USAID Kenya Nutrition and Health Program Plus
QUARTERLY PROGRESS REPORT
April 01 to June 30, 2019
JULY 2019 This publication was produced for review by the United States Agency for International Development. It was prepared by Kenya Nutrition and Health Program plus
Kenya Nutrition and Health Program plus
Year 5 Quarter 3 Progress Report
April 01 – June 30, 2019
Award No: AID-615-H-15-00001
Prepared for Ruth Tiampati United States Agency for International Development/Kenya C/O American Embassy United Nations Avenue, Gigiri P.O. Box 629, Village Market 00621 Nairobi, Kenya
Prepared by FHI360 Nutrition and Health Program plus 2nd Floor Chancery Building, Valley Road P.O Box 38835 00623 Nairobi, Kenya
DISCLAIMER The authors’ views expressed in this report do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
TABLE OF CONTENTS
TABLE OF CONTENTS ...... I ACRONYMS AND ABBREVIATIONS ...... III EXECUTIVE SUMMARY ...... VI I. INTRODUCTION ...... 10 II. PROJECT IMPLEMENTATION PROGRESS AND KEY ACHIEVEMNETS...... 10 I. IMPROVED ACCESS & DEMAND FOR QUALITY NUTRITION INTERVENTIONS AT COMMUNITY & FACILITY LEVELS ...... 11 1.1. Strengthening Leadership, Advocacy and Policy Planning ...... 11 1.2 Improved Nutrition Service Delivery Management, Coordination and Implementation ...... 14 1.3 Improved Nutrition Related Behaviour ...... 16 1.4 Increasing Opportunities for Learning and Sharing of Best Practices in Nutrition ...... 19 1.5 Increased Knowledge and Skills for Health Care Workers ...... 22 2. STRENGTHENED NUTRITION COMMODITY MANAGEMENT ...... 23 2.1 Improving Production, Supply and Distribution of Nutrition Commodities ...... 23 2.2 Improving Quality and Safety of Food Commodities and Agricultural Products ...... 29 2.3 Strengthening Sustainability and Innovation in Nutrition Commodity Development & Management 29 3.0 IMPROVED FOOD AND NUTRITION SECURITY ...... 31 3.1 Increased Market Access and Consumption of Diverse and Quality Foods ...... 31 3.2 Increased Resilience of Vulnerable Households and Communities ...... 49 4.0 MONITORING AND EVALUATION ...... 57 4.1 Facility Reporting ...... 57 4.2 Electronic Nutrition Reporting ...... 57 4.3 Nutrition Portal...... 58 4.4 SMART Surveys ...... 58 I. ACTIVITY PROGRESS – QUANTITATIVE IMPACT ...... 62 II. RESEARCH AND DEVELOPMENT ...... 68 III. PROGRESS ON LINKS TO OTHER USAID PROGRAMS ...... 73 IV. PROGRESS ON LINKS TO OTHER GOK AGENCIES ...... 73 KNAP LAUNCH ACTIVITIES...... 73 CNAP DEVELOPMENT ...... 73 COHA KENYA STUDY...... 73 V. IMPLEMENTATION CHALLENGES ...... 74 VI. LESSONS LEARNT ...... 74 VII. SUBSEQUENT QUARTER’S WORKPLAN ...... 75 STATUS OF ACTIVITIES PLANNED FOR THE REPORTING PERIOD ...... 75 PLANNED ACTIVITIES FOR THE SUBSEQUENT QUARTER ...... 77 VIII. FINANCIAL INFORMATION ...... 79 IX. PROJECT ADMINISTRATION INFORMATION ...... 83 X. PAYMENT OF FIXED FEE – SCHEDULE AND PERFORMANCE ...... 85 XI. SUCCESS STORIES ...... 86 ANNEX I: PERFORMANCE DATA TABLES ...... 90 ANNEX 1: SUMMARY OF COMMODITIES DISTRIBUTED ...... 90 ANNEX 2: NUMBER OF HIV POSITIVE CLINICALLY MALNOURISHED CLIENTS WHO RECEIVED THERAPEUTIC AND/OR SUPPLEMENTARY FOOD ...... 92 ANNEX 3: NUMBER OF PLHIV NUTRITIONALLY ASSESSED VIA ANTHROPOMETRIC MEASUREMENT ...... 94 ANNEX 4: NUMBER OF CHILDREN UNDER 5 WHO RECEIVED VITAMIN A FROM USG SUPPORTED PROGRAMS ...... 96 ANNEX 5: NUMBER OF PEOPLE TRAINED IN CHILD HEALTH AND NUTRITION THROUGH USG-SUPPORTED PROGRAMS) ...... 97
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ANNEX 6: NUMBER OF CHILDREN UNDER FIVE (0-59 MONTHS) REACHED WITH NUTRITION SPECIFIC INTERVENTIONS BY USG-SUPPORTED NUTRITION PROGRAMS ...... 98 ANNEX 7: NUMBER OF PREGNANT WOMEN REACHED WITH NUTRITION-SPECIFIC INTERVENTIONS THROUGH USG-SUPPORTED PROGRAMS (RAA) ...... 99 ANNEX 8: COMPREHENSIVE NACS IMPLEMENTED PROVIDING SERVICES BEYOND CCC/ART SITES ..... 100 ANNEX II: GIS INFORMATION ON AGRI NUTRITION GROUPS/ACTIVITIES ...... 103
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ACRONYMS AND ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome AMPATHplus Academic Model for Providing Healthcare Plus AMREF African Medical and Research Foundation ANC Antenatal Care APHIAplus AIDS, Population and Health Integrated Project ART Antiretroviral Therapy ASAL Arid and Semi-Arid Lands ASDSP Agricultural Sector Development Support Programme AVCD Accelerated Value Chain Development BCC Behavior Change Communication BFCI Baby Friendly Community Initiative BFHI Baby Friendly Health Facility Initiative CCC Comprehensive Care Centers CDC Centers for Disease Control CEC County Executive Committee CECM County Executive Committee Member CHEW Community Health Extension Worker CHIS Community Health Information System CHV Community Health Volunteer CME Continuous Medical Education CMLAP County Measurements, Learning and Accountability Program CNAP County Nutrition Action Plan CNTF County Nutrition Technical For a COHA Cost of Hunger Africa COR Contracts Officer Representative CORPS Community Own Resource Persons CPHR Centre for Public Health Research CSC CPHR Scientific Committee CU Community Unit DD Dietary Diversity DD-W Dietary Diversity for Women DQA Data Quality Audit DTC Drought Tolerant Crops ECDE Early Childhood Development Education EDARP East Deanery AIDS Relief Program ENP Equatorial Nut Processors – Fortified Ltd FBF Fortified Blended Food FBP Food by Prescription F-CDRR Facility Consumption Data Report and Request FES Focused Ethnographic Studies FEW Frontline Extension Worker FHI Family Health International FNSP Food and Nutrition Security Policy FtF Feed the Future FY Fiscal Year GAM Global Acute Malnutrition GAP Good Agricultural Practices GDP Gross Domestic Production GF Global Fund GMP Growth Monitoring and Promotion/Good Manufacturing Practice GOK Government of Kenya HCW Health Care Worker HiNi/HINI High Impact Nutrition Interventions HIV Human Immunodeficiency Virus HMT Health Management Team
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HTS HIV Testing Services ICP Intra-Cranial Pressure ICRISAT International Crops Research Institute for the Semi-Arid Tropics IEC Information, Education and Communication IFAS Iron and Folic Acid Supplements IGA Income Generating Activity ILRI International Livestock Research Institute IMAM Integrated Management of Acute Malnutrition IP Implementing Partner IR Intermediate Result/Implementation Research IRB Institutional Review Board IUGR Intrauterine Growth Restriction IVCD Inclusive Value chain Development KALRO Kenya Agriculture and Livestock Research Organization KEBS Kenya Bureau of Standards KEMRI Kenya Medical Research Institute KENTTEC Kenya Tsetse and Trypanosomiasis Eradication Council KCDMS Kenya Crops and Dairy Marketing Systems KDHS Kenya Demographic and Health Survey KEBS Kenya Bureau of Standards KEMSA Kenya Medical Supplies Authority KHIS Kenya Health Information System KICC Kenyatta International Conference Centre KIPPRA Kenya Institute of Public Policy Research and Analysis KNAP Kenya Nutrition Action Plan K-RAPID Kenya Resilience Arid Lands Partnerships for Integrated Development KCSAP Kenya Climate Smart Agriculture Project LMS Livestock Market Systems MAD Minimum Acceptable Diet M&E Monitoring and Evaluation MEAL Monitoring, Evaluation, Accountability and Learning MCH Maternal and Child Health MCP Medical Commodities Program MFI Micro-Finance Institutions MIYCN Maternal Infant and Young Child Nutrition MNCH Maternal Newborn and Child Health MOALF(I) Ministry of Agriculture, Livestock Fisheries (and Irrigation) MOE Ministry of Education MOH Ministry of Health MT Metric Ton MtMSG Mother-to-Mother Support Group MUAC Mid-Upper Arm Circumference NACS Nutritional Assessment, Counseling and Support NASCOP National AIDS and STI Control Program NCPB National Cereal Produce and Board NDMA National Drought Management Authority NDU Nutrition and Dietetics Unit NHPplus Nutrition and Health Program Plus NI Nutrition International NIT National Implementation Team NITWG Nutrition Information Technical Working Group NRT Northern Rangelands Trust PACE Policy, Advocacy, and Communication Enhanced (for Population and Reproductive Health) PEPFAR President’s Emergency Program for AIDS Relief PHO Public Health Officer
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PLW Pregnant and Lactating Women PLHIV People Living with HIV PMEP Performance Monitoring and Evaluation Plan PMTCT Prevention of Mother-to-Child Transmission PPB Parts Per Billion PREG Partnerships for Resilience and Economic Growth PrEP Pre-exposure Prophylaxis RCT Randomized Controlled Trial RO Required Outcome RTI Research Triangle Institute RUSF Ready-to-use Supplementary Food RUTF Ready-to-use Therapeutic Food SBC(C) Social Behavior Change (Communication) SBMS Small Busines Management Studies SC Sub-County SCALE+ System-Wide Collaborative Action for Livelihoods and Environment plus SCHMT Sub-County Health Management Team SCHRIO Sub-County Health Records Information Officer SISN Society for implementation Science in Nutrition SMART Standardized Monitoring and Assessment of Relief and Transitions SME Small and Medium Size Enterprise SQA Supplier Quality Audit SRA Short Rains Assessment STI Sexually Transmitted Infections TA Technical Assistance TBD To be Determined TWG Technical Working Group UNICEF United Nations Children’s Fund URC Uganda Research Centre USD United State Dollar USAID United States Agency for International Development USG United States Government VPA Volume Purchase Agreement WASH Water, Sanitation and Hygiene WBW World Breastfeeding Week WEF Women Enterprise Fund WFP World Food Program WHO World Health Organization ZOI Zone of Influence
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EXECUTIVE SUMMARY
The overall goal of the Kenya Nutrition and Health Program Plus (NHPplus) is to improve the nutrition status of Kenyans. Its objectives are to increase access and demand for nutrition services at community and facility levels, and to strengthen HIV nutrition commodity management at national level. The program is designed to advance nutrition through collaboration with Feed the Future (FTF) and Afya partners in Busia, Tharaka Nithi, Kitui, Samburu and Marsabit counties and to implement nutrition-related activities that aim at ending preventable child and maternal deaths, and contribute to reduction of stunting by 10% in its zones of influence. The program uses integrated development approach to address determinants of undernutrition at different levels in the causal chain. The program is in its fifth and final year of implementation and will end on December 31, 2019. This report describes accomplishments of assigned outputs and required outcomes during the period of April to June 2019.
