Nutrition Financing in Senegal

in Senegal Marie-Jeanne Offosse N. Marie-Jeanne Offosse Nutrition Financing Financing Nutrition

ANALYSIS & PERSPECTIVE: 15 YEARS OF EXPERIENCE IN THE DEVELOPMENT OF NUTRITION POLICY IN SENEGAL

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Nutrition Financing in Senegal

July 2018 Marie-Jeanne Offosse N.

Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal

Attribution—Please cite the work as follows: Offosse N., Marie-Jeanne. 2018. “Nutrition Financ- ing in Senegal.” Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal. World Bank, Washington, DC; CLM, Dakar, Sénégal. License: Creative Com- mons Attribution CC BY 3.0 IGO

This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, 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.

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The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202–522–2625; e-mail: [email protected]. Cover photo: Adama Cissé/CLM Cover design: The Word Express, Inc. Acknowledgments

his report was written by Marie-Jeanne Offosse N, MD, MSc with acknowledgements to Menno Mulder-Sibanda, Abdoulaye Ka and all the members of the CLM as well as all the T nutrition stakeholders in Senegal for their tremendous support and contribution throughout data collection and analysis.

Reviewers. We are grateful to all reviewers of the reports of the series—Elodie Becquey (IFPRI), Patrick Eozenou (World Bank), Dominic Haazen (World Bank), Derek Headey (IFPRI), Abdou- laye Ka (CLM), Jakub Kakietek (World Bank), Ashi Kohli Kathuria (World Bank), Christine Lao Pena (World Bank), Biram Ndiaye (UNICEF), Jumana Qamruddin (World Bank), Claudia Rokx (World Bank). They each generously dedicated their time and effort, and their invaluable input played an important role in the evolution of the series.

Partners. We would also like to give thanks to the following members of the task force of development partner organizations, who provided guidance on the conceptualization, implementation and finalization of the series: Sophie Cowpplibony (REACH), Aissatou Dioum (UNICEF), George Fom Ameh (UNICEF), Julie Desloges (Government of Canada), Aida Gadiaga (WFP), Laylee Moshiri (UNICEF), Aminata Ndiaye (Government of Canada), Marie Solange N’Dione (Indepen- dent Consultant), and Victoria Wise (REACH).

Client. Finally, our greatest appreciation is extended to the dedicated staff of the CLM, whose work is chronicled in the series, and the thousands of health workers and volunteers who are daily delivering life-saving nutrition services to vulnerable populations throughout Senegal.

This work was conducted under the guidance of Menno Mulder-Sibanda (Task Team Lead and Senior Nutrition Specialist, World Bank). The series was prepared by Andrea L. Spray (Consul- tant), Janice Meerman (Consultant), and Aline Deffry (Consultant). Aaron Buchsbaum (World Bank) led on publishing and dissemination, along Laura Figazzolo (Consultant).

Information regarding the financial support for the series is provided at the end of the report. About the Series

he government of Senegal, through the Cellule de Lutte contre la Malnutrition (Nutrition Coordination Unit) (CLM) in the Prime Minister’s Office is embarking on the development T of a new Plan Stratégique Multisectoriel de Nutrition (Multisectoral Strategic Nutrition Plan) (PSMN), which will have two broad focus areas: (1) expanding and improving nutrition services; and (2) a reform agenda for the sector. The reform agenda will include policy reorientation, governance, and financing of the PSMN. The PSMN will discuss the framework and timeline for the development of a nutrition financing strategy, which will require specific analysis of the sector spending and financial basis, linking it to the coverage and quality of nutrition services.

Senegal is known for having one of the most effective and far-reaching nutrition service delivery systems in Africa. Chronic malnutrition has dropped to less than 20 percent, one of the lowest in continental Sub-Saharan Africa. Government ownership of the nutrition program has grown from US$0.3 million a year in 2002 to US$5.7 million a year in 2015, increasing from approximately 0.02 percent to 0.12 percent of the national budget. Yet, these developments have not led to enhanced visibility of nutrition-sensitive interventions in relevant sectors such as agriculture, education, water and sanitation, social protection, and health. The absence of nutrition-sensitive interventions in the relevant sectors, combined with the recent series of external shocks, has favored continued fragmentation of approaches, discourse, and interventions that address nutrition. In addition, there is no overall framework for investment decision making around nutrition, which puts achievements made to date in jeopardy. Meanwhile, nutrition indicators are stagnat- ing and other issues with major implications (such as low birth weight, iron deficiency anemia, maternal undernutrition, and acute malnutrition) have received little or no attention.

A review of policy effectiveness can help raise the importance of these issues, including household and community resilience to food and nutrition insecurity shocks, as a new priority in nutrition policy development. This series of analytical and advisory activities, collectively entitled Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal (“the series”), aims to support the government of Senegal in providing policy and strategic leadership for nutrition. Further, the series will inform an investment case for nutrition (The Case for Investment in Nutrition in Senegal) that will: (1) rationalize the use of resources for cost-effective interventions; (2) mobilize actors and resources; (3) strengthen the visibility of nutrition interventions in different sectors; and (4) favor synergy of interventions and investments.

The series was produced with guidance from a task force of development partner organizations under the leadership of the World Bank, and in close collaboration with the CLM. The task force comprised representatives from the following organizations: Government of Canada, REACH, UNICEF and the World Bank. Documents in the series:

Report Description Nutrition Situation in Senegal An analysis of the nutritional status of key demographic groups Marc Nene in Senegal, including the geographic and sociodemographic inequalities in nutrition outcomes and their determinants. Evolution of Nutrition Policy in An historical analysis of the nutrition policy landscape in Senegal, Senegal including the evolution of nutrition policies and institutions and Andrea L. Spray their respective implications for programming and prioritization of interventions. Political Economy of Nutrition An analysis of the policy and political levers that can be used Policy in Senegal in Senegal to foster government leadership and galvanize the Ashley M. Fox intersectoral coordination needed to mainstream nutrition into government policies and programs, and effectively, efficiently, and sustainably deliver nutrition interventions. Nutrition Financing in Senegal An analysis of the allocated funding to nutrition interventions in Marie-Jeanne Offosse N. Senegal from 2016 to 2019, estimates of budgetary capacity for financing nutrition by government, and estimated costs for selected high-impact interventions. Capacities of the Nutrition An analysis of the organizational and institutional capacities for Sector in Senegal addressing nutrition in Senegal, covering the CLM, key ministries, Gabriel Deussom N., Victoria and other stakeholders contributing to improvements in nutrition at Wise, Marie Solange Ndione, the central, regional, and local levels. Aida Gadiaga Cost and Benefits of Scaling Analysis of the relative costs and effectiveness of alternative Up Nutrition Interventions in scenarios for scaling up nutrition interventions in Senegal over the Senegal five years covering the PSMN. Christian Yao Risks for Scaling Up Nutrition Analysis of the potential risks to the scale-up of nutrition in in Senegal Senegal, their likelihood of occurrence, potential impact, and Babacar Ba potential mitigation measures. A Decade of World Bank The World Bank Independent Evaluation Group Project Support to Senegal’s Nutrition Performance Assessment Report, which evaluates the extent to Program which World Bank operations supporting nutrition in Senegal from Denise Vaillancourt 2002–14 achieved their intended outcomes and draws lessons to inform future investments. Acronyms

Acronym English Acronyme Français AACID Agencia Andaluza de AACID Agencia Andaluza de Cooperación Internacional Cooperación Internacional para el Desarrollo / para el Desarrollo / Agence Andalusian Agency for andalouse de coopération International Development internationale pour le Cooperation développement ACF Action Against Hunger ACF Action Contre la Faim ADF African Development Fund FAD Fonds africain de développement AECID Spanish Agency for AECID Agence Espagnole pour la International Cooperation and Coopération Internationale et Development le Développement AFD French Development Agency AFD Agence Française de Développement ARC Community Relay Agent ARC Agent Relais Communautaire ARI Acute Respiratory Infection IRA Infection Respiratoire Aigüe BCC Behavior Change CCC Communication de Communication Changement de Comportement BCEAO Central Bank of West African BCEAO Banque Centrale des États de States l’Afrique de l’Ouest CDD District Development CDD Comité Départemental de Committee Développement CEGEP General and Professional CEGEP Collège d’Enseignement Education Middle School Général et Professionnel CFA Financial Community of Africa CFA Communauté Financière d’Afrique CL Local Government CL Collectivités Locales CLM Nutrition Coordination Unit CLM Cellule de Lutte contre la Malnutrition CLP Local Steering Committee CLP Comité Local de Pilotage CLTS Community Led Total ATPC Assainissement total piloté Sanitation par la communauté ECHO European Commission—Civil ECHO Direction Générale pour Protection & Humanitarian la Protection Civile et Aid Operations les Opérations d’Aide Humanitaire Européennes de la Commission européenne Acronym English Acronyme Français EU/ EDF European Union / European UE/ EDF Union Européenne / Fonds Development Fund Européen de Développement EVE Water – Life – Environment EVE Eau – Vie – Environnement FAO Food and Agricultural FAO Organisation des Nations Organization of the United Unies pour l’Alimentation et Nations l’Agriculture GAIN Global Alliance for Improved GAIN Alliance mondiale pour Nutrition l’amélioration de la nutrition GAVI Global Alliance for Vaccines GAVI Alliance mondiale pour les and Immunization vaccins et la vaccination GDP Gross Domestic Product PIB Produit Intérieur Brut GFF Global Financing Facility GFF Mécanisme de financement global GMP Growth Monitoring and SPC Suivi et Promotion de la Promotion Croissance HKI Helen Keller International HKI Helen Keller International ICCO Interchurch organization for ICCO Organisation inter-églises development cooperation pour la coopération au développement IFAD International Fund for FIDA Fonds international de Agricultural Development développement agricole IFRC International Federation of FICR Fédération internationale des Red Cross and Red Crescent sociétés de la Croix-Rouge et Societies du Croissant-Rouge IGA Income Generating Activity AGR Activités Génératrices de Revenus IIRPA International Institute for IIRPA Institut International de Research on Food Policies Recherche sur les Politiques Alimentaires IMCI Integrated Management of PCIME Prise en Charge Intégrée des Childhood Illness Maladies de l’Enfant IYCF Infant and Young Child ANJE Alimentation du Nourrisson et Feeding du Jeune Enfant MI Micronutrient Initiative MI Initiative pour les micronutriments NCBA National Cooperative NCBA Association nationale des Business Association CLUSA entreprises coopératives International CLUSA International NGO Nongovernmental ONG Organisation Organization Non-Gouvernementale NVF Dutch Society for NVF Société néerlandaise de Phytotherapy phytothérapie Acronym English Acronyme Français OECD/DAC Organization for Economic OCDE/CAD Organisation de Coopération Co-operation and et de Développement Development / Development Économiques / Comité d’Aide Assistance Committee au Développement OPEC Organization of Petroleum OPEP Organisation des pays Exporting Countries exportateurs de pétrole P2RS Multinational Programme P2RS Programme Multilatéral for Food and Nutritional de Renforcement de la Resilience Building in the Résilience à l’Insécurité Sahel Alimentaire et Nutritionnelle au Sahel PABRA Pan-Africa Bean Research PABRA Alliance Africaine pour la Alliance recherché sur le haricot PAFA Agricultural Sector Support PAFA Projet d’Appui aux Filières Project Agricoles PASAV Food Security Support for PASAV Project d’Appui à la Sécurité Vulnerable Households Alimentaire des Ménages Project Vulnérables PECMA Management of Acute PECMA Prise en Charge de la Malnutrition Malnutrition Aigüe PECMAS Management of Severe Acute PECMAS Prise en charge de la Malnutrition malnutrition aigüe sévère PERSA Projet Pilote de Promotion PERSA Projet Pilote de Promotion des Énergies Renouvelables des Énergies Renouvelables pour la Sécurisation pour la Sécurisation Alimentaire Alimentaire PFSN Health and Nutrition Project PFSN Projet Financement Santé Financing Nutrition PIARAN Integrated Food and Nutrition PIARAN Projet Intégré d’Appui à la Resilience Support Project Résilience Alimentaire et Nutritionnelle PINKK Integrated Nutrition Project in PINKK Integrated Nutrition Project in Kolda and Kédougou Regions Kolda and Kédougou Regions PLDM Project to Fight Malnutrition PLDM Projet de Lutte contre Determinants les Determinants de la Malnutrition PMA2 Multi-Actors Program 2 PMA2 Programme Multi-Acteurs 2 PMRCA World Food Crisis Response PMRCA Programme Mondial de Program Réponse à la Crise Alimentaire PMTCT Prevention of mother-to-child PTME Prévention de la transmission transmission (HIV) mère-enfant du VIH PNDN National Policy for the PNDN Politique Nationale de Development of Nutrition Développement de la Nutrition Acronym English Acronyme Français PRAO Regional Program for Support PRAO Programme Régional d’Appui to Artisanal Fisheries in West à la Pêche Artisanale en Africa Afrique Occidentale PRF Program for the Enhanced PRF Programme de Renforcement Food Fortification in Senegal de la Fortification au Sénégal PSMN Multisectoral Strategic PSMN Plan Stratégique Nutrition Plan Multisectoriel de la Nutrition PTIP Three-Year Public Investment PTIP Programme Triennal Programme d’Investissements Publics RBF Results-Based Financing FBR Financement Basé sur les Résultats REACH Renewed Efforts Against REACH Efforts renouvelés contre la Child Hunger and faim et la sous-alimentation undernutrition chez les enfants SADMAD Sustainable food system and SADMAD Système Alimentaire Durable fight against malnutrition in et lutte contre la Malnutrition the Dakar region en Région de Dakar SAM Severe Acute Malnutrition MAS Malnutrition Aigüe Sévère SUN Scaling Up Nutrition SUN Mouvement pour le Renforcement de la Nutrition UEMOA West African Economic and UEMOA Union Économique et Monetary Union Monétaire Ouest-Africaine UNICEF United Nations Children’s UNICEF Fonds des Nations Unies pour Fund l’Enfance USAID United States Agency for USAID Agence Améraiciane pour le International Development Développement International USD United States dollar USD Dollar américain USE Solidarity and Mutual Aid USE Union pour la Solidarite et Association l’Entraide USI Universal Iodization of Salt IUS Iodation Universelle du Sel WADB West African Development BOAD Banque Ouest-Africaine de Bank Développement WAAPP West Africa Agricultural PPAAO Programme de Productivité Productivity Program. Agricole en Afrique de l’Ouest WASH Water, Sanitation and Hygiene WASH Eau hygiène assainissement WFP World Food Programme PAM Programme Alimentaire Mondial WHO World Health Organization OMS Organisation Mondiale de la Santé WB World Bank BM Banque Mondiale Unless otherwise indicated, child nutrition indicators referenced in this report are taken from the UNICEF-WHO-World Bank Joint Child Malnutrition Estimates.1 All monetary amounts are U.S. dollars unless otherwise indicated.

