Nourishing Ideas for Action: The South Asia Food and Nutrition Security Initiative 2010-18 © 2019 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street NW Washington D.C. 20433 Telephone: 202-473-1000 Internet: www.worldbank.org All rights reserved. This volume is a product of the staff of the International Bank for Reconstruction and Development/ the World Bank. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. All financial figures in this report are expressed in U.S. dollars. Rights and Permissions The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/the World Bank encourages dissemination of its work and will normally grant permission to reproduce portions of the work promptly. Contents Acknowledgements ....................................................................................................................... 4 Executive Summary ....................................................................................................................... 5 1. Introduction ................................................................................................................................ 7 2. Food and Nutrition Security in South Asia – Progress and Challenges ......................... 10 3. The SAFANSI Portfolio ............................................................................................................... 13 Box 1. Bangladesh: Protecting children with a toilet and soap ............................................... 20 Box 2. Bhutan: Telling the story of healthy diets ...................................................................... 22 Box 3. India: Village self-help groups teach nutrition ............................................................... 23 Box 4. India: Social Observatory dataset helps villagers, researchers ................................... 24 Box 5. Nepal: A 1,000-day window of opportunity .................................................................. 26 4. Program Management and Administration ........................................................................ 29 5. Main Findings .............................................................................................................................. 31 Box 6. Tool to prioritize and budget support for breastfeeding ............................................. 32 6. Lessons Learned ......................................................................................................................... 33 7. Conclusion - Looking Forward .................................................................................................. 34 Box 7. Private sector partnership fortifies milk for millions .................................................... 35 Annex 1: Participants in Consultations about SAFANSI’s Impact ................................................ 39 Annex 2: SAFANSI Portfolio .............................................................................................................. 41 Annex 3: SAFANSI Portfolio - Main Findings (summarized) ......................................................... 47 Annex 4: Results Framework, Phase I ............................................................................................ 59 Annex 5: Results Framework, Phase II ........................................................................................... 68 Annex 6: SAFANSI Outputs by Country .......................................................................................... 77 Annex 7: Overview of projects linked to SAFANSI grants ............................................................. 89 Nourishing Ideas for Action Acknowledgements The report, “Nourishing Ideas for Action: The South Asia Food and Nutrition Security Initiative 2010-18,” was prepared by the SAFANSI team with help from experts throughout the World Bank. The core team was comprised of staff from the Agriculture Global Practice: Md Mansur Ahmed, Agricultural Economist; Jamie Greenawalt, Operations Officer; Iftekhar Haque and Yurie Hoberg, Consultants; Xueling Li, Agricultural Specialist; Juan Carlos Rojas, Graphic Designer; Miki Terasawa, Consultant; and Julie Vorman, Editor. The team was co-led by Bremala Malli, Senior Operations Officer, and Pauline Zwaans, Senior Operations Officer. The team acknowledges valuable guidance and inputs for this report from many reviewers in the World Bank. These include former and current SAFANSI team leaders, country management units, global practices for agriculture, and for health, nutrition, and population in the South Asia region, and SAFANSI Steering Committee members. A special thanks to Robert J. Saum, Director of Regional Integration and Partnerships for South Asia, and Mary Kathryn Hollifield, Practice Manager in the Agriculture Global Practice South Asia Region, for their support and interest in this work. We acknowledge the valuable inputs from those who participated in the consultative meetings (see Annex 1) at the beginning of this process. As the scope and direction of the project evolved, we are grateful to all for their guidance and commitment that helped us to complete this report. This report was prepared with contributions from the Government of Australia Department of Foreign Affairs and Trade, UK’s Department for International Development, and the European Commission. 4 Executive Summary The South Asia Food and Nutrition Security Initiative (SAFANSI) was created in 2010 to foster actions that lead to measurable improvements in food and nutrition security (FNS). Through flexible small grants, the program aims to address the South Asian Enigma — chronic malnutrition and undernutrition that remain stubbornly intractable despite high economic growth. Conceived at a time when FNS work was evolving from narrowly focused interventions by ministries of health to a multisectoral approach with different stakeholders, SAFANSI’s innovative work cuts across many sectors. These sectors include agriculture, rural development, health, social safety nets, water supply and sanitation, public administration, education, communications, and regional integration. Administered by the World Bank, SAFANSI is a trust fund financed program that has received funding and support from the European Commission, the United Kingdom’s Department for International Development, and Australia’s Department of Foreign Affairs and Trade. This report assesses SAFANSI activities over the past eight years to understand the program’s effectiveness and performance in addressing FNS in South Asia. Based on a comprehensive review of relevant documents and interviews with stakeholders and program team leaders, the report identifies major achievements and lessons learned from SAFANSI-supported activities. The report also proposes a select number of focus areas for support under a potential SAFANSI follow-on nutrition program. During two phases, SAFANSI has allocated $23.8 million to finance 93 activities 1 addressing undernutrition in South Asia. India, Nepal, and Bangladesh have been the primary recipients of SAFANSI grants. Regional activities supporting two or more countries constituted about 20 percent of SAFANSI’s work. SAFANSI activities have targeted the poor and vulnerable, especially women and children, in disadvantaged areas of Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. The program has informed national nutrition policies in Bangladesh, Nepal, and Bhutan. Other SAFANSI activities have ranged from testing better ways to deliver nutrition services in villages to creating datasets about the behavior of recipient households. SAFANSI is working with the private sector to support production of 2.7 million metric tons of A- and D-fortified milk, consumed by 55 million people across 16 states in India. Main findings: • With financial support from SAFANSI, South Asian countries now have a deep portfolio of practical knowledge, policy advice, evidence-based analysis, and enhanced capacity to improve nutrition. SAFANSI has contributed to mainstreaming FNS as a regional priority in the Bank’s South Asia work. • SAFANSI has directly influenced nutrition policy by sharing data, pilot project results, and analytical studies with national governments throughout the region. The analytical work has informed a total of 11 national government policies in South Asia, including a half-dozen national nutrition action plans developed by Afghanistan, Bangladesh, Nepal, and Sri Lanka (and subsequent five-year plans for Bangladesh and Bhutan). In Pakistan, SAFANSI supported the development of nutrition policy guidance notes in four provinces, which informed World Bank-financed health sector projects in these provinces.2 1 The technical analysis in this report is based on the review of 78 activities totaling $20.8 million approved before May 31, 2018. An additional 15 activities were approved after May 31, 2018. 2 The focus of this report is on SAFANSI’s contribution to the development of nutrition policies and action plans at the national and sub-national level in the South Asia region. However, the authors recognize that the development, adoption and implementation of these policies and action plans is attributable first and foremost to a government commitment to food and nutrition security (FNS), as well as the collective support of the FNS agenda by the larger development community active in the region. 5 Nourishing Ideas for Action • SAFANSI has, with $20.8 million, informed, contributed to, or leveraged, through knowledge products and innovative pilot programs, 32 Bank- financed projects worth $6.3 billion3 with more than 35.6 million target beneficiaries. One of the largest SAFANSI-financed activities is the Social Observatory, a monitoring mechanism in India that collected data from households about village food prices and availability. The data were used to improve the nutrition design of four Bank- financed rural livelihood development projects in India totaling $1.45 billion. Social Observatory tools have also been adopted by several governments and non-governmental organizations (NGOs). • SAFANSI research, data, and knowledge exchange strengthened a multisectoral approach to nutrition interventions at the national, provincial, and community levels. SAFANSI has facilitated multisectoral collaboration among provincial government departments in Pakistan and multisectoral delivery of nutrition services in villages in Bangladesh, India, and Sri Lanka. Key lessons learned include: • Historically, collaboration among South Asian countries has been limited. Through regional projects, knowledge sharing events, and innovative interventions, SAFANSI has facilitated dialogue and learning. Despite these gains, regional cooperation remains a challenge. A follow-on FNS program would be an opportunity for further collaboration, learning, and exchange among countries to tackle cross-border issues, common standards, trade, and other shared FNS-related challenges. • Although the overall funding available through SAFANSI was small, funding was flexible and catalytic. The well-targeted use of limited resources has had a significant impact driving the FNS agenda in South Asia and developing a comprehensive body of research, data, and knowledge. However, the financing available was insufficient to support recipient-executed activities, which had originally been envisaged. • The SAFANSI governance structure is simple and adequate for the size of the program. Fund allocation could be made more strategic by aligning the process with the annual World Bank work program planning cycle. • Housing the SAFANSI Secretariat in the Bank’s Agriculture Global Practice contributed to the breakdown of silos and provided funding for nutrition in the agriculture space in South Asia. • The relatively short implementation timeframe for the two phases of SAFANSI limited the types of interventions that could be supported and the results that could be measured. A potential third phase of SAFANSI would build on the program’s data, knowledge products, service delivery models, and the regional FNS portfolio to support unfinished strategic priorities. It could also address six evolving priorities that demand attention: (1) nutrition-sensitive agriculture, (2) private sector in FNS, (3) child undernutrition, (4) gender and nutrition, (5) urban malnutrition, and (6) climate change. 3 The amount represents the aggregation of the total costs of the Bank-financed projects that SAFANSI contributed to or leveraged through grants approved before May 31, 2018. The amount is not limited to FNS activities or components only. Sectors supported by these Bank projects include agriculture, health, social protection, and water and sanitation. 6 1. Introduction South Asia has the highest rate of undernutrition4 in the world. About 40 percent of the world’s stunted children — defined as those who are too short for their age — live in the region. While most stunted children are from poor families, data shows that stunting does not disappear with income growth in some countries. The South Asia Food and Nutrition Security Initiative (SAFANSI) seeks to understand why widespread and high levels of undernutrition persist despite sustained rapid economic growth and agricultural productivity gains in the region. SAFANSI was created as a multi-donor program implemented in two consecutive phases. The objective of SAFANSI Phase I in 2010-15 (SAFANSI I) was to increase the commitment of government and development partners to more effective and integrated FNS actions in South Asia. SAFANSI Phase II in 2015-19 (SAFANSI II) built on the successes and lessons learned of the first phase to improve FNS for individuals and communities through a stronger commitment and increased capacity for more integrated FNS actions across the region. Although the two phases supported the same overall objectives and priorities, they were funded through separate multi-donor Trust Funds with distinct administrative arrangements. This hampered the continuity in the implementation of the program between the two phases. The European Commission (EC), the United Kingdom’s (UK) Department for International Development, and Australia’s Department of Foreign Affairs and Trade5 have provided financial support to the Program. Over its lifetime, total contributions paid-in to the program amounted to $27.4 million. SAFANSI I was funded with $13.7 million from the UK and Australian governments. SAFANSI II received $13.7 million from the UK government and the EC. Due to changing priorities in its foreign aid program, the UK government exited SAFANSI on November 15, 2017. SAFANSI was conceived at a time when FNS work was evolving from traditional, narrow interventions organized by ministries of health to a multisectoral approach involving the health, agriculture, water and sanitation, education, and rural development sectors, among others. SAFANSI was designed as a catalytic and niche program to advance the changing nutrition agenda. By providing access to small but flexible seed funding, SAFANSI addressed the need for greater government commitment, more evidence-based policies and programs, and inter-sectoral approaches to FNS. To ensure country ownership and maximum flexibility to respond to identified needs, SAFANSI was set up as a programmatic trust fund.6 Activities funded through SAFANSI have been mostly demand-driven except for a few commissioned activities aligned with strategic priorities. This approach, and the multi-faceted and complex nature of FNS issues in South Asia, resulted in an extensive portfolio of relatively small activities at the regional, country, or sub-national level. Since its inception, SAFANSI has provided funding for 93 activities across a wide range of themes and sectors.7 Although the intention had been to finance a mix of Bank-executed and recipient- 4 Undernutrition is defined by UNICEF as the outcome of insufficient food intake and repeated infectious diseases. Undernutrition includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin for one’s height (wasted) and deficient in vitamins and minerals (micronutrient malnutrition). 5 The UK contributed to both phases of SAFANSI. Australia contributed only to Phase I and the EC contributed only to Phase II. 6 SAFANSI is a programmatic trust fund that finances grants in a two-stage mechanism. In the first stage, donors agree to a thematic framework with criteria for supporting a program of activities. In the second stage, grants are approved for specific activities based on the agreed criteria. 7 Please see Annex 2 for a full list of SAFANSI-funded grants under Phases I and II through January 31, 2019. 7 Nourishing Ideas for Action executed activities,8 the limited time frame for each phase of the program was more conducive to financing Bank-executed technical assistance, awareness raising, research, and knowledge activities.9 The large portfolio of diverse activities has produced a wealth of outputs as captured in the SAFANSI I and II results (see Annexes 4 and 5, respectively). However, the aggregation of grant-level outputs does not capture SAFANSI’s broader impact at the program level. SAFANSI helped develop and advance a multisectoral nutrition agenda in client countries and within the World Bank. Globally, annual World Bank lending for projects with a nutrition objective or nutrition-sensitive outcome increased from $40.6 million in fiscal year (FY) 200810 to $1.4 billion in FY18.11 Over the last eight years, SAFANSI funding directly informed, contributed to, or leveraged $6.3 billion12 in World Bank investment lending in South Asia (see Annex 7). By advocating for multisectoral nutrition action — and backing that advocacy with funds for analysis, capacity development, and pilots to learn by doing — SAFANSI helped expand nutrition interventions in the World Bank’s investment portfolio. In comparison, many other FNS initiatives in the region focus solely on advocacy. Feedback from SAFANSI team leaders confirmed that much of this work could not have been done without SAFANSI financing. With SAFANSI Phase II scheduled to close on September 30, 2019, the SAFANSI donor and steering committees requested a retrospective review analyzing all activities financed under both phases of the program and their impacts.13 The primary audiences for this report are SAFANSI donors and the World Bank, specifically staff working on South Asia and on FNS. More broadly, the report may also be of interest to national and sub-national governments, development partners, and other stakeholders and practitioners in the region. The findings in this report are based on a comprehensive review of project documents, reports, analytical papers, and other outputs from 78 SAFANSI grants.14 The findings also reflect face-to-face consultations with 24 key stakeholders in Bangladesh, India, and Nepal, and videoconference consultations with 8 key stakeholders in Bhutan and Pakistan in December 2018.15 Within the World Bank, the report authors interviewed former and current SAFANSI team leaders, South Asia region country program coordinators, global nutrition leaders, former SAFANSI Secretariat staff and other staff involved in SAFANSI since its inception. The report is organized as follows: Chapter 2 provides an overview of the FNS situation in South Asia, including progress and challenges over the last eight years. Chapter 3 examines SAFANSI grant-funded activities, including a portfolio analysis, grant results, and, where available, the program’s impact at the country level. Chapter 4 describes the genesis and evolution of SAFANSI from Phase I to Phase II in terms of program governance and 8 Bank-executed activities are projects for which the World Bank is the implementing entity. Recipient-executed activities are implemented by a client government. 9 Out of 93 activities funded by SAFANSI, only two were recipient-executed activities, both funded under SAFANSI Phase I. 10 The World Bank’s fiscal year (FY) runs from July 1 through June 30. 11 This lending data captures only those projects tagged against the Food Security and Nutrition theme and counts only the percentage of the total project amount allocated to the FNS theme, not the total project amount. 12 The amount represents the aggregation of the total costs of the 32 Bank-financed projects that SAFANSI contributed to or leveraged through grants approved before May 31, 2018. The amount is, therefore, not limited to FNS activities or components only. The contribution to about one-third of the Bank-financed projects is through leveraging or stimulating, in which SAFANSI has provided turnkey technical or operational support, such as strategic policy guidance notes or design and implementation of critical pilots. These activities have led to the development of or a scale-up/replication in the Bank-supported projects or a FNS component. For the remaining two-thirds of the Bank-supported projects, SAFANSI has financed more general implementation support, including impact evaluation (studies and/or design support), technical studies, learning notes, and behavioral change communication tools. 13 The authors of this retrospective study reviewed all closed or active grants financed by SAFANSI between 2010 and May 31, 2018. Grants that became effective after May 2018 were not included in the analysis. A complete list of SAFANSI-financed activities is provided in Annex 2. 14 Not included in this study’s analysis are 15 grants approved after May 31, 2018, and 9 grants related to program management and administration. 15 Videoconferences were also organized for Afghanistan and Sri Lanka, however, confirmed participants did not connect. See Annex 1 for a full list of participants by country. 8 communications. Chapter 5 aggregates the key lessons learned from SAFANSI-funded grants and program execution. Finally, based on the findings of this report, and parallel research carried out to understand what was happening in the region over the course of the same period, Chapter 6 looks forward and concludes with unfinished and emerging priority FNS areas requiring attention. Seven annexes are included at the end of the report. These include a list of stakeholders consulted (Annex 1), an overview of all SAFANSI grants (Annex 2), a summary of the main results from each completed grant (Annex 3), the Results Framework for SAFANSI I (Annex 4) and SAFANSI II (Annex 5), a list of all SAFANSI publications (Annex 6), and an overview of World Bank projects to which SAFANSI grants have contributed (Annex 7). 9 Nourishing Ideas for Action 2. Food and Nutrition Security in South Asia – Progress and Challenges The scale of the undernutrition problem in South Asia is exceptional. Two key indicators of undernutrition in children under five are the rates of stunting (too short for the child’s age) and wasting (too thin for the child’s height). Most countries in South Asia have stunting rates above 30 percent and wasting rates above 10 percent (see Figure 1). The region is home to an estimated 40 percent of the world’s 155 million children that are stunted and 54 percent of the world’s 52 million children suffering from wasting.16 According to the most recent data available, stunting and wasting rates in South Asia vary widely between countries. While the stunting rates are highest in Afghanistan (41 percent), followed by India and Pakistan (38 percent each), the rate in Sri Lanka is 17 percent. In terms of wasting, India has a rate above 20 percent, followed by Sri Lanka at 15 percent. Pakistan and Bhutan have the lowest rates of 7 percent and 6 percent, respectively (see Figure 1). Additionally, a key measure of nutrition for adolescent and adult women is whether they suffer from anemia, a nutrition disorder typically caused by insufficient dietary iron. Current anemia rates for women of reproductive age vary from 52 percent in Pakistan to 33 percent in Sri Lanka (see Figure 1). A high level of child undernutrition carries sizeable economic costs for countries through the loss of human capital and higher health costs.17 Studies for low- and middle-income countries find that undernutrition has negative effects in several dimensions. Child undernutrition, measured by stunting and other indicators, is associated with lower motor, cognitive, emotional, and social development; and with higher rates of illness, disability, and premature death. An estimated 45 percent of child deaths around the world each year are attributed to stunting, wasting, and underweight status, along with other measures of undernutrition. Child undernutrition is associated with poorer socioeconomic outcomes in adolescence and adulthood, measured by student academic achievement, employment, and earnings. Progress in reducing undernutrition in the region has been mixed. For example, stunting rates have been declining in Pakistan, Bangladesh, Nepal, and India, while the rate in Sri Lanka is unchanged. There has been a 7 percentage point reduction between 2012 and 2017 in Pakistan.18 In Bangladesh, India, and Nepal, stunting has declined by 1 to 1.4 percentage points per year since 2000. In 2012, the World Health Organization adopted global targets for reducing child and maternal undernutrition by 2025. The targets included reducing the child stunting burden by 40 percent, reducing anemia among women of reproductive age by 50 percent, and reducing the child wasting rate to less than 5 percent. Most countries in South Asia are behind in meeting the stunting and wasting targets. None of the South Asian countries are likely to meet the anemia targets.19 A comparison of the Global Burden of Disease20 estimates in 1990 and 2010 indicate that protein-energy malnutrition and iron-deficiency anemia remain among the leading causes of premature death and disability in the region. 16 Key findings of the 2017 edition of “Levels and Trends in Child Malnutrition,” UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates, at https://www.who.int/nutgrowthdb/jme_brochoure2017.pdf 17 Losses in yearly GDP due to undernutrition have been estimated as high as 12 percent in low-income countries. 18 See the National Institute of Population Studies, “Pakistan Demographic and Health Survey 2017-18,” January 2019. 19 The UNICEF targets are available at https://data.unicef.org/resources/nutrition-targets-tracking-tool/. 20 The Global Burden of Disease is produced by The Institute for Health Metrics and Evaluation at http://www.healthdata.org/gbd. 10 Figure 1: Undernutrition rates, South Asia21 21 The stunting rate is defined as the share of children under age five with HAZ less than -2 standard deviations. The wasting rate is the share of children under age five with WHZ less than -2 standard deviations. The anemia rate is the share of women of reproductive age whose hemoglobin concentration in the blood is less than 120g/L. 11 Nourishing Ideas for Action Compared to the rest of the developing world, the levels and trends in child and maternal undernutrition in South Asia are inconsistent with or insensitive to the: (1) level of economic development, (2) rates of economic growth and poverty reduction, and (3) presence of several public food, cash, and maternal and child health programs with substantial infrastructure and human resources. Since 2000, the region’s income per capita has more than doubled and its poverty rate has been cut by more than half. Some health indicators, such as under-five and maternal mortality rates, have improved. But stunting and wasting rates for South Asian countries tend to be markedly higher than what would be predicted by gross national income per capita, especially, considering the improvement in under-five and maternal mortality rates in the region. The nature of “nutrition production technology” is now well-established in the literature. Undernutrition can be transmitted between generations, and erasing deficits can take time, even with substantial improvements in environmental and social conditions. It is well known that differences in genes explain little of the variation in nutrition status between populations, that environmental and social factors explain much, and that history matters. In other words, there are no genetically similar groups of people who tend toward stunting, wasting, or other characteristics of malnutrition. Meanwhile, “nutrition production technology,” which is technology to generate nutrition gains, including the etiology of nutrition gains, is well known. It includes biological processes behind undernutrition, and what nutrition-specific interventions are needed such as supplementation and fortification, breastfeeding and complementary feeding, diversification, and emergency nutrition. It also includes when these interventions are needed during the lives of women and children, and the relationship of food and feeding, water and sanitation, and reproductive, newborn, child, and maternal health services. Biologically speaking, these nutrition-specific interventions work. However, they can fail to yield results if implemented poorly, especially when maternal and child health service availability and utilization are limited.22 A key question for nutrition research is why the application of nutrition production technology has not translated into greater declines in undernutrition in South Asia. The first area of investigation is the supply of nutrition-promoting goods and services by the public sector and private markets. Do governments and private markets fail to provide these goods and services? If so, to what extent, in what ways, and why? Specifically, are public initiatives undermined by nutrition program design and/or implementation issues? Is there an adequate service delivery mechanism for the community level at large? A second area of inquiry is consumer behavior with nutrition-promoting goods and services. Do households underinvest in nutrition, possibly differentially across household members? If so, to what extent, in what ways, and why? Specifically, is it due to high prices, nonmonetary constraints, or beliefs and preferences? Failures in public and private delivery and in household behaviour may interact in complex ways to maintain a high level of undernutrition. These questions on delivery and behavioral failure were a strategic focus for interventions under SAFANSI II. To further understand the nutrition space in which SAFANSI was operating over the past eight years, a review of the nutrition interventions and knowledge products produced during that time was conducted. The review identified prominent gaps in evidence or where existing evidence is of poor quality, including nutrition-sensitive agriculture, private sector in FNS, gender and nutrition, child wasting, urban malnutrition, and climate change. These critical gaps will be discussed in detail in this report’s Conclusions – Looking Forward section. 22 See “Risk Factors for Chronic Undernutrition Among Children in India: Estimating Relative Importance, Population Attributable Risk and Fractions,” by D.J. Corsi et al. and published in Social Science & Medicine 157, 2016, pp. 165-185. 12 3. The SAFANSI Portfolio SAFANSI can finance activities in any of the eight South Asian countries — Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka — and regional activities in two or more of those countries. SAFANSI’s focus themes include agriculture (including livestock, fishery, forestry, and rural development); health, nutrition, and population; social safety nets; water supply and sanitation; rural policies and institutions; public administration; information and communications; and regional integration. To anchor all activities, SAFANSI uses four strategic pillars: (1) improved evidence and analysis; (2) enhanced awareness and commitment; (3) building systems and capacity; and (4) fostering innovations (see Figure 2). Pillar 4 was added under SAFANSI II. All SAFANSI grants are linked to at least one pillar, and many are linked to two or more. Figure 2: SAFANSI Strategic Pillars Source: SAFANSI In addition to alignment with the pillars, SAFANSI II proposals that responded to the following strategic areas were prioritized for funding: (1) research on critical delivery and behavioral failures, (2) innovations, and (3) data and capacity building. SAFANSI II seeks more high-quality research to identify the precise nature of FNS “delivery failures” and household “behavioral failures.” The underlying drivers of such failures vary in small geographic areas, within communities, and in rapidly changing societies. Innovations are needed to address bottlenecks in public service or market deliveries, or ease barriers that prevent some households from participating in nutrition- enhancing services. Lastly, a critical gap is the lack of adequate information on government expenditures on nutrition through multisectoral interventions. Public expenditure reviews are needed to track nutrition spending, develop guidance notes, and strengthen government capacity for data collection. The programmatic and multisectoral nature of SAFANSI and wide range of potential activities has posed a challenge in aggregating results and capturing the overall impact of SAFANSI through the program- level results frameworks. The SAFANSI I results framework was designed to capture its impacts through its influence on national or country policies (see Annex 4). 