 0 S tr a te g ic A ct iv it y 2 P ri n t a n d d is tr ib u te 1 0 0 0 0 0 G u id e li n e s o n p e e r h e a lt h a n d n u tr it io n e d u ca ti o n b y Q 2 , 2 0 1 6 1 0 0 ,0 0 0 1 0 0 ,0 0 0 1 0 0 0 0 0 g u id e li n e s p ri n te d a n d d is tr ib u te d 1 0 1 ,0 0 0 ,0 0 0 1 ,0 0 0 ,0 0 0 S tr a te g ic A ct iv it y 3 Tr a in in g P e e r H e a lt h a n d N u tr it io n E d u ca to rs ta rg e ti n g 1 0 l e a rn e rs a t e a ch o f th e 8 1 1 2 sc h o o ls b y Q 3 , 2 0 1 4 8 ,1 1 2 8 ,1 1 2 Tr a in e d P e e r H e a lt h a n d N u tr it io n E d u ca to rs 1 5 0 1 ,2 1 6 ,8 0 0 1 ,2 1 6 ,8 0 0 S tr a te g ic A ct iv it y 4 E st a b li sh in g P e e r H e a lt h a n d N u tr it io n E d u ca ti o n C lu b s in a ll sc h o o ls O n g o in g 8 ,1 1 2 8 ,1 1 2 P e e r H e a lt h a n d N u tr it io n S ch o o l C lu b s e st a b li sh e d Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 93 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 S tr a te g ic A ct iv it y 1 Tr a in t h e N FS C i n 2 0 1 4 . 9 1 F u n ct io n a l N F N S C 1 ,3 5 0 1 2 ,1 5 0 1 2 ,1 5 0 S tr a te g ic A ct iv it y 2 Tr a in a n d r e su sc it a te 3 6 re m a in in g D F N S C s a n d 8 P F N S C s in 2 0 1 4 3 6 4 4 F u n ct io n a l P & D F N S C 2 ,2 9 5 8 2 ,6 2 0 8 2 ,6 2 0 S tr a te g ic A ct iv it y 3 F in a li ze t h e M & E t ra in in g p a ck a g e f o r F N S C s in cl u d in g D R R 1 1 M & E T ra in in g p a ck a g e f o r F N S C s 1 ,6 0 0 1 ,6 0 0 1 ,6 0 0 S tr a te g ic A ct iv it y 4 R o ll o u t M & E T ra in in g t o a ll P F N S C & D F N S C i n 2 0 1 4 a n d 2 0 1 5 . 3 5 3 4 6 9 N a ti o n a l, P ro v in ci a l & D is tr ic t F N S C s tr a in e d i n M & E . 3 ,5 3 5 1 2 3 ,7 2 5 1 2 0 ,1 9 0 2 4 3 ,9 1 5 S tr a te g ic A ct iv it y 5 P ro v id e a n a n n u a l co n st ra in t re m o va l b u d g e t fo r d a y t o d a y ru n n in g o f F N S C s a t a ll l e ve ls . 1 9 2 2 7 6 2 7 6 2 7 6 2 7 6 1 ,2 9 6 FN S C C o o rd in a ti o n M e e ti n g m in u te s a n d F ie ld v is it r e p o rt 5 9 0 1 1 3 ,2 8 0 1 6 2 ,8 4 0 1 6 2 ,8 4 0 1 6 2 ,8 4 0 1 6 2 ,8 4 0 7 6 4 ,6 4 0 S tr a te g ic A ct iv it y 6 Tr a in 5 0 % o f W F N S C s b y 2 0 1 8 . 2 0 0 2 0 0 2 0 0 2 0 0 8 0 0 F u n ct io n a l W F N S C 9 8 0 1 9 6 ,0 0 0 1 9 6 ,0 0 0 1 9 6 ,0 0 0 1 9 6 ,0 0 0 7 8 4 ,0 0 0 G o a l 1 4 : To i n cr e a se t h e p ro p o rt io n o f h o u se h o ld s co n su m in g s a fe a n d a cc e p ta b le d ie ts a ll y e a r ro u n d t o a t le a st 8 0 % b y 2 0 1 8 8 ,8 7 1 ,2 2 7 6 ,2 9 4 ,9 3 7 6 ,2 1 0 ,4 8 7 6 ,1 8 1 ,7 8 7 6 ,1 8 1 ,7 8 7 3 3 ,6 9 1 ,0 2 4 S tr a te g y 1 : P ro m o te c ro p d iv e rs if ic a ti o n i n cl u d in g a d o p ti o n o f b io f o rt if ie d c ro p s ri ch i n i ro n , zi n c a n d v it a m in A S tr a te g ic A ct iv it y 1 E st a b li sh 6 0 d e m o n st ra ti o n p lo ts p e r ye a r o n c ro p d iv e rs if ic a ti o n 6 0 6 0 6 0 6 0 6 0 3 0 0 F u n ct io n a l D e m o n st ra ti o n p lo t. 3 5 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 1 0 5 ,0 0 0 S tr a te g ic A ct iv it y 2 Tr a in 3 0 0 f a rm e rs p e r w a rd p e r ye a r o n c ro p d iv e rs if ic a ti o n s 3 0 0 3 0 0 3 0 0 3 0 0 3 0 0 1 ,5 0 0 Tr a in e d f a rm e r 1 1 5 0 1 5 0 1 5 0 1 5 0 1 5 0 7 5 0 S tr a te g ic A ct iv it y 3 S ta g e o n e s e e d f a ir p e r d is tr ic t a n n u a ll y. 6 0 6 0 6 0 6 0 6 0 3 0 0 S u cc e ss fu l se e d fa ir 1 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 3 0 ,0 0 0 S tr a te g y 2 : P ro m o te i m p ro ve d p o st h a rv e st h a n d li n g , p ro ce ss in g , st o ra g e a n d v a lu e a d d it io n t o i n cr e a se s h e lf l if e a n d f o o d s a fe ty o f h a rv e st e d f o o d s S tr a te g ic A ct iv it y 1 Tr a in 3 0 0 f a rm e rs p e r w a rd p e r ye a r o n p o st h a rv e st in g h a n d li n g 3 0 0 3 0 0 3 0 0 3 0 0 3 0 0 1 ,5 0 0 Tr a in e d f a rm e r 1 1 5 0 1 5 0 1 5 0 1 5 0 1 5 0 7 5 0 S tr a te g ic A ct iv it y 2 S ta g e o n e p o st h a rv e st te ch n o lo g y f a ir p e r d is tr ic t p e r ye a r. 6 0 6 0 6 0 6 0 6 0 3 0 0 S u cc e ss fu l p o st h a rv e st te ch n o lo g y f a ir 1 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 6 ,0 0 0 3 0 ,0 0 0 S tr a te g ic A ct iv it y 3 E st a b li sh 6 0 p o st h a rv e st te ch n o lo g y d e m o n st ra ti o n s p e r ye a r 3 0 3 0 3 0 3 0 1 2 0 P o st h a rv e st te ch n o lo g y d e m o n st ra ti o n ce n tr e 1 ,6 5 0 4 9 ,5 0 0 4 9 ,5 0 0 4 9 ,5 0 0 4 9 ,5 0 0 1 9 8 ,0 0 0 S tr a te g y 3 : P ro m o te p ro d u ct io n a n d a va il a b il it y o f sm a ll l iv e s to ck , a q u a cu lt u re a n d a p ic u lt u re a n d c o n su m p ti o n o f a n im a l so u rc e p ro te in f o o d s S tr a te g ic A ct iv it y 1 Tr a in 3 0 0 f a rm e rs p e r w a rd p e r ye a r o n p ro d u ct io n o f sm a ll st o ck , a q u a cu lt u re a n d a p ic u lt u re 3 0 0 3 0 0 3 0 0 3 0 0 3 0 0 1 ,5 0 0 Tr a in e d f a rm e r 1 1 5 0 1 5 0 1 5 0 1 5 0 1 5 0 7 5 0 G o a l 1 3 : A ll p ro v in ce s a n d d is tr ic ts h a v e f o o d a n d n u tr it io n s e cu ri ty c o m m it te e s th a t a re f u ll y d is ch a rg in g t h e ir t e rm s o f re fe re n ce b y 2 0 1 4 , 5 0 % o f w a rd l e v e l co m m it te e s fu n ct io n in g b y 2 0 1 8 3 3 3 ,3 7 5 4 7 9 ,0 3 0 3 5 8 ,8 4 0 3 5 8 ,8 4 0 3 5 8 ,8 4 0 1 ,8 8 8 ,9 2 5 S tr a te g y 1 : C a p a ci ty d e ve lo p m e n t o f F N S C o n t h e ir c o re m a n d a te s Zimbabwe National Nutrition Strategy, 2014 -2018 94 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 2 E st a b li sh 6 0 d e m o n st ra ti o n s o n a q u a cu lt u re a n n u a ll y 6 0 6 0 6 0 6 0 6 0 3 0 0 A q u a cu lt u re d e m o n st ra ti o n 1 ,8 3 6 1 1 0 ,1 6 0 1 1 0 ,1 6 0 1 1 0 ,1 6 0 1 1 0 ,1 6 0 1 1 0 ,1 6 0 5 5 0 ,8 0 0 S tr a te g ic A ct iv it y 3 E st a b li sh 6 0 d e m o n st ra ti o n s o n a p ic u lt u re a n n u a ll y 6 0 6 0 6 0 6 0 6 0 3 0 0 A p ic u lt u re d e m o n st ra ti o n . 