74153 Seeding Action for Change at Scale Phase 1 Final Report of the Japan Trust Fund for Nutrition GOVERNMENT OF JAPAN THE WORLD BANK Seeding Action for Change at Scale Phase 1 Final Report of the Japan Trust Fund for Nutrition September 2012 GOVERNMENT OF JAPAN THE WORLD BANK Contents Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Acronyms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi The Japan Trust Fund for Nutrition: By the Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Purpose and Structure of this Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Crosscutting Themes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Going Forward: Opportunities for Building From Phase I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Regions In-Depth: Catalyzing the Scale-Up of Nutrition Around the World . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Health, Nutrition, and Population Unit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Support to the Scaling Up Nutrition (SUN) Global Movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Health, Nutrition and Population Unit Published Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Africa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 A Strategic Development Plan for Food and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Technical Assistance to Increase Capacity while Keeping It Affordable. . . . . . . . . . . . . . . . . . . . . . . . .19 A Multisectoral Plan for Addressing Chronic Undernutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Leveraging Funding through Prioritizing & Costing a Multisectoral Nutrition Action Plan . . . . . .20 Africa Region Published Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Latin America and the Caribbean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Second Regional Nutrition Workshop in Central America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Mi Futuro en Mis Primeros Centimetros. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Strengthening the Impact of CCT Programs on Nutritional Outcomes . . . . . . . . . . . . . . . . . . . . . . . . 25 iii Improving Integrated Care Via Self-Evaluation for Women and Children at the Community Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 From Pilot to National Nutrition Program: Household Development Agents . . . . . . . . . . . . . . . . . . 28 Beyond the ABC and 123. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Latin America and the Caribbean Region Published Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 South Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Training Courses to Strengthen Capacity in Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 A Nutrition Assessment to Catalyze Multisectoral Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Accelerating Progress in Reducing Maternal and Child Undernutrition. . . . . . . . . . . . . . . . . . . . . . . . 34 A Multisectoral Plan Catalyzes Investment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 South Asia Region Published Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Europe and Central Asia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Regional Situational Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Europe and Central Asia Region Published Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Middle East and North Africa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 National Food Fortification Programme Policy Dialogue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Nutrition Mapping Seminar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Multisectoral Program Design to Drive Demand of Community-Based Nutrition Services Using CCTs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Annex 1. Phase 1 Results Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Annex 2. Japan Trust Fund for Nutrition: Activities by Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Annex 3. Cross-Listing of Case Studies by Theme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 iv JAPAN TRUST FUND FOR NUTRITION List of Boxes Box 1. The Japan Trust Fund for Nutrition Phase I Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Box 2. Nutrition Country Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 6 Box 3. Investing in Nutrition: Let’s Grow Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 Box 4. Webinar Series Continues to Fuel the Regional Exchange of Experiences . . . . . . . . . . . . . . . . . . 23 Box 5. Mi Futuro en Mis Primeros Centimetros. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Box 6. Regional Workshop to Examine AIN-C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 7 Box 7. Nutrition Advocacy Brochures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Box 8. Regulatory Monitoring Workshop on Salt, Wheat Flour and Oil Fortification Programmes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6 List of Figures Figure 1. Confirmed SUN Countries as of July 2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 List of Tables Table 1. Summary of Activities Financed by the Japan Trust Fund for Nutrition by Region . . . . . . . . . xii CONTENTS v Acknowledgements With financial support from the Japan Trust Fund for Nutrition, the Health, Nutrition, and Population (HNP) unit undertook this summary report of Phase 1 of the Japan Trust Fund for Nutrition. Meera Shekar, AFTHW, led the development of the Japan Trust Fund proposal and the implementation of Phase I. The World Bank gratefully acknowledges the leadership and support for nutrition from Mr. Nobumitsu Hayashi, Executive Director (7/2010–8/2012) for Japan and Eiji Kozuka and Eiji Wakamatsu, Advisors, Japan Executive Director’s office. The task manager for this report was Leslie Elder (HDNHE). Andrea L. Spray, consultant, was the main author of the report. The design and review of this study benefitted from valuable guidance provided by Julie Ruel-Bergeron (HDNHE). Thanks are due to the World Bank staff who contributed to this report, including Omar Arias (ECSH4), Lucy Bassett (LCSHS), Amparo Gordillo-Tobar (LCSHH), Nelson Gutierrez (LCSHS), Alaa Hamed (MNSHH), Ziauddin Hyder (AFTHW), Polly Jones (LCSHS), Ashi Kathuria (SASHN), Francesca Lamanna (LCSHS), Luc Laviolette (SASHN), Alessandra Marini (LCSHS), Nkosinathi Mbuya (SASHN), Marie Chantal Messier (LCSHH), Menno Mulder-Sibanda (AFTHW), Patrick Mullen (SASHN), Christine Pena (LCSHH), Tamer Rabie (MNSHH), Claudia Rokx (ECSH1), and Eileen Sullivan (EASHH). vii Acronyms AFR Africa Region FAO Food and Agriculture Organization AIN-C Atención Integral a la Niñez con base GDP Gross Domestic Product Comunitaria, Community-based GPS Global Positioning System Integrated Children Care Strategy GOJ Government of Japan AINM-C Atención Integral a la Niñez y la mu- HCP High Commission for the Plan jer en la Comunidad, Integrated (Morocco) Care for Children and Women at the HNP World Bank Health, Nutrition, and Community level Population Unit AusAID Australian Government Overseas Aid HPP International Development Program Association Health and Population BDH Bono de Desarrollo Humano Project (Ecuador) IDA International Development BPHS Basic Package of Health Services Association CAN National Council on Food and IMF International Monetary Fund Nutrition (Benin) INCAP Institute of Nutrition of Central CCT Conditional Cash Transfer America and Panama CBGP Community-based Growth IYCF Infant and Young Child Feeding Promotion JICA Japan International Cooperation CIDA Canadian International Agency Development Agency JSDF Japan Social Development Fund CMAM Community Management of Acute LCR Latin America and Caribbean Region Malnutrition MDG Millennium Development Goal CPS Country Partnership Strategy MNA Middle East and North Africa Region CRB Communications Resource Bank MNPs Micronutrient powders CSB Corn soy blend MOH Ministry of Health CSO Civil Society Organizations MOH&P Ministry of Health and Population DfID Department for International NAGA Nutrition Assessment and Gap Development Analysis EAP East Asia and the Pacific Region NGO Non-governmental organization ECA Europe and Central Asia Region PIC Integrated Nutrition ECD Early Child Development Communication Plan (Benin) ix PND Public Nutrition Department SMS Short Message Service (Afghanistan) SUN Scaling Up Nutrition PSDAN Strategic Development Plan for TOR Terms of Reference Food and Nutrition (Benin) UNAP Uganda Nutrition Action Plan PSQCA Pakistan Standards Quality Control UNDP United Nations Development Agency Programme RSR Rapid Social Response Trust Fund UNICEF The United Nations Children’s Fund RUTF Ready-to-Use therapeutic food USAID United States Agency for SAFANSI South Asia Food and Nutrition International Development Security Initiative WFP World Food Program SAR South Asia Region WHO World Health Organization SEETF South–South Exchange Trust Fund x JAPAN TRUST FUND FOR NUTRITION Executive Summary In Phase I, the Japan Trust Fund for Nutrition fi- and the Caribbean, another was prepared for nanced catalytic country-level activities to South Asia, and South–South Peer Reviews support the scale up of nutrition in high undernu- are being conducted in Africa. Other training trition-burden countries. With small allocations workshops, webinars and modules were con- of Japan Trust Fund financing distributed across ducted throughout Latin America and the 33 countries, the accomplishments achieved dur- Caribbean and South Asia during this initial ing this first phase far exceeded expectations, and funding period. laid important groundwork for the burgeoning t With support from the Japan Trust Fund in Scaling Up Nutrition (SUN) Global Movement. addition to resources from several other do- nors, the SUN Framework and Roadmap were At the end of Phase 1: completed, with the Scaling Up Nutrition Framework endorsed by over 100 partners t Country scale-up plans were completed in worldwide. By the end of Phase I, twenty-eight Benin, The Gambia, Mozambique, Uganda, developing countries had committed to scal- Haiti, Djibouti, Yemen, and Nepal, with seven ing up nutrition. more under development. t The World Bank collaborated with the Japan t Fourteen new nutrition projects are under Embassy staff on the development of several preparation, leveraging nearly US$200M in JSDF proposals. Japan Embassy and JICA staff IDA investments plus additional funding in the around the world have participated in Japan form of South–South Exchange Trust Funds Trust Fund for Nutrition-financed regional ex- (SEETF), Rapid Social Response (RSR) grants, changes and project meetings. Japan Social Development Fund (JSDF) grants, and other funding. t Innovative nutrition pilot projects are being implemented in Ethiopia, Haiti, Guatemala, Peru, Ecuador, Nepal and Yemen. t Capacity Assessments were completed in Rwanda, India, Kenya, Tanzania, and Uganda. Capacity-building projects were complet- ed in The Gambia, Tanzania, Guatemala, Haiti, Morocco, and Pakistan. A South–South Regional Exchange occurred in Latin America xi The work accomplished by the Japan Trust Fund Financing from the Japan Trust Fund targeted differ- for Nutrition can be categorized according to the ent activities in each of the five regions supported: following crosscutting themes: Catalyzing activi- Africa (AFR), Latin America and the Caribbean (LCR), ties, leveraging additional project funding, capaci- South Asia (SAR), Europe and Central Asia (ECA), and ty-building, working multisectorally, South–South the Middle East and North Africa (MNA) (Table 1). knowledge exchange, innovative use of media, and nutrition and early child development. Many proj- The following report chronicles these and oth- ects span multiple themes. er case studies from the Japan Trust Fund for Nutrition Phase 1. Table 1. Summary of Activities Financed by the Japan Trust Fund for Nutrition by Region AFR Provide technical assistance to inform policy dialogue Angola, Benin, Ethiopia, The Gambia, Kenya, and project preparation, and build capacity. Liberia, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia LCR Promote visibility of the nutrition problem, promote Belize, Bolivia, Ecuador, El Salvador, expansion and quality improvements in community Guatemala, Haiti, Honduras, Mexico, based growth promotion activities, and strengthen Nicaragua, Panama, Peru the linkages between demand and supply of nutrition programs, with a focus on conditional cash transfer programs. SAR Increase the awareness of undernutrition, build Afghanistan, India, Nepal, Pakistan, Sri Lanka capacity of policy makers and opinion leaders to advocate for nutrition-sensitive policies, and assist in providing technical assistance to inform policy dialogue. ECA Provide technical assistance to inform policy dialogue. Kyrgyz Republic, Tajikistan MNA Provide technical assistance to inform policy dialogue. Djibouti, Morocco, Yemen xii JAPAN TRUST FUND FOR NUTRITION 33 countries in 5 regions benefited from Japan Trust Fund for Nutrition financing 11 countries participated in the Latin America and Caribbean regional exchange 6 countries produced Mi Futuro en Mis Primeros Centimetros videos Over 34,000 YouTube views of Mi Futuro en Mis Primeros Centimetros The Japan Trust Fund for Nutrition: By the Numbers Over 24,000 nutrition country profiles were disseminated to 69 high undernutrition-burden countries 15 countries initiated the creation of national plans 8 Japan Social Development Trust Fund linkages 4 IDA investments leveraged Over 90 activities financed by the Japan Trust Fund for Nutrition xiii Introduction Background (Years 2–5), and Phase III – Institutionalization (Years 4 onward). Malnutrition impedes economic and human devel- opment. Undernourished children have higher mor- The objectives of Phase 1 were to support the de- tality, lower cognitive and school performance, and velopment of new national nutrition plans, build 10–17% lower income potential as adults. Improved nutrition planning and implementation capaci- nutrition can therefore be a driver of economic ty, catalyze in-country nutrition policy dialogue, growth. Improving nutrition is a pro-poor strategy, and lay the foundation for new International with high potential return on investments. Development Association (IDA) investments in 4–6 high undernutrition-burden countries.1 The cross-sectoral nature of nutrition, multiple stakeholders, and the lack of a single institution- al home may result in low attention to nutrition as a development issue. Global and country-lev- el financing for nutrition is minimal, human re- sources and capacities for implementing large scale nutrition programs are scarce in many coun- tries, and nutrition metrics need concerted at- tention. While the evidence base and the science for improving nutrition outcomes are relatively well established, few countries are implementing these proven interventions at scale, and the bur- den of malnutrition remains high in many poor countries. In February 2009 the Government of Japan (GOJ) approved US$2M for Phase I of a proposed five- year initiative to expand the implementation of 1 Malnutrition is a term that comprises both undernutrition proven nutrition interventions in high undernu- (stunting or low height-for-age, wasting or low weight-for- height, underweight or low weight-for-age, and micronutri- trition-burden countries. The Japan Trust Fund for ent deficiencies) and overnutrition (overweight and obesity). Nutrition was planned to roll out in three phases: In this report, undernutrition and malnutrition are used in- Phase 1 – Initiation (Year 1), Phase II – Consolidation terchangeably. Any reference to overnutrition is explicit. 