13 Nourishing Ideas for Action SAFANSI Results Framework Program Results (2010–18)23 SAFANSI I (2010–15) contributed to: SAFANSI II (2015–18) contributed to: • 37 national-level planning or policy documents • 7 multisectoral and evidence-based food and emphasizing an integrated and coordinated nutrition policies, programs or action plans (cross sector) approach to FNS. developed and adopted by governments with • 32 development partners’ country strategies with financial or technical support from SAFANSI; of an integrated, cross sector approach to FNS which 4 support women and girls of reproductive age and/or children <2 years of age • 30 integrated FNS country programs / operations in place. • Design, implementation or evaluation of 13 World Bank nutrition-sensitive projects, totaling $2.2 billion and reaching 16.2 million beneficiaries. • 1 national or sub-national comprehensive multisectoral nutrition budgets developed. Notes: For the purposes of measurement, a Notes: Estimated/projected or actual contribution would take the form of direct financial beneficiaries, as of March 31, 2018. support for studies or dialogues that lead to policy Multisectoral budgets can indicate spending in reform/creation, technical advice provided through ministries/ departments directed to activities that SAFANSI-funded programs or as a result of SAFANSI- will contribute to achieving nutrition outcomes as funded programs, or policies/programs that cite defined in national/sub-national policies/strategies. SAFANSI materials as reference in their development. Source: SAFANSI I Results Framework (Annex 4). SAFANSI Source: SAFANSI II Results Framework (Annex 5), directly measures I grants contributed to Bank investment of $4.1 billion (see the: (a) contribution of SAFANSI to the design, implementation or Annex 7), though not directly measured through the results evaluation of World Bank nutrition-sensitive projects; (b) number framework. of projects; and (c) volume of lending. Using lessons learned from the previous phase,24 the SAFANSI II results framework was set up to capture SAFANSI’s outcomes and impacts beyond its influence on nutrition policies, such as the development of national or sub-national nutrition budgets and SAFANSI’s contribution to Bank investments. Outcome indicators were better defined and more result-oriented, with an emphasis on gender, and contributions to/or leveraging of Bank-financed projects (see Annex 5). The results frameworks do not capture the full impact of SAFANSI, which will only become evident over time because influencing upstream policy and anthropometric results is a long- term process requiring sustained engagement. With a total contribution of $27.4 million, SAFANSI provided small, yet flexible, seed funds, in line with its four pillars, to help understand the cause of persistent undernutrition in South Asia and support the design of innovative FNS service delivery mechanisms. In keeping with its objective, SAFANSI, through its broad set of activities, has strengthened government commitment and increased capacity for effective and integrated FNS actions. 23 The SAFANSI Results Frameworks highlight SAFANSI’s contribution to the development of nutrition policies and action plans at the national and sub-national level in South Asian countries. However, the authors recognize that the development, adoption, and implementation of these policies and action plans is attributable first and foremost to government commitment to FNS and the collective support to the FNS agenda by the larger development community active in the region. 24 An independent evaluation of the program in 2013 by the UK’s Department for International Development noted that the Phase I results framework was “too input- and activity-focused, and therefore failed to capture how SAFANSI is influencing outcomes and ultimately contributing to FNS impact.” See HEART, Independent Evaluation and Strategic Review of the South Asia Food and Nutrition Security Initiative (SAFANSI) Report, page 10. 14 3.1 Portfolio at a Glance Figure 3: SAFANSI Grant Funding by Country SAFANSI supported stakeholder platforms to operationalize cross-sectoral action and effective domestic stewardship of the FNS agenda. SAFANSI has supported 78 activities25 with a total of $20.8 million in funding to address the undernutrition challenge in South Asia. The SAFANSI portfolio includes grants to all South Asian countries, excluding the Maldives,26 and regional grants for activities in two or more countries. Of the 78 activities, regional activities constituted about 20 percent of the portfolio. Most of the regional activities supported analytical work to fill critical knowledge gaps, such as multisectoral engagement in FNS, gender and nutrition, infant and young child feeding, and other issues. India, Nepal, and Bangladesh were the primary recipients of SAFANSI grant funding, with 34, 15, and 11 percent respectively. Afghanistan and Bhutan received the fewest number of grants and least amount of funding Source: SAFANSI with 2 percent each (see Figure 3). At the outset, it was envisaged that the Figure 4: Number of Grants By Sector program would finance a balance between Bank-executed and recipient-executed activities. In practice, out of the 78 technical grants approved, only two were recipient- executed. The limited implementation timeframe and funding envelope under each phase, was more conducive to funding Bank-executed activities. Recipient-executed activities typically require larger grant amounts to have an impact and more time to design, implement and complete, compared to Bank-executed grants. Source: SAFANSI SAFANSI has consistently promoted multisectoral and cross-sectoral approaches to address undernutrition. During both phases of SAFANSI, the health (31 grants)27 and agriculture (28 grants) sectors initiated and led most activities in the portfolio.28 Other sectors such as social protection, water and seven multisectoral activities also received grants (see Figure 4). 25 The portfolio analysis was limited to the review of 78 technical grants that were approved between 2010 and May 31, 2018, and excludes program-level grants, e.g. program management and administration, communications, and activities in support of SAFANSI as a knowledge platform (roundtable events, and other workshops), and grants approved after June 1, 2018. 26 The SAFANSI Secretariat did not receive proposals requesting funding for activities in the Maldives. 27 Also referred to as Health, Nutrition and Population (HNP) within the Bank. 28 The sector analysis is based on sector and sub-sector reporting through the Grant Funding Request (GFR) form for Phase I. For Phase II, the sector information is based on the sector associated with the Bank’s lead global practice for the activity. Although the majority of activities were led by the Agriculture and Health Global Practices, most were multisectoral in nature. 15 Nourishing Ideas for Action About half of SAFANSI activities focused on improving FNS evidence and analysis. Under this strategic pillar, the program supported various policy papers and independent impact evaluations of World Bank investment operations. SAFANSI-supported evidence-based analysis helped to raise the quality of project design, as well as policy and strategic dialogue with government counterparts. The second most common pillar supported was building systems and capacity, which included capacity strengthening activities related to Bank operations, as well as setting up project management systems, including monitoring and evaluation systems to capture nutrition outcomes. As many as 17 SAFANSI grants contributed to building systems and capacity (see Figure 5). Figure 5: Number of Grants by Strategic Pillar Activities that enhanced awareness and commitment, another strategic pillar of the program, included organizing conferences and roundtables. Other key activities to reach stakeholders involved the development of communications strategies, information notes, educational videos, blogs, a comprehensive, user- friendly website and training journalists about nutrition issues. In phase II, SAFANSI-supported activities Source: SAFANSI under the fourth pillar of fostering innovations included technological solutions such as data visualization tools and interactive dashboards accessible through smartphones. Other activities rolled out innovative institutional mechanisms, such as the Social Observatory participatory tracking (P-tracking) systems and rapid results for nutrition initiatives. 3.2 SAFANSI Achievements – by Country 3.2.1 Regional Portfolio SAFANSI has worked to deepen regional, multisectoral coordination across South Asia. Historically, regional cooperation or integration has been rather limited in South Asia. Through its regional activities, SAFANSI has supported policy development and advocacy across the region, such as budgeting nutrition interventions and strengthening infant and young child feeding. It facilitated knowledge sharing across countries through communication and capacity building activities, involving high level policymakers and government officials. Replicability of innovative interventions is also evident across countries. A monitoring tool developed by the Social Observatory in India is in use in Nepal, and a community-level nutrition promotion model in Bangladesh was first tested and proven by the Integrating Nutrition Promotion and Rural Development (INPARD) project in Sri Lanka. To this end, SAFANSI established stakeholder platforms that can operationalize cross - sectoral action and enable more effective domestic stewardship of the FNS agenda. By building on SAFANSI’s regional FNS portfolio, the agriculture sector is developing nutrition-smart agriculture29 profiles in South Asia with the dual objectives of improving human nutrition and increasing farm productivity or profits. 29 Nutrition-smart agriculture provides a set of agriculture or agro-processing technologies or practices that help improve human nutrition and increase farm productivity, income, or profits. 16 South Asia Regional Activities: Snapshot of broad thematic areas supported by SAFANSI SAFANSI has supported FNS policy and advocacy across the region and beyond. The SAFANSI-financed Strengthen Infant and Young Child Feeding Capacity in South Asia Project developed World Breastfeeding Costing Initiative tools that were adopted by Afghanistan, Bangladesh, India, Nepal and 16 countries outside the region. This project expanded the SAFANSI I-financed regional study, “South Asia Regional Assistance Strategy for Nutrition 2011-16,” and fostered a greater commitment to FNS through a multisectoral approach in South Asia. The infant and young child feeding project supported a study, “The Need to Invest in Babies,” which highlighted infant feeding practices and introduced the World Breastfeeding Costing Initiative tool to scale up the interventions. The project built the capacity of the Breast-Feeding Promotion Network of India and its partners in the International Baby Food Action Network in the above four focus countries in South Asia. It also supported strengthening infant and young child feeding programs and policies and helped the governments develop action plans. As a follow-up, the SAFANSI-financed project, Addressing Critical Failures of Infant and Young Children Feeding (IYCF) in South Asia, is focusing on urban working mothers in Colombo and Delhi to understand constraints, such as access to child care among newly arrived migrant families from rural villages. These regional initiatives have influenced countries outside South Asia and would not have been possible without SAFANSI’s regional financing. SAFANSI has paid special attention to gender in its regional activities. SAFANSI-financed regional activities examined links between gender and malnutrition in a flagship report and ways to empower women and their networks to make changes. The SAFANSI-supported report, “Gender-Inclusive Nutrition Activities in South Asia,” provided pathways for FNS gender inclusive programs. The report highlighted that gender was too narrowly addressed in most FNS interventions that focused on mothers’ knowledge, skills, and physical health, and overlooked social factors such as household and community support, resource control, and mental health. Additionally, adolescent girls are often ignored by existing programs despite high rates of undernutrition and pregnancy.30 SAFANSI has also worked with a regional network of women’s group, the Business, Enterprise and Employment Support (BEES) Network for Women in South Asia, to improve family income through dairy development, fisheries management and other entrepreneurial endeavors. These activities led to innovations in seed/food banks and ready-made meals, followed by another SAFANSI-financed project in the Chittagong Hills Tract in Bangladesh and a grant from the World Bank-administered South Asia Region Trade Facilitation Program. 3.2.2 Afghanistan FNS is a major concern in Afghanistan. The government’s 2010 mortality survey reported an infant mortality rate of 77 out of every 1,000 births. Diarrhea, acute respiratory infections, and vaccine-preventable illnesses account for nearly 60 percent of deaths in children under five in Afghanistan. In 2012, about 9 million Afghans did not eat the daily minimum necessary.31 Childhood stunting linked to poor nutrition was 41 percent in 2013, one of the highest rates in the world.32 Recognizing the importance of FNS, the Afghanistan 30 See the World Bank’s “Gender-Inclusive Nutrition Activities in South Asia, Volume I: Mapping Report,” published in June 2012. 31 See the World Food Programme report on Afghanistan at https://www1.wfp.org/countries/afghanistan. 32 See UNICEF data about malnutrition at https://data.unicef.org/topic/nutrition/malnutrition/, and the Global Database on Child Growth and Malnutrition prepared by UNICEF, the World Health Organization and the World Bank at https://www.who.int/nutgrowthdb/estimates/en/. 17 Nourishing Ideas for Action government launched its Food Security and Nutrition Agenda in 2017. The goal of the program is to ensure that every Afghan is well-nourished through the availability of sufficient, stable food supplies and healthy diets. Afghanistan: Snapshot of broad thematic areas supported by SAFANSI Note: “Afghanistan and Region” refers to SAFANSI regional activities with a focus on Afghanistan, such as the Infant and Young Child Feeding Project and the Regional Cost and Cost-Effectiveness Study. Despite a fragile and difficult operating environment, SAFANSI contributed to the evolution of nutrition policies in Afghanistan by supporting the implementation of the Nutrition Action Framework with five key ministries and informing the Afghanistan National Nutrition Plan that is under development. Focusing on the first 1,000 days of life — pregnancy through a child’s two-year birthday — the Government of Afghanistan developed the Nutrition Action Framework, which complemented the Afghanistan National Development Strategy (2008-13). In supporting the implementation of the action framework, SAFANSI’s Multisectoral Plan to Promote FNS developed the “Nutrition Solution Series,” which identified and refined promising programmatic platforms for scaling-up effective nutrition solutions. SAFANSI worked with Afghanistan’s ministries of public health, agriculture, commerce, education, and rural development. Among other things, the “Nutrition Solution Series” documented findings from the “Care for Afghan Families” pilot which received an award from the South Asia Development Marketplace for Nutrition. Infant and young child feeding practices are a key determinant of malnutrition in Afghanistan. In three northeastern provinces, the pilot promoted exclusive breastfeeding for children under six months old and encouraged families to offer age-appropriate complementary foods to children between six and 24 months old. The pilot formed breastfeeding support groups in villages and established breastfeeding counseling centers at district health facilities. The outreach targeted mothers and their community and social support networks, especially mothers-in-law and husbands. The pilot aimed for increases of 10-15 percent in women who began breastfeeding immediately after childbirth and in women who exclusively breastfed their infant for the first six months. According to the impact evaluation, increases of 17 percent or greater occurred in both feeding indicators. This pilot was one of 21 innovative projects financed by the South Asia Development Market Place for Nutrition with implementation and evaluation by the SAFANSI-financed regional project, Evaluating and Learning from Innovative Community Approaches to Improving Child Nutrition. The new National Nutrition Plan is informed by the SAFANSI-financed Regional Costing and Cost-effective Analysis. A scale-up in preventive interventions to full coverage level through the Bank-financed project, Systems Enhancement for Health Action in Transition, would have a bigger impact reducing stunting and anemia. The study examined the costs, impacts, and cost-effectiveness in the next five years of scaling up the nutrition interventions, including Afghanistan’s Basic Package of Health Services, which invested in human capital in the early years. Accordingly, the total public investment required for the scale up to government-set program coverage levels is estimated at $44 million annually over five years, or $1.49 per capita per year. With an additional $5 million each year through a Bank-supported systems enhancement project, the preventive interventions could reach full program coverage levels. That would result in almost double the number of deaths 18 averted and prevent almost eight times as many cases of stunting, resulting in a 3 percentage point decline in stunting to 38 percent at the end of five years. The prevalence of anemia in pregnant women could decline by 12 percentage points, and exclusive breastfeeding could increase by 18 percentage points. 3.2.3 Bangladesh Bangladesh has made remarkable progress in reducing poverty, supported by annual economic growth of more than 6 percent over the last decade. During this period, poverty levels were halved and real per capita GDP almost quadrupled. Life expectancy, literacy rates, and per capita food production have increased significantly. In July 2015, the World Bank elevated Bangladesh’s status from a low-income country to a lower- middle income country. In 2018, Bangladesh fulfilled all three eligibility criteria to graduate from the UN’s Least Developed Countries (LDC) list. While income growth, human development, and vulnerability reduction efforts have been significant, 22 million Bangladeshis or 14.8 percent of the population continue to live below the international poverty line of $1.90 per person per day.33 About 36 percent of children under five suffer from chronic malnutrition and 14 percent are acutely malnourished.34 Maternal undernutrition is high, with 50 percent of pregnant women and 40 percent of non-pregnant/non-lactating women suffering from anemia. Bangladesh: Snapshot of broad thematic areas supported by SAFANSI SAFANSI contributed to key national policies of the Government of Bangladesh: the Second National Plan of Action on Nutrition and the Seventh Five-Year Plan. SAFANSI also informed the World Bank’s Systematic Country Diagnostic in 2015 and Country Partnership Framework in FY 2016-20. The SAFANSI-financed study, “Regional Costing and Cost-Effectiveness,” contributed to the nutrition budgeting of the government’s national plan of action launched in August 2017. It is a major policy milestone and updated the previous food security plan by introducing a multisectoral approach to nutrition and nutrition security. SAFANSI’s study estimated the total cost of key nutrition interventions at $537 million over 10 years, to be implemented through government health, nutrition, population, social protection, water, education, and agriculture and rural development programs. The interventions would gradually be scaled up to reach 90 percent coverage of the population. Interventions include providing iron and folic acid supplements to pregnant women (current coverage of 27 percent), therapeutic solution for diarrhea treatment (currently 38 percent), and rice fortification (currently 1 percent). The study argues that the interventions would prevent almost 50,000 deaths in children under five and more than 500,000 cases of stunting. The gains would increase the nation’s economic productivity by about $5.6 billion over the lifetimes of the children, with a cost-benefit ratio of 20.5.35 33 See the World Bank’s Poverty and Equity Data Portal for Bangladesh at http://povertydata.worldbank.org/poverty/country/BGD. 34 Bangladesh Nutrition Profile, USAID, 2018. 35 The economic benefits were estimated based on mortality, stunting, and micronutrient deficiency reductions resulting from the coverage expansion. One life year saved was valuated as one-time gross domestic product (GDP) per capita (current USD). To estimate the value of the reduction in stunting, a year of life lived without stunting was valued based on the assumption that stunted individuals lose an average of 21 percent of lifetime earnings. Future benefits were then age-adjusted and discounted at two potential discount rates (3 and 5 percent) to arrive at their present values. The present value of future benefits was then compared with that of the estimated 10- year public investment required, which allowed to estimate the net present value and internal rate of return of the investment. 19 Nourishing Ideas for Action The SAFANSI-financed study, “Bangladesh Dynamics of Rural Growth,” informed the Government of Bangladesh’s Five-Year Plan for 2016-20 and the World Bank’s Systematic Country Diagnostics and Country Partnership Framework. The study had five key findings: (1) 87 percent of rural households still rely on farm income; (2) lack of credit constrains rural non-farm enterprises; (3) the largest share of public expenditure on agriculture goes to fertilizer subsidies; (4) crop diversification is an important priority; and, (5) the private sector should be allowed in the seed sector. The study has also informed ongoing policy dialogue on the promotion of nutrition-focused agricultural policies instead of food security-centered agricultural policies. SAFANSI made a substantial contribution to social protection in Bangladesh by supporting an impact evaluation of a conditional cash transfer pilot program to the poorest households.36 The impact evaluation found participating households that received cash payments averaging $5-10 per month increased food consumption and reduced wasting in children under two. The Shombhob, or “Possible,” conditional cash transfer pilot delivered bimonthly payments for about 18 months to the poorest families with children up to three years old or primary school aged, provided they fulfilled a range of nutrition or education- related obligations such as regular child growth monitoring and nutrition awareness training. The payment amount varied by family size. The evaluation found almost all cash transfers were spent on food, which boosted total food consumption by 11 percent in surveyed households. Purchases of protein-rich foods increased significantly among households that participated in voluntary nutrition awareness sessions. The pilot also supported a reduction of about 13 percentage points in the incidence of wasting among infants who were 10-22 months old at baseline. The evaluation concluded that the combination of cash, nutrition education, and child growth monitoring motivated mothers to feed their infants and children more nutritious food.37 The pilot was scaled up, through a $300 million Bank project, Income Support Program for the Poorest, focusing on child nutrition and cognitive development. SAFANSI funds also supported the development of detailed impact evaluation methodology for this project. Box 1: Bangladesh: Protecting children with a toilet and soap After months of saving, Amena Begum made a major investment to protect the health of her three young children. She spent $100 to construct a modest toilet outside her home. Amena, who lives in a village in the Habiganj district in Bangladesh, made the toilet a priority after learning about the deadly risks of fecal contamination. In rural villages, families without toilets often discard feces in nearby bushes, creating a dangerous hazard for young children playing outdoors. A SAFANSI-funded study of childhood diarrhea in Bangladesh found traces of human feces on children’s hands and in soil. In addition to promoting toilet use, the study recommended behavior changes such as handwashing with soap and discouraging young children from accidentally or intentionally eating soil. SAFANSI funds studies such as this to guide its work to photo: World Bank improve childhood nutrition. 36 The project defined poorest household as households that belong to the bottom two expenditure quintiles with pregnant women and/or mothers of children below the age of 60 months. 37 See two World Bank publications: “Using Cash Cards to make Better Nutrition Choices in Bangladesh,” published by SAFANSI in October 2015; and “Can Conditional Cash Transfers Improve Education and Nutrition Outcomes for Poor Children in Bangladesh? Evidence from a Pilot Project,” by Celine Ferre and Iffath Sharif in Policy Research Working Paper no. 7077 published in 2014. 20 SAFANSI has played an important role filling critical knowledge gaps about undernutrition in Bangladesh and promoting innovations to achieve better nutritional outcomes among pregnant and lactating mothers and children under two in indigenous and disadvantaged areas. SAFANSI has demonstrated the effectiveness of information and communication technology (ICT) such as websites, TV, radio, and YouTube to change behavior. The SAFANSI-financed project, Leveraging Information Technology to Achieve Better Nutrition Outcomes in the Chittagong Hill Tracts, also supported women’s groups in the BEES Network to mobilize women and children in participatory video-making. This was facilitated by Digital Green, an NGO promoting technology in small-scale agriculture systems. The preliminary assessment said the project showed great potential for the creation of a community-learning system to improve nutrition, and the ICT-based approach has been featured in reference tools such as the “ICT in Agriculture e-Sourcebook.”38 SAFANSI also supported WorldFish in producing videos and notes on micronutrient- rich small fish, including availability, accessibility, and preparation. SAFANSI has also promoted behavioral change interventions based on research (see Box 1). In the health sector, SAFANSI produced two videos on community clinic healthcare, which were seen by more than 20,000 viewers of a TV talk show. The videos were viewed more than 25,000 times on Facebook Live, and viewed 23,000 times on-line. 3.2.4 Bhutan Bhutan’s national poverty rate was 8.2 percent in 2017.39 Despite significant improvements, the stunting rate of children under five is about 34 percent and the wasting rate is around 6 percent. The mortality rate for children under five was about 30 deaths per 1,000 live births,40 and the death rate was twice as high in rural areas compared to towns and cities.41 Anemia is also stubbornly high. About 81 percent of children and 55 percent of women in Bhutan are anemic. Women, especially, are anemic throughout their lives. Among adolescent girls, the rate of anemia is 59 percent; among women ages 21 to 35, the rate is 51 to 54 percent; and in women over 36 the rate rises to 65 percent. Bhutan’s poorest people live in remote, mountainous terrain that exacerbates food and nutrition insecurity. Bhutan’s FNS goals, objectives, policy and planning are generally stated in its 2014 Food and Nutrition Security Policy. Bhutan: Snapshot of broad thematic areas supported by SAFANSI By engaging multisectoral stakeholders, the SAFANSI-financed study, “National Nutrition Assessment,” identified direct and indirect nutrition-specific factors contributing to undernutrition in Bhutan. The study informed the government’s Five-Year Plan for 2013-18. The study found the key causes of stunting were indirect and nutrition-sensitive: women’s poor nutrition and care before and during pregnancy as reflected in anemia rates. Other factors were specific to Bhutan. Many villages are inaccessible, some at high altitudes that affect 38 See also an updated edition of “ICT in Agriculture: Connecting Smallholders to Knowledge, Networks, and Institutions,” published by the World Bank in 2017. 39 See the World Bank’s “Poverty and Equity Brief” about Bhutan at https://databank.worldbank.org/data/ download/poverty/33EF03BB-9722-4AE2-ABC7-AA2972D68AFE/Global_POVEQ_BTN.pdf. 40 Source for all stunting, wasting and mortality data: UNICEF’s Country Profile of Bhutan at https://data.unicef.org/country/btn/ 41 See the World Health Organization’s “Country Cooperation Strategy Bhutan 2014–18.” 21 Nourishing Ideas for Action crop selection and production, and urban migration means there are fewer farm workers. Bhutan’s dependence on food imports makes it vulnerable to world price fluctuations. Cultural and ethnic factors influence access to nutrition services and feeding practices. Finally, communities are unaware of the nutrition links to stunting and anemia, and few nutrition experts are available to educate and change community behavior (see Box 2). The SAFANSI study recommended five short-term priorities: (1) providing iron supplements for school-age girls and pregnant and lactating mothers; (2) fortifying food with nutrients; (3) coordinating nutrition-specific/sensitive interventions; (4) raising awareness of health, education, agriculture, and water/sanitation staff to nutrition issues; and (5) reducing adolescent pregnancies. Without the SAFANSI-financed analytical work, nutrition issues could not have been mainstreamed in Bhutan because the Bank’s financial resources and budget allocation are limited. Box 2: Bhutan: Telling the story of healthy diets Story-telling keeps the kingdom of Bhutan’s colorful Himalayan culture alive. A different kind of story-telling is now being used to persuade Bhutanese to improve their health and diets. The rugged terrain challenges Bhutan’s ability to grow enough food. Bhutanese living in isolated rural areas cannot access a reliably diverse diet throughout the year and eat mostly two vegetables — potatoes and chili peppers. The lack of variety of foods is a concern, especially for pregnant and nursing women and young children. Malnutrition during pregnancy and the first year of life can cause irreversible damage and contribute to stunted growth, lower cognitive development, and a predisposition to adult-onset diseases. Bhutan’s agriculture and health ministries recently launched a pilot project to improve nutrition during the first 1,000 days of children’s lives. The SAFANSI-supported project identifies drivers of food habits. Life stories, testimonials, and images are used to convey positive messages to encourage behavior changes. The program is run by the Tarayana photo: World Bank Foundation, a local civil society group, with government help. In following up, the SAFANSI-financed project, Capacity Development and Communication for Improved Nutrition Outcomes in Rural Households, supports the first 1,000 days of life in remote rural villages. The project targets pregnant and lactating mothers to diversify their diets and improve child care practices, using the participatory platforms formed by the Bhutan Food Security and Agriculture Productivity Project, and financed by the Global Food Security and Agriculture Program. 3.2.5 India India has made rapid strides in improving its food and nutrition security. India has become a net food exporter thanks to a five-fold increase in food grain production to about 250 million tons, up from 50 million tons in 1951. In health, the rate of stunting children under five declined to 38 percent in 2016, from 48 percent just 10 years earlier. However, India has a population of more than 1 billion and is home to one-third of the world’s poor, and continues to have one of the world’s highest child undernutrition rates. India has nearly 195 million undernourished people.42 42 Source for all data in this paragraph: UN website, Nutrition and Food Security in India, at http://in.one.un.org/un-priority-areas-in-india/nutrition-and-food-security/. 22 The Government of India launched POSHAN Abhiyaan in March 2018, which is a multi-ministerial convergence mission to reduce stunting in targeted districts with the goal of a malnutrition-free India by 2022. The 2013 National Food Security Act made access to food a legal right, and aims to ensure food and nutrition security for the most vulnerable through various programs. In 2016, the government launched programs to double farmers’ incomes by 2022, including the National Food Security Mission, Rashtriya Krishi Vikas Yojana, the Integrated Schemes on Oilseeds, Pulses, Palm Oil and Maize, Pradhan Mantri Fasal Bima Yojana, the e-marketplace, and a large-scale irrigation and soil and water harvesting program.43 India: Snapshot of broad thematic areas supported by SAFANSI SAFANSI’s key contribution in India is the development of a village-level multisectoral nutrition service delivery system, which was scaled up and refined through Bank-financed national and state rural livelihood projects. In implementing recommendations from the Bank’s report, “South Asia Regional Assistance Strategy for Nutrition 2011-16,” the SAFANSI-financed project, Multisectoral Nutrition Actions in Bihar, supported the design of a multisectoral nutrition convergence pilot in the state of Bihar. The project was implemented through community- level institutions, such as self-help groups and their federations, formed by the Bank-supported project, Bihar Rural Livelihoods, known as Jeevika. Focusing on the first 1,000 days of life, the pilot increased availability of nutritious food for pregnant and lactating mothers through a Food Security Fund set up by Jeevika. The fund loaned food grains to poor households as part of efforts to improve health and nutrition (see Box 3). The pilot delivered nutrition counseling through the Bank-financed Integrated Child Development Services Systems Strengthening and Nutrition Improvement, and nutrition and sanitation behavior change communications by the Swachh Bharat Mission Support Operation. The SAFANSI-supported project, Community Managed Food and Nutrition Security Initiative in High Poverty States in India, developed knowledge products about village-level FNS deliveries that informed three Bank-supported rural livelihood projects in the states of Telangana, Andhra Pradesh, and Odisha. Box 3: India: Village self-help groups teach nutrition Village self-help groups are an important source of nutrition education for millions of Indian women who never went to school. At a group in Bihar’s Saharsa district, Shoba proudly held her 10-month-old, Anjali. The baby appeared healthy, thanks to a diet of breast milk plus diverse vegetables, pulses and cereals. But as the women talked, Shoba revealed that Anjali received barely a spoonful or two of solid foods at each meal. None of the women realized such tiny amounts put Anjali at risk of malnourishment. SAFANSI works with self-help photo: World Bank groups to promote behavior changes. 