The Maximising the Quality of Scaling up Nutrition Programmes Framework (MQSUN) is a DFID-funded consortium of partners, led by PATH, collaborating to scale up DFID nutrition programs globally. MQSUN is a four year project spanning from February 2011 through February 2015 MQSUN aims to provide DFID with technical services to improve the quality of nutrition-specific and nutrition- sensitive programmes. DFID has 17 priority countries including: *Bangladesh, Myanmar, Ethiopia, India, Kenya, Malawi, Mozambique, Nepal, Nigeria, Pakistan, Somalia, Sudan, Tanzania, Uganda, Yemen, Zambia, Zimbabwe About MQSUN Aim of the study should be clearly written. Where possible summarise using bullet points. Do not cut and paste long paragraphs from documents/ trips reports. These are often too long and wordy for presentation formats.

Our Partners Aga Khan University Agribusiness Systems International ICF International Institute for Development Studies International Food Policy Research Institute Health Partners International, Inc. PATH Save the Children UK Outline the key methodology used for the study eg field trips, questionnaires, interviews etcs Who did you work with? How many people? Keep to bullet points or two short paragraphs where possible

MQSUN Calldown Activities Nutrition Audits Business Cases Knowledge Management & Dissemination Operations Research Impact Evaluations Governance and Political Economy Analysis Capacity Building Costing and Financial Tracking Outline the key methodology used for the study eg field trips, questionnaires, interviews etcs Who did you work with? How many people? Keep to bullet points or two short paragraphs where possible

Supporting SUN Secretariat – History MQSUN core activity Review of National Nutrition Plans of 17 DFID* priority countries Checklist tool for reviewing the National Nutrition Plans Summary document of the review for 17 countries Partners: HPI and PATH Phase I – Supporting Movement of Scaling Up Nutrition What would it cost to scale up nutrition working with SUN countries and networks Development of costing tool – for standardizing the costing of national plans for scaling up nutrition 16 costed plans reviewed Results presented in the Brussels SUN meeting (March 2013) Partners: ICFI, HPI and PATH Timeline: 2 months Phase II – Country visits to get a better understanding of the plans and costing Pilot testing of the costing tool – Kenya Country visits – 8 countries (Nepal, Bangladesh, Indonesia, Sierra Leone, Burkina Faso, Madagascar, Malawi, Rwanda) Continued desk reviews – 21 + countries Results presented at the G8 Nutrition for Growth event in London, June 2013 Timeline: 8 months *Bangladesh, Myanmar, Ethiopia, India, Kenya, Malawi, Mozambique, Nepal, Nigeria, Pakistan, Somalia, Sudan, Tanzania, Uganda, Yemen, Zambia, Zimbabwe Aim of the study should be clearly written. Where possible summarise using bullet points. Do not cut and paste long paragraphs from documents/ trips reports. These are often too long and wordy for presentation formats.

Phase III – Supporting Movement of Scaling Up Nutrition Technical support and assistance to the SUN countries (via SUN Secretariat) to accelerate action to tackle childhood undernutrition Areas of support to the SUN countries: Review of policy legislation and to develop plan summaries Organization and implementation of the Common Results Framework (CRF) based on the country action plans Financial tracking and resource mobilization Aggregating and documenting the lessons learned Disseminating the work at global events and with global networks Timeline: 12 months Aim of the study should be clearly written. Where possible summarise using bullet points. Do not cut and paste long paragraphs from documents/ trips reports. These are often too long and wordy for presentation formats.

Investigating Country Efforts in Scaling Up Nutrition in 20+ SUN Countries Washington, DC 30 September 2013

MQSUN Technical Support and Assistance to the SUN Movement Phase I Policy review Analytical framework Methodology for country visits Phase II Remote support to countries and SUN Movement Secretariat (SMS) Country visits Support SMS at International events Phase III Policy, legislation, and plan reviews and summaries Support effective nutrition-sensitive implementation around a Common Results Framework Support financial tracking and resource mobilization

Phase I Develop an analytical framework and associated methodology Aggregated Cost Tool (Standardized categorization) Methods for cross-country review

Phase I – Analytical Framework Aggregated Cost Tool (ACT) Establishing a common set of measures based on submitted plans Programme description Programme classification Target groups Lead budget holder Annual costs Annual secured funding amounts Funding source

Phase I – Support Methodology Prepare draft methodology for country visits Gain better understanding of existing plan Which sectors were involved How costs were calculated How targets were selected How donor networks/funds are incorporated into plan activities Financial mapping and budget allocations

Phase II Desk support and analysis Targeted support International event support

Phase II – Desk Support Cross-country Review (Desk Support) Enter 21 submitted plans into ACT Review plans in a standardized framework Incorporate feedback and corrections from countries Identify policy shifts to enhance scale up (e.g., inclusion of governance, nutrition-sensitive factors) Review country and external funding, where available Prepare summary documentation for dissemination