1 Specific activities financed during this initial phase of the Japan Trust Fund are outlined in Box 1 Box 1. The Japan Trust Fund for and Annex 1. Nutrition Phase I Activities 1. Country scale-up plans Purpose and Structure of this Report 2. Policy dialogue and project preparation 3. Piloting of innovative approaches The purpose of this report is to demonstrate the 4. Training and capacity-development plans catalytic role of the Japan Trust Fund in raising the 5. Global action plan for nutrition and profile of nutrition through its support of World reform of global aid architecture Bank activities. As is clear from Annex 1, Phase I achievements far exceeded expectations. It is an- ticipated that, if funded, Phase II will commence was carried out. The report includes case stud- by building off of the accomplishments achieved ies from the World Bank Health, Nutrition, in Phase 1, and extend support to an additional and Population (HNP) unit, Africa (AFR), Latin 6–10 high undernutrition-burden countries. America and the Caribbean (LCR), South Asia (SAR), Europe and Central Asia (ECA), and the This report is intended to serve as both an at- Middle East and North Africa (MNA). The case a-glance summary of the work completed dur- studies are organized by region, with icons used ing Phase I of the Japan Trust Fund for Nutrition to indicate the crosscutting themes of this body (Annex 2), as well as a compendium of case stud- of work. Annex 3 provides a cross-listing of coun- ies from each region illustrating how that work try case studies by theme. 2 JAPAN TRUST FUND FOR NUTRITION Crosscutting Themes 3 Catalyzing activities LCR – Haiti Morocco Innovative use of media Haiti LCR – Ecuador, Mexico Guatemala, Honduras, Belize Guatemala Honduras Mexico, Peru El Salvador Nicaragua The Gambia Benin Panama Liberia Ecuador Peru Capacity-building Bolivia AFR – The Gambia Nutrition and Early Child Development LCR – Peru South–South Knowledge Exchange LCR – LCR 4 JAPAN TRUST FUND FOR NUTRITION Leveraging additional project Kyrgyz Republic funding Tajikistan SAR – Pakistan Afghanistan Nepal Pakistan India Yemen Djibouti Working Ethiopia Sri Lanka multisectorally Uganda SAR – Nepal Kenya Rwanda Tanzania Angola Malawi Zambia Mozambique Highlights of Crosscutting Themes: Country Examples of the Japan Trust Fund – Supported Activities Countries benefitting from Japan Trust Fund for Nutrition resources CROSSCUTTING THEMES 5 Catalyzing activities The Japan Trust Fund for Nutrition is the only Trust Fund that specifically targets nu- trition interventions and outcomes at the World Bank. Through financing catalytic country-level activities, the Japan Trust Fund has fostered fluid dialogue between gov- ernments and World Bank staff, rallied partners around a common cause, and ensured the inclusion of nutrition initiatives on national and institutional agendas. Catalyzing activities LCR – Haiti The Japan Trust Fund supported analytical work and improvements in nutrition pro- grams in close collaboration with UN agencies, donors and NGOs in Haiti. In particular, the Japan Trust Fund was crucial in financing the development of a national nutrition policy and providing technical assistance in the development of an innovative multisec- toral program aiming to ameliorate nutrition and food insecurity in a comprehensive and integrat- ed manner using community health agents already working in the community. The program, designed with technical assistance from the World Bank and UN agencies and with the support of the Japan Trust Fund, is applicable to any rural area in Haiti but is currently being piloted in the De- partment of the Center, one of the most impoverished departments in Haiti with the poorest so- cial and health indicators. The Household Development Agent program design has been identified by the Na- tional Programme for the Fight against Hunger and Malnutrition, “Aba Grangou�, announced by President Mi- chel Martelly in January 2012, to be replicated throughout the country. This announce- ment is the culmination, in part, of close policy dialogue with the Director of Nutrition in the Ministry of Health, and the First Lady of the Republic Sophia Martelly, who has been appointed President of the Commission responsible for coordinat- ing and monitoring the activities of “Aba Grangou�. Read more on page 28. 6 JAPAN TRUST FUND FOR NUTRITION Leveraging additional project funding Seed money from the Japan Trust Fund for Nutrition played a crucial “multiplier� role in leveraging more sizeable funding for projects. Simply having Japan Trust Fund financing available enabled World Bank staff to initiate partner dialogue for nutrition projects that they might not otherwise have engaged in. Leveraging additional project funding SAR – Pakistan Armed with the Scaling Up Nutrition Framework and a review of infant and young child feeding (IYCF) and community-based management of acute malnutrition (CMAM) pro- grams financed by the Japan Trust Fund, a meeting of the D–10 Group (a body of devel- opment partners chaired by the Minister of Finance) in September 2011 agreed that Pakistan’s provinces would prepare comprehensive nutrition plans for addressing malnutrition through multi- sectoral approaches. The provincial plans would include detailed costing of resources available with- in the provinces and the fiscal gaps, from which the federal plan would be revised accordingly. The World Bank was asked to coordinate a coherent development partner response to the plans. Already there has been in- terest expressed from the South Asia Food and Nu- trition Security Initiative (SAFANSI) at the World Bank to support a process to enable the provinces to prepare policy guidance notes on the multisectoral aspects of malnutrition, which will build on avail- able information and past experience in each prov- ince. The World Bank has also created a multi-do- nor Trust Fund called “Partnership for Nutrition in Pakistan Trust Fund� to support provincial pro- grams. AusAID was the first donor partner to pledge, committing US$40M to financing improved nutrition in Pakistan. Read more on page 35. CROSSCUTTING THEMES 7 Capacity-building Around the world, the Japan Trust Fund for Nutrition was used in creative ways to develop in-country capacity of ministry staff, senior level policy makers, volunteer community health workers, and program staff for implementing and managing nu- trition initiatives. Capacity-building AFR – The Gambia In The Gambia, the Japan Trust Fund was used to enhance the po- tential of the existing core staff at the newly formed National Nu- trition Agency by developing technical proto- cols and increasing the number of trained staff. The Agency was able to recruit additional key staff, including a financial management spe- cialist, a monitoring and evaluation officer, and a communications specialist. The Agen- cy leveraged the work financed by the Japan Trust Fund to attract a Rapid Social Response (RSR) grant of US$3M. Lacking funds to direct- ly hire qualified staff, the Agency instead hired young apprentices and used the RSR grant and other Trust Funds to pay experts for one year to train the apprentices for their roles. The Ja- pan Trust Fund financing was thereby used to leverage additional project funding, and build capacity in the National Nutrition Agency by training young staff for roles that were other- wise too costly to hire directly by the Agency. Read more on page 19. 8 JAPAN TRUST FUND FOR NUTRITION Working multisectorally The determinants of malnutrition are multisectoral; similarly the programs de- signed to address them must also take a multisectoral approach. One of the pil- lars of the SUN—to accelerate progress on undernutrition—lies in multisectoral work. Activities financed by the Japan Trust Fund for Nutrition engaged govern- ment ministers, Bank management and donors in multisectoral dialogue to garner buy-in across sectors, ensure that innovations spread to other sectors, and enable and enact policy-level changes to address undernutrition more comprehensively and effectively. Working multisectorally SAR – Nepal With financing from the Japan Trust Fund, a high-level delegation from Nepal led by the Minister of Health and Population attended the annual meetings of the World Bank in November 2009. In his pre- sentation at the special meeting on Scaling Up Nutrition:  What Will It Take?: The Window of Development Opportunity, the Minister of Health and Population presented Nepal’s nutrition situation and committed to a multisectoral approach involv- ing Japan Trust Fund-financed technical assistance to inform the new plan. Technical assistance provided by the Bank has resulted in important evidence to inform the Mul- tisectoral National Nutrition Plan of Action and, in so doing, provided a final push to implement multisectoral nutrition-sensitive initiatives. Nepal is an example of a country that through active engagement at the highest levels combined with the support of catalytic activities financed by the Japan Trust Fund and other sources, is leading the charge in scaling up nutrition. The Prime Minister of Nepal is now a member of the Lead Group for the Scaling Up Nutrition global movement. Read more on page 34. CROSSCUTTING THEMES 9 South–South knowledge exchange To complement the more traditional North–South approach of development as- sistance, staff used the Japan Trust Fund for Nutrition resources to foster South– South operational learning and sharing through regional exchanges aimed at brokering dialogue among peer countries. South–South Knowledge Exchange LCR – LCR More than 80 high-level policymakers and country program staff responsible for set- ting and implementing nutrition policies for 11 countries in the region convened for the Second Regional Nutrition Workshop “Promoting Healthy Growth to Prevent Chronic Malnutrition: Advances and Opportunities for Community-based Strategies in Central America�, in Panama City, Panama from October 26–28, 2011. The workshop provided a fo- rum for participants to share their recent innovations and challenges, and to learn from the experi- ences and expertise of others in the region. Regional exchanges like this are instrumental for multiplying the impact of effective nutrition inter- ventions across countries with similar contexts. The workshop generated excite- ment among participants and was a catalyst for last- ing South–South collabora- tion across the region. Read more on page 22. 10 JAPAN TRUST FUND FOR NUTRITION Innovative use of media The Japan Trust Fund for Nutrition financed truly catalytic communications, mak- ing effective use of video and other media to build awareness among policy makers, drive demand for community-based nutrition services, and foster behavior change for improved nutrition outcomes. Innovative use of media LCR – Ecuador, Guatemala, Honduras, Mexico, Nicaragua, Peru Mi Futuro en Mis Primeros Centimetros was created to address the fact that stunting (being too short for one’s age) is commonly perceived to be “normal� by families and communities in Latin American countries and therefore not a problem. The 10-minute video asserts that every child has the same potential for linear growth, regardless of their ethnicity, nationality, and socioeconomic status. It was first produced in Peru, but on the heels of major success there, it was later culturally adapted and translated for use in five other countries in the region, including: Ecuador, Guatemala, Honduras, Mexico and Nicaragua. Mi Futuro en Mis Prim- eros Centimetros was highly effective not only in getting the message out to ben- eficiaries and health workers, but also by making a real impact on high-level nutrition policy in nearly every country in which it was replicated. In acknowl- edgement, the video series was awarded first place in the World Bank’s Innovation Fair and a bronze med- al in the World Bank’s Knowlympics competition (May 2012). Read more on page 24. CROSSCUTTING THEMES 11 Nutrition and Early Child Development The Japan Trust Fund for Nutrition financed activities aimed at stimulating dia- logue on the synergy between nutrition and early child development, and its sig- nificance for human and economic development across multiple sectors and the business community. Nutrition and Early Child Development LCR – Peru Beyond the ABC and 123 was launched on June 21, 2011 in an effort to frame nutri- tion as critical for Peru’s economic growth, competitiveness, and employability, and not solely as a human rights issue. The video, financed by the Japan Trust Fund, was a companion to an eye-opening report (Strengthening Skills and Employability in Peru) on the link between nutrition, early childhood development, and future employability. This initiative helped to get child malnutrition on the broader agenda. Stakeholders in the health sector were pleased to see child nutrition linked so directly and vividly to future performance in the labor market through its role in cognitive and socio-emotional development. Moreover, the Beyond the ABC and 123 video catalyzed a multisectoral response in Peru and helped put the topic of nutri- tion squarely on the educational agenda. Read more on page 30. 12 JAPAN TRUST FUND FOR NUTRITION Going Forward: Opportunities for Building from Phase I As the report highlights, the results of Phase I 1 – Expand catalytic activities helped to catalyze action for nutrition in 33 coun- tries in five regions. Technical assistance Phase II of the Japan Trust Fund for Nutrition will t Assist governments in the development of na- continue to finance catalytic country-level activi- tional nutrition strategies and multisectoral ties to support the development of new national action plans for countries that do not yet have nutrition plans for delivery of nutrition programs them, and ensure availability of the right re- at-scale, innovative pilot projects and addition- sources to do so. al activities to lay the groundwork for IDA in- t Support South–South exchange initiatives vestments for nutrition. It will also link to the that provide the opportunity to learn from the SUN movement’s multisectoral nutrition agenda successes and challenges of peer countries in through support to innovative learning and tech- the same or other regions. nical assistance and capacity-building for design t Support capacity-building initiatives. and delivery of Bank-supported “nutrition-sen- t Provide assistance in sustaining high-level in- sitive� investments in agriculture, food security, terest of politicians, and the media through poverty reduction, social protection, water and advocacy communication. sanitation, etc. Inputs to policy dialogue and project Phase II of the Japan Trust Fund for Nutrition is preparation for nutrition components and well-positioned to build off of Phase I results projects through the following: t Support impact assessments to strengthen policy dialogue. t Assist countries to scale up or initiate opera- tional nutrition programs. 