Contents

Acknowledgments iii

Executive Summary 1

Introduction 5

Objectives and Methodology 7

Results 11

Appendix A: Nutrition Expenditures by Intervention and Sources of Financing 21

Appendix B: Nutrition Expenditure by Intervention and Financing Agent/ Organization 25

Appendix C: Nutrition-Related Expenditures by Intervention and Implementing Organization 29

Appendix D: Budgetary Resources for Nutrition by Project, 2016–20 33

Appendix E: Costing a Nutrition Cash Transfer Programme Without Conditionalities 43

Appendix F: Costing a Nutrition Monetary Transfer Programme With Conditionality 45

Appendix G: Costing a Community Based Nutrition Promotion Programme 47

Appendix H: Costing a Community Based Management of Acute Malnutrition Programme 51

Endnotes 55

References 57

List of Figures Figure 1: Distribution of Nutrition Expenditures by Intervention Category, 2012–15 12 Figure 2: Major Funding Sources for Nutrition-Specific Interventions and Governance (2012–15) 13 Figure 3: Financing Management Mechanisms for Nutrition 14 Figure 4: Funding Management Mechanisms Disaggregated by Intervention Category (2012–15) 15 Figure 5: Distribution of Funding for Nutrition-Specific Interventions by Public Sector Entity (percent) 16 Figure 6: Distribution of Projected Expenditures by Financing Agent, 2016–20 17 List of Tables Table 1: Nutrition Interventions Included in the Analysis 8 Table 2: Expenditures on Nutrition in Senegal 12 Table 3: Distribution of Nutrition Expenditures by Category of Nutrition-Related Intervention 2012–2015 13 Table 4: Distribution of Funding for Nutrition-Specific Interventions by Public Sector Entity (CFA francs) 16 Table 5: Nutrition Expenditures in Senegal by Major Management Bodies and Funders, 2012–15 17 Table 6: Potential Refinements of Existing Projects to Improve Nutritional Status 18 Executive Summary

xii Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Executive Summary

his report identifies and analyzes actual and po- ®® Nutrition interventions related to food security (such tential sources of financing for implementation as micro-production and food processing) T of the Plan Stratégique Multisectoriel de Nutri- ®® Social protection linked to nutrition tion (Multisectoral Strategic Nutrition Plan) (PSMN). ®® WASH (promotion of appropriate community-based technologies) Its primary objectives were to: ®® Nutrition-related health interventions ®® Nutrition governance (coordination, research, ad- ®® define an operating framework for monitoring nutri- vocacy and mobilization of resources for nutrition). tion expenditures ®® estimate the level of financial resources allocated Financing and Management of to nutrition interventions Nutrition-related Resources ®® analyze financial flows for nutrition interventions ®® estimate budgetary resources for financing nutri- As of 2016, 88 percent of financing for nutrition ex- tion interventions by the government penditures in Senegal was estimated to come from ®® estimate the cost of nutrition-specific interventions; external sources. Development aid through bilateral nutrition-sensitive interventions; and interventions cooperation agreements provided 15 billion FCFA, 56 related to nutrition governance percent of the external resources used to finance nutrition interventions. The report was informed by secondary data as well as information from questionnaires and stakeholder inter- Although the government’s contribution was estimated views. It considers the following intervention categories: to be 12 percent of overall nutrition expenditures, when the parameters were narrowed to focus exclusively ®® Community Nutrition Interventions on nutrition-specific expenditures and nutrition gover- ®® Micronutrient supplementation and fortification of nance, the statistic increases to 23 percent. Funding staple foods (for the prevention of micronutrient from external sources for nutrition-specific interventions deficiencies) and sector governance was an estimated 77 percent.

Nutrition Financing in Senegal 1 Expenditures for nutrition interventions were man- Resources for these five nutrition intervention cat- aged by public administrative entities (42 percent), egories were estimated at about 87 billion FCFA multilateral cooperation agencies (39 percent) and during the period in question. This is almost equal nongovernmental organizations (NGOs) (10 percent). to the total expenditures incurred for the same in- Notably, bilateral cooperation, although the main terventions during the four-year period from 2012 source of financing, ranked fourth in direct manage- through 2015. ment of the funding allocated to nutrition. This reflects the existence of good technical leadership of the State With respect to future projections, funding for com- and its structures. munity nutrition interventions and governance was expected to vary little, while funding allocated to mi- Analysis by type of intervention revealed a different cronutrient supplementation and fortification of staple distribution of funding management. Sixty-four percent foods was predicted to triple due to implementation of of resources used for food security interventions were new projects. managed by international agencies (multi- and bilateral cooperation agencies and international NGOs). Because support for food security generally comes Increasing Budgetary Resources during a crisis or an emergency, the resources allocated to it are managed directly by the World Food Three options for increasing budgetary resources were Programme and other nongovernmental actors, which identified: (1) establishment of new nutrition projects; have mechanisms for quick action. (2) increasing funding for existing projects or projects being finalized; and (3) upgrading and initiating nutri- Funding for community nutrition interventions was divid- tion-sensitive interventions in projects and programs ed almost equally between external entities (52 percent) implemented in sectors such as agriculture, fisher- and public administrative bodies (46 percent), with the ies, livestock, and research and education. There is Cellule de Lutte contre la Malnutrition (Nutrition Coordi- enormous potential within these sectors for increased nation Unit) (CLM) playing a key management role. integration of nutrition-sensitive interventions into current and future projects.

Estimate of Budgetary Resources Additional considerations regarding budgetary resources for nutrition are as follows: The report provides provisional budget information for the following nutrition intervention categories for the ®® The completion of the PSMN costing exercise period 2016–19. will provide more information on funding that is potentially available for both nutrition-specific ®® Community Nutrition Interventions and nutrition-sensitive interventions. Moreover, ®® Micronutrient supplementation and fortification of participants were made aware of the activities staple foods carried out within their respective sectors that are ®® Prise en Charge de la Malnutrition Aigüe Sévère directly related to the objectives of the nutrition (Management of Severe Acute Malnutrition) (PEC- policy; which should enable them to identify the MA) in hospitals funding available for nutrition in their respective ®® Nutrition interventions related to food security sectors. ®® Governance ®® Senegal’s eligibility for the World Bank’s Global Fi- nancing Facility (GFF) is likely to result in increased Financing forecasts were based on projects that were pooled donor funding for public sector management active or being initiated between 2014 and 2019. activities, including nutrition.

2 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Unit Costs of Nutrition Interventions tions, which generally target food intake and include nutrition objectives). As part of the analysis, average unit costs of key nutrition interventions were estimated. These unit costs Total expenditures on nutrition in Senegal were can be used both for the budgeting of sectoral opera- estimated at just over 112 billion FCFA for the pe- tional plans and for the conduct of economic analysis. riod 2012–15. This equals approximately annual expenditures of roughly 29 billion FCFA, except for a Annual unit costs per beneficiary were estimated as 20 percent drop in 2014, followed by an increase of follows: the same amount in 2015, possibly attributable to the government’s dialogue with key nutrition stakeholders ®® Cash transfer without conditionalities: 47,113 FCFA to finance the 2014 Food Insecurity Response Plan. ®® Cash transfer with conditionalities: 36,690 FCFA ®® Community nutrition activities: 3,560 FCFA Annual expenditures on nutrition were estimated at about ®® Community screening and Prise en Charge de la $4 per capita (2,073 FCFA), of which approximately: Malnutrition Aigüe (Management of Acute Malnutri- tion Protocol) (PECMA): 32,230 FCFA ®® 34 percent was for nutritional interventions related to food security, In the life cycle of projects, capacity-building, advo- ®® 31 percent was for nutrition-related health cacy and awareness-raising expenditures generally interventions, decrease over time. As a result, the annual costs per ®® 22 percent was for community nutrition interventions, beneficiary vary depending on whether the project is ®® 5 percent was for nutrition governance, newly initiated or routine. While the estimates listed im- ®® 4 percent was for the prevention of micronutrient mediately above assume a newly initiated project, the deficiencies, main report provides additional estimates on unit costs ®® 1 percent was for WASH, and that have been reduced due to routine implementation. ®® 1 percent was for social protection lined to nutrition

The remaining 2 percent of nutrition expenditures target- Structure of Nutrition Expenditures ed several or all of the above classification categories.

Between 2010 and 2016, there were just over 60 Analysis by category of nutrition intervention reveals that projects dedicated partially or entirely to nutrition inter- over the period 2012–15, 58 percent of total expenditure vention in Senegal. Fifty-six were implemented between on nutrition sensitive interventions was allocated to ac- 2010 and 2014. tivities associated with food security. Total expenditure on nutrition-specific interventions was approximately 39 Approximately 42 nutrition projects are being imple- billion FCFA; with approximately 62 percent allocated to mented between 2016 and 2019, including 4 new community nutrition interventions, 25 percent to PECMA projects launched between 2015 and 2016. (Note that by the health system, and 13 percent for micronutrient this projection does not include humanitarian interven- supplementation and fortification of staple foods.