1 1 2 6 ,7 2 0 6 ,7 2 0 6 ,7 2 0 6 ,7 2 0 6 ,7 2 0 3 3 ,6 0 0 S tr a te g ic A ct iv it y 4 E st a b li sh 6 0 d e m o n st ra ti o n s o n sm a ll l iv e st o ck a n n u a ll y 6 0 6 0 6 0 6 0 6 0 3 0 0 S m a ll s to ck d e m o n st ra ti o n (a n y o f in d ig e n o u s ch ic ke n s, sh o a ts , ra b b it s, g u in e a f o w l e tc ) 2 5 0 1 5 ,0 0 0 1 5 ,0 0 0 1 5 ,0 0 0 1 5 ,0 0 0 1 5 ,0 0 0 7 5 ,0 0 0 S tr a te g y 4 : P ro m o te r e se a rc h a n d d e ve lo p m e n t o f im p ro ve d v a ri e ti e s o f b io f o rt if ie d s e e d s S tr a te g ic A ct iv it y 1 S e t u p 1 3 o n s ta ti o n M u lt i lo ca ti o n t e st in g s it e s o f a lr e a d y d e ve lo p e d b io fo rt if ie d va ri e ti e s 1 3 1 3 1 3 1 3 1 3 6 5 Te st in g s it e 9 2 5 1 2 ,0 2 5 1 2 ,0 2 5 1 2 ,0 2 5 1 2 ,0 2 5 1 2 ,0 2 5 6 0 ,1 2 5 S tr a te g ic A ct iv it y 2 S e t u p 6 0 o n f a rm M u lt i lo ca ti o n t e st in g s it e s o f a lr e a d y d e ve lo p e d b io fo rt if ie d va ri e ti e s 6 0 6 0 6 0 6 0 6 0 Te st in g s it e 8 2 0 4 9 ,2 0 0 S tr a te g ic A ct iv it y 3 E st a b li sh 6 0 d e m o n st ra ti o n s o n b io f o rt if ie d v a ri e ti e s a n n u a ll y. 6 0 6 0 6 0 6 0 6 0 3 0 0 D e m o n st ra ti o n si te 3 5 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 2 1 ,0 0 0 1 0 5 ,0 0 0 S tr a te g ic A ct iv it y 4 C o n st it u te 5 0 n e w b io f o rt if ie d va ri e ti e s/ g e rm p la sm a n n u a ll y 5 0 5 0 5 0 5 0 5 0 2 5 0 R o w s o f n e w cr o ss co m b in a ti o n s 5 5 0 5 0 5 0 5 0 5 0 2 5 0 S tr a te g ic A ct iv it y 5 R e le a se 4 b io f o rt if ie d v a ri e ti e s b y 2 0 1 8 1 1 1 1 4 B io f o rt if ie d va ri e ti e s 3 1 0 3 1 0 3 1 0 3 1 0 3 1 0 1 ,2 4 0 S tr a te g y 5 : P ro m o te a w a re n e ss o f a n d d e m a n d f o r n u tr it io u s fo o d , w it h a n e m p h a si s o n p ro d u ct io n , p ro ce ss in g , p re se rv a ti o n , st o ra g e a n d p re p a ra ti o n o f d iv e rs e f o o d s S tr a te g ic A ct iv it y 1 D e ve lo p a n u tr it io n a n d a g ri cu lt u re b e h a v io u r ch a n g e a n d c o m m u n ic a ti o n s tr a te g y i n 2 0 1 4 . 1 1 b e h a v io u r ch a n g e co m m u n ic a ti o n st ra te g y 1 3 ,1 0 0 1 3 ,1 0 0 1 3 ,1 0 0 S tr a te g ic A ct iv it y 2 Tr a in 7 2 0 A G R IT E X o ff ic e s o n th e b e h a v io u r ch a n g e a n d co m m u n ic a ti o n s tr a te g y a n n u a ll y 7 2 0 7 2 0 7 2 0 7 2 0 7 2 0 3 ,6 0 0 Tr a in e d A G R IT E X o ff ic e rs 2 5 8 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 1 8 5 ,4 0 0 9 2 7 ,0 0 0 S tr a te g ic A ct iv it y 3 D e ve lo p 6 f o o d b a sk e ts f o r sp e ci fi c a g ro e co lo g ic a l re g io n s 1 3 2 6 Fo o d b a sk e ts 4 ,8 5 0 4 ,8 5 0 1 4 ,5 5 0 9 ,7 0 0 2 9 ,1 0 0 S tr a te g ic A ct iv it y 4 D e ve lo p Z im b a b w e a n f o o d co m p o si ti o n t a b le s 1 1 Fo o d co m p o si ti o n ta b le 6 5 0 ,0 0 0 6 5 0 ,0 0 0 6 5 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 95 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 1 Im p le m e n t th e n a ti o n a l st a p le fo o d f o rt if ic a ti o n s tr a te g y 1 N a ti o n a l S ta p le Fo o d Fo rt if ic a ti o n S tr a te g y Im p le m e n te d 3 0 ,7 2 1 ,3 5 9 7 ,7 2 8 ,1 7 2 5 ,8 0 4 ,6 7 2 5 ,7 4 2 ,1 7 2 5 ,7 2 3 ,1 7 2 5 ,7 2 3 ,1 7 2 3 0 ,7 2 1 ,3 5 9 S tr a te g ic A ct iv it y 2 C o n d u ct 2 b io f o rt if ic a ti o n e ff ic a cy s tu d ie s. 1 1 2 E ff ic a cy s tu d y re p o rt 1 7 ,1 0 0 1 7 ,1 0 0 1 7 ,1 0 0 3 4 ,2 0 0 S tr a te g ic A ct iv it y 3 M a rk e t a n d p ro m o te b io fo rt if ie d s e e d a n d c ro p s th ro u g h im p le m e n ti n g a m u lt i m e d ia m a rk e ti n g s tr a te g y e ve ry y e a r. 1 1 1 1 1 5 M e d ia P a ck a g e 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 2 5 ,0 0 0 1 2 5 ,0 0 0 G o a l 1 5 : S ca le u p e v id e n ce b a se d n u tr it io n s e n si ti v e i n te rv e n ti o n s in s o ci a l p ro te ct io n s e rv ic e s to 8 0 % c o v e ra g e b y 2 0 1 8 2 3 ,4 1 3 ,3 5 0 4 3 ,3 5 2 ,4 6 4 6 3 ,3 9 6 ,8 6 4 7 7 ,3 4 6 ,8 6 4 7 7 ,3 6 6 ,8 6 4 2 8 5 ,1 0 5 ,6 4 5 S tr a te g y 1 : P ro v is io n o f co n d it io n a l ca sh t ra n sf e rs t o n o n l a b o u r co n st ra in e d v u ln e ra b le h o u se h o ld s u n d e r th e f o o d p o ve rt y l in e t o i n cr e a se u ti li za ti o n o f h e a lt h s e rv ic e s b y p re g n a n t a n d l a ct a ti n g w o m e n a n d c h il d re n u n d e r fi ve S tr a te g ic A ct iv it y 1 S e n si ti se s ta ke h o ld e rs o n n u tr it io n s e n si ti ve c o n d it io n a l ca sh t ra n sf e rs i n 2 0 1 4 1 1 S ta ke h o ld e r m e e ti n g 4 ,0 5 0 4 ,0 5 0 4 ,0 5 0 S tr a te g ic A ct iv it y 2 R e v ie w t h e e xi st in g u n co n d it io n a l ca sh t ra n sf e r p ro g ra m m e t h ro u g h in te g ra ti n g a n u tr it io n s e n si ti ve c o n d it io n a l ca sh tr a n sf e r fo r v u ln e ra b le h o u se h o ld s b y 2 0 1 4 t a rg e ti n g 5 0 ,0 0 0 o f th e 2 5 0 ,0 0 0 h o u se h o ld s b y 2 0 1 8 1 1 U p d a te d c a sh tr a n sf e r fr a m e w o rk a n d o p e ra ti o n a l m a n u a l a n d 2 1 0 0 0 0 h o u se h o