13 t Provide technical assistance to conduct nutri- t Provide technical assistance to sectors (for tion assessments and cost/benefit analyses. example, agriculture and social protection) t Assist in brokering regional collaborations. to design and implement nutrition-sensitive t Provide technical assistance to understand lo- interventions. cal infant and young child feeding practices t Finance monitoring and evaluation of innova- and how they contribute to malnutrition. tive approaches to nutrition services. t Supplement IDA-financed projects to enhance the quality of nutrition components. 2 – Generate operational knowledge Pilots to test innovative approaches and 3 – Support the work of the SUN best practices for both direct nutrition Global Movement (nutrition-specific) and indirect nutrition (nutrition-sensitive) interventions/ Support the implementation of the SUN approaches Global Movement t Support the institutionalization of effective t Continue to support national governments to models for community-based growth promo- scale up nutrition programs in SUN early riser tion (CBGP) initiatives. countries. 14 JAPAN TRUST FUND FOR NUTRITION Regions In-Depth: Catalyzing the Scale-Up of Nutrition Around the World Health, Nutrition, and Population was partially financed by the Japan Trust Fund. It (HNP) Unit outlines core priorities, components and actions necessary to address malnutrition at scale in high Support to the Scaling Up Nutrition (SUN) undernutrition-burden countries. Global Movement Background to the SUN Global Movement: The The Role of the Japan Trust Fund for Nutrition: SUN Global Movement was launched in 2010 in Analytical work supporting the development of response to continuing high rates of undernutri- the Scaling Up Nutrition: Framework for Action tion around the world. A broad informal global Figure 1. Confirmed SUN Countries as of July 2012 Bangladesh Benin Burkina Faso Ethiopia The Gambia Ghana Guatemala Haiti Indonesia Kyrgyz Republic Laos PDR Madagascar Malawi Mali Mauritania Mozambique Namibia Nepal Niger Nigeria Peru Rwanda Senegal Sierra Leone Tanzania Uganda World Bank donor convenor/co-convenor SUN countries Zambia SUN Countries Zimbabwe 15 partnership was established in 2008–9 through households and women in particular, to improve a collaborative process of consensus building on their own and their children’s nutrition, by imple- how to scale up nutrition. The fruits of this engage- menting a set of specific nutrition interventions, ment between developing countries, academic expanding the pool of resources for this effort, and research institutions, civil society organiza- and integrating nutrition into health, agriculture, tions (CSOs), the private sector, bilateral develop- education, employment, social welfare and devel- ment agencies, UN agencies, and the World Bank opment programs. resulted in the SUN Framework for Action and the SUN Roadmap. Overall, there is very strong political momentum behind the SUN, and Japan’s active involvement Project Details: The SUN Framework was launched adds further impetus. in April 2010 at the World Bank/International Monetary Fund (IMF) spring meetings, in a high- level event co-hosted by the Government of Japan, Canadian International Development Agency (CIDA), United States Agency for International Box 2. Nutrition Country Profiles Development (USAID) and the World Bank. With support from the NUTRITION at a GLANCE OTS BO W NA SWA N The three main elements of the SUN global move- Japan Trust Fund, profiles The Costs of Malnutrition D Overone-thirdofchilddeathsareduetounder- nutrition, mostly from increased severity of dis- ease.2. D Children who are undernourished between con- Annually, Botswana loses over US$78 million in GDP to vitamin and mineral de�ciencies.3,4 Scaling up core micronutrient nutrition interventions would cost less than US$1 million per year. ceptionandagetwoareathighriskforimpaired (See Technical Notes for more information) cognitive development, which adversely affects of 69 countries with the thecountry’sproductivityandgrowth. Key Actions to Address Malnutrition: D The Africa region is anticipated to lose at least a Increase nutrition capacity within the Ministries ment are: cumulative US$4.0 billion to chronic disease by of Health and Agriculture. 2015.5 Improve infant and young child feeding through D The economic costs of undernutrition and over- effective education and counseling services. weight include direct costs such as the increased burden on the health care system, and indirect Increase coverage of vitamin A supplementation for young children and deworming. Country Context costsoflostproductivity. D Childhood anemia alone is associated with a Achieve universal salt iodization. highest burden of under- HDI ranking: 125th out of 182 2.5%dropinadultwages.6 countries1 Improve dietary diversity through promoting production of a diversity of foods and market and Life expectancy at birth: 54 years2 Where Does Botswana Stand? infrastructure development. Lifetime risk of maternal death: D 29%ofchildrenundertheageoffivearestunted, 1 in 1302 11%areunderweight,and6%arewasted.2 D 48% of those aged 15 and above are overweight Under-�ve mortality rate: 31 per orobese.7 1,000 live births2 D 10%ofinfantsarebornwithalowbirthweight.2 nutrition were created to Global ranking of stunting The Double Burden of Undernutrition and prevalence: 56th highest out of 136 As seen in Figure 1, Botswana has similar rates Overweight 1. Scale up evidence-based interventions with countries2 of stunting to other countries in its region with Though Botswana is currently on track to meet muchlowernationalincome.Countrieswithlower MDG 1c (halving 1990 rates of child underweight per capita incomes in other regions, such as Alba- by2015)9ithasseenarecentincreaseinadifferent niaandIraqexhibitreducedratesofchildstunting. nutritional problem, adult obesity. The coexistence Technical Notes Thisdemonstratesthatstuntingisnotafunctionof of undernutrition and overnutrition may lead to Stunting is low height for age (too short). incomealone. particularrisks:low-birthweightinfantsandstunt- edchildrenmaybeatgreaterriskofchronicdiseas- provide summary infor- Underweight is low weight for age (too es such as diabetes and heart disease than children small). FIGURE 1 Botswana has Higher Rates of Stunting than highest priority to the “minus 9 to 24 months whostartoutwell-nourished.10 Wasting is low weight for height (too thin). Expected Given its National Income This “double burden� is the result of various Current stunting, underweight, and wasting 29.5 factors. Progress in improving community infra- Prevalence of Stunting Among estimates are based on comparison of the 29.0 Ecuador structure and development of sound public health Botswana Children Under 5 (%) most recent survey data with the WHO Child 28.5 systems has been slow, thwarting efforts to reduce Growth Standards, released in 2006. 28.0 The Gambia undernutrition; while rapid urbanization and the Low birth weight is a birth weight less 27.5 Togo adoption of Western diets high in refined carbohy- mation in a concise two- 27.0 South Africa than 2500g. drates, saturated fats and sugars, combined with a 26.5 window of opportunity� (which is “the first Overweight is a body mass index (kg/m2) 26.0 Iraq Albania of * 25; obesity is a BMI of * 30. 25.5 0 1000 2000 3000 4000 5000 6000 7000 Most of the irreversible damage due to The methodology for calculating nationwide GNI per capita (US$2008) costs of vitamin and mineral de�ciencies, malnutrition happens during gestation and interventions included in the cost of Source: Stunting rates were obtained from WHO Global Database on Child Growth and Malnutrition. GNI data were obtained from the World Bank’s and in the �rst 24 months of life9. scaling up, can be found at: www.worldbank. World Development Indicators. org/nutrition/pro�les 1000 days� in a child’s life when improved nu- page format for country trition can prevent damage to future human leaders, development partners, and stakehold- capital), ers about the extent, costs, and causes of mal- 2. Support a multisectoral approach (link sup- nutrition in each country, as well as potential port for nutrition with agriculture, social pro- country-specific interventions. Profiles for some tection, health, poverty reduction, gender and countries have been translated into French other relevant sectors), and and Spanish for distribution at country level, 3. Recognize that country ownership/leadership where country teams are using them as discus- is key to the success of the SUN movement. sion starters to raise political awareness and to launch development of full nutrition projects The SUN Framework has been endorsed by over and/or components. All profiles can be down- 100 partners, including CSOs, academia, UN age- loaded from the World Bank Nutrition Country ncies (WFP and UNICEF) and bilateral agencies, Profile website. and 28 countries have identified themselves as “early riser countries� (Figure 1). Leaders of these View countries have committed to working together to Nutrition Country Profiles on WorldBank.org support national nutrition programs that will help 16 JAPAN TRUST FUND FOR NUTRITION Box 3. Investing in Nutrition: Let’s Grow Together This inspirational advocacy video presents the argument for the need to invest in scaling up nutrition programs in high undernutrition-burden countries. Several of the individuals interviewed for the video participated in a World Bank meeting on scaling up nutrition held in November 2009 in Washington D.C. as members of country delegations from Haiti, Nepal, Burkina Faso, and Senegal. Their presentations on country experience with scaling up nutrition programs enriched the meeting. The participation of country teams was made possible through the Japan Trust Fund. View Investing in Nutrition: Let’s Grow Together on YouTube Additional tools created with Japan Trust Fund re- sources in support of the advocacy and communi- Health, Nutrition and Population Unit cations work for improved nutrition at the global Published Materials level include a set of 69 nutrition country profiles (Box 2) and an advocacy video (Box 3), Investing in Selected Publications Nutrition: Let’s Grow Together. t Scaling Up Nutrition: A Framework for Action (2010) t Scaling Up Nutrition: Report of a high-level meeting (2010) Videos t Investing in Nutrition: Let’s Grow Together REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 17 Africa A Strategic Development Plan for Food and Nutrition Benin The Role of the Japan Trust Fund for Nutrition: Technical assistance financed in part by the Japan Trust Fund aided preparation of policy reforms to create a more effective and harmonized imple- mentation framework for nutrition in Benin. The policies of the Core Nutrition Group that under- went revision included the Strategic Development Plan for Food and Nutrition (PSDAN), the operat- ing manual of the National Council on Food and Nutrition (CAN), and the Integrated Nutrition Communication Plan (PIC). Benin’s Nutrition Challenge: In 2007, Benin began turning the corner on making nutrition policy a public sector priority as a result of a multisectoral consensus workshop attended by Benin’s Council of nutrition in Benin; (ii) the delineation of the of Ministers and other key stakeholders. The pur- strategic plan; and (iii) a multisectoral commu- pose of the workshop was to discuss the existing nity nutrition program (Programme National de nutrition policy, identify barriers to reform, define Nutrition Axé sur les Resultats or PNAR) focusing a vision for the future, and create a road map for on implementing the strategic plan. The PSDAN achieving it including essential milestones to pro- has subsequently been costed using a variety of mote improved nutrition. scenarios. The workshop also established the multisectoral The 17-member CAN council has been installed, al- Core Nutrition Group, a coordinating body led by though the permanent secretariat is still pending. a nutritionist in collaboration with the local gov- Financing from the Japan Trust Fund was used to ernment, the Social and Economic Council, the par- prepare a financial management and administra- liament, and many other institutions involved in tive operations procedures manual for the CAN, national development policy implementation. Prior and the terms of reference for the CAN’s Permanent to this, the institutional home for nutrition policy Secretariat. The PIC, developed in February 2010, in Benin was split amongst three competing minis- defines the upstream and downstream communi- tries, and the sectoral fragmentation had begun to cations related to nutrition programs, advocacy, negatively affect nutrition policy development. funding, and institutional development. Project Details: The PSDAN is composed of The Impact of the Japan Trust Fund for Nutrition: three parts: (i) a situation analysis on the state A strategic costing exercise is underway to assess 18 JAPAN TRUST FUND FOR NUTRITION the financial capacity of Benin’s national budget commendable in itself, staff from the MOH moved to fund food and nutrition activities. The final re- to the Agency and the team has essentially re- port will be used to mobilize resources and will be mained intact ever since. The staff at the Agency presented to the Council of Ministers for alloca- is highly educated—all have Masters degrees— tion of a budget targeting nutrition. and well-informed, but had been unable to prop- erly scale up nutrition interventions due to limited While the policies financed by the Japan Trust resources. Fund have not yet translated into a national nu- trition program implemented at scale, they dem- Project Details: Technical assistance was provid- onstrate political will to reposition nutrition ed to the Agency by the World Bank to develop improvements as a public sector priority. Benin protocols for communication, fiduciary manage- is a good example of the role that the Japan Trust ment and resource mobilization. Together, the Fund played in contributing to small but strategi- World Bank and Agency staff finalized and vali- cally important deliverables during a window of dated their National Nutrition Policy, and devel- opportunity for getting nutrition back on the na- oped and costed a National Nutrition Strategic tional agenda. Plan. They also created the Business Plan for Better Nutrition, which outlines strategies and Technical Assistance to Increase Capacity costs for addressing undernutrition. And, final- while Keeping it Affordable ly, they conducted a human resource and institu- tional capacity assessment. The Gambia The Impact of the Japan Trust Fund for Nutrition: “You could see – provide a small amount These initiatives positioned the Agency to re- of money and they will do miracles with it. cruit additional key staff, including a financial The people are so invested! But we didn’t management specialist, a monitoring and eval- have that money before.