Nutrition Financing in Senegal 3 4 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal 1 Introduction

Context of the Study and low birthweight, iron-deficiency anemia, adoles- cent undernutrition, and maternal undernutrition have Senegal is known for having one of the most effective received little attention. These shortcomings threaten and far-reaching nutrition service delivery systems in the achievements of recent decades. Africa. Government commitment to improving the nutritional status of the population has increased over Recognizing this challenge, the government of Sen- time and has been marked, among other things, by egal joined the Mouvement pour le Renforcement de the creation in 2001 of the CLM and its Bureau Ex- la Nutrition (Scaling Up Nutrition) SUN Movement in écutif National (National Executive Bureau) (BEN); an 2011 and adopted the United Nations Approach to increase in annual budget allocations to nutrition (from Renewed Efforts Against Child Hunger and Under- $0.3 million in 2002 to $5.7 million in 2015); and inten- nutrition (REACH) in 2014. These initiatives aim to sification of community-based nutrition interventions. strengthen institutional capacity and facilitate a mul- These commitments are reflected in the improvement tisectoral process to help governments plan, prioritize of nutrition indicators, notably a 46 percent reduction and more efficiently manage nutrition actions involv- in under-five stunting from 1992 to 2014. ing multiple stakeholders. With respect to national policy, the government of Senegal has adopted the Unfortunately, these improvements have not led to Politique Nationale de Développement de la Nutri- greater visibility of nutrition sensitive interventions in rel- tion (National Policy for the Development of Nutrition) evant sectors such as agriculture, livestock, education, (PNDN)2 covering the period 2015 to 2025, which will social protection and health. This shortfall, combined be operationalized through a multisectoral nutrition with a recent series of exogenous shocks, has led to strategy, outlined in the Plan Stratégique Multisecto- recurrent fragmentation of nutrition approaches, par- riel de la Nutrition (Multisectoral Nutrition Strategic adigms and interventions, resulting in the absence of Plan) (PSNM). These policies aim to expand coverage a general framework that provides guidance on both and improve the quality of nutrition services in sectors nutrition-specific and nutrition-sensitive investments. whose functional prerogatives affect the prevention Meanwhile, progress in reducing stunting has slowed, and management of malnutrition.

Nutrition Financing in Senegal 5 Against this background, a set of analytical and advi- sector performance and for making recommendations sory activities was undertaken by the World Bank in to improve the technical relevance and allocative effi- consultation with the United Nations Children’s Fund ciency of expenditures stipulated by the PSNM. Beyond (UNICEF), REACH, the government of Canada, the declarations of good intentions, funding for nutrition European Union, and the United States Agency for interventions must be reflected in the budget lines of International Development (USAID) to support the all sectors relevant to the fight against malnutrition in government of Senegal through a series of studies Senegal. The information on unit costs and other data aimed at (1) rationalizing the use of resources for provided in this analysis should be used as a tool to cost-effective interventions; (2) mobilizing actors and facilitate precisely this type of participatory budgeting.3 resources; (3) increasing visibility of nutrition interventions in different sectors; and (4) strengthening The analysis aimed to provide answers to the follow- synergies between interventions and investments. ing questions:

®® What is the government’s contribution and what pro- Rationale for the Study portion of total nutrition funding is it responsible for? ®® Where do funds allocated by financial partners go? Given the gradual reduction of international aid, and with ®® Who manages funds mobilized for nutrition? a view to capitalizing on the achievements of previous ®® What potential funding might be available in the interventions and extending them to all target groups, near future? this financial analysis constitutes an important contribution to the set of analytic and advisory activities cited Eight annexes provide details on these and related above. It provides information for assessing nutrition findings discussed in the body of the report.

6 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal 2 Objectives and Methodology

Objectives Nutrition is a multisectoral field that involves health sector interventions; agriculture; WASH; social Multisectorality in the fight against malnutrition encom- protection; and education. However, not all the ex- passes the implementation and financing of nutrition penditures incurred in these sectors are nutrition 4 interventions by all sectors whose administrative or expenditures. functional prerogatives have an impact on the prevention and management of malnutrition. Beyond This estimate of fiscal resources for nutrition includes statements of good intentions, funding for nutrition funding only by government and key donors active in interventions must be reflected in the budgets of all financing nutrition in Senegal. sectors concerned with the fight against malnutrition. This report, which comprises findings from an analysis of nutrition financing, aims to contribute to participato- Methodology ry and realistic budgeting of the PSMN. Interventions The primary objectives of the analysis were to: The analysis focused on interventions whose main ®® Define an operating framework for monitoring nutri- purpose is to restore, improve, and maintain the nu- tion expenditures tritional status of the population or a specific group of ®® Estimate the level of financial resources allocated people and which can be influenced by policy makers. to nutrition interventions As shown in table 1, the analysis used a functional ®® Analyze financial flows for nutrition interventions delimitation based on seven intervention categories. ®® Estimate budgetary resources for financing nutri- Nutrition-specific interventions; nutrition-sensitive tion interventions by the government interventions; and interventions related to nutrition ®® Estimate the unit cost of selected interventions governance were all included.5

Nutrition Financing in Senegal 7 TABLE 1: Nutrition Interventions Included in the Analysis

Category Interventions Community Nutrition • Integrated management of community-based acute malnutrition Interventions • Monitoring and promotion of growth (including related community initiatives) • Integrated management of community-based childhood illnesses • Nutrition Education Program • Promoting key behaviors conducive to good nutrition Micronutrient • Supplementation of children from birth to 59 months supplementation and • Supplementation of pregnant and lactating women with iron, folic acid, and calcium fortification of staple foods • Home and small-scale fortification • Industrial fortification (including compliance interventions) • Iodization of salt (including interventions to monitor compliance with standards). Nutrition interventions related • Development of family farming to food security • Promotion of market gardening perimeters • Biofortification for food crops • Promotion of local production • Introduction and promotion of high nutritional value crops Social protection • Social safety net programs for vulnerable groups • Income generation through microprojects for healthy and balanced nutrition • Functional literacy program focused on nutrition WASH (promotion of • Promotion of hand washing with soap appropriate community- • Assainissement Total Piloté par la Communauté (Community Led Total Sanitation) (CLTS) based technologies) • Promotion of the use of latrines • Treatment of drinking water at the household level Nutrition-related health • Management of diarrhea interventions • Acute Respiratory Infection (ARI) management • Reproductive health program • Deworming of children and pregnant women • Follow-up of pregnancy • Disease prevention through vaccinations • Prevention of mother-to-child transmission (PMTCT) • Management of Severe Acute Malnutrition (SAM) with and without complications Governance • Monitoring and evaluation • Operational research • Horizontal and vertical coordination • Development of policy and strategic documents • Legislation • Advocacy • Resource mobilization

It should be noted that this is not a standardized opera- ®® On-site intervention tional framework at the international level, but rather is ®® Project and program management based on a mapping of nutrition interventions in Sene- ®® Monitoring, evaluation, and supervision of activities gal conducted in 2015 by the CLM. It was then revised ®® Training and capacity building and validated by the CLM; REACH, and the World Bank. ®® Coordination and advocacy

Time span and type of expenditures Investment expenditures:

The analysis included expenditures incurred between ®® Anthropometric equipment 2010 and 2015, as follows: ®® Construction and rehabilitation of Centers of Re- covery and Nutritional Education, Recovery and Current expenditures: Nutritional Education Units, and Oral Rehydration

8 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Units–Centers of Recovery and Nutritional stakeholders in Senegal. As such they also informed Education the selection process of which organizations and entities to contact for data on nutrition expenditures.7 The analysis also considered official commitments6 from the government; donors; local government re- Data on nutrition expenditures sources; NGOs; and private companies for the period from 2016 through 2020. Data were collected from public administrative entities, NGOs, and donors and reported on the implemen- The analysis included only those resources intended tation of project budgets and nutrition programs for exclusively for interventions with a demonstrated impact 2010–15, on budgeted work plans for nutrition proj- on nutritional status; expenses incurred for cross-cut- ects, and on projections for future funding. In cases ting interventions and those for which direct impact on where information was not available in published nutrition could not be demonstrated were excluded. For reports, a questionnaire was used that asked about example, staff salaries in hospitals or health centers expenditures made and funds transferred to other without therapeutic nutrition units were not counted. organizations for the implementation of nutrition interventions from 2010 through 2015, as well as projected Document review and interviews with key financial commitments and forecasts for the period informants from 2016 through 2020.

Data collection was conducted via a series of interviews Data were organized according to: with representatives from the Ministries of Agriculture and Rural Equipment; Fisheries; Livestock and Animal ®® Year of expenditure Husbandry; Health and Social Affairs; and Education. ®® Name of project or program These interviews provided information regarding the ®® Source of financing various ministries’ involvement in nutrition, including ®® Implementing agency or agencies mechanisms used in relevant sectors to implement in- ®® Geographical location terventions with a direct impact on nutritional status. ®® Type of nutrition intervention (based on the seven categories listed in table 1) Interviews were also held with the Ministry of Econo- ®® Nature of expenditure my, Finance, and Planning, and with local authorities ®® Amount of expenditure in the community of Keur Moussa to inquire about funding mechanisms for nutrition interventions by CLs and other local-level change agents. Data were consolidated in a spreadsheet (appendix A) and converted where necessary into CFA francs using In tandem with these informant interviews, a literature exchange rates for the period 2010–15, as published review examined potential mechanisms for collabo- on the website of the Central Bank of West African ration between public and private actors in the fight States (BCEAO). against malnutrition in Senegal. The review focused on (1) the mapping of nutrition stakeholders in Sen- The estimate of fiscal resources for the period 2016–20 egal; and (2) projects in the health, agriculture, water was made using exchange rates for 2015. and sanitation, social protection, and education sectors and related to humanitarian aid. Because data collection was carried out in most cases both for the source of funding and for the Both the literature review and the informant interviews implementing agency, the data were triangulated contributed to the identification of important nutrition (by comparison and selection of the information re-

Nutrition Financing in Senegal 9 ceived) to avoid duplication of information, and to The final database was used for the following analyses: maximize accuracy. Respondents were contacted for clarification whenever there was a difference of over ®® Production of aggregates 2 percent between data from several sources on a ®® Production of indicators given intervention. ®® Unit cost estimates

10 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal 3 Results

Analysis of Financial Flows As in Côte d’Ivoire, Madagascar, and Tanzania, Sen- egal’s total expenditure on nutrition accounts for less General aggregates than one percent of gross domestic product (GDP). However, the efficiency with which funds are used in Total expenditure on nutrition8 in Senegal is estimat- Senegal is unusually high; Senegal has had better ed to have been about 113 billion FCFA for the period results than most countries of Sub-Saharan Africa in 2012–15. Funding remained more or less constant improving the nutritional status of the population. throughout the period, with the exception of an approximately 20 percent decline in 2014, followed by a Where do the mobilized resources go? relative increase in 2015. The latter is likely explained by increased government commitment to fighting Between 2012 and 2015, 34 percent of resources malnutrition and improving food security, galvanized mobilized for nutrition in Senegal were allocated to by rainfall deficits and compromised agricultural nutrition interventions related to food security (not in- production. cluding distribution of food to the general population). And although funding allocated to nutrition-related food Annual expenditures on nutrition in Senegal over the security interventions declined slightly after 2012 from period 2012–15 averaged 29 billion FCFA, equal to an 13 billion FCFA to an average value of 10 billion FCFA average per capita expenditure of $4 per year (table between 2013 and 2015, it remained the most funded 2). It should be noted, however, that about 58 percent intervention category during this time period (figure 1). of expenditures were incurred for nutrition-sensitive interventions, which usually have higher unit costs The second most funded category between 2012 than nutrition-specific interventions. Estimated annual and 2015 was nutrition-related health interventions. expenditures for nutrition-specific interventions were Total expenditures on these was estimated at about 9 only about 10 billion FCFA, equal to an average annu- 31 percent of total nutrition expenditures (figure 1). al per capita expenditure of $1.30. In addition to PECMAS, health-related expenditures