The NHPplus implementation strategy encompasses strengthening public health and food systems through capacity building in nutrition leadership, advocacy and capacity building for multi-sectoral programming and integrated responses, increasing availability and coverage of nutrition-specific services including NACS with High Impact Nutrition Interventions (HINI) beyond HIV and in communities with high prevalence of early childhood undernutrition, scale up of agri-nutrition programming using evidence-based pathways of food production, income generation and women’s empowerment to improve food and nutrition security and social behavior change interventions. Regarding strengthening nutrition commodity supply chain, the program collaborates with local private sector organizations and regulatory bodies to strengthen production systems for diversified high-quality nutritional commodities.
During the quarter, the program supported key staff in the Division of Nutrition and Dietetics (NDU) to undertake training courses in strategic leadership and senior management. Under coordination, the program participated in the planning of the drafting and launch of the Kenya Nutrition Action Plan (KNAP), 2018-2022. The KNAP provides foundation for the development of contextualized County Nutrition Action Plans (CNAP) for the focus counties. In this respect, all five focus counties initiated CNAPs development process within mandates of respective County Nutrition Technical Forums (CNTF). Busia, Samburu and Kitui convened the write-shops during the quarter and have working drafts. In Busia and Tharaka Nithi, the program is collaborating with Nutrition International (NI) to support the design and drafting their respective CNAP. In addition, the program supported coordination meetings of National Technical Working Groups (TWGs) in Maternal, Infant and Young Child Nutrition (MIYCN, HIV Nutrition, Agri-Nutrition (FtF) Partners, Nutrition Commodities and Nutrition Research.
The National Implementing Team (NIT) of the Cost of Hunger Africa Study in Kenya produced the preliminary estimates of economic and social costs of undernutrition in Kenya. Based on the KDHS (2014), the study estimated the cost of undernutrition at US$ 4.2 billion which is equivalent to 6.9% of Gross Domestic Product (GDP). The largest loss was estimated under productivity of adults who experienced early childhood stunting at 94.5%. of GDP loss. The loss from direct cost of rehabilitation of clinically undernourished children and school grade repetition among learners
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accounted for 5.5% of the GDP loss. The findings of the study will be validated during quarter 4 and launch of final report is scheduled to take place in early October 2019. Evidently, the findings of COHA will significantly strengthen advocacy activities aimed at strengthening position of nutrition as a development agenda and mobilizing resources required to implement KNAP and CNAPs.
The direct service delivery activities comprised continuing outreach services and baby friendly community initiative (BFCI) activities. In this regard, the program supported planning and implementation of county wide Malezi bora campaign by county government staff under the direction of public health officers. Community Health Extension Workers (CHEWS) supervised CHVs and other community resource persons who carried out a door to door campaign to encourage uptake of vitamin A supplementation (VAS). Overall coverage of VAS in the focus counties was estimated at 90% of the assigned target of 440,389 children. The uptake ranged between 75% in Marsabit and 96% in Samburu County. The lower coverage in Marsabit was attributed to insecurity in Saku Sub-county. To improve service delivery to 0-23-month-olds, the program supported county department of health, CHVs and lead mothers to mobilize the communities to participate in growth monitoring and promotion. The cumulative performance of this indicator reached 72% of assigned annual target of 60,358 children.
The implementation research study proposal on consumption of iron folate supplements (IFAS) was subjected to peer review and approved for submission to the Institution Review Board at KEMRI. The final proposal included investigations to improve early initiation of antenatal care services to cost analysis of delivery of enhanced IFAS package. Implementation of the proposal entail focused ethnographic analysis of barriers to early service uptake, in depth interviews, monitoring service utilization and activity-based costing. Regarding complementary foods, the program-initiated expansion of the national flour blending policy to include selected legumes in the drought tolerant crops category. The candidate legumes are those with a relatively short cooking time and nil or low proteases (enzyme) inhibitor activity. Sensory evaluation of porridge recipes comprising maize-cowpeas and maize-green grams blended flours as base ingredients showed better acceptance of maize-cowpeas blends (p<0.002). Preliminary assessment of pre- cooked maize-green grams blended flour and use of brown-green grams variety demonstrated improved acceptability of the blended flour.
During the quarter, the program procured 515.7 MT of fortified foods products and distributed 316.5 MT to 275 facilities in 38 counties. Cumulatively the program procured 1472 MT of FBF or 87.4% of approved annual target. The program served 37,081 patients bringing the cumulative total to 123,660 patients or 85.7 % of assigned annual targets. In addition, the program participated in the national quantification of HIV commodities workshop during which targets for FY19 and planning for FY19 to FY 22 was carried out. The workshop streamlined distribution of FBF and RUSF commodities to eliminate overlaps and quantified anthropometric equipment requirements. Furthermore, in response to direction by USAID regarding transition of procurement, ware housing and distribution functions to KEMSA/MCP, an inception meeting was held and actions with timelines that will ensure a seamless transition were recommended. In this regard, it was envisioned that NHPplus procurement and distribution functions will end on September 30, 2019
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and October 31, 2019 respectively. Both programs agreed to reach out to USAID regarding clarification of priority counties/sites during FY2020.
To address required diversification of nutrition commodities, the program supported Kenya Bureau of Standards (KEBS) to convene a national level consultative meeting to review the East African Standard on fortified composite flours. A technical expert meeting reviewed four standards related to the subject matter namely, specification for fortified composite flours, specification for food fortification pre-mixes, guidelines for monitoring and sampling of fortified food products and processed cereal based foods for older infants and young children. The draft recommendations of the experts meeting will be presented to the National Technical Committee on Nutrition and Foods for Special Dietary Uses during the 4th quarter for review and consensus on the national position before submission to East African Community Standards Committee for regional consideration.
Regarding nutrition sensitive interventions, the agriculture component of the program focused on strengthening multi-sectoral approach to improve food and nutrition security and building resilience of vulnerable households. Of special interest was contextualized dietary diversification skills and cooking demonstrations to achieve minimum acceptable diets (MAD) for children under 5 years and dietary diversity for women of reproductive age (DD-W). The frontline implementers comprising CHEWs, FEWs, ECDE staff, CHVs and other Community Resource Persons reached 10,754 adults (10,130 women and 624 men) in the five focus counties. To further improve service delivery by frontline agri-nutrition implementers, 525 agri-nutrition dialogue cards were distributed to the zones of influence. The cards along with agri-nutrition curriculum that is underway will contribute to the trans generational continuity of agri-nutrition practices among the youth through sensitizing them with the ‘why and how’ of food security and dietary diversity. WASH interventions and economic empowerment were embedded in these interventions. Along the production pathway knowledge and skills development for production of diversified foods, 19 demonstration gardens were established (38% of the annual target of 50) benefitting 1,594 households. The program continued supporting contextualized production interventions appropriate for each agro-climatic zone. The priority technologies included waters harvesting technology, drought tolerant crops, intensive home gardening technologies, gooseberry and groundnut production, chicken rearing technology (synchronization model), rabbit keeping and fodder preservation. In the learning sites in Kitui East sub-county and Laisamis sub-county, consumption of blended flours made from locally available grains was intensified. The choice of novel porridges facilitated demonstration of enrichment with oil and milk to improve energy and nutrient density. The program provided technical assistance to RTI/KCDMS program through training 26 implementers on agri-business and value chain development and analysis. The participants were drawn from Sixteen (16) KCDMS implementing firms situated in Kisumu, Busia, Homa Bay, Migori, Kisii, Siaya and Bungoma counties. The aim was to build capacity of the implementers to make informed decisions on choice of value chains and entry point within a market system. The enhanced capacity is intended to significantly reduce chances of failure. It is expected that the beneficiary firms will link with the program supported 105 community groups in Kitui and 42 groups in Busia. Other efforts included linking of 70 beneficiaries with private financial sector players and the microfinance institutions (MFIs), Women Enterprise Fund (WEF), UWEZO Fund
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and Centenary SACCO took place in Tharaka Nithi. The intention was to facilitate transformation of small individual businesses into micro- and small enterprises with a view to stimulate growth in demand for services and financial products. Promotion of SCALE+ methodology in all the counties significantly strengthened collaboration between stakeholders with networks for specific interventions. In Tharaka Nithi the Food Safety network for aggregators and processors demonstrated early maturity since they held own meetings and activities without support from the program. The network also organized activities to inspect all milling plants with the aim of checking cleanliness of the machines and quality control of the products. Plans by trained aggregators were made in the region to educate the farmers on good agricultural practices (GAP) and good manufacturing practices (GMP) with respect to aflatoxin control. Program supported acquisition of data on aflatoxin contamination of groundnuts and cereals to motivate implementation of the county-owned food quality and safety improvement interventions.
The findings of SMART surveys in Samburu and Marsabit Counties demonstrated a decline in prevalence of stunting by about 6.5% between 2018 (35.8% in Samburu and 28.3% in Marsabit) and 2019 (29.3% in Samburu and 21.1% in Marsabit). While changes in the prevalence of underweight children during the two years were relatively small, Marsabit experienced an increase in global acute malnutrition (GAM) from 12.4% to 18%. The distribution of Z-scores showed that overall only 5.9% of under 5-year-olds children had optimal growth in weight in Laisamis/North Horr, Marsabit. The proportions of children with a positive weight for age Z- score in Saku/Moyale and Samburu county waere 17.6% and 11.5% respectively. Similarly, positive height for age Z scores was observed in 13.6%, 19.4% and 17.1% of children in Laisamis/North Horr, Saku/Moyale and Samburu County in that order. The mean weight for age Z-score decreased with increasing age in all three sites. This observation underscored inadequate catch up growth. The distribution of mean height for age Z-score was consistent with loss in growth velocity peaking at 18-23 months and subsequent recovery tendencies shown by downward trend in the mean Z-score. The findings of these surveys underlined major nutrient and energy deficits even in settings where prevalence of stunting and underweight appeared reasonably stable or improved.
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I. INTRODUCTION
The Kenya Nutrition and Health Program Plus (NHPplus) aims to improve the nutrition status of Kenyans through increasing access and demand for quality nutrition services at community and facility levels, strengthening nutrition commodity management and improving food and nutrition security. At the national level NHPplus works to expand Nutrition Assessment Counseling and Support (NACS) services beyond HIV and provide technical and financial support to roll-out NACS to include High Impact Nutrition Interventions (HINI). In the focus counties of Busia, Marsabit, Tharaka Nithi, Kitui and Samburu, the program is implementing Maternal Newborn and Child Health (MNCH) activities that aim at ending preventable child and maternal deaths through ensuring a greater effect for women and children under two years with regards to nutrition. Additionally, NHPplus collaborates with Feed the Future (FtF) implementing partners in strengthening food and nutrition security through implementation of nutrition-sensitive and agri- nutrition activities with the object to contribute to reduction of stunting by 10% in its zones of influence within the focus counties.