� uation officer, and a communications special- — Senior Nutrition Specialist ist. The Agency leveraged the work financed by the Japan Trust Fund to attract an RSR grant of The Role of the Japan Trust Fund for Nutrition: In US$3M. Lacking funds to directly hire qualified The Gambia, the Japan Trust Fund was used to en- staff, the Agency instead hired young apprentic- hance the potential of an existing core staff at the es and used the RSR grant and other Trust Funds newly formed National Nutrition Agency, to devel- to pay experts for one year to train the apprentic- op their capacity in terms of protocols and to in- es for their roles. The Japan Trust Fund financing crease the number of trained staff. was thereby used to leverage additional proj- ect funding, and build capacity in the National The Gambia’s Nutrition Challenge: The smallest Nutrition Agency by training young staff for roles country in continental Africa, The Gambia is also that were otherwise too costly to hire directly by one of the most impoverished and least devel- the Agency. oped. In 2000, The Gambia created the National Nutrition Agency, which absorbed the nutrition The initial objective of the Japan Trust Fund- unit of the Ministry of Health (MOH) and was financed technical assistance was to finalize the charged with coordinating the implementation of reforms of the National Nutrition Agency, which the National Nutrition Policy. A feat of retention was not yet fully independent. As a result of this REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 19 work the Agency became fully independent and Project Details: The Nutrition Analysis report the staff has almost doubled. However, through aimed to: (a) review the scale, severity and key de- savvy use of the Japan Trust Fund and other fi- terminants of undernutrition in Kenya; (b) review nancing, the Agency managed to keep their in- the capacity of institutional and implementation creased capacity affordable. arrangements in public and private sectors to ad- dress undernutrition; (c) identify options for the A Multisectoral Plan for Addressing Chronic Government of Kenya and donor support to scale Undernutrition up evidence-based cost effective interventions primarily to prevent chronic undernutrition; and Kenya (d) suggest institutional arrangements, organi- zational (system) development and the technical The Role of the Japan Trust Fund for Nutrition: A and management capacity-building required to ad- Nutrition Analysis financed by the Japan Trust Fund dress identified gaps. Methods utilized included was prepared to inform a longer-term, develop- interviews with stakeholders, analysis of available ment-oriented response to the problem of chronic policies, strategies and plans of action at national undernutrition and to define a multisectoral ap- or sector level, and secondary data analysis to un- proach to scaling up nutrition in Kenya. derstand key determinants of chronic undernutri- tion in Kenya. Kenya’s nutrition challenge: A chronic situation of vulnerability can quickly tip to crisis in the Impact of the Japan Trust Fund for Nutrition: The event of natural or man-made disasters. In 2011 immediate impact of the Nutrition Analysis report a food security crisis hit Kenya as a result of two financed by the Japan Trust Fund was to leverage consecutive droughts. Famine was declared in an additional US$30M IDA investment for a proj- parts of neighboring Somalia, leading to a mas- ect to treat acute malnutrition, an example of how sive influx of refugees to northeastern and south- the Japan Trust Fund seed money catalyzed large eastern Kenya. investments in nutrition. However, it is by ad- dressing the root causes and prevention of under- Despite the recent crisis situation, there is great nutrition that vulnerability can be decreased and potential for Kenya to achieve its nutrition goals. resilience increased in Kenya. To that end, the re- Trained and motivated staff is available, and in- port is contributing to the preparation of a cost- frastructure is increasing. Improving nutrition in ed multisectoral national nutrition action plan to Kenya, and specifically reducing rates of chron- address chronic undernutrition in Kenya by identi- ic undernutrition (stunting), requires a multi- fying various platforms that can make scaling up sectoral response to address varied underlying possible and highlighting the many available path- causes. The basis for such a response is now pres- ways toward a multisectoral response. ent in Kenya, with the Constitution and Vision 2030 documents, in addition to the National Food Leveraging Funding through Prioritizing & and Nutrition Security Policy, Strategy and Action Costing a Multisectoral Nutrition Action Plan Plan. Integration of nutrition into the health, agri- culture, education, and social protection sectors is Mozambique and Uganda included in the plan, and will be facilitated by the existing infrastructure already in place to support The Role of the Japan Trust Fund for Nutrition: nutrition Uganda and Mozambique conducted similar 20 JAPAN TRUST FUND FOR NUTRITION activities to cost and prioritize nutrition inter- costing exercises in Uganda and Mozambique was ventions identified in their country’s respective to fill this gap by calculating the approximate an- action plans, using the methodology outlined in nual cost of delivering a package of direct, nutri- the World Bank publication, Scaling Up Nutrition: tion-specific interventions to 100% of the relevant What Will it Cost? target populations. The Nutrition Challenge in Uganda: In Uganda, The Impact of the Japan Trust Fund for Nutrition: despite remarkable economic growth in the past In Uganda, the costing exercise triggered an in- 20 years with GDP growth per capita averag- creased level of interest leading to the Minister ing 4% in the 2000s and poverty rates declining of Finance formally requesting the World Bank to from 57% in 1993 to 31% in 2006, rates of under- finance nutrition-related activities in the coun- nutrition have not declined proportionately. In try. It also contributed to the development of a 1995, the prevalence of stunting among children Japan Social Development Fund (JSDF) proposal under-5 was an estimated 45%; ten years later for US$3M to pilot a set of community-based nu- this rate has only fallen by six percentage points trition interventions with BRAC Uganda and in to 39%. The Government of Uganda has recent- partnership with the Ministry of Agriculture. In ly approved a five-year Uganda Nutrition Action Mozambique, the costing report became an effec- Plan (UNAP) to be implemented from 2011–2016. tive tool for the government, leveraging a US$50M UNAP recognizes the many causes underlying un- IDA investment to prepare a new nutrition project. dernutrition and the need for a multi-pronged approach, involving the health, education, agri- The cases of both Uganda and Mozambique are culture, social welfare, water and sanitation, and examples of how small technical assistance can trade sectors. catalyze interest at a high level and mobilize the World Bank and other partners to invest in The Nutrition Challenge in Mozambique: Over nutrition. the last decade, Mozambique has experienced sustained economic growth, with per capita GDP growing at an average rate of 8% per year. However, child undernutrition has not decreased Africa Region Published Materials at the same pace, remaining at an unacceptably high level. Stunting dropped only marginally from Selected Publications 47 to 43% between 2003 and 2008, remaining t Angola Nutrition Gap Analysis (2011) above the WHO’s threshold for “very high� stunt- t Combating Malnutrition in Ethiopia: An ing (national prevalence rate >40%). Evidence-Based Approach for Sustained Results (2012) Project Details: The Scaling Up Nutrition t Documento de Discussao sobre SNP Análise Framework highlights the dearth of localized das Deficiências Nutricionais em Angola costing data for nutrition interventions focus- (2011) ing on the “window of opportunity� , also known t Value chain approach to increase production as the critical period between conception and of RUTF/CSB (2011) 24 months of age during which undernutrition can and should be prevented. The purpose of the REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 21 Latin America and the Caribbean Central America’s Nutrition Challenge: The impe- tus for this exchange originated from a dialogue “The Japan Trust Fund for Nutrition re- with clients in each of the countries that ex- sources provided seed capital to devel- pressed interest in engaging with other regional op innovative products, promote robust implementers of community-based nutrition pro- knowledge exchange, and foster better grams. Specifically, countries were interested to and broader nutrition investments in sev- discuss operational lessons learned, to share ideas en LCR countries.� about how to improve the program model, and to — Sector Director learn about new modules that had been integrat- ed into other regional programs since a similar ex- Second Regional Nutrition Workshop in change in 2006. Central America Project Details: The workshop focused on AIN-C Latin America and the Caribbean Region programs, which are recognized as a promising preventive approach to reducing malnutrition “This type of exchange is a popular idea, and are being adapted and scaled up as an inte- but it doesn’t get to happen very often.� gral component of many country-based nutrition — Nutrition Specialist strategies in Latin America and worldwide. During the workshop, countries presented recent innova- The Role of the Japan Trust Fund for Nutrition: tions, including an early childhood development More than 80 high-level policymakers and coun- component, a mechanism to assess the quality try program staff responsible for setting and im- plementing nutrition policies for 11 countries in the region convened for the Second Regional Nutrition Workshop “Promoting Healthy Growth to Prevent Chronic Malnutrition: Advances and Opportunities for Community-based Strategies in Central America�, in Panama City, Panama from October 26–28, 2011. The workshop provided a fo- rum for participants to share their recent inno- vations and challenges, and to learn from the experiences and expertise of others in the region. Financing from the Japan Trust Fund enabled the inclusion of additional countries not yet imple- menting the traditional community-based growth promotion (CBGP) model of Central America, known as AIN-C (Atención Integral a la Niñez con base Comunitaria, Integrated Care for Children of health and nutrition services at the communi- at the Community level). Participating countries ty-level, intercultural adaptation of services for in- included Belize, Bolivia, Ecuador, El Salvador, digenous populations, and monitoring systems to Guatemala, Haiti, Honduras, Mexico, Nicaragua, track beneficiaries at the community, municipal, Panama and Peru. regional and national levels. 22 JAPAN TRUST FUND FOR NUTRITION Technical experts presented on the potential to And, finally, there was a program “marketplace� enhance the effectiveness of the community- (Mercado), in which country participants dis- based integrated child care strategy (AIN-C for its played—and viewed others’—training and com- Spanish acronym) model. They discussed growth munication materials in a casual market setting. measurement, including its purpose and the tools The Mercado provided participants the oppor- that are most appropriate at the community level, tunity to see how their peers integrated com- the use of cell phones for program monitoring, the prehensive cultural sensibility components into strengthening of behavior change communication their training and communication materials, as strategies, and the role of community-based pro- well as how other modules (early child develop- grams in supporting the use of micronutrient pow- ment, for example) were incorporated into the ders (MNPs). AIN-C workplan. There were three unique practical learning op- The Impact of the Japan Trust Fund for Nutrition: portunities for workshop attendees. One was Regional exchanges like this are instrumental for a field visit to two communities in the province multiplying the impact of effective nutrition inter- of Coclé in Panama (Lubá and San Pedro), where ventions across countries with similar contexts. participants observed the AIN-C program in ac- The workshop generated excitement among par- tion. Another was a hands-on activity to prac- ticipants and was a catalyst for lasting collabora- tice using cell phones for program monitoring. tion across the region. Box 4. Webinar Series Continues to Fuel the Regional Exchange of Experiences A series of webinars have been initiated in response to demand from participants for more in-depth discussion of challenges identified by participating countries at the workshop. As is the case with the workshop, learning from each other is an important component of the webinar series. The first of these follow-up webi- nars took place in April 2012, focusing on motivation and retention of community volunteers, a challenge noted by every presenting country. The 75-minute webinar was hosted and moder- ated by the World Bank and included a presentation on the theory of motivation by an expert in strategic communication, followed by a presentation of a successful program in Guatemala which aimed to improve worker motivation using short message service (SMS) text messages. The webinar concluded with an ac- tive discussion among 20 participants from four countries. Financed by the South–South Experience Exchange Trust Fund (SEETF), the second webinar in this series focused on program monitoring, and involved interactive scenarios where countries were encouraged to share their own monitoring indicators, with an expert highlighting the positive and negative aspects of them. Country participants also had an opportunity to ask program-specific questions, and learned about certain “ideal� monitoring indicators for CBGP programs. The webinar series is one way that the World Bank is finding creative ways to reach country program staff and fueling the collaboration catalyzed by the Japanese Trust Fund. REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 23 Mi Futuro en Mis Primeros Centimetros children can stand more than a head shorter than their well-nourished peers. However, in a commu- Ecuador, Guatemala, Honduras, Mexico, nity where over 30% of children are stunted, this Nicaragua, Peru form of undernutrition can go