Nutrition Financing in Senegal 11 TABLE 2: Expenditures on Nutrition in Senegal

Expenditure 2012 2013 2014 2015 Total expenditures on nutrition (million FCFA) 28,564 32,039 26,036 25,918 Annual nutrition expenditure per capita (FCFA) 2,073 2,253 1,774 1,715 Annual nutrition expenditure per capita ($) 4 5 4 3 Total expenditures on nutrition as a percent of GDP) 0.4% 0.4% 0.3% 0.2% Nutrition-specific expenditures (million FCFA) 7,034 12,650 9,050 9,978 Nutrition-sensitive expenditures (million FCFA) 20,062 17,971 14,872 12,909 Governance expenditures (million FCFA) 1,468 1,418 1,440 1,346 Cross-sectional expendituresa (million FCFA) 0 0 673 1,685 Note: GDP= gross domestic product. a Cross-sectional expenditures are those that respondents could not attribute to one of the categories of analysis defined in this study. Some sectors use a classification system for the monitoring of their expenses that does not easily dovetail with the classification system for expenses used here.

include mitigation of the underlying causes of malnu- Promotion (GMP), and education in good nutrition trition including promotion of appropriate birth spacing, practices. and prevention and treatment of infectious and para- sitic diseases in children from birth to 48 months. Governance, which encompasses a variety of interventions ranging from research to coordination to Community nutrition interventions constituted the third advocacy, ranked fourth in nutrition spending in Sene- most funded intervention category of nutrition ex- gal at 5 percent of total expenditures between 2012 and penditures in Senegal during the period in question, 2015; just over 5.5 billion FCFA (table 3). Notably, how- accounting for 22 percent of total nutrition expendi- ever, funding for governance interventions decreased tures between 2012 and 2015 (figure 1); approximately during this period. In the absence of data on the cor- 24 billion FCFA (table 3). This intervention category relation between governance funding and improvement includes all interventions related to the screening and of nutritional status, it is difficult to conclude that the management of malnutrition, Growth Monitoring and current stagnation of nutrition indicators in Senegal is

FIGURE 1: Distribution of Nutrition Expenditures by Intervention Category, 2012–15

Water and sanitation 1% Nutritional interventions related to food security Governance 34% 5%

Community nutrition interventions 22%

Social protection linked to nutrition 1% Nutrition-related health interventions 31% Multiple 2% Prevention of micronutrient deficiencies (micronutrient supplementation and fortification of staple foods) 4%

12 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal TABLE 3: Distribution of Nutrition Expenditures by Category of Nutrition-Related Intervention 2012–2015

Category of nutrition-related intervention Amount (FCFA)a Nutrition-specific interventions 38,710,740,419 Community nutrition interventions 24,047,609,113 PECMAS in hospital/health interventions related to nutrition 9,823,683,119 Supplementation and fortification of staple foods 4,839,448,187 Nutrition-sensitive interventions 65,814,005,392 Other health interventions related to nutrition 25,147,553,056 Social protection linked to nutrition 1,039,304,153 Nutritional interventions related to food Security 38,442,459,396 WASH 1,184,688,787 Governance 5,673,958,587 Cross-sectional interventions 2,358,164,674 Total 112,556,869,073 a Figures were based on the current value of the funding allocated at the time the first draft of this report was written (2016), with foreign currencies converted to FCFA using the exchange rate history published on the BCEAO website. attributable to this decline. It would be useful to conduct Who finances nutrition in Senegal? a comparative analysis of the distribution of governance spending in countries with better performance Between 2012 and 2015, approximately 88 percent of in improving nutritional status. Such an analysis would financing for nutrition expenditures in Senegal came identify key governance interventions that might, with from external sources, constituting about 2 percent of more funding, help lift Senegal out of stagnation. total development assistance.10

Micronutrient supplementation and fortification of sta- Development aid through bilateral cooperation agree- ple foods ranked fifth, at 4 percent of total nutrition ments provided 16 billion FCFA (figure 2), approximately expenditures (figure1), or 4.8 billion FCFA (table 3). 56 percent of the total external resources provided to Funding for this intervention category fluctuates widely. finance nutrition interventions. The government of

FIGURE 2: Major Funding Sources for Nutrition-Specific Interventions and Governance (2012–15)

18,000,000,000 16,000,000,000 14,000,000,000 12,000,000,000 10,000,000,000 8,000,000,000 6,000,000,000 CFA francs (billions) 4,000,000,000 2,000,000,000 0 Bilateral Multilateral International foundations Government cooperation cooperation and initiatives

Prevention of micronutrient deficiencies Community nutrition interventions Governance

Nutrition Financing in Senegal 13 Canada contributed 74 percent of this type of external and oral rehydration therapy for treatment of diar- assistance during this period, with funds allocated to rhea in children under five) nutrition-related interventions linked to food security (75 percent), community nutrition interventions (15 per- Local authorities play a critical role in the implementation cent), health interventions related to nutrition (5 percent) of projects and programs at the local level. But because and micronutrient supplementation (5 percent). local government budgets do not include a budget line for the support of actions and activities to combat malnu- Multilateral cooperation represented the second larg- trition, and because in many cases the contributions are est source of funds at slightly more than 10 billion not recorded as nutrition interventions in accounting re- FCFA (figure 2), constituting 25 percent of total funds. cords, it has been difficult to identify explicit expenditure Major contributors within this category included ECHO amounts. As such, while important from a community (25 percent of multilateral funds), UNICEF, (19 per- mobilization perspective, the expenditures of local au- cent), the European Union (17 percent), and the World thorities were not included in this analysis. Bank (16 percent). Notably, nutrition-based expenditures from multilaterals are increasing, while those What are the nutrition financing management from bilaterals are on the decline. mechanisms?

International foundations and initiatives were the Expenditures for nutrition interventions are managed third-highest external funding source at just over by “financing agents”. These are public administrative 4 billion FCFA (figure 2), representing 13 percent entities or international cooperation agencies which of external contributions to nutrition expenditures. act as intermediaries, transferring funds between do- The Global Alliance for Vaccines and Immunization nors and the organizations that implement nutrition (GAVI) was the largest contributor within this category interventions. As shown in figure 3, public administra- (58 percent), followed by the Global Alliance for Im- tive entities were the principal type of financing agent proved Nutrition (GAIN) (40 percent). (42 percent), followed closely by multilateral cooperation (39 percent) and international NGOs (10 percent). With respect to domestically-based financing, the gov- Bilateral cooperation, although the main source of fi- ernment’s contribution constituted 12 percent of the intervention categories cited above, but—notably— increased to 23 percent when the analysis was FIGURE 3: Financing Management Mechanisms for narrowed to nutrition-specific expenditures and nutri- Nutrition tion governance. Nutrition financing by the government National NGOs as a percentage of total annual government spending International 2% was 2 percent from 2012 to 2015. NGOs 10% Public administrative Although not quantified or valued in this study, house- entities holds contribute to national expenditures on nutrition 42% in a variety of ways. For example, as a result of:

®® Community-based health and nutrition education and cooking demonstrations Multilateral cooperation ®® Health and nutrition education and cooking demon- 39% strations in nutrition rehabilitation centers ®® Nutrition-related health expenditures, (such as iron Bilateral cooperation and folic acid supplements for pregnant women, 7%

14 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal nancing for nutrition in Senegal, ranked fourth in direct by multilateral cooperation agencies and interna- management of funds. tional NGOs, notably UNICEF (26 percent) and the Micronutrient Initiative (MI) (30 percent). Management of all funding allocated to nutrition from ®® Management of funding for community nutri- 2012 to 2015 was shared by external entities (56 per- tion interventions was shared by external entities cent) and public administrative entities (42 percent). (52 percent; primarily multilaterals) and public ad- However, a more in-depth analysis of the manage- ministrative entities (46 percent). ment mechanisms by intervention category (figure 4) gives a different picture: In general, the public sector, main actor in the implementation of nutrition interventions in Senegal, ®® Eighty-seven percent of funding for governance in- manages less than half of the funding allocated to the terventions was managed by public administrative sector (figure 3). entities. The remaining funding was managed by multi- and bilateral cooperation agencies, including Multisectorality and nutrition financing REACH (10 percent). management ®® Seventy percent of funding for nutrition-linked social protection interventions were managed by As of 2015, 64 percent of total funding for nutrition11 public administrative entities, international NGOs and 77 percent of nutrition-specific funding was managed the remaining 30 percent. allocated to activities implemented by public admin- ®® External agencies (multi- and bilateral cooperation istrative entities across multiple relevant sectors, with agencies and international NGOs), managed 64 CLs, the health sector, and the Prime Minister’s cabi- percent of the resources for nutrition-related food net through the CLM managing the most funds (table security interventions. Just over half of this funding 4, figure 5). This pattern—where more than half of was managed by the WFP. community nutrition interventions are carried out by ®® Sixty-three percent of resources allocated to com- local development actors—is in contrast with practice batting micronutrient deficiencies were managed in the majority of countries in West Africa.

FIGURE 4: Funding Management Mechanisms Disaggregated by Intervention Category (2012–15)

100 90 80 70 60 50

Percent 40 30 20 10 0 Governance Community Nutrition-related Prevention of Social Nutrition nutrition health interventions micronutrient protection linked interventions related interventions deficiencies to nutrition to food security

Public administrative entities Bilateral cooperation Multilateral cooperation International NGOs National NGOs

Nutrition Financing in Senegal 15 TABLE 4: Distribution of Funding for Nutrition-Specific Interventions by Public Sector Entity (CFA francs)

Community nutrition Prevention of micronutrient Total nutrition-specific Sector interventions deficiencies interventions Education 243,964,513 n/a 243,964,513 Health 6,707,200,400 2,748,446,866 9,455,647,266 CLs 13,386,339,926 33,141,791 13,419,481,717 Prime Minister’s office 12,056,858 1,076,092,636 1,088,149,494 Research 1,964,886,426 33,319,958 1,998,206,384 Commerce n/a 384,518,039 384,518,039 Industry n/a 68,445,394 68,445,394 Total 22,314,448,123 4,343,964,684 26,658,412,807

FIGURE 5: Distribution of Funding for Nutrition- ®® Prevention of micronutrient deficiencies was inte- Specific Interventions by Public Sector grated into 12 of these projects. Entity (percent) ®® Governance and social protection linked to nutrition were integrated into 7 and 3 of these projects, Prime Minister's Office respectively. Local 19% Development 42% There was a clear correlation between the priority ac- Research 7% corded to these categories of nutrition intervention and Commerce the total amount of funding allocated to them between 1% 2012–15. Agriculture 0% Education Budgetary Resources 1%

Health Estimated budget resources 30% The estimates in this section are for the following interventions, for the period 2016–19:12 Operational planning of nutrition interventions ®® Community nutrition; This analysis screened 60 projects dedicated par- ®® Micronutrient supplementation and fortification of tially or entirely to nutrition interventions in Senegal staple foods; between January 2010 and July 2016. Fifty-six were ®® PECMAS in hospitals; implemented between 2010 and 2014; the remaining ®® Food security; four were initiated in 2015 or 2016: ®® Governance.

®® Thirty-two of these projects, just over 50 percent, Total resources for these five nutrition categories for had a partial or exclusive food security focus, mak- the period 2016 to 2019 were estimated at approxi- ing food security the most common element in mately 87 billion FCFA.13,14 This is 13 billion FCFA nutrition interventions during this period. more than expenditures on nutrition by the CLM, WFP ®® Eighteen of these projects were community nutri- and other main management bodies and sources of tion interventions. nutrition funding during the period 2012–15 (table 5).

