CALL TO ACTION

NUTRITION CHALLENGES/ GAPS CALL FOR ACTION RESPONSIBLE THE REPUBLIC OF GOVERNANCE AREA OFFICE Coordination and Inadequate transport Integration of nutrition activities with other departmental field District Planner, partnerships: facilities for coordination activities. CAO, DPO, DEO, DISTRICT LOCAL GOVERNMENT of nutrition activities DCDO, DHO ADVOCACY BRIEF ON STRENGTHENING NUTRITION GOVERNANCE FOR MULTI-SECTORAL RESPONSE Limited coordination Ensure functionality of the coordination structures at the DNFP, SAS of nutrition activities at district and sub county/town council level by institutionalizing sub-county level mechanisms that foster regular engagements for joint planning, budgeting, monitoring and technical support supervision at subcounty level Systems capacity Delegation of majority Build capacity of the DNCC members to strengthen coordination District Planner, Systems capacity building (functional, unavailable therefore this first FSNA data will Building (functional, of nutrition activities through joint work planning, budgeting and implementation of DNFP, CAO, institutional and Human capacities) be used as a baseline to compare progress institutional and to the District Nutrition multi-sectoral nutrition actions. SAS, Principal in achievement of health, nutrition and WASH local government was supported Human capacities) Focal Person Township indicators in subsequent FSNAs. Annual FSNAs Schedule periodic orientation of DNCC/SNCC/TNCC/DiNCC/ to build the capacity of the coordination Officer, Town will be conducted to assess annual progress. MNCCs on their roles and responsibilities using the TORs in the structures at district level and respective lower SOPs clerk local governments to plan, budget, implement, The Nebbi DNCC has been trained on nutrition Policy and legal Limited awareness Support the wide dissemination of sectoral(departmental) District Planner and monitor multisectoral nutrition actions. 15 governance and supported to use reporting framework on available policies, policies and guidelines such as National Health Policy (NHPII), staff members of District Nutrition Coordination templates and monitoring tools previously guidelines that support Health Sector Development Plan (HSDP II) 2015/16–2019/20, Committee (DNCC) were trained to develop their developed as part of the Standard Operating multisectoral nutrition Integrated Early Childhood Development (NIECD) Policy (2016), DNAPs while 195 staff from eight sub counties, Procedures for nutrition governance. The action. Presidential Initiative on healthy eating and healthy lifestyles one town council, one Municipality and three reporting templates and monitoring tools are (July, 2019) National Agriculture Policy (NAP) of 2013 and the divisions developed SNAPs, TNAPs, MNAPs and currently in use by the district for program Agriculture Sector Strategic Plan (2015/16-2020/20) and Food DiNAPS respectively. implementation. Security Strategy, the Education Sector Strategic Plan (ESSP) The DNCC, SNCC, TNCC, MNCC and DiNCC (20017-2020) and Guidelines on Parent led School Feeding Policy development, implementation and conduct monthly monitoring and supervision and Nutrition (2012),the Social Development Sector Plan legal framework (2015/16 - 2019/20),the National Community Development visits and quarterly meetings to assess progress MOYO of program implementation. Policy for Uganda (2015) and the Water and Environment Sector The District Nutrition Coordination Committee KOBOKO LAMWO of Nebbi district developed a District Nutrition Development Plan (2015/16-2019/20) and the UNAP during joint YUMBE Action Plan (DNAP) aligned to the Uganda Financial and resource mobilization multisectoral forums with the DNCC and IPs in the district. DISTRICT PROFILE POPULATION 238,757 Nutrition Action Plan 2. The DNAP was also District should align the DNAP 2020-25 with the Adjumani DDP The DNCC was supported to develop annual Nebbi District is in the West sub region of approved by the District Council. III 124,025 114,732 workplans for implementation of multisectoral Uganda. It is bordered by district to the north, Female Male Information Inadequate use of Mentorship of department (both department heads and District Planner, KITGUM Eight sub counties, one town council, one nutrition actions. The 2019/2020 annual workplan Zombo to the northwest, DRC to the southwest management nutrition data & other department staff) on the use of reporting templates and DNFP MARACHA ADJUMANI Municipality and three divisions developed was signed by the Chief Administrative Officer and to the south–east. Nebbi district Infants Orphans (monitoring, monitoring