unnoticed. The lack of awareness of the extent of the problem in the “The videos made the malnutrition prob- community can hamper attempts to address it in lem visible and understandable to parents, the face of other competing priorities. health service providers, media and policy- makers in many countries in the region� Project Details: Mi Futuro en Mis Primeros Centime- — Senior Economist tros describes the effects of chronic undernutri- tion and presents ways to prevent it by depicting The Role of the Japan Trust Fund for Nutrition: Mi the stories of real people from the local communi- Futuro en Mis Primeros Centimetros was created to ties where it was produced, using simple, repeated address the fact that stunting (being too short for messages portrayed in a visually engaging manner. one’s age) is commonly perceived to be “normal� by The video was disseminated through various ven- families and communities in Latin American coun- ues in each country in which it was produced. tries and therefore not a problem. The 10-minute video asserts unequivocally that every child has the Longer versions of the video were disseminated same potential for linear growth up to the age of through the conditional cash transfer (CCT) pro- two years, regardless of their ethnicity, nationality, grams in Ecuador, Honduras and Mexico where and socioeconomic status. It was first produced in they are used in health center waiting rooms Peru, but on the heels of major success there, it was with a rapt audience of mothers awaiting their later culturally adapted and translated for use in appointment. In Mexico, the video was translat- five other countries in the region including Ecuador, ed into several indigenous languages to increase Guatemala, Honduras, Mexico and Nicaragua. reach to the broadest at-risk population possi- ble. In Honduras and Peru, 30-second television Latin America’s Nutrition Challenge: For many, mal- spots, posters and pamphlets were produced nutrition conjures the image of children emaciat- based on the messages of the video. Shorter ver- ed by acute malnutrition (wasting) resulting from sions of the video were presented to policymak- episodes of extreme drought or famine. However, ers at high-level meetings. All videos are available malnutrition in Latin America is typically not due on YouTube, where together they have been to a massive shock, but rather subtler causes such viewed over 34,000 times. Financing was used to as sub-optimal feeding and child caring practices reproduce the video at a relatively low cost across that result in the stunted growth of children. This the region, and thereby maximize the benefit of is evidenced by the low levels of acute malnutri- the investment. tion documented in the region (prevalence around 2%). Low regional prevalence rates hide disparities The Impact of the Japan Trust Fund for Nutrition: inside the region and within countries. Persistent Mi Futuro en Mis Primeros Centimetros was a ma- inequalities exist as malnutrition affects signifi- jor success not only in getting the message out to cantly more of the poorest and least educated, es- beneficiaries and health workers, but also by mak- pecially indigenous populations. ing a real impact on high-level nutrition policy in nearly every country in which it was replicated. In Chronic undernutrition, or stunting, is exceeding- acknowledgement, the video series was awarded ly difficult to detect by the untrained eye. Stunted first place in the World Bank’s Innovation Fair and 24 JAPAN TRUST FUND FOR NUTRITION a bronze medal in the World Bank’s Knowlympics In Mexico the Commission for Social Protection competition (May 2012). in Health included the video in its new commu- nications strategy, and more than ten thou- In Peru, national nutrition standards were de- sand copies were distributed to 31 states. The fined based on the key messages in the video and Commission considers the video to be critical in the former Prime Minister requested the produc- promoting the importance of measuring height tion of shorter spots that were shown extensive- as well as weight in growth monitoring during ly on public television and disseminated through the critical window of opportunity in the first radio. In Honduras, the video contributed to get- years of life. ting nutrition on the national agenda by catalyz- ing interest on the part of Bank staff and country The video made innovative use of media to raise ministers. the visibility of chronic undernutrition, estab- lish appropriate growth standards, and set expectations for child growth. This type of ad- vocacy is vital to keeping the issue of nutri- tion on the agenda for policymakers, and is an Box 5. Mi Futuro en Mis Primeros effective companion to other more academ- Centimetros ic initiatives. The project would not have hap- pened—certainly not at the scale in which it did —without the support of the Japanese Trust Fund. It is a testament to the fact that a small amount of seed money astutely invested can be a game- changer for scaling up nutrition. Strengthening the Impact of CCT Programs on Nutritional Outcomes Ecuador “The funds were instrumental to support the definition of nutrition co-responsibil- ities in the Conditional Cash Transfer Pro- gram Bono de Desarrollo Humano which are expected to promote attendance at nutri- View tion services� Mi Futuro en Mis Primeros Centimetros on — Operations Officer YouTube: t Ecuador The Role of the Japan Trust Fund for Nutrition: t Guatemala The Japan Trust Fund supported the prepara- t Honduras tion of a strategy to strengthen the nutrition- t Mexico al impact of cash transfers in Ecuador’s Bono de t Nicaragua is coming soon Desarrollo Humano (BDH) CCT program through t Peru re-evaluation of the BDH incentive scheme, identification of adequate procedures to verify REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 25 compliance of health co-responsibilities, and the CCT programs have become one of the most wide- definition of an early warning system to identify spread social protection instruments, particu- children at risk for stunting. larly in the Latin America Region. The delivery of cash subject to compliance with co-responsi- Ecuador’s Nutrition Challenge: Ecuador is among bilities or conditionalities has led to improved the Latin American countries that have a high health and education indicators, as well as the level of chronic child malnutrition despite being reduction of poverty in many countries. CCT pro- a middle-income country. In 2006, the stunting grams also provide an opportunity to positively rate for children under five years old was 26%, shift nutrition indicators through: (i) increasing similar to those reported by Botswana (23%), family income and a family’s ability to consume Ghana (26%) and South Africa (23%). more and/or better quality food; (ii) enforc- ing conditionalities that require access of basic Eradication of stunting is therefore a top priori- health and nutrition services in order to receive ty and is included in the National Plan for Good the cash transfers; (iv) providing educational ses- Living (Plan Nacional para el Buen Vivir, 2009– sions that promote changes in nutrition, hygiene 2013). In 2009, the Government of Ecuador de- and health habits; (v) promoting delivery of mi- signed a multisectoral nutrition strategy that cronutrients; and (vi) promoting accountability prioritized assistance for pregnant women and in health service provision. children from birth to five years. After two years of implementation, there was a 12% reduction in The Japan Trust Fund supported a review of the the anemia rate in the Central Sierra Region and technical and operational details of the health a drop of three percentage points in the prev- and nutrition conditionalities of CCT programs alence of stunting at the national level, but im- across Latin America. This review examined the provements have been insufficient to achieve different design and implementation mecha- national and Millennium Development Goals. nisms of nutrition conditionalities and how they have been adapted to local contexts, analyzed Project Details: Underlying these unsatisfactory key implementation challenges, and summarized nutritional results are causes linked with home best practices across the region. The results of nutrition caring behaviors, lack of coverage and the review contributed to CCT work in Ecuador quality health services, and lack of communi- and Peru. ty and home counseling. Reforming the design and governance of the existing CCT and other so- The Impact of the Japan Trust Fund for Nutrition: cial assistance programs was needed in order to The support of the Japan Trust Fund has been in- achieve nutrition goals. Technical recommenda- strumental in the Government of Ecuador’s ef- tions provided by the World Bank focused on the forts to transform Bono de Desarrollo Humano payment system and analysis of the financial sus- from an unconditional to a conditional cash tainability of an additional monetary incentive transfer program, conditioned on participation scheme for the BDH under the conditionality of in health and nutrition sessions, and starting in pre-natal and post-natal nutritional check-ups. the poor rural areas where services are already in The work culminated in the creation of the Zero place. Malnutrition program (Desnutricion Cero), imple- mented by the Government of Ecuador. 26 JAPAN TRUST FUND FOR NUTRITION Improving Integrated Care Via Self- educator who usually comes from the communi- Evaluation for Women and Children at the ty itself, conducts periodic, systematic reviews Community Level of health charts for all children age 2 months, 6 months, 12 months, and 24 months, using a check- Guatemala list specifically designed for use at primary care centers. Community health workers then follow- “We’re building the capacity of the commu- up with families, particularly those who have nities in Guatemala to systematically mon- missed weight and height measurement sessions. itor the nutritional status of their children, with the help of health workers.� The Japan Trust Fund financed technical assistance — Senior Human Development Economist for the Guatemala Ministry of Health to design, train, pilot, and supervise the community moni- The Role of the Japan Trust Fund for Nutrition: toring tool, and ensure its acceptability, long-term With technical assistance from the World Bank feasibility and sustainability while expanding it to and financing, in part, by the Japanese Trust Fund, other areas. It was vital to ensure that any indica- the Government of Guatemala designed an inno- tor included on the checklist (i.e. immunizations, vative “auto-analysis� system of quality control, counseling on infant and child feeding, supplemen- thereby increasing the capacity of community tation, etc.) could be easily understood and mon- health volunteers to monitor the nutritional sta- itored by uneducated community members with tus of children in their community. It is a simple the support of community educators. Effort was yet practical tool designed to facilitate a means also made to sensitize community leaders, care- of community stocktaking while at the same time givers/mothers, midwives, and other household fostering a communal sense of responsibility. Guatemala’s Nutrition Challenge: Although Guate- mala is a middle-income country, its stunting Box 6. Regional Workshop to Examine rate of 49.8% is the highest in the Latin America AIN-C and Caribbean Region, and among the highest in the world, comparable to that of lower income The concept of community-based countries in Africa and South Asia. Capacity of AIN-C has been well accepted in the health infrastructure is weak; the Maternal- Guatemala and the program has Infant Health and Nutrition Program focuses on been showing improvement over the sizable proportion of the population that is time. However, at the request of rural, poor, and indigenous, and lacks access to the Government of Guatemala and with financ- basic services. In the past, communities would ing from the Japan Trust Fund, the World Bank have been dependent on more highly trained med- convened a regional workshop to examine the ical staff from outside the community to conduct evidence from CBGP programs around the world an assessment, usually without involving the in September 2010. Technical experts presented community. on the compiled knowledge from other coun- tries, and provided guidance on opportunities Project Details: The team of community health for Guatemala to improve their program. volunteers in collaboration with a community REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 27 members (e.g. mothers-in-law and fathers) on From Pilot to National Nutrition Program: appropriate nutritional and health practices. Household Development Agents Through validation testing, Bank staff and consul- tants helped guide the selection of indicators that Haiti were both meaningful and simple, and phased-in implementation of the monitoring tool. “The idea is to reduce the cost, because it’s very expensive to have all of these agents. Another important aspect of the Maternal and And then hopefully with the same money, Infant Health and Nutrition Program is the dis- we could cover the entire area.� semination and reinforcement of consistent, sim- ple messages about positive infant and young “It’s a tool to simplify the work and to child feeding practices, made difficult by the make sure that you’re not only going to the number of indigenous populations and languag- families that are the closest.