43 See UN website, Nutrition and Food Security in India, at http://in.one.un.org/un-priority-areas-in-india/nutrition-and-food-security/. 23 Nourishing Ideas for Action SAFANSI’s eco-system development and knowledge management were made possible by the rich community-level data collected by the Social Observatory, the largest SAFANSI-financed activity and one of the most innovative. To diagnose how market, government, and behavioral failures affected FNS outcomes, the Social Observatory set up a monitoring mechanism in Bihar and collected FNS data from targeted households through participatory surveys about village food prices, availability, and affordability. The mechanism supported, for instance, an impact evaluation of Jeevika’s Food Security Fund. The evaluation indicated self-help group members living in villages that participated in the fund consumed the quantity and types of food that they desired by 0.2 days and 0.4 more days per week, respectively, than villagers in control areas. The data and the results of various impact evaluations were used to improve the FNS design of Bank-supported rural livelihoods projects in India (see Box 4). Box 4: India: Social Observatory dataset helps villagers, researchers The SAFANSI-financed Social Observatory collected data from more than 10,000 households in the Indian states of Bihar, Tamil Nadu, and Odisha to increase citizen engagement in community projects. For example, one annual survey created by village members asked how many times a day a respondent eats, whether the family member who eats last gets enough to eat, and other questions about family income, assets, and health. Village self-help groups and Bank staff use the data to make mid-course corrections in programs to improve their effectiveness. The Social Observatory and its participatory tracking, or P-tracking, technique has been adopted by Nepal, Indonesia, and other governments and NGOs. Researchers have used the trove of data to publish 10 peer-reviewed studies about anti-poverty interventions. For example, one study analyzed Odisha food security and safety nets in the context of climate change and disaster risk management. Scholarly analyses using Social Observatory data have been presented at national and international conferences photo: World Bank and cited in other research papers at least 75 times. Additionally, the Social Observatory’s monitoring mechanism at community levels was established as the Participatory Tracking (P-tracking) system, collecting data from households to use as a management tool by the self-help groups and their federations, and Bank-project staff. The Social Observatory developed a P-tracking manual and five training videos for wider use. P-tracking has also been adopted by governments and NGOs, including a nationwide effort in Nepal and Indonesia. SAFANSI has worked with the private sector to improve nutrition in the dairy value chain, through the Improved Nutrition Through Milk Micronutrient Fortification pilot program. The 12-month pilot initiative targeted the production of 2 million metric tons of A- and D-fortified milk across four states. The business model supported five dairy producer companies and state-level milk federations, and informed regulatory reforms that permitted the fortification of all types of liquid milk such as skim, low-fat and full cream. The pilot was rapidly scaled up through the World Bank’s National Dairy Support Project to 16 states, and, through February 2019, had already reached some 12 million consumers with 607,000 metric tons of fortified milk. By the end of the project in June 2019, an estimated 55 million consumers will have been reached with an aggregate 2.8 million metric tons of fortified milk. 24 SAFANSI-financed activities have filled critical knowledge gaps in FNS in marginalized areas and among tribal people. The SAFANSI-financed program, Cross-Sectoral Technical Support on Nutrition in the North East of India, is supporting an impact evaluation of the Bank-financed project, Nagaland Health. Focus group findings reported that not enough specific services for nutrition were available, and health and nutrition government departments needed to collaborate more in planning and implementing them. The SAFANSI-financed report, “Improving Food Security in Tribal Areas,” supported guidance notes about the drivers of food and nutrition insecurity in tribal areas and action steps, which informed national and state rural livelihood development projects. 3.2.6 Nepal Food and nutrition security are a significant concern for the Government of Nepal. The agricultural sector employs about two-thirds of the population yet struggles to produce adequate food for the country. Approximately 36 percent of Nepal’s children under five suffer from stunting, 10 percent from wasting and almost 53 percent from anemia. Thirty-five percent of reproductive age women suffer from anemia44 and 17 percent have long-term energy deficiencies. These statistics differ by geographical region and social group. Although undernutrition remains a significant issue in Nepal, obesity is becoming a health concern because 22 percent of women are overweight or obese45 . To tackle these issues, the Government of Nepal launched the Multisector Nutrition Plan II. Nepal: Snapshot of broad thematic areas supported by SAFANSI SAFANSI-financed analytical work informed the government’s first National Multisector Nutrition Action Plan for 2013-17 and supported the pilot and design of the Bank-financed project, Sunaula Hazar Din – Community Action for Nutrition. The SAFANSI-supported impact evaluation of the Sunaula Hazar Din project facilitated SAFANSI’s continued engagement in the development of a second National Multisector Nutrition Action Plan that runs through 2022. The SAFANSI-financed work, Scaling-Up Nutrition Initiative Technical Assistance (SUNITA), informed the government’s first national nutrition action plan. SUNITA supported the pilot program, Rapid Results for Nutrition Initiatives, which mobilized targeted village development committees to form community action plans setting nutrition, health, food security, and/or water and sanitation goals to improve the well-being of mothers and infants during their first 1,000 days. The village committees accessed public or private funds to implement their action plans. Key findings from SAFANSI-financed impact evaluations of the Sunaula Hazar Din nutrition project said that the selected goals were more likely to benefit the whole community rather than pregnant and lactating mothers and children under two. About 53 percent of the village committees surveyed set the goal of ending open defecation, 44 Anemia data from the World Health Organization’s Global Health Observatory Data Repository at https://data.worldbank.org/indicator/SH.ANM.ALLW.ZS?view=chart. 45 Source for stunting, wasting, anemia, long-term energy deficiencies, overweight and obesity (unless otherwise specified): Multisectoral Nutrition Plan II (2018-2022), Government of Nepal National Planning Commission, 2017. 25 Nourishing Ideas for Action while 46 percent set a goal to achieve clean and safe water. The nutrition goals most relevant to the first 1,000 days of a child’s life — pregnant women and young children eating more animal protein, and mothers taking iron and folic acid supplements — were chosen by only 27 percent and 5 percent of the village committees, respectively. Focus groups also found that women were less likely to participate in the nutrition project action plans, and that ethnic minorities often did not participate (see Box 5). Box 5: Nepal: A 1,000-day window of opportunity In the Nepal language, “Sunaula Hazar Din” means “Golden 1,000 Days” — a critical period from conception to age two for nutrition. Sunaula Hazar Din is also the nickname of a nutrition project that aimed to change practices that contribute to malnutrition in women of reproductive age and young children. Communities in the project formed groups of nine members who selected and worked together on an activity to address malnutrition for 100 days. SAFANSI supported a study to learn how groups carried out their work. It found male group members hindered the meaningful participation of women. One group facilitator said, “making women leaders is quite challenging as illiterate men start to feel threatened.” Such information is valuable because some of the project techniques will be photo: World Bank embedded in local governance structures. 3.2.7 Pakistan Pakistan has become a food-surplus country and a major producer of wheat and rice in recent years. Despite the growth in food production, Pakistan’s poorest and most vulnerable cannot afford a sufficient and nutritious diet. According to the UN World Food Program, approximately 60 percent of Pakistanis face food insecurity,46 and malnutrition is high. About 38 percent of children under five suffer from stunting. Women and girls are further disadvantaged in accessing food and humanitarian assistance, due to social and cultural norms and practices. Ongoing conflict between the Government of Pakistan and militant groups, natural disasters such as drought, earthquakes and floods, and economic instability exacerbate food insecurity and disrupt livelihood opportunities, particularly in rural areas. In recent years, the government’s commitment to address such challenges is increasingly evident, with steps to scale up a nationwide, multisectoral approach at the core of its development agenda. Pakistan’s latest Five-Year Development Plan includes a nutrition component, and provincial action plans are being implemented together with decentralized budget analyses. 46 From the USAID Food Assistance Fact Sheet, September 30, 2018, https://www.usaid.gov/pakistan/food-assistance. 26 Pakistan: Snapshot of Broad Thematic Areas Supported by SAFANSI SAFANSI has supported the government by providing analytical works to help address child stunting. By expanding on the midline evaluation of the Bank-supported project, Pakistan Poverty Alleviation Fund III, the SAFANSI-supported Child Nutritional Outcomes and Community Based Health Service Provision Project revealed the level of water and sanitation awareness in rural Pakistan. The study found more than two-thirds of water at the source, and three-fourths of water held in storage containers were significantly contaminated, but less than 4 percent of households treated stored water. One-third of surveyed households had no toilet facility, and only one-third reported washing hands after cleaning a child’s bottom. After the central government delegated nutrition-related issues to provincial governments in 2010, SAFANSI supported the development of nutrition policy guidance notes in four provinces, which facilitated the development of three Bank-financed projects in the health sector. The SAFANSI-financed project, Multisectoral Nutrition Dialogue and Technical Assistance, helped the four provincial governments of Balochistan, Khyber Pakhtunkhwa, Punjab, and Sindh prepare their own nutrition policy guidance notes. Among these provinces, Sindh had a stunting rate of 57 percent, higher than the national average of 45 percent in 2012- 13. The stunting rate was lower in Khyber Pakhtunkhwa and Punjab (42 percent and 40 percent, respectively), but stunting was evident among at least one-fourth of young children living in food-secure households.47 The four nutrition policy guidance notes stress multisectoral coordination and focus on water and hygiene, food security, health care services, girls’ education, and social safety nets. As a result of this work, Pakistan joined the Scaling Up Nutrition movement and developed two new Bank-financed health sector projects at provincial level: Sindh Enhancing Response to Reduce Stunting Project and Enhanced Nutrition for Mothers and Children to improve nutrition service delivery in the first 1,000-day window. In Punjab, the provincial policy guidance note led to a restructuring of the Bank-supported Punjab Health Sector Reform Project ($71 million), which reallocated resources for health-related nutrition interventions. The findings and recommendations from the SAFANSI-financed study, Adolescent Nutrition in Pakistan Identifying Opportunities and Setting Priorities, contributed to the development of a national strategy for adolescent nutrition under preparation by the Federal Ministry of National Health Services, Regulations and Coordination. The grant helped establish a National Technical Advisory and Advocacy Working Group to influence policies, strategies, and action plans to improve adolescent nutrition, including those goals set out in the Framework for Action. This advocacy and learning platform created by the health ministry brings together key stakeholders in the government, development community including the Scaling Up Nutrition Secretariat, UN agencies and implementing partners from the public and private sectors. 3.2.8 Sri Lanka Sri Lanka’s stunting rate is 17 percent, which is the second lowest in South Asia. The nation’s wasting rate of 15 percent ranks second in the region, after India with 21 percent. Acute malnutrition and 47 Source for all stunting data in this paragraph: Pakistan Demographic and Health Survey 2012-13. 27 Nourishing Ideas for Action micronutrient deficiencies remain serious concerns. Sri Lanka has pockets of underserved areas, such as tea estates. An island country, Sri Lanka is highly vulnerable to climate change and natural disasters. Sri Lanka joined the Scaling Up Nutrition movement in 2012. The country’s National Nutrition Council serves as the multisectoral governance mechanism to operationalize the Multisectoral Action Plan for Nutrition 2017-20. Sri Lanka: Snapshot of Broad Thematic Areas Supported by SAFANSI In Sri Lanka, SAFANSI focused on disadvantaged areas. SAFANSI supported development of a community- based nutrition promotion model in collaboration with government ministries at the divisional level in Sri Lanka’s post-conflict northeast. SAFANSI also collected data on malnutrition in the tea estate sector. These activities informed the government’s Multisector Action Plan for Nutrition. The SAFANSI- financed project, Integrating Nutrition Promotion and Rural Development (INPARD), supported village development organizations in the northeast, formed by the Bank-supported project, Community Livelihoods in Conflict- Affected Areas, to develop and implement nutrition plans for school children and their families. The plans were developed with technical support from local offices of the government’s health, education, agriculture, fisheries, livelihoods, and economic development departments. With support from the local government, nutrition training was provided at schools and villages, which led some schools to serve nutritionally balanced lunches using local produce. A SAFANSI-financed impact evaluation of the INPARD project found consumption of vegetables increased in surveyed areas (2 extra servings or 160 grams per week per person), compared to control areas (a reduction by 0.1 serving). The evaluation also found an increase in the number of men and women with a healthy weight and waist circumference. Other findings included a decline in the number of schools selling sugary snacks and a significant decrease in the number of students eating fast food. The INPARD community-based nutrition promotion model informed the Sri Lanka government’s nutrition action plan and was replicated in the Bank- financed rural livelihoods development Nuton Jibon project in Bangladesh. A SAFANSI-supported project, Improving Nutrition through Modernizing Agriculture in Sri Lanka, will pilot the INPARD model through the Bank- financed Agriculture Sector Modernization Project, which supports farmer organizations in partnership with public and private sectors to boost production and sales. The SAFANSI-financed project, Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector, informed the nutrition action plan for the tea estate sector, which fed into the government’s nutrition action plan. SAFANSI has supported an evidence-based public policy dialogue to help develop an estate nutrition plan of action. A collaborative network of public, private and NGO partners has also been supported by SAFANSI to engage in advocacy, community mobilization, and information and communication technology to advance the development and implementation of an estate nutrition plan of action. The SAFANSI-financed study, Nutrition Positive Deviance Analysis, identified successful behaviors of positive deviance that could help estate sector residents achieve better nutrition. 28 4. Program Management and Administration Governance. SAFANSI was created as a multi-donor program and financed through two consecutive multi-donor trust funds. The program was originally governed by a small secretariat housed in the World Bank’s agriculture department for South Asia. Placing the secretariat there was a strategic decision to change the traditional image of nutrition as solely a health issue, and to encourage agriculture and health sector specialists to collaborate. The sectoral diversity of the SAFANSI portfolio is a testament to the positive impact of this decision. Under Phase II, SAFANSI program management is led jointly by the Bank’s South Asia Regional Integration Office and the Agriculture Global Practice, creating stronger linkages with the regional strategy and country management units. The strategic direction and overall guidance for SAFANSI has been provided by the Donor Committee, which has representatives from each donor. Under SAFANSI II, the governance structure expanded to include a SAFANSI Steering Committee chaired by the Bank’s South Asia Regional Integration Director. Other members included World Bank experts from the Global Practices for Agriculture, and Health, Nutrition, and Population; South Asia country program coordinators; and the South Asia region’s chief economist. The SAFANSI Steering Committee is responsible for funding allocation decisions. A Technical Advisory Committee, which was planned but not operationalized under SAFANSI I, began reviewing proposals to ensure the technical quality of funding requests under SAFANSI II. Committee members are technical experts from relevant departments throughout the Bank. SAFANSI funding allocations are based on a call for proposals process. Calls are issued periodically subject to funding availability. Proposals are initiated by World Bank team leaders, using SAFANSI’s proposal template, and aligned with client country or regional priorities. The procedures were slightly revised between Phase I and Phase II, but under both phases proposals were subject to a technical review and clearance by the relevant World Bank country management unit to ensure country ownership of the activity. Final approval of proposals was by the SAFANSI Program Manager during Phase I, and by the Steering Committee under Phase II. Team leaders interviewed for this report said the grant approval process was relatively simple. Consultation with country management units found the prioritization of proposals and inclusion of Country Program Coordinators on the Steering Committee helped to ensure approved proposals were well-aligned with ongoing country programs. Approved proposals are subject to the same due diligence and quality control as projects financed from Bank’s budget or the International Development Association. One of the innovations created during SAFANSI II was a just-in-time window to finance small activities that can provide a quick response. Proposals are accepted on a rolling basis for grants up to $50,000 to be implemented within eight months. The just-in-time window has proven a successful addition under Phase II, with seven grants approved for knowledge sharing and dissemination, exchange of information between South Asian countries, and rapid surveys and evaluations (see Annex 2 grants marked “Just-in-Time Window”). Knowledge Management. A critical innovation during Phase II prioritized SAFANSI funding in response to evidence-based knowledge. The operating principles were expanded to acknowledge the need to embed an effective knowledge management system in the trust fund’s operations. The principles for Phase II established the need to generate, disseminate, and leverage original research to tackle food quality and safety issues, and nutrient deficiencies and their impacts on labor productivity, economic activity, quality of life, and society in general. As a logical extension of this innovation, the program focused on communications and knowledge management. SAFANSI II developed a communications strategy with branding and visibility guidelines. Communications 29 Nourishing Ideas for Action activities included creating a monthly SAFANSI newsletter, SAFANSI results stories and blogs, a SAFANSI website, a series of SAFANSI roundtables, and other knowledge sharing events. The knowledge management system has sought new ways to make SAFANSI findings available to stakeholder communities, including events to stimulate discussion of FNS issues. SAFANSI’s communications team organized a series of roundtable meetings to bring together policy and program planners, private sector stakeholders, nutrition experts, client governments and donors. Such outreach meetings ensure better strategic alignment of activities to support nutrition and identify pathways for sustainable government support of nutrition outcomes. The events successfully promoted networking and cross-sectoral collaboration to expand on SAFANSI’s existing work. Though the program is not yet complete, SAFANSI I and II have produced more than 100 communications products such as videos, blogs, feature stories, studies, and social media messages that showcase FNS results. The SAFANSI website engages with the public on FNS issues and makes available all program outputs on the SAFANSI Products page. 30 5. Main Findings SAFANSI has mainstreamed multisectoral approaches in FNS interventions at national, provincial, district, and/or community levels in South Asian countries. In addition to the national-level multisectoral collaboration in developing national nutrition action plans or five-year plans, SAFANSI has facilitated provincial- level collaboration in Pakistan, and divisional, as well as community-level collaboration in Sri Lanka. At the community level, SAFANSI supported design and implementation of FNS interventions through village-level institutions in India, Nepal, and Sri Lanka. The multisectoral FNS service delivery mechanisms were scaled up, and/or replicated, in Bank-financed agriculture projects in Bangladesh, India, and Sri Lanka. In India, especially, the multisectoral FNS interventions through self-help groups and their federations have been mainstreamed in national and state rural livelihoods development projects. As a result, SAFANSI-financed projects contributed to, or leveraged many Bank-financed projects and operationalized various multisectoral models. This has also contributed to the increase in nutrition-sensitive projects in the Bank’s South Asia portfolio. SAFANSI has informed 11 national policies in South Asia,48 including six national nutrition action plans in Afghanistan, Bangladesh, Nepal, and Sri Lanka. In Pakistan, SAFANSI supported the development of provincial nutrition policy guidance notes in four provinces, which informed Bank-financed health sector projects in the provinces. In Afghanistan and Nepal, SAFANSI has continued its support in developing and/or implementing the national nutrition action plans over two cycles: The National Action Framework in support of the Afghanistan National Development Strategy (2008-13) and the National Nutrition Plan (under development) in Afghanistan, and the National Multisectoral Nutrition Action Plan I (2013-17) and II (2018- 22) in Nepal. Through analytical work, SAFANSI informed nutrition budgets in recent nutrition action plans in Afghanistan and Bangladesh. In Nepal and Sri Lanka, SAFANSI’s contribution to the nutrition action plans was through community-level implementation mechanisms, based on lessons learned from SAFANSI-financed pilots and knowledge products. SAFANSI also informed other key national policies, such as the five-year plans in Bangladesh and Bhutan, the World Bank’s Systematic Country Diagnostic and Country Partnership Framework in Bangladesh,49 and regulatory reforms in India on milk fortification. In Pakistan, SAFANSI facilitated provincial level FNS engagement upon the decentralization of the nutrition-related issues to provincial governments. The provincial nutrition policy guidance notes were critical in developing Bank- supported projects that address stunting in the four provinces. Through knowledge products and innovative pilots, SAFANSI has contributed to or leveraged 32 Bank- financed projects worth $6.3 billion50 targeting more than 35.6 million beneficiaries.51 About one-third of SAFANSI financing has leveraged or stimulated Bank-supported projects through turnkey technical and operational support, including strategic policy guidance notes in Pakistan and design and implementation of critical FNS pilots in India, Nepal, and Sri Lanka. The SAFANSI-financed impact evaluation for the conditional cash 48 This represents the total number of national policies influenced by SAFANSI I and II. 49 The Systematic Country Diagnostic is a diagnostic exercise conducted by the World Bank in close consultation with national authorities, the private sector, and other stakeholders, as appropriate. The Country Partnership Framework builds selectively on a country’s development program with a results-based engagement. 50 The amount represents the aggregation of the total costs of the Bank-financed projects that SAFANSI contributed to or leveraged and is not limited to FNS interventions or components only. 51 These figures sum up achievements of both SAFANSI I and II. The 35.6 million beneficiaries do not include an additional 43 million people who are expected to receive fortified milk through the SAFANSI pilot that was scaled-up by the World Bank and remains under way 31 Nourishing Ideas for Action transfer pilot in Bangladesh provided key evidence for a scale up of the pilot through a Bank-supported project. The remaining two-thirds of SAFANSI financing has provided more general implementation support, such as impact evaluations (studies and/or design) and learning notes. Some 34 SAFANSI-financed projects contributed to, or leveraged, 32 Bank-supported projects. Additionally, five SAFANSI-financed projects informed national nutrition action plans or policies (see Annex 7 for World Bank projects linked to SAFANSI grants). Beneficiaries of the SAFANSI-financed projects are the poor and vulnerable, and include pregnant and lactating mothers, children, small farmers, landless, and ethnic minorities in disadvantaged areas. In Sri Lanka, SAFANSI focused on the post-conflict northeast and the estate sector with Bank-financed agriculture and health projects. In Bangladesh and India, SAFANSI financed studies and pilots in indigenous/tribal or underserved areas, which influenced the agriculture and health projects in those countries (see Annex 7 for an overview of World Bank projects linked to SAFANSI grants). On infant and young child feeding, SAFANSI supported the development of a World Breastfeeding Costing Initiative tool, which was adopted by governments in South Asia and beyond (see Box 6). Box 6: Tool to prioritize and budget support for breastfeeding Mothers who exclusively breastfeed infants during their first six months reduce malnutrition, promote brain development, and give children a better chance to lead a healthy, productive life. Ideally, women begin breastfeeding within one hour after giving birth. SAFANSI financed the World Breastfeeding Costing Initiative, which developed a financial planning tool for countries to prioritize, promote, and adopt breastfeeding policies. National policies typically include ensuring that women receive unbiased and accurate information about the health benefits of breastfeeding and are not subject to commercial pressures immediately after delivery. Other important steps create “baby friendly hospitals” that keep newborns physically close to their mothers to encourage breastfeeding, and training community volunteers to show nursing women how to add age-appropriate, complementary solid foods starting in a baby’s sixth month. The WBCi tool is a user-friendly spreadsheet that helps countries budget and scale up services to support mothers based on local conditions. The initiative has been adopted by Afghanistan, Bangladesh, India, photo: World Bank Nepal, and by 16 countries outside South Asia. Communications notes and materials such as videos, communications strategies, conferences, and roundtables were important contributors leveraging the SAFANSI knowledge platform. SAFANSI evidence or analysis was presented at about 164 World Bank or partner-led knowledge sharing events. Nearly 1000 policymakers, government officials, or practitioners were trained for effective FNS program development, delivery and/or monitoring at in-country seminars and workshops. About 175 feature stories and blogs highlighted SAFANSI-supported activities, products, or knowledge. As SAFANSI focused on innovation during Phase II, more than 20 promising new concepts, technologies, and approaches were evaluated or tested with target groups, and each addressed gender issues.52 52 This information is only available for SAFANSI II as it was not part of the results framework for the first phase. 32 6. Lessons Learned Through regional projects, knowledge sharing events and other innovative interventions, SAFANSI has facilitated cross-country dialogue and learning. Despite these gains, regional cooperation remains a challenge. A follow-on nutrition program would present an opportunity for further collaboration, learning and exchange between countries to tackle cross border issues, common standards, trade, and other shared FNS- related challenges. Although the overall funding amount available through SAFANSI was small, funding was flexible and catalytic. The well-targeted use of limited resources has had a significant impact on driving the FNS agenda in the South Asia region and developing a comprehensive body of research, data, and knowledge. However, the financing available was insufficient to support recipient-executed activities, which the program originally envisaged. SAFANSI’s governance and call for proposals process are relatively simple and adequate for the size of the program. Lessons from SAFANSI I informed changes to the governance structure under SAFANSI II. The introduction of a Steering Committee, Technical Advisory Committee, and Secretariat staffed by the South Asia region and agriculture team strengthened linkages between the sectors and country priorities. This could be further strengthened through a more strategic approach to the allocation of funding in a future phase. In line with the World Bank’s trust fund reform agenda, fund allocation should be integrated to the extent possible in the annual World Bank work program planning process to maximize the strategic alignment between trust fund and World Bank financing. This will further coordinate SAFANSI program activities with sector, thematic, and country priorities. A greater focus on communications under SAFANSI II improved knowledge sharing and increased the visibility of the program. The website, blogs, a monthly newsletter, and knowledge sharing events gave SAFANSI activities and results greater visibility. SAFANSI roundtables have been an important platform to engage policy makers, development partners, and other stakeholders in the region. A future program should build on and expand the communications platform developed under SAFANSI II. Housing the SAFANSI Secretariat in the Bank’s Agriculture Global Practice contributed to breaking down silos and stimulating a multisectoral approach to nutrition. SAFANSI provided dedicated funding for nutrition in the agriculture space. The implementation timeframe for the two phases of SAFANSI limited the types of interventions that could be supported and the results that could be measured. The independent evaluation of SAFANSI Phase I recommended that any subsequent phase have a longer timeframe of 5 to 10 years. Despite this recommendation, Phase II will have been active for not quite 5 years when it closes at the end of September 2019. The limited timeframe was not conducive for financing recipient-executed activities, which generally require a longer preparation and implementation period. Similarly, influencing upstream policy and anthropometric results takes time. For any subsequent phases of SAFANSI or an alternate FNS program, a longer implementation timeframe should be considered. 