16 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal TABLE 5: Nutrition Expenditures in Senegal by FIGURE 6: Distribution of Projected Expenditures by Major Management Bodies and Funders, Financing Agent, 2016–20 2012–15 Multilateral cooperation organization Organization Amount (FCFA) 7% CLM 20,655,980,025 Public Sector 46% WFP 19,840,040,166 UN Agency Ministry of Finance, the Economy 12,419,551,978 26% and Planning UNICEF 6,495,077,069 USAID 3,714,288,490 European Union 3,637,339,060 French Red Cross 3,244,228,424 World Bank 2,652,218,072 MI 2,097,994,983 NGOs Total 74,756,718,267.00 25%

With respect to financing agents, the public sector was expected to be responsible for 46 percent of these trition-sensitive interventions into current and future projected expenditures (figure 6). projects, leading to concomitant budget increases for nutrition. For example, table 6 presents options for It is important to note that these projections underes- nutrition sensitive interventions that could be made to timate the total volume of funding actually allocated projects implemented in relevant sectors. Appendices to the five categories of interventions listed above. C and D, while not exhaustive, provide additional infor- Moving forward, annual updating of the information mation on this topic, namely an annualized overview presented in appendix B would provide the CLM and of nutrition-related expenditures by intervention type other stakeholders with a more accurate estimate. and implementing organization, including the sectors listed above, and the 2016–2020 budget for nutrition, Potential for increasing budgetary resources organized by project.

Funding for community nutrition interventions and The CLM is making significant efforts to educate rel- governance is expected to vary little in the near fu- evant sectors on the links between their interventions ture. In contrast, funding allocated to the prevention and nutrition. However, these efforts will not lead to of micronutrient deficiencies and fortification of staple increased budget allocations for nutrition, unless finan- foods is projected to triple with the implementation of cial partners, members of parliament, and the Ministry new projects. of Finance, the Economy and Planning are all involved. Advocacy and dialogue on specific policy instruments Budgetary resources could be increased through (1) es- is strongly recommended. For example, reducing taxes tablishment of new nutrition projects; (2) increasing charged to businesses selling heathy food products, or funding for existing projects or projects being finalized; instituting legislation requiring that a minimum thresh- and (3) upgrading and initiating nutrition-sensitive in- old or percentage of funding in relevant sectors be terventions in projects and programs implemented in earmarked for nutrition-sensitive interventions. sectors such as agriculture, fisheries, livestock, and research and education. There is enormous potential Some sectors, notably health and local development within these sectors for increased integration of nu- have already successfully integrated nutrition-sensitive

Nutrition Financing in Senegal 17 TABLE 6: Potential Refinements of Existing Projects to Improve Nutritional Status

Financing through Source of Code Project Potential refinement 2015 (million FCFA) financing 11022 PAFA Integration of education on food 14,498 State; IFAD; diversification and BCC OPEC Fund 11038 Promotion of Agricultural Development of cereal banks at the 3,586 UEMOA Product Storage Units community level 14014 PRAO Development of secondary aquaculture 10,290 State; WB ponds in villages with a high prevalence of malnutrition and promotion of consumption by vulnerable groups 11039 Promotion of Rice in the Integration of home fortification of rice 17,009 State; EU/EDF; Delta porridge for children age 6–59 months ADF; BOAD in producer households Biofortification 11043 Improvement of Agricultural Financing of research projects on the 40,500 State; WB Production (WAPP) / processing of artisanal groundnut oil for Agricultural Productivity household consumption Project in West Africa 11077 Project for the Integration of an IGA component to 31,786 State; IFAD; Consolidation and enable women to grind and fortify cereals BOAD; Extension of Food Security Support production and standardization beneficiaries in the Matam Region of enriched flour for the management of acute malnutrition BCC Source: Triennial Program of Public Investment (PTIP) 2014, 2015. Note: See Acronym List for full names of projects, interventions and financing sources.

interventions into their projects and programs but are be revised, such as by adding a category or head- currently faced with the challenge of scaling up and ing of “nutrition” to ensure that resources allocated sustaining these activities throughout the country: to nutrition are so used.

®® Within the health sector, innovative financing Additional considerations regarding budgetary re- mechanisms, both internal and external, could lead sources for nutrition are as follows: to implementation at the national level of key interventions such as deworming, vaccinations, free ®® The completion of the PSMN costing exercise prenatal care, and access to family planning ser- will provide more information on funding that is vices on a regular basis. potentially available for nutrition-specific and nutri- ®® The local development sector needs not only an tion-sensitive interventions. Moreover, participants increase in budgetary resources, but also the es- were made aware of the activities carried out within tablishment of legal safeguards to prevent any their respective sectors that are directly related to fiduciary risks. The current budget framework does the objectives of the nutrition policy; which should not provide for the creation of specific budget lines enable them to identify the funding available for nu- for nutrition interventions in the budgets of the CLs. trition in their respective sectors. As a result, a budget increase does not guarantee ®® Senegal’s eligibility for the GFF is likely to result an increase in the resources allocated to nutrition in increased pooled donor funding for public sector interventions. The current budget framework should management activities, including nutrition.

18 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Unit Costs of Interventions such, the demand for maternal care generated by this transfer program addresses the underlying causes of As part of this analysis, we estimated the average an- malnutrition. Unit cost per beneficiary per year was nual unit costs of key nutrition interventions. These estimated at 36,690 FCFA, of which 18 percent was unit costs can be used for the budgeting of sectoral dedicated to implementation of the program. operational plans and for economic analysis. There are two caveats to consider when using this es- The estimates are based on the costs of the following timate of unit cost: interventions implemented at the community level and managed by the CLM: 1. It was based on the project pilot, which was implemented by the CLM and benefited from existing ®® Unconditional cash transfers coordination and implementation arrangements. ®® Conditional cash transfers Unit cost will increase when implementation is not ®® Community nutrition promotion activities, screening part of an existing project. and PECMA 2. The annual unit cost per beneficiary of a multiyear conditional cash transfer project could be reduced In the life cycle of projects, capacity-building, advo- by as much as 2 percent from year 1 to year 2. Sav- cacy and awareness-raising expenditures generally ings would result from reduced costs of orientation decrease over time. As a result, estimates of annual for Agents Relais Communautaires (Community costs per beneficiary varied depending on whether the Relay Agents) (ARCs) and the establishment of lo- intervention in question was part of a new project in a cal administrative entities. district or CL (deployment), or was part of an existing project (routine). Appendix F describes the activities that support this cash transfer program. Unconditional cash transfers: This social protection project links to nutrition and targets mothers with chil- Community Nutrition Promotion activities: Annual cost dren from birth to 5 years. The project incorporates for initial implementation of the Community Nutrition nutrition education and empowers households to Promotion activity package was estimated at about ensure adequate nutrition for children under 5. The 3,560 FCFA per child. This estimate includes GMP, transfers are carried out on a bimonthly basis, over behavior change communication (BCC), and emotion- a period of six months. Annual unit cost per benefi- al and physical stimulation. Unit cost for a multiyear ciary for unconditional cash transfers was estimated program would be about 2,700 FCFA. at 47,113 FCFA, of which 11 percent was dedicated to the implementation of the program. Appendix E de- Introduction of screening and PECMA in a community scribes the activities carried out in this cash transfer was estimated at about 32,230 FCFA per child in the program. first year. The unit cost for a multiyear program would be about 32,040 FCFA. Conditional cash transfers: These cash transfers are linked to compliance with conditionalities that promote Appendices G and H describe the activities that sup- good maternal health practices (such as prenatal vis- port these community promotion, screening and its and childbirth assisted by health personnel). As PECMA interventions.

Nutrition Financing in Senegal 19 20 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX A Nutrition Expenditures by Intervention and Sources of Financing

Nutrition Financing in Senegal 21 2,776,000 894,336,932 521,517,591 335,278,484 210,058,313 7,316,864,139 1,125,942,288 1,417,810,162 5,946,649,002 1,468,187,090 5,907,594,775 Grand total 11,755,800,938 10,315,738,110 13,384,153,895 32,038,604,765 28,564,102,955 (continued on next page) NGOs International 2,776,000 43,551,944 150,000,000 147,209,151 171,263,774 150,000,000 9,428,890 1,267,364,901 92,962,219 206,003,583 66,233,437 78,227,552 initiatives Government international Foundations and 15,774,400 50,868,777 981,105,048 344,521,103 43,796,701 50,978,853 374,308,440 Multilateral cooperation 41,315,234 47,506,884 143,886,415 80,851,908 542,910,111 161,371,652 146,503,225 668,284,582 158,691,904 225,248,346 Bilateral 2,225,940,868 1,565,214,759 3,022,379,612 503,328,900 6,048,024,409 1,984,073,535 1,815,067,286 1,908,635,708 2,206,028,665 3,530,302,336 2,104,747,055 1,593,860,302 1,765,041,645 483,000,000 cooperation 10,149,963,710 13,052,233,895 181,920,000 19,233,402,677 3,821,099,825 6,031,288,608 2,952,813,655 18,159,652,989 6,033,948,251 1,945,660,306 2,424,841,409 Social protection linked to nutrition Food Security Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Social protection linked to nutrition Community-based Nutrition Interventions Prevention and Treatment Prevention and Treatment micronutrient deficiencies Food Security Governance Governance Community-based Nutrition Interventions Nutrition-related health interventions 2013 and sanitation Water Intervention 2012 and sanitation Water CFA Francs CFA

22 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal 54,576,184 363,251,781 460,434,378 673,322,150 276,100,209 1,595,599,898 1,684,842,524 8,382,805,971 5,774,601,717 1,346,217,948 1,223,569,069 6,109,438,198 7,825,090,549 1,441,743,387 Grand total NGOs International 89,460,320 (4,790,200) 150,000,000 206,458,975 6,716,093,274 160,589,776 79,460,169 8,026,474,117 13,325,870 2,264,505,801 85,669,719 881,663,080 43,874,540 initiatives Government international Foundations and 59,366,384 71,022,161 83,543,109 108,063,336 44,896,769 120,210,876 1,024,662,054 58,340,254 175,944,178 327,099,518 673,322,150 1,684,842,524 Multilateral cooperation 41,815,777 988,063,533 302,071,095 202,848,160 102,617,110 307,862,988 171,645,337 594,503,026 362,503,628 135,232,899 131,329,516 251,973,687 Bilateral 2,112,967,184 1,413,592,888 1,765,041,645 483,000,000 6,008,083,967 351,550,332 2,191,545,422 3,913,428,878 7,153,040,734 633,383,437 2,382,166,872 1,479,229,681 1,765,041,645 483,000,000 2,980,665,780 823,231,731 2,002,803,526 2,018,389,511 cooperation 11,780,168,430 7,879,417,371 2,174,948,730 3,876,995,791 206,458,975 25,917,989,298 62,577,389,974 22,136,472,614 14,395,005,308 13,162,082,032 285,919,144 112,556,869,072 13,404,165,877 4,402,007,168 4,243,107,665 3,907,431,177 79,460,169 26,036,172,056

(continued) Multiple Social protection linked to nutrition Nutrition-related health interventions Prevention and Treatment micronutrient deficiencies Food Security Grand Total Community-based Nutrition Interventions Governance Water and sanitation Water Food Security 2015 Social protection linked to nutrition Multiple Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Community-based Nutrition Interventions Governance Intervention 2014 and sanitation Water CFA Francs CFA

Nutrition Financing in Senegal 23 24 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX B Nutrition Expenditure by Intervention and Financing Agent/Organization