� es in Guatemala. All communication materials — Social Protection Economist in Guatemala have been translated into at least eight languages, and the program ensures that The Role of the Japan Trust Fund for Nutrition: the messages are both consistent and relatable The Japan Trust Fund financed analysis, policy di- to each of the various ethnicities present in the alogue and improvements in nutrition programs country. in close collaboration with the United Nations, donors and NGOs in Haiti. In particular, the Japan The Japan Trust Fund also contributed to the dis- Trust Fund was crucial in financing the develop- semination of the communication materials by ment of a national nutrition policy and provid- supporting the Guatemalan communications spe- ing technical assistance in the development of cialist who developed the country-specific ma- an innovative multisectoral program aiming to terials to present his work both at the Regional ameliorate nutrition and food security in a com- Nutrition Workshop in Central America and in prehensive and integrated manner using com- Washington, D.C. All communications materials munity health agents already working in the related to the project are housed in a Communica- community. The program, designed with techni- tions Resource Bank (CRB) in Guatemala City that cal assistance from the World Bank and United is open to anyone working on nutrition in Guate- Nations and with the support of the Japan Trust mala. Various materials are available including flip Fund, is applicable to any rural area in Haiti but charts, audio CDs, DVDs, radio spots/radio dra- is currently being piloted in the Department of mas, and e-learning courses. the Center, one of the most impoverished de- partments in Haiti, with the poorest social and The Impact of the Japan Trust Fund for Nutrition: health indicators. The quality control program was piloted in a few communities in 2009/2010 and is now be- Haiti’s Nutrition Challenge: Government financ- ing refined based on lessons learned in prepara- ing and leadership in Haiti has been limited over tion for adoption, adaptation and scale up. The the past decade. Health and nutrition services Japan Trust Fund played a critical role in develop- are highly fragmented, and primarily financed by ing the capacity of community health volunteers donors and provided by non-governmental orga- throughout Guatemala to monitor their children’s nizations (NGOs). Family health and nutrition ser- growth and the provision of important nutrition- vices remain limited, with some areas experiencing al services. wasteful duplication of effort and other areas 28 JAPAN TRUST FUND FOR NUTRITION lacking any services at all. As result, over one-third each household. A technical working group was of children are chronically malnourished. charged with defining and procuring the mini- mum package distributed to families to reduce Community agents in Haiti working under a specif- malnutrition. This group was also responsible for ic project deliver one item at a time (e.g. distribute defining the indicators used for performance- bed nets, give a specific vaccine). Used as a pe- based payment of agents, exams for the agents, ripheral strategy to reach families by the Ministry and recruitment. of Health, the Ministry of Agriculture, and the Ministry of Social Affairs, agents are provided guid- The agents were recruited from the community ance by their respective ministry but are paid and and have often been working with partner NGOs supervised by the NGO that hires them. The result already. However, training exceeds the scope of is that in the same area or even the same NGO, dif- services traditionally provided by agents, and was ferent community agents are reaching out to the done modularly to ensure retention of informa- same families with different services or products. tion across a large variety of topics, including, for Agents visiting families may notice other issues in example, vaccines, malaria, nutrition, education, the household, but are limited to the single product and hygiene. Training was completed over a peri- or service they have been charged with distributing. od of one year. Project Details: The goal of the new program design Innovative components of the program include is to enable the agent to address each family com- the creation of a municipal hub to support the prehensively—cutting across sectors to address the community agents, a management information most important individual and household needs, as system using Global Positioning System (GPS) co- identified both by the agent as well as by the fami- ordinates for all households in the community, and ly itself. The new design replaces overlapping agents a comprehensive census of all service providers in covering geographic areas with approximately 1,500 the area. These aspects are vital to simplifying and people distributing individual products or services, systematizing the work of the agents, enabling with one “polyvalent� agent responsible for provid- proactive nutrition and food security monitoring ing health, nutrition, and social services to 100–150 and prioritization of households, and fostering households, and providing referrals as needed. collaboration and shared ownership among part- ners and locally elected leaders to ensure that the Using a diagnostic socio-economic assessment data are maintained. specifically designed for the purpose of the initia- tive, agents were paired with professional enumer- The Impact of the Japan Trust Fund for Nutrition: ators to categorize households into four levels of The Household Development Agent pilot pro- vulnerability based on indicators for the following gram design has been identified by the National six categories: demographic data, health, econo- Programme for the Fight against Hunger and my, living environment, food security, and educa- Malnutrition, “Aba Grangou�, announced by tion. A score was given for each indicator based on President Michel Martelly in January 2012, to be the response of the family during the vulnerability replicated throughout the country. assessment, and a family vulnerability index was then constructed. The Japan Trust Fund financed part of the design and technical assistance for the implementation of The family’s vulnerability rank determines the the initiative. In so doing, it is perhaps the epitome frequency with which community agents visit of a small project benefiting from the support of the REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 29 Japan Trust Fund that has truly made an impact at for 10 years, despite investment of US$200M per the very highest levels. year in nutrition programs. The Government of Peru under President Garcia defined malnutrition Beyond the ABC and 123 as a key government priority and set a goal of re- ducing malnutrition by five percentage points in Peru five years. “When you have half a million kids chron- Project Details: The video and report were ically malnourished, it’s very hard to talk launched in a seminar of over 100 attendees from about the future labor force. Everything the health, education, labor, and finance sectors. starts there. Anything that happens later Another 80 people participated via WebTV pro- in school, you’re just starting with a very vided by Salgalú TV, a channel dedicated to ear- strong limitation.� ly child development in Peru which webcast the —Lead Economist event. The Role of the Japan Trust Fund for Nutrition: With over 4,000 YouTube views in the first month Beyond the ABC and 123 was launched on June 21, of its launch, the Spanish version of Beyond the 2011 in an effort to frame nutrition as critical for ABC and 123 was the most viewed World Bank vid- Peru’s economic growth, competitiveness, and eo in the Latin America and Caribbean region. The employability, and not solely as a human rights video is also available in English. The simple visu- issue. The video, financed by the Japan Trust al format of the video enables key communication Fund, was a companion to an eye-opening report messages to reach a broader audience than is typ- (Strengthening Skills and Employability in Peru) ical for the World Bank. And hosting the video on on the link between nutrition and early childhood YouTube has allowed it to be shared and discov- development. ered by new audiences long after the initial launch, demonstrating the multiplier effect of this Japan That nutrition is important for development of Trust Fund investment. Ultimately the Beyond the cognitive skills has been well established, but link- ABC and 123 video had far greater reach than the ing nutrition with socio-emotional development written report. (skills related to work ethics, reliability and inter- personal relations) is something that has not pre- The Impact of the Japan Trust Fund for Nutrition: viously received much attention. In making the This initiative helped to get child malnutrition on link between nutrition and basic socio-emotion- the broader agenda. Stakeholders in the health al skills, Beyond the ABC and 123 fostered wide- sector were pleased to see child nutrition linked spread dialogue in Peru on this emerging area of so directly and vividly to future performance in research. the labor market through its role in cognitive and socio-emotional development. Moreover, the Peru’s Nutrition Challenge: With a prevalence Beyond the ABC and 123 video catalyzed a multi- of stunting among children under-5 at approxi- sectoral response in Peru and helped put the top- mately 30%, the rate of malnutrition in Peru is ic of nutrition squarely on the educational agenda. higher than would be expected for the level of de- The Ministry of Education has approached the velopment of the country. In 2005/2006, when Bank with interest in adapting policies (e.g. learn- the World Bank first started working on nutrition ing standards and teacher training) to reflect the in Peru, the malnutrition rate had been stagnant importance of socio-emotional skills. 30 JAPAN TRUST FUND FOR NUTRITION The video received an unanticipated level of trac- lenses (nutrition, health, early child development tion in the business sector’s ongoing discussions (ECD), basic education, training). about competitiveness and employability. The connection between early childhood nutrition in- Ultimately the video has reached far beyond Peru. terventions and the work skills that impact their It is considered to be an example of an effective vid- bottom line, as well as the notion that efforts eo campaign by think tanks that promote the im- to address malnutrition in their community con- portance of socio-emotional learning, such as the tributes to the quality of their future workforce, Collaborative for Academic, Social, and Emotional was compelling. Respected opinion leaders— Learning (CASEL), and the Novo Foundation, two even those in the business community—echoed leading nonprofit organizations in this area in the key messages across major media outlets (news- United States. papers, television, radio) and through all relevant Latin America and the Caribbean Region Published Materials Selected Publications t Nutrition Security in Haiti: An Assessment of Pre- and Post-Earthquake Conditions and Recomme- ndations for the Way Forward, English | French (2010) t Promoting Nutrition Security in Haiti: An Assessment of Pre- and Post-Earthquake Conditions and Recommendations for the Way Forward, English | French (2010) Videos t Beyond the ABC and 123: Skills for Peruvians of the 21st Century t Mi Futuro en Mis Primeros Centimetros, Ecuador t Mi Futuro en Mis Primeros Centimetros, Guatemala t Mi Futuro en Mis Primeros Centimetros, Honduras t Mi Futuro en Mis Primeros Centimetros, Mexico t Mi Futuro en Mis Primeros Centimetros, Peru t Webinar: Motivación de Los Voluntarios Comunitarios REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 31 South Asia Training Courses to Strengthen Capacity in Nutrition South Asia Region The Role of the Japan Trust Fund for Nutrition: In the South Asia Region, as in other areas, the lack of strong political commitment and the low capac- ity of national entities is a barrier to scaling up nu- trition. The Bank seeks to contribute to meeting these challenges by increasing the capacity of poli- cymakers as well as national and sub-national pro- gram managers/coordinators to understand the nature and costs of malnutrition for national de- velopment and to take appropriate actions to con- trol and prevent malnutrition from community to national levels. Box 7. Nutrition Advocacy Brochures Afghanistan, Nepal, Pakistan With the Japan Trust Fund financing, nutrition advocacy brochures were produced for Afghanistan, Nepal, and Pakistan. The brochures serve as a brief summary for policymakers and opinion leaders of the scale, causes and potential responses to undernutrition in their country. For Bank staff and other nutrition advocates, they serve as a quick communication tool for use in brief or serendipitous engagements. Unlike typical Bank re- ports, each page of the short brochure is highly visual, incorporating bold headlines and striking graphics and charts that can be easily referenced in conversation. Given a brief moment to make an impact, it is cru- cial to have compelling and convincing information at hand. The brochures strike the perfect balance of convincing data and high visual appeal, and have proven their worth as effective communication tools. In Afghanistan the brochure was translated from English into Pashto and Dari at the request of the Minister of Public Health, where it contributed to raising the profile of nutrition to the highest level. In Pakistan the brochure became an effective tool for catalyzing interest in nutrition even within World Bank management, and it contributed to donor engagement with a new multi-donor Trust Fund to scale-up nutrition programs. 32 JAPAN TRUST FUND FOR NUTRITION With financing from the Japan Trust Fund, the complete that it is possible to attract funders, but Bank has engaged the Institute of Nutrition at financing is required in order to create the course Mahidol University, Thailand to develop two in the first place. The Japan Trust Fund financing training courses. The purpose of the courses is to was therefore crucial to leveraging the additional increase participant understanding of the impor- funds necessary to implement the training. tance and benefits of multisectoral integration of food, health and development for nutrition im- A Nutrition Assessment to Catalyze provement among vulnerable groups. The Institute Multisectoral Action houses faculty, technical experts, and capacity- building initiatives that are well respected in the Afghanistan region for their success in addressing malnutrition. “We’re investing heavily in education but Project Details: Many nutrition program man- our investment is not as efficient because agers in the region are not nutritionists. The in- we have these high rates of malnutrition.