33 Nourishing Ideas for Action 7 Conclusion - Looking Forward Over the past eight years, SAFANSI has been a catalyst in advancing the FNS agenda in South Asia by filling critical gaps in research, advocacy, data, and innovation. A primary focus has been the public and private sectors’ failure to deliver nutrition production technology to supplement and fortify food, support breastfeeding, diversify crops, and provide emergency nutrition. Much has been accomplished, but evolving and emerging nutrition issues mean that even more remains to be done. SAFANSI has identified six FNS areas that need attention. These are (1) nutrition-sensitive agriculture, (2) private sector involvement in FNS, (3) child undernutrition, (4) gender and nutrition, (5) urban malnutrition, and (6) climate change. SAFANSI’s successful milk fortification pilot program with the private sector in India is an example of an innovative approach that makes an impact. The pilot to add Vitamins A and D to milk, was scaled up to benefit more poor people through the Bank-financed National Dairy Support project. Similarly, SAFANSI has demonstrated how to encourage change by developing community-level FNS delivery mechanisms in India, Nepal, and Sri Lanka. However, SAFANSI has not yet tackled emergency nutrition, consumer behavior, and how household dynamics affect family nutrition. A Social Observatory study of safety nets in Odisha, India after a cyclone found that participation in a Bank-financed rural livelihood development project did not prevent families from cutting spending on food. The impact of natural disasters on the household food basket, especially among pregnant and lactating mothers, needs further study. Although there has been progress, undernutrition remains a huge challenge for the region. By expanding data, knowledge products, service delivery models, and the regional FNS portfolio developed in the last eight years, a follow-on nutrition program could address the unfinished and evolving FNS agenda. Such work would leverage broader development strategies such as the Bank’s Human Capital Project, its focus on Maximizing Finance for Development, and the Agriculture Global Practice report, “Future of Food: Shaping the Global Food System to Deliver Improved Nutrition and Health.” The need for a follow-on program is based on a critical review of the existing research literature on South Asia nutrition and development and analysis performed for the Bank report, “Ending Undernutrition in South Asia.” Future work would address prominent gaps in evidence or where existing evidence is of poor quality, such as nutrition-sensitive agriculture and the private sector. The six areas for future work are relevant to the current undernutrition problem and how the issue is expected to evolve based on socio-economic developments. Challenges include common claims that are untested, and existing evidence that is scarce, weak, or inconclusive. Insight for sound policy and program design is at present limited in these areas. Nutrition-sensitive agriculture The SAFANSI-financed study, “Regional Costing and Cost-Effectiveness,” demonstrated that scaling up key nutrition interventions, such as food fortification, in Bangladesh would prevent 500,000 cases of stunting among children under five. That health improvement would translate into a $5.6 billion increase in economic productivity over the lifetime of the treated children. The World Bank Agriculture Global Practice’s priorities, 34 as outlined in its report on the future of food, argues improved nutrition and health for better lives and well- being can be delivered by transforming the food system, which is defined as “the set of institutions, resources, stakeholders, and behaviors involved in the production, transformation, delivery, sale, and consumption of food.”53 This requires a combination of improved knowledge, sound policies, regulations, and investments across the production-to-consumption continuum. In mainstreaming FNS into the transformative food system, the nutrition effects of agricultural diversification and other issues such as food safety should be assessed carefully. For example, the innovative use of information and communication technology, or ICT, could create a consumer feedback mechanism on food safety. At the same time, the FNS agenda should also be mainstreamed in policy dialogue on nutrition-sensitive agriculture. SAFANSI should engage with policy makers to move from calorie-focused policies toward nutrition-focused policies, as it did in Bangladesh’s second National Plan of Action on Nutrition. Private sector in FNS Governments have focused on improving agricultural production, which plays a key role in achieving food security and nutrition. Yet the broader and more complex system that moves food from a farm field to a consumer’s home is often ignored. The private sector largely dominates the food supply chain’s processing, storage, and retail marketing. Consumers buy food primarily in private markets. There is an opportunity to better understand constraints and opportunities of engaging with the private sector in nutrition value-chains. More information is needed about how a consumer interacts with markets, how food preferences and prices affect consumption, how government policies can enable or distort nutrition-sensitive food markets, and how to reduce food losses and waste. Box 7: Private sector partnership fortifies milk for millions The private sector is an important partner to improve nutrition in children, and SAFANSI is eager to explore more ways to work with companies and federations. One of SAFANSI’s most successful programs has been a partnership with India’s National Dairy Development Board and Tata Trusts to explore how fortified milk can prevent wasting and stunting in children. In India, half of all children are deficient in Vitamin A and more than 70 percent of children under 5 lack enough Vitamin D. SAFANSI worked with several milk federations, milk unions, and dairy producer companies to launch a pilot program delivering fortified milk in four targeted states. SAFANSI’s role included working behind the scenes to help establish regulatory standards for fortifying whole, low fat, and skim milk. One glass of fortified milk (320 grams) provides about one-third of Vitamin A and nearly half of Vitamin D recommended for daily consumption. The pilot program was quickly expanded to other states in India by the World Bank and is expected to provide 2.7 million metric photo: World Bank tons of fortified milk to 55 million consumers by June 2019. 53 The definition is from the World Bank report, “Future of Food: Shaping the Global Food System to Deliver Improved Nutrition and Health,” published in 2016. 35 Nourishing Ideas for Action It is crucial to understand how to work with the private sector to promote nutrition via safe and nutritious food, and to provide sanitation and safe water. This work includes regulatory and institutional changes needed to attract private investments. While this is a historically difficult area, successful interventions leveraging the private sector are valuable. The SAFANSI-supported milk fortification pilot in 16 states in India with Tata Trusts, dairy producer companies, and state-level milk federations will provide lessons on how to scale up and replicate a private sector engagement model in FNS in India and the region (see Box 7). SAFANSI is supporting a sanitation micro-enterprise development pilot at the village level in Bihar, India, which will create jobs providing sanitation goods and services to self-help group members. The Bank’s new approach of Maximizing Finance for Development and use of “multiplier” funds such as the Power of Nutrition and Global Financing Facility are an opportunity for SAFANSI to participate in critical development financing trends. Gender and nutrition Over the past eight years, SAFANSI has supported several key regional and country level studies and pilots focused on gender. Despite a recognition of the importance of gender, this remains a lagging and critical area for intervention. Transforming the food system means analyzing the important role of women in linking the food system to household nutrition. As recommended by the regional flagship report on gender and nutrition, SAFANSI facilitated household and community support for feeding infants and young children in Afghanistan by engaging husbands and mothers-in-law. In Bangladesh, SAFANSI mobilized men as well as women and children in developing an information and communication technology-based learning program on nutrition. Studies on adolescent girls’ nutrition have been or are being carried out in Pakistan and Bangladesh, and delivery mechanisms will have to be developed or piloted in the future. There are other gender dimensions in food system or nutrition value chains, such as feminization of agriculture, female labor market participation, and mothers’ employment. All dimensions should be assessed for more effective program design. Growing evidence suggests that the social status of poor women is a significant driver of undernutrition for both boys and girls in the region. The adverse effects of a woman’s low social status start before children are conceived, when future mothers are adolescents. Many parents demonstrate a bias for sons in investment choices, which may lead to girls falling behind in health and nutrition status in households where money is tight. Key policy questions should look at: (1) understanding the evolution of the health and nutrition status over a woman’s life from adolescence onward; (2) the specific pathways through which a woman’s low social status produces poor child health and nutrition; and (3) the specific adverse conditions when girls fall behind their brothers in nutrition. Child undernutrition There is a continuing need to address child stunting and human capital development, in line with the priorities of the Bank’s Human Capital Project. SAFANSI has financed many knowledge products and pilots that focused on the first 1,000 days of child’s life and created feeding capacity for infants and young children in Afghanistan, Bangladesh, India, and Nepal. SAFANSI has also supported nutrition-informed budgets in Afghanistan and Bangladesh. However, countries in the region have made little progress in reducing wasting — a measure of acute malnutrition that results from inadequate dietary intake and sharply raises the chance of death. 36 Apart from Bhutan, Maldives and Pakistan, wasting rates in all other countries in the region were at or above 10 percent, which is quite high. While several South Asian countries are on course to meet the 2025 World Health Assembly target to reduce stunting, all South Asian countries are behind in meeting the target to decrease wasting. This is the case even though much of nutrition service delivery in the region takes the form of permanent or emergency services to prevent and treat wasting. Unlike stunting, empirical evidence sheds little light on the drivers of wasting, which are much more mixed. Specific policy-relevant focuses include understanding the drivers of wasting, better prediction of wasting, and testing interventions to prevent wasting. Urban malnutrition SAFANSI has financed many rural activities addressing the nexus of food production, diversification, and consumption to stimulate agriculture and rural development in South Asia. Because the prevalence of poverty has historically been higher in rural areas, SAFANSI should contribute to the development of transformative food systems and FNS service delivery in unserved areas through community mobilization. Figure 6: South Asia’s urban population growth At the same time, SAFANSI cannot ignore urban malnutrition. South Asia’s urban population has grown threefold over the 35-year period from 1980 to 2015, from 202 million (24 percent of the region’s total population) to 565 million (35 percent). Over the next 35 years, it is expected to double to an estimated 1.13 billion by 2050, transforming the region’s population to a majority of urban-dwellers (see Figure 6). While most of the urban population growth will occur in smaller cities and towns, South Asia is expected to have one- fourth of the world’s megacities by 2030. Urbanization offers an important opportunity to boost the overall income level in the region. The region’s urbanization comes with important risks, stemming from deficiencies in urban planning, regulation, infrastructure, and basic services. The risks can undermine the performance of governments and private markets in promoting the health and nutrition status of urban residents, including meeting increasing demands for food and nutrition products and services. Rapid economic growth in cities is accompanied by a twin problem of undernutrition and obesity. There is a critical need to understand the variation in health and nutrition status in cities, and the drivers of, and barriers to, reducing undernutrition and tackling obesity. The implications of rapid growth of supermarkets, the role of large agribusiness, and the nutrition value chain of fortified food products on the nutrition outcomes of urban population should carefully be assessed and promote nutrition actions to counter urban malnutrition. The SAFANSI-financed project, Integrating Nutrition Promotion and Rural Development, tackled the issue of overweight school children and their parents in Sri Lanka through community-based awareness raising and action plan implementation at schools. The lessons learned could be applied to urban areas. 37 Nourishing Ideas for Action Climate change Climate change is an important strategic area for the World Bank. In South Asia, climate change is predicted to greatly increase the extent and depth of child undernutrition by adversely affecting nutrient intake and health. There are multiple ways through which climate change can undermine nutrition in children and adults. Climate change could impair food production by reducing key agricultural inputs and farm land, and by transforming areas with surplus crops to areas of shortages. Climate change can lead to food loss, reduce nutrients available in plant-based foods, and increase mycotoxins in cereals. Climate change can heighten the risk of food-, water-, and vector-borne infectious diseases. It can spur large population movements that may heighten nutrition risk for migrants. Proactive mitigation and adaptation measures can counter the negative effect of climate change on nutrition. A simulation exercise indicates that the number of malnourished children in poor countries will be about 10 percent higher in 2050 under a scenario of climate change with no mitigation than one with perfect mitigation. A third phase of SAFANSI could better understand the extent and nature of the relationship between climate change and nutrition status in the region. The design of a future nutrition program would be consistent with national strategies, and developed in collaboration with development partners, World Bank Global Practices and the Bank’s South Asia region. 38 Annex 1: Participants in Consultations about SAFANSI’s Impact Kathmandu, Nepal – December 10, 2018 (Face to Face) Name Title Organization 1. Manav Bhattarai Sr. Heath Specialist World Bank 2. Stephane David Programme Manager Delegation of the European Union to Nepal 3. Mim Hamal Programme Manager Delegation of the European Union to Nepal 4. Peter Newsum Country Director, Nepal and Bhutan SNV- Netherlands Development Organization 5. Stanley Chitekwe Chief, Nutrition Section UNICEF- Nepal 6. Pradiumna Dahal Nutrition Specialist UNICEF- Nepal 7. Dilli Sedai Project Director Nepal Livestock Sector Innovation Project Dhaka, Bangladesh - December 13, 2018 (Face to Face) Name Title Organization Team Leader, Food & Nutrition 8. Manfred Fernholz Delegation of the European Union Security & Sustainable Development Programme Manager, Food Security 9. Assunta Testa Delegation of the European Union and Nutrition 10. Saiqa Siraj Programme Head, Nutrition, HNP Building Resources Across Communities54 11. Imran Ahmed Building Resources Across Communities International Food Policy Research Institute, Consortium of International Agriculture Research 12. Nazmul Alam Program Manager Center’s Program on Agriculture for Nutrition and Health (A4NH) in Bangladesh 13. Md. Khairul Bashar Country Manager CIAT-HarvestPlus 14. Manievel Sene Sr. Agricultural Specialist World Bank 54 The definition is from the World Bank report, “Future of Food: Shaping the Global Food System to Deliver Improved Nutrition and Health,” published in 2016. 39 Nourishing Ideas for Action Pakistan - December 17, 2018 (Videoconference) Name Title Organization Deputy Director of Health, Population 15. Han Kang USAID and Nutrition Global Alliance for Improved Nutrition (GAIN) 16. Asma Badar Project Manager Adolescent Nutrition Pakistan Global Alliance for Improved Nutrition (GAIN) 17. Faiz Rasool Head of Programs Pakistan 18. Tausif Akhtar Janjua Technical Director Food Fortification Nutrition International 19. Aliya Kashif Sr. Heath Specialist World Bank SUN Secretariat (Ministry of Planning Development 20. Irshad Danish Advocacy Specialist & Reform) India - December 20, 2018 (Face to Face) Name Title Organization Breast feeding Promotion Network of 21. Arun Gupta India and South Asia Coordinator for IBFAN South Asia IBFAN 22. Alok Indranand Ranjan Senior Program Officer - Nutrition Bill & Melinda Gates Foundation 23. Vivek Arora Senior Advisor Tata Trusts Gadha Raj Project Coordinator, Milk Fortification 24. National Dairy Development Board (NDDB) Nadupparambil Pilot Project Agriculture Practice Manager, South 25. Kate Hollifield World Bank Asia 26. Gayatri Acharya Lead Rural Development Economist World Bank 27. Chakib Jenane Lead Agriculture Economist World Bank 28. Abel Lufafa Senior Agricultural Specialist World Bank Balakrishnan Madhavan 29. Rural Development Specialist World Bank Kutty 30. Abhishek Gupta Rural Development Specialist World Bank 31. Ashi Kathuria Senior Nutrition Specialist World Bank Bhutan - December 21, 2018 (Videoconference) Name Title Organization 32. Karma Zangmo Intern U.N. Food and Agriculture Organization 33. Dungkar Drukpa Officer in Charge for Bhutan World Food Programme 40 Annex 2: SAFANSI Portfolio All figures in U.S. dollars Phase I – Technical Activities (2010-2015) Trust Fund Country Activity name Amount Closing Date Number 1. TF010381 Regional Gender and Nutrition 160,192.01 10/31/2013 2. TF011469 Regional Linking Measures of Food Security with Nutritional Outcome 111,385.64 10/31/2013 3. TF011712 Regional Visualizing the ‘Invisible’ Epidemic of UnderNutrition 64,684.59 12/31/2013 4. TF011910 Regional Global Conference on Women in Agriculture 25,652.14 08/30/2012 5. TF013549 Regional Strengthening Infant and Young Child Feeding Capacity (Recipient-Executed) 600,699.00 01/31/2015 6. TF013556 Regional Supervision of Grant to Breastfeeding Promotion Network of India 68,081.46 03/31/2015 7. TF014546 Regional Towards Understanding the Effects of Food Price Polices on FNS 203,007.39 08/31/2015 8. TF014901 Regional Agriculture Extension and Nutrition through ICTs 187,602.25 01/31/2015 Enhancing Knowledge and Awareness of Critical Factors that Promote FNS Through Women's 9. TF015348 Regional 253,699.51 09/30/2015 Network Groups International outreach of SAFANSI and Business, Enterprise, and Employment Support (BEES) 10. TF017273 Regional 17,254.65 06/25/2014 program 11. TF017660 Regional Coordination, Partnership Development and Results Monitoring for FNS in South Asia Region 67,736.51 08/31/2015 12. TF097620 Regional Evaluating and Learning from Innovative Community Approaches to Improving Child Nutrition 436,732.85 06/30/2012 13. TF099039 Regional Cross-Sectoral Approaches to FNS 49,877.74 03/31/2012 14. TF099707 Regional Adequacy of Food, Health and Care to Nutrition Outcomes 133,615.94 09/30/2013 15. TF015365 Afghanistan Visualizing Stunting: A Call for a Concerted Action 127,865.49 08/31/2015 16. TF098874 Afghanistan Multisectoral Plan to Promote FNS 252,196.90 02/20/2014 17. TF011841 Bangladesh Nutrition, Health, Diarrhea and Sanitation Security 214,493.76 03/31/2014 18. TF014744 Bangladesh Strengthening Awareness and Advocacy of the Potential of Fisheries to Improve FNS 212,342.13 03/31/2014 41 42 Trust Fund Country Activity name Amount Closing Date Number 19. TF016363 Bangladesh Nutrition and Food Security Implications of Rural Growth 507,693.51 09/30/2015 Nourishing Ideas for Action 20. TF016677 Bangladesh Impact Evaluation of Integrated Agricultural Productivity Project 246,835.64 03/31/2015 21. TF098429 Bangladesh Multisectoral Simulation Tool for Scaling Up Nutrition 186,924.40 08/31/2013 22. TF099422 Bangladesh Impact Assessment of Conditional Cash Transfer Pilot through Local Government 147,202.57 06/30/2014 23. TF012082 Bhutan National Nutrition Assessment 119,496.79 02/28/2014 24. TF010794 India Developing a Framework for Applied Political Economy Analysis of FNS in South Asia 89,781.27 04/30/2013 25. TF011993 India Social Observatory for the NRLM: Food Security Issues in South Asia 2,734,495.78 09/30/2015 26. TF012081 India Multisectoral Nutrition Actions in Bihar 160,510.25 03/31/2015 27. TF012122 India Improving Food Security in Tribal Areas 341,406.95 06/30/2014 28. TF012676 India Community-Managed FNS Initiative in High Poverty States 297,538.29 03/31/2015 29. TF014041 India Strengthening Agriculture Education and Policy Making for FNS 33,231.27 06/30/2013 Food grains Storage and Trade Policy Option: Tradeoffs and Implications for Food Security: A 30. TF014636 India 102,054.17 09/30/2014 Knowledge Development Activity Global Policy Consultation and International Conference on Leveraging Agriculture for 31. TF098748 India 200,000.00 06/30/2012 Improving Nutrition and Health (Recipient-Executed) 32. TF0A0585 India Community-Based Food Security Enhancement 61,650.26 09/30/2015 33. TF010274 Nepal FNS Thematic Report (NLSS) 101,670.84 05/30/2013 34. TF012123 Nepal Evaluating the Nutritional Impacts of FNS Programs 34,355.98 05/31/2013 35. TF012285 Nepal Community-Based Behavior Change for Nutrition Improvement 61,325.00 10/31/2013 36. TF012286 Nepal Review of Infant and Young Child Feeding Insecurity and Malnutrition 28,977.05 02/28/2014 37. TF013189 Nepal District Profiles of Determinants of Food Insecurity and Malnutrition 40,131.19 02/28/2014 38. TF013868 Nepal Sunaula Hazar Din – Community Action for Nutrition Project Impact Evaluation 449,835.83 08/31/2015 39. TF013934 Nepal Support to Nutrition Policy Dialogue II 19,747.14 02/28/2014 Training of Social Mobilizers and Coaches in a Results-Based Community Driven Approach to 40. TF014834 Nepal 435,408.60 03/31/2015 Reducing Malnutrition 41. TF015218 Nepal Small Area Estimation of FNS 40,118.00 03/31/2014 Trust Fund Country Activity name Amount Closing Date Number 42. TF015361 Nepal Gender Equality and Social Inclusion for Food and Nutrition Security in Nepal 218,353.49 12/31/2014 43. TF016678 Nepal Impact Evaluation of Agriculture and Food Security Project (AFSP) 26,616.08 10/31/2014 44. TF018790 Nepal Training Journalists on FNS 23,171.22 03/31/2015 45. TF098873 Nepal Nutrition Policy Dialogue III 429,245.66 03/31/2015 Child Nutritional Outcomes and Community Based Health Service Provision: Evidence from a 46. TF011848 Pakistan 442,757.49 09/30/2015 Randomized Field Experiment in Rural Pakistan 47. TF012245 Pakistan Multisectoral Nutrition Dialogue and Technical Assistance 60,243.77 02/28/2014 48. TF014344 Pakistan Long-run Economic Effects of Childhood Nutrition and Health Status 379,137.34 09/30/2015 Engaging Planning Commission, Agriculture and Water Ministries on FNS in Policy and 49. TF099154 Pakistan 3,232.98 06/30/2011 Investment Planning 50. TF015520 Sri Lanka Integrating Nutrition Promotion and Rural Development (INPARD) 701,228.87 08/31/2015 51. TF017744 Sri Lanka Multisectoral Nutrition Assessment and Gap Analysis in Estate Sector 184,647.71 08/31/2015 TOTAL $12,096,380.25 Phase I – Program Activities (2010-2015) Trust Fund Country Activity name Amount Closing Date Number 52. TF017500 Program SAFANSI Trust Fund Administration 269,300.21 09/30/2015 53. TF098394 Program SAFANSI Program Management (including secretariat functions) 590,871.78 03/31/2015 54. TF098925 Regional SAFANSI Program Management (including secretariat functions) 468,610.18 08/31/2015 TOTAL $ 1,328,782.17 43 44 Phase II – Technical Activities (2015-2019) Trust Fund Country Activity name Amount Closing Date Number Nourishing Ideas for Action Costing and Cost-Effectiveness Analysis of Scaling Up Nutrition-related Interventions in the 1. TF0A2323 Regional 400,000.00 12/31/2018 South Asia Region Background Analytical Outputs for The Regional Undernutrition Report: Ending Undernutrition 2. TF0A5366 Regional 800,000.00 12/31/2018 in South Asia 3. TF0A5836 Regional Addressing Critical Failures of Infant and Young Child Nutrition in South Asia 325,925.00 09/15/2019 4. TF0A1834 Bangladesh Dynamics of Rural Growth: Outreach and Dissemination (Just-in-Time Window) 49,501.54 07/31/2016 Leveraging Information Technology to Achieve Better Nutrition Outcomes in the Chittagong 5. TF0A3110 Bangladesh 315,000.00 01/31/2019 Hills Tract Can Conditional Cash Transfers Improve Child Nutrition and Cognitive Development? (Just-in- 6. TF0A3566 Bangladesh 44,030.55 06/30/2017 Time Window) 7. TF0A3672 Bangladesh Bangladesh Capacity Development in Nutrition Surveillance and Research 250,000.00 02/28/2019 8. TF0A5601 Bangladesh Tackling Malnutrition: The Story of Community Clinics (Just-in-Time Window) 40,421.02 04/30/2018 9. TF0A8172 Bangladesh Role of Agriculture Polices on Nutrition Outcomes: Exploiting a Unique Panel Survey 108,280.00 05/31/2019 10. TF0A3584 Bhutan Food Security and Agriculture (Just-in-Time Window) 28,525.76 06/30/2017 Capacity Development and Communication for Improved Nutrition Outcomes in Rural 11. TF0A3887 Bhutan 300,000.00 07/31/2019 Households Burden of Malnutrition for the States of Utter Pradesh, Nagaland, Uttarakhand, and 12. TF0A1098 India 501,622.93 12/31/2016 Meghalaya (Phase 1) Social Observatory: Catalyzing Improved Implement in Project to Improve Food and Nutrition 13. TF0A1325 India 1,000,000.00 05/31/2019 Security 14. TF0A2780 India Cross-Sectoral Technical Support on Nutrition in North East India 380,000.00 07/30/2019 Andhra Pradesh and Telangana Rural Inclusive Growth and Nutrition Project (Just-in-Time 15. TF0A3328 India 49,942.09 02/28/2017 Window) Improved Nutrition through Milk Micronutrient Fortification: Testing the Business Case under 16. TF0A4103 India 451,000.00 06/30/2019 the National Dairy Support Project Design and Plotting of Conditional Cash Transfers for Maternal and Child Health and Nutrition 17. TF0A4384 India 250,000.00 08/31/2019 in Madhya Pradesh (India) 18. TF0A5734 India Enterprise Development for Nutrition and Sanitation in Bihar 355,000.00 08/31/2019 Trust Fund Country Activity name Amount Closing Date Number Impact Evaluations of the Agriculture and Food Security Project and Sunaula Hazar Din 19. TF0A0635 Nepal 987,391.60 06/30/2018 Community Action for Nutritional Project 20. TF0A1374 Nepal Qualitative Assessment and Knowledge Enhancement of Community-Driven Nutrition Project 284,243.03 03/31/2018 Women’s Enterprise Initiatives to Ensure Community FNS in upland Nuwakot (Just-in-Time 21. TF0A2708 Nepal 48,786.31 02/15/2017 Window) 22. TF0A5674 Pakistan Adolescent Nutrition: Identifying Opportunities and Setting Priorities 267,800.00 05/31/2019 Technical Design Support for Nutrition Focused Conditional Cash Transfer Pilot Rollout in 23. TF0A6660 Pakistan 424,000.00 08/31/2019 Punjab 24. TF0A6922 Pakistan Tracking Nutrition Expenditure 350,000.00 05/31/2019 25. TF0A1146 Sri Lanka Integrating Nutrition Promotion and Rural Development (INPARD) 196,669.04 03/31/2017 Building Effective Nutrition Communication through Partnerships: Addressing Estate Sector 26. TF0A3103 Sri Lanka 49,988.71 03/31/2017 Nutrition Issues (Just-in-Time Window) 27. TF0A5051 Sri Lanka Nutrition Positive Deviance Analysis 119,034.94 03/31/2019 28. TF0A5987 Sri Lanka Improving Nutrition through Modernizing Agriculture in Sri Lanka (INMAS) 400,000.00 08/31/2019 TOTAL $8,813,127.58 Phase II – Technical Activities Approved after March 31, 2018, and Not Included in Report Analysis Trust Fund Country Activity name Amount Closing Date Number 29. TF0A7657 Regional Public Expenditure Review for Nutrition in South Asia 20,000.00 09/15/2019 30. TF0A8772 Regional Food Safe and Nutritionally Secure Asian Cities (Urban Food Systems) 200,000.00 7/31/2019 31. TF0A8082 Afghanistan Nutrition Costing Report 7,917.46 12/31/2018 32. TF0A8111 Afghanistan Afghanistan: Investing in Early Years: Options to Improve Nutrition 865,000.00 09/15/2019 33. TF0A8100 Bangladesh Food Prices, Food Security, and Nutrition 190,000.00 08/31/2019 34. TF0A8172 Bangladesh Role of Agriculture Policies in Nutrition Outcomes 108,280.00 05/31/2019 35. TF0A8333 Bhutan Sub Task: Public Expenditure Review for Nutrition (linked to TF0A7657) 120,000.00 07/31/2019 45 46 Trust Fund Country Activity name Amount Closing Date Number Technical Assistance for Operationalization of Convergent Action Plans Focused on Investing in 36. TF0A8287 India 450,000.00 08/31/2019 Nourishing Ideas for Action Early Years in Select States 37. TF0A8335 India Sub Task: Public Expenditure Review for Nutrition (linked to TF0A7657) 120,000.00 07/31/2019 Technical Assistance to Meghalaya: Community-led Integrated Pilot to Improve Nutrition and 38. TF0A8591 India 120,000.00 8/14/2019 ECD Outcomes 39. TF0A8751 India Assam: Improving Nutrition and Development Outcomes in Early Years 270,000.00 8/31/2019 40. TF0A8101 Nepal Analysis of Programs, Institutions, and Developments 115,000.00 08/31/2019 41. TF0A8375 Nepal Sub Task: Public Expenditure Review (linked to TF0A7657) 120,000.00 07/31/2019 Integrating Early Learning and Stimulation with the Maternal-Child Health-Nutrition Service 42. TF0A8060 Pakistan 220,000.00 07/31/2019 Delivery Platform in the Sindh Province of Pakistan 43. TF0A8334 Sri Lanka Sub Task: Public Expenditure Review (linked to TF0A7657) 120,000.00 07/31/2019 TOTAL $3,038,280.00 Phase II – Program Activities (2015-2019) Trust Fund Country Activity name Amount Closing Date Number 44. TF0A1187 Program SAFANSI Secretariat 202,012.00 09/30/2019 45. TF0A1473 Program SAFANSI Communications 705,886.00 09/30/2019 46. TF0A2872 Program SAFANSI Program Management and Administration 440,932.88 09/30/2019 47. TF0A7231 Program SAFANSI Roundtable 2018 139,803.47 08/15/2018 48. TF0A7232 Program SAFANSI Retrospective 2010-18 200,000.00 03/22/2019 49. TF0A9498 Program SAFANSI Roundtable 2019 200,000.00 04/30/2019 TOTAL $1,936,716.88 Annex 3: SAFANSI Portfolio - Main Findings (summarized) Phase I (2010-2015) Trust Fund Country Activity name Main findings Number The grant supported an expansion of gender work in the Pakistan country program 1. TF010381 Regional Gender and Nutrition and increased visibility of the Bank's growing role in the country's gender and development sector. The grant was to fill the acutely perceived knowledge gap on the relationship Linking Measures of Food Security with 2. TF011469 Regional between food security and nutrition by focusing on drawing out messages that can Nutritional Outcome lead to a greater coordination of the twin agendas of FNS. The grant produced the South Asia Regional Assistance Strategy for Nutrition 2011- 16, which sets out four pillars: (1) building and sustaining a strong constituency for Visualizing the ‘Invisible’ Epidemic of 3. TF011712 Regional nutrition, (2) positioning the Bank lending operations in SAR to improve nutrition, (3) Under-Nutrition implementing analytical work to address knowledge gaps in nutrition, and (4) testing geographical convergence of multiple sectors. At the conference, the Business, Enterprise, and Employment Support (BEES) for women in South Asia network was formed. BEES includes representatives of NGOs and Bank-supported projects from seven South Asia countries, which collectively Global Conference on Women in 4. TF011910 Regional reached close to 100 million women within the region with empowerment, capacity Agriculture building, institutional development, and technical and financial assistance. There were knowledge exchanges on sustainable food security and access to land. The concept of one-dish meals was replicated in the network. Strengthening Infant and Young Child Additional financing for capacity building with regional infant and young children 5. TF013549 Regional Feeding (IYCF) Capacity in South Asia feeding (see TF013556 above). Region In building capacity in infant and young child feeding (IYCF) in South Asia, the grant supported analytical works, such as the South Asia IYCF Report Card and a Supervision of Grant to Breastfeeding costing study. The study, “The Need to Invest in Babies,” was disseminated at the 6. TF013556 Regional Promotion Network of India World Health Assembly in 2014 and other international platforms. The grant also supported regional IYCF workshops for governments and CSOs and informed national IYCF programs and action plans. The “Food Price Stabilization in South Asia” report was published. The major findings were that national policies in Pakistan and Bangladesh were ineffective in stabilizing Towards Understanding the Effects of 7. TF014546 Regional domestic prices, and India’s policies were associated with moderate externalities on Food Price Polices on FNS cereal sectors of neighboring countries. These findings lead to consider a regional approach to stabilize food prices using market mechanisms. 