ld s w it h P re g n a n t, la ct a ti n g a n d w it h u n d e r 5 C h il d re n ta rg e te d 2 2 ,0 0 0 2 2 ,0 0 0 2 2 ,0 0 0 S tr a te g ic A ct iv it y 3 V u ln e ra b le p e o p le b e n e fi ci a ry li st c o n ti n u o u sl y u p d a te d a n d re v ie w e d t h ro u g h i d e n ti fy in g h o u se h o ld s o n t h e l is t w it h p re g n a n t a n d l a ct a ti n g w o m e n a n d h o u se h o ld s w it h c h il d re n u n d e r fi ve 1 6 2 5 2 5 2 5 2 5 1 1 6 U p t o d a te v u ln e ra b le b e n e fi ci a ry l is t 4 ,4 0 0 7 0 ,4 0 0 1 1 0 ,0 0 0 1 1 0 ,0 0 0 1 1 0 ,0 0 0 1 1 0 ,0 0 0 5 1 0 ,4 0 0 S tr a te g ic A ct iv it y 4 R e g u la r tr a in in g o f tr a in e rs a n d S e n si ti za ti o n o f d is tr ic t h e a lt h w o rk e rs i n c a sh t ra n sf e r ta rg e t a re a 1 6 2 5 2 5 2 5 2 5 1 1 6 S e n si ti ze d h e a lt h w o rk e rs a n d co m m u n it ie s 2 ,2 5 0 3 6 ,0 0 0 5 6 ,2 5 0 5 6 ,2 5 0 5 6 ,2 5 0 5 6 ,2 5 0 2 6 1 ,0 0 0 S tr a te g y 2 : P ro v id in g a c o n si st e n t a d e q u a te n u tr it io n a ll y s e n si ti ve u n co n d it io n a l so ci a l ca sh t ra n sf e r to u lt ra p o o r la b o u r co n st ra in e d h o u se h o ld s fo r th e m t o m e e t th e ir n e e d s fo r a h e a lt h y p ro d u ct iv e l if e S tr a te g ic A ct iv it y 1 S ta ke h o ld e r se n si ti za ti o n m e e ti n g G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 S tr a te g y 6 : P ro m o te a w a re n e ss a n d d e m a n d f o r fo rt if ie d s ta p le f o o d s Zimbabwe National Nutrition Strategy, 2014 -2018 96 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 2 R e v ie w t h e u n co n d it io n a l ca sh tr a n sf e r fr a m e w o rk a n d o p e ra ti n g s ys te m to i n te g ra te n u tr it io n 1 6 2 5 2 5 2 5 2 5 1 1 6 R e v ie w e d ca sh tr a n sf e r fr a m e w o rk S tr a te g ic A ct iv it y 3 D e ve lo p I E C m a te ri a l o n n u tr it io n e d u ca ti o n b y 2 0 1 4 5 0 ,0 0 0 5 0 ,0 0 0 2 0 ,0 0 0 1 2 0 ,0 0 0 P ri n te d p a m p h le ts a n d p o st e rs 1 5 0 ,0 0 0 5 0 ,0 0 0 2 0 ,0 0 0 1 2 0 ,0 0 0 S tr a te g ic A ct iv it y 4 E d u ca te b e n e fi ci a ri e s o n n u tr it io n p u rc h a si n g a n d re fe rr a ls t o n u tr it io n s u p p o rt p ro g ra m m e th ro u g h f a m il y cl u b s 1 6 2 5 2 5 2 5 2 5 1 1 6 N u tr it io n p u rc h a si n g E d u ca te d b e n e fi ci a ri e s 54 0 8 ,6 4 0 1 3 ,5 0 0 1 3 ,5 0 0 1 3 ,5 0 0 1 3 ,5 0 0 6 2 ,6 4 0 S tr a te g y 3 : E n su re t h a t n u tr it io n e d u ca ti o n a n d b e h a v io u r ch a n g e c o m m u n ic a ti o n a re i n te g ra l p a rt o f a ll s o ci a l a ss is ta n ce p ro g ra m m e s S tr a te g ic A ct iv it y 1 D e ve lo p a i n s e rv ic e t ra in in g cu rr ic u lu m f o r N u tr it io n e d u ca ti o n b e h a v io u r ch a n g e co m m u n ic a ti o n 1 1 Tr a in in g C u rr ic u lu m d e ve lo p e d 5, 6 0 0 5 ,6 0 0 5 ,6 0 0 S tr a te g ic A ct iv it y 2 Tr a in S S O s o n N u tr it io n E d u ca ti o n a n d C o u n se ll in g 1 1 5 1 ,6 8 0 5 1 ,6 8 0 5 1 ,6 8 0 S tr a te g ic A ct iv it y 3 S u p p o rt a n d s u p e rv is io n A ct iv it ie s 1 1 1 1 4 S u p p o rt v is it s 3 1 ,3 3 0 3 1 ,3 3 0 3 1 ,3 3 0 3 1 ,3 3 0 3 1 ,3 3 0 1 2 5 ,3 2 0 S tr a te g y 4 : E m p o w e r co m m u n it ie s th ro u g h p ro d u ct iv e a ss e t cr e a ti o n a n d i n fo rm a ti o n t o b u il d a c u lt u re o f sa fe ty a n d r e si li e n ce t o d is a st e rs S tr a te g ic A ct iv it y 1 S e n si ti se 3 0 k e y s ta ke h o ld e rs in cl u d in g f u n d in g p a rt n e rs o n in te g ra ti o n o f n u tr it io n i n P C W p ro g ra m m e s b y 2 0 1 4 1 1 S e n si ti se d k e y st a ke h o ld e rs 90 0 9 0 0 9 0 0 S tr a te g ic A ct iv it y 2 F in a li se a n d p ri n t th e P ro d u ct iv e C o m m u n it y w o rk s fr a m e w o rk a n d o p e ra ti o n a l m a n u a l in te g ra ti n g n u tr it io n f o r im p le m e n ta ti o n i n 2 0 1 4 1 ,0 0 0 1 ,0 0 0 P ri n te d P ro d u ct iv e co m m u n it y w o rk s fr a m e w o rk a n d o p e ra ti o n a l m a n u a l 1 0 1 0 ,0 0 0 1 0 ,0 0 0 S tr a te g ic A ct iv it y 3 La u n ch t h e p o li cy a t n a ti o n a l le ve l a n d i n v it e a ll s ta ke h o ld e rs 1 1 P o li cy l a u n ch e d 3 ,0 0 0 3 ,0 0 0 3 ,0 0 0 S tr a te g ic A ct iv it y 4 S ca le u p i m p le m e n ta ti o n o f P C W p ro g ra m m e 1 0 0 ,0 0 0 2 0 0 ,0 0 0 3 0 0 ,0 0 0 3 7 0 ,0 0 0 3 7 0 ,0 0 0 1, 3 4 0 ,0 0 0 H o u se h o ld s b e n e fi t fr o m P u b li c W o rk s p ro g ra m m e 2 0 0 2 0 ,0 0 0 ,0 0 0 4 0 ,0 0 0 ,0 0 0 6 0 ,0 0 0 ,0 0 0 7 4 ,0 0 0 ,0 0 0 7 4 ,0 0 0 ,0 0 0 2 6 8 ,0 0 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 97 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 1 S e t u p a n d c a p a ci ta te co o rd in a ti o n m e ch a n is m s fo r n u tr it io n s e n si ti ve D R M a t a ll le ve ls b y Q 3 ,2 0 1 4 1 1 C o o rd in a ti o n m e ch a n is m f o r n u tr it io n se n si ti ve D R M e st a b li sh e d a n d ca p a ci ta te d 2 4 ,0 7 5 2 4 ,0 7 5 2 4 ,0 7 5 S tr a te g ic A ct iv it y 2 D e ve lo p ri sk p ro fi le i n cl u d in g a n a ss e ss m e n t o f th e n u tr it io n im p a ct s o f d is a st e rs , u n d e rl y in g ca u se s a n d p ro g ra m m in g o p ti o n s b y Q 3 , 2 0 1 4 1 1 R is k p ro fi le o n n u tr it io n se n si ti ve D R M d e ve lo p e d 1 3 ,0 8 0 1 3 ,0 8 0 1 3 ,0 8 0 S tr a te g ic A ct iv it y 3 C o n d u ct a y e a rl y r e g u la r ri sk a n d v u ln e ra b il it y a ss e ss m e n ts , co ll a ti n g a n d d is se m in a ti