� depth course for program managers is thus aimed —Sector Manager at building their capacities to plan, implement, manage and supervise nutrition programs as well The Role of the Japan Trust Fund for Nutrition: as coordinate nutrition and nutrition-related ac- Afghanistan has the highest levels of child stunt- tions across multiple sectors. It consists of three ing in the world: Sixty percent of children un- two-week modules, each covering a different der-5 are chronically malnourished. In an effort technical or programmatic aspect of nutrition. to catalyze the interest of the Government of Students are expected to come to Thailand for Afghanistan in nutrition, the Japan Trust Fund each two-week module and return to their coun- supported a comprehensive review of nutrition try in between modules. The one week duration of including the nutritional status of women and the second course targets senior level policymak- children, the types of programs that are avail- ers who cannot leave their posts for long. It focus- able, their coverage, institutional arrangements es on building capacity to prioritize nutrition on and key stakeholders, and other sectors that the development agenda. could potentially play a role in scaling up nutri- tion. The results were published as a World Bank The overall purpose of the two courses is the same. “Directions in Development� book (2011). This re- Part of the motivation for conducting the course view was carried out with the participation of a in Thailand is for participants to learn from the wide group of stakeholders, thereby generating Thai experience, so field visits and group work are a common understanding of the main causes of incorporated into the curriculum. And, in addition malnutrition in Afghanistan. to imparting technical and programmatic knowl- edge, the course fosters networking among par- Afghanistan’s Nutrition Challenge: Since 2001, ticipants, so that they can learn from each other’s development partners have worked to create a experiences and about initiatives that other coun- strong infrastructure for nutrition in Afghanistan. tries are implementing. From 2002 to 2005, an intensive investment was made in the Public Nutrition Department (PND) The Impact of the Japan Trust Fund for Nutrition: in the Ministry of Public Health. Although based This project reflects a challenge typical of capaci- in the health sector, the PND coordinated ac- ty-building initiatives. It is only once the course is tions across many sectors for nutrition through a REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 33 network of task forces. However, there have been Accelerating Progress in Reducing Maternal challenges to sustaining this capacity. and Child Undernutrition Project Details: The nutrition assessment was cru- Nepal cial for catalyzing response among World Bank management and government ministers. Senior The Role of the Japan Trust Fund for Nutrition: World Bank leadership championed nutrition; sub- With financing from the Japan Trust Fund, a high- sequent dialogue with the Ministry of Finance level delegation from Nepal led by the Minister of and development partners has led to increased Health and Population attended the annual meet- investment in nutrition and to a high-level coor- ings of the World Bank in November 2009. In his dination mechanism to sustain these renewed presentation at the special meeting on Scaling investments. Up Nutrition: What Will It Take?: The Window of Development Opportunity, the Minister of Health With the Japan Trust Fund and other resources, and Population presented Nepal’s nutrition situ- the World Bank is leading the preparation of a ation and committed to a multisectoral approach multisectoral nutrition action framework to ad- involving Japan Trust Fund-financed technical as- dress malnutrition in a comprehensive and sus- sistance to inform the new plan. tainable manner. The initiative brings together five ministries in the development of a multisec- Nepal’s Nutrition Challenge: Nepal has historical- toral framework that identifies specific actions to ly been a world-leader in nutrition for its micro- be taken to scale up nutrition. The Vice President nutrient program as well as the site of numerous of Afghanistan has since assumed the immedi- groundbreaking studies. Nutrition was there- ate coordinating role for the initiative. Following fore on the national agenda, but only a sliver of the release of the World Bank book, the Ministry the malnutrition problem was being addressed. of Public Health and its development partners The Government of Nepal recognized the need to (USAID, European Community and the World look at nutrition more broadly and to transition Bank) are also placing much greater emphasis on from the health sector to a more multisectoral scaling up the nutrition interventions in the Basic approach. Package of Health Services (BPHS). Project Details: The Nepal Nutrition Group, a body The Impact of the Japan Trust Fund for Nutrition: of development partners that meets monthly to The scale up of nutrition that has happened in coordinate on action, along with the Minister of Afghanistan is a testament to the impact that Health and Population (MOH&P), requested the small catalytic activities like the nutrition assess- World Bank to do a review of global nutrition inter- ment and the nutrition advocacy brochure can ventions in the health sector. Financed by the Japan have in raising the profile of nutrition. The level of Trust Fund, the Accelerating Progress in Reducing awareness about malnutrition and commitment Maternal and Child Undernutrition in Nepal report to address it amongst policy makers and develop- has become a tool for enabling the MOH&P to de- ment partners in Afghanistan has increased signif- termine what interventions are ready to scale up icantly with the release of the World Bank book. within the health sector. This, in conjunction with 34 JAPAN TRUST FUND FOR NUTRITION the Nutrition Assessment and Gap Analysis (NAGA), The Impact of the Japan Trust Fund for Nutrition: formed the foundation for Nepal’s Multisectoral Technical assistance provided by the Bank has National Nutrition Plan of Action. resulted in important evidence to inform the Multisectoral National Nutrition Plan of Action In recognition that Nepal is a leading country for and, in so doing, a final push to implement mul- food fortification, it was selected as a positive case tisectoral nutrition-sensitive initiatives. Nepal is study for a regional meeting held in The Philippines an example of a country that through active en- in September 2011. But while the review, which was gagement at the highest levels combined with financed by the Japan Trust Fund, was expected to the support of catalytic activities financed by be a story about a successful implementation of the Japan Trust Fund and other sources, is lead- a regulatory monitoring system, it identified nu- ing the charge in scaling up nutrition. The Prime merous weaknesses in the system. In combination Minister of Nepal is now a member of the Lead with other initiatives to scale up nutrition, the re- Group for the SUN global movement. port has been catalytic in helping Nepal further re- fine its regulatory monitoring system for fortified A Multisectoral Plan Catalyzes Investment foods, with a particular focus on the iodization of salt and on fortification of wheat flour. Pakistan The Japan Trust Fund has also contributed to scal- “Two years ago, Pakistan was not on the ing up nutrition in Nepal by financing catalyt- nutrition map. Beyond what was actual- ic components of truly novel research that will ly produced by the Japan Trust Fund, hav- continue to feed into the national nutrition pol- ing seed money also enabled us to engage. icy. In a randomized control trial funded by DfID That speaks to the multiplier effect of the (UK Department for International Development) Fund.� comparing social transfers (i.e. food versus cash), — Senior Nutrition Specialist to determine which performs better in improv- ing birthweight, the Japan Trust Fund financed a The Role of the Japan Trust Fund for Nutrition: review to evaluate appropriate foods for weight Armed with the Scaling Up Nutrition Framework gain during pregnancy in the Nepali context. Low and a review of IYCF and CMAM programs financed birthweight is an important contributor to child by the Japan Trust Fund, a meeting of the D-10 mortality and so this study will have important Group (a body of development partners chaired ramifications for the MDGs. by the Minister of Finance) in September 2011 agreed that Pakistan’s provinces would prepare Finally, in an example of the impact of the Japan comprehensive nutrition plans for addressing mal- Trust Fund for Nutrition in simply enabling Bank nutrition through multisectoral approaches. The staff to be at the table, the Japan Trust Fund was provincial plans would include detailed costing, also used to leverage US$2M for a Community resources available within the provinces and the Challenge Fund Pilot Study. The Japan Trust Fund fiscal gaps, from which the federal plan would be financed just the operations manual for this study, revised accordingly. The World Bank was asked to but doing so was crucial for securing the remain- coordinate a coherent development partner re- der of the financing. sponse to the plans. REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 35 Pakistan’s Nutrition Challenge: The D-10 Group theory—but in terms of specific interventions. typically meets to discuss economic issues. The foundational research reports along with the However this 2011 meeting at the Planning provincial scale-up plans will be used to update Commission was triggered, in part, by a presen- the national nutrition strategy. tation on the economic ramifications of mal- nutrition in Pakistan, and marked a significant In February 2012, the Japan Trust Fund financed escalation of interest in nutrition in Pakistan. the follow-up D-10 Planning Commission meet- While a multisectoral approach is ultimately what ing where the provinces presented their plans. Pakistan needs in order to achieve sustainable im- With results of the recently concluded National provements in nutrition, it is first necessary to im- Nutrition survey showing little improvement of plement the direct nutrition interventions at the nutrition status in the country, Pakistan’s leader- provincial level. ship reemphasized their commitment to the mul- tisectoral approach to scale up nutrition in the Project Details: The capacity in Pakistan to scale February meeting. up nutrition is weak, leading to the use of the Japan Trust Fund resources for technical assis- The World Bank has since facilitated the for- tance to the Government of Pakistan to help with mation of the Pakistan Nutrition Development development of the scale-up plans (PC-1s) for the Partners Group to enhance the coordination of do- provinces. Workshops were organized to help nor response. teams think through what was needed—not in Box 8. Regulatory Monitoring Workshop on Salt, Wheat Flour and Oil Fortification Programmes Through the devolution process described above, responsibilities that used to reside at the federal level in Pakistan have been relegated instead to provinces, including the Department of Health, the Department of Agriculture and the Department of Food. As a result, there is a lack of both training and adequate knowl- edge on food control systems. In March 2012, the Regulatory Monitoring Workshop on Salt, Wheat Flour and Oil Fortification Programmes was convened to provide technical training to representatives of the provincial agencies, federal agencies such as Pakistan Standards and Quality Control Agency (PSQCA), Pakistan Atomic Energy Commission, wheat flour industry leaders, salt industry leaders and vegetable oil producers. The Japan Trust Fund financed the participation of a leading expert in food fortification regu- latory systems who presented on food control systems, legislation and standards, and internal, external and commercial monitoring. This workshop mobilized key partners to consider food fortification as an im- portant component of scaling up nutrition in Pakistan. 36 JAPAN TRUST FUND FOR NUTRITION The Impact of the Japan Trust Fund for Nutrition: with a little seed funding, by one of the countries The SAFANSI has expressed interest in supporting most lagging in nutrition programs. In both cases, a process to enable the provinces to prepare poli- the Japan Trust Fund was key to progress. cy guidance notes on the multisectoral aspects of malnutrition, which will build on available infor- mation and past experience in each province. The World Bank has also created a multi-donor Trust South Asia Region Published Materials Fund called “Partnership for Nutrition in Pakistan Trust Fund� to support provincial programs. Selected Publications AusAID (Australian Government Overseas Aid t Accelerating Progress in Reducing Maternal Program) was the first donor partner to pledge, and Child Undernutrition in Nepal: A review committing US$40M to financing nutrition in of global evidence of essential nutrition Pakistan. interventions for the Nepal Health Sector Plan II and Multisectoral Plan of Action for What the D-10 Group accomplished has had a sig- Nutrition (2012) nificant impact on nutrition programs in countries t Malnutrition in Afghanistan: Scale, Causes around the globe. If Nepal is an example of a country and Potential Response (2011) that is already a leader in nutrition but in need of as- t Nutrition in Nepal A National Development sistance to transition to a multisectoral approach, Priority (2012) Pakistan is an example of what can be accomplished, REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 37 Europe and Central Asia Regional Situational Analysis Kyrgyz Republic, Tajikistan “Through the research, we provided the ratio- nale for why we need to invest in these nutri- tion programs first before moving onto any- thing else.� — Senior Health Specialist The Role of the Japan Trust Fund for Nutrition: With support from the Japan Trust Fund, compre- hensive situational analyses were conducted in the Kyrgyz Republic and Tajikistan, two countries most affected by undernutrition and the 2008 food crisis in Central Asia, to assist them in pri- oritizing nutrition interventions and developing Project Details: The analysis included a review of their national nutrition strategies. nutritional indicators and an assessment of the reach and coverage of nutrition programs in each Kyrgyz Republic and Tajikistan Nutrition country. Cost-effectiveness data of ten nutrition Challenge: At the time the research was initiated, interventions from the Lancet 2008 Child Survival both Kyrgyz Republic and Tajikistan were in the Series were then used with the coverage data to midst of developing their national nutrition strat- calculate the cost/benefit of the interventions in egies. However, a lack of evidence about the nutri- Kyrgyz Republic and Tajikistan at the pragmatic tion situation and scientific rationale for selecting level (20% coverage) and universal coverage for the interventions threatened the effectiveness of the whole population. From this resulted a list of the policies in reducing malnutrition. high-priority interventions that each government 38 JAPAN TRUST FUND FOR NUTRITION should focus on, and a calculation of dollars lost reduced out-of-pocket payments, but thus far had under a scenario of “inaction�. failed to impact health outcomes including ma- ternal and child health outcomes. The Situational The resulting Situational Analysis report for Analysis provides guidance to ensure the Bank is fi- Kyrgyz Republic was launched via a communica- nancing the right interventions to target the right tion campaign that included a video summarizing conditions to ultimately impact outcomes. the findings. The Impact of the Japan Trust Fund for Nutrition: In Kyrgyz Republic the project has leveraged a Europe and Central Asia Region US$10M IDA investment to scale up the nutri- Published Materials tion interventions that were prioritized in the re- port, including micronutrient powders and a flour Selected Publications fortification program. In Tajikistan the nutrition t Situational Analysis: Improving economic component of an ongoing health project will incor- outcomes by expanding nutrition porate findings from the report. programming in the Kyrgyz Republic (2012) Videos The research also benefited the Bank’s work on t Building Tomorrow Through Better Nutrition health financing reforms in Kyrgyz Republic, which in