CALL TO ACTION

NUTRITION GOVERNANCE CHALLENGES/ GAPS CALL FOR ACTION RESPONSIBLE THE REPUBLIC OF AREA OFFICE Coordination and Duplication of efforts among Support periodic stakeholder DNCC partnerships: players and lack of synergy for mapping exercises (biannually) to DISTRICT LOCAL GOVERNMENT implementation of multisectoral identify who is doing what where. ADVOCACY BRIEF ON STRENGTHENING NUTRITION GOVERNANCE FOR MULTI-SECTORAL RESPONSE nutrition actions Systems capacity Building Lack of clarity on the contribution Sustain the engagement DNCC/DNFP (functional, institutional to nutrition sensitive programing momentum of Nutrition by ensuring and Human capacities) for the nontraditional departments continuous technical support (community-based services, supervision of frontline cadres in education, water, production, nutrition commercial services) Avail Monitoring and supervision tools to coordination structures so that they can do their work. Technical staff in the District of Support trainings on governance for CAO Karenga that broke off Kaabong not the newly created Nutrition Coordination established at the district Information management (monitoring, trained in Nutrition governance and its respective new lower level and respective 19 lower level local governments. evaluation, surveillance and research) local governments. These include the Kaabong District Nutrition Policy and legal framework Limited awareness on available Support wide district level CAO/Human A baseline food security and nutrition coordination committee(DNCC),and the policies, guidelines that support dissemination of UNAP, IMAM, IYCF, resource office assessment(FSNA) was conducted in Kaabong following 18 sub-count(ies) nutrition coordination Multisectoral nutrition programing Gender Policies. district for benchmarking information, and the committees (SNCCs) of Karenga, Kapedo, Information management Lack of harmonized reporting Support the wide roll out DNFP key findings of which have been used to inform Kapedo South, Kalapata, Kathile , Kathile south, (monitoring, evaluation, tools on multisectoral nutrition of Standard operating nutrition programming in the district. Periodic Kamion, Kawalakol, Karapata, Kaabong East, surveillance and research) programming (that can help capture procedures(SOPs) and use of assessments/surveys will also be conducted Kaabong West, Sidok, lobalangit, Lolelia, Loyoro, nutrition related data especially in templates generated in those SOPs annually to assess progress. Lodiko, Sangar, Subcounties, and 1towncouncil non-traditional departments) nutrition coordination committee (TNCC) of The Link Nutrition Causal Analysis (Link NCA) Lack of nutrition related indicators Advocate at department level to CAO/Planner Kaabong Town council study was also conducted, to identify the in the PBB at DLG level by program make sure that relevant nutrition MOYO contextual major causal pathways leading to output related indicators in the PBS system PROFILE LAMWO Systems capacity building (functional, wasting, stunting and anaemia among the most by program output YUMBE POPULATION 167,879 institutional and human capacities) vulnerable populations, and results of which Financial and resource Nutrition actions not integrated in Support integration of nutrition DNCC/Planner Kaabong district is in the extreme north eastern have been used to adapt programming in order mobilization the DDP and therefore not budgeted actions in the DDP and ensure that corner of Uganda, bordered in the North and East by Capacity of the respective Nutrition coordination CAO/District 29,182 to propose more targeted nutrition sensitive for in the DDP budget is created to support their Republics of Southern Sudan and respectively. structures (built) to plan, budget, implement, and council Households interventions. implementation. monitor Multisectoral nutrition actions. It also shares borders with the districts of Kitgum to KITGUM Advocate with district council to MARACHA the West, Moroto, Napak and KotidoADJUMANI Districts to the 15 of members of Kaabong DNCC were trained approve these budgets Infants Women of reproductive Financial and resource mobilization South. The District is located between longitudes <1 year age 15-49 years in Nutrition governance. Inadequate human resources Advocate for