n g cl im a te r e la te d i n fo rm a ti o n a n d co o rd in a ti n g m it ig a ti o n a ct io n s a cr o ss a r a n g e o f se ct o rs f ro m 2 0 1 5 t o 2 0 1 8 1 1 1 1 4 A n n u a l ri sk a n d v u ln e ra b il it ya ss e ss m e n t re p o rt 1 ,2 0 0 1 ,2 0 0 1 ,2 0 0 S tr a te g ic A ct iv it y 4 S u p p o rt t o p 5 s e ct o r m in is tr ie s to i n te rg ra te D R M i n to t h e ir p o li ci e s, s tr a te g ie s a n d p ro g ra m m e s b y 2 0 1 8 2 3 5 se ct o rs t h a t h a ve su cc e ss fu ll y in te g ra te d n u tr it io n se n si ti ve D R M , 2 2 9 ,2 4 0 S tr a te g ic A ct iv it y 5 M o n it o r a n d e va lu a te t h e D R M n u tr it io n s e n si ti ve m a in st re a m in g p ro ce ss a n d o u tc o m e s 4 4 4 4 1 6 Q u a rt e rl y m o n it o ri n g re p o rt s 1 3 ,8 8 6 5 5 ,5 4 4 5 5 ,5 4 4 5 5 ,5 4 4 5 5 ,5 4 4 2 2 2 ,1 7 5 S tr a te g y 6 : In te g ra te n u tr it io n i n d ic a to rs i n to t a rg e ti n g , m o n it o ri n g a n d e va lu a ti o n s ys te m s fo r so ci a l p ro te ct io n p ro g ra m m e s S tr a te g ic A ct iv it y 1 D e ve lo p , a n M a n d E f ra m e w o rk fo r a ll s o ci a l ca sh t ra n sf e r p ro g ra m m e s w h ic h i n te g ra te s n u tr it io n in d ic a to rs f ro m Q 2 t o Q 3 1 1 D e ve lo p e d M & E F ra m e w o rk 1 1 ,2 6 0 1 1 ,2 6 0 1 1 ,2 6 0 S tr a te g ic A ct iv it y 2 Tr a in 1 0 S S O s a n n u a ll y o n u se o f a n d i n te rp re ta ti o n o f M a n d E d u ri n g Q 3 1 0 1 0 1 0 1 0 1 0 5 0 M & E T ra in e d S S O s 5 1 ,6 8 0 5 1 6 ,8 0 0 5 1 6 ,8 0 0 5 1 6 ,8 0 0 5 1 6 ,8 0 0 5 1 6 ,8 0 0 2 ,5 8 4 ,0 0 0 S tr a te g ic A ct iv it y 3 Im p le m e n t th e M a n d E fr a m e w o rk q u a rt e rl y , e ve ry 4 th Q u a rt e r 1 1 1 1 1 5 M & E R e p o rt 1 0 ,8 0 0 1 0 ,8 0 0 1 0 ,8 0 0 1 0 ,8 0 0 1 0 ,8 0 0 1 0 ,8 0 0 5 4 ,0 0 0 S tr a te g ic A ct iv it y 4 R e v ie w b e n e fi ci a ry r e g is te r fo r so ci a l p ro te ct io n th ro u g h in cl u d in g n u tr it io n a l in d ic a to rs in t a rg e ti n g 1 1 1 1 1 5 R e v ie w e d b e n e fi ci a ry R e g is te r w it h N u tr it io n In d ic a to rs in cl u d e d . 2 ,6 4 0 2 ,6 4 0 2 ,6 4 0 2 ,6 4 0 2 ,6 4 0 2 ,6 4 0 1 3 ,2 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 S tr a te g y 5 : In te g ra te n u tr it io n s e n si ti ve D R M i n to s e ct o r p ro g ra m m e s a n d b u d g e ts ( su p p o rt iv e p o li cy , le g a l a n d i n st it u ti o n a l fr a m e w o rk s fo r D R M ; e a rl y w a rn in g i n fo rm a t io n , so ci a l b e h a v io u r ch a n g e t o w a rd s a c u lt u re o f sa fe ty a n d r e si li e n ce ; in te g ra ti n g D R M i n to se ct o r p ro g ra m m e s; a n d D R M c a p a ci ty b u il d in g a t a ll l e ve ls ) Zimbabwe National Nutrition Strategy, 2014 -2018 98 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response St ra te g ic A ct iv it y 1 D e ve lo p a n u tr it io n a l s e n si ti ve e m e rg e n cy p re p a re d n e ss p la n a n d g u id e lin e s fo r so ci a l s a fe ty n e ts p ro g ra m m e s 1 1 E m e rg e n cy P re p a re d n e ss p la n P ro d u ce d 1 0 ,1 0 0 1 0 ,1 0 0 1 0 ,1 0 0 St ra te g ic A ct iv it y 2 P ro vi d e e m e rg e n cy r e lie f th a t m e e ts t h e s p h e re s ta n d a rd s 1 0 ,0 0 0 1 0 ,0 0 0 1 0 ,0 0 0 1 0 ,0 0 0 1 0 ,0 0 0 5 0 ,0 0 0 N u m b e r o f a ss is te d H o u se h o ld s p e r ye a r 2 5 5 2, 5 5 0 ,0 0 0 2 ,5 5 0 ,0 0 0 2 ,5 5 0 ,0 0 0 2 ,5 5 0 ,0 0 0 2 ,5 5 0 ,0 0 0 1 2 ,7 5 0 ,0 0 0 St ra te g ic A ct iv it y 3 Tr a in d is tr ic t fo o d a n d n u tr it io n se cu ri ty c o m m it te e s in d is a st e r re sp o n se 1 5 1 5 1 ,1 1 5 16 ,7 2 5 1 6 ,7 2 5 G o a l 1 6 : A t le a st 5 0 % o f co m m u n it y b a se d h e a lt h w o rk e rs p ro m o te W A S H r e la te d b e h a v io u r ch a n ge w h il st i n te g ra ti n g n u tr it io n m e ss a g in g b y 2 0 1 8 5 9 ,8 7 5 1 6 3 ,4 5 0 2 2 3 ,3 2 5 St ra te g y 1 : C a p a ci ta te W A SH c o m m it te e s a t a ll le ve ls o n n u tr it io n a n d W A SH li n ka g e s St ra te g ic A ct iv it y 1 D e ve lo p a s ta n d a rd W A SH a n d N u tr it io n S e n si ti sa ti o n G u id e li n e fo r a d v o ca cy b y Q 2 2 0 1 4 1 1 St a n d a rd W a sh a n d N u tr it io n Se n si ti sa ti o n G u id e lin e p ro d u ce d 2 2 ,0 0 0 2 2 ,0 0 0 2 2 ,0 0 0 St ra te g ic A ct iv it y 2 P ri n t a n d d is tr ib u te 1 0 0 0 c o p ie s o f th e s ta n d a rd W A SH a n d N u tr it io n S e n si ti sa ti o n G u id e lin e b y Q 3 2 0 1 5 1 ,0 0 0 1 ,0 0 0 1 0 0 0 c o p ie s o f g u id e lin e p ri n te d a n d d is tr ib u te d 1 5 1 5 ,0 0 0 1 5 ,0 0 0 St ra te g ic A ct iv it y 3 C o n d u ct N u tr it io n S e n si ti sa ti o n M e e ti n g s fo r th e N a ti o n a l W A SH C o m m it te e o n t h e n e w G u id e lin e a n d r e vi e w e d P H H E to o l b y Q 4 2 0 1 4 1 1 1 N a ti o n a l W A SH Se n si ti sa ti o n M e e ti n g co n d u ct e d 8 ,5 0 0 8, 5 0 0 8 ,5 0 0 St ra te g ic A ct iv it y 4 C o n d u ct N u tr it io n S e n si ti sa ti o n M e e ti n g f o r 1 0 P ro vi n ci a l W A SH C o m m it te e s o n t h e n e w G u id e lin e a n d r e vi e w e d P H H E to o l b y Q 1 2 0 1 5 5 5 1 0 1 0 P ro vi n ci a l W A SH C o m m it te e m e e ti n g s co n d u ct e d 2 ,8 7 5 14 ,3 7 5 1 4 ,3 7 5 2 8 ,7 5 0 St ra te g ic A ct iv it y 5 C o n d u ct N u tr it io n S e n si ti sa ti o n M e e ti n g f o r 6 0 D is tr ic t W A SH C o m m it te e s (R u ra l) a n d 2 9 U rb a n W A SH C o m m it te e s o n th e n e w G u id e lin e a n d r e vi e w e d P H H E