Phase II – Desk Support Analytical Support Estimating external contributions Defining the financing gap Assist SMS with quantitative analysis and special requests

Phase II – Targeted Support Selection of countries Supplied a ratified plan Full engagement of the focal point for the visit Nutrition burden within the country is high Plan is considered to be high quality or country has identified a specific short-term need for June Event Purpose of visit Work with focal points and stakeholders to help them understand and apply the analytical framework and methods Develop an understanding of the elements, inputs, and calculations in the submitted cost plans Both what is included and what is omitted Identify the financial contributions and pledges of relevant stakeholders Identify activity priorities Identify financial gaps, where possible

Phase II – International Events Scaling Up Nutrition Senior-level Meeting, Brussels, March 2013 Analysis of plans from 16 countries Summary of methods and results Reports with national and aggregated statistics “Nutrition for Growth: Beating Hunger through Business and Science”, Pre-G8 Meeting, London, June 2013 Analysis of plans from 20 countries Assist in development of country-specific two-page documents for countries to share policy priorities and advocate for financing requests Provide intensive remote support to countries leading up to and during the event

Phase II Submitted Country Plans Bangladesh (2011 – 2015) Benin (2012 – 2015) Burkina Faso (2010-2015) The Gambia (2011 – 2015) Guatemala (2013-2014) Haiti (2013-2017) Indonesia (2011-2017) Kenya (2013- 2017) Madagascar (2012 – 2015) Malawi (2012-2016) Mozambique (2011 – 2016) Nepal (2013 – 2017) Niger (2012-2015) Peru (2012-2013) Rwanda (2012) Senegal (2013-2017) Sierra Leone (2013 – 2017) Tanzania (2012 – 2016) Uganda (2012 – 2016) Yemen (2013) Red = countries visited

Overview of Submitted Plans Key Considerations Analytic Framework Aggregated Results Lessons Learned Next Steps

Overview – Key Considerations Plans reflect national commitments inclusive consultation process between the government and in-country partners Plans are used as reference for implementation this implies (need for) more detailed planning and budgeting at sub-national levels

Overview – Key Considerations Plan differences (caveats for comparison) Inclusions/exclusions Existing government inputs (labor, infrastructure) New versus existing interventions Stakeholder and sector involvement Assumptions for scale-up Percentage increase District rollout National coverage Cost methodologies Total intervention costs (ingredients) Marginal budgeting Program unit costs Cost estimations Program planning Country budgets External budgets

Political & Cultural Environment Disempowerment of women Overview – Analytical Framework Lack of good CARE for mothers & children & support for mothers on appropriate child feeding practices Inadequate access to HEALTH sanitation & clean water services Insufficient access to affordable, nutritious FOOD throughout the year ROOTED IN Political & Cultural Environment Disempowerment of women Poverty

Applied Classification of Interventions in the Country Plans Specific Nutrition Actions Good Nutrition Practices Vitamin and Mineral Intake Acute Malnutrition Management Enrichment of diet nutrient density for pregnant and lactating women and children 6-23 months Nutrition-sensitive Approaches Food Security and Agriculture Care Environment Public Health and Water and Sanitation Governance Coordination and Information Management Policy and Legislation Development Advocacy and Communication System Capacity Building

Overview - Plan Variety Bangladesh, Sierra Leone, Uganda and Nepal have incorporated interventions from other sectoral plans

Specific Nutrition Actions TOTAL COST: US$ 4.0 billion (timeframe 2011-2015) US$ 2.4 billion for good nutrition practices (61%) US$ 650 million for acute malnutrition management (21%) US$ 717 million for vitamin and mineral intake (18%) US$ 198 million for nutrient dense diet for PLW and young children (5%).* *Peru, Mozambique and Madagascar Total annual: US$ 1.1 billion Average annual (without highest or zeros): US$ 231.5 million

Specific Nutrition Actions Good nutrition practices include maternal, IYCF (38%) and healthy diet (31%). Maternal and IYCF includes also advocacy and implementation of key legislation such as the BMS code and the maternity leave

Composition of Specific Nutrition Actions Welcome emphasis on the prevention of malnutrition in all its forms through the promotion of good nutrition practices. Also Vitamin & Mineral intake is well reflected in most plans. “Lower than expected costing” of acute malnutrition management is largely linked to the limited degree of scale-up within country plans. Similar consideration when reflecting on the low presence of nutrient-dense foods in the country plans. Out of the US$ 542 million for acute malnutrition, US$ 364 million is for Kenya and US$ 76 million is for Yemen

Nutrition-sensitive Approaches TOTAL COST: US$ 28.9 billion (timeframe 2011-2015) US$ 19.6 billion for nutrition-sensitive food systems. Note: Bangladesh alone is US$ 8.5 billion US$ 89.5 million for interventions enhancing caring environments US$ 9.2 billion for interventions in public health services, including reproductive health and WASH Total annual: US$ 6.6 billion Average annual excluding highest or zeros: US$ 1.3 billion