Nutrition Financing in Senegal 25 2,776,000 894,336,932 521,517,591 7,316,864,139 1,417,810,162 5,946,649,002 1,468,187,090 (continued on next page) 6,920,000 13,384,153,895 NGO National NGO Grand total International 9,254,100 23,924,792 14,185,716 19,636,523 84,793,032 82,441,172 42,824,109 210,058,313 256,436,969 320,925,610 226,220,667 66,233,437 42,824,380 335,278,484 Multilateral cooperation Bilateral cooperation Public 316,974,353 361,484,155 306,138,000 157,012,382 280,097,751 21,210,000 1,125,942,288 3,347,561,898 493,890,000 4,857,202,955 893,870,164 723,213,093 10,315,738,110 3,525,708,512 1,541,024,850 1,846,858,054 403,272,723 3,733,984,524 489,444,990 6,231,022,803 1,226,919,440 74,429,181 11,755,800,938 1,383,987,923 3,713,954,828 510,230,000 8,436,393,300 716,655,767 2,248,041,645 1,552,625,180 1,644,173,303 501,808,873 3,024,847,493 433,695,500 1,962,608,452 431,330,216 55,113,114 5,907,594,775 1,435,008,198 11,304,853,910 2,802,688,680 12,294,234,569 2,036,258,572 126,067,223 28,564,102,955 12,310,993,210 2,524,359,840 13,431,927,163 2,930,857,898 840,466,653 32,038,604,765 administration Social protection linked to nutritionFood Security 2,776,000 Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Community-based Nutrition Interventions Governance Water and sanitation Water 2013 Food Security Social protection linked to nutrition 521,517,591 Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Community-based Nutrition Interventions Governance Water and sanitation Water Intervention 2012 CFA Francs CFA

26 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal 54,576,184 363,251,781 673,322,150 460,434,378 1,595,599,898 1,684,842,524 5,774,601,717 1,346,217,948 1,223,569,069 6,109,438,198 1,441,743,387 NGO National NGO Grand total International 141,111,910 124,599,737 10,388,562 276,100,209 441,975,554 600,222,969 354,804,770 17,777,087 262,601,439 100,650,342 673,322,150 327,099,518 400,145,677 295,173,095 278,532,044 18,319,064 Multilateral cooperation 2,222,473,760 1,201,262,152 261,861,921 6,716,093,274 1,684,842,524 2,659,092,092 2,019,858,974 66,297,301 8,382,805,971 Bilateral cooperation Public 553,401,376 973,636,091 528,250,297 3,030,495,441 2,681,991,645 434,711,250 2,440,923,822 216,975,000 3,637,557,604 3,128,903,986 691,082,000 2,601,625,086 833,898,402 770,964,642 8,026,474,117 2,248,041,645 1,347,926,750 2,110,197,080 403,272,723 5,270,200,883 789,808,000 1,602,563,273 137,463,132 25,055,260 7,825,090,549 1,144,892,278 47,001,129,411 8,590,576,520 43,927,472,431 10,936,589,148 2,101,101,563 112,556,869,072 10,931,658,341 434,711,250 10,066,713,961 4,156,746,524 328,159,221 25,917,989,298 12,453,623,949 2,828,816,750 8,134,596,738 1,812,726,154 806,408,465 26,036,172,056 administration

(continued) Grand Total Food Security Multiple Social protection linked to nutrition 54,576,184 Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Community-based Nutrition Interventions Governance Water and sanitation Water Multiple Social protection linked to nutrition 133,334,860 Food Security 2015 Prevention and Treatment Prevention and Treatment micronutrient deficiencies Nutrition-related health interventions Community-based Nutrition Interventions Water and sanitation Water Governance Intervention 2014 CFA Francs CFA

Nutrition Financing in Senegal 27 28 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX C Nutrition-Related Expenditures by Intervention and Implementing Organization

Nutrition Financing in Senegal 29 Grand total

Not specified (continued on next page)

NGO

partners Donors Development

Multi- sectorial

Industry

Commerce

Research

Office of the prime minister Public sector Dev local

Health

Education ——— — — 59 220 1,865 1 — 3,656 40 — 12 1,354 — 20 0 — — — — — — — — — — 3 0 109 1,552 — 4,612 7 11,756 — 335 1,418 — — 629 (37) 238 14 — 36 — — 1 13 894 —— — — 85 10 — — — 1,432 — 21 — — — — — 2 — — 125 3 — — 210 1,468 — —— 550 — — — 225 522 7 — — — 12 — — — — — 327 — 4 — 1,126 — 522 — — 6,691 — — — — — — — 626 — 7,317 ———3————————3 —— 53 — 896 5,213 2,925 — — — — — — — — — — — 0 — 609 1,425 733 5,908 — 5,947 Agriculture 5,1924,720 — 74 — 9,406 3,661 — 1,740 145 52 19 — — 36 — — — 958 1,784 4,382 1,215 7,010 5,030 32,039 13,384 5,192 53 6,755 3,447 1,802 46 — 12 2 1,784 3,013 6,459 28,564 4,720 16 — — 136 17 — — — 954 2,094 2,379 10,316 Food Security 2013 and sanitation Water Governance Community-based Nutrition Interventions Prevention and micronutrient Treatment deficiencies Interventions 2012 and sanitation Water Governance Prevention and micronutrient Treatment deficiencies Social protection linked to nutrition Nutrition-related health interventions Social protection linked to nutrition Community-based Nutrition Interventions Nutrition-related health interventions Food Security CFA Francs, Millions CFA

30 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Grand total

Not specified

NGO

partners Donors Development

Multi- sectorial

Industry

Commerce

Research

Office of the prime minister Public sector Dev local — — — 16 — — — — 2,896 1,985 8,026 Health

Education 11 — — 753 5 434 6 259 20 — — 23 96 1,596 — — — 55 — — — — — — — — 55 — — 69 — 972 18 — — 5 282 0 — 1,346 — — 5,124 — — — — — — — 651 — 5,775 — — — — — — — — — — 1,685 — 1,685 — — 263 — — — — — — — 101 — 363 — 57 2,628 2,601 — 969 — — — — 2,106 22 8,383 — — — 127 — — — — — — 333 — 460 — —— 816 — 65 — 179 — 6 — 126 — — — — — — — 0 — 31 673 1,224 — 673 —— 76 — 1,319 4,204 5,655 0 — 995 — — — — — — — 0 — 464 — 767 454 7,825 — 6,109 —— — — 139 6 — — — 1,140 — 20 — — — — — 5 — 270 135 — 2 — 276 1,442 Agriculture 3,118 3,118 87 7,935 4,396 1,319 1,037 126 — 5 270 4,957 2,785 26,036 3,030 — — — — 16 — — — — 768 2,901 6,716 3,030 57 8,836 2,661 1,406 1,009 259 20 5 282 5,334 3,019 25,918 16,061 270 32,932 14,165 6,268 2,144 385 68 12 3,293 17,685 19,273 112,557

(continued) Prevention and micronutrient Treatment deficiencies Social protection linked to nutrition Food Security GRAND TOTAL Governance Nutrition-related health interventions Multiple 2015 and sanitation Water Food Security Community-based Nutrition Interventions Social protection linked to nutrition Prevention and micronutrient Treatment deficiencies Multiple Community-based Nutrition Interventions Nutrition-related health interventions Water and sanitation Water Governance Interventions 2014 CFA Francs, Millions CFA

Nutrition Financing in Senegal 31 32 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX D Budgetary Resources for Nutrition by Project, 2016–20

Nutrition Financing in Senegal 33 — — — — — — — — — Total 160,363,238 268,547,314 160,363,238 134,740,000 7,049,040,000 1,154,484,320 6,297,187,200 6,297,187,200 7,049,040,000 1,154,484,320 (continued on next page) — 268,547,314 — 134,740,000 2020 2019 2018 2017 2016 40,090,810 40,090,810 40,090,810 40,090,810 67,136,82940,090,810 67,136,829 40,090,810 67,136,829 40,090,810 67,136,829 40,090,810 67,136,829 67,136,829 67,136,829 67,136,829 33,685,000 33,685,000 33,685,000 33,685,000 42,500,000 42,500,000 42,500,000 42,500,000 42,500,000 212,500,000 42,500,000 42,500,000 42,500,000 42,500,000 42,500,000 212,500,000 288,621,080 288,621,080 288,621,080 288,621,080 288,621,080 288,621,080 288,621,080 288,621,080 343,280,000 343,280,000 343,280,000 343,280,000 343,280,000 1,716,400,000 343,280,000 343,280,000 343,280,000 343,280,000 343,280,000 1,716,400,000 1,762,260,000 1,762,260,000 1,762,260,000 1,762,260,000 1,574,296,800 1,574,296,8001,574,296,800 1,574,296,8001,762,260,000 1,574,296,800 1,574,296,800 1,762,260,000 1,574,296,800 1,762,260,000 1,574,296,800 1,762,260,000 2,296,000,000 2,296,000,000 2,296,000,000 2,296,000,000 2,296,000,000 11,480,000,000 2,296,000,000 2,296,000,000 2,296,000,000 2,296,000,000 2,296,000,000 11,480,000,000 WFP EU CIAT EVE EU UNICEF UNICEF UNICEF French Red Cross ECHO Canada European Union Canada NVF International European Union Multi-Donor Multi-Donor Multi-Donor Support for the prevention, detection and management of acute malnutrition in Senegal Integrated Food and Nutrition Security AISAN Support Improving socio-economic status and food security with particular attention to women and children African Bean Research Alliance African Bean Research 032162001) Phase IV (A PABRA Advocacy and engagement of decision-makers in nutrition Senegal Women’s Action for Nutrition (AFNut) Women’s 33,685,000 33,685,000 33,685,000 33,685,000 UNICEF/WASH programme UNICEF/WASH UNICEF/Nutrition programme Project/Program UNICEF/Health Programme

34 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — — — — — — — — — — — — Total 26,287,477 26,287,477 56,965,069 56,965,069 36,150,600 36,150,600 4,402,557,674 4,402,557,674 1,349,382,196 2,667,390,604 2,667,390,604 1,349,382,196 (continued on next page) N/A N/A 2020 — — — — N/A N/A 2019 — — — N/A N/A 2018 — — N/A N/A 2017 N/A N/A 2016 26,287,477 56,965,069 26,287,477 56,965,069 18,075,300 18,075,300 18,075,300 18,075,300 337,345,549 337,345,549 337,345,549 337,345,549 666,847,651 666,847,651 666,847,651 666,847,651 666,847,651 666,847,651 666,847,651 666,847,651 337,345,549 337,345,549 337,345,549 337,345,549 1,467,519,225 1,467,519,225 1,467,519,225 1,467,519,225 1,467,519,225 1,467,519,225 actors Min Agriculture ACF IIRPA Micronutrient Initiative NCBA/Yaajeende and other NCBA/Yaajeende CEGEP IFRC WHO HKI Canada European Union Canada Canada USAID Canada Canada Canada Canada Niayes Development and Economic Development Program PADEN CA-3-A031958001 Prevent undernutrition in children (M013757-001) Community Nutrition Program – PROCONU Feed The Future IFA Supplementation of Iron and Folic IFA Acid in Pregnant Women Women Entrepreneurship and Women Adaptation (CA-3-S065792001) Crisis in the Sahel – IFRC 2012 (CA-3-M013755001) Progress in nutrition-related programming and policies (M013784-001) Project/Program Support for health/child survival days (CA-3-M013429001) (continued)

Nutrition Financing in Senegal 35 — — — — — — — — — — — — — — — — Total 266,181,440 425,000,000 5,827,542,404 (continued on next page) — 425,000,000 — 5,827,542,404 N/A N/A N/A N/A N/A 2020 N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A 2018 N/A N/A N/A N/A N/A 2017 N/A N/A N/A N/A N/A 2016 266,181,440 150,000,000 150,000,000 150,000,000 150,000,000 150,000,000 750,000,000 416,181,440 150,000,000 150,000,000 150,000,000 150,000,000 1,016,181,440 106,000,000 116,000,000 101,500,000 101,500,000 106,000,000 116,000,000 101,500,000 101,500,000 1,456,885,601 1,456,885,601 1,456,885,601 1,456,885,601 1,456,885,601 1,456,885,601 1,456,885,601 1,456,885,601

Associates ; EVE

Unspecified Dakar City Council Directorate of Horticulture CLM USE World Bank World USAID Abt Government/Ministry of Economics and Finance orld Food Crisis Response Program European Union FAO Government ADF ICCO Canada USAID Canada Food and Nutrition Improvement Project-Casamance National Micro-gardens Program Multinational Program for Strengthening Resilience to Food and Nutritional Insecurity in the Sahel (P2RS) Multi-Actors Program 2 (PMA2) W (PMRCA) (CA-3-m013185001) Community Health & Program II (PSSC II) Project/Program Support Program for Casamance Development PADEC (CA-3-A032792001) (continued)