t o o l b y Q 4 2 0 1 5 8 9 8 9 8 9 D is tr ic t W A SH Se n si ti sa ti o n M e e ti n g s co n d u ct e d 1 ,6 7 5 1 4 9 ,0 7 5 1 4 9 ,0 7 5 St ra te g y 2 : In te g ra te n u tr it io n in to P H H E d e liv e re d t h ro u g h t h e c o m m u n it y h e a lt h c lu b a p p ro a ch St ra te g ic A ct iv it y 1 R e vi e w e xi st in g P H H E t o o l k it t o in cl u d e n u tr it io n b y Q 3 2 0 1 4 1 1 1 R e vi se d P H H E To o l K it 2 2 ,0 0 0 2 2 ,0 0 0 2 2 ,0 0 0 St ra te g ic A ct iv it y 2 P ri n ti n g a n d d is tr ib u ti o n o f 2 0 0 0 co p ie s o f th e r e vi e w e d P H H E to o l k it b y Q 4 2 0 1 4 2 ,0 0 0 2 ,0 0 0 2 0 0 0 p ri n te d a n d d is tr ib u te d re vi se d P H H E to o l k it s 3 0 6 0 ,0 0 0 6 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 S tr a te g y 7 : P ro v is io n o f ti m e ly s o ci a l sa fe ty n e ts i n e m e rg e n ci e s a n d c ri si s si tu a ti o n s th a t m e e t u n iv e rs a ll y a cc e p te d m in im u m s ta n d a rd s a n d n a ti o n a l fo o d a n d n u tr it io n s ta n d a rd s (w h e re a p p li ca b le ) Zimbabwe National Nutrition Strategy, 2014 -2018 99 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 3 R e v iv e a t le a st 1 C o m m u n it y H e a lt h C lu b p e r H e a lt h C e n tr e ca tc h m e n t a re a i n a t le a st 9 6 0 H e a lt h F a ci li ti e s b y 2 0 1 8 2 0 0 2 0 0 3 0 0 3 0 0 1 ,0 0 0 1 0 0 0 C o m m u n it y H e a lt h C lu b s re v iv e d 1 5 0 3 0 ,0 0 0 3 0 ,0 0 0 4 5 ,0 0 0 4 5 ,0 0 0 1 5 0 ,0 0 0 S tr a te g ic A ct iv it y 4 Tr a in 1 6 0 0 C o m m u n it y H e a lt h C lu b s u si n g t h e re v is e d P H H E To o l K it b y 2 0 1 8 4 0 0 4 0 0 4 0 0 4 0 0 1 ,6 0 0 1 6 0 0 C o m m u n it y H e a lt h C lu b s tr a in e d o n t h e re v is e d P H H E To o l k it 3 7 5 1 5 0 ,0 0 0 1 5 0 ,0 0 0 1 5 0 ,0 0 0 1 5 0 ,0 0 0 6 0 0 ,0 0 0 1 0 ,9 5 9 ,2 5 0 2 ,0 8 5 ,9 5 0 2 ,2 9 9 ,9 8 0 1 ,9 8 3 ,1 0 0 1 ,9 8 3 ,1 0 0 1 9 ,3 1 1 ,3 8 0 S tr a te g y 1 : A ll p o rt s o f e n tr y c a p a ci ta te d w it h p o rt h e a lt h o ff ic e rs S tr a te g ic A ct iv it y 1 A d vo ca te fo r 1 2 0 s u b st a n ti ve p o st s fo r P o rt H e a lt h O ff ic e rs a n d T e ch n ic ia n s a t th e 3 0 D e si g n a te d P o rt s o f E n tr y b y Q 1 2 0 1 5 1 1 1 2 0 P o rt H e a lt h a n d T e ch n ic ia n s p o st s cr e a te d 3 0 0 3 0 0 3 0 0 S tr a te g ic A ct iv it y 2 A p p o in tm e n t a n d r e cr u it m e n t o f 1 2 0 P o rt H e a lt h O ff ic e rs a n d Te ch n ic ia n s a t D e si g n a te d P o rt s o f E n tr y b y D e c 2 0 1 6 1 0 0 2 0 1 2 0 1 2 0 P o rt H e a lt h a n d T e ch n ic ia n s p o st s fi ll e d 1 0 0 1 0 ,0 0 0 2 ,0 0 0 1 2 ,0 0 0 S tr a te g ic A ct iv it y 3 M o n th ly p a y m e n t o f sa la ri e s fo r th e P o rt H e a lt h O ff ic e rs 1 0 0 1 2 0 1 2 0 1 2 0 1 2 0 P o rt H e a lt h O ff ic e rs p a id o n a m o n th ly b a si s 4 0 0 4 0 ,0 0 0 4 8 ,0 0 0 4 8 ,0 0 0 4 8 ,0 0 0 1 8 4 ,0 0 0 S tr a te g ic A ct iv it y 4 In se rv ic e / R e fr e sh e r tr a in in g o f 1 2 0 P o rt H e a lt h P ra ct it io n e rs o n fo o d s a fe ty O n g o in g 1 0 0 2 0 3 0 3 0 1 8 0 1 8 0 P o rt H e a lt h P ra ct it io n e rs tr a in e d o n F o o d S a fe ty 6 8 0 6 8 ,0 0 0 1 3 ,6 0 0 2 0 ,4 0 0 2 0 ,4 0 0 1 2 2 ,4 0 0 S tr a te g ic A ct iv it y 5 M o n it o ri n g a n d e n fo rc e m e n t o f P o rt H e a lt h L a w s a n d R e g u la ti o n s O n g o in g 3 0 3 0 3 0 3 0 1 2 0 P o rt H e a lt h La w s a n d R e g u la ti o n s e n fo rc e d a n d m o n it o re d 1 ,2 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 3 6 ,0 0 0 1 4 4 ,0 0 0 S tr a te g y 2 : H a rm o n is a ti o n o f re g u la ti o n s re la te d t o i m p o rt a ti o n o f fo o d s a m o n g Z IM R A , M O H C C , M A M ID ( ve te ri n a ri a n s) a n d S A Z t o m e e t In te rn a ti o n a l S ta n d a rd s S tr a te g ic A ct iv it y 1 Id e n ti fy re le va n t re g u la ti o n s re la te d t o i m p o rt e d f o o d co m m o d it ie s to b e h a rm o n iz e d w it h o th e r re le va n t se ct o r m in is tr ie s b y Q 4 2 0 1 4 1 1 R e le va n t re g u la ti o n s id e n ti fi e d a n d h a rm o n is e d 4 8 ,0 0 0 4 8 ,0 0 0 4 8 ,0 0 0 S tr a te g ic A ct iv it y 2 U p d a ti n g o f re le va n t re g u la ti o n s re la te d t o i m p o rt e d f o o d co m m o d it ie s to b e h a rm o n iz e d w it h o th e r re le va n t se ct o r m in is tr ie s b y Q 3 2 0 1 5 1 3 4 R e le va n t re g u la ti o n s u p d a te d a n d h a rm o n is e d 1 7 ,2 5 0 1 7 ,2 5 0 5 1 ,7 5 0 6 9 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 100 G o a l 1 7 : B y 2 0 1 8 e n su re t h a t a t le a st 5 0 % o f im p o rt e d a n d l o ca ll y p ro d u ce d f o o d s a re e v a lu a te d f o r sa fe ty Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response S tr a te g ic A ct iv it y 3 E n fo rc e m e n t o f re le va n t re g u la ti o n s re la te d t o i m p o rt e d fo o d c o m m o d it ie s to b e h a rm o n iz e d w it h o th e r re le va n t se ct o r m in is tr ie s O n g o in g 8 9 8 9 8 9 8 9 3 5 6 R e le va n t re g u la ti o n s e n fo rc e d 1 0 ,8 0 0 9 6 1 ,2 0 0 9 6 1 ,2 0 0 9 6 1 ,2 0 0 9 6 1 ,2 0 0 3 ,8 4 4 ,8 0 0 S tr a te g y 3 : P ro v id e l o w c o st f o o d s a fe ty r a p id t e st k it s u se d a t p o rt s o f e n tr y a n d m a rk e t p la ce s S tr a te g ic A ct iv it y 1 C o n d u ct S it u a ti o n a l A ss e ss m e n t o f re le va n t u se fu l ra p id f o o d sa fe ty t e st in g k it s to b e u se d a t p o rt s o f e n tr y a n d i n la n d b y Q 3 2 0 1 4 1 1 1 S it u a ti o n a l A ss e ss m e n t co n d u ct e d 2 0 0 2 0 0 2 0 0 S tr a te g ic A ct iv it y 2 P ro cu re m e n t o f re le va n t fo o d te st in g k it s O n g o in g 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 2 0 0 ,0 0 0 Fo o d t e st in g k it s p ro cu re d 2 0 8 0 0 ,0 0 0 8 0 0 ,0 0 0 8 0 0 ,0 0 0 8 0 0 ,0 0 0 8 0 0 ,0 0 0 4 ,0 0 0 ,0 0 0 S tr a te g ic A ct iv it y 3 In se rv ic e / R e fr e sh e r tr a in in g o f 1 ,6 0 0 E n v ir o n m e n ta l H e a lt h P ra ct it io n e rs o n t h e u se o f fo o d sa fe ty r a p id t e st k it s O n g o in g 4 0 0 4 0 0 4 0 0 4 0 0 1 ,6 0 0 Tr a in in g o f E n v ir o n m e n ta l H e a lt h p ra ct it io n e rs o n th e u se o f fo o d sa fe ty r a p id t e st k it s co n d u ct e d . 