NHPplus uses an integrated approach towards both underlying and systemic causes, as well as immediate determinants of malnutrition through systems strengthening and service delivery. The approach encompasses strengthening public health and food systems through the following: capacity building of institutions, leadership and advocacy; multi-sectoral capacity strengthening and technical assistance for numerous-sectoral nutrition coordination and data management/monitoring and evaluation (M&E) support to health managers and workers at both National and Focus County levels; capacity building for multi-sectoral teams to inform and increase the coverage of nutrition services at high volume facilities in areas with the highest burden of HIV; support for efficiencies in nutrition commodity procurement, management, distribution, quality control and safety; partnering with stakeholders to impact good nutrition through scale up of nutrition-sensitive and social behavior change interventions including HINI, NACS, maternal child health (MCH) and community service delivery platforms; multi-sectoral agri-nutrition programming using evidence-based pathways of food production, income generation and women’s empowerment; and other nutrition sensitive approaches to address malnutrition during the first 1,000 days “window of opportunity in the focus counties.
Now in its fifth and final year of implementation since 01 January 2015, this report describes progress and accomplishments of NHPplus assigned outputs and outcomes during the period of April 01 to June 30, 2019.
II. PROJECT IMPLEMENTATION PROGRESS AND KEY ACHIEVEMNETS
This section outlines the project implementation progress and key achievements in line with the specific intermediate result areas (IRs), sub-IRs and, to varying extents, the required outcomes (ROs) under each sub-IR.
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I. Improved Access & Demand for Quality Nutrition Interventions at Community & Facility Levels
1.1. Strengthening Leadership, Advocacy and Policy Planning
1.1.1 Strengthened long term capacity of the government of Kenya (GOK) and other stakeholders to direct, manage and finance Kenya’s nutrition programs NHPplus targeted to build capacity of seven (7) officers in the FY19 as part of ongoing efforts towards strengthening capacity for leadership in nutrition. This quarter the program facilitated four (4) senior officers at national level who included the Head Division of Nutrition and three program officers to undertake leadership and senior management courses. The Head, Division of Nutrition, Veronica Kirogo, enrolled at Strathmore Business School for the six-month leadership course on Leading High-Performance Health Organizations. John Mwai, Food Fortification lead, Immaculate Nyaugo, Nutrition Sensitive Lead, and Lucy Maina, Clinical Nutrition lead, were successfully admitted at Kenya School of Government for the six-week course on Strategic Leadership and Senior Management respectively.
The program has over the last four years facilitated training of 13 senior officers at national and county levels to address capacity gaps in nutrition. However, for these gains to be sustained beyond the life of the program, wider governance reforms are required to ensure nutrition sector embraces an all-inclusive-rights-based approach to nutrition service delivery. Thereby, translate to proper institutionalization that ensures good governance and effective community participation; a key pre- requisite to achievement of self-reliance and long-term sustainability of nutrition programming
1.1.2 Strengthened country capacity for multi-sectoral planning processes and establishing linkages between strategic planning, budgeting and resource use Kenya Nutrition Action Plan 2018 – 2023 During this reporting period, NHPplus participated in national level planning meetings for the launch of the Kenya Nutrition Action Plan (KNAP) 2018–2022 scheduled to take place during the Health Summit at the Kenyatta International Conference Centre (KICC) in Nairobi, on August 14, 2019.
The KNAP (2018–2022) is an evidence-based five-year strategic action plan that seeks to address malnutrition in Kenya in all its forms and for all ages. It is the second National Nutrition Action Plan for the implementation of the Kenya Food and Nutrition Security Policy (FNSP) 2011, after the first National Nutrition Action Plan (NNAP) 2012–2017, building on the success, limitations and opportunities of the previous five years. The plan applies a life-course approach and promotes cross-sectoral collaboration to address the social determinants of malnutrition sustainably. The overall expected result of the KNAP is Kenyans achieving optimal nutrition for a healthier and better-quality life and improved productivity for the country’s accelerated social and economic growth.
The KNAP development process was driven by government through the Division of Nutrition, Ministry of Health. The process involved wide consultation with all key stakeholders including line ministries, county governments, development partners and donor agencies, civil society organizations, research and academic institutions and the private sector. The process recognized 11 FY 19 Q3April-June Quarterly Report
successes, challenges and lessons learnt from the implementation of the 2012–2017 NNAP. The KNAP has been organized into eight chapters as follows: Chapter 1, the introduction, discusses the global, regional and national frameworks under which the KNAP is anchored, the 2018–2022 KNAP development process including the review of the 2012–2017 NNAP, and the main users/audience for the NNAP. A comprehensive nutrition situation trend analysis is presented in Chapter 2, while Chapter 3 presents the KNAP design framework including its rationale, theory of change and objectives. Chapter 4 presents the key result areas, and challenges, strategic objectives, key strategies and interventions and the expected outcomes. Chapters 5 and 6 present the resource needs of the KNAP and the Monitoring, Evaluation, Accountability and Learning (MEAL) Framework respectively. Chapter 7 discusses institutional and legal frameworks for the KNAP while Chapter 8 deals with risk assessment, analysis and mitigation. The KNAP is structured into three main result areas with corresponding interventions. These include nutrition- specific, nutrition-sensitive and enabling environment.
Development of County Nutrition Action Plans As outlined in the FY19 Workplan, the program supported activities at national and county levels for the development of County Nutrition Action Plans (CNAP) in the five focus counties. At national level, the program facilitated a meeting with the national KNAP technical team to develop the scope of work that will guide the development of CNAPs. The outcome of this consultation was an outline of steps for CNAP development as summarized below: • Step 1: CNAP preparatory activities – Key informant interviews with selected county level respondents and desk review of relevant county documents • Step 2: Formation of CNAP secretariat through nomination of various representatives from departments of agriculture, education, labour – social protection and health. The County Executive Committee Member (CECM) for Health will send letters of request for nomination of representatives to CNAP secretariat • Step 3: CNAP Secretariat Inception meeting to nominate leader, identify the relevant key result areas for the county and schedule the follow-on CNAP activities i.e. three write-shops, stakeholder validation meeting, and meeting with CECMs and Governor. • Step 4: Oversight and technical assistance by National government. The Division of Nutrition assigned four officers to provide technical assistance to the counties. Namely, Betty Samburu, John Mwai, Leila Akinyi and Florence Mugo.
Currently, all the five counties have completed step 2 as listed above. Busia, Kitui and Samburu have conducted first write-shop and have working draft document.
As part of co-creation activities, the program will collaborate with Nutrition International (NI) to facilitate the development of CNAPs in Busia and Tharaka Nithi Counties. NI committed resources for consultants, CNAP printing and launch. NHPplus will facilitate all secretariat activities and linkage with national team. The program will also facilitate dissemination of CNAPs to county assembly.
1.1.3 Strengthened coordination with non-health sector ministries, partners, programs and projects for improved nutrition NHPplus participated in several strategic technical working groups at national and county levels. The key outcomes form these meetings are summarized in Table 1. 12 FY 19 Q3April-June Quarterly Report
Table 1: Key Outcomes of Strategic Technical Working Group (TWG) Meetings Technical Working Group Month Key Outcome Maternal, Infant and Young May • Review of baby friendly community initiative (BFCI) Child Nutrition (MIYCN) June internal & external assessment tools • Strategy to revamp MIYCN TWG • World Breastfeeding Week (WBW) week activities and budget Nutrition Information June • Presentation of Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology for Marsabit and Samburu counties Nutrition Research May • Presentation of Implementation Research proposal for iron and folic acid supplementation (IFAS) at Kenya Medical Research Institution (KEMRI) Centre for Public Health Research (CPHR) scientific committee FtF Partners Agri-Nutrition May • Documentation of progress for learning questions (Ag Nut) HIV Commodities June • Nutrition Commodities Quantification Plan for FY2020 - 2023 HIV Nutrition TWG May • Review and development of Nutrition & HIV job aids June MOALFI – Third Ag Nut April • Concept note, call for abstracts and conference poster Conference Planning May Secretariat June County Nutrition Technical April • Formation of CNAP secretariat Forum (CNTF) – Busia • Malezi Bora joint planning CNTF – Kitui CNTF – Marsabit May • Formation of CNAP secretariat CNTF – Samburu May • Malezi Bora joint planning • SMART survey planning
1.1.4 Strengthened capacity of policy makers to advocate for nutrition Cost of Hunger Africa (COHA)Study - Kenya The COHA Kenya study is on track for completion by end of September 2019 with national launch scheduled for October 03, 2019 by the Head of State. This activity is coordinated by a multisectoral national implementing team (NIT) led by The National Treasury. The initial results of the Social and Economic Cost of Undernutrition in Kenya study show that Kenya Shillings (Ksh.)373.9 billion or US$4.2 billion were lost in the year 2014 (the reference year for study based on latest Kenya Demographic and Health Survey - KDHS) as a result of child undernutrition. This is equivalent to 6.9 percent of gross domestic product (GDP).
Social and Economic Impacts on Health Based on the differential probability analysis undertaken with KDHS data in Kenya, underweight children under 5 years had an increased risk of diarrhoea (of 4.1 percentage points), and an increased risk of fever/malaria (equal to 1.8 percentage points). In 2014, there were 2.2 million incremental episodes of illness related to diseases associated with underweight which incurred a cost of an estimated KShs.17.8 billion or US$202 million. In addition, pathologies related to calorie and protein deficiencies and low birth weight associated with intrauterine growth restriction (IUGR), totalled more than 174,822 episodes in 2014; and incurred a cost of an estimated Ksh.
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808 million or US$ 9.2 million. Most of these costs incurred were associated with the protocol required to bring an underweight child back to a proper nutritional status, which often requires therapeutic feeding. An important element to highlight is the increased costs generated by the treatment of low birth weight children. These cases represented 2.21 percent of all the episodes but generated 25.5 per cent of the total cost of treatment. The total cost to the health system is Ksh. 18.6 billion or US$212 million.
Social and Economic Impacts on Education The repetition rate for stunted children in 2014 was 6.7 percent, as compared to 2.8 percent for non-stunted children, i.e., an incremental risk of 2 percentage points for stunted children. Thus, given the proportion of stunted students, the model estimates that 94,708 students or 18.9 percent of all repetitions in 2014 were associated with stunting, which cost Kenyan families and the education system Ksh. 3.2 billion or US$ 36 million.
Social and Economic Impacts on Productivity In Kenya 25.2 percent of the working age population were stunted as children. Research shows that adults who suffered from stunting as children are less productive than non-stunted workers and are less able to contribute to the economy. This represents approximately 14.3 million people whose potential productivity is affected by undernutrition. The model estimated an annual loss in potential income of Ksh.352 billion (US$4billion), equivalent to 6.52 percent of the GDP in 2014 due to lower productivity.