47 48 Trust Fund Country Activity name Main findings Number The grant enhanced extension curriculums with nutrition-sensitive agriculture Agriculture Extension and Nutrition Nourishing Ideas for Action in India by collaborating with three state agriculture universities in Tamil Nadu, 8. TF014901 Regional through Information and Communication united Andhra Pradesh, and Bihar. The activity also reviewed their curriculums in Technologies (ICTs) consultations with national, state, and community stakeholders. The grant was to strengthen the BEES Network. Their meetings and products developed surfaced a number of issues that were very relevant to agriculture and Enhancing Knowledge and Awareness of rural development programs, including gender-based violence, managing advocacy Critical Factors that Promote Food and campaigns, production and quality control for handicrafts, human trafficking 9. TF015348 Regional Nutrition Security Through Women's and women, entrepreneurship identification and development, legal issues for Network Groups poor producers, accounting for women's work in national labor statistics, and the importance of the care economy. Derivative communication products were developed for dissemination. International Outreach of SAFANSI and 10. TF017273 Regional Additional financing to support the BEES Network (see above). BEES Program Supported three consultation events/ meetings which were instrumental in sustaining the momentum in the partnerships for improved FNS: • Partnership meeting in London (September 5-10, 2014); a Capacity Building Coordination, Partnership Development workshop in Oxford (September 7, 2014) and also the conference that the World 11. TF017660 Regional and Results Monitoring for FNS in South Public Health Nutrition Association was organizing entitled Building Healthy Asia Region Global Food Systems; • Regional Coordination Meeting of the UN and other partners working on nutrition in the Asia Region in Bangkok (March 4-6, 2015) • Donor Committee Meeting for SAFANSI II in Brussels (January 14-15, 2015). South Asia Development Marketplace financed 21 innovative proposals, focusing on child malnutrition. Fifteen projects focused on improving infant feeding practices (some also included a focus on the nutritional status of pregnant women) and Evaluating and Learning from Innovative the remaining six projects focused on reducing food insecurity, anemia, iodine 12. TF097620 Regional Community Approaches to Improving deficiency, diarrhea, mothers’ mental stress, and on the nutritional rehabilitation Child Nutrition of severely malnourished children. Lessons learned include partnership with government programs and private sector, communication outreach, monitoring and evaluation. The Baby Friendly Village Project in Afghanistan won an award. The grant took stock of international multisectoral efforts in reducing malnutrition, focusing on enabling policy changes, institutional framework, and multisectoral 13. TF099039 Regional Cross-Sectoral Approaches to FNS implementation arrangements. These were highlighted in a knowledge brief on Malaysia which achieved 8 percentage points reduction in malnutrition in five years. Adequacy of Food, Health and Care to Additional financing to prepare the South Asia Regional Assistance Strategy for 14. TF099707 Regional Nutrition Outcomes Nutrition 2011-16 (see TF011712 above). In supporting the Bank-financed System Enhancement for Health Action in Visualizing Stunting: A Call for a Concerted 15. TF015365 Afghanistan Transition Project, the grant engaged the Public Nutrition Department in the Action Ministry of Public Health to develop the script for the video. Trust Fund Country Activity name Main findings Number Afghanistan Nutrition Solution Series were developed, which identified and refined promising programmatic platforms for scaling-up effective nutrition solutions in health, education, agriculture, rural development, and social protection. The 16. TF098874 Afghanistan Multisectoral Plan to Promote FNS featured Bank-financed projects include the Baby Friendly Village Project, National Solidarity Project, National Horticulture and Livestock Project, and Female Youth Employment Project. The study analyzed causes of diarrhea using microbiological and behavioral measurements through a large-scale randomized controlled trial of water, sanitation, hygiene and nutrition interventions in rural Bangladesh. Over 95% of Nutrition, Health, Diarrhea and Sanitation 17. TF011841 Bangladesh WASH intervention households had access to an improved latrine and a sani-scoop Security for child feces disposal, compared to two thirds of control households. However, there were frequent fecal contaminations in water sources. Animal fecal markers were highly prevalent. In support of the Bank-financed National Agricultural Technology Project, a nutrition Strengthening Awareness and Advocacy of 18. TF014744 Bangladesh policy brief on the availability, accessibility, and utilization of micronutrient-rich the Potential of Fisheries to Improve FNS small fish was prepared and widely disseminated. The key study findings are: (1) 87% of rural households still rely on farm income; (2) lack of credit remains a constraint to rural non-farm enterprises; (3) the largest share of public expenditure on agriculture goes to fertilizer subsidies; (4) crop 19. TF016363 Bangladesh FNS Implications of Rural Growth diversification is an important priority; and, (5) private sector should be allowed in the seed sector. The report was published in the Directions in Development Series and widely disseminated. Impact Evaluation of Integrated Prepared impact evaluation concept note for Global Agriculture and Food Security 20. TF016677 Bangladesh Agricultural Productivity Project (IAPP) Program-financed IAPP. The multisectoral simulation tool (MST) for scaling up nutrition combines a causal model of the factors determining nutritional outcomes (based on the familiar Multisectoral Simulation Tool for Scaling UNICEF framework) with implementation models of the activities that will either 21. TF098429 Bangladesh Up Nutrition directly or indirectly influence nutritional outcomes. MST supported district-level multisectoral nutrition interventions implemented through the Bank-financed Bangladesh Health Nutrition and Population Sector Program. The conditional cash transfer pilot significantly increased the expenses on protein- rich foods, and the increase was higher among those households which participated Impact Assessment of Conditional Cash in nutrition awareness sessions. The pilot also supported 13 percentage points or 22. TF099422 Bangladesh Transfer Pilot through Local Government about 40% reduction in the incidence of wasting among targeted children who were 10-22 months old at baseline. The pilot was scaled up through the Bank-supported Income Support Program for the Poorest at a total cost of $300 million. 49 50 Trust Fund Country Activity name Main findings Number By engaging multisectoral stakeholders, the assessment identified direct and Nourishing Ideas for Action indirect nutrition-specific determinants contributing to undernutrition in Bhutan, where stunting among children under 5 and anemia among women and children 23. TF012082 Bhutan National Nutrition Assessment were high. Key short-term recommendations include iron supplement provisions, food fortification, coordination among nutrition-specific/sensitive interventions, awareness raising, and reduction in adolescent pregnancy. The grant developed an applied political economy framework to better understand Developing a Framework for Applied and promote FNS programs and initiatives across the seven countries in the South 24. TF010794 India Political Economy Analysis of FNS Issues in Asian region. The report included a case study of the Bank-financed Integrated Child South Asia Development Services Scheme and a Rapid Assessment tool for measuring political commitment and opportunity to advance food and nutrition security policies. The Social Observatory set up a participatory monitoring mechanism at the community level to diagnose how market, government, and behavioral failures affected FNS outcomes. It collected FNS data from the targeted households in Social Observatory for the National Rural the Bank-financed Bihar Rural Livelihoods Project (Jeevika), including food prices, 25. TF011993 India Livelihoods Mission: Food Security Issues availability, and affordability in villages and carried out an impact evaluation of in South Asia Jeevika’s Food Security Fund. The data and the impact evaluation results were used to improve FNS interventions in the National Rural Livelihoods Mission and state- level rural livelihoods development projects in India. Technical and operational support to the multisectoral nutrition convergence pilot in Bihar, implemented through self-help groups and village organizations formed by Jeevika, which were also used for service delivery by two other Bank-financed 26. TF012081 India Multisectoral Nutrition Actions in Bihar projects, the Integrated Child Development Services in health and Swachh Bharat Mission Support Operation in water. The pilot increased availability of nutritious food through Food Security Fund for pregnant and lactating mothers and delivered nutrition counseling and nutrition and sanitation behavior change communication. The grant financed preparation and dissemination of guidance notes on the Drivers 27. TF012122 India Improving Food Security in Tribal Areas of Food and Nutrition Insecurity in Tribal Areas and the Action Steps that National Rural Livelihoods Mission can take to address FNS in tribal areas. The grant supported a development of several knowledge products on how Community Managed FNS Initiative in High community platforms, such as self-help groups and village organizations, created 28. TF012676 India Poverty States institutional ecosystem to deliver nutrition services at household level by integrating livelihoods, food security, health, nutrition, and sanitation. The study identified policy and investment priorities that would accelerate Strengthening Agriculture Education and sustainable agricultural productivity growth. It sought to understand the drivers of 29. TF014041 India Policy Making for FNS past and current productivity growth, as well as to identify the binding constraints to future growth, with special emphasis on small and marginal farmers. Trust Fund Country Activity name Main findings Number This grant developed a model to evaluate policy options for a large economy to Food Grains Storage and Trade Policy assess current policies and identify cost-effective alternatives. The findings and the Option: Trade-offs and Implications for model structure were presented at two major national and international public 30. TF014636 India Food Security: A Knowledge Development events. This is a new model to evaluate policy options for price stabilization in a Activity large country. The work contributes to existing literature on the topic as, to the best of our knowledge, such a model has not been used before. The grant financed a global policy consultation to unleash the potential of Global Policy Consultation and agriculture as a supplier of food, as a source of income, and as an engine of growth International Conference on Leveraging 31. TF098748 India to sustainably reduce malnutrition and ill health for the world’s most vulnerable Agriculture for Improving Nutrition and people. The centerpiece of the consultation was an international conference on Health February 10-12, 2011. The grant financed to generate lessons learnt from best practices and success of the Community-Based Food Security Bank-financed Second Madhya Pradesh District Poverty Initiatives Project (MPDPIP) 32. TF0A0585 India Enhancement in the context of food and nutrition security and to capture the unintended FNS- related impacts of the MPDPIP on the beneficiary households and communities. The grant assisted the Government of Nepal to implement multisectoral 33. TF010274 Nepal FNS Thematic Report (NLSS) approaches to address chronic malnutrition, including the activities identified in the government's multisectoral plan of action for nutrition. The grant financed a study, “Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition,” and led to the development of new nutrition Evaluating the Nutritional Impacts of FNS 34. TF012123 Nepal sensitive guidelines by the government on both targeting and monitoring the Programs execution of civil works. It also supported an impact evaluation of Nepal’s Community Challenge Fund. Community-Based Behavior Change for Continued support for the implementation of Nepal’s multisectoral nutrition action 35. TF012285 Nepal Nutrition Improvement plan. Review of Infant and Young Child Feeding 36. TF012286 Nepal Implementation support of Nepal’s multisectoral nutrition action plan. Insecurity and Malnutrition District Profiles of Determinants of Food 37. TF013189 Nepal Implementation support of Nepal’s multisectoral nutrition action plan. Insecurity and Malnutrition Impact evaluation design has been finalized and the concept note has been Sunaula Hazar Din – Community Action for 38. TF013868 Nepal approved by the Bank. The baseline survey for impact evaluation has been Nutrition Project Impact Evaluation completed. 39 TF013934 Nepal Support to Nutrition Policy Dialogue II Implementation support of Nepal’s multisectoral nutrition action plan 51 52 Trust Fund Country Activity name Main findings Number The grant provided technical assistance to the Sunaula Hazar Din by (1) preparing Nourishing Ideas for Action training materials including facilitators’ manual for each goal laid out in the project appraisal document, (2) preparing training work plan outlining the timetable, Training of Social Mobilizers and Coaches methodology and resources required and train the social mobilizers and coaches 40. TF014834 Nepal in a Results-Based Community Driven to familiarize them with the rapid results approach of Sunaula Hazar Din, and (3) Approach to Reducing Malnutrition providing backstopping to the social mobilizers and coaches during the period of the project to successfully run nutrition initiatives in the communities supported by the project. The study provided small area estimates (prevalence, gap and severity) at the sub district level to contribute to programing targeting assistance, and formulating evidence-based policies, to the most food insecure and malnourished population. 41. TF015218 Nepal Small Area Estimation of FNS It generates small area estimates the following key indicators of food insecurity: undernourishment (measured by kilo calorie intake); and food poverty (measured by the monetary value of consumption intake expressed in local prices). The grant supported the development and incorporation of gender-aware and culturally appropriate behavioral change communications messages to improve Gender Equality and Social Inclusion for 42. TF015361 Nepal the effectiveness of food and nutrition security projects. The program incorporated FNS greater gender sensitivity in developing behavior change messages for nutrition and into the Ministry of Agriculture’s policies and programming. The grant supported to assess (1) the effectiveness of Agriculture and Food Security Impact Evaluation of Agriculture and Food Project’s agricultural initiatives on yield, income and nutritional practices; (2) the 43. TF016678 Nepal Security Project effect of Behavior Change Communication (BCC) which is designed to increase the demand for nutritious food; and (3) program variations in BCC messaging. The grant trained journalists to provide broader coverage of nutrition that educates 44. TF018790 Nepal Training Journalists on FNS the public and sensitizes decision makers about the importance of nutrition on the development agenda. The grant supported implementation of the Multisectoral Nutrition Plan and ensured it was the basis for the design of the Sunaula Hazar Din Bank-financed project, which adopted a multisectoral approach to addressing malnutrition from 45. TF098873 Nepal Nutrition Policy Dialogue conception through the first two years of a child’s life. The plan also facilitated the preparation of the Nepal Agriculture and Food Security Program which has a strong nutrition component. Follow-up analytical work was done on targeting. Trust Fund Country Activity name Main findings Number This study builds upon the midline evaluation of the Bank-supported Pakistan Poverty Alleviation Fund project. More than two-thirds of water at source and three-fourths of water held in storage containers was significantly contaminated, but less than 4% of households actually treated their water in any way. Also, 1 in Child Nutritional Outcomes and 3 households had no toilet facility at all, so open defecation by children and field Community Based Health Service defecation were common. Close to one-half of children and one-third of adults walk 46. TF011848 Pakistan Provision: Evidence from a Randomized barefoot in the village. Over 80% of households said they used soap, but only two- Field Experiment in Rural Pakistan thirds had any soap in the home. Only one-third reported washing their hands after cleaning a child's bottom and only 18% said they washed their hands before feeding children. The impact of inclusion mandates on both health outcomes and behaviors was weak; there was a strong impact on perceptions about women among youth, and young men in particular. These could have knock-on effects on health. Four provincial governments — Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh — prepared their own nutrition policy guidance notes, focusing on water Multisectoral Nutrition Dialogue and and hygiene, food security, use of heath care services, girls’ education, and social 47. TF012245 Pakistan Technical Assistance safety nets, while engaging relevant line ministries at provincial level. As a result, Pakistan joined the Scaling Up Nutrition (SUN) movement. The guidance notes were transformed into detailed and costed provincial nutrition strategies. The grant tested whether poor nutrition in utero and in early childhood had adverse consequences for adult life labor outcomes and to understand the determinants of Long-run Economic Effects of Childhood 48. TF014344 Pakistan childhood malnutrition and the intervening pathways through which effects of early Nutrition and Health Status malnutrition may persist through different stages of childhood and adolescence into early adulthood. Engaging Planning Commission, This activity funded the beginning of a platform that enabled the dialogue on food 49. TF099154 Pakistan Agriculture and Water Ministries on FNS in and nutrition to grow within the national (and provincial) forum for agriculture. Policy and Investment Planning Building on the Bank-financed Reawaking Project in post-conflict northeast, INPARD supported village-level nutrition promotion, which was facilitated by multisector Integrating Nutrition Promotion and Rural divisional government stakeholders. It improved health and nutrition of school 50. TF015520 Sri Lanka Development (INPARD) children and their parents by promoting local food production and consumption. The project informed the nutrition component of the Bangladesh Nuton Jibon Project. In support of the Bank-financed Second Health Sector Development Project, the Multisectoral Nutrition Assessment and 51. TF017744 Sri Lanka grant supported the preparation of the Multisectoral Nutrition Assessment in the Gap Analysis in Estate Sector estate sector. Supported the preparation of SAFANSI annual and completion reports, highlighting how SAFANSI brought together multisectoral stakeholders in health, nutrition, 52. TF017500 Program SAFANSI Trust Fund Administration education, agriculture and rural development, water and sanitation, and social protection in the Bank and national or provincial governments in South Asia countries. 53 54 Trust Fund Country Activity name Main findings Number SAFANSI Program Management (including 53. TF098394 Program SAFANSI program management. Nourishing Ideas for Action secretariat functions) SAFANSI Program Management (including 54. TF098925 Program SAFANSI program management. secretariat functions) Phase II Trust Fund Country Activity name Main findings Number In Afghanistan and Bangladesh, the project analyzed the costs of scaling up nutrition interventions and their cost-effectiveness in economic productivity and growth over 5 to 10 years. In Afghanistan, each dollar invested would yield at least $13 in economic returns, and the economic benefits would total $815 million over the Costing and Cost-Effectiveness Analysis of 1. TF0A2323 Regional productive lives of the beneficiaries. In Bangladesh, every dollar invested in nutrition Scaling Up Nutrition-related interventions would bring over $20 in economic benefits. The scale-up in nutrition interventions would increase economic productivity worth about $5.6 billion over the productive lives of the beneficiaries. Both analyses influenced the government’s nutrition action plans. Background Analytical Outputs for the The grant supports the preparation of background analytical outputs for the report, 2. TF0A5366 Regional Regional Undernutrition Report: Ending “Ending Undernutrition in South Asia.” Undernutrition in South Asia Focusing on India, Nepal, and Sri Lanka, the grant identifies challenges, barriers, and facilitating factors for appropriate behaviors, programs, and policies, particularly, as Addressing Critical Failures of Infant and they relate to both (1) working women engaged in formal and informal sectors and 3. TF0A5836 Regional Young Child Nutrition living in urban settings, and (2) the Baby Friendly Hospital Initiative for promoting and protecting breastfeeding in health facilities during the time of delivery and hospital stay. An in-country launch and dissemination workshop were held in Dhaka in May Dynamics of Rural Growth: Outreach and 2016. The report was well received by the government. Key findings informed 4. TF0A1834 Bangladesh Dissemination (Just-in-Time Window) Bangladesh's new Five-Year Plan and provided key inputs to the Systematic Country Diagnostic and Country Partnership Framework. In partnership with Digital Green, the grant produced five nutrition awareness Leveraging Information Technology to videos in three indigenous languages, based on the findings from the gap analysis 5. TF0A3110 Bangladesh Achieve Better Nutrition Outcomes in the that was participated by the target communities. About 2,120 community members Chittagong Hills Tract were trained, 67% of whom were women. Trust Fund Country Activity name Main findings Number The grant supported the development of detailed impact evaluation methodology. The impact evaluation focused on assessing: (1) the socioeconomic conditions Can Conditional Cash Transfers and food security of beneficiary families, (2) child nutrition, (3) child cognitive 6. TF0A3566 Bangladesh Improve Child Nutrition and Cognitive development, and (4) readiness for school. It also examined the relative cost- Development? (Just-in-Time Window) effectiveness of each intervention with respect to its impact on child development outcomes and readiness for school. A policy platform has been formed in collaboration with UNICEF, the BRAC School of Public Health, and Shornokishoree Network Foundation. Comprehensive dietary and Capacity Development in Nutrition anthropometric data of adolescent girls have been analyzed to identify multisectoral 7. TF0A3672 Bangladesh Surveillance and Research policy actions in improving food and nutritional security of adolescent girls. Three dissemination events drew more than 200 government officials, development partners, civil society members, academic researchers, and journalists. Two videos on community clinics and mother and child healthcare were produced Tackling Malnutrition: The Story of and disseminated through TV and social media. There were over 20,000 viewers of 8. TF0A5601 Bangladesh Community Clinics (Just-in-Time Window) a TV talk show, more than 25,000 views and 78 likes on Facebook Live, and 23,000 views on community clinics videos. Some of lessons learned from a study tour to Nepal have been applied in the Food Security and Agriculture Productivity Project, financed by the Global Agriculture and Food Security and Agriculture (Just-in-Time 9. TF0A3584 Bhutan Food Security Program, including inter-district study visits and hiring beneficiary Window) farmers as resource persons. Small grants may be provided to communities to implement innovative livelihood projects. Capacity Development and A stakeholder meeting was held, and a field survey was initiated to identify the 10. TF0A3887 Bhutan Communication for Improved Nutrition social change agents and social drivers of diet/care practices. Outcomes in Rural Households The key findings in the study on malnutrition in four states: (1) over the past 25 years, India has made significant gains in life expectancy, with larger gains for females than males; (2) gains in life expectancy have come from reducing deaths from diarrhea, lower respiratory infections, and other common infectious diseases, Burden of Malnutrition for the States of and to a lesser extent preventing deaths from neonatal disorders, HIV/AIDS, 11. TF0A1098 India Utter Pradesh, Nagaland, Uttarakhand, and tuberculosis; and (3) an examination of premature mortality shows that two and Meghalaya (Phase 1) communicable, maternal, neonatal, and nutritional diseases (diarrhea and neonatal preterm birth complications) cause the most premature mortality in Meghalaya and Nagaland, while non-communicable diseases account for the most premature mortality in Uttar Pradesh and Uttarakhand. Based on the village-level monitoring mechanism, the Social Observatory (SO) developed the Participatory Tracking (P-tracking) system, which has been adopted Social Observatory: Catalyzing Improved by governments and NGOs. The SO also has analyzed the FNS data from national 12. TF0A1325 India Implement in Project to Improve FNS and state rural livelihoods development projects in India and published 10 peer- reviewed papers. The papers have been cited at least 75 times and presented at national and international conferences. 55 56 Trust Fund Country Activity name Main findings Number A qualitative study in the state of Nagaland helped to better understand current Nourishing Ideas for Action nutrition practices, focused on maternal and child nutrition, and facilitators and Cross-Sectoral Technical Support on 13. TF0A2780 India barriers to nutrition and health service utilization. In general, specific services for Nutrition in North East India nutrition were low in quantity and convergence was often lacking between health and nutrition government departments in planning and implementing services. The grant helped strengthen nutrition-focus on overall impact evaluation (IE) design for the project, including assessing the impact on nutrition from greater local availability of nutritious foods and the conditions with and without nutrition Andhra Pradesh and Telangana Rural awareness campaigns. The IE also disentangled demand and supply effects and 14. TF0A3328 India Inclusive Growth and Nutrition Project the role of availability and affordability. The results of process monitoring, which (Just-in-Time Window) incorporated nutrition related information, indicate that a demand from local shops for fresh produce and for training on the sale and use of hygiene products, so these interventions will receive attention as implementation progresses. The IE design could be replicated by other rural livelihoods projects supported by the Bank. The grant supports the National Dairy Development Board to pilot milk fortification. Improved Nutrition through Milk As of February 2019, 607,000 metric tons of fortified milk has been produced across Micronutrient Fortification: Testing the 15. TF0A4103 India 16 states and consumed by 12 million people to reduce vitamin A and D deficiency. Business Case Under the National Dairy The pilot also supported regulatory reforms to permit fortification of all types of Support Project liquid milk (e.g., skim, low-fat, full cream). Design and Plotting of Conditional Cash The grant supports the government of Madhya Pradesh in designing and developing 16. TF0A4384 India Transfers for Maternal and Child Health the state’s nutrition-focused conditional cash transfers program, which will build on and Nutrition in Madhya Pradesh three national programs for pregnant and nursing mothers and children. Enterprise Development for Nutrition and The grant supports development of social enterprises to improve the rural poor’s 17. TF0A5734 India Sanitation in Bihar access to low cost nutritious foods and hygiene and sanitation products. The grant supports two impact evaluations (IEs) for the Bank-supported Sunaula Hazar Din Community Action for Nutrition Project and the Agricultural and Food Security Project financed by the Global Agriculture and Food Security Program. The Impact Evaluation of the Agricultural and Sunaula Hazar Din IE found modest improvements in undernutrition indicators in Food Security Project and Sunaula Hazar treatment villages: wasting fell from 21% at baseline to 16% at end line, underweight 18. TF0A0635 Nepal Din Community Action for Nutritional among children under 2 fell from 32% to 15%, and stunting fell from 38% to 33%. Project The agricultural project IE found no substantial change in food security. In mother and child health there was a large increase in membership in ward-level health mothers’ groups and an increase in dietary diversity score among pregnant and nursing (18% in treatment vs. 13% in control). Trust Fund Country Activity name Main findings Number The study observed some good practices by village development committees that successfully improved knowledge and practices of the target population. It found that Sunaula Hazar Din’s Rapid Results 100-day model was implemented overall in isolation without building capacity of coaches and community-based Qualitative Assessment and Knowledge teams or effectively linking existing platforms. To avoid disputes, goal selection 19. TF0A1374 Nepal Enhancement of Community-Driven is likely directed to benefit the entire community rather than Sunaula Hazar Din’s Nutrition Project target population. Women lagged in participating in work plan implementation and minorities often did not participate in Sunaula Hazar Din activities. The study has informed the Multi Sector Nutrition Plan (MSNP, 2018-22), which was recently endorsed by the government of Nepal on implementation at community level. About 1,000 packets of vegetable seeds were distributed, and 91 women were Women’s Enterprise Initiatives to Ensure trained in organic farming, nutritional food awareness and development of “one 20. TF0A2708 Nepal Community FNS in Upland Nuwakot (Just- dish meals” (focusing on eating nutritionally balanced meals with locally available in-Time Window) food), and agribusiness development. Two women’s cooperatives were able to move their agribusiness enterprises to the next level of development. Adolescent Nutrition: Identifying The grant is to provide concrete policy and program options to improve adolescent 21. TF0A5674 Pakistan Opportunities and Setting Priorities nutrition in Pakistan. The strategy for effective communication and citizen engagement for the health and Technical Design Support for Nutrition 22. TF0A6660 Pakistan nutrition conditional cash transfer (CCT) program has been developed and tested Focused (CCT) Pilot Rollout in Punjab locally. The grant is to establish a monitoring system for nutrition-specific and nutrition- 23. TF0A6922 Pakistan Tracking Nutrition Expenditure sensitive public expenditure and embed it within the public financial management systems in Pakistan. The INPARD impact evaluation found (1) an increase in vegetable consumption in surveyed INPARD areas (2 extra servings or 160g per week per person) vs control areas (reduction by 0.1 serving); (2) an increase in the number of men and women Integrating Nutrition Promotion and Rural with healthy weights and a healthy waist circumference in INPARD areas; (3) a drop 24. TF0A1146 Sri Lanka Development (INPARD) in the number of INPARD schools with sugary snacks on sale, and (4) an increase in the number of students who did not eat fast food in the past week: girls almost doubled, while boys more than doubled. The results were disseminated nationally as well as internationally. The grant supported the implementation of recommendations of the Multisectoral Nutrition Assessment (MNA) in the tea estate sector (see TF017744 above). A short video documentary captured the key messages of the report and was Building Effective Nutrition widely disseminated online. At the national level, the findings of the MNA were Communication through Partnerships: 25. TF0A3103 Sri Lanka disseminated to key stakeholders including regional plantation companies, Ministry Addressing Estate Sector Nutrition Issues of Health, and NGOs. The need for strategic approaches, such as Behavior Change (Just-in-Time Window) Communication in communities, were discussed and flagged for follow up. Some 50 youth were trained on the key findings of the MNA, including using social media to disseminate nutrition messages. 57 58 Trust Fund Country Activity name Main findings Number The grant supports identifying successful behaviors of positive deviance that could 26. TF0A5051 Sri Lanka Nutrition Positive Deviance Analysis Nourishing Ideas for Action enable tea estate sector residents to achieve better nutrition outcomes. The grant support piloting INPARD’s multisectoral nutrition promotion in a producer Improving Nutrition through Modernizing alliance project, such as the Bank-financed Agriculture Sector Modernization Project, 27. TF0A5987 Sri Lanka Agriculture in Sri Lanka (INMAS) which aims at supporting farmer producer organizations to partner with public and private sectors in increasing production and sales. 28. TF0A1187 Program SAFANSI Secretariat SAFANSI program management. The grant supported development of a communications strategy with branding and visibility guidelines. Activities included creating a website and publishing results stories, short videos, and newsletters to share key messages and findings from 29. TF0A1473 Program SAFANSI Communications SAFANSI-sponsored work. The grant also supported the first SAFANSI roundtable, “A Focus on Government Action for Nutrition in South Asia,” on September 7-8, 2017 in Kathmandu. The grant supported SAFANSI annual and completion reports to highlight how SAFANSI Program Management and SAFANSI brought together multisectoral stakeholders in health, nutrition, education, 30. TF0A2872 Program Administration agriculture and rural development, water and sanitation, and social protection from the Bank and governments. The grant supported the preparation and delivery of the 2nd SAFANSI roundtable, “Putting the Lens on the Consumer in Nutrition-Sensitive Agriculture and Food Systems in South Asia,” in Colombo, Sri Lanka on June 25-26, 2018. The event brought together government ministries responsible for addressing malnutrition, and members of civil society, nutrition-focused organizations, donor 31. TF0A7231 Program SAFANSI Roundtable 2018 organizations, UN organizations, international and regional NGOs, research institutions, and the private sector from all 8 South Asian countries. Participants explored the implications for scaling up interventions, engaging with consumers, and emphasizing the importance of consumer education through improved communication, advocacy, monitoring, and evaluation. The grant supports preparation of a stock-taking report, which captures and reviews the research and knowledge that has been generated with support from SAFANSI, 32. TF0A7232 Program SAFANSI Retrospective 2010-18 and facilitate knowledge sharing, replication across countries, and identification of gaps. Annex 4: Results Framework, Phase I March March March March March March Results Indicator 2010 2011 2012 2013 2014 2015 Program Development Objective Increased commitment of governments and development partners in South Asia Region for more effective and integrated food security and nutrition actions. 