2 9 0 1 1 6 ,0 0 0 1 1 6 ,0 0 0 1 1 6 ,0 0 0 1 1 6 ,0 0 0 4 6 4 ,0 0 0 S tr a te g ic A ct iv it y 4 M o n it o ri n g o f fo o d a t d e si g n a te d p o rt s o f e n tr y a n d in la n d u si n g l o w c o st f o o d sa fe ty r a p id te st k it s O n g o in g Fo o d a t d e si g n a te d p o rt s o f e n tr y a n d i n la n d m o n it o re d u si n g lo w c o st f o o d sa fe ty r a p id t e st k it s S tr a te g y 4 : C a p a ci ta te ( w it h s k il ls , e q u ip m e n t a n d s u p p li e s) e xi st in g G o ve rn m e n t A n a ly st L a b o ra to ry S tr a te g ic A ct iv it y 1 C o n d u ct a s it u a ti o n a l a ss e ss m e n t o f sk il ls , e q u ip m e n t a n d s u p p li e s a t G o ve rn m e n t A n a ly st L a b o ra to ry b y Q 2 2 0 1 4 1 1 S it u a ti o n a l a ss e ss m e n t o f sk il ls , e q u ip m e n t a n d su p p li e s co n d u ct e d 5 0 0 5 0 0 5 0 0 S tr a te g ic A ct iv it y 2 P u rc h a se m o d e rn e q u ip m e n t a n d s u p p li e s fo r a n a ly si s o f fo o d fo r sa fe ty b a se d o n t h e si tu a ti o n a l a ss e ss m e n t b y Q 4 2 0 1 4 1 1 M o d e rn e q u ip m e n t a n d su p p li e s fo r a n a ly si s o f fo o d fo r sa fe ty p u rc h a se d 1 0 ,0 0 0 ,0 0 0 1 0 ,0 0 0 ,0 0 0 1 0 ,0 0 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 101 St ra te g ic A ct iv it y 3 In s e rv ic e / R e fr e sh e r tr a in in g o f 5 0 h e a lt h w o rk e rs a t G o ve rn m e n t A n a ly st L a b o ra to ry o n u se d o f m o d e rn e q u ip m e n t in t e st in g f o o d f o r sa fe ty b y Q 2 2 0 1 5 5 0 5 0 5 0 h e a lt h w o rk e rs a n d G o ve rn m e n t A n a ly st La b o ra to ry tr a in e d o n u se o f m o d e rn e q u ip m e n t in te st in g f o r sa fe ty 3 0 1 ,5 0 0 1 ,5 0 0 St ra te g y 5 : C o n d u ct o p e ra ti o n a l r e se a rc h o n p e st ic id e r e si d u e a n d a fl at o xi n s a n d G M O s in h o u se h o ld d ie ts St ra te g ic A ct iv it y 1 P ro p o sa l d e ve lo p m e n t fo r re se a rc h o n p e st ic id e r e si d u e s a n d a fl at o xi n in h o u se h o ld d ie ts b y Q 4 2 0 1 5 1 1 1 P ro p o sa l d e ve lo p e d St ra te g ic A ct iv it y 2 Su b m is si o n o f p ro p o sa l f o r fu n d in g b y Q 1 2 0 1 6 1 1 R e se a rc h fu n d e d b y Q 1 2 0 1 6 1 0 0 1 0 0 1 0 0 St ra te g ic A ct iv it y 3 C o n d u ct R e se a rc h b y Q 4 2 0 1 6 1 1 R e se a rc h co n d u ct e d b y D e c 2 0 1 6 3 2 1 ,5 8 0 3 2 1 ,5 8 0 3 2 1 ,5 8 0 St ra te g y 6 : C a p a ci ta te t h e N a ti o n a l E n vi ro n m e n ta l H e a lt h D e p a rt m e n t to e ff e ct iv e ly im p le m e n t a n d m o n it o r a b o ve m e n ti o n e d s tr a te g ie s St ra te g ic A ct iv it y 1 P u rc h a se o f 3 p ro g ra m m e ve h ic le s to m o n it o r Fo o d S a fe ty , P o rt H e a lt h a n d W A SH a ct iv it ie s b y Q 4 2 0 1 4 3 3 3 p ro g ra m m e ve h ic le s p u rc h a se d f o r Fo o d S a fe ty , P o rt H e a lt h a n d W A SH 3 0 ,0 0 0 9 0 ,0 0 0 9 0 ,0 0 0 St ra te g ic A ct iv it y 2 P u rc h a se a n d m a in te n a n ce o f e q u ip m e n t a n d s ta ti o n e ry f o r im p le m e n ta ti o n o f st ra te g ie s O n g o in g 2 1 1 1 1 6 St a n d a rd p a ck a ge o f st a ti o n e ry a n d e q u ip m e n t p u rc h a se d a n d m a in ta in e d 1 ,5 0 0 3 ,0 0 0 1 ,5 0 0 1 ,5 0 0 1 ,5 0 0 1 ,5 0 0 9 ,0 0 0 S u b T o ta l K R A 5 S tr e n g th e n in g m u lt i se ct o ra l co o rd in a ti o n a n d c o ll a b o ra ti o n f o r in te g ra te d n u tr it io n r e sp o n se 5 3 ,3 7 3 ,1 1 7 6 2 ,5 4 5 ,2 7 1 8 8 ,4 4 2 ,2 4 1 1 0 3 ,9 9 5 ,2 7 1 9 4 ,3 1 4 ,9 9 1 4 0 2 ,7 2 2 ,8 2 9 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Key Result Area 5: Strengthening multi-sectoral coordination and collaboration for integrated nutrition response Zimbabwe National Nutrition Strategy, 2014 -2018 102 Key Result Area 6: Resource mobilization and capacity development for Nutrition G o a l 1 8 : B y 2 0 1 8 t h e n a ti o n a l n u tr it io n d e p a rt m e n t h a s a c ri ti ca l m a ss o f st a ff w it h t h e a b il it y, t o o ls , su p p o rt iv e s u p e rv is i o n a n d r e so u rc e s to in te g ra te n u tr it io n i n to o th e r se ct o rs 1 3 0 ,0 8 0 3 2 2 ,8 1 7 1 5 8 ,7 6 0 1 3 2 ,1 2 0 1 4 4 ,0 4 0 8 8 7 ,8 1 7 S tr a te g y 1 : O rg a n is a ti o n a l ca p a ci ty a ss e ss m e n t a n d e st a b li sh m e n t o f re le va n t p o st s S tr a te g ic A ct iv it y 1 C o n d u ct a n o rg a n is a ti o n a l ca p a ci ty a ss e ss m e n t in Q 4 , 2 0 1 4 1 1 O rg a n is a ti o n a l C a p a ci ty A ss e ss m e n t re p o rt 1 3 0 ,0 0 0 1 3 0 ,0 0 0 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 1 3 0 ,0 0 0 S tr a te g ic A ct iv it y 2 A d vo ca te f o r e st a b li sh m e n t o f n a ti o n