COHA Advocacy Plan Using a collaborative approach, NHPplus has facilitated nutrition advocacy using the COHA Kenya study, the estimates generated from the Kenya model as summarised above, are the cornerstone of nutrition advocacy. Nutrition advocacy is a platform to create movement toward greater political and social commitment for nutrition in Kenya. It is a planned, systematic, and deliberate process that is defined and shaped by the Kenyan context. It engages national stakeholders by using a participatory and consensus-building approach towards a shared national vision for nutrition.
The COHA Kenya Report shall be completed by 30 September 2019. The study results shall be used to engage government and other high-level stakeholders in a collaborative nutrition advocacy process to identify, prioritize, and advocate for evidence-based actions to reduce malnutrition. Such actions may include developing or refining policies, implementing existing policies, identifying priority geographic areas in which selected interventions should be focused, scaling up current interventions, and introducing new nutrition interventions, among others.
1.2 Improved Nutrition Service Delivery Management, Coordination and Implementation
1.2.2 Strengthened capacity at community, dispensary and health center levels for targeted interventions as dictated by local nutrition needs and context Malezi Bora Activities
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The strategy for this year’s semester one Malezi bora was based on utilizing investments made through community level activities i.e. BFCI and Growth Monitoring and Promotion (GMP). Experience over the last four years has demonstrated that successful Malezi bora campaigns are products of meticulous results-based planning at sub county level guided by targets granulated to ward level; and aggressive community driven door-to-door mobilization by ward level teams. The semester 1 2019 Malezi bora planning begun in April at sub county level with review and development of targets for all wards. This was followed by request and distribution of the vitamin A supplements and lastly mobilization of resources and teams for supplementation activities in May. The supplementation activities conducted include: door-to-door mobilization by community health volunteers (CHVs), supplementation at village level, daily targets appraisal by public health officers (PHOs) and community health extension workers (CHEWs), and data entry review meetings at sub county level. Table 2 summarizes performance of semester 1 Malezi bora in the focus counties while performance by specific sub-counties is shown in Annex 9.
Table 2: Semester 1 Vitamin A Supplementation Coverage of Under-fives in Focus Counties Targets for Children under five Performance for Semester 1 2019 % County Children 6 – 11 Children 12 – 59 Children 6 - 11 Children 12 - 59 Coverage Months Months Months Months Busia 25,480 122,629 39,730 98,855 94% Kitui 28,376 142,429 38,702 122,551 94% Marsabit 9,807 43,096 9,573 30,357 75% Samburu 8,509 44,746 12,247 38,699 96% Tharaka Nithi 9,874 47,649 7,710 37,548 79% Total 82,046 400,548 107,962 328,010 90% Source: Kenya Health Information System (KHIS) 2019
The program achieved 90% coverage of the population of children under five years during this year’s semester 1 Malezi bora.
1.2.3 Increased capacity of community units to mobilize communities to demand quality nutrition services
Child Growth Assessment/ Growth Monitoring To increase capacity of community units to mobilize and create demand for child growth assessment, the program conducted outreach activities at village level targeting children under two years. The program conducted the following strategic activities to achieve the target of assessing 25,327: • Sub county health management team (HMT) planning meetings to develop monitoring and movement plans for outreaches • One day sensitization of sub county teams and Community Units (CU) by Sub county nutrition officers, and Community Focal person • Village level door-to-door social mobilization for three days by CHVs and lead mothers using standardized messaging • Conducting Growth monitoring integrated outreaches during market days, at early childhood development education (ECDE) centre. Table 3 shows the number of children 0 – 23 months old reached through Growth monitoring and promotion (GMP) activities. • Sub county level data review meeting and reporting of data on KHIS
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Table 3: Number of Children Under-two Years Reached through Growth Monitoring and Promotion Activities at Community Level in Focus Counties Number of children under two (0-23 months) reached with community- County level nutrition interventions through USG-supported programs Target FY19 Total Achievement in Quarter 3 Busia 13,900 6,975 Kitui 21,491 4,523 Marsabit 9,966 4,349 Samburu 9,880 2,036 Tharaka Nithi 5,121 5,251 Grand Total 60,358 23,134
The overall program performance for children under-two years reached by the end of this reporting period was 72%.
1.3 Improved Nutrition Related Behaviour Baby Friendly Community Initiative (BFCI) Villages implementing BFCI By the end of quarter three the program had covered a total of 489 villages with BFCI using 566 trained CHVs. Figure 1 illustrates the number of villages covered with BFCI by sub county in the focus counties. Details on the number villages covered with BFCI villages covered and the number of related CHVs by community unit, ward, sub-county and county are summarized in Annex 10
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Villages Implementing BFCI
Tharaka-South 33
Nithi Tharaka-North 29 Tharaka Samburu North 26 Samburu East 42
Samburu Samburu Central 17 Saku 28 Moyale 12
Marsabit Laisamis 28 Mwingi North 51 Mwingi Central 22
Kitui Kitui South 42 Kitui East 40 Teso North 40
Samia 51 Busia Nambale 28
0 10 20 30 40 50 60 # of Villages Covered
Figure 1: Number of Villages Covered with BFCI by Sub-County in the Five Focus Counties.
BFCI assessment of community units for certification The FY19 work plan targets BFCI certification of five community units (CUs). In preparation for certification by national MIYCN TWG, the program conducted an internal appraisal of BFCI implementation activities in five community units in Kitui and Tharaka Nithi as listed in Table 4. The selected CUs had been implementing BFCI interventions for at least one year. The assessment provided an opportunity for learning through challenges identified, address gaps in implementation of BFCI activities and provide guidance on sustaining baby friendly supportive environment within the villages covered.
Table 4: Community Units Appraised for BFCI Implementation in Kitui and Tharaka Nithi Counties County Sub County Ward Community Unit Appraised Kitui Mwingi Central Waita/Mwambui Mwambui Thonoa Waita Mwingi North Kyuso Kimu Mumoni Kakuyu/Kyanduli Tharaka Gakombe Tharaka Tharaka North Gatunga Kathangachini Nithi Tharaka South Nkondi Matakiri
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The BFCI External Assessment tool was used to interview respondents and make observations at facility and community level. The respondents were selected randomly and included pregnant mothers, mothers with children less than 6 months old, mothers with children 6 – 23 months old, health facility staff and CHVs. A total of 599 respondents were interviewed. Table 5 summarizes information on respondents.
Table 5: Respondents of the BFCI Internal Appraisal in Kitui and Tharaka Nithi Counties County Sub Community Unit # of # of Health # of Community # of County Facilities Care Workers Health Volunteers Mothers Kitui Mwingi Waita 1 8 25 134 Central Mwingi Kakuyu/Kyanduli 1 5 6 82 North Gakombe 1 4 7 78 Tharaka Tharaka Kathangachini 1 6 11 81 Nithi North Tharaka Matakiri 1 5 11 96 South Total 5 28 60 471
The findings from the assessment indicate that only one of the five CUs is on track for BFCI certification. The Tharaka North, Kathangachini CU attained an overall score of 73% thereby is likely to receive BFCI certificate of Commitment (Table 6). The other four CUs attained scores less than 49% and hence need to address critical gaps before the follow up assessment in three months.
Table 6: BFCI Internal Assessment Scores by Implementation Step and Community Unit BFCI Program Assigned Score Attained by Community Unit Implementation Score Kathangachini Matakiri Waita Gakombe Kakuyu/ Step Kyanduli Step 1: Policy 3 3 2 3 2 2 Step 2: Training 4 2 0 1 3 2 Step 3: Maternal 7 6 4 4 5 1 Nutrition Step 4: Information 26 15 2 3 7 3 on breastfeeding Step 5: Support for 18 18 9.5 10 6.5 11 breastfeeding Step 6: Sustained 22 14 11 5 2 3 Lactation Step 7: Breastfeeding 6 4 2.5 2.5 2.5 1 environment Step 8: Collaboration 14 11 10 9 8 6 Support Total Score 100 73 41 37.5 36 29
The interpretation of assessment scores is as follows: • 0 – 49% is Poor. Actions for CU include: Review implementation activities, address gaps and reschedule self –assessment.
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• 50 – 79% is Satisfactory: CU should address existing gaps and request for external assessment. It is likely to receive BFCI certificate of commitment. • 80 – 100% is Good. The CU should address existing gaps and request for external assessment in readiness for achieving BFCI certification.
1.4 Increasing Opportunities for Learning and Sharing of Best Practices in Nutrition Towards undertaking implementation research on IFAS, several activities were conducted during the quarter, including development of the proposal and stakeholder engagement through presentation of the proposal to KEMRI/CPHR scientific committee and participation in Society for Implementation Science in Nutrition (SISN) webinar.
Development of Implementation Research (IR) Study Proposal The development of the IR study proposal was an iterative process that involved a team of collaborators from four institutions namely Kenya Medical Research Institute (KEMRI), Nutrition International (NI), Ministry of Health (MOH) and Family Health International (FHI360). This team of collaborators represented the Principal, Co-Principal and Co – investigators for the study. The principal investigator for the study was selected from KEMRI and Co – Principal Investigator from FHI360.
The process of developing the IR study proposal was broken into four steps: (1) Development of the objectives and methodology (2) Stakeholder consultation and review (3) External Review and (4) Proposal finalization and submission to IRB
Development of IR Objectives and Methodology The development of IR study objectives and methodology was done collaboratively by three institutions i.e. KEMRI, SISN and FHI360. A review of the bottleneck assessment report was conducted whereby the overall goal as provided by workshop participants was refined to guide in development of the main objective of the study. The common goal identified during the bottleneck assessment workshop was as follows “Reduce iron deficiency anaemia among pregnant women through increased consumption of IFAS for at least 90 days by use of CHV to: map, identify and refer pregnant women; promote disclosure of pregnancy and subsequent initiation of focused antenatal care (FANC) services; and provide interpersonal counselling on maternal nutrition.” This was followed by drafting of the study objectives.
Defining IR Objectives The study objectives were discussed via skype calls and meetings to develop consensus on coherence to implementation science initiative vis-à-vis conventional research. The outcome of these consultations was agreement on overarching research question, goal of the proposal and implementation objective.
Overarching Research Question “How can the implementation of an enhanced package for IFAS address some major implementation bottlenecks and increase the early initiation of FANC and adherence to IFAS among pregnant women?”
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Program goal To improve the delivery of defined community activities related to IFAS and assess their effects on increasing early initiation of FANC and adherence to IFAS for at least 90 days by pregnant women.
Implementation objective To strengthen the delivery of an enhanced package for IFAS using active community units implementing BFCI.
The specific objectives of the IR study are as follows: 1. To investigate the barriers of early initiation of FANC package of services, including the late disclosure of pregnancy and subsequent FANC visit 2. To examine the implementation process of an enhanced package for IFAS that uses the active BFCI community units 3. To determine the effectiveness of the enhanced package for IFAS on early initiation of FANC and adherence to 90-day consumption of IFAS 4. To assess the feasibility of the enhanced package for IFAS through program cost analysis of the enhanced package for IFAS
Methodology The first objective on the barriers for early initiation of FANC will involve focused ethnographic studies and will be done early to better understand the barriers and potentially act upon some of them through the implementation of the enhanced package for IFAS. The second objective will involve a process evaluation that will document and follow closely the implementation of the package and some changes that may occur during this initiative. The third one on the effectiveness of the enhanced package will require collecting baseline and end line data. Finally, a cost-analysis will be carried out to assess one aspect of the feasibility of carrying out this enhanced implementation package. Figure 2 summarizes the data collection process for the IR study.