1. Number of national-level planning or policy documents emphasizing an integrated and coordinated 0 2 2 12 23 37 (cross sector) approach to FNS. Previous Reporting Years (2010-14): (i) Nutrition Framework for Afghanistan; (ii) Multisectoral Plan of Action for Nepal; (iii) TF012245 Punjab Nutrition Policy Guidance Note; (iv) TF012245 Balochistan Nutrition Policy Guidance Notes; (v) TF012245 Khyber Pakhtunkhwa Nutrition Policy Guidance Note; (vi) TF012245 Sindh Nutrition Policy Guidance Notes; (vii) TF012082 Nutrition in Bhutan: Situational Analysis and Policy Recommendations; (viii) TF013549 World Breastfeeding Trends Initiative: South Asia Report Card 2012; (ix) TF014041 Indian Council for Agricultural Research: IX Agricultural Sciences Congress “the Roadmap Forward”; (x) TF010274 Nepal Thematic Report on Food Security and Nutrition 2013; (xi) TF012676 Innovations in Development: Community-Run Centers Improve Nutrition for Women and Children, Andhra Pradesh Rural Poverty Reduction Project; (xii) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP; (xiii) TF013769 Nepal Inception Report of Small Area Estimate of Food Security and Nutrition in Nepal; (xiv) TF012285 Inception report of small area estimation of food security and nutrition; (xv) TF010381 Gender and Nutrition in South Asia Report (xvi) TF010381 Gender Nutrition Policy Note 1: Mapping Report; (xvii) TF010381 Gender Nutrition in SAR Policy Note 2: International Experiences in Gender and Nutrition; (xviii) TF015361; (xviii-xxi) TF011993 Social Observatory (3) policy briefs; (xxii) TF014744: In March 2014, 25 copies of policy papers distributed to 4 regional country partners (Cambodia, India, Myanmar and Nepal); (xxiii) TF012123- design and implementation of a randomized evaluation of the pilot community challenge fund completed May 2013. 2014-15 Reporting Year: (xxiv – xxix) TF015348: six (6) localized nutritional reports produced (Gaps in food and nutrition status identified supported with recommendations by Tarayana Foundation; Guidelines for Food- Nutrition of Pregnant Women Lactating Mothers and Children established by Manusher Jonno Foundation; Communication Materials on Food Security and Nutrition of Pregnant Women and Lactating Mothers in the Chittagong Hill Tracts (CHT)- Manusher Jonno Foundation; Sanjeevi Program implemented by Viluthu; Viluthu NGO Plan of Action in Muttur and Tarayana Foundation Completion Report); (xxx-xxxii) TF012122: (1) analytical report on pilot interventions to improve FNS in tribal areas, (1) field action report (04/30/2014) and (1) final report; (xxxiii) TF013868: detailed impact evaluation concept note related to measuring the effectiveness of the Nepal Sunaula Hazar Din Community Action for Nutrition Project (P125359); (xxxiv – xxxv) TF013549: South Asia Report Card and Trend Analysis report, complementary feeding study; (xxxvi – xxxvii) TF017744: study on childhood malnutrition in the estate sector in Sri Lanka and one (1) published and disseminated report on the findings from the comprehensive multisectoral nutrition assessment and gap analysis that will inform future Government of Sri Lanka’s strategies and WB support. 2. Number of development partners’ country strategies with an integrated, cross sector approach to 0 3 4 17 28 32 FNS Previous Reporting Years (2010-14): (i) the UNICEF Maternal and Child Nutrition Security Project; (ii) the International Food Policy Research Institute 2020 Vision; (iii) the World Food Programme; (iv) the Renewed Efforts Against Child Hunger and Under-nutrition (REACH) Initiative; (v) TF013549 World Breastfeeding Trends Initiative; (vi) TF014041 Indian Council for Agricultural Sciences: FAO Global Forum on Agricultural Research post-conference involvement; (vii) TF014041 Indian Council for Agricultural Research; (viii) TF012245 D-10 Development Partner Nutrition Working Group in Pakistan[1]; (xviii -xxviii) TF011993 Social Observatory (10) country strategy documents. 59 60 2014-15 Reporting Year: (xxix) TF011993: MIS and Monitoring System for two FNS-focused interventions set up in Tamil Nadu; (xxx) TF012122: one (1) Policy Guidance Note completed on April 30, 2014; (xxxi) TF014546: study to generate empirical evidence on effects of food price stabilization policies on food and nutritional security, to examine the extent to which markets for food commodities are integrated (regionally and also within countries) and its effects on availability of food, and to use the empirical evidence to draw recommendations for a regional food price stabilization agenda for improved food and nutritional security; (xxxii) TF016363: support an Nourishing Ideas for Action ESW/Technical Assistance that will inform the FNS dimensions of the Government of Bangladesh’s agricultural and rural development strategy and the relevant World Bank operations: inform the implementation of the current Five-Year Plan (FYP, 2011-2015 period) and potentially feed into the next FYP, provide input into the food security components of the Five Year Plans and the ongoing National Food Policy Plan of Action 2008-2015, and update the knowledge on the agriculture sector on recent developments and to inform discussions on rural development policies, and consolidate stakeholder inputs towards refining the Bank’s operational strategy. 3. Number of integrated FNS country programs / operations in place 0 3 8 16 26 30 Previous Reporting Years (2010-2014): (i) Bangladesh Conditional Cash Transfer (CCT); (ii) Nepal Agriculture and Food Security Project (NAFSP); (iii) 1000 Days Nepal; (iv) Previous Reporting Years (2010-14): (i) Bangladesh Conditional Cash Transfer (CCT); (ii) Nepal Agriculture and Food Security Project (NAFSP); (iii) 1000 Days Nepal; (iv) Pakistan Enhanced Nutrition for Mothers and Children project(P115889); (v) Pakistan Health System Strengthening in 6 districts of Khyber and Pakhtunkhwa with strong focus on nutrition; (vi) Pakistan Health System Strengthening in the province of Punjab with strong focus on nutrition; (vii) Afghanistan Enhancing Health System; (viii) Afghanistan: Female Youth Employment Initiative (adds nutrition dimension); (ix) Punjab Agricultural Competitiveness Project (PCN stage 06/16/2012); (x) Sindh Agricultural Growth Project (P128307); (xi) India: ICDS Systems Strengthening & Nutrition Improvement Program (P121731); (xii) TF012123 Rural Community Infrastructure Works program, (xiii) TF012123 Rural Accessibility Improvement and Decentralization Project; (xiv) TF012123 Road Sector Development Project; (xv) TF011993 Social Observatory Clients: NRLP (National Rural Livelihoods Program), North Eastern Rural Livelihoods Project (NERLP), Bihar Rural Livelihoods Project (BRLP), MPDPIP-2 (xvi) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha: Pilot Intervention Design Workshop Report; (xvii-xx) TF014744: 3 country action plans on fisheries and nutrition linkages approaches developed and distributed to 4 regional country partners (Cambodia, India, Myanmar and Nepal); (xxi-xxvi) TF014344 Memorandum of Understanding among partner institutions including PPAF, PIDE, NRSP, Research and Development Solutions, and Social Collective, plus others). 2014-15 Reporting Year: (xxvii) TF017500: active development and dissemination of the findings and messages emerging from SAFANSI-sponsored activities done through derivative products, materials like newsletters and a website, and events across South Asia; (xxviii) TF012122: building evidence base for and designing pilot interventions to improve food and nutrition security in tribal areas in Jharkhand and Odisha, India; (xxix) TF013868: impact evaluation to measure the effectiveness of the Nepal Hazar Din Community Action for Nutrition Project (Sunaula Hazar Din-CANP, P125359); (xxx) TF016677: study of the effectiveness of the Farmer Field School (FFS) approach to provide insight into how group members can improve agricultural productivity, leading to improved FNS outcomes. Pillar I: Analysis Improved Evidence and Analysis on the most effective ways to achieve FNS outcomes in South Asia 1. Number of FNS-related case studies documented and disseminated using sex and other 0 2 6 13 21 (43) [1] disaggregated data (at least 30% include gender-related issues) Previous Reporting Years (2010-14): (i) Multisectoral Approaches to Promote Nutrition: Past Experiences and Future Course of Action – involves seven program/country level case studies, although reported only as one product here; (ii) India Health Beat: Nutrition in India; (iii) SAFANSI Modifiable Adequacy analysis video case study on Bangladesh and India; (iv) Evaluation of the effectiveness of cell phone technology as community based intervention to improve exclusive breastfeeding; (v) SAFANSI: Winners of the 2009 Development Marketplace – potentially 20 case studies, of which 5 in detail; (vi) Bangladesh report: “Review of the Institutional Environment For Nutrition in the Planning Process in Bangladesh” (March 2012 ) (vii) TF010381 Gender Aware Nutrition Activities in South Asia - A Mapping Exercise has identified 82 government, multilateral, and civil society activities in the region that address gender aspects of nutrition; (viii) TF010794 Developing a Framework for Applied Political Economy Analysis of Food and Nutrition Security Issues in South Asia; (ix) TF011469 Linking Food Security and Nutrition: Bangladesh; (x) TF011469 Linking Food Security and Nutrition: Nepal; (xi) TF012245 ‘Engaging Development Partners in Efforts to Reverse Malnutrition Trends in Pakistan’; (xii) TF010381 Gender-Inclusive Nutrition Activities in South Asia, Volume II: Lessons From Global Experiences; (xiii) TF012676 Innovations in Development: Community-Run Centers Improve Nutrition for Women and Children Andhra Pradesh Rural Poverty Reduction Project; (xiv) TF099422: End line Survey Report on Bangladesh CCT Pilot; (xv) TF012676: Field innovation in public sector and civil society sector on FNS briefing benefiting from multisectoral interventions; (xvi-xviii) TF012081 Multisectoral Nutritional Actions in Bihar; (xix - xxi) TF014744 (3) policy briefs delivered to over 1,000 GoB partners and staff. 2014-15 Reporting Year: (xxii – xxv) TF012676: 4 learning notes created (best practice documentation); (xxvi – xxix) TF015348: four (4) best case study reports documented: NGO Plan of Action in Muttur, Sri Lanka (Viluthu), two case studies about the evidence-based benefits from Rice Banks and case study from Samtse, Bhutan about the evidence-based impact of advocacy on dietary diversity; (xxx – xxxii) TF015348: three (3) gap analysis reports prepared by Tarayana Foundation, Manusher Jonno Foundation and Viluthu; (xxxiii – xxxix) TF011993: (2) case studies related to Bihar; (5) papers related to Tamil Nadu; TF012122: case studies from April 30, 2014 [2]; TF017660: ongoing collection of results stories, detailed FNS portfolios have been created for each country and are being updated [3]; TF012081: (1) case study on the Bihar pilot; TF011848: one (1) mid-line report. 2. Number of FNS-related Policy and Issues Briefs published and circulated by SAFANSI (at least 30% 0 4 8 16 32 46 include gender-related issues) Previous Reporting Years (2010-14): (i) Report of Proceedings: Roundtable Discussion on Agriculture and Water in Pakistan; (ii) India Health Beat: Nutrition in India; (iii) Five Advances Making It Easier to Work on Results in Development: An Operational Perspective with South Asia Nutrition Examples; (iv) Developing a Framework for Applied Political Economy Analysis of Food and Nutrition Security Issues in South Asia[3]; (v) Reshaping Agriculture for Nutrition and Health; (vi) Thailand: A brief on multisectoral nutrition program which experienced significant reduction of malnutrition over the past three decades through multisectoral collaboration; (vii) Pakistan Nutrition Issue Brief: outlines the impact of malnutrition on the country’s growth and development and the cost-effectiveness of nutrition intervention; (viii) Malaysia: A SAFANSI brief on multisectoral nutrition program which experienced significant reduction of malnutrition over the past three decades through multisectoral collaboration (ix) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition; (x) TF010274 Nepal Thematic Report on Food Security and Nutrition; (xi) TF014041 Reducing Malnutrition in South Asia: The Role of Agricultural Research, Education & Extension; (xii) TF013549 WBTI South Asia report Card 2012; (xiii) TF012082 Nutrition in Bhutan: Situational Analysis and Policy Recommendations; (xiv) TF012676 Innovations in Development: COMMUNITY-RUN CENTERS IMPROVE NUTRITION for WOMEN AND CHILDREN Andhra Pradesh Rural Poverty Reduction Project; (xv) TF011469 Linking Food Security and Nutrition: Bangladesh; (xvi) TF011469 Linking Food Security and Nutrition: Nepal; (xvii) TF010274: Review of IYCF Practice, costed strategic communications plan, Capacity building to strengthen local government and community participation; (xviii) TF010381: Gender and Nutrition in SAR Dissemination Presentation in SAR; (xix) TF011841 Policy Brief on relation between mortality and morbidity due to diarrheal diseases and sanitation coverage, December 2013; (xx) TF015348 Gap analysis reports completed and finalized in February 2014; (xxi) 6 localized nutritional studies completed as intermediate inputs to the Gap analysis reports submitted in February 2014; (xxii) TF099422 Conducted evaluation of the various processes involved in implementation of the pilot, covering targeting of beneficiaries, providing information sessions and making payments December 2013; (xxiii) TF099873: (2) Papers on targeting households which are food insecure and have malnourished children; (xxiv) TF012082: Comprehensive Nutrition Assessment and Gap Analysis and 2 policy briefs published (February 2014); (xxvii) TF015520 Nutritional Impact Assessment and Evaluation (December 2013); (xxviii) TF014636 Technical Paper for Foodgrains Storage and Trade Policy Options: Tradeoffs and Implications for Food Security in India; (xxix) TF011469 Linking Food Security and Nutrition: Nepal; (xxx-xxxi) TF014744 Strengthening Awareness and Advocacy of the Potential of Fisheries to Improve Food and Nutrition Security in Bangladesh (2) policy briefs on pond aquaculture and wetlands management (March 2014); (xxxii) TF011848 Workshops to disseminate early results framework reached 150 attendees. 61 62 2014-15 Reporting Year: (xxxiii - xxxvi) TF012676: four (4) innovation briefs on field innovations in public sector and civil society sector on food and nutrition security benefiting from multisectoral interventions; (xxxvii) TF012081: (1) detailed report capturing the findings from the design and incorporation of FNS interventions in the following Bank operations across multiple sectors in Bihar: the Bihar Rural Livelihoods Project (BRLP), the Bihar Panchayat Strengthening Project (BPSP), and the Rural Water Supply and Sanitation in Low Income States (RWSS-LIS); (xxxviii) TF015361: (1) report and know how on effective gender-aware cultural appropriate IYCF behavioral Nourishing Ideas for Action change messages developed and shared with the Ministry of Health; (xxxix) TF013556: technical inputs fed into project (P133329) outputs; (XL - XLVI) TF016363: two (2) drafts of background papers on agricultural productivity; one (1) background paper on rural non-farm drivers of growth, one (1) draft chapter on linking farm and non-farm activities’ value chain analysis based on analyzed survey data, two (2) background papers drafts on nutrition using household survey data, one (1) draft of a background paper on food security prospects 3. Number of major public programs tested/evaluated for impact on FNS outcomes. 0 0 0 12 18 43 Previous Reporting Years (2010-14): (i) TF012123 Nepal Rural Community Infrastructure Works program, (ii) TF012123 Nepal Rural Accessibility Improvement and Decentralization Project; (iii) TF012123 Nepal Road Sector Development Project; (iv) TF011993 Social Observatory Impact Evaluation of core SHG Intervention: Bihar (Prospective) (Retrospective); (v) TF011993 Social Observatory Impact Evaluation of Food Security intervention: Bihar; (vi) TF011993 Social Observatory Impact Evaluation of core SHG Intervention: Odisha; (vii) TF011993 Social Observatory Impact Evaluation of core SHG Intervention: Rajasthan; (viii) TF011993 Social Observatory Impact Evaluation of core SHG Intervention: Tamil Nadu (retrospective and prospective); (ix) TF011993 Social Observatory: Technical Assistance to the North Eastern Rural Livelihoods Project (NERLP) Sikkim, Mizoram, Nagaland, Tripura; (x) TF011993 Social Observatory: Tamil Nadu Impact Evaluation: Community-based health card intervention targeted at women’s health indicators, including anemia; (xi) TF011993 Social Observatory: Chhattisgarh and Maharashtra Resource Block Study; (xii) TF011993 Social Observatory: Technical Assistance to MPDPIP-2 to systematically track beneficiaries of the skills intervention in Madhya Pradesh; (xiii) TF012081 Multisectoral Nutritional Actions in Bihar: SIEF-funded impact evaluation; (xiv - xviii) TF011993 Social Observatory (1) impact evaluation; (3) baselines have been complete for FNS interventions. 2014-15 Reporting Year: (xix – xx) TF015520: baseline survey successfully completed; reporting mechanism on interventions has been designed; (xxi – xxxvii) TF011993: eleven (11) impact evaluations that examine how different elements of the UNICEF framework contribute to improved FNS outcomes have been designed; baseline surveys for five (5) impact evaluations are complete; Bihar Baseline Survey for targeted FNS intervention completed; (xxxviii – xxxix) TF014344: (1) survey-based analysis to test whether poor nutrition in utero and in early childhood has adverse consequences for adult life labor outcomes and evaluate the determinants of childhood malnutrition and the intervening pathways through which effects of early malnutrition may persist through different stages of childhood and adolescence into early adulthood; (1) fully integrated child panel from 1986 to 2010 completed and released on the web; (xl) TF016677: (1) follow-up survey completed; (xli) TF011848: testing the impact of greater involvement of women in community-based health provision on child nutritional and health outcomes; (xlii) TF014636: one (1) evaluation of policy options for managing wheat price volatility; (xliii) TF099422 Impact Assessment of Bangladesh Conditional Cash Transfer Pilot through Local Governments. 4. Number of programming guidance notes prepared (all addressing gender issues) 0 5 5 15 31 Previous Reporting Years (2010-14): (i) Report of Proceedings: Roundtable Discussion on Agriculture and Water in Pakistan; (ii) Five Advances Making It Easier to Work on Results in Development: An Operational Perspective with South Asia Nutrition Examples; (iii) Nepal’s Nutrition National Plan of Action; (iv) Afghanistan’s National Nutrition Framework; (v) Addressing Nutrition Through Multisectoral Approaches – World Bank Draft ESW; (vi) TF010794 Developing a Framework for Applied Political Economy Analysis of Food and Nutrition Security Issues in South Asia; (vii) TF012082 Nutrition in Bhutan: Situational Analysis and Policy Recommendations; (viii) TF012676 Innovations in Development: Community-Run Centers Improve Nutrition for Women and Children, Andhra Pradesh Rural Poverty Reduction Project; (ix) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP; (x) TF011469 Linking Food Security and Nutrition: Bangladesh; (xi) TF011469 Linking Food Security and Nutrition: Nepal; (xii) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha: Pilot Intervention Design Workshop Report; (xiii) TF012122 Evidence from National Sample Survey on Household Consumption Expenditure; (xiv) TF014041 Reducing Malnutrition in South Asia: The Role of Agricultural Research, Education & Extension; (xv) TF014041 ICAR’s XI Agricultural Science Congress: Roadmap on Reforming Agricultural Education; (xvi) TF014636 Inputs into the Economic Survey of India; (xvii) TF010794: Delivery of India PEA Case Study 4/30/2013; (xviii) TF013189 District Nutrition Profile Tool; (xix - xxii) TF012676: 4 learning notes created including a typology of 30 CMHN initiatives across the country. These are (i) Bringing Nutritional Security to Rural Households: Strategies and Program Design, (ii) Lessons for India from Mexico and Brazil, (iii) Mobile applications for Nutrition and (iv) Typology of 30 CMHN initiatives in India; (xxiii-xxiv) TF012081 Multisectoral Nutritional Actions in Bihar guidance notes; (xxv-xxxi) TF011993 Social Observatory (7) programming guidance notes produced. 2014-15 Reporting Year: (xxxii – xxxiii) TF012676: 2 guidance notes for SRLMs on designing and managing community managed food security, health and nutrition initiatives (September 2014); (xxxiv – xxxvii) TF015348: four (4) FNS toolkits/ guidance notes developed; (xxxviii) TF012122: one (1) Policy Guidance Note completed on April 30, 2014; (xxxix – xl) TF013549: (1) study “The Need to Invest in Babies: A Global Drive for Financial Investment in Children’s Health and Development through Universalizing Interventions for Optimal Breastfeeding” and (1) qualitative study to understand barriers in the adoption and practice of appropriate complementary feeding by mothers of children under 2 years of age; (xli) TF012081: (1) program guidance note for integrating FNS concerns into Bank operations/ programs in different sectors in Bihar; (xlii – xliii) TF098873: analysis and report on targeting food insecurity and child malnutrition (with a focus on inequalities related to gender, social exclusion, poverty and geographic location) in Nepal completed. Pillar II: Advocacy Improved Awareness of FNS-related challenges, and advocacy for action, among relevant stakeholders 1. Number of high-profile senior policy makers and opinion leaders sensitized/ “trained” 0 50 75 110 264 (293) [4] Previous Reporting Years (2010-14): (i) SAFANSI co-sponsorship of the IFPRI conference on Leveraging Agriculture for Improving Nutrition and Health brought together leading international figures and policy makers, who were sensitized to the cross-sectoral nature of the related Agriculture, Nutrition and Health problems. Approximately 1000 people were in attendance; many senior figures in various governments and organizations, most notably including H.E. Manmohan Singh, Prime Minister, Republic of India; (ii) the Pakistan Roundtable Discussion on Agriculture and Water: Introducing Food and Nutrition Security to Government Planning trained/sensitize approximately 100 senior national and provincial-level officials; (iii) SAFANSI Task Supporting Afghanistan’s High Level Task Force on Food and Nutrition Security, sensitized the Ministers of Finance, Health, Agriculture, Education, Rural Rehabilitation and Development; (iv) 2011 World Bank Innovation Day: Business Unusual: Tackling Malnutrition in South Asia; (v) World Bank-IMF Annual Meetings: Ensuring Nutrition and Food Security for Results in South Asia; (vi) SAFANSI Technical Advisory Committee; (vii) Knowledge, Tools and Lessons for Informing the Design and Implementation of Food Security Strategies in Asia Conference in Nepal; (viii) London Conference on Measuring the Effects of Integrated Agriculture-Health Interventions; (ix) The Global Conference on Women in Agriculture; (x) World Bank Workshop on Food Security and Nutrition: From Measurement to Results; (xi) FAO International Scientific Symposium on Food and Nutrition Security Information; approximately 30 individuals representing international organization, research outfits and independent researchers engaged in the field of food security and nutrition; (xii) SAR Development Marketplace on Nutrition dissemination events have also trained several key state/local governing officials and other high ranking Development practitioners; (xiii) SAFANSI Panel Discussion at IFPRI Conference: Building a Platform for Improving Food and Nutrition Security. It is estimated that over 100 people were in attendance at this event and as of March 28, 2012 there were 355 recorded hits on the video of the session; (xiv) Pakistan: Two-day National Workshop on Regulatory Systems for Food Fortification; (xv) TF097620 South Asia Regional Knowledge Forum on Improving Infant and Young Child Nutrition, June 2012 (xvi) TF014041 ICAR IX ACS Conference on Reforming Agricultural Education; (xvii) TF098394 How Can Agriculture Help to Solve the Nutrition Crisis? SDN Forum Event on What We Know and What We Need to Know: Wednesday 27 February; (xviii) TF012676 Innovations in Development: Community-Run Centers Improve Nutrition for Women and Children Andhra Pradesh Rural Poverty Reduction Project; 63 64 (xix) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP; (xx) TF011993 Social Observatory: National workshop on using data for action: included developing a framework for tracking food security involving project staff from 12 states participated, including 4 Project Directors of State Livelihood Missions; (xxi) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha: Pilot Intervention Design Workshop Report; (xxii) TF012676 SDN Forum - Improving Nutrition through Community Driven Approach: Thinking beyond Agriculture, Food Nourishing Ideas for Action Security and Rural Development - 4:00 PM - 5:30 PM, 8th March, 2013; (xxiii) February 2014 event to disseminate information before commencing assessment (well over 40 senior policy-makers joined discussions); (xiv) TF012676: Training of Trainers workshop executed (spearhead teams of 40 people); (cxc-ccxl) TF011993 Social Observatory 130 of 200 trained as of December 2013; (ccxli-ccxliii) TF014901 Agricultural Extension and Nutrition through ICTs (3) sr. policymakers trained as of 3/31/14; (ccxliv - ccliii) TF014744 (10 policymakers trained March 2014; (ccliv - cclxiv) TF014344 senior persons trained by April 2014. 2014-15 Reporting Year: (cclxv) TF012676: (1) training of trainers on development of spearhead trams (CRPs, experts and YPs); (cclxvi) TF015348: (1) capacity building training in Muttur Division, Sri Lanka to enable their own solution building process (Viluthu); (cclxvii) TF013549: review and updating of the 4-in-1 Training module in IYCF; (cclxvii - ccxciv) TF018790: 25 media professionals trained in three regional hubs, completion report prepared; (ccxcv) TF014834: initial orientation and training on the Rapid Results approach provided to Village Development Committee level coaches and supervisors from 15 districts, training materials developed and reports on all trainings provided to the government counterparts and the Bank team 2. Number of regional, national and other prominent consultations and workshops organized 2 6 9 16 35 72 (addressing gender where appropriate) Previous Reporting Years (2010-14): (i) Pakistan Roundtable Discussion on Agriculture and Water: Introducing Food and Nutrition Security to Government Planning; (ii) Multiple SAFANSI Consultations for Supporting Afghanistan’s High Level Task Force on Food and Nutrition Security including a mid-point national workshop for the preparation of the multisectoral plan of action for FNS; (iii) SAFANSI Technical Advisory Committee; (iv) Knowledge, Tools and Lessons for Informing the Design and Implementation of Food Security Strategies in Asia Conference in Nepal; (v) London Conference on Measuring the Effects of Integrated Agriculture-Health Interventions; (vi) World Bank Workshop on Food Security and Nutrition: From Measurement to Results; (vii) FAO International Scientific Symposium on Food and Nutrition Security Information; (viii) Multiple SAFANSI Consultations for Supporting Nepal’s High Level Task Force on Food and Nutrition Security; (ix) D-10 Working Group on Nutrition in Pakistan; (x) Pakistan national workshop on the regulatory systems for food fortification; (xi) TF014041 ICAR IX ACS Conference on Reforming Agricultural Education; (xii) TF098394 How Can Agriculture Help to Solve the Nutrition Crisis? SDN Forum Event on What We Know and What We Need to Know: Wednesday 27 February; (xiii) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP; (xiv) TF011993 Social Observatory: National workshop on using data for action: included developing a framework for tracking food security involving project staff from 12 states participated, including 4 Project Directors of State Livelihood Missions; (xv) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha: Pilot Intervention Design Workshop Report; (xvi) TF012676 SDN Forum - Improving Nutrition through Community Driven Approach: Thinking beyond Agriculture, Food Security and Rural Development - 4:00 PM - 5:30 PM, 8th March, 2013; (xvii) TF013189: Consultation on District nutrition profile; (xviii) TF012082 Held a national level workshop in February 2014 to disseminate and discuss the comprehensive draft report; (xix-xxi) TF012081 Multisectoral Nutritional Actions in Bihar: 3 workshops; (xxii - xxiii) TF011993 Social Observatory (2) workshops conducted; (xxiv - xxxiv) TF014744 (11) regional workshop meetings arranged March 2014; (xxxv) TF011848) questionnaire and data submitted and distributed via workshop December 2013. 2014-15 Reporting Year: (xxxvi) TF014901: expert consultation held in New Delhi, December 2014; (xxxvii) TF012676: National level workshop held in December 2014 with the objective of connecting policy, practice and evidence from SAR to advance multisectoral actions for improved FNS outcomes; (xxxviii – L) TF015348: three (3) local FNS workshops conducted with proceedings focused on identifying entry points, five (5) knowledge exchanges involving Manusher Jonno Foundation, Tarayana Foundation and Viluthu; TF013549: two (2) South Asia Regional Workshops (March 2014, December 2014); one (1) dissemination event related to the WBCi Study, (1) dissemination of information regarding the Financial Planning Tool at the World Health Assembly, 2014, (1) national workshop on using the WBCi tool to facilitate development of IYCF Action Plans in Afghanistan; TF012081: workshops to share and disseminate learning; (li) TF014636: the main findings and the model structure was presented for feedback at a global conference on Food Price Volatility, Food Security and Trade Policy, organized by the Development Research Group of the World Bank on September 18-19, 2014, in Washington; (lii-lxxii) TF011993: (1) conference in Delhi and (20) conferences in Tamil Nadu 3. Number of advocacy events (e.g. awareness raising campaigns) carried out 0 6 12 19 42 (74)[5] Previous Reporting Years (2010-14): (i) IFPRI conference on Leveraging Agriculture for Improving Nutrition and Health; (ii) 2011 World Bank Innovation Day: Business Unusual: Tackling Malnutrition in South Asia; (iii) World Bank-IMF Annual Meetings: Ensuring Nutrition and Food Security for Results in South Asia; (iv) The Global Conference on Women in Agriculture; (v) World Bank Workshop on Food Security and Nutrition: From Measurement to Results; (vi) FAO International Scientific Symposium on Food and Nutrition Security Information; (vii) mHealth Summit; (viii) SAR Development Marketplace Mid-term Workshop; (ix) SAR Development Marketplace India Grantees Workshop; (x) Dr. Reddy’s Foundation Workshop; (xi) SAFANSI Panel Discussion at IFPRI Conference: Building a Platform for Improving Food and Nutrition Security. It is estimated that over 100 people were in attendance at this event and as of March 28, 2012 there were 355 recorded hits on the video of the session; (xii) Pakistan Nutrition Partners’ Group (D-10) meetings since Feb 2012; (xiii) TF097620 SAR Regional Knowledge Sharing Forum; (xiv) TF014041 ICAR IX ACS Conference on Reforming Agricultural Education; (xv) TF098394 How Can Agriculture Help to Solve the Nutrition Crisis? SDN Forum Event on What We Know and What We Need to Know: Wednesday 27 February; (xvi) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP November 7, 2012; (xvii) TF011993 Social Observatory: National workshop on using data for action: included developing a framework for tracking food security involving project staff from 12 states participated, including 4 Project Directors of State Livelihood Missions; (xviii) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha: Pilot Intervention Design Workshop Report; (xix) TF012676 SDN Forum - Improving Nutrition through Community Driven Approach: Thinking beyond Agriculture, Food Security and Rural Development - 4:00 PM - 5:30 PM, 8th March, 2013; (xx) TF010381: Gender and Nutrition Presentation September 25,2013; (xxi) TF015348: One knowledge exchange conducted in March 2014; (xxii-xxiii) TF012676: Community Managed Food Security and Health and Nutrition Initiatives pilots in 2 states (June 2013); xxiv - xxv) TF011993 Social Observatory (2) advocacy events carried out; (xxvi - xli) TF014744 (16) regional, national and other prominent consultations and workshops arranged March 2014; (xlii) TF014344: workshop completed April 2014. 2014-15 Reporting Year: (xliii – lxvii) TF014901: (25) videos were developed on nutrition-agriculture topics and shared with JEEVIKA project; (lxviii) TF014344: workshop to disseminate early results and to discuss policy relevance and next steps with government and CSOs held in December 2014; TF016677: dissemination of IE Results to Government in February 2015; (lxix) TF015361: development of gender-sensitive and culturally-aware behavior change messages for nutrition; (lxx – lxiii) TF015365: four (4) videos about stunting in Afghanistan produced and delivered to the World Bank, scheduled for dissemination through local media outlets including TV and radios; [lxxiv - TF013549: (1) The World Breastfeeding Conference (December 2014), media and advocacy events on IYCF (4 in each of the target countries), dissemination events covering 20 countries in Oceania, Africa, Asia, Latin America and Europe using the grantees existing networks; 4. Number of changes relating to FNS agenda/policies enabled/supported 0 4 7 12 13 26 Previous Reporting Years (2010-14): (i) Nepal Agriculture and Food Security Project; (ii) Afghanistan Action Framework; (iii) Nepal Nutrition Plan of Action; (iv) Pakistan Roundtable Discussion on Agriculture and Water: Introducing Food and Nutrition Security to Government Planning; (v) Nutrition Assessment and Capacity Building in Bhutan; (vi) Nepal’s 1000 Days Initiative for Sunaula Hazar Din - Community Action for Nutrition Project; (vii) A White Paper on Scaling Up Nutrition in Pakistan which identified key steps (e.g. provincial and federal institutional structures) that are leading to a more coherent approach to addressing malnutrition in Pakistan; (viii) TF012245 Four Pakistan Provincial Policy Notes; (ix) TF012123 Women and Civil Works Programs: Empowerment, Gender Equality and Nutrition A Review of Existing Policies and Data on RCIW, RAIDP and RSDP November 7, 2012; (xi) TF011993 Social Observatory; (xii) TF012122 Improving Food Security and Nutrition Status in the State of Jharkhand and Odisha; (xiii) TF010794: Delivery of Political Economy Analysis Framework, 4/30/2013. 