a l n u tr it io n d e p a rt m e n t m a n a g e r p o st s a n d p ro v in ci a l h o sp it a l d ie ti ci a n p o st s b y Q 4 2 0 1 5 1 4 1 4 P o st s e st a b li sh e d 8 1 1 2 1 1 2 S tr a te g ic A ct iv it y 3 A d vo ca te f o r e st a b li sh m e n t o f 4 fo ca l n u tr it io n is ts p o st s in k e y l in e M in is tr ie s b y Q 2 2 0 1 5 4 4 Fo ca l N u tr it io n is ts p o st s e st a b li sh e d 8 3 2 3 2 S tr a te g ic A ct iv it y 4 A d vo ca te f o r u n fr e e zi n g o f d is tr ic t n u tr it io n is t p o st s b y Q 2 2 0 1 5 1 0 1 0 D is tr ic ts N u tr it io n is t p o st s u n fr o ze n 8 8 0 8 0 S tr a te g y 2 : R e cr u it m e n t o f st a ff t o f il l in e st a b li sh e d p o st s S tr a te g ic A ct iv it y 1 R e cr u it 1 n a ti o n a l n u tr it io n m a n a g e r p e r ye a r st a rt in g i n 2 0 1 5 1 1 1 1 4 N a ti o n a l N u tr it io n M a n a g e rs R e cr u it e d 1 2 ,0 0 0 1 2 ,0 4 0 2 4 ,0 4 0 3 6 ,0 4 0 4 8 ,0 4 0 1 2 0 ,1 6 0 S tr a te g ic A ct iv it y 2 R e cr u it 4 f o ca l n u tr it io n is ts , o n e e a ch f o r A g ri cu lt u re , S o ci a l P ro te ct io n , E d u ca ti o n a n d W o m e n a n d G e n d e r in 2 0 1 6 4 4 Fo ca l N u tr it io n is ts re cr u it e d 9 6 0 0 3 8 ,4 4 0 3 8 ,4 4 0 S tr a te g ic A ct iv it y 3 M o b il iz e 1 c o m m u n it y b a se d n u tr it io n v o lu n te e r p e r v il la g e f o r 7 0 % o f w a rd s b y 2 0 1 5 8 1 9 0 8 1 9 0 C o m m u n it y B a se d N u tr it io n V o lu n te e rs re cr u it e d 2 9 2 3 4 ,0 4 8 2 3 4 ,0 4 8 S tr a te g ic A ct iv it y 4 R e cr u it 1 0 d is tr ic t n u tr it io n is ts t o fi ll v a ca n t p o st s b y 2 0 1 5 1 0 1 0 D is tr ic t N u tr it io n is ts re cr u it e d 9 6 0 0 9 6 ,1 6 0 9 6 ,0 0 0 9 6 ,0 0 0 2 8 8 ,1 6 0 S tr a te g ic A ct iv it y 5 R e cr u it 1 0 p ro v in ci a l h o sp it a l d ie ti ci a n s b y 2 0 1 7 2 3 3 2 1 0 P ro v in ci a l H o sp it a l D ie ti ci a n s re cr u it e d 4 0 8 0 1 2 0 1 2 0 8 0 4 0 0 Zimbabwe National Nutrition Strategy, 2014 -2018 103 St ra te g ic A ct iv it y 1 P ro vi d e o n t h e j o b t ra in in g o n t h e g o ve rn m e n t re su lt s b a se d m a n a g e m e n t a n d r e p o rt in g s ys te m ta rg e ti n g 7 0 n u tr it io n is ts a n d 1 0 H Q s ta ff f ro m t h e N a ti o n a l N u tr it io n D e p a rt m e n t in Q 1 2 0 1 5 8 0 8 0 N u tr it io n is ts a n d N a ti o n a l N u tr it io n D e p a rt m e n t St a ff tr a in e d o n R B M 1 1 2 8 ,9 2 5 8 ,9 2 5 St ra te g ic A ct iv it y 2 P ro vi d e o n t h e j o b t ra in in g o n st a n d a rd r e p o rt in g f o rm a t fo r th e n u tr it io n d e p a rt m e n t, t a rg e ti n g 7 0 n u tr it io n is ts in Q 1 , 2 0 1 5 7 0 7 0 N u tr it io n is ts tr a in e d o n t h e st a n d a rd r e p o rt fo rm a t 3 0 7 2 1 ,5 1 0 2 1 ,5 1 0 St ra te g ic A ct iv it y 3 P ro vi d e o n t h e j o b t ra in in g t o 7 0 n u tr it io n is ts a n d 1 0 H Q s ta ff o n t h e Fi n a n ci a l T ra ck in g T o o l f o r N u tr it io n , in Q 2 2 0 1 5 8 0 8 0 N u tr it io n is ts a n d N a ti o n a l N u tr it io n D e p a rt m e n t St a ff tr a in e d o n t h e fi n a n ci a l T ra ck in g to o l f o r N u tr it io n 3 4 4 2 7 ,5 1 3 2 7 ,5 1 3 St ra te g ic A ct iv it y 4 P ro vi d e o n t h e j o b r e se a rc h a n d d a ta m a n a g e m e n t tr a in in g f o r 7 0 n u tr it io n is ts d u ri n g Q 3 , 2 0 1 5 6 0 7 0 N u tr it io n is t tr a in e d o n re se a rc h a n d d a ta m a n a g e m e n t 3 0 7 1 8 ,4 3 7 1 8 ,4 3 7 G o a l 1 9 : To i n cr e a se r e so u rc e a ll o ca ti o n t o n u tr it io n t o 1 % o f G D P b y 2 0 1 8 . (T o b e d is cu ss e d f u rt h e r a ft e r co st in g ) 6 3 3 ,6 5 0 1 ,2 5 4 ,2 5 4 7 4 9 ,1 8 0 8 2 ,9 0 0 8 2 ,9 0 0 2 ,8 0 2 ,8 8 4 St ra te g y 1 : St re n gt h e n a d vo ca cy w it h M in is tr y o f Fi n a n ce o n t h e in ve st m e n t ca se f o r n u tr it io n ( a d vo ca cy p a p e r o n c o st o f h u n g e r in r e la ti o n t o e co n o m ic g ro w th , h u m a n c a p it a l d e ve lo p m e n t) St ra te g ic A ct iv it y 1 C a rr y o u t a n a ss e ss m e n t o n t h e co st o f h u n g e r in Z im b a b w e in 2 0 1 4 1 1 C o st o f h u n g e r re p o rt 1 2 0 ,0 0 0 1 2 0 ,0 0 0 1 2 0 ,0 0 0 St ra te g ic A ct iv it y 2 N a ti o n a l s ta ke h o ld e r co n fe re n ce o n t h e b e n e fi ts o f in ve st in g in n u tr it io n a n d la u n ch o f SU N M o ve m e n t in Z im b a b w e 1 1 SU N M o ve m e n t la u n ch e d 5 3 9 0 0 5 3 ,9 0 0 5 3 ,9 0 0 St ra te g ic A ct iv it y 3 D e ve lo p a T ra ck in g T o o l f o r M o n it o ri n g R e so u rc e s A llo ca te d t o N u tr it io n 1 N u tr it io n R e so u rc e T ra ck in g To o l 1 0 1 0 0 1 0 ,1 0 0 1 0 ,1 0 0 St ra te g ic A ct iv it y 4 O ri e n ta ti o n o f p e rm a n e n t se cr e ta ri e s fo r th e 1 7 k e y m in is tr ie s co ve re d b y th e N N S th ro u g h t h e W o rk in g P a rt y o f P e rm a n e n t Se cr e ta ri e s o n b u d g e ti n g f o r n u tr it io n 1 7 1 7 P e rm a n e n t Se cr e ta ri e s o ri e n te d o n b u d g e ti n g f o r n u tr it io n 1 0 8 5 1 8 ,4 5 0 1 8 ,4 5 0 Key Result Area 6: Resource mobilization and capacity development for Nutrition G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 S tr a te g y 3 : O n t h e j o b c a p a ci ty d e ve lo p m e n t Zimbabwe National Nutrition Strategy, 2014 -2018 104 S tr a te g ic A ct iv it y 5 O ri e n ta ti o n o f b u d g e t o ff ic e rs f o r th e k e y m in is tr ie s co ve re d b y t h e N N S o n b u d g e ti n g f o r n u tr it io n 