submission unfilled CAO/HRO 33˚ 30’ 31’’ to 34° 31’ 28’’ and latitudes 3° 45’ 11’’ A Five-year Kaabong Nutrition Action Plan for Nutrition (Unfilled Nutritionist vacancies and adjustment of Budget 4,713 33,911 270 members of Subcounty technical staff from (DNAP) with a respective final mobilization plan position at Kaabong Hospital) ceiling to accommodate recruitment to 3° 6’ 44’’ east of the Green Witch Meridian. The People with 19 sub-counties were trained as subcounty was approved by the district council (2020-2025) of a Nutritionist total land area of Kaabong district is 7,300Km sq. Children AMURU under 5 years disabilities >2 years nutrition coordination committees ThereARUA is no significant water mass in Kaabong. PADER All 18 Subcounties and 1 town council were also Communication (for Inadequacy of Diets for children Support the scale up of DNCC/DHO 28,243 17,061 supported to develop subcounty nutrition action Nutrition behavior change 6-23 month (Low diversity) community-based programs and Kaabong has three major types of soils, namely AGAGO Policy and legal framework plans for approval by their respective subcounty and advocacy) ensure malnourished children’s ferallic, vertigos and ferruginous tropical soils, other GULUChildren Formal education level The DNCC was supported to develop an Councils households are targeted/linked to types include litho soils. Administratively, Kaabong is these by respective community- 6-12 years of household head Annual Nutrition Workplan (FY 2019/20) and this made up of one county – Dodoth - comprising two based projects implemented by 37,087 35.6% 24.3% Primary, multisectoral workplan was approved by the Communication for nutrition behavior Mercy Corps, BRAC, GOAL in (2) constituencies; Dodoth East and Dodoth West, O’level 7.7%, A level and above 3.6% Chief Administrative officer(CAO) change and advocacy Kaabong district. Build linkages 13 sub-counties and one town council, 84 Parishes, NWOYA between supplementary feeding 60+ years The district was also supported to develop a A number Frontline community structures were ZOMBO 574 LC I Villages and 29,725 households. Kaabong Source: Uganda National Population OTUKE Five-year Nutrition Action Plan (DNAP) For 2020- trained in Key Family care practices, as change programs supported by UN WFP District has a total of 27 health facilities including 1 5,955 and Housing Census 2014 to community livelihood programs 2025 and this was approved the district council agents for nutrition. These include 334 members hospital,NEBBI 4 HC III, and 17 HC II. to build resilience of Vulnerable OYAM of Parish development committees(PDC) and The 18 sub-counties and 1 town council were households KOLE also supported to develop annual nutrition Functional Adult Literacy instructors (FALs) as well as 732 Village health team members (VHTS) workplans that were approved by the subcounty This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of chiefs. UNICEF and do not necessarily reflect the views of the European Union. DEVELOPMENT INITIATIVE FOR NORTHERN UGANDA EUROPEAN UNION NUTRITION GOVERNANCE ACTIVITIES SUPPORTED IN THE DISTRICT NUTRITION, WASH AND HEALTH STATUS OF THE DISTRICT Coordination and Partnerships Stakeholder mapping exercise was conducted in Kaabong district Local Government. The district had FSNA baseline (2018) Desired situation (2025) FSNA baseline (2018) Desired situation (2025) 37 stakeholders overseeing and/or implementing Nutrition interventions (classified as nutrition specific, NUTRITION STATUS HEALTH INDICATORS sensitive and governance interventions) within the district. In total, 19 (40.4%) were for Nutrition specific, 25 Acute (53.1%) were in Nutrition sensitive and 3 (6.3%) were for governance interventions. The figure below shows Almost 4 in every 10 children had stunted growth, 15 of every 100 children Respiratory Kaabong District map and the distribution of Nutrition interventions (specific, nutrition sensitive and enabling had wasted bodies and 5 of every10 children lacking enough blood (aneamic). 47% Malaria 21% Diarrhea 54% Infections environment) implemented of households of households KAABONG DISTRICT MAP SHOWING DISTRIBUTION OF NUTRITION 6.3% SPECIFIC, NUTRITION SENSITIVE AND GOVERNANCE INTERVENTIONS 57% are food insecure 35% have food stocks Governance