the Kyrgyz Republic had successfully increased access to services and REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 39 Middle East and North Africa salt iodization and staple food fortification with iron—would cost Djibouti about US$800,000 per National Food Fortification Programme year, with potential returns on investment of 8 to Policy Dialogue 30-fold. In contrast to other regions, food fortifica- tion is new to the Middle East and North Africa, al- Djibouti though separate fortification initiatives are being implemented in Tunisia, Algeria, Egypt, Ethiopia, The Role of the Japan Trust Fund for Nutrition: In and Iran. And although Djibouti could benefit from Djibouti, the Japan Trust Fund has supported on- collaboration with neighboring Ethiopia, their re- going policy dialogue and advocacy to launch food lationship has historically been difficult. fortification to address micronutrient deficiencies in the country, particularly among women and chil- The Impact of the Japan Trust Fund for Nutrition: dren. The focus of mandatory staple food fortifi- With a new government and key partners support- cation is on flour and vegetable oil; however more ing the initiative, momentum is building around work is needed to draft standards for fortified implementation of food fortification in Djibouti. foods and to modify existing regulatory systems. Planning is underway for a workshop to dissemi- Currently there are no national standards for the nate research findings and recommendations, cat- fortification of flour, vegetable oil or salt. A reg- alyze development of policies and legislation, and istration and inspection system that is already in mobilize high-level stakeholders. place for all bakeries in Djibouti could be amend- ed to require the use of fortified flour, and thereby provide a strong incentive to ensure that fortified flour is imported and used in the country. Djibouti’s Nutrition Challenge: Due to the geogra- phy of the country, Djibouti is not self sufficient for meeting the food needs of the population. Practically all food is imported, including raw ma- terials (grains) and processed foods (vegetable oil, canned foods, baby cereals, wheat flour). As with many other countries in East Africa there is a heavy reliance on cereals as the main source of calories. Traditionally the population has relied on meat from camel and goat as the main protein source. Despite being a coastal nation with ac- cess to the sea, the consumption of fish as an al- ternative protein source is very low due to cultural norms. Project Details: Food fortification is a promising option for such a small country with high rates of malnutrition. In a report published in 2011, the World Bank showed that the scaling up of four core micronutrient interventions – including universal 40 JAPAN TRUST FUND FOR NUTRITION Nutrition Mapping Seminar nutrition and anthropometric data collected in household surveys, and thereby develop policies Morocco and programs that are properly targeted to the most vulnerable populations. The Role of the Japan Trust Fund for Nutrition: With support from the Japan Trust Fund, the World Multisectoral Program Design to Drive Bank conducted a week-long seminar on nutrition Demand of Community-Based Nutrition mapping to assist the High Commission for the Services Using CCTs Plan (HCP) of Morocco, which manages all data and statistics for the country, in its effort to prepare Yemen nutritional maps based on nutrition data collect- ed via household surveys. During the training ses- The Role of the Japan Trust Fund for Nutrition: For sion, the details of the technique, what it is, how many countries in the Middle East, efforts to scale it can be used, how to tie it in with a poverty map- up nutrition came to a standstill with the onset of ping exercise already underway in the country, as the Arab Spring in 2011. A unique initiative focus- well as the necessary tools for implementing nutri- ing on the design of the nutrition intervention de- tion mapping were covered. There were fifteen at- livery model in Yemen withstood the turmoil. The tendees at the seminar, all staff of the HCP. design of the delivery model, supported by the Japan Trust Fund, is part of a larger initiative in- Project Details: Nutrition mapping is similar to volving two projects working in coordination— poverty mapping in that a census and a survey are one, a JSDF—funded project and the other, an IDA combined to arrive at small-area statistics. The Health and Population Project (HPP). survey is used to estimate the relationship be- tween the outcome variable of interest (such as Yemen’s Nutrition Challenge: Nutrition is a major poverty and nutrition) and its covariates, where problem in Yemen with prevalence of stunting over each covariate must be a variable that is includ- 50% and increasing. Although a National Nutrition ed in both census and survey. Using the estimated Strategy has been drafted, little has been done to relationship, one can predict the outcome vari- operationalize it, there is a severe lack of capacity able in the census. A simulation technique is used at the community level, and nutrition is not yet a to take account of the errors associated with the priority on the national agenda. estimation. Project Details: The supply side of the delivery In addition to technical differences, nutrition map- model, financed by the IDA HPP, focuses on inte- ping differs from poverty mapping in the outcome grating the delivery of nutrition services within variable. Child undernutrition is not the same as the regular service delivery mechanism: for health, poverty because child undernutrition can occur integrating within outreach services and referral not only because of lack of caloric intake but also health facilities; for education, integrating within due to the lack of adequate childcare and illness. a school health program; and for social protection, Therefore, the geographic distribution of child un- integrating within a community-driven develop- dernutrition may be different from that of poverty. ment program. The Impact of the Japan Trust Fund for Nutrition: However, the HPP faces a hurdle in identifying and As a result of this seminar, the staff of the HCP reaching out to communities, especially in rural ar- will be able to produce nutritional maps based on eas. The program design, financed by the Japan REGIONS IN-DEPTH: CATALYZING THE SCALING-UP OF NUTRITION AROUND THE WORLD 41 Trust Fund and described in a pending JSDF pro- and children to the Ministry of Public Health and posal, seeks to create demand for the community- Population facilities for treatment, and provision of based nutrition intervention delivery model among nutrition education services for all mothers of chil- the most remote communities in Yemen through dren under five years old. Additional cash assistance linkages with the existing conditional cash transfer will be provided conditional on satisfactory partici- program and new nutrition-based conditionalities. pation in nutrition and health activities. The proposed pilot complements the existing pro- The Impact of the Japan Trust Fund for Nutrition: gram, administered by the Social Welfare Fund, by This pilot is a collaborative effort to scale up nutri- targeting the poorest of these one million house- tion among multiple sectors of the Bank, and is an holds with nutrition services, including: nutrition example of a project that has been initiated as a surveillance for children under-5 and pregnant and result of the Japan Trust Fund specifically target- lactating women, referral of malnourished women ing nutrition initiatives. 42 JAPAN TRUST FUND FOR NUTRITION Annexes 43 44 Annex 1. Phase 1 Results Framework Japan Overall Trust Fund activities and supported Indicators to measure Triggers for next outputs activities success phase Status as of June 30 2012 Phase I Prepare country 1-Country Scale-up plans started in Fully-costed Eight countries have completed nutrition scale up plans to scale- scale-up 4–6 high undernutrition- strategies developed plans (Benin, The Gambia, Mozambique, Uganda, Haiti, up nutrition plans burden countries. in the selected Djibouti, Yemen, and Nepal) with an additional seven countries countries on track to develop plans based on the Japan Trust Fund-supported analytical work. Actionable plans for Prepare new 2-Policy IDA Project preparation capacity-building Fourteen new projects are under preparation, three JAPAN TRUST FUND FOR NUTRITION projects for dialogue under way in 3–4 high developed in the of them have received IDA financing (Angola, Ethiopia, scaling up and project undernutrition-burden selected high and Kenya) with one other currently under review for nutrition preparation countries undernutrition- IDA financing (Benin). Strengthen 3-Pilot Lessons learned burden countries. Pilots of innovative approaches are being implemented Capacity for innovative disseminated & in Ethiopia, Haiti, Guatemala, Peru, Ecuador, Nepal, and Nutrition approaches incorporated into scale- Yemen. Lessons learned will be disseminated following Program up plans and project evaluation of the pilots by mid-FY12. Development, operations Management 4-Training Training plans and Capacity Assessments have been completed in and supervision and capacity- knowledge networks Rwanda, India, Kenya, Tanzania, and Uganda. Capacity- in Africa and development identified, and agreements building projects were completed in The Gambia, South Asia plans signed with partners in Tanzania, Guatemala, Haiti, Morocco, and Pakistan. Africa and South Asia A South–South Regional Exchange occurred in Latin America and the Caribbean, and another is under preparation for South Asia. South–South Peer Reviews are being conducted in Africa. Training workshops were conducted in India and Pakistan. A webinar series has launched in Latin America and the Caribbean. In South Asia, training modules to build capacity among policy makers and nutrition program managers were created. Prepare global 5-Global Draft global scale-up plan The SUN Framework and Roadmap have been action plan action plan ready for discussion with completed. Implementation is starting in twenty-eight for nutrition countries and partners “early-riser countries� Reform aid and reform architecture in of global aid Background report on A stewardship study looking at aid architecture Nutrition architecture options to reform aid- options for scaling up nutrition is complete. architecture commissioned; dialogue with partners initiated Annex 2. Japan Trust Fund for Nutrition: Activities by Country Activities 1 2 3 4 5 Activities 1 2 3 4 5 Africa South Asia Angola x x Afghanistan x x Benin x x x India x x x x Ethiopia x x x Nepal x x x x The Gambia x x x x Pakistan x x x x Kenya x x x Sri Lanka x Liberia x Europe and Central Asia Malawi x Kyrgyz Republic x x x Mozambique x x x Tajikistan x x x Rwanda x x Middle East and North Africa Tanzania x x x Djibouti x x Uganda x x x Morocco x x Zambia x Yemen x x x Latin America and the Caribbean Belize x Bolivia x Ecuador x x x El Salvador x Guatemala x x x The Japan Trust Fund for Nutrition Phase I Activities Haiti x x x x 1 Country scale-up plans Honduras x x 2 Policy dialogue and project preparation Mexico x 3 Pilot innovative approaches Nicaragua x 4 Training and capacity-development plans Panama x 5 Global action plan for nutrition and reform of Peru x x x x global aid architecture ANNEXES 45 Annex 3. Cross-Listing of Case Studies by Theme Catalyzing activities HNP Support to the Scaling Up Nutrition Global Movement p.15 AFR A Strategic Development Plan for Food and Nutrition p.18 AFR A Multisectoral Plan for Addressing Chronic Undernutrition p.20 AFR Leveraging Funding through Prioritizing & Costing Multisectoral Nutrition p.21 Action Plan LCR Mi Futuro en Mis Primeros Centimetros p.24 LCR Strengthening the Impact of CCT Programs on Nutritional Outcomes p.25 LCR From Pilot to National Nutrition Program: Household Development Agents p.28 LCR Beyond the ABC and 123 p.30 SAR Nutrition Advocacy Brochures p.32 SAR A Nutrition Assessment to Catalyze Multisectoral Action p.33 SAR Accelerating Progress in Reducing Maternal and Child Undernutrition p.34 SAR A Multisectoral Plan Catalyzes Investment p.35 MNA National Food Fortification Programme Policy Dialogue p.40 Leveraging additional project funding HNP Support to the Scaling Up Nutrition Global Movement p.15 AFR Technical Assistance to Increase Capacity While Keeping It Affordable p.19 AFR A Multisectoral Plan for Addressing Chronic Undernutrition p.20 AFR Leveraging Funding through Prioritizing & Costing Multisectoral Nutrition p.21 Action Plan SAR Training Courses to Strengthen Capacity in Nutrition p.32 SAR Accelerating Progress in Reducing Maternal and Child Undernutrition p.34 SAR A Multisectoral Plan Catalyzes Investment p.35 ECA Regional Situational Analysis p.38 MNA Multisectoral Program Design to Drive Demand of Community-Based p.41 Nutrition Services Using CCT Capacity-building AFR Technical Assistance to Increase Capacity While Keeping It Affordable p.19 LCR Improving Integrated Care Via Self-Evaluation for Women and Children at p.27 the Community Level SAR Training Courses to Strengthen Capacity in Nutrition p.32 SAR A Multisectoral Plan Catalyzes Investment p.35 MNA Nutrition Mapping Seminar p.41 MNA Multisectoral Program Design to Drive Demand of Community-Based p.41 Nutrition Services Using CCT MNA National Food Fortification Programme Policy Dialogue p.40 (continued on next page) 46 JAPAN TRUST FUND FOR NUTRITION Annex 3. Cross-Listing of Case Studies by Theme (continued) Working multisectorally HNP Support to the Scaling Up Nutrition Global Movement p.15 AFR A Strategic Development Plan for Food and Nutrition p.18 AFR A Multisectoral Plan for Addressing Chronic Undernutrition p.20 AFR Leveraging Funding through Prioritizing & Costing Multisectoral Nutrition p.21 Action Plan LCR From Pilot to National Nutrition Program: Household Development Agents p.28 LCR Beyond the ABC and 123 p.30 SAR Accelerating Progress in Reducing Maternal and Child Undernutrition p.34 MNA Multisectoral Program Design to Drive Demand of Community-Based p.41 Nutrition Services Using CCT South–South knowledge exchange LCR Second Regional Nutrition Workshop in Central America p.22 LCR Webinar Series Continues to Fuel the Regional Exchange of Experiences p.23 LCR Strengthening the Impact of CCT Programs on Nutritional Outcomes p.25 LCR Regional Workshop to Examine AINM-C p.27 SAR Training Courses to Strengthen Capacity in Nutrition p.32 SAR Accelerating Progress in Reducing Maternal and Child Undernutrition p.34 Innovative use of media HNP Investing in Nutrition: Let’s Grow Together p.17 LCR Webinar Series Continues to Fuel the Regional Exchange of Experiences p.23 LCR Mi Futuro en Mis Primeros Centimetros p.24 LCR Beyond the ABC and 123 p.30 SAR Nutrition Advocacy Brochures p.32 Nutrition and Early Child Development LCR Second Regional Nutrition Workshop in Central America p.22 LCR Beyond the ABC and 123 p.30 ANNEXES 47