Obj 1: Focused IR ques ons ethnographic study on 1. What are some barriers to early ini a on of FANC? 2. When do the women disclose their pregnancy? barriers of early ini a on Obj 4: Cost of FANC visit 3. Does late disclosure of pregnancy affect the ini a on of FANC visits? analysis (feasibility) Baseline Obj 3: IR ques ons Evalua on of 1. How much Obj 2: Process INTERVENTION ARM COMPARISON ARM enhanced addi onal evalua on of the package cost did the Enhanced package for IFAS delivered enhanced package Standard package effec veness enhanced through BFCI pla orm delivered through BFCI package IR ques ons Community level: pla orm Effec veness require? 1. To what extent was • Mapping of household Community level: ques ons the enhanced • Use of Familia Bora score card and • Mapping without 1. Did women package delivered? CHV informa on bo4o-Cklaeltl w Twaha and Sara_18.09.2018_Part I 4-Call w Twaha and Sara_18.09.2018_Part I emphasis on the a end FANC 2. What cons tuted • Provision and use of Mother Child implementa on earlier? the enhanced Handbook process 2. Did it improve package? Facility level: Facility level: the quality of 3. What were the • Monthly review of indicators • Review with no the supply challenges and rela ng to coverage of IFAS focus on IFAS system, improvements • Review of facility level commodity indicators counseling and made? status including IFAS indicators mobilizing?
Endline Figure 2: Overview of Implementation Research Study 20 FY 19 Q3April-June Quarterly Report
Data Collection Tools The IR study will employ robust data collection tools for each of the specific objectives as summarised in Table 7.
Table 7: Proposed Data Collection Methodology and Tools by Specific Study Objective Objective Methodology Data collection tools Investigate the barriers of early Focussed Design of key informant interviews and initiation of FANC package of Ethnographic observations will be guided by advisory services studies group and structured as modules Examine the implementation process In depth interviews Maternal Nutrition KAP structured of an enhanced package for IFAS questionnaire Determine the effectiveness of the Service level Mother Child Handbook – ANC enhanced package for IFAS on early monitoring profile initiation of FANC Assess the operational cost of the Activity Based Activity budgets and accrual reports enhanced package for IFAS Costing
Preliminary Review of the Implementation Research Proposal Following the development of the zero draft of the IR proposal, the process of external review was initiated by an internal review at the KEMRI/CPHR. Two reviewers were identified namely Dr Violet Wanjihia and Dr Joseph Mutai who reviewed the proposal and comments shared to Centre for Public Health Scientific Committee. The Co-Principal investigator and other Co- investigators were invited for an oral presentation of the proposal to the scientific committee. After presentation the comments from reviewers were shared with the panel and discussed. The committee raised several concerns, for example on the methodology, sampling and overall structure of the proposal, however, the proposal was approved with major changes. This meant that all the comments had to be addressed and proposal submitted to reviewers for confirmation and registration with IRB.
Stakeholder Engagements As part of the development process for the IR proposal on IFAS, several stakeholder engagements were conducted during the reporting period. Implementation Science Initiative Webinar- 17 April 2019 This joint webinar was carried out to share the progress and provide insights to the experiences from Kenya and Uganda on principles of implementation science. Of the 137 people who registered for the webinar, 70 participants attended and stayed on to the end of the conversation. Three panellists from SISN, Uganda Research Centre (URC) and FHI360 Kenya. Overall, 21 attendees completed feedback survey and majority indicated that they were very satisfied and would recommend the webinar. A recording of this webinar is available on SISN website (https://www.implementnutrition.org/webinars/) Technical Team Meetings During the proposal development, stakeholder engagements were focussed at national level. Several meetings were conducted during the development of the IR proposal with the technical team. Following the bottleneck assessment report, a meeting was held to review and identify key bottlenecks to inform drafting of the IR objectives. This was then followed by meeting to review draft objectives based on discussions with SISN technical team. Following consensus on objectives, the three chapters of proposal (introduction, literature review and methodology) were 21 FY 19 Q3April-June Quarterly Report
drafted for discussion and review. A consultative meeting to review methodology and data collection approaches was held during which it was agreed that the IR proposal adopt a hybrid design methodology. The first presentation of the protocol to the full technical team was done in preparation for the KEMRI/CPHR Scientific Committee (CSC), after which it was presented to the committee and accepted with major changes. A follow up meeting was held to review the comments and prepare responses to reviews from KEMRI. Finally, a skype call was conducted with current Chair of Society for Implementation Science (SISN), Prof Gretel Pelto to discuss use of Focussed Ethnographic Studies (FES) as a method of investigating barriers to IFAS consumption. Following this call, changes were made to the methodology for inclusion of FES for first specific objective of the study. Table 8 summarizes the stakeholder engagement activities during development of IR proposal.
Table 8: Stakeholder Engagement Activities during Development of Implementation Research Proposal Date Stakeholder Engagement Activity Organizations 2 May Review of objectives and mapping of data collection KEMRI, FHI360, SISN approaches 13 May Technical Team Meeting MOH, Nutrition International, SISN, KEMRI, FHI360 22 May Presentation of IR proposal at KEMRI CSC FHI360, KEMRI 18 Jun Skype Call with Prof Gretel on use FES approach FHI360, SISN, KEMRI 24 Jun Review of responses based on CSC presentation and Nutrition International, finalization for IRB KEMRI, FHI360
1.5 Increased Knowledge and Skills for Health Care Workers Summary of Trainings During the Quarter As part of improving quality for nutrition service delivery the program conducted training for nutrition officers newly hired by Kitui county for various sub counties. This sensitization on NACS/IMAM is part of building sustainability and self-reliance for nutrition specific activities. Table 9 summarizes the participants for three-day sensitization. Details of the training are provided in section 2.1.
Table 9: Nutrition Specific Training Participants by Sub-County in Kitui County County Sub County Training Title F M Total Kitui Mwingi North NACS/Integrated Management of Acute 3 1 4 Mwingi Central Malnutrition (IMAM) three-day Sensitization 5 2 7 Kitui South 3 0 3 Kitui East 2 1 3 Kitui Central 7 0 7 Kitui West 3 0 3 Kitui Rural 3 0 3 Mwingi West 1 0 1 Grand Total 27 4 31
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2. Strengthened Nutrition Commodity Management
2.1 Improving Production, Supply and Distribution of Nutrition Commodities
The program, by the end of the reporting period, had cumulatively procured 1,472.4 metric tons (MT), (87.4% of annual target) and distributed 1,063.21 MT of Fortified Blended Flours (FBF) reaching 123,660 patients against the annual target of 144,278 (85.7%). During the quarter, the program focused on close out activities including the transition of procurement, warehousing and distribution components to the Kenya Medical Supplies Authority (KEMSA). An initial introductory meeting was held, and a plan developed as shared later in this report.
NHPplus engaged the Kenya Bureau of Standards (KEBS) through facilitation of a workshop to review the draft East Africa Standards on composite flours with the aim of adopting/aligning to the National Standards. This will be a guide to both market leaders in this sector as well as the small and medium size enterprises (SMEs), creating a diverse range of safe and reliable nutritional products in the local market.
Procurement and Distribution of Commodities During the quarter the program had procured 515.7MT of FBF and distributed 316.53 MT across 275 health facilities in 38 counties to reach 37,081 patients as summarized in Figure 3.
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Trends 900 300000
800 250000 700
600 200000
500 150000 400
300 100000 NumberPatients of
Number Metric of Tonnes 200 50000 100
0 0 Y1-Q2 Y1-Q3 Y1-Q4 Y2-Q1 Y2-Q2 Y2-Q3 Y2-Q4 Y3-Q1 Y3-Q2 Y3-Q3 Y3-Q4 Y4-Q1 Y4-Q2 Y4-Q3 Y4-Q4 Y5-Q1 Y5-Q2 Y5-Q3 (Jan- (Apr- (Jul- (Oct- (Jan- (Apr- (Jul- (Oct- (Jan- (Apr- (Jul- (Oct- (Jan- (Apr- (Jul- (Oct- (Jan- (Apr- Mar- Jun- Sep- Dec- Mar- Jun- Sep- Dec- Mar- Jun- Sep- Dec- Mar- Jun- Sep- Dec- Mar- Jun- 2015) 2015) 2015) 2015) 2016) 2016) 2016) 2016) 2017) 2017) 2017) 2017) 2018) 2018) 2018) 2018) 2019) 2019) Metric Tonnes 0 276.43 422.59544.704760.63414.056679.572804.27 243.99547.266505.026310.36 424.87 403.20 604.80 214.2 532.48 316.53 Patients Assessed Target 49200 49200 49200 35031 35031 35031 35031 87500 87500 87500 87500 96250 96250 96250 96250 96250 96250 96250 Patients Assessed 45,002 33,306 40,466 83,292103,783108,281124,145128,823118,249160,492146,757201,603226,246215,352246,379223,628238,194204,594 Patients on Food Target 30,000 30,000 30,000 24,971 24,971 24,971 24,971 27,469 27,469 27,469 27,469 36,070 36,070 36,070 36,070 36,070 36,070 36,070 Patients on Food 8,290 8,962 11,928 14,902 21,002 35,152 32,908 31,814 26,383 34,538 25,968 37,812 36,456 42,647 47,046 39,399 47,180 37,081
Metric Tonnes Patients Assessed Target Patients Assessed Patients on Food Target Patients on Food
Figure 3: Trends in Nutrition Commodities Distributed and Patients Served, 2015 – 2019
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NACS Training in Kitui NHPplus in partnership with Kitui County Government Department of Health Services conducted a 3- day training of 31 health care workers (HCWs) newly employed by the county on a package of World Health Organization (WHO) Growth Standards, NACS and IMAM. The main objective of the training was to equip the HCWs with knowledge, skills and technique in management of malnutrition at health facility level including how to: - take proper anthropometric measurements, - diagnose for malnutrition, - provide quality nutrition intervention to rehabilitate different categories of malnutrition - manage nutrition commodities - monitor the patients - report (both at county and national levels – KHIS)
Additionally, the participants were taken through their role in service delivery and the county organization structures.
From the sensitization, it was noted that the county continues to face challenges in service delivery especially due to frequent staff transfers affecting provision of quality nutrition services and lack of harmonization of MOH data capture and reporting tools with various versions in use (e.g. 2 versions of MOH 734, the commodity consumption summary tool; 2 versions of MOH 733 in KHIS, duplication of nutrition services tools – MOH 407, MOH 711, MOH 713) resulting to poor quality reports that may not inform decision making.
Following these challenges, the county committed to do the following by December 2019, - Conduct mentorship for the participants to help internalize the competencies and skills learnt - Lobby for funding to train the nutritionists on IMAM - Lobby for funding to conduct Baby Friendly Health Facility Initiative (BFHI) training for the level 4 hospitals in each sub county.
The National AIDS and STI Control Program (NASCOP) has taken up harmonization of the tools as a key activity within this FY and NHPplus will support the process.