IMMUNISATION (DPT3) Kamion VIT A SUPPLEMENTATION (12-23mo) LOW BIRTH WEIGHT 93% 78% 10% 70% Kawalakol STUNTING 80% 37 10% STAKEHOLDERS Kathile Kalapata Kapedo Kaabong East 42% overseeing / implementing Lodiko ANAEMIA IN WOMEN interventions Sidok 20% Lobalangit 32% DEWORMING (12-23 mo) Lolelia 12% 66% Source: Food Security and Nutrition Assessment in 8 Loyoro districts of Karamoja 2018, Makerere University School 40.4% 53.1% 100% of Public Health. WASTING ANAEMIA IN CHILDREN Nutrition specific Nutrition sensitive <=14 interventions 15 - 19 interventions >=20 interventions 15% 53% 4% 25% NUTRITION GOVERNANCE INTERVENTIONS TARGET GROUP KAABONG Scale up coverage of optimal breast feeding practices Pregnant and lactating women, Adolescents Girls (10-19Yrs) INFANT AND YOUNG CHILD FEEDING PRACTICES FSNA baseline (2018) Desired situation (2025) WHAT IS NUTRITION GOVERNANCE AND WHY IT IS IMPORTANT FOR NUTRITION Promote infant and young child feeding practises Mothers / caregivers 55% Whereas most children are breastfed, 9 of 10 children do not get minimum acceptable diet OUTCOMES? Promote optimal nutrition Children with special needs 0-11 months (eat inadequate number of meals a day and less variety) for proper growth. Promote appropriate adolescent nutrition Adolescents (Boys & Girls) Governance can be defined with regard to institutional structures, relationships between actors and/or organizations, Scale up and sustain effective coverage Vitamin A Children 6-59 months, postpartum women 100% Min. acceptable diet Min. diet diversity (6-23mo) Min. meal frequency decision-making processes, and incentives. It involves the capacity to act, the power to act and the commitment to act. supplementation to children 6-59months Iron and Folic supplementation to pregnant Pregnant women (15-49) 70% 1% 3% 40% Good nutrition governance entails making adequate policy decisions in a timely manner, committing the necessary Outpatient management of acute malnutrition without Children 0-59 months, Pregnant women (15-49 ) 25% 40% 60% financial and organizational resources to their effective implementation, i.e. ensuring that benefits reach most of the medical complication population, preferably the most vulnerable. It also entails a sustained political commitment to ensure that nutrition Inpatient management of acute malnutrition with medical Children 0-59 months, Pregnant women 25% programs and policies can withstand threats and constraints from changes in district leadership, political and complication Continued breast feeding (2yr) Exclusive breast feeding Breast feeding within first 1 hour socioeconomic upheavals (Solon 2007). Management of moderate acute malnutrition (MAM) Children 0-59 months 50% 76% 96% 89% Provide deworming tablets to children (1-14yrs) Children 12-59 months NUTRITION GOVERNANCE FRAMEWORK Deworming for pregnant women Pregnant women (15-49 yrs) 95% 80% 80% 80% Intermittent Prevention Treatment of malaria (IPT3???) for Pregnant women (15-49 yrs) 50% PILLARS OF GOVERNANCE Pregnant women Scale up and sustain effective coverage of ORS-Zinc for Children 0-59 months Intersectoral Cooperation diahorrea FSNA baseline (2018) Desired situation (2025) WASH STATUS Scale up and sustain coverage of long lasting insecticide Pregnant & Lactating women, Children 55% treated nets (LLINs) Policy Technical Frame Treatment of malaria All 60% Capacity Sustainable Funding Nutrition Works Outcomes Sustain universal coverage of available routine Children 0-59 months, Pregnant women Monitoring immunization services

Stakeholders Vertical Partnership Building Promote EMCT services Pregnant & Lactating mothers 15-49 years with HIV 55% Frame work Information Financial and Communication Management Coordination Coordination and Policy and legal

System Capacity Provide ARV medication to HIV+Ve All HIV +VE incld Pregnant & Lactating mothers 15-49 years 60% Resource Mobilization LATRINE COVERAGE SAFE WATER ACCESS Advocacy with HIV Diet therapy into routine disease therapy Children 12-59 months with special needs (Nutrition Behavior Change. Advocacy) 39% 68% Prevention and Management of diet-related NDCs Women of reproductive age 15-49yrs 25%

95% 87% Source: Institute of Development studies (IDS), 2013 Source: Nutrition Stakeholder Mapping for Uganda Report. 2019