36 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — — — — — — — — — — — — — Total 712,167,479 500,000,000 204,623,937 1,440,000,000 (continued on next page) — 712,167,479 — 1,440,000,000 — 204,623,937 N/A N/A N/A 2020 — N/A N/A N/A 2019 — N/A N/A N/A 2018 — N/A N/A N/A 2017 N/A N/A N/A 2016 112,167,479 200,000,000 200,000,000 200,000,000 115,000,000 185,000,000 115,000,000 70,000,000 15,000,000 112,167,479 200,000,000 200,000,000 200,000,000 360,000,000 360,000,000 360,000,000 360,000,000 360,000,000 360,000,000 360,000,000 360,000,000 204,623,937 204,623,937 1,433,481,107 1,433,481,107 1,433,481,107 1,433,481,107 1,433,481,107 7,167,405,537 1,548,481,107 1,618,481,107 1,548,481,107 1,503,481,107 1,448,481,107 7,667,405,537 REACH Secretariat World Association of Community World Radio Broadcasters USE Micronutrient Initiative CLM EU USE CLM Canada Canada Christian Aid (UK) Canada European Union ACPP’s FS.RI ACPP’s Government Canada International Agricultural Alliance Renewed Efforts Against Child Renewed Efforts Hunger (REACH) Promotion of Development and Good Governance by Community Radio S064624-002 Pilot Project for the Promotion of Renewable Energies for Food Security (PERSA) Integrated Nutrition Project in Kolda and Kedougou (PINKK) Integrated Food and Nutrition Resilience Support Project (PIARAN) Food Security Support Project for Households (PASAV) Vulnerable Agricultural Production Strengthening Project Project/Program Support Project for Rice Production for Food Security in Senegal 034552001) BEYDUNDEE (CA-3-A (continued)

Nutrition Financing in Senegal 37 — — — — — — — — — — — — — — — — Total 1,340,000,000 (continued on next page) — 1,340,000,000 N/A N/A N/A N/A N/A 2020 N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A 2018 N/A N/A N/A N/A N/A 2017 N/A N/A N/A N/A N/A 2016 335,000,000 335,000,000 335,000,000 335,000,000 335,000,000 335,000,000 335,000,000 335,000,000 EU EU EU HKI HKI European Union European Union European Union Canada Canada Strengthen the resilience of 1,000 households in Kolda through a multidimensional approach Strengthening of social safety nets in the department of Podor and the Kolda region through pilot projects to promote local production, introduction of food with high nutritional value and respect for the environment in school canteens Strengthening the food and nutritional security of family farms in the Kolda Department by promoting agro-ecology and reducing gender inequalities Strengthening the Resilience of Households in the Vulnerable – Casamance Department Velingara Affected by Food Insecurity and Malnutrition European Union EU Strengthening Nutrition Through Enhanced Food Production (M013707-001) Project/Program Strengthening Nutrition (M013618-001) (continued)

38 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — — — — — — — — — — — — Total 358,089,976 417,205,354 1,038,893,167 (continued on next page) — 1,038,893,167 — 417,205,354 N/A N/A N/A 2020 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2017 N/A N/A N/A 2016 89,522,494 89,522,494 89,522,494 89,522,494 57,238,450 57,238,450 57,238,450 57,238,450 57,238,450 286,192,250 57,238,450 57,238,450 57,238,450 57,238,450 57,238,450 286,192,250 259,723,292 259,723,292 259,723,292 259,723,292 259,723,292 259,723,292 259,723,292 259,723,292 104,301,338 104,301,338 104,301,338 104,301,338 104,301,338 104,301,338 104,301,338 104,301,338 172,242,323 172,242,323 172,242,323 172,242,323 172,242,323 861,211,613 172,242,323 172,242,323 172,242,323 172,242,323 172,242,323 861,211,613

World Bank World Micronutrient Initiative Micronutrient Initiative UE Micronutrient Initiative WHO Micronutrient Initiative EU Canada Canada Canada European Union Canada WHO Canada European Union Agricultural Market Development Program ZINCH USI Universal Iodization of Salt Sustainable food system and fight against malnutrition in the Dakar region (SADMAD) SVA Supplementation in Vit A through A Supplementation in Vit SVA routine Sentinel Nutrition Surveillance Program Right Start and N-LIFT Right Start and N-LIFT (Nutrition leverage and Influencing for Transformation) Project/Program Strengthen the food and nutritional security of 2000 poor and very families in 8 rural communities the Region (continued)

Nutrition Financing in Senegal 39 — — — — — — — — — — — — — — — — — Total 52,469,200 44,350,000 98,037,965 655,957,000 163,989,250 163,989,250 4,200,000,000 5,247,656,469 1,551,950,000 16,400,000,000 (continued on next page) — 4,200,000,000 — 2020 — 2019 — 2018 655,957,000 — 2017 — 2016 27,331,542 109,326,167 27,331,542 52,469,200 44,350,000 98,037,965 114,792,475 49,196,775 223,027,924 2,199,272,064 2,011,665,815 813,690,666 385,000,000 388,983,333 388,983,333 388,983,333 1,000,000,000 1,066,666,667 1,066,666,667 1,066,666,667 1,000,000,000 1,066,666,667 1,066,666,667 1,066,666,667 2,900,000,000 3,000,000,000 3,500,000,000 3,500,000,000 3,500,000,000 CLM CLM CLM CLM CLM CLM CLM CLM CLM CLM CLM CLM CLM World Bank World GAIN AECID European Union Spain/AACID/Andalous Spain/AECID/PLCM Canada/MI Spain/AECID/PLDM World Bank/JSDF World UNICEF/Salt iodization support + Home fortification WFP/Blanket feeding UNICEF/Community Nutrition Intervention Government Health and Nutrition Project Financing (PFSN) Programme for Enhanced Food Fortification in Senegal (PRF) Project/Program Nutrition Strengthening Program 3,845,009,106 5,746,778,339 5,927,980,690 4,702,673,999 3,500,000,000 23,722,442,134 (continued)

40 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — Total 254,240,000 188,720,000 254,240,000 188,720,000 125,000,000 1,120,000,073 — 1,120,000,073 — 125,000,000 2020 — — — — 2019 — — — 2018 — 2017 2016 94,360,000 94,360,000 94,360,000 94,360,000 127,120,000 127,120,000 127,120,000 127,120,000 454,503,986 372,859,990 292,636,098 454,503,986 372,859,990 292,636,098 125,000,000 125,000,000 19,889,271,343 21,264,837,845 21,697,718,004 18,011,298,990 8,009,741,880 88,872,868,062 FAO FAO FAO CLM Unspecified Unspecified European Union World Bank World Total TCP/SEN/3602 – Integrated approach to productive social safety nets, school feeding and nutrition in Senegal TCP/SEN/3601 – Strengthening Food Nutrition and Resilience to Security, Climate Shocks Project PRO-ACT Project/Program FBR Pre-Pilot Project (continued)

Nutrition Financing in Senegal 41 42 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX E Costing a Nutrition Cash Transfer Programme Without Conditionalities15

Description Unit Unit cost Quantity Frequency Amount Cash transfer Beneficiary 14,000 2,452 3 102,966,738 Project management 12,535,000 1 1 12,535,000 Staff remuneration Lumpsum 6,655,000 Training of Community Workers (CW) CW Supervisor 157,292 24 1 3,775,000 Supervisors Allowance for Community Workers CW Supervisor 20,000 24 6 2,880,000 Supervisors Identification and nomination of beneficiaries Lumpsum 960,000 Allowance for local steering committees District 110,000 1 2 220,000 Allowance for nomination committees Village 80,000 4 2 640,000 Allowance for village meetings Village 25,000 4 1 100,000 Communication (radio broadcasts) Radio station 60,000 4 3 720,000 Programme Management District 4,200,000 1 1 4,200,000 Support to local steering committee District 360,000 1 1 360,000 Support to the nomination committees District 720,000 1 1 720,000 Monitoring of the selection process District 1,400,000 1 1 1,400,000 Counter verification of the selection process District 240,000 1 1 240,000 Programme monitoring District 1,200,000 1 1 1,200,000 Data entry and management District 280,000 1 1 280,000 Total 12,535,000

Unit Cost per beneficiary 47,113 FCFA From which Project implementation cost 5,113 FCFA Disbursement to beneficiary 42,000 FCFA

Nutrition Financing in Senegal 43 44 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX F Costing a Nutrition Monetary Transfer Programme With Conditionality16

Nutrition Financing in Senegal 45 Total Total (FCFA) 35,104,589 5,000 10,560,000 6,000 3,172,800 (FCFA) 1,281,494 2,296,562 Unit cost 8 10,000 80,000 881 100,0001 680,000 114,840 800,000 5,440,000 700,000 1,033,560 700,000 11 325,0008 200,00088 325,000 100,0008 200,000 100,0008 100,000 800,000 8 2,400,000 133,3332 148,750 800,000 8 1,066,667 50,0008 1,190,000 60,0001 50,0001 400,000 60,0001 120,000 200,000 400,000 800,000 1,320,000 480,000 200,000 2,640,000 800,000 1 1 1 9 1 1 1 1 3 1 1 1 1 1 1 1 1 1 2 1 5,288 30,000 158,640,000 12 176

CW Unit Ward Village Village Village Village Village Village Village Village District District District District District District (FCFA) Freq Quantity Beneficiary Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine Routine activity Type of Type Additional CW/day Additional AdditionalAdditional Village Village 6,639 30,000 36,639 Overhead RBF Training for health facility Nurse in ChargeTraining RBF Additional District Local steering committee’s meeting Local steering committee’s Programme Monitoring at village level Fuel for district monitoring Communication allowance costs (CW) allowance Community Workers RBF Training for Community Workers Supervisors for Community Workers Training RBF Additional CW supervisor/day 3 176 Sensitization meetings with District Development Committees Set up local steering committees Nomination Committee Meetings Head Consultation with Village Monitoring of the selection process Supervision of the selection process Counter verification of the selection process activities Support to steering committees’ Set up the nomination committee’s Support to village leadership meetings RBF training for local radio station RBF radio broadcast fees Community sensitization on MNCH services to beneficiaries Transfer Cash otal T Project phasesTraining Expenditure type (CW) for Community Workers Training RBF Unit cost per beneficiary (FCFA) From which Cash transfer Programme management Monitoring at Community level Management Costs Selection of programme beneficiaries Communication and visibility Cash transfer

46 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX G Costing a Community Based Nutrition Promotion Programme

Nutrition Financing in Senegal 47 — — — — — — approach enhanced Total cost_ Total (continued on next page) — — — — — — 33,333 33,333 144,000 144,000 150,000 500,000 320,000 320,000 100,000 100,000 routine 1,000,000 1,000,000 2,007,333 2,357,333 1,320,000 4,400,000 1,510,0731,420,000 1,510,073 4,500,000 6,906,8732,830,073 10,336,873 2,830,073 1,320,000 1,320,000 approach Total cost Total intervention 1 1 1 1 — 0.67 0.67 0.67 0.67 0.67 nutrition nutrition Proportion Proportion allocated to promotion (100%) activities additional Unit cost _ 2,0007,500 2,000 7,500 5,000 5,000 5,000 5,000 5,000 5,000 routine Unit cost_ intervention 1 1,000,000 1,000,000 5 10,000 10,000 6 25,000 25,000 12 18,000 18,000 40 30,000 30,000 12 40,000 40,000 88 15,000 50,000 10 50,000 125,000 160 160 492 264 Qty (annual)