National Quantification for HIV Commodities Workshop NHPplus participated in the FY19 – FY22 National Quantification for HIV Commodities workshop. Other participants included – NASCOP with representation from all programs i.e. Adult anti-retroviral therapy (ART), Pediatric ART, Laboratory, HIV Testing Services (HTS), Key Populations, Prevention of mother-to-child transmission (PMTCT), Pre-exposure prophylaxis (PrEP) and Nutrition, United States Agency for International Development (USAID), Centres for Disease Control (CDC) and KEMSA Medical Commodities Program (MCP) as the host.
The objectives of this forum were a) to review and revise (where applicable) targets for FY19; b) supply planning for FY 19-22; c) to identify funding gaps and d) to review/provide technical
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specifications for all commodities. The teams were requested to draw lessons from FY18 experiences where the following were considered: i) Forecasts Vs policy shift - transition challenges from one drug regime to another ii) Provisions for grace period especially where there is a planned shift from one regime to another and/or introduction of new products iii) Product technical specifications - critical to have the right specifications for the product as it has an impact on overall quantification e.g. Ready-to-use Supplementary Food (RUSF) packaging into 100g Vs 92g iv) Forecasts Vs Scale up - Scale up is not provided for in the current quantification model, however, supply plans should accommodate any scale up plans. v) Estimated Costs – all costs should be included e.g. freight costs, where not provided, use of global price index is advised; increase in prices should also be factored. vi) Forecasts Vs supplier factors – consider 6-months buffer stocks (dependent on expiry dates) to counter factors such as long lead times and supplier capacity.
In the nutrition program, it was noted that there had been a delay of 1 year+ in procurement of Ready to Use Supplemental Foods (RUSF) and Ready to Use Therapeutic Foods (RUTF) from Global Fund (GF). This impacted negatively to the overall program as most of the non arid and semi-arid lands (ASAL) counties did not have commodities save for those supplied under NHPplus. From the projections, available funding (GF and President’s Emergency Program for AIDS Relief, PEPFAR) and if commodities are received in good time, the country will meet at least 80% of the requirements. It was recommended that the nutrition program should have a strategy in place to ensure that the available resources are efficiently managed to reach as many patients as possible. One such strategy was to ensure that health facilities receiving FBF should not receive RUSF since both commodities work towards the same goal.
The team quantified for anthropometric equipment which had been identified as a gap during a national data quality audit (DQA). The budget for this component is USD 4.1M with a commitment from GF of approximately USD 49,500 (1.2%). The NASCOP nutrition team will need a strategy for repairing the nonfunctional equipment and conducting routine calibration.
Transition to KEMSA/MCP NHPplus received correspondence on transfer of the procurement, warehousing and distribution of nutrition commodities to KEMSA/MCP, the national supply chain for medical commodities. The program held an introductory meeting where KEMSA/MCP sought to understand NHPplus operations and subsequent planning for the transition. The discussions are summarized in the Table 10.
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Table 10: Summary of Nutrition Commodity Transition Issues Discussed with the Kenya Medical Supplies Authority (KEMSA)/MCP Key discussion points Action Due Date Progress Modalities for transition: a) Shadowing – suggestion that KEMSA Quantification, factory visits, Health facility visits Immediately Supported NASCOP during shadows NHPplus activities to gain insights into the program operations Quantification exercise; Factory visits planned for August 2019 b) Deeper engagement during close out period Transfer of activities From 1st Oct 2019 Information Package: - Technical specifications for nutrition Prepare the various documents for handover By end Sep Compilation of documents and commodities (standards) 2019 distribution of tools/job aids on-going - Supplier Quality Audit (SQA) reports including international/local certifications
- Data collection and summary tools to be Extra data collection and summary tools to be 30th Oct distributed distributed by NHPplus 2019 Operations Package: Quantification and procurement: National level Volume Purchase Agreement (VPA) which ends 30th Sep Quantification at national level done and participation for HIV Program (NASCOP); At on 30th Sep 2019 2019 supply plan developed (to be shared in Program level, align targets to available funds the coming quarter) and track through Task Orders Procurement for FY20 to be initiated by NHPplus is using Volume Purchase Agreement KEMSA/MCP (VPA) model where the food processors and *Seek guidance from Contracting Officers/ transporters are contracted for 2 years. The VPA Representatives (CORs) on contract extension is executed using Task Orders and Purchase for the current suppliers under NHPplus to orders. ensure seamless transition? (include budget Immediately KEMSA to decide on which model to use for considerations as this period is not factored in procurement – essential is to ensure there are NHPplus current budget) stocks in the facilities during the transition
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Key discussion points Action Due Date Progress period. All indications are that NHPplus commodities will be depleted by end Oct 2019
Concern over the lead time for procurement of NHPplus to provide buffer stock data by To be nutrition commodities. facility/county determined *NHPplus should have finalized all procurement (TBD) by September 30, 2019; no arrangements in place for the period Oct-Dec 2019
Distribution: Oct 2019 List of facilities to be supported by the program Confirm list of facilities with USAID (last quarterly Data Management/Reporting: report) NHPplus receives data directly from health Cease receipt of data directly to the program – facilities. This has been a good control measure communication to the counties to be done TBD Space required for the NHPplus database for accountability purposes and ensures that data is 150 – 160GB; Discussions with uploaded on KHIS is correct (invested in DQAs, NHPplus database – discussions are on-going NASCOP indicate they may have space data review meetings, site supervision and in the server – to confirm mentorship visits to ensure data quality) Discussions with NASCOP, KHIS on Agreed with NASCOP to introduce the There are two (2) versions of MOH 734 harmonization of the tools (Transition from integrated MOH 734 to the non ASAL (commodity consumption tool for nutrition vertical reporting to integrated reporting KHIS) counties; NASCOP has funds to do commodities – FCDRR) printing. Communication to health facilities through the NHPplus has been printing and distributing tools counties to be done soon as USAID shares the Awaiting list of facilities – NASCOP will for data collection and summary. It was noted list of facilities to continue with the support assist in facilitating this process that this could be a gap in the lower level health facilities and counties may not be able to allocate funds for this activity
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2.2 Improving Quality and Safety of Food Commodities and Agricultural Products
Equatorial Nut Processors (ENP) NHPplus held meetings with ENP with the main objective of ensuring that production was on course. It was noted that there were challenges in accessing maize as Kenya Government is yet to release maize from the National Cereals and Produce Board (NCPB). This has affected market dynamics where a bag of maize was being traded at KShs 3,500 compared to the average of KShs 2,500. ENP expressed optimism in accessing maize at favorable prices and other raw materials. The need to have all procurement finalized by 30th September 2019 was emphasized. It is worth noting that by the end of the quarter, ENP was on schedule.
Post batch sampling and testing of FBF was carried out within the quarter. The full report will be shared in the coming quarter.
2.3 Strengthening Sustainability and Innovation in Nutrition Commodity Development & Management
Collaboration with Kenya Bureau of Standards (KEBS) Kenya had successfully requested for initiation of the development of an East Africa Standard on fortified composite flour. KEBS, through NHPplus facilitation, commenced this process through a 3-day meeting with technical experts from various institutions. The main objective of the meeting was to review the draft East Africa Standards on cereal-based products including fortified composite flours and their premix formulation with a view to develop a draft Kenya position/comments as recommendation to be considered for adoption as the National position. The recommendations would be presented during the plenary meeting of the Technical Committee on Nutrition and Foods for Special Dietary Uses.
The meeting discussed and provided comments and justification to change some of the clauses in the following four (4) standards: a) Specification for fortified composite flours b) Specification for food fortification premixes; c) Guidelines for monitoring and sampling of fortified food products; and d) Processed cereal based foods for older infants and young children.
Arising from the discussion of the draft standards, the Technical Working Group (TWG) recommended: a) Nutrition and Dietetics Unit (NDU) to take lead in initiating discussions on the possibility of including iodine as part of the food fortification premix for flours as an alternative food vehicle to salt; b) NDU to consider inclusion of survey of fortified flours in the planned food consumption survey to inform future review of the standards; c) There is need for further studies on levels of phytates beyond which they will have a significant effect on nutrient absorption to inform future review/revision of the standards;
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d) There is need for KEBS to consider developing a code of practice to guide the millers on the treatment techniques of cereals such as fermentation, germination and others that will help to reduce antinutrients factors and improve bioavailability of nutrients; e) More studies/research are necessary to inform decision making on the use of milk as an ingredient especially in products likely to be consumed by older infants; f) There is need to investigate the extend of aluminum contamination in foods and specifically in flour with a view of developing guidance on controlling the contaminant; g) Upon publication of the standards, sensitization packages targeting SMEs should be developed to create awareness amongst them on the requirements of the standards to promote production of safe, quality and nutritious products. h) The Technical Committee adopt the comments annexed in the report as the National Comments for the Draft East African Standards
This activity informs required outcome on continued, reliable supply of safe, local procured food commodities. Once adopted, it is expected that there will be an expanded manufacturing base for nutritious commodities by the private sector (mainly through SMEs) and an increased diversity in products for management of malnutrition.
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3.0 Improved Food and Nutrition Security
This IR area seeks to improve nutrition outcomes through agriculture. It focuses on promotion of nutrition sensitive practices alongside specific actions targeting the underlying, intermediate and immediate causes of malnutrition to improve food and nutrition security and build resilience of vulnerable households. The implementation model of multi-sectoral approach involves various stakeholders with the expected overarching goal of reduction in stunting by 10% at the household level. The entry point to the community has been through groups where most of the trainings and demonstrations were done to influence behavior of the households in production and utilization of certain foods for food security and dietary diversity (DD). The program targets improvement in minimum acceptable diets (MAD) for children under five (5) years and dietary diversity for women (DD-W) of reproductive age, pregnant and lactating women. The frontline implementers include CHVs, CHEWs, frontline extension workers (FEW)s, ECDE staff, and Community Resource Persons (CRPSs.
Contextualized agri-nutrition packages were delivered to build capacity of staff in both knowledge and skill. Resilience building of the community is among the target outcomes of the program. In line with the proven pathway for addressing undernutrition, economic empowerment of the community was among the interventions used to achieve this outcome. At program level we integrated nutrition specific and sensitive interventions converging through agri-nutrition packages and BFCI structures at community level improving achievement of target outcomes. Specific contextualized packages included: promoting and emphasizing consumption of animal source foods within the diversified diet efforts; water, sanitation and hygiene (WASH); production technologies aimed at improving food availability and access through home gardening, and consumption through cooking and food preparation demonstrations. Nutrition education cut across all beneficiaries covering key nutrition specific interventions like exclusive breastfeeding and childcare practices among others. Collaborative activities were carried out with different partners ranging from providing technical assistance to joint implementation for increased synergy and impact.