data within monitoring tools as provided for in the SOPs on nutrition <1 year <18 years Subcounty Nutrition Action Plans (SNAPs), and is under implementation. has a total area of about 985.00 Sq. Kilometres evaluation, the departments. governance as well as how to make use of data to improve Town council Nutrition Action Plans (TNAPs) and average population density of 296.1. Nebbi 11,938 131,555 The Nebbi District Nutrition Action Plan ((2020- surveillance and nutrition program implementation. and Municipality Nutrition Action Plans (MNAPs) district has population of 238,757 (114, 732 2025) to support the implementation of research) Children Women of reproductive and Division Nutrition Action Plans (DiNAPs) males, 124,025 females) people as projected from AMURU under 5 years multisectoral nutrition actions was approved by Communication (for ARUA PADERage 15-49 years respectively aligned to the Nebbi District Inadequate knowledge Use of selected nutrition champions for positive behavior change CAO, DCDO, National Population and Housing Census 2014. the District Council. Nutrition behavior 48,229 Nutrition Action plan.. on the importance communication. DHO, DEO, Nebbi District is currently divided into 13 Lower ?? AGAGO Ten sub counties and one town council all change and practice) of nutrition in the DPO, Support the training on nutrition packages across different Local Governments i.e. Eight (8) rural Sub-Counties Children had their Nutrition Action plans approved by community and Pregnant women Information management (monitoring, departments such as training of VHTs on nutrition, training of i.e. (Akworo, Nyaravur, Kucwiny, Ndhew, Atego, below 18 years application of nutrition expected evaluation, surveillance and research) their respective councils. Activities from their CDOs, PDCs, FALs on KFCPs, training of agriculture extension Nebbi, Erussi, ), one (1) Town Council sensitive actions 10,267 workplan are being implemented in the district. workers on nutrition sensitive agriculture, training of schools on i.e. (Parombo Town Council) one (1) Municipal 10,267 Nebbi district was supported carry out a nutrition etc. Council i.e. (Nebbi Municipal) and three(3) divisions Nutrition Causal Analysis (NCA) to understand Adolescents Source: Uganda National Communication for nutrition social behavior i.e (Abindu, Nebbi, Thatha).The DistrictNWOYA has 42 10-24 years the food and nutrition security situation and to Advocacy (for Low funding for Resource mobilization from implementing partners and other DNFP, CAO ZOMBO Population and Housing change and Advocacy parishes, 429 villages. Nebbi Municipality has got explore the causal pathways for malnutrition in planning, budgeting multi-sectoral nutrition stakeholders for infrastructural support and skills enhancement 42,260 Census 2014 OTUKE three (3) Divisions, nine (9) Wards, 46 cells. the district. Data from the NCA will be/ is being 115 FAL groups, PDCs and CDOs were trained and resource activities in the district at district and lower local government levels NEBBI used to support program implementation. on the Key Family Care Practices and are mobilization) Generate periodic advocacy and policy briefs for politicians OYAM KOLE supporting communities implement nutrition and district and LLG level as a tool to advocate for funding for Nebbi was also supported to conduct a Food sensitive actions. Security and Nutrition Assessments (FSNA). nutrition. FSNA data was not available previously This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of UNICEF DEVELOPMENT INITIATIVE and do not necessarily reflect the views of the European Union. FOR NORTHERN UGANDA EUROPEAN UNION NUTRITION GOVERNANCE ACTIVITIES SUPPORTED IN THE DISTRICT NUTRITION, WASH AND HEALTH STATUS OF THE DISTRICT Coordination and Partnerships Stakeholder mapping: Result from the stakeholder mapping conducted in Nebbi District revealed that the district has 32 stakeholders either overseeing or implementing Nutrition specific and sensitive interventions NUTRITION STATUS FSNA baseline (2019) Desired situation (2025) HEALTH INDICATORS FSNA baseline (2019) Desired situation (2025) as well as and creating an enabling environment for Nutrition implementation within the district. In total, 20 (62.5%) are for Nutrition specific, 10 (31.3%) are in Nutrition sensitive and 2 (6.2%) are for governance Common childhood illnesses in Nebbi district include; Acute interventions. of households of households Respiratory MAP SHOWING DISTRIBUTION OF NUTRITION are food insecure have food stocks 51% 40% Malaria Diarrhea Infections 6.2% SPECIFIC, NUTRITION SENSITIVE AND GOVERNANCE INTERVENTIONS. 22% 4% 2% Governance