CW Year Unit Child Child Event Month Month District Facilitator 12 188,759 188,759 Lumpsum 10 15,000 50,000 Facilitator/ Participants Nutrition ward Acute ransport allowance for SAM referrals Child Radio broadcast fees Motorcycle Insurance Community workers motorcycle maintenance Community sensitization during screening campaigns Programme Management Tools Transport allowance for case detectionTransport allowance for Facilitators Transport Child 16,000 T Integrated management of childhood illness (IMCI) and feeding practices training for community workers Orientation session of local steering committees Other Direct Costs Training Growth monitoring training/refresher course for facilitators Facilitator remuneration On-Site Intervention Remuneration Allowances to Community workers (CW) CW Allowance for lost to follow up severe acute malnutrition (SAM) cases malnutrition (MAM) case detection Allowance for Moderate Description

48 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — — — — — — 7,407 approach enhanced Total cost_ Total (continued on next page) — — — — — — — — — 7,407 80,000 80,000 40,000 40,000 26,667 26,667 119,467 119,467 637,739 637,739 777,778 777,778 538,176 538,176 555,556 555,556 666,667 666,667 133,333 133,333 250,000 250,000 399,467 399,467 250,000 250,000 360,000 360,000 routine 3,894,433 3,894,433 approach Total cost Total intervention 1 1 1 — — — 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0.67 0..67 nutrition nutrition Proportion Proportion allocated to promotion (100%) 15,385 187,500 activities additional Unit cost _ 2,778 2,778 8,500 8,500 7,500 7,500 3,000 3,000 33,593 33,593 routine Unit cost_ intervention 1 1 10 25,000 25,000 0.3 2,500,000 2,500,000 120 120 Qty (annual) illage 12 83,333 83,333 ard

Unit Ward W Month Month Village Village Village Village illage/Month Month/Village 0.0 35,000,000 35,000,000 Month/Village 12 79,717 79,717 Month/Village 12 67,272 67,272 Village/Month Month/V Village/Month 12 14,933 14,933 Village/Month Relay/Quarter Nutrition ward/ Nutrition ward/ Quarter/Village 4 Village/Quarter 4 50,000 50,000 ehicle Bank charges V Motorcycles Area Supervisor/District Salary Investments Planning meeting with the Local steering committee Accounting Salary Vehicle rentals Vehicle Quarterly meeting on project outcome with Community workers Direct Management Costs Project Manager Salary Supervision of sites by local authorities Village/Quarter 4 15,000 15,000 Fuel Monthly project coordination meeting Agent/Month 12 10,000 10,000 Allowance for project Supervision visits Village/Quarter 4 10,000 10,000 Vehicle maintenance and repairs Vehicle Cooking utensils Sound system projector Video Monitoring and evaluation at Community level Supervision visits of project activities V Cooking demonstration Nutrition ward equipment Capital expenditure Support to Early Child Development programme Description (continued)

Nutrition Financing in Senegal 49 3,588 2,584 approach enhanced approach Enhanced Total cost_ Total 111,111 111,111 2,700 1,727 400,000 400,000 200,000 200,000 routine Routine approach Total cost Total approach 10,801,307 14,231,307 intervention 0.67 0.67 0.67 nutrition nutrition Proportion Proportion allocated to promotion (100%) activities additional Unit cost _ From which On site intervention/child (f CFA) Total cost per child (f CFA) Total

600,000 600,000 routine Unit cost_ intervention Qty (annual) Unit Year/Village Year/Village 1 Month/Village 2 150,000 150,000 Month/Village 0.0 5,000,000 5,000,000 Office Rental telephone, electricity, Overhead (water, office supplies and any other running costs) Total Office equipment (lumpsum) Description (continued)

50 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal APPENDIX H Costing a Community Based Management of Acute Malnutrition Programme

Nutrition Financing in Senegal 51 — — — — — — — — — — — approach enhanced Total cost_ Total — — — — — — — — — — — (continued on next page) 16,667 16,667 72,000 72,000 50,000 50,000 160,000 160,000 320,000 320,000 500,000 1,250,000 550,000 1,300,000 755,037 755,037 800,000 800,000 1,200,000 1,200,000 2,460,000 2,460,000 4,015,037 4,015,037 routine approach Total cost Total 120,000,000 120,000,000 121,448,667 121,448,667 126,213,437 126,963,437 intervention 1 1 1 1 1

1 (100%) Proportion allocated to management of malnutrition

15,385 187,500 activities additional Unit cost _

routine Unit cost_ intervention 1 1,000,000 1,000,000 1 5 10,000 10,000 0.33 1

10 25,000 25,000 12 18,000 18,000 0.33 40 30,000 30,000 12 40,000 40,000 0.33 88 15,000 50,000 160 2,000 2,000 264492 5,000 5,000 5,000 5,000 Qty (annual) ard

CW CW Year Year Chid Unit Child 16,000 7,500 7,500 Child 160 5,000 5,000 Child W Ward Ward Ward Event Month District Websites 10 15,000 50,000 Facilitator 10 50,000 125,000 Facilitator 12 188,759 188,759 0.33 Ward/Month Ward/Month 120 3,000 3,000 Acute malnutrition ransport allowance for SAM referrals Capital expenditure Radio broadcast fees Support to Early Child Development programmeCooking demonstration Ward/Month 120 Nutrition ward equipment Cooking utensils Sound system Motorcycle Insurance Video projector Video Community workers motorcycle maintenance Month Programme Management Tools Community sensitization during screening campaigns Transport allowance for case detection Transport allowance for Facilitators Transport T Other Direct Costs Integrated management of childhood illness (IMCI) and feeding practices training for community workers Orientation session of local steering committees Participants 6 25,000 25,000 0.33 Growth monitoring training/refresher course for facilitators Training Facilitator remuneration Allowance for lost to follow up severe acute malnutrition (SAM) cases Remuneration Description On-Site Intervention Allowances to Community workers (CW) (MAM) case detection Allowance for Moderate

52 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal — — — — — approach enhanced approach Enhanced Total cost_ Total — — — — — 3,704 3,704 55,556 55,556 40,000 40,000 20,000 20,000 66,667 66,667 59,733 59,733 13,333 13,333 200,000 200,000 100,000 100,000 388,889 388,889 277,778 277,778 318,869 318,869 269,088 269,088 333,333 333,333 199,733 199,733 32,04031,553 32,228 31,741 1,947,217 1,947,217 routine Routine approach Total cost Total approach 128,160,653 128,910,653 intervention 0.33 (100%) Proportion allocated to management of malnutrition activities additional Unit cost _ Total cost per child (f CFA) Total From which On site intervention/child

7,500 7,500 0.33 8,500 8,500 0.33 33,593 33,593 0.33 routine Unit cost_ intervention Qty (annual)

Unit Village Village 0.3 2,500,000 2,500,000 0.33 illage/Month 12 83,333 83,333 0.33 illage/Month Village/Year 1 600,000 600,000 0.33 Agent/month 12 10,000 10,000 0.33 Village/Month 0.0 5,000,000 5,000,000 0,33 Village/Month 2 150,000 150,000 0.33 Village/Month 0.0 35,000,000 35,000,000 0.33 Village/Month 4 2,778 2,778 0.33 Village/Month 12 79,717 79,717 0.33 Village/Month 12 67,272 67,272 0.33 V Village/Month Village/Month Village/Month 12 14,933 14,933 0.33 V Relay/Quarter Village/Quarter 4 15,000 15,000 0.33 Village/Quarter 4 50,000 50,000 0.33 Village/Quarter 4 10,000 10,000 0.33 ehicle Overhead (water, electricity, telephone and other electricity, Overhead (water, running costs) TOTAL Office equipment (lumpsum) Motorcycles Office Rental V Investments Bank charges Area Supervisor/District Salary Accounting Salary Project Manager Salary Quarterly meeting on project outcome with Community workers DIRECT MANAGEMENT COSTS Monthly project coordination meeting Supervision of sites by local authorities Vehicle rentals Vehicle Planning meeting with the Local steering committee Vehicle maintenance and repairs Vehicle Fuel Allowance for project Supervision visits Supervision visits of project activities Description Monitoring and evaluation at Community level (continued)

Nutrition Financing in Senegal 53 54 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal Endnotes

1. Joint Child Malnutrition Estimates, UNICEF (Unit- nutrition-specific objectives and actions. As such, ed Nations Children’s Fund), WHO (World Health nutrition-sensitive programmes can serve as de- Organization) and World Bank (accessed 2017), livery platforms for nutrition-specific interventions, http://datatopics.worldbank.org/child-malnutrition/. potentially increasing their scale, coverage, and 2. The PNDN is referred to in earlier reports as “Doc- effectiveness (Ruel and Alderman, 2013). ument de Politique Nationale de Développement Nutrition governance interventions include de la Nutrition (DPNDN).” coordination, research, advocacy, and mobiliza- 3. A follow-up analysis of this study’s results, con- tion of resources for nutrition. sidering the PSMN’s designated budget, should 6. Official commitments are those in an official doc- enable decision-makers to assess whether fund- ument of the government of Senegal or any other ing is geared towards the priority actions of the official document that commits a donor, NGO, or national nutrition policy. any other recognized entity to funding interventions 4. Total expenditures on nutrition equals the sum of with a demonstrated impact on nutritional status. expenditures on nutrition-specific interventions, nutri- 7. Notably, this preliminary review found that the tion-sensitive interventions, and nutrition governance. private sector is not heavily involved in the financ- 5. Nutrition-specific interventions target the most ing of nutrition in Senegal. (This is in contrast to immediate drivers of good nutrition—proper intake a number of other African countries, where nutri- of food and nutrients, good maternal and child tion education programs benefit from financing by care practices, and prevention and treatment of food and beverage companies as part of corporate infectious disease (Ruel and Alderman 2013). commitments to social responsibility.) Nutrition-sensitive interventions target the 8. Total expenditure on nutrition equals the sum of underlying or “root” drivers of good nutritionfood expenditures on nutrition-specific interventions, security; adequate care giving resources at the nutrition-sensitive interventions, and nutrition sec- maternal, household and community levels; and tor governance. access to health services and a safe and hy- 9. The level of expenditure on nutrition-related health gienic environment.—while also incorporating interventions is likely underestimated because

Nutrition Financing in Senegal 55 study parameters did not permit comprehensive 13. It should be emphasized that this estimate is data collection across all sectors relevant to ma- based substantially on projects and programs ternal and child health. related to nutrition-specific interventions with the 10. OECD/DAC. addition of some projects and programs related to 11. The proportion of total funding dedicated to inter- nutrition-sensitive interventions. Given the multi- ventions implemented by the public sector could sectoral focus of the PSMN, any nutrition-sensitive reach 80 percent if interventions for which donors interventions that are budgeted for at a later date were unable to specify the implementing body should be included in an updated version of this were included (appendix C). analysis. 12. The data collection effort covered the period from 14. Due to a lack of information, these estimates do 2016 through 2020. The response rate for the not include WFP’s projected expenditures or ex- 2020 expenditure forecast was so low, however, ternal funding received directly by local NGOs. that the estimate was limited to the period from 15. Estimates based on data from the 3-month Cash 2016 to 2019. Additionally, twelve projects were transfer pilot in Koumpentoum District, Senegal. considered cross-cutting because they included 16. Conditionality for this project is the “use of mater- multiple categories of nutrition interventions. nal care services”.

56 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal References

Ruel, M.T., and H. Alderman. 2013. “Nutrition-Sen- Ruel-Bergeron, J. 2017. “The Case for Investment sitive Interventions and Programmes: How Can in Nutrition in Senegal.” Analysis & Perspective: They Help to Accelerate Progress in Improving 15 Years of Experience in the Development of Nu- Maternal and Child Nutrition?” Lancet 382 (9891): trition Policy in Senegal. Washington, DC: World 536–51. Bank; Dakar, Sénégal: CLM.

Nutrition Financing in Senegal 57

1818 H Street, NW Washington, DC 20433

Funding for the report was provided by the World Bank and the Japanese Trust Fund for Nutrition.

The task force providing oversight of the series was composed of members of the following organizations: