WINNN OVERVIEW

Working to Improve Nutrition in Northern (WINNN) is funded by UK’s Department for International Development and implemented by UNICEF, Action Against Hunger (ACF) and Save the Children International (SCI), in partnership with the Federal Government of Nigeria and the State Governments of Jigawa, , Kebbi, Yobe and Zamfara

1 Working To Improve Nutrition In Northern Nigeria (WINNN)

• UK-DFID Funded 6 Year Project, September, 2011- August, 2017 • A UNICEF and an INGO consortium of Save the Children (SC UK) and Action Against Hunger (AAH) • Operational research and impact evaluation (ORIE) conducted by independent nutrition researchers and evaluation experts- led by Oxford Policy Management • Implemented in partnership with Government in 5 Northern States of Jigawa, Yobe, Katsina, Zamfara and Kebbi

2 The proportion of malnourished children (stunted, underweight or wasted) by Programme state (NDHS 2008)

3 Aim of WINNN

Improve nutritional status of children under five through delivery of nutrition interventions through routine health services What are the expected results?

Expected Results: By 2017, WINNN will improve the nutritional status of : • 11 million children under five in northern Nigeria. • 158,000 children with severe acute malnutrition will receive treatment. • Contribute to national targets of reducing underweight and stunting by 20% (absolute reduction) and • Exclusive breast feeding rates will increase by 15% in the selected five northern states. Key interventions

 Prevention of Micronutrients Deficiencies: Iron-folate to pregnant women and vitamin A, Zinc-ORS, deworming tablets to children through routine primary health services and MNCH week campaigns Promotion of Infant and young child feeding practices (IYCF): Pregnant and lactating mothers are counselled on exclusive breastfeeding, continued breastfeeding and complementary feeding Community management of acute malnutrition: Children with severe acute malnutrition are treated in an outpatient therapeutic center (OTP) using ready to use therapeutic food (RUTF) and complicated cases are treated at Stabilization Care (SC) centers. Strengthening of nutrition multi-sectoral coordination and planning mechanisms at the national and state levels Independent operational and impact evaluation research to examine the wider determinants and structural barriers of undernutrition and generate knowledge on nutrition policy development

6 STRATEGIES

• Support the development of National Nutrition Policies and Strategic Frameworks • Enhance government planning and coordination of nutrition multi-sectoral response FEDERAL • Support Join monitoring and supervision of nutrition interventions GOVERNMENT

• Support states to adapt National Nutrition Policies and Costed Strategic plans • Build capacity of states to plan and coordinate Nutrition multi-sectoral response • Support the development of Nutrition annual operational plans STATE • Advocate to states to appropriate a Nutrition budget line GOVERNMENT • Advocate for timely budget release of budget line by states

• Build capacity of LGs to plan and coordinate Nutrition multi-sectoral response • Support LGAs to develop LGA specific Nutrition multi-sectoral plan • Advocate for LGA funding contribution to nutrition interventions LOCAL GOVERNMENT • Build capacity of health facilities and HCWs to implement CMAM& F-IYCF interventions

• Build capacity of communities to support the implementation of IYCF interventions • Support behavior change communication on Nutrition in partnership with the traditional and religious leaders, the media etc COMMUNITY • Raise voice and accountability mechanism for Nutrition to enhance government responsiveness and accountability

7 Programme headline results

8 Prevention of Micronutrients Deficiency

10,546,311 (117% of target) unique children received Vitamin A supplementation

Community mobilization -MNCH community drama 9 Supported innovations in MNCH Weeks

1. Enhanced Stock reporting and dispatched Vit A considering existing Vitamin A stock 2. Developed State preparedness Dashboard 3. Operationalized MNCHW planning and reporting matrix nationally 4. Supported Ops room and strengthened external MNCHW monitoring (particularly the “R” Response) 5. Currently piloting follow up of HFs with stock out using SMS. Based on the lessons learnt this platform will also be used to collect stock status from HFs prior to campaign Provision of Iron –Folate to pregnant women

8,156,734 (105% of 70 months target and 96% of Y6) unique pregnant women received Iron Folate supplements

• Bi annual MNCH Weeks • Routine health services- ANC

11 Promotion of Infant and Young Child Feeding (IYCF) practices

923,987 (210% 70 months target and 117% of Y6) pregnant women and mothers of children less than 24 months received counselling on appropriate IYCF

• About 8,0000 CVs engaged to in support groups & CMAM • Food demonstrations • Community dramas • Video shows

12 Community Management Of Acute Malnutrition (CMAM)

287,677 (134% of 70 months target and 100% of Y6) children were admitted into CMAM and treated for SAM

• Outpatient Therapeutic Programme (OPT Centres in PHCs • Stabilization centres in General Hospitals/Comprehensive Health Centres

13 Management of Diarrhoeal Disease

1,066,219 (209% of 70 months target and 193% of Y6) children with diarrhoea were treated with Zinc/LoORS

14 Other innovations in programme implementation

• Incorporation of care group model using promoters and mother leaders to improve community IYCF practices • Integration of Early Childhood Development into CMAM and community IYCF programme for children under 5 years accompanying mothers to OTP centers and support group meetings • Conduct of cost of diet analysis • Conduct of barrier analysis to IYCF practices • Integration of maternal nutrition into programme • Establishment of male support groups for IYCF

15 Supporting Government planning and coordination

16 Reviewed National policy on Food and Nutrition approved by FEC and launched by the Wife of the President supported by 3 Hon. Ministers

17 Development of Health Sector component of Nutrition National Strategic Plan of Action

18 Celebration of the National Breastfeeding week

The WINNN IYCF Hausa video songs were launched during the The WINNN IYCF Hausa video Flag Off by the rep of Min of Health songs were launched during the Flag Off by the rep of Min of Health

19 Senate Policy Dialogue CALL TO ACTION on Nutrition

“WE THEREFORE ASK THAT RAPID INCREASES IN ALLOCATION TO COMBAT MALNUTRITION IS CARRIED OUT BY ALL STATES AND THE FEDERAL GOVERNMENT; WE ASK THAT ALL RELEVANT GOVERNMENTS AND PARTNERS INFORM ON A REGULAR BASIS THE NATIONAL & STATE PARLIAMENTS & THE NIGERIAN PEOPLE THEIR SPENDING AND THE IMPACT OF SUCH SPENDING; ENDING MALNUTRITION IS A POLITICAL CHOICE THAT GOES BEYOND PARTY LINES AND THE ECONOMIC ARGUMENTS OF RECESSION. IT IS REALLY THE EVIDENCE OF “THE CHANGE” THE PEOPLE VOTED FOR”.

Global Nutrition Report also launched

20 • Advocacy visit to Government leading to increase in 2016 budget line from N30million to N200 million

21 Advocacy meeting with Katsina State Governor on Nutrition funding

22 2 Weeks Later

Katsina State Governor visited Maiadua OTP centre

The Governor observing distribution of RUTF and asking questions from the Commissioner for health while the Speaker Katsina State house of assembly, District head of Yandi and Mai’adua LGA Representative at the State house of assembly listened 23 Legislative engagement

Bi-annual Review Meeting on Nutrition Resourcing with State Houses of Assembly and Chairmen of Food and Nutrition Committees held Legislatures and WINNN reps in a group picture reiterating their resolve to work together in improving the nutritional status in their states 24 . Developed 5 year Nutrition Strategic plan in all 5 WINNN states

. Held advocacy/ . Supported quarterly capacity building meetings of States and workshop for top National Food and government officials on Nutrition Committee nutrition resourcing and meetings. budget monitoring

25 . Innovative Financing Mechanism Study to identify fiscal space in states study ongoing

. Domestication of . Development LGAs 5 National Policy on food year Nutrition Strategic and Nutrition ongoing in plan in all 5 WINNN all WINNN supported states ongoing states

26 High level policy makers engagement Training Workshop on Budget release and budget tracking permanent secretaries, accountants Nutrition Sensitization general and office of the Workshop for High Level SSG policy makers - commissioners of nutrition line ministries

27 Partnership with Media and Civil Society Network & Community

28 Civil Society Networks • Partnership in Media Advocacy, Nutrition Voice and ADVOCACY, VOICE & Accountability, ACCOUNTABILITY Budget tracking and Behavior Change Community Communication

29 Media & CSO engagement

Media Executives and representatives of Civil Society Organizations field visit and media briefing in Katsina State

Media parley with Katsina State Government officials and WINNN representatives

30 WDCs training

• Conducted Training of trainers workshop for WDCs on community participation in Nutrition

• Stepdown training for WDCs

31 Emirate Councils

Held sensitization meetings with emirate councils

32 Engagement of Religious Leaders

• Developed IYCF Sermon Guide for Imams and preachers

• Conducted training of trainers workshop for Islamic clerics

33 Best Practices . Delivery through PHC - the deployment of Government structures as the primary means of implementation… . WINNN as a Catalytic Pilot- The WINNN model efficiently attracted funding from other donors such as CIFF and the Dangote Foundation which assisted in scaling up nutrition interventions in Northern Nigeria. . Nutrition Resourcing –Statutory budget lines established though releases remain a challenge in all the 5 WINNN implementing states. . Programme Flexibility- The review of the mode of delivering a development Nutrition programme in conflict affected areas came to fore with the December 2014 and January 2015 insurgency attacks on Yobe … . Adaptive programming - The findings of the ORIE Studies on CMAM, MNCHW and IYCF has proven essential to programme quality improvement . Government and Community Ownership- this is to ensure capacity building and sustainability Lesson’s Learnt

. Ownership and Sustainability –– The delivering of CMAM through Government owned primary health care services . . Provision of Essential Drugs - CMAM performance can be hindered by the lack of essential drugs. Specifically, the availability of routine medicines (namely antibiotics and antimalaria) which depends mostly on government’s contribution, characterized by frequent stock out remains a challenge. . Engagement of CVs- Maintaining quality and performance of CMAM and IYCF interventions is challenging in an environment with heavy dependency on CVs for the delivery of these services, due to the shortage of qualified health workers. . Nutrition as a political agenda- To ensure that nutrition is properly resourced there has been the need for sustained and systematic engagement of the political structures. . Use of Government Data –In Nigeria large discrepancies have been found between government reported data and Survey data (e.g. the MNCHW and SMART surveys) and it is essential that these are addressed so that policy makers understand what, how and where they need to respond to . Use of mobile teams- in hard to reach areas to improve coverage during MNCH weeks Challenges

• Government funding for Nutrition is grossly inadequate • Weak growth monitoring services in PHCs • Low usage of child health card • Non release of funds from the nutrion budget lines • There are still thousands of severely malnourished children in need of treatment • Community IYCF coverage is low mainly limited to WINNN supported LGAs • Lack of appropriate and simple tool for post MNCH coverage assessment • Lack of updated data on MND • Shortage of HRH and resort to working with CVs in CMAM and IYCF

36 Thank you

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