Nutrition-sensitive Food Systems General strategies (1%) and supplemental feeding (2%) make up the remainder. Diversified production includes small livestock (small ruminant, poultry)

Composition of Nutrition-sensitive Food Systems Costed plans provide a useful guidance on the range of activities that can be included in guideline for definitions and selection of nutrition-sensitive approaches. Supplementary feeding interventions do not specify the type of food

Diversified and Nutrient Dense Diet Place smallholders, especially female farmers, and their needs for assets and services at the core Diversify and intensify production (Agriculture) Improve use of biodiversity (Agriculture) Improve processing and storage (Agriculture, Industry and SMEs) Ensure food safety (Health) Distribute (Markets and Public Works) Availability Regulate or subsidize prices (Markets) Ensure minimum income (Employment , micro-enterprise and SMEs) Include in school meals (Education) Include in employment schemes (Welfare) Supplement to specific vulnerable groups (Welfare ) Accessibility Promote and educate with a focus on maternal and IYCF (Health) Utilization Production of dairy, poultry, fishery, vegetable, fruit, legumes and oily seeds

Fortified Foods Accessibility Availability Utilization Import and distribute (Markets) Produce, fortify and distribute (Agriculture & Markets) Regulate (Health) Availability Subsidize prices (Markets) Supplement to specific groups (Welfare ) Supplement under special circumstances (Emergency) Accessibility Promote and educate as part of a diversified diet (Health, Markets) Utilization

Nutrition-sensitive Public Health Household water treatment Water schemes maintenance Community-led total sanitation Sanitation campaigns WASH in schools Management and control of NCD Management of malaria Nutrition counseling of PLWHA

Governance TOTAL COST: US$ 2.3 billion (timeframe 2011-2015) US$ 1.5 billion for system-wide capacity building (66%) US$ 629 million for coordination and information management (28%) US$ 143 million for policy development, advocacy and communication (6%) Total annual: US$ 441.2 million Average annual excluding highest or zeros: US$ 27.3 million

Nutrition Governance Multi-sectoral coordination at different levels Quarterly monitoring meetings Stakeholder mapping and other planning exercises Capacity to plan, implement and monitor Capacity for intra-ministerial coordination Capacity for sub-national planning

20 Countries At A Glance 99.9 million U5 Children (2013 proj.): 38 million stunted average prevalence 39% range 19.5-57.7 average annual reduction rate of 1.3% 3.2 million severely wasted average prevalence 2.9% range 0.1-7.9 7.0 million moderately wasted average prevalence 6.2% range 0.3-11.6) Specific nutrition actions: US$ 1.1 billion per year US$ 71.6 million per country annually Nutrition sensitive approaches: US$ 6.7 billion per year US$ 370 million per country annually Governance for nutrition: US$ 441 million per year US$ 26 million per country annually Note: 36 high-burden countries received from OECD ODA an annual average of US$ 218 million (2009-2011) 54% among sub-saharan African countries Nutrition sensitive agriculture: If highest ranges are excluded the average annual is 3 million (very low) Yemen: 57.7% stunting; Peru: 19.5% stunting Benin: 7.9% severe wasting; Peru: 0.1% severe wasting

Messages from Country Visits Elevate nutrition within governmental agendas Centralize national planning and coordination processes Position national task forces above ministerial level Utilize Champions to enable national campaigns to reach wider and more influential audiences Include stakeholders from multiple arenas in planning and coordination Advocate and campaign for more domestic investment Use this to leverage international funding Issue of absorption

Messages from Country Visits Develop multi-sectoral plans and innovative or pooled funding mechanisms Decentralize the national costing processes to include sub-national managers, decision makers, and practitioners Use the Aggregated Cost Tool to advocate for resources at the national level offer guidance for definitional issues related to classification of activities

Continuing Needs Technical support Finalise plans, costing, and M&E frameworks Decentralise planning and costing Advocacy Build internal country support Appeal to external donors Financial mapping and funding gaps Support peer learning to share examples, lessons, and successes Support research to extend knowledge of what works

Next Steps – Phase III Policy, legislation and plan reviews and summaries Assess, evaluate and peer-review national sectoral documents Support effective nutrition-sensitive implementation around a Common Results Framework (CRF) Build and expand on knowledge base of effective interventions Support financial tracking and resource mobilization Establish systems for multi-sectoral planning, costing, financial tracking, assessment of budgetary shortfalls and completion of strategic plans and documentation Aggregate and document the lessons learned from the work with countries Disseminate lessons learned across the SUN global networks (Donor, UN agencies, civil society, and business). Support the SMS in the preparation of briefs, presentations and reports to ensure information exchange and lessons learned