Wadelai

LOW BIRTH WEIGHT

12% IMMUNISATION (DPT3) VIT A SUPPLEMENTATION (12-23mo) 32 Nebbi Panyango STAKEHOLDERS Kucwiny 10% Alwi Pakwach TC STUNTING 92% 51% overseeing / implementing Nebbi TC interventions Atego 29% 70% 80% Nyaravur ANAEMIA IN WOMEN Ndhew Pakwach 20% Parombo 13% Erussi Panyimur <=14 interventions Akworo 12% 31.3% 62.5% 15 - 19 interventions DEWORMING (12-23 mo) Nutrition sensitive Nutrition specific >= 20 interventions Source: Food Security and Nutrition Assessment in 10 ANAEMIA IN CHILDREN 50% WASTING districts of Northern Uganda and West Nile 2019, Makerere 3% 52% 100% University School of Public Health. INTERVENTIONS TARGET GROUP NEBBI 25% 4% Promote, protect and support breast feeding Pregnant and lactating women, Adolescents Girls (10-19Yrs) INFANT AND YOUNG CHILD FEEDING PRACTICES FSNA baseline (2019) Desired situation (2025) NUTRITION GOVERNANCE Promote age appropriate complementary feeding Mothers / caregivers 50% practises Promote optimal nutrition Children with special needs 0-11 months Min. acceptable diet Min. diet diversity (6-23mo) Min. meal frequency WHAT IS NUTRITION GOVERNANCE AND WHY IS IT IMPORTANT? Promote adolescent nutrition Adolescents (Boys & Girls) 9% 33% 28% Good nutrition governance entails making adequate policy decisions in a timely manner, committing the necessary Vitamin A supplementation to children Children 0-59 months, postpartum women 100% financial and organizational resources to their effective implementation, i.e. ensuring that benefits reach most of the 40% Iron and Folic supplementation Pregnant women (15-49) 75% population, preferably the most vulnerable. It also entails a sustained political commitment to ensure that nutrition programs and policies can withstand threats and constraints from changes in district leadership, political and Outpatient management of acute malnutrition Children 0-59 months, Pregnant women (15-49) 25% Continued breast feeding (2yr) Exclusive breast feeding Breast feeding within first 1 hour socioeconomic upheavals (Solon 2007). Inpatient management of acute malnutrition Children 0-59 months, Pregnant women 25% 54% 58% 75% Management of moderate acute malnutrition (MAM) Children 0-59 months 50% NUTRITION GOVERNANCE FRAMEWORK Provide deworming tablets to children (1-14yrs) Children 12-59 months 85% 80% 80% 80% PILLARS OF GOVERNANCE Deworming for pregnant women Pregnant women (15-49yrs) 100% IPT of malaria (IPT and IPTs2) for Pregnant women Pregnant women (15-49yrs) 50% Intersectoral Cooperation Diahorrea with ORS & Zinc Children 0-59 months 65% WASH STATUS FSNA baseline (2019) Desired situation (2025) Long lasting insecticide treated nets (LLINs) Pregnant & Lactating women, Children 75% Policy Technical Frame Treatment of malaria All 95% Capacity Sustainable Funding Nutrition Works Outcomes Recommended vaccines in the national schedule by Children 0-59 months, Pregnant women 80% Monitoring recommended age

Stakeholders Vertical Partnership Building Frame work Information Financial and Communication Management 70% Coordination Coordination and Promote PMCT /EMCT of HIV Pregnant & Lactating mothers 15-49years with HIV Policy and legal System Capacity Resource Mobilization Provide ARV medication All HIV +VE incld Pregnant & Lactating mothers 80% LATRINE COVERAGE SAFE WATER ACCESS Advocacy Diet therapy into routine disease therapy Children 12-59 months with special needs (Nutrition Behavior Change. Advocacy) 98% 98% Prevention and Management of diet-related NDCs Women of reproductive age 15-49yrs 30% 80% 87% Source: Institute of Development studies (IDS), 2013 Source: Nutrition Stakeholder Mapping for Uganda Report. 2019