2014-15 Reporting Year: (xiv – xx) TF011993: seven (7) action research projects that support the capacity of projects to identify learning needs, define an appropriate case study or quick turnaround survey, and then implement interventions based on these have been supported; (xxi – xxii) T015361: (1) GESI Results Frameworks for agriculture sector developed, (1) GESI Results Frameworks for health and nutrition sector developed; (xxiii – xxiv) TF017744: study on childhood malnutrition in the estate sector in Sri Lanka and one (1) report on the findings from the comprehensive multisectoral nutrition assessment and gap analysis published and disseminated; (xxv) TF011848: (1) health facilities scorecard designed (August 2014) and implemented (October 2014), information provided to communities, facilities and providers at face-to-face meetings; (xxvi) TF016678: Nutrition Baseline Report on the effectiveness of AFSP’s agricultural initiatives on yield, income and nutritional practices, the effect of behavioral change communication (BCC) on the demand for nutritious food, and program variations in BCC messaging released and presented to ministry team in Nepal 65 66 Pillar III: Capacity Building Strengthened regional and in-country policy and programming capacity in relevant areas to achieve FNS outcomes Nourishing Ideas for Action 1. Number of country or regional policy networks/ forums/ platforms supported (or formed) to advance 0 3 4 6 20 31 the FNS agenda Previous Reporting Years (2010-14): (i) Afghanistan Action Framework; (ii) Nepal Nutrition Plan of Action (iii) Pakistan Roundtable Discussion on Agriculture and Water: Introducing Food and Nutrition Security to Government Planning; (iv) Pakistan Nutrition Partners’ Group (D-10) meetings since Feb 2012; (v) TF014041 ICAR IX ACS Conference on Reforming Agricultural Education; (vi) TF011993 Social Observatory; (vii) TF010274 Support to High Level Food Security and Nutrition Steering Committee Secretariat, Community Behavior Change Rapid Results Initiatives Pilot, STC supporting nutrition related AAA; (viii) TF0122455: Published article in IDS Bulletin (May 2013) about the process to prepare province-specific secondary analysis of the National Nutrition Survey 2011; workshops in all four provinces; National inter-provincial workshop and dissemination workshops and events in each province; (ix) TF014834 Training of Coaches on Rapid Results Approach for Sunaula Hazar Sin Nutrition Project; (x - xx) TF014744 (11) regional workshop/sub-national meetings arranged March 2014. 2014-15 Reporting Year: (xxi – xxvi) TF012676: 6 training modules for spearhead teams and for training community institutions on community managed food security, health and nutrition initiatives; (xxvii – xxviii) TF011993: (2) community-based livelihood projects in Bihar and Tamil Nadu; (xxix) TF013549: (1) project progress report that should feed into government documents on IYFC interventions; (xxx) TF017660: ongoing portfolio and performance reviews through Completion Summary Reviews of all activities; (xxxi) TF098873: continuation of support to the Secretariat at the National Planning Commission (NPC) in Nepal to support the implementation of the Multisectoral Nutrition Plan 2. Number of South-South training/capacity building visits to re-orient and improve FNS programs 0 4 6 10 15 25 (ensuring a balance of men and women) Previous Reporting Years (2010-14): (i) SAR DM Mid-term Workshop event; (ii) SAR DM Workshop for India Grantees; (iii) Dr. Reddy’s Foundation Dissemination Event in Hyderabad; (iv) SAFANSI arranged for two mobilized community leaders of a SAR DM sponsored project to present their models at IFPRI’s international conference on Leveraging Agriculture for Improving Nutrition and Health; (v) Tanzania - Introduction of Multisectoral simulation tool for SUN initiative to the REACH partners (vi) Kenya -Application of SAFANSI Modified Adequacy technique (data visualization technique) for epidemiological analysis on child stunting in Kenya; (vii) TF097620 SAR Regional Knowledge Sharing Forum; (viii) TF014041 ICAR IX ACS Conference on Reforming Agricultural Education; (ix) TF098394 How Can Agriculture Help to Solve the Nutrition Crisis? SDN Forum Event on What We Know and What We Need to Know: Wednesday 27 February; (x) TF011993 Social Observatory: National workshop on using data for action: included developing a framework for tracking food security involving project staff from 12 states participated, including 4 Project Directors of State Livelihood Missions; (xi) TF010794: Workshop for the Dissemination of Political Economy Analysis (4/30/2013); (xii - xiv) TF012081 Multisectoral Nutritional Actions in Bihar capacity building visits to 3 sectoral projects; (xv) TF014744 field trip arranged March 2014. 2014-15 Reporting Year: (xvi – xx) TF015348: five (5) knowledge exchanges so that participating partner organizations receive training and gain exposure to other partners’ efforts; (xxi – xxiii) TF017660: participation in three (3) important partnership meetings that have been instrumental in sustaining the momentum in the partnerships for improved FNS in a coordinated manner: in Oxford, London (September 5-10, 2014), in Bangkok, Thailand (March 4-6, 2015) and in Brussels (January 14 and 15, 2015); (xxiv) TF016677: workshop in Kigali in June 2014 attended by the IAPP team; (xxv) TF016678: Nepal team attended DIME IE workshop in Kigali in June 2014 3. Number of service delivery mechanisms analyzed and identified for up-scaling 0 2 9 11 13 99 Previous Reporting Years (2010-14): (i) Three service delivery mechanisms from 6 rounds of surveillance were analyzed. These relate to water and sanitation; national nutrition service; and institutional arrangements for multisectoral simulation; (ii) Five innovative designs identified by the Development Marketplace as worthy scaling up; (iii) Bangladesh Conditional Cash Transfer; (iv) TF012123 Rural Community Infrastructure Works (RCIW) program, (v) TF012123 Rural Accessibility Improvement and Decentralization Project (RAIDP); (vi) TF012123 Road Sector Development Project (RSDP); (vii) TF011993 Social Observatory: National workshop on using data for action: included developing a framework for tracking food security involving project staff from 12 states participated, including 4 Project Directors of State Livelihood Missions; (viii) TF014041 National Agricultural Education Project proposal submitted to WB for support to reform the Agricultural Education System; (ix-x) TF011993 Social Observatory (2) mechanisms analyzed for scaling-up; (xi-xii) TF014901 Agricultural Extension and Nutrition through ICTs (2) extensionists surveyed in 2 locations; (xiii) TF012123 Evaluating the Nutritional Impacts of FNS in Nepal- completed evaluation May 2013. 2014-15 reporting year: (xiv – xcv) TF012676: 82 pilots commenced in at least 50 villages – Community Managed Food Security and Health and Nutrition Initiatives in two states; (xcvi) TF013549: (1) document on scaling up of IYCF Interventions in SAR; (xcvii – xcix) TF014901: (3) analyses of curriculum of three SAUs and a proposal for incorporation of nutrition dimension into the rural advisory (extension) services. 4. Number of community-level alliances for promoting FNS outcomes supported 0 6 14 20 31 37 Previous Reporting Years (2010-14): (i) 14 Grantees of the SAR Development Marketplace on Nutrition; (ii) Development Partner nutrition working group (D-10) in Pakistan; (iii) TF012676 Society of the Elimination of Rural Poverty – Andhra Pradesh; (iv) TF011469 Pakistan Institute for Development Economics; (v) TF098874/TF097620 Care for Afghan Families; (vi) TF099422 Impact Assessment of Bangladesh CCT Pilot through Local Governments; (vii) TF098429 Multisectoral Simulation Tool for Scaling Up Nutrition; (xx-xxii) TF012081 Multisectoral Nutritional Actions in Bihar; (xxiii-xxx) TF011993 Social Observatory (8) trainings via alliances completed as of December 2013; (xxxi) TF014344 created alliance with community organizations April 2014. 2014-15 Reporting Year: (xxxii) TF017273: Links established with regional and international FNS programs for learning and advocacy; (xxxiii – xxxv) TF015348: three (3) partnerships established with relevant public institutions; (xxxvi – xxxvii) TF011993: Social Observatory Advisory Committees created in Bihar and Tamil Nadu. [1] Estimate. Final number will be provided based on task team leader’s feedback. [2] Actual number of case studies produced is expected from the task team leader of TF012122. [3] Actual number of results stories and detailed FNS portfolios created and updated by March 31, 2014 is expected from the task team leader. [4] Estimate. Final value will be provided based on TF014834 task team leader’s inputs on the exact number of Village Development Committee level coaches and supervisors trained and the number of reports provided to the government counterparts and the Bank team. [5] Estimate. Final value will be provided based on TF013549 task team leader’s inputs on the exact number of media and advocacy events on IYCF (4 in each of the target countries) and dissemination events covering 20 countries in Oceania, Africa, Asia, Latin America and Europe using the grantees existing networks. 67 68 55 Annex 5: Results Framework, Phase II Impact Indicators (Agreed by EC and DFID. Not included in WB Results Framework) Nourishing Ideas for Action Impact Impact Indicators* 56 Baseline 2020 To improve food and nutrition security for individuals and communities in • Prevalence of stunting (children under 5) South Asia, especially among the poorer disadvantaged section of society • Prevalence of wasting (children under 5) 0 in South Asia with particular focus on women of reproductive age and their • Prevalence of low-birthweight babies children, especially those under two years of age 55 The SAFANSI Results Framework was developed by the World Bank in collaboration with SAFANSI donors and adopted by SAFANSI Donor Committee. The Results Framework is a living document. Future targets are updated annually based on additional project approvals. 56 SAFANSI is intended only to contribute to impact level indicators, which provide context for the interventions supported. Baseline and end line data taken from the Global Nutrition Report (existing data sources). Impact Indicator Baseline Dataset (from 2015 Global Nutrition Report): % Stunting <5s % Wasting <5s % Low Birth Weight Afghanistan 40.9 9.5 - Bangladesh 36.1 14.3 22 Bhutan 33.6 7.6 9.9 India 47.9 20 28 Maldives 20.3 10.2 11 Nepal 40.5 11.2 17.8 Pakistan 45 10.5 32 Sri Lanka 14.7 21.4 17 Outcome Indicators57 Year 1 Year 2 Year 3 Year 4 Outcome Outcome indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Results Results Results Target Target 1. Number of food and nutrition policies, programs or action In FY18, the Nepal Multi Sector Nutrition Plan plans developed (MSNP, 2018-22) has been informed by the and adopted by Impact Evaluations for Agriculture and Food Governments with Security Project and Sunaula Hazar Din, and the financial or technical a) 0 a) 0 a) 5 a) 7 a) 12 a) 17 Qualitative Assessment of Sunaula Hazar Din. support from SAFANSI: The Afghanistan National Nutrition Plan (under a) which are b) 0 b) 0 b) 2 b) 4 b) 8 b) 11 development) is being informed by the “Regional multisectoral and Costing and Cost-Effectiveness Study” targeting evidence-based; and Afghanistan and Bangladesh. Contribution to b) which support the Bangladesh Second National Action Plan for women and girls of Nutrition was a part of FY17 outputs. Governments reproductive age and/or and children <2 years of age development partners have In FY18 alone, SAFANSI has supported 5 IDA or increased trust fund-financed projects, which amounts to commitment, $158.7 million with an outreach of 1.6 million funding and beneficiaries. capability to improve food • Impact Evaluations for Agriculture and Food and nutrition 2. Contribution58 of Security Project and Sunaula Hazar Din informed security in SAFANSI to the design, the Nepal Food and Nutrition Security South Asia. implementation or Enhancement Project ($22.7 million with a) 0 a) 1 a) 9 a) 13 a) 10 a) 15 65,000) and Nepal Livestock Sector Innovation evaluation of World Bank nutrition-sensitive Project ($80 million/200,000). b) 0 b) $125m b) $2.06b b) $2.22b b) $2.1b b) $2.15b • The Nutrition Technical Support in Northeast projects. (a) number of projects India supports Nagaland Health Project ($48 c) 0 c) 0 c) 14.6m c) 16.2 m c) 15 m c) 15.5 m million/1.18 million). (b) volume of lending (c) beneficiaries • The Bhutan Capacity Development and the reached59 Food Security Just-in-Time project also support Bhutan FSAPP ($8 million with 52,000). • Sri Lanka INMAS is supporting IDA-financed Agriculture Sector Modernization Project ($ 125 million/110,000). The dollar amount has already been counted in FY16. The number of beneficiaries has been included in FY18. 57 The indicators show SAFANSI contribution and attribution, where possible. All data are cumulative. 58 For the purposes of measurement, a contribution would take the form of direct financial support for studies or dialogues that lead to policy reform/creation, technical advice provided through SAFANSI- funded programs or as a result of SAFANSI-funded programs, or policies/programs that cite SAFANSI materials as reference in their development. 59 Estimated/projected or actual beneficiaries, as of March 31, 2018. 69 70 Year 1 Year 2 Year 3 Year 4 Outcome Outcome indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Results Results Results Target Target Nourishing Ideas for Action All projects, including three completed projects, 3. Proportion (a) are rated more than moderately satisfactory in and Number (b) of a) 0% a) 36% a) 100% a) 100% a) 80% a) 80% both project development objective (PDO) and SAFANSI-supported implementation progress (IP). Four projects are grants scoring at least b) 0 b) 4 b) 18 b) 19 b) 20 b) 25 not rated. India Social Observatory and Regional ‘moderately satisfactory’ Costing are rated highly satisfactory for both PDO and IP. 4. Number of national or sub-national Regional Costing supported nutrition budget comprehensive 0 0 0 1 2 3 development as a part of Bangladesh NPAN2. multisectoral nutrition budgets developed60 Output Indicators61 Pillar 1 - Improved Evidence and Analysis Year 1 Year 2 Year 3 Year 4 Output 1 Output indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Results Results Results Target Target Improved evidence and analysis 1.1 Number of peer 5 studies were peer reviewed in FY18: available on reviewed studies the effects of • 2 by India Social Observatory, published that help to interventions 0 1 12 17 27 31 • 1 by Nepal Sunaula Hazar Din Impact improve evidence and on Food and Evaluation (quantitative), and analysis on Food and Nutrition • 2 by Regional Costing. Nutrition Security.62 Security outcomes in South Asia 60 Multisectoral budgets can indicate spending in line ministries/departments directed to activities that will contribute to achieving nutrition outcomes as defined in national/subnational policies/strategies. 61 All output indicators are directly attributable to SAFANSI and will include gender disaggregated information wherever possible. All data is cumulative. 62 Multisectoral budgets can indicate spending in line ministries/departments directed to activities that will contribute to achieving nutrition outcomes as defined in national/subnational policies/strategies. Year 1 Year 2 Year 3 Year 4 Output 1 Output indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Results Results Results Target Target 13 new communication products in FY18: • 2 SAFANSI briefs • Technews bulletin by India Milk Fortification, • 3 podcasts and a YouTube video on data by women’s groups by India Social Observatory • Blog by Nepal Sunaula Hazar Din (qualitative) 1.2 Number of • 1 health and nutrition promotion video by communications 0 3 21 34 34 35 Bangladesh ICT in Chittagong Hills Tract products63 published. • 2 knowledge sharing videos by Bangladesh Community Clinics. The FY18 results also include Sri Lanka Integrating Nutrition Promotion and Rural Development final report and India Social Observatory’s MIS manual, which were delivered in FY17 but were not included as FY17 results. 1.3 Number of (a) unique, external a) 0 a) 11,225 a)13,226 a) 14,186 a) 950 a) 1050 downloads of SAFANSI publications and (b) b) 0 b) 3,119 b) 6,888 b) 6,878 b) 9,000 b)11,000 unique external visits to SAFANSI website. There were 16 dissemination events in FY18: • 2 brown-bag lunches in DC by Nepal Sunaula 1.4 Number of World Hazar Din (qualitative) Bank- or partner-led • 3 workshops by Bangladesh Nutrition knowledge sharing Surveillance Capacity Building 0 5 17 23 25 35 • 4 international talks by India SO events at which SAFANSI evidence or • 4 workshops by Nepal Impact Evaluations analysis is presented. for Agriculture and Food Security Project and Sunaula Hazar Din • 3 workshops by Regional Costing (including a SAFANSI workshop in Nepal) 63 Communication products are materials that derive from technical studies/outputs financed by SAFANSI. They are intended to extend the audience of SAFANSI messages, and thus the impact of SAFANSI activities, from technical experts to policymakers, opinion leaders, interested lay-persons, and (where appropriate) the general public. They can take the form of newsletters, articles, briefs, talking point memos, videos, photo essays, and social media communications. 71 72 Pillar 2 – Enhanced Advocacy and Awareness Year 1 Year 2 Year 3 Year 4 Output 2 Output indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Nourishing Ideas for Action Results Results Results Target Target In FY18, there were 807 such participants in SAFANSI-supported awareness raising events, including: • 7 government officials in a study tour by Nepal Sunaula Hazar Din qualitative • 190 government and other stakeholders in 2.1 Number of ministers, Nepal Impact Evaluations for Agriculture and parliamentarians, Food Security Project and Sunaula Hazar Din public officials and/ workshops or development 0 502 674 1,481 700 750 • 200 government officials in Bangladesh partners participating in Nutrition Surveillance Capacity Building Improved SAFANSI supported FNS • 180 government, donor agencies, and awareness of Food awareness raising events. practitioners in Regional Costing and Cost- and Nutrition Effectiveness workshops (in Dhaka and at Security-related SAFANSI workshop in Kathmandu) challenges and • More than 70 milk federations and dairy demonstrated producer companies in India Milk Fortification action among launch workshop decision makers in • About 160 for India Social Observatory talks. South Asia. There were 7 media stories in FY18: • 3 podcasts and a YouTube video on data by women’s group by India Social Observatory 2.2 umber of FNS media • 1 additional video by Bangladesh ICT in stories resulting from Chittagong Hills Tract SAFANSI or SAFANSI- 0 35 55 62 65 70 • 2 videos by Bangladesh Community Clinics. supported activities, The videos were widely circulated and seen products or knowledge.64 by over 20,000 viewers of a TV talk show on Channel I, more than 25,000 views and 78 likes on Facebook Live, and 23,000 views on community clinics videos. 64 Including any qualitative evidence of reach where available. Year 1 Year 2 Year 3 Year 4 Output 2 Output indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Results Results Results Target Target 2.3 Number of priority platforms, networks and/or groups actively About 2,120 community members, including strengthened or pregnant and lactating mothers, trained by supported through 0 4,102 5,958 8,078 6,100 6,500 Bangladesh Information and Communication SAFANSI that explicitly Technology in Chittagong Hills Tract in FY18. advocate for improved food and nutrition security. 5 more projects successfully implemented planned communication activities in FY18: 2.4 Number of SAFANSI grants with a successfully • Nepal Sunaula Hazar Din (qualitative) implemented65 0 1 7 12 17 25 • Regional Costing communication or • Bangladesh Nutrition Surveillance Capacity engagement strategy.66 Building • Bangladesh Community Clinics • India Milk Fortification. 65 Strategy objectives met. 66 This is intended to capture work that goes beyond individual ‘products’ (such as a publication or media story) and delivers a targeted / coordinated package of relevant dissemination or advocacy activities to key audiences to achieve a stated objective (e.g. share key emerging evidence / ensure specific government officials take ‘X’ action/s etc). 73 74 Pillar 3 – Wider and Stronger Systems and Capacity Year 1 Year 2 Year 3 Year 4 Output 3 Output indicators Baseline (FY16) (FY17) (FY18) (FY19) Comments Nourishing Ideas for Action Results Results Results Target Target In FY18, there were 839 policy makers, government officials or practitioners trained, including: • 7 government officials in a study tour by Nepal Sunaula Hazar Din (qualitative) • 190 government and other stakeholders in Nepal 3.1 Number of policy • Impact Evaluation for Agriculture and Food makers, government Security Project and Sunaula Hazar Din Governments officials or practitioners workshops and development trained for effective FNS 0 600 674 1,513 700 1078 • 200 government officials in Bangladesh partners have program development, Nutrition Surveillance Capacity Building, strengthened delivery and/or 180 government, donor agencies, and policy and monitoring. practitioners in Regional Costing and programming Cost-Effectiveness workshops (in Dhaka capacity to achieve and at SAFANSI workshop in Kathmandu), FNS outcomes more than 70 milk federations and for the poor and dairy producer companies in India Milk disadvantaged. Fortification launch workshop, about 160 for India Social Observatory talks, and 32 mostly NGO practitioners in Bangladesh ICT in Chittagong Hill Tracts. 3.2 Number of FNS systems supported 2 additional FNS systems supported in through SAFANSI that 0 4 15 17 20 25 FY18: India Milk Fortification and Bangladesh help to improve food Nutrition Surveillance Capacity Building. and nutrition data, monitoring and use.67 67 With a focus, where possible, on reaching the poorest and most disadvantaged, and with a capacity to disaggregate data. Pillar 4 – Fostering Innovation Year 1 Year 2 Year 3 Year 4 Output 4 Output indicators Baseline (FY16) (FY 17) (FY 18) (FY 19) Comments Results Results Results Target Target 7 new concepts/technologies/ approaches have been evaluated or tested in FY18: • costing and cost-effectiveness measurements in Bangladesh and Afghanistan by Regional Costing; 4.1 Number • fortified milk production and of promising consumption (607,000 metric tons new concepts / consumed daily by 12 million people) technologies / and PPP business model by India Milk approaches that are Fortification; 0 7 21 28 25 30 evaluated or tested • podcast dissemination by India Social (0) (7) (21) (23) (25) (27) with target groups Observatory; New and (and number thereof • establishment of a policy platform innovative FNS that specifically for adolescent girls’ food and interventions address gender nutrition security by Bangladesh tested and/or issues).68 Nutrition Surveillance Capacity implemented Building; at the • nutrition awareness videos community developed locally and disseminated level. in indigenous areas by Bangladesh Information and Communication Technology in Chittagong Hills Tract. There are 3 new replications / scale- up of SAFANSI supported innovations 4.2 Number and in FY18. India Social Observatory’s percentage of tested P-tracking is replicated in Tamil Nadu FNS interventions as a citizen-data based planning that have been 0 (0%) 0 4 7 15 18 system and in Sri Lanka as a village adopted for planning tool. Also, one dish meals are replication and/or replicated by Bangladesh Information scaling-up. and Communication Technology in Chittagong Hills Tract. 68 The poor and disadvantaged, particularly girls, women of reproductive age and children under two. 75 76 Year 1 Year 2 Year 3 Year 4 Output 4 Output indicators Baseline (FY16) (FY 17) (FY 18) (FY 19) Comments Results Results Results Target Target Nourishing Ideas for Action 4.3 Number of beneficiaries reached through 2,120 community members, including a) 0 a) 100,750 a) 100,906 a) 103,026 a) 102,000 a) 105,000 food and nutrition pregnant and lactating mothers, security innovation by Bangladesh Information and b) 0 b) 1,750 b) 1,871 b) 3,291 b) 2,000 b) 2,300 pilots, a) total Communication Technology in Chittagong # reached, b) # Hills Tract. 67% were women, and 10- c) 0 c) 350 c) 350 c) 570 c) 700 c) 1,000 women, c) # children 15% were children. under 5 years of age reached.69 The percentage is indicative in FY17 4.4 Number and and 18, based on project reports. percentage of Beneficiary feedback was overall innovation pilots positive on Bangladesh Information and 0 (0%) 0 (0%) 4 (80%) 5 (80%) 15 (80%) 21 (80%) where communities Communication Technology in Chittagong and clients report Hills Tract, India Social Observatory, satisfaction. and India Milk Fortification. Beneficiary surveys are expected in FY19. 69 With a focus on under two-year olds to address stunting. Annex 6: SAFANSI Outputs by Country Phase I TF Number Country Activity name Outputs Blumberg, Rae Lesser; Dewhurst, Kara; Sen, Soham G.; Summers, Jordan; Blumberg, Rae Lesser; Dewhurst, Kara; Sen, Soham G.; Summers, Jordan. 2012. Gender-Inclusive Nutrition Activities in South Asia: Mapping report (English). Washington, DC: World Bank. TF010381 Regional Gender and Nutrition http://documents.worldbank.org/curated/en/513231468101988482/Mapping-report https://openknowledge.worldbank.org/handle/10986/15980 Tiwari, Sailesh; Skoufias, Emmanuel; Sherpa, Maya. 2013. Shorter, Cheaper, Quicker, Better: Linking Measures of Household Food Security to Nutritional Outcomes in Bangladesh, Nepal, Pakistan, Uganda, and Tanzania (English). Policy Research working paper; no. WPS 6584. Washington, DC: World Bank. TF011469 Regional Linking Measures of FNS Outcome http://documents.worldbank.org/curated/en/986391468207262071/Shorter-cheaper-quicker- better-linking-measures-of-household-food-security-to-nutritional-outcomes-in-Bangladesh-Nepal- Pakistan-Uganda-and-Tanzania World Bank. 2014. South Asia - Regional Assistance Strategy for Nutrition. Washington, D.C.: World Visualizing the ‘Invisible’ Epidemic of TF011712 Regional Bank Group. Under-Nutrition https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19412306 Global Conference on Women in TF011910 Regional   Agriculture World Bank. 2015. India - Strengthening Infant and Young Child Feeding Capacity in SAR Project (English). Washington, D.C.: World Bank Group. Strengthening Infant and Young Child TF013549 Regional Feeding Capacity (Recipient-Executed) http://documents.worldbank.org/curated/en/211011467999674682/India-Strengthening-Infant- and-Young-Child-Feeding-Capacity-in-SAR-Project Supervision of Grant to Breastfeeding TF013556 Regional   Promotion Network of India Mghenyi, Elliot Wamboka; Villoria, Nelson; Cho, Cheol Keun. 2016. Food Price Stabilization in South Toward Understanding the Effects of Asia: Impact of National Policies and Implications for a Regional Approach. Washington, D.C.: TF014546 Regional Food Price Polices on FNS World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=26566764 77 78 TF Number Country Activity name Outputs Gandhi, Rikin; Pandey, Ritika; Havimo, Terhi Elisa; Pehu, Eija. 2015. Promoting Agriculture Nutrition Convergence through Participatory Extension Videos. Agriculture Global Practice note, no. 1. Nourishing Ideas for Action Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24433777 Gandhi, Rikin; Pandey, Ritika; Havimo, Terhi Elisa; Pehu, Eija. 2015. Digital Green Agriculture: Nutrition Convergence - Final Report: The World Bank’s South Asia Food and Nutrition Security Initiative. Agriculture Global Practice Note,no. 3. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24740152 Agriculture Extension and TF014901 Regional Nutrition through Information and Babu, Suresh Chandra; Havimo,Terhi Elisa; Pehu,Eija. 2015. Fostering Agriculture-Nutrition Links: Communication Technology Recommendations for Agriculture Extension Curriculum Reforms in India. Agriculture Global Practice Note, no. 2. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24481743 Babu, Suresh Chandra; Singh, Meera; Hymavathi, T. V.; Rani, Uma; Kavitha, G. G.; Karthik, Shree. 2016. Improved Nutrition Through Agricultural Extension and Advisory Services: Case Studies of Curriculum Review and Operational Lessons from India. Agriculture Global Practice technical assistance paper. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=25929966 6 localized nutrition reports were produced: 1. Gaps in food and nutrition status identified supported with recommendations - Tarayana Foundation; Enhancing Knowledge and Awareness 2. Guidelines for Food - Nutrition of Pregnant Women Lactating Mothers and Children established TF015348 Regional of Critical Factors that Promote FNS by Manusher Jonno Foundation; Through Women's Network Groups 3. Communication Materials on Food Security and Nutrition of Pregnant Women and Lactating Mothers in the Chittagong Hill Tracts (CHT) - Manusher Jonno Foundation; 4. Sanjeevi Program implemented by Viluthu; 5. Viluthu NGO Plan of Action in Muttur, Sri Lanka; and 6. Tarayana Foundation Completion Report. World Bank. 2015. Sanjeevi: An Enterprising Solution for Food and Nutrition in Sri Lanka (English). SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/834201468102547687/Sanjeevi-An-enterprising- International Outreach of SAFANSI solution-for-food-and-nutrition-in-Sri-Lanka TF017273 Regional and BEES Program World Bank. 2015. One Dish Meals of South Asia (English). SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/680231468170980286/One-dish-meals-of-South-Asia Coordination, Partnership Outputs include visual identity and branding guidelines, internal to the World Bank, as well as TF017660 Regional Development and Results Monitoring development of SAFANSI website, and all knowledge products. for FNS in South Asia Region TF Number Country Activity name Outputs World Bank. 2012. Family and Community Approaches to Improve Infant and Young Child Evaluating and Learning from Nutrition in South Asia: A Report of the World Bank South Asia Region Development Marketplace. TF097620 Regional Innovative Community Approaches to Washington, D.C.: World Bank. Improving Child Nutrition https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=16518830 TF099039 Regional Cross-Sectoral Approaches to FNS   Adequacy of Food, Health and Care to TF099707 Regional   Nutrition Outcomes Visualizing Stunting: A Call for a TF015365 Afghanistan   Concerted Action Policy Note 1: Case study: enhancing skills for improved infant and young child nutrition - baby friendly village approach - Takhar Province, Afghanistan. Policy Note 2: A rapid assessment of iron and folic acid supplementation during pregnancy through the basic package of health services. Policy Note 3: Raising nutrition awareness among young women in Afghanistan through the TF098874 Afghanistan Multisectoral Plan to Promote FNS female youth employment initiative. Policy Note 4: Nutrition information with the pilot cash transfer program. Policy Note 5: Increasing the nutritional impact of the National Horticulture and Livestock Productivity project. Policy Note 6: The National Solidarity Program: improving nutrition and empowering women. World Bank. 2015. Assessment of exposure pathways to fecal contamination, association with diarrhea, and sanitation coverage in Bangladesh. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=25220140 Nutrition, Health, Diarrhea and TF011841 Bangladesh Sanitation Security World Bank. 2016. Early Childhood Diarrhea in Rural Bangladesh (English). The South Asia Food and Nutrition Security Initiative (SAFANSI). Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/994521481108174372/Early-childhood-diarrhea-in- rural-Bangladesh Strengthening Awareness and Nourishing Bangladesh with Micronutrient Small Fish: http://pubs.iclarm.net/resource_centre/AAS- TF014744 Bangladesh Advocacy of the Potential of Fisheries 2014-08.pdf to Improve FNS Gautam, Madhur; Faruqee, Rashidur R.; Ahmed, Md Mansur; Shilpi, Forhad J.; Khandker, Shahidur R.; Ahmed, S. Amer; Verissimo, Patrick; Kar, Anuja; Chellaraj, Gnanaraj. 2016. Dynamics of Rural TF016363 Bangladesh FNS Implications of Rural Growth Growth in Bangladesh: Sustaining Poverty Reduction. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=26377500 79 80 TF Number Country Activity name Outputs World Bank. Integrated Agriculture and Productivity Project: Impact Evaluation Comprehensive End-line Report. Nourishing Ideas for Action Washington, D.C.: World Bank. http://microdata.worldbank.org/index.php/catalog/2826/download/39953 World Bank. 2013. Baseline Household Survey Report. Washington, D.C.: World Bank. Impact Evaluation of Integrated TF016677 Bangladesh This report presents the main findings from a baseline survey for the impact evaluation of the Agricultural Productivity Project (IAPP) Bangladesh Integrated Agricultural Productivity Project (IAPP), conducted between August and October 2012. After a brief introduction to IAPP, the IAPP Impact Evaluation, and the baseline data collection exercise, the report provides descriptive statistics on the following topics: socioeconomic profile of the households, access to agricultural extension services, agricultural production and commercialization, household income and expenditures, access to and use of rural financial services, food security and women’s dietary diversity, and irrigation. http://microdata.worldbank.org/index.php/catalog/2826/download/39954 Multisectoral Simulation Tool for TF098429 Bangladesh - Scaling Up Nutrition Ferre, Celine; Sharif, Iffath. 