Workshop on financial tracking Abidjan, April Conclusions and recommendations

Re-cap Analysis focused on national Government budgets publically available. But allocations not relevant enough in some countries. Would rather use the expenditures Some countries wanted to link investments to impact and results but difficulties to do it Did not include off-budget donor, NGO, multilateral and private funding, even if budget for nutrition at National Level is very low and some countries would find useful to have access to decentralized budgets and other partners’ budgets 7 countries did presentations on the results from the 3-step approach and 1 (Côte d’Ivoire) presented both the 3-step approach and the national health account methodology In national budgets, difficult to identify the nutrition specific interventions as per the Lancet – which partially explain the low percentage of nutrition specific interventions in some countries Contribution of the Agricultural and Health sectors very high in most of the countries 10 countries out of 11 did the weighting exercise but was challenging for both nutrition- specific and nutrition-sensitive interventions and highly varied – no standardized approach between countries. Asked for further guidance to refine it. Some decisions linked to the categorization and weighting were very political and depended a lot of the context in each of the countries Using key words was sometimes simplistic and didn’t allow to identify all the relevant interventions The results of this exercise should be as accurate as possible for best use with advocacy.

Conclusions On nutrition-specific: Consensus to use the Lancet recommendations to define ‘nutrition-specific’ interventions but they are not exhaustive: – Consensus on the need to add : overweight management; HIV management; adolescent nutrition (if it has a nutritional objective as fighting anemia); folic acid and iron supplementation (difficult to find as such because included in the micronutrients package); bio-fortification; – No consensus on : promotion of growth monitoring (mix of nutrition- sensitive and nutrition-specific interventions); Importance of the continuum of care targeting the 1000-days and women in reproductive age, especially adolescent girls. Need more clarity on how to include budgeted costs for Human Resources, Governance for nutrition, Nutrition as such, Gender and Natural Resources

Conclusions On nutrition-sensitive Contribution of the Agricultural and Health sectors very high in most of the countries But “judgement calls” required on which programmes/interventions to include agreed upon criteria on nutrition sensitivity: clarity on the targeted populations; on the expected nutrition outcomes; improvement of governance at community level; contribution to nutritional education For Agriculture sector, criteria as food safety, food availability, diversification are crucial Importance of priorisation and causal analysis to decide if the program is nutrition-sensitive or not Need for clearer, standard definitions, criteria and norms

Conclusions On weighting: Weights assigned for similar interventions varied widely between countries Need for clearer, standard definitions, criteria and norms (at least in similar nutritional situations) 25% is too high in some cases Need to obtain sufficient information about programs in order to determine which components are nutrition-sensitive

Recommendations Systematization and replication of the exercise over the years Gaps identification between allocations and expenditures and between budgetisation and budget available > do the link with multisectoral plans Cost- effectiveness of spending Support to use the exercice on Financial tracking for advocating at national level (in parallel with global level) Obtain more guidance on evidences already existing on nutrition-sensitive interventions Accompanying SUN countries individually to take this exercise forward

Next steps Global Nutrition Report will feature these initial efforts to estimate nutrition-relevant budgets, reflecting nutrition-specific and nutrition-sensitive Conduct a peer-review process and/or independent expert review of country budget analyses towards greater harmonization of criteria/definitions: bottom-up development of guidance based on identified patterns