3 4 3 4 B u d g e t O ff ic e rs o ri e n te d o n b u d g e ti n g f o r n u tr it io n 4 6 8 1 5 ,9 0 0 1 5 ,9 0 0 S tr a te g ic A ct iv it y 6 S e n si ti ze F o o d a n d N u tr it io n S e cu ri ty C o m m it te e s o n t h e N N S a n d h o w t o b u d g e t fo r n u tr it io n a n d k e e p t ra ck o f re so u rc e s a ll o ca te d t o n u tr it io n 5 7 6 5 7 6 F N S C m e m b e rs o ri e n te d o n b u d g e ti n g f o r n u tr it io n 2 0 2 1 1 6 ,4 1 4 1 1 6 ,4 1 4 S tr a te g ic A ct iv it y 7 E st a b li sh F o o d a n d N u tr it io n S e cu ri ty C o m m it te e s in 7 0 % o f ru ra l a n d u rb a n w a rd s in e a ch d is tr ic t a n d p ro v id e o ri e n ta ti o n o n a d vo ca cy f o r re so u rc e a ll o ca ti o n th ro u g h e le ct e d p o li ti ca l re p re se n ta ti ve s a t co n st it u e n cy le ve l 4 5 5 4 5 5 4 5 5 13 6 5 Fo o d a n d N u tr it io n S e cu ri ty C o m m it te e s E st a b li sh e d a n d O ri e n ta te d o n A d vo ca cy 36 3 1 6 5 ,3 0 0 1 6 5 ,3 0 0 1 6 5 ,3 0 0 4 9 5 ,9 0 0 S tr a te g y 2 : P ro m o te P P P i n s u p p o rt o f n u tr it io n t h ro u g h a s tr a te g ic p a rt n e rs h ip w it h r e le va n t o rg a n iz a ti o n s (s u ch a s G A IN ) S tr a te g ic A ct iv it y 1 C a rr yo u t a l a n d sc a p e a n a ly si s o f th e m a rk e tp la ce f o r n u tr it io n i n 2 0 1 4 t o : a ) a n a ly ze t h e n u tr it io n b u rd e n ; b ) d e fi n e t a rg e t g ro u p s in u rb a n a n d r u ra l a re a s; c ) id e n ti fy tr e n d s, g a p s a n d o p p o rt u n it ie s in lo ca l fo o d p ro d u ct io n , fo o d p ro ce ss in g a n d c o n su m p ti o n ; a n d d ) id e n ti fy i n ve st m e n t o p p o rt u n it ie s a n d 1 b u si n e ss p a rt n e r p e r p ro v in ce w it h p o te n ti a l fo r P P P b y Q 4 , 2 0 1 4 1 1 La n d sc a p e a n a ly si s o f m a rk e tp la ce fo r n u tr it io n r e p o rt 2 5 0 0 0 0 2 5 0 ,0 0 0 2 5 0 ,0 0 0 S tr a te g ic A ct iv it y 2 S u p p o rt f o rm a ti o n a n d f u n ct io n in g o f 1 M a rk e tp la ce f o r N u tr it io n p la tf o rm a t n a ti o n a l le ve l a n d o n e e a ch a t p ro v in ci a l le ve l fo r k n o w le d g e , n e tw o rk in g a n d fi n a n ci n g o f n u tr it io n r e la te d in ve st m e n t in Q 1 , 2 0 1 5 4 4 4 4 2 2 2 2 1 3 2 M a rk e tp la ce f o r n u tr it io n p la tf o rm in fo rm a ti o n sh a ri n g a n d n e tw o rk in g m e e ti n g s h e ld 1 9 5 0 8 5 ,8 0 0 8 5 ,8 0 0 4 2 ,9 0 0 4 2 ,9 0 0 2 5 7 ,4 0 0 S tr a te g ic A ct iv it y 3 D e ve lo p a s tr a te g y f o r b u si n e ss l e d a ct io n t o s tr e n g th e n f o o d v a lu e ch a in t o i n cr e a se m a rk e tp la ce a va il a b il it y o f n u tr ie n t d e n se f o o d s a n d d ie ta ry d iv e rs it y i n t a rg e t p o p u la ti o n s b y Q 3 , 2 0 1 5 1 1 A s tr a te g y f o r b u si n e ss le d a ct io n d e ve lo p e d 1 7 8 9 0 1 7 ,8 9 0 1 7 ,8 9 0 Key Result Area 6: Resource mobilization and capacity development for Nutrition G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 105 Key Result Area 6: Resource mobilization and capacity development for Nutrition St ra te g ic A ct iv it y 4 P ro vi d e t e ch n ic a l s u p p o rt t o 1 2 b u si n e ss p a rt n e rs t o d e ve lo p se lla b le b u si n e ss p la n s to p ro d u ce a n d s u p p ly t h e m a rk e t w it h t h e p ri o ri ti ze d n u tr it io u s fo o d s b y Q 4 2 0 1 5 1 2 1 2 1 2 b u si n e ss p a rt n e rs h av e se lla b le b u si n e ss p la n s 4 3 0 0 5 1 ,6 0 0 5 1 ,6 0 0 St ra te g ic A ct iv it y 5 Li n k 1 2 b u si n e ss p a rt n e rs t o p o te n ti a l p ro vi d e rs o f fi n a n ce t o fi n a n ce m a rk e tp la ce n u tr it io n b u si n e ss p la n s in p a rt n e rs h ip w it h G A IN b y Q 1 2 0 1 6 8 4 1 2 1 2 b u si n e ss p a rt n e rs w it h fi n a n ce d m a rk e tp la ce n u tr it io n b u si n e ss p la n s 1 0 0 ,0 0 0 8 0 0 ,0 0 0 4 0 0 ,0 0 0 1 ,2 0 0 ,0 0 0 St ra te g ic A ct iv it y 6 C a p a ci ta te 3 b u si n e ss p a rt n e rs t o lo ca lly p ro d u ce r e a d y t o u se th e ra p e u ti c fo o d s fo r IM A M p ro g ra m m e u si n g lo ca lly a va ila b le fo o d p ro d u ct s b y Q 3 2 0 1 6 3 3 3 b u si n e ss p a rt n e rs ca p a ci ta te d t o p ro d u ce R U T F 1 9 3 6 0 5 8 ,0 8 0 5 8 ,0 8 0 St ra te g ic A ct iv it y 7 D e ve lo p b y Q 4 2 0 1 5 a M a rk e tp la ce N u tr it io n m u tu a l b u si n e ss a cc o u n ta b ili ty f ra m e w o rk (M B A F) 1 1 M a rk e tp la ce N u tr it io n m u tu a l b u si n e ss a cc o u n ta b ili ty fr a m e w o rk (M B A F ) d e ve lo p e d 1 7 2 5 0 1 7 ,2 5 0 1 7 ,2 5 0 St ra te g ic A ct iv it y 8 Im p le m e n t a M a rk e tp la ce N u tr it io n M u tu a l B u si n e ss A cc o u n ta b ili ty Fr a m e w o rk ( q u a rt e rl y re vi e w o f p ro g re ss ) 4 4 4 1 2 Jo in t q u a rt e rl y re vi e w r e p o rt s w it h a g re e d a ct io n p o in ts f o r p a rt n e rs 1 0 0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 4 0 ,0 0 0 1 2 0 ,0 0 0 S u b T o ta l K R A 6 R e so u rc e M o b il is a ti o n a n d c a p a ci ty d e ve lo p m e n t fo r N u tr it io n 7 6 3 ,7 3 0 1 ,5 7 7 ,0 7 1 9 0 7 ,9 4 0 2 1 5 ,0 2 0 2 2 6 ,9 4 0 3 ,6 9 0 ,7 0 1 G o a ls a n d S tr a te g ie s S tr a te g ic A ct iv it ie s A n n u a l O u tp u t Ta rg e ts To ta l o u tp u ts D e sc ri p ti o n o f O u tp u t C o st p e r u n it o f o u tp u t, U S D C o st p e r y e a r, U S D To ta l C o st , U S D 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 Zimbabwe National Nutrition Strategy, 2014 -2018 106