2014. Can Conditional Cash Transfers Improve Education and Nutrition Outcomes for Poor Children in Bangladesh? Evidence from a Pilot Project. Policy Research Working Paper no. WPS 7077. Washington, D.C.: World Bank Group. Impact Assessment of Condition https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=20334344 TF099422 Bangladesh Cash Transfer Pilot through Local Government World Bank. 2015. Using Cash Cards to Make Better Nutrition Choices in Bangladesh. The South Asia Food and Nutrition Security Initiative (SAFANSI). Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=25216804 Atwood, Stephen J.; Nagpal, Somil; Mbuya, Nkosinathi V.; Laviolette, Luc. 2014. Nutrition in Bhutan: TF012082 Bhutan National Nutrition Assessment Situational Analysis and Policy Recommendations. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=23951129 Reich, Michael R.; Balarajan, Yarlini; Reich, Michael R.; Balarajan, Yarlini. 2012. Political Economy Developing a Framework for Applied Analysis for Food and Nutrition Security (English). Health, Nutrition and Population (HNP) TF010794 India Political Economy Analysis of FNS discussion paper. Washington, D.C.: World Bank. Issues in South Asia http://documents.worldbank.org/curated/en/327051468337182275/Political-economy-analysis- for-food-and-nutrition-security TF Number Country Activity name Outputs World Bank. 2017. A Picture is Worth a Thousand Words. SAFANSI. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27192939 Sanyal, Paromita; Rao, Vijayendra; Majumdar, Shruti. 2015. Recasting Culture to Undo Gender: a Sociological Analysis of Jeevika in Rural Bihar, India (English). Policy Research Working Paper no. WPS 7411. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/346831467995637047/Recasting-culture-to-undo- Social Observatory for the NRLM: TF011993 India gender-a-sociological-analysis-of-Jeevika-in-rural-Bihar-India Food Security Issues in South Asia World Bank. 2017. Jeevika in Rural Bihar: Social Mobilization and Cultural Transformation (English). The South Asia Food and Nutrition Security Initiative (SAFANSI). Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/647801487142077058/Jeevika-in-rural-Bihar-social- mobilization-and-cultural-transformation http://socialobservatory.worldbank.org/articles/participatory-tracking-customizing-visualizations Kathuria, Ashi Kohli; Khanna, Rajni. 2014. Incorporating Nutrition Actions in Rural Livelihoods Multisectoral Nutrition Actions in TF012081 India Projects. Program guidance note. Washington, D.C.: World Bank Group. Bihar https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24788089 Singh, Varun; Sen, Soham; Chatterjee, Meera. 2014. India - Food Security and Nutrition in Tribal Areas (English). Washington, D.C., World Bank Group. http://documents.worldbank.org/curated/en/247861468049771762/India-Food-security-and- Improving Food Security in Tribal nutrition-in-tribal-areas TF012122 India Areas World Bank. 2014. Food and Nutrition Security in Tribal and Backwards Areas in India. SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24438847 Shah, Parmesh; Prasad, Vivek; Machiraju, Sitaramachandra; Vutukuru, Vinay Kumar. 2015. Community Managed Food and Nutrition Security Initiatives in High Poverty States in India Community Managed FNS Initiative in TF012676 India (English). Washington, D.C.: World Bank Group. High Poverty States http://documents.worldbank.org/curated/en/159641468187781707/Community-managed-food- and-nutrition-security-initiatives-in-high-poverty-states-in-India World Bank. 2014. India - Accelerating Agricultural Productivity Growth, Vol. 1 of India - Accelerating Agricultural Productivity Growth. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=23789323 Strengthening Agriculture Education TF014041 India and Policy Making for FNS World Bank. 2014. Overview, Vol. 2 of India - Accelerating Agricultural Productivity Growth. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27871956 81 82 TF Number Country Activity name Outputs Food Grains Storage and Trade Policy World Bank. 2014. India - Managing Wheat Price Volatility: Evaluating Policy Options. Washington, Option: Trade-offs and Implications TF014636 India D.C.: World Bank Group. Nourishing Ideas for Action for Food Security: A Knowledge https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19705543 Development Activity Global Policy Consultation and World Bank. 2016. Impacting Food Security and Nutrition Outcomes through Strengthening International Conference on Livelihoods: The Experience from India Livelihood Projects. The South Asia Food and Nutrition TF098748 India Leveraging Agriculture for Improving Security Initiative (SAFANSI). Washington, D.C.: World Bank Group. Nutrition and Health (Recipient- https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=26503987 Executed) World Bank. 2016. Integrating Nutrition in Rural Livelihoods and Value Chains and the Role of Community-Based Food Security Producer Companies. The South Asia Food and Nutrition Security Initiative (SAFANSI). Washington, TF0A0585 India Enhancement D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=26503961 World Bank. 2014. Nepal - Nutrition Policy Dialogue II: Summary of Activities. Washington, D.C.: TF010274 Nepal FNS Thematic Report (NLSS) World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19308259 Evaluating the Nutritional Impacts of World Bank. 2015. Nepal - Social Safety Nets Project. Washington, D.C.: World Bank Group. TF012123 Nepal FNS Programs https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24991737 Contributed to this paper: World Bank. 2012. Nutrition in Nepal: A National Development Priority. Community-Based Behavior Change TF012285 Nepal Washington, D.C.: World Bank. for Nutrition Improvement https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=16259424 Review of Infant and Young Child TF012286 Nepal - Feeding Insecurity and Malnutrition World Bank. 2014. Nepal - Nutrition Policy Dialogue II: Summary of Activities. Washington, D.C.: District Profiles of Determinants of TF013189 Nepal World Bank Group. Food Insecurity and Malnutrition https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19308259 Sunaula Hazar Din – Community World Bank. 2018. Nepal Sunaula Hazar Din Community Action for Nutrition Project: End Line TF013868 Nepal Action for Nutrition Project Impact Report. Washington, D.C.: World Bank. Evaluation https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=29856136 World Bank. 2014. Nepal - Nutrition Policy Dialogue II: Summary of Activities. Washington, D.C.: TF013934 Nepal Support to Nutrition Policy Dialogue II World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19308259 Training of Social Mobilizers World Bank. 2015. Nepal - Nutrition Policy Dialogue III: Summary of Activities. Washington, D.C.: and Coaches in a Results-Based TF014834 Nepal World Bank. Community Driven Approach to https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24467268 Reducing Malnutrition TF Number Country Activity name Outputs World Bank. 2014. Nepal - Nutrition Policy Dialogue II: summary of activities. Washington, D.C.: TF015218 Nepal Small Area Estimation of FNS World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=19308259 Gender Equality and Social Inclusion TF015361 Nepal for FNS World Bank. 2018. Nepal - Agriculture and Food Security Project: Impact Evaluation – End Line Impact Evaluation of Agriculture and TF016678 Nepal Survey Report. Washington, D.C.: World Bank Group. Food Security Project https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=30196880 World Bank. 2015. Nepal - Nutrition Policy Dialogue III: Summary of Activities. Washington, D.C.: TF018790 Nepal Training Journalists on FNS World Bank. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24467268 TF018790 Nepal Training Journalists on FNS Child Nutritional Outcomes World Bank. 2015. Evidence from Pakistan: Child Nutritional Outcomes and Community-Based and Community Based Health Health Service Provision. SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: TF011848 Pakistan Service Provision: Evidence from a World Bank Group. Randomized Field Experiment in Rural https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=24438395 Pakistan World Bank. 2018. Guiding Policy and Investment in Human Nutrition in Four Provinces of Multisectoral Nutrition Dialogue and Pakistan. SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: World Bank TF012245 Pakistan Technical Assistance Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=30363091 Long-run Economic Effects of TF014344 Pakistan - Childhood Nutrition and Health Status Engaging Planning Commission, TF099154 Pakistan Agriculture and Water Ministries on - FNS in Policy and Investment Planning World Bank. 2014. Integrating Nutrition Promotion and Rural Development in Sri Lanka. SAFANSI. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=23182704 Integrating Nutrition Promotion and TF015520 Sri Lanka Rural Development (INPARD) World Bank. 2018. Integrating Nutrition Promotion and Rural Development in Sri Lanka (English). SAFANSI The South Asia Food and Nutrition Initiative. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/154791539114896281/Integrating-Nutrition- Promotion-and-Rural-Development-in-Sri-Lanka 83 84 TF Number Country Activity name Outputs World Bank. 2017. Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector. Washington, D.C.: World Bank Group. Nourishing Ideas for Action https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27327421 Multisectoral Nutrition Assessment TF017744 Sri Lanka and Gap Analysis in Estate Sector World Bank. 2017. Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27327236 TF017500 Program SAFANSI Trust Fund Administration World Bank. 2013. South Asia Food and Nutrition Security Initiative (SAFANSI): Annual Report and Work Program 2012-2013 (English). Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/162581467994710725/South-Asia-food-and- nutrition-security-initiative-SAFANSI-annual-report-and-work-program-2012-2013 SAFANSI Program Management TF098394 Program (including secretariat functions) World Bank. 2014. South Asia Food and Nutrition Security Initiative (SAFANSI): 2013-2014 Annual Report and Work Program (English). Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/462791468107937404/South-Asia-Food-Nutrition- Security-Initiative-SAFANSI-2013-2014-annual-report-and-work-program World Bank. 2016. South Asia Food and Nutrition Security Initiative (SAFANSI): 2014-2015 Annual SAFANSI Program Management Report (English). Washington, D.C: World Bank Group. TF098925 Regional (including secretariat functions) http://documents.worldbank.org/curated/en/393321468197956146/South-Asia-food-and- nutrition-security-initiative-SAFANSI-2014-2015-annual-report Phase II (Not including grants approved after May 31, 2018) TF Number Country Activity name Outputs Walters, Dylan David; Eberwein, Julia Dayton; Schultz, Linda Brooke; Kakietek, Jakub Jan; Ahmadzai, Habibullah; Mustaphi, Piyali; Saeed, Khwaja Mir Ahad; Zawoli, Mohammad Younus; Shekar, Meera. 2018. An Investment Framework for Nutrition in Afghanistan: Estimating the Costs, Impacts, and Cost-effectiveness of Expanding High-impact Nutrition Interventions to Reduce Stunting and Invest in the Early Years. Health, Nutrition and Population (HNP) Discussion Paper. Washington, D.C.: Costing and Cost-Effectiveness World Bank Group. TF0A2323 Regional Analysis of Scaling Up Nutrition- https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=29892847 related Interventions Kakietek, Jakub Jan; Provo, Anne Marie; Mehta, Michelle Ashwin; Sharmin, Farhana; Shekar, Meera. 2018. Supporting the National Action Plan on Nutrition (English). Health, Nutrition and Population (HNP) Discussion Paper. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/553931536092795914/Supporting-the-National- Action-Plan-on-Nutrition TF Number Country Activity name Outputs Dizon, Felipe Jr Fadullon; Herforth, Anna Whitson. 2018. The Cost of Nutritious Food in South Asia. Policy Research Working Paper no. WPS 8557. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=30352929 Torlesse, Harriet; Raju, Dhushyanth. 2018. Feeding of Infants and Young Children in South Asia. Background Analytical Outputs for Policy Research Working Paper no. WPS 8655. Washington, D.C.: World Bank Group. TF0A5366 Regional the Regional Undernutrition Report: https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=30646853 Ending Undernutrition in South Asia Dizon, Felipe Jr Fadullon; Herforth, Anna Whitson. 2018. The Cost of Nutritious Food in South Asia (English). Policy Research Working Paper no. WPS 8557. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/382091534429994437/The-cost-of-nutritious-food-in- South-Asia An inception report and 2 progress reports have been completed; a report of the key findings Addressing Critical Failures of Infant and recommendations of the study of challenges and constraints faced by working women in TF0A5836 Regional and Young Child Nutrition urban areas in feeding and care of infants and young children and a report of the key findings and recommendations of the BFHI study will be available in August 2019. Gautam, Madhur; Faruqee, Rashidur R.; Ahmed, Md Mansur; Shilpi, Forhad J.; Khandker, Shahidur R.; Ahmed, S. Amer; Verissimo, Patrick; Kar, Anuja; Chellaraj, Gnanaraj. 2016. Dynamics of Rural Dynamics of Rural Growth: Outreach Growth in Bangladesh: Sustaining Poverty Reduction (English). Washington, D.C.: World Bank TF0A1834 Bangladesh and dissemination (Just-In-Time Group. Window) http://documents.worldbank.org/curated/en/951091468198235153/Dynamics-of-rural-growth-in- Bangladesh-sustaining-poverty-reduction 1. Lactating Mother’s Additional Nutritious Food and Colostrum https://www.youtube.com/watch?v=NzUS9K8aYsc 2. Pregnant mother care and nutrition https://www.youtube.com/watch?v=v1DcpWIpI_s 3. Pregnant mother care and nutrition (Marma language) Leveraging Information Technology to https://www.youtube.com/watch?v=ZXT2CEKflN8 TF0A3110 Bangladesh Achieve Better Nutrition Outcomes in 4. Locally Available Nutritious Food and Khichuri (Chakma Language) the Chittagong Hills Tract https://www.youtube.com/watch?v=wjfUItsEMbI 5. Locally Available Nutritious Food and Khichuri (Marma language) https://www.youtube.com/watch?v=zOT7IYEPjlk&t=2s 6. Child diseases and prevention https://www.youtube.com/watch?v=Qshz2rCaaM0 7. Supplementary Food for Children from Six months of age https://www.youtube.com/watch?v=QhQjRhICCVc Can Conditional Cash Transfers TF0A3566 Bangladesh Improve Child Nutrition and Cognitive Impact evaluation methodology. Development? (Just-In-Time) Capacity Development in Nutrition TF0A3672 Bangladesh Policy Brief developed; second policy brief to be completed in August 2019. Surveillance and Research Tackling Malnutrition: The Story of TF0A5601 Bangladesh Project ongoing Community Clinics (Just-In-Time) 85 86 TF Number Country Activity name Outputs Role of Agriculture Polices on TF0A8172 Bangladesh Nutrition Outcomes: Exploiting a Project ongoing Unique Panel Survey Nourishing Ideas for Action Food Security and Agriculture (Just-In- TF0A3584 Bhutan Not applicable. Time) Tarayana Foundation is developing and piloting a behavior change communication strategy to be Capacity Development and mainstreamed by the Food Security and Agriculture Project. To date, Tarayana has successfully Communication for Improved TF0A3887 Bhutan completed a baseline survey, and has developed and piloted behavior change communication Nutrition Outcomes in Rural materials. Forthcoming activities include a national workshop for discussion and dissemination of Households the strategy. Burden of Malnutrition for the States of Utter Pradesh, Nagaland, TF0A1098 India https://cloud.ihme.washington.edu/index.php/s/EMj3EYWKaqMSPKC Uttarakhand, and Meghalaya (Phase 1) 1) TN Retrospective https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/0MJ1AY 2) TN Prospective Baseline https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/GOELLL 4) Orissa Prospective Baseline https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/AKGHHF Social Observatory: Catalyzing 5) Orissa Prospective Endline TF0A1325 India Improved Implement in Project to https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/ZBZCZ2 Improve Food and Nutrition Security 6) Bihar RCT https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/6PAHVM 7) Bihar Jeevika Retrospective https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/QHF29P The impact evaluation papers/publications can be found here: http://socialobservatory.worldbank.org/ Project ongoing Cross-Sectoral Technical Support on TF0A2780 India Study of nutrition determinants and strategies in Nagaland will be delivered July 2019. Nutrition the North East of India Andhra Pradesh and Telangana Rural TF0A3328 India Inclusive Growth and Nutrition Project - (Just-in-Time Window) Improved Nutrition through Milk Micronutrient Fortification Testing TF0A4103 India Project ongoing. the Business Case Under the National Dairy Support Project, India TF Number Country Activity name Outputs Two pieces of analytical work (operational research) were carried out: (1) a pilot monitoring and evaluation, and (2) a process evaluation of the Pradhan Mantri Matru Vandana Yojana (PMMVY) Design and Plotting of Conditional in Madhya Pradesh. The deliverables consist of two reports and PowerPoint presentations that Cash Transfers for Maternal and summarize the findings of the operational studies. TF0A4384 India Child Health and Nutrition in Madhya To improve implementation of the conditional cash transfers under PMMVY, capacity building was Pradesh (India) provided to various categories of implementers to increase knowledge of the PMMVY scheme, including operational details needed for successful implementation. Deliverables include training materials that were developed and used during the sessions. A market assessment is being conducted, with the four background pieces now completed: Enterprise Development for Nutrition TF0A5734 India inception report, scoping report, supply side report, and demand side report. These four pieces will and Sanitation in Bihar underpin the final business strategy and roadmap for the scale-up of nutrition enterprises. Impact Evaluations of the AFSP and World Bank. 2018. Nepal Sunaula Hazar Din Community Action for Nutrition Project: Endline Report. TF0A0635 Nepal Sunaula Hazar Din Community Action Washington, DC: World Bank. for Nutritional Project https://hubs.worldbank.org/docs/ImageBank/Pages/DocProfile.aspx?nodeid=29856136 Oshima, Kaori; Biradavolu, Monica Rao; Bashyal, Chhitij; Bhattarai, Manav. 2017. Qualitative Study of Qualitative Assessment and “Sunaula Hazar Din” Community Action for Nutrition Project Nepal (English). Washington, D.C.: World TF0A1374 Nepal Knowledge Enhancement of Bank Group. Community-Driven Nutrition Project http://documents.worldbank.org/curated/en/402341506091977400/Qualitative-study-of-Sunaula- Hazar-Din-community-action-for-nutrition-project-Nepal The project mainly focused on: (1) training women farmers in organic winter vegetable production; Women’s Enterprise Initiatives (2) training the same households in community food bank management, food preservation to Ensure Community Food and TF0A2708 Nepal techniques, and on the preparation of nutritious meals; and (3) providing business development Nutrition Security in Upland Nuwakot services to producers to create sustainable food enterprises that can continue to serve local (Just-in Time-Window) markets. Final deliverables will be available in July 2019 and will include: • Evidence related to adolescent nutrition consolidated and understanding of determinants Adolescent Nutrition in Pakistan articulated in clear and concise causal pathway TF0A5674 Pakistan Identifying Opportunities and Setting • Documentation of way forward for more detailed and in-depth research and design of pilot Priorities programs and interventions to reach out to adolescent addressing girls and boys as per their gender roles and potential contribution to improve nutrition. • A list of recommendations and options for policy and program development and design which are translated into implementation by various relevant agencies and stakeholders. Technical Design Support for Nutrition TF0A6660 Pakistan Project ongoing Focused (CCT) pilot rollout in Punjab The project is developing user-friendly dashboards for real-time reporting of nutrition-specific TF0A6922 Pakistan Tracking Nutrition Expenditure expenditure. Dashboards will be ready in July 2019. World Bank. 2018. Bringing Rural Development to Bear on Human Nutrition (English). The South Integrating Nutrition Promotion and Asia Food and Nutrition Security Initiative (SAFANSI). Washington, D.C.: World Bank Group. TF0A1146 Sri Lanka Rural Development (INPARD) http://documents.worldbank.org/curated/en/515591530196088179/Bringing-rural-development- to-bear-on-human-nutrition 87 88 TF Number Country Activity name Outputs World Bank. 2017. Fact Sheet: Multisectoral Nutrition Assessment in Sri Lanka’s Estate Sector. Washington, D.C.: World Bank Group. Building Effective Nutrition https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27463978 Nourishing Ideas for Action Communication through Partnerships: TF0A3103 Sri Lanka Addressing Estate Sector Nutrition Gunawardene, Nalaka Jayampati. 2016. Building Effective Nutrition Communication through Issues (Just-in-Time Window) Partnerships: An Assessment of Communication Needs and Opportunities in Sri Lanka’s Estate Sector. Washington, D.C.: World Bank Group. https://hubs.worldbank.org/docs/imagebank/pages/docprofile.aspx?nodeid=27463987 World Bank. 2018. Improving Nutrition Outcomes for Children in Sri Lanka’s Estate Sector: The Positive Deviance Approach (English). Washington, D.C.: World Bank Group. TF0A5051 Sri Lanka Nutrition Positive Deviance Analysis http://documents.worldbank.org/curated/en/109211544531399484/Improving-Nutrition- Outcomes-for-Children-in-Sri-Lanka-s-Estate-Sector-The-Positive-Deviance-Approach Improving Nutrition through TF0A5987 Sri Lanka Modernizing Agriculture in Sri Lanka Project ongoing (INMAS) TF0A1187 Program SAFANSI Secretariat Blogs about SAFANSI activities are published at: https://blogs.worldbank.org/taxonomy/ TF0A1473 Program SAFANSI Communications term/16658 SAFANSI Program Management and Reports, policy notes, videos, and other materials published by SAFANSI are summarized at: http:// TF0A2872 Program Administration www.worldbank.org/en/programs/safansi#3 TF0A7231 Program SAFANSI Colombo Roundtable 2018 Roundtable presentations are available at: http://www.worldbank.org/en/programs/safansi#5 Annex 7: Overview of projects linked to SAFANSI grants Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition million) (million)70 and/or food security theme Developed Afghanistan Multisectoral Plan to National Action Nutrition Solution Series to N/A N/A N/A Promote FNS (I) Framework support the implementation of the Framework In support of SEHAT, the grant engaged the Public Afghanistan Visualizing Stunting: A Call System Enhancement for Nutrition Department in the N/A for a Concerted Action (I) Health Action in Transition Ministry of Public Health to 550 71 1.46 develop the script for the (SEHAT) Project (Health Sector)** video. National Nutrition Plan (under development) The regional project Regional Costing and Cost- focused on Afghanistan and Effectiveness Analysis (II) Second National Action N/A N/A N/A Bangladesh, respectively. Plan for Nutrition (NPAN2) Assessment of SAFANSI supported impact Conditional Cash Transfer evaluation (IE), including N/A Pilot through Local design, implementation, and Governments (I) Income Support Program for analyses the Poorest Project (ISPP) 300 0.60 Bangladesh Can Conditional Cash SAFANSI supported the (Social Protection Sector)** Transfers Improve Child development of detailed N/A Nutrition and Cognitive impact evaluation Development? (II) methodology Bangladesh Rural Water Nutrition, Health, Diarrhea Study on the cause of child Supply and Sanitation Project 42 1.20 N/A and Sanitation Security (I) diarrhea (Water Sector) 70 Number of project beneficiaries according to project appraisal document or implementation completion report, unless otherwise noted. 71 Number of pregnant women receiving antenatal care during a visit to a health provider (overall beneficiary number not available in implementation completion report). 89 90 Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition Nourishing Ideas for Action million) (million)70 and/or food security theme Strengthening Awareness Nutrition policy brief on the National Agricultural and Advocacy of the availability, accessibility, and Technology Project I 63 0.40 N/A Potential of Fisheries to utilization of micronutrient- (Agriculture Sector) Improve FNS (I) rich small fish Impact Evaluation of Integrated Agricultural IAPP (Agriculture Sector) 46 0.15 N/A Impact evaluation design Productivity Project (IAPP) (I) Five Year Plan Systemic Country SAFANSI-I financed the Dynamics of Rural Growth Diagnostic (SCD) study. SAFANSI-II supported (I&II) Country Partnership dissemination activities. Framework (CPF) Sri Lanka Integrating INPARD stimulated the Nutrition Promotion Nuton Jibon Project 200 1.00 N/A nutrition component design and Rural Development (Agriculture Sector)** of the Nuton Jibon (INPARD) (I) National Nutrition SAFANSI supported Assessment and Gap N/A N/A N/A 11th Five Year Plan multisectoral nutrition Analysis (I) assessment GAFSP, or Global Agriculture and Food Security Program is another trust fund. Capacity development Bhutan GAFSP-financed Bhutan Food SAFANSI is supporting for improved nutrition (2013-2018) Security and Agriculture development of behavior outcomes (II) 8 0.05 Productivity Project (FSAPP) change communication tools (Agriculture Sector)** for pregnant and nursing mothers. Food Security and SAFANSI financed a study N/A Agriculture Project (II) tour to Nepal. Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition million) (million)70 and/or food security theme Developing a Framework Integrated Child Development for Applied Political Services (ICDS) Systems The Framework included a N/A Economy Analysis of FNS Strengthening & Nutrition 106 72 case study from ICDS. N/A Issues in South Asia (I) Improvement Program (Health Sector)** N/A Technical and operation support to develop and Swachh Bharat Mission Multi-sectoral Nutrition implement multisectoral Support Operation (Water 1,500 66.0073 N/A Actions in Bihar (I) nutrition action plan in Bihar, Sector) using Jeevika’s village-level 163 1.20 N/A institutions. Bihar Rural Livelihoods Project (Jeevika) (Agriculture Participatory Tracking Sector) (P-Tracking), which is a India community-based M&E Bihar Transformative system, including food Development Project (Jeevika 290 5.00 N/A production, nutrition Social Observatory (I&II) 2) (Agriculture Sector) and food prices. Social Tamil Nadu Empowerment Observatory stimulated the and Poverty Reduction Project 274 1.50 N/A M&E system of the rural (Agriculture Sector) livelihoods development projects in India. N/A Influenced development National Rural Livelihood and implementation of an 724 4.80 FNS in Tribal Areas (I) Project (Agriculture Sector) integrated nutrition and food security model at community level 72 The project beneficiaries are expected to be India’s pregnant women and children under six years of age, with a focus on children 0-3 years old, according to the project appraisal document 73 Project appraisal document expects 66 million people to live in open defecation free villages. 91 92 Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition Nourishing Ideas for Action million) (million)70 and/or food security theme Community Managed FNS Telangana Rural Inclusive SAFANSI-I financed the Initiative in High Poverty Growth Project (Agriculture 75 0.50 N/A development of knowledge States in India (I) Sector)** products on how community platforms, such as self-help Orissa Rural Livelihoods groups and village organiza- “Tripti” Project (Agriculture 66 0.39 N/A tions, created institutional Sector) ecosystem to deliver nutrition services at household level by integrating livelihoods, food security, health, nutrition, and sanitation. N/A Andhra Pradesh Rural Inclusive Growth Project 75 0.50 (Agriculture Sector)** Rural Inclusive Growth and N/A Nutrition sensitive IE design Nutrition (II) Second Madhya Pradesh Community-Based Food District Poverty Initiatives Impact Evaluation on FNS of 100 0.42 N/A Security Enhancement (I) Project (MPDPIP-II) MPDPIP-II (Agriculture Sector)** Regulatory reforms that Improved Nutrition permitted the fortification National Dairy Support Project SAFANSI is supporting milk through Milk Micronutrient 352 12.0074 of all types of liquid milk (Agriculture Sector) fortification pilot Fortification (II) (e.g., skim, low-fat, full cream) Technical support to cross- Nagaland Health Project sectoral work on nutrition 48 1.18 N/A Impact Evaluation (Health Sector)** in the North East (II) 74 This figure is current as of February 2019 and is expected to reach 55 million beneficiaries by June 2019. Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition million) (million)70 and/or food security theme National Multisector National Multisector N/A N/A N/A Nutrition Action Plans I Nutrition Action Plan I (I) (2013-2017) SAFANSI support also Scaling Up Nutrition leveraged the Community Initiative Technical N/A Challenge Fund for Action Assistance (SUNITA) (I) Plan Impact Evaluation Sunaula Hazar Din (Sunaula ($141,000). Hazar Din) Community Action 40 N/A75 for Nutrition Project (Health National Multisector Qualitative Assessment of Sector)** Nutrition Action Plans II Impact Evaluation Sunaula Hazar Din (II) (2018-22) Nepal Sunaula Hazar Din Impact N/A Impact Evaluation Evaluation (II) GAFSP-financed Agriculture and Food Security Project 23 0.06 N/A Impact Evaluation AFSP Impact Evaluation (II) (AFSP) (Agriculture Sector)** Livestock Sector Innovation 80 0.20 N/A Impact Evaluation Project (Agriculture Sector)** Evaluating the Nutritional Social Safety Nets Project Impacts of FNS Programs 58 0.94 N/A Impact Evaluation (Social Protection Sector)** (I) 75 The project targeted 280 village development committees, according to the implementation completion report. 93 94 Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition Nourishing Ideas for Action million) (million)70 and/or food security theme Punjab Human Capital Punjab Human Capital Bank-financed project under Investment Project (Health 200 TBD N/A Investment Project (II) preparation. Sector)** Supported four provincial Sindh Enhancing Response governments to develop their to Reduce Stunting Project 62 2.22 N/A own nutrition policy guidance Pakistan Multisectoral Nutrition (Health Sector)** notes. Sindh note leveraged Dialogue and Technical the Bank-financed project. Assistance The Punjab nutrition policy Punjab Health Sector Reform 76 guidance note facilitated 71 N/A N/A Project (Health Sector) restructuring of the Bank- financed project Based on the Balochistan Sindh, and Khyber Enhanced Nutrition for Pakhtunkhwa nutrition policy Mothers and Children (Health 68 N/A77 N/A guidance notes, the Project Sector) supports enhancing nutrition service delivery. Child Nutritional Outcomes and Community Based Health Service Study built on the midline Provision: Evidence from N/A evaluation of the Bank- a Randomized Field Pakistan Poverty Alleviation financed PPAF Experiment in Rural Fund (PPAF) III (Agriculture 256 1.29 Pakistan (I) Sector) Long-run Economic Effects of Childhood Nutrition and The study built on the PPAF’s N/A Health Status in Pakistan IE. (I) 76 The project appraisal document indicates the entire population of Punjab will benefit from the project, particularly, the poor and disadvantaged. 77 According to the project appraisal document, the project is to address chronic malnutrition in Balochistan and Sindh by focusing on the 1,000-day window. Mothers and children in targeted districts are to benefit from the project interventions. Leveraging/Linkages SAFANSI Project Bank Project No. of Country Amount Policy Contribution Note (I or II) (Lead Practice Area) beneficiaries ($ ** projects with a nutrition million) (million)70 and/or food security theme SAFANSI-I supported community institutions formed by the Bank-financed project in developing and Community Livelihoods implementing participatory in Conflict-Affected Areas Multisectoral Nutrition nutrition action plans INPARD (I&II) 123 0.80 Project (Re-awakening Project) Action Plan in collaboration with (Agriculture Sector) district-level multisectoral stakeholders. SAFANSI- II financed IE was also supported by Oxford Sri Lanka University ($50k). Improving Nutrition SAFANSI-II is supporting the Agriculture Sector through Modernizing replication of the INPARD Modernization Project 125 0.10 N/A Agriculture in Sri Lanka model in an agriculture value (Agriculture Sector) (INMAS) (II) chain development project. To inform the Bank-financed Nutrition Action Plan Multisectoral Nutrition project, the multisectoral Second Health Sector for the Estate Sector, Assessment and Gap Nutrition Assessment was Development Project (Health 200 N/A78 which will be fed into Analysis in Sri Lanka’s undertaken in the estate Sector)** the National Multisector Estate Sector (I & II) sector. SAFANSI-II financed Nutrition Action Plan dissemination. Advancing Women’s Enterprises for Economic Leveraged another trade- Global Conference on Regional Impact in the Farm/nonfarm 0.8 N/A N/A focused grant under a SAR Women in Agriculture Value Chain and Regional regional program. Trade (Agriculture Sector) 39 projects 32 projects (34 projects contributed (19 agriculture,8 health, Total to Bank-financed 6,289 35.60 11 national policies 3 social protection, projects, while 5 projects 2 Water) specifically informed national policies) 78 The PAD expects the entire population of Sri Lanka to benefit from the Project 95 This material has been funded thanks to the contributions of (1) the Government of Australia Department of Foreign Affairs and Trade (DFAT), (2) UK Aid from the UK government, and (3) the European Commission (EC) through the South Asia Food and Nutrition Security Initiative (SAFANSI), which is administered by the World Bank. The views expressed do not necessarily reflect the EC or UK government’s official policies or the policies of the World Bank and its Board of Executive Directors.