During the quarter, total disaggregated beneficiaries were 16,360 households. Based on interventions, the direct beneficiaries for DD contextualized packages (dietary diversity skills and cooking demonstrations) were 10,754 households (10,130F, 624M), 1,594 households (1309, 275M) for production technologies through home gardening, 2,701 households (2,471F, 230M) for WASH, 4,647 households (4355F, 292M) for cooking/food preparation demonstrations, 1,311 households (1016F,295M) and 1,263 pregnant and lactating mothers for Economic empowerment and Income generating activities. Indirect beneficiaries were 16,493 (8014F, 8479M) children 0-23 months 7091 (3332F, 3759M) and 9,402 (4682F, 4720M) children 24-59 months
3.1 Increased Market Access and Consumption of Diverse and Quality Foods
3.1.1 10% reduction in stunting rates in the feed-the-future (FtF) /MNCH regions During the quarter activities targeting improving access and consumption of diverse and quality foods continued focusing on promotion in adoption of practical interventions These included appropriate production technologies especially the climate change mitigation strategies, safe
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handling, preparation and cooking practices all contributing towards reduction of stunting in the zones of influence. The interventions are as summarized in Table 10 while Table 11 shows the number of children and pregnant women reached in the focus counties.
Table 11: Summary of interventions and beneficiaries per county and sub-county Agri-Nutrition Package County Sub-County Beneficiaries Female Male Total Generic Agri-Nutrition Package Dietary diversity in complementary feeding Busia Butula 1045 42 1087 and pregnant mothers Teso North 623 47 670 Samia 474 102 576 Nambale 329 39 368 Samburu Central, East 189 6 195 and North Promotion of drought resistant crops green Kitui Kitui East 2006 5 2011 grams, samosa and millet/sorghum in the Kitui South 322 0 322 wake of climate change and climate change Mwingi Central 32 0 32 adaptation practices Mwingi North 320 0 320 Marsabit Moyale 395 45 440 Samburu Central 40 46 86 Sub-Total 5775 332 6107 Home gardening Water conserving technologies, DTCs and Busia Teso North 318 64 382 good agriculture practices Samia 88 44 132 Butula 201 42 243 Good farming practices-planting kales, Samburu Samburu 23 0 23 carrots, spinach crop rotation, mulching, Central watering and preparation of seedling nursery Promotion of climate change practices Marsabit Moyale 51 54 115 Promotion and adoption of drought Moyale 212 39 251 tolerant crops, intensive production Laisamis 103 5 108 technologies for dietary diversity crops and (Loiyangalani) rearing of small stock especially chicken Kitui Kitui East 313 27 340 Sub-Total 1309 275 1594 WASH Hand washing at four critical times, food Busia Butula 1045 42 1087 hygiene, water treatment methods, Teso North 623 47 670 rainwater conservation and lastly use of Samia 474 102 576 toilet Nambale 329 39 368 Sub-Total 2471 230 2701 Cooking/Food Preparation Demos
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Agri-Nutrition Package County Sub-County Beneficiaries Female Male Total Preparation of complementary foods for Busia Samia 346 56 402 children above 6 months and women of reproductive age (WRA) Food safety training and demonstrations on Teso North 215 118 333 effects of aflatoxin and methods of preventing aflatoxin contamination Promoting consumption of diverse and Tharaka Tharaka-North 277 113 390 nutritious food for improved children and Nithi and Tharaka- women health and nutrition South. Promotion of utilization of drought Kitui Kitui East 2006 5 2011 resistant crops in preparation of delicious Kitui South 322 0 322 family meals for instance green grams, Mwingi Central 32 0 32 samosa and millet/sorghum cakes Mwingi North 320 0 320 Cooking demonstration on complementary Marsabit Moyale, Saku, 363 0 363 feeding and women of reproductive age Loiyangalani during the baby friendly gathering and nutrition counselling Cooking demonstration on porridge Samburu Central 98 0 98 fortification with eggs, Sorghum North 223 0 223 utilization, Fish and vegetables preparation East 153 0 153 Sub-Total 4355 292 4647 Income Generating Activities Small Business Management skills Tharaka Tharaka North 55 15 70 Value addition of local fruit trees products Nithi Tharaka South 180 55 235 Tamarind, Baobab and Amarula as IGA Value Chain Development Kitui Central 19 7 26 Value Chain Development Busia Matayos 0 3 3 General IGA Teso North 201 41 242 Making soya beverage, soya milk and 561 174 735 liquid soap for both commercial and home use Sub-Total 1016 295 1311 Grand Total 14,452 1,424 15,886
Table 12: Children and Pregnant Mothers Reached in Focus Counties and Sub-County Beneficiary County Sub-county Number reached Category Female Male Total Children Samburu Samburu Central, East and North 36 43 79 under 2 Tharaka Tharaka-North 46 36 82 years Nithi Tharaka-South 41 54 95 Kitui Kitui East 546 532 1078 Kitui South 164 108 272 Mwingi North 66 59 125
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Mwingi Central 7 8 15 Busia Butula 87 93 180 Teso North 1618 1786 3404 Butula 155 350 505 Nambale 73 109 182 Samia 171 210 381 Marsabit Moyale 245 277 522 Laisamis 77 94 171 Sub Total 3332 3759 7091 Children Samburu Samburu Central 23 15 38 24-59 Tharaka-North 10 7 17 Months Tharaka-South 22 16 38 Kitui East 699 678 1377 Kitui Kitui South 155 94 249 Mwingi North 88 68 156 Mwingi Central 8 8 16 Busia Butula 25 24 49 Teso South 106 114 220 Teso North 2912 2859 5771 Nambale 217 218 435 Samia 212 382 594 Marsabit Moyale 176 199 375 Laisamis 29 38 67 Sub Total 4682 4720 9402 Grand Total 8014 8479 16493 Pregnant Busia Butula 228 228 Mothers Teso North 75 75 Nambale 89 89 Samia 87 87 Kitui Kitui East 76 76 Kitui South 25 25 Mwingi North 18 18 Mwingi Central 2 2 Marsabit Moyale 363 363 Laisamis 99 99 Tharaka-North 56 56 Tharaka-South 102 102 Samburu East, Central, North 43 43 Total 1263 1263
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Contextualized High Impact Packages and the Multi-Sectoral Approach NHPplus continued to use and promote the multisectoral approach along nutrition pathways of improved food production, income and women empowerment to deliver specific focus county contextualized agri-nutrition packages. Dissemination focused on practical demonstrations to impart appropriate skills to the household members mainly through champion mothers, with backstopping from frontline extension staff. Two contextualized proven high impact, simple, practical and easily adoptable packages from food and nutrition security were disseminated in addition to WASH and Economic empowerment packages. The households were the target action units of operation aimed at increasing access and consumption of diversified of quality foods. Ministry of Agriculture, Livestock and Fisheries (MOALF), MOH and Ministry of Education (MOE) multi-sectoral teams provided the trainings and supervision of the champion mothers delivering the packages. CHVs played a pivotal role in this process. Quality control of the packages was done by the supervisors, the frontline workers. The implementation of this package was also administered through integrated approach with BFCI and community outreaches to deliver both nutrition specific and nutrition sensitive packages. The following packages were delivered varying with target groups based on knowledge gap revelations; 1. Exclusive breastfeeding 2. Age for introduction of complementary feeds 3. Consumption of at least four or more out of 7 food groups 4. Use of animal source foods 5. Preparation of food with appropriate consistency based on age 6. Feed required number of meals based on age 7. Amount of meal based on age 8. Complementary Feeding for 6 - 23 Months Children 9. Production and utilization of drought resistant crops 10. Cooking demonstration of complementary foods using composite flour of green grams and cowpeas flour 11. Porridge consistency and diversity ingredients 12. Food safety and hygiene 13. Demonstrations on establishment of kitchen gardens using water saving technologies
Contextualized flour blending for dietary diversity (DD) among women children Current government policy advocates flour blending for food and nutrition security and the guidelines are elaborate. To complement these efforts the program has been promoting this at community level using locally available materials with the aim of improving children and women DD in malnutrition hotspots like Kitui and Marsabit. This is on top of the promotion of animal source and vegetable additives in children porridge to at least reach the 4 and 5 minimum basic food groups for a child and mothers standard nutrition respectively. Under the flour blending effort significant strides have been made and the results both in acceptability and adoption are impressive.
Outcome In Kivutini, Kitui East Sub County, Mzee Patrick Michael Kula 65 years old who lives with his son Samuel Michael who is six years old and his grandson Michael Kula who is two and a half years are adopter beneficiaries. Mzee Kula lost his wife last year and he has since been taking care of the children on his own. He joined the Mwaani mother to mother support group, where his late wife used to attend so that he can continue to learn on the best practices and how he can take care of his two children better. In his farm, Mzee Kula has planted high value drought tolerant crops which include green grams, pigeon peas, cowpeas, in addition maize and kales. He is assured of a good harvest and will have enough food for his family’s consumption and will sell the surplus to earn him income35 to support other family needs. FY 19 Q3AprilMzee- JuneKula Quarterlyappreciates Report that this new way of preparing porridge is less expensive because the green grams and cowpeas are locally available and that the initiative will help change the minds of many people in the community to grow these drought resistant crops and use them for both their consumption as well as make income from it.
In Marsabit county, Loiyangalani Community unit for decades, the burden of malnutrition across the entire community unit remained high and progress remains unacceptably slow. This has been contributed by poor eating habits and high levels of poverty among the households. Dietary diversity is crucial among the vulnerable groups particularly children under two years of age to curb malnutrition. The Program during the quarter introduced the flour blending initiative similar to Kitui county. The three porridge recipes involved were maize flour + green grams flour and kale powder, sorghum flour +cowpeas flour and kales powder and maize flour + cowpeas flour and kale powder through participatory cooking demonstrations. The activity was done in 6 villages Kiwanja, Kula samaki, Nakwamekwi, Achukule, Dikilkimat and Kula-pesa.
Outcome The acceptance and responses were very high with the children scrambling for more all the time. A total of 266 women of reproductive age (caregivers) and 191 children under the age of two years from 6 villages benefitted.
3.1.2 Effective linkages established with private sector, food security/livelihoods/economic strengthening programs through FtF and non- USG funded programs New linkages were created during the quarter as well as strengthening existing ones with private sector, food security/livelihoods/economic strengthening programs. This applied to both FtF and non-USG funded programs.
National level Partnerships for Resilience and Economic Growth (PREG) Forums, FtF Nutrition TWG and non-PREG actors Collaborative activities organized by PREG leadership to strengthen coordination and linkages among USAID and other partners in resilience building and food and nutrition security platform were carried out during the quarter. The program participated in the PREG monthly and FtF Nutrition TWG bi-monthly meetings that attracts all PREG partners and agri-nutrition stakeholders respectively. Others are the Planning meetings for the 3rd National Agri-nutrition Conference, a collaborative activity for all food and nutrition security stakeholders.
USAID Field Monitoring Visit Busia During the period USAID Family Health team conducted routine monitoring visit to Busia county. While focus was on NHPplus program activities also visited was the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) Project also funded by USAID. The team of 3 high level officials led by Dr Sheila Macharia accompanied by Ruth Tiampati and Ms Immaculate Wambui visited Nangina health facility and Luchululo community unit. The visitors witnessed implementation of both nutrition sensitive and nutrition specific interventions at facility and community level where the multi-sectoral approach was very conspicuous involving the County Government Administration, the Ministry of Interior, MOALF, MOH and MOE. The activities included courtesy calls on the Deputy Governor with other County Chief Executive Members and field visits with a final debrief on the last day.
Nangina Dispensary Site
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The team was taken through all the units within the facility with thorough run through data and other facility entries especially commodities. The Nutritionist and Nursing Officer in-charge did the explanations in the presence of the Sub-county MOH. Some entertainment in praise of the support the community receives as well as the nutrition service trainings were displayed by a neighboring community unit.
Luchululo Community Unit This is where nutrition sensitive interventions were exhibited. The team was taken through a multi- sectoral agenda with several stations namely home garden technologies demonstrations for improving access to diversified, safe and quality foods exhibiting vertical bag gardens, mandala garden, sunken and raised beds and zai pits technologies. On climate change the community demonstrated water harvesting techniques, climate change adaptation practices, drought tolerant crops and their utilization. To promote animal source foods chicken rearing under the synchronized rearing system technology was displayed that also coupled as an income generating activity alongside some interlocking brick making machine activity. Food security displays included production of sweet potatoes, cassava and local green vegetables. Readily prepared foods on different recipes for different categories of age groups for ensuring dietary diversity using locally available materials took a good fraction of the displays with value addition component for income generating purposes. WASH component had an improved toilet and hand washing facilities on display. Alongside the displays were the growth monitoring unit of the MOH that takes anthropometric data for women and children under 5 to monitor their nutrition status. food preparation and preservation, optimal complementary feeding practices, local dietary diversity products and foods for different age cohorts.
USAID Team at Luchululo during the field monitoring visit in Busia
NHPplus – Research Triangle Institute (RTI)/Kenya Crops and Dairy Marketing Systems (KCDMS) Collaboration The program has the mandate of providing technical assistance (TA) to other FtF implementing partners (IPs). During the quarter the program provided technical assistance to RTI/KCDMS program by training the latter implementers on agri-business and value chain development and analysis. The objective was to build capacity of the players in understanding value chain development process, inclusive market development and opportunities, value chain mapping, business models and sustainable solutions. The aim was to build capacity of the implementer to understand the small-scale farmers and the intricacies around them and be able to help them achieve meaningful development through agriculture value chains. The beneficiaries are then able
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to make informed decisions on choice of value chains and entry point along the value chain within the market system significantly reducing chances of failure. Against this background the program trained 26 KCDMS implementers and some government staff from Kisumu, Busia, Homa Bay, Migori, Kisii, Siaya and Bungoma counties an activity that took place in Kisumu. The team were representatives of 16 KCDMS implementing firms.
NHPplus and KCDMS Groups Linkage During the period the program linked its groups for Busia and Kitui counties to KCDMS for onward linkage with private sector players under the latter’s program. In the linkage were 105 groups from Kitui and 42 from Busia. This is in line with the journey to self-reliance where the communities can be reaching out to private sector for support and partnership.
Value chain development and analysis training participants and training in progress International Food Safety Conference
Food Safety Conference The program participated in the 1st International Food Safety Conference during the quarter. The program presented the Multi-sectoral approach to Food and Nutrition Safety poster and supported the MOALFI in procuring some displays. The 3-day conference held at Kenyatta University attracted hundreds of stakeholders from diverse fields in food security, nutrition and safety.
Focus Counties PREG Coordination The program continued serving as chair and deputy chair of Marsabit and Samburu counties PREG committees respectively. Among the partners who are in this collaboration include the county MOALFI, MOH, Water and MOE, NHPplus, WFP, AFYA TIMIZA, TUSOME, NRT, NDMA, PALLADIUM CMLAP 11, AFYA NYOTA ya BONDE, K-RAPID, AVCD and LMS (Refer to section on Acronyms and Abbreviations for definitions).
Sub-county Agri-nutrition Review Meetings Busia and Kitui counties held sub-county agri-nutrition review meetings during the quarter. These aimed at strengthening coordination and linkages among partners and stakeholders. The forums brought together the frontline workers from MOALF and MOH as well as the sub-county officers. Among the key issues discussed are; - Progress of the Agri-nutrition implementation
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- Climate Smart Strategies and adaptation - Feedback on progress of the Agri-nutrition groups
Challenges Noted: 1. The group approach has been quite difficult especially in maintaining the group agri nutrition demonstration gardens; most of the members leave the maintenance responsibility to the host farmers but still want to benefit. 2. Poor ownership of the demonstration gardens by group members 3. Inheriting groups from previous programs has been a challenge because members come with different priorities which do not match program objectives 4. Other areas within Samia are very dry and has salty water which makes the vegetables in kitchen gardens to dry hence making it difficult to sustain the gardens.
Integrated Outreaches: The Multi-Sectoral Approach Integrated outreaches have been conducted in all the counties coupled with Malezi Bora with very high level of success reaching a larger audience as opposed to single group training. In this approach various pertinent topics are covered both theoretically and through demonstrations to address food and nutrition security. MOALFI, MOH, Ministry of Interior and Department of Social Services participate in the joint activity. The approach strengthens collaboration through the multi-sectoral approach to food and nutrition security. The program has been promoting joint planning and execution of activities aimed at improving community nutrition outcomes. Topics covered during outreach include nutrition education and health, agriculture, co-ordination and integration related that include promotion of climate change adaptation practices, drought tolerant crops, early land preparation, enterprise choice for adaptation to the changing climate and agribusiness, water harvesting, conservation agriculture, Exclusive breastfeeding and optimal complementary feeding. Demonstrations are carried out on food preparation and cooking, value addition on root crops, vegetables, fruits, and legumes. Vitamin A improvement and complimentary food enrichment with legumes, green grams, and beans to enhance quality food consumption and improved diversified diets for pregnant and lactating women (PLW) and children under 5 years. In Busia one such activity also covered crop production practices on groundnut value chain and vegetables production (Spinach. Kales, nightshade, coriander, pumpkins, cow peas). Groundnuts were bought for bulking which were later tested for aflatoxin and the results indicated acceptable level of aflatoxin. Other packages covered were proper seed bed construction and aflatoxin management. During the integrated activity MOH conducts nutrition education talks and physical screening for malnutrition for children under 5 years and women of reproductive age. Identified cases are referred to health facilities for attention.
Agri-nutrition/BFCI Platform The program through the baby friendly community initiative promotes both nutrition sensitive and nutrition specific interventions carried out by a multi-sectoral team of trainers. This collaborative effort mostly by MOALFI, MOH and MOE strengthens linkage between the different sectors in the counties.
System-wide Collaborative Actions for Livelihoods and Environment (SCALE+) Methodology
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Promotion of SCALE+ methodology in all the counties has significantly strengthened collaboration between stakeholders with networks for specific interventions increasing in size.
Tharaka Nithi County In Tharaka Nithi the Food Safety network for aggregators and processors has developed to an extent where they have held meetings and activities without support from the program. During the quarter the network besides holding a meeting organized an activity to inspect all milling machines with the aim of checking cleanliness of the machines and quality control of the products.
To cascade the effectiveness of the SCALE+ methodology, the program conducted a sensitization workshop for the aggregators and agro-dealers in March 2019 to enlighten them on pre-and post- harvest management practices and identify areas of synergy to be explored to improve food safety in Tharaka-Nithi County
In May 2019, the trained Aggregators and Agro-Vets also conducted their own Farmers Field Day with no support from the county or partners in which 357 farmers participated in Giekuri, Nkondi Ward in Tharaka-South Sub-County. The aggregators used the forum to dialogue with the farmers in the region for better understanding of the obstacles as well as the opportunities to prevent and mitigate aflatoxin contamination in Tharaka-Nithi County. Benefiting from the link established with the department of health, they invited the Sub-County Nutrition Officer to give a talk to the farmers on aflatoxin contamination and control in foods.
Outcomes: To determine the extent of aflatoxin contamination in sorghum, millet, maize and groundnuts which are the main grains used as complementary foods in Tharaka-Nithi County, the program has been collecting samples of these grains from households, markets and cereal bulking stores at harvest time and postharvest storage sites for aflatoxin analysis. The results reveal that contamination is more widespread in Tharaka-South Sub-County than in Tharaka-North Sub- County. In Tharaka-South Sub-County, some samples had high aflatoxin levels of 7.5 parts per billion (ppb) near the maximum level allowed by the Kenyan government which is 10 ppb. Contamination levels were higher in the grains and cereals after the harvest and varied between villages in the two Sub-Counties. Journey to self-reliance: Plans have been made in the region by the trained aggregators to educate the farmers on good agricultural practices (GAP) and good manufacturing practices (GMP) for aflatoxin prevention and control. This responds well to journey to self-reliance where private sector
and local business community pick up serious issues to offer local home-grown solutions.
Outcomes Self-initiated activities by Aggregators and millers: After the workshop, the aggregators led by their Coordinator – Mr. Peter Mutegi linked with the County Department of Public Health in April 2019 to conduct inspection of posho mills in Tharaka-North and Tharaka-South Sub-Counties to establish whether they were following the recommended GMP for aflatoxin prevention and control. The aggregators assessed 5 posho mills in Tharaka-South Sub-County and 3 in Tharaka-North Sub- County. During the inspection, the trained aggregators shared with the traders and millers the learnt knowledge and skills from the training on how to safely handle and process the grains and cereals. The millers confessed having never cleaned their posho mills since establishment and after the sensitization by the aggregators they committed to ensure food safety as an added value at their posho mills. The traders and millers are now cleaning their posho mills every evening after their daily operations and every morning before they begin milling. They are also analyzing the cereals and grains for clean products and encouraging their customers to sort and wash their grains before milling to reduce exposure to aflatoxin. Sorting of discoloured40 (mouldy) crops minimizes the contamination FYof 19 aflatoxins Q3April in-June the Quarterlycereals and Report washing of seeds before milling helps to reduce the chance of having fungal/aflatoxin in foods.
Peter demonstrating how to clean the posho mill in Tharaka Nithi
Kitui County In Kitui as part of SCALE+ follow up activities towards improving dietary diversity through flour blending, training for flour millers was conducted in Kitui East sub-county. The training covered flour blending and food safety standard operating procedures. Nineteen (19) people (7F, 12M) benefitted from the training.
Busia, Samburu and Marsabit SCALE+ Activities The counties of Busia, Marsabit and Samburu are have a slow start on SCALE+ activities and so far only meetings to agree on joint activities from the action plans have been conducted.
Busia Collaborators Workshop This workshop was organized by County Executive Committee Member and supported by Farm Africa and Research Triangle International (RTI) with the following in attendance: Agricultural Sector Development Support Programme (ASDSP) and Kenya Climate Smart Agriculture Project (KCSAP), Farm Africa, African Medical and Research Foundation (AMREF) Africa, NHPplus, Send a Cow, World Vision, Kenya Breweries Limited, International Livestock Research Institute (ILRI) and Kenya Tsetse and Trypanosomiasis Eradication Council (KENTTEC). Pertinent issues were discussed and areas to improve collaboration between partners and county government.
Outcomes Lesson learnt Lessons1)There learnt/outcomeis diversity among the implementing partners 2)Human resource is available and they are cooperative at the county and sub county level 3)There is political goodwill in Busia county lead by CEC Agriculture and Chief Officer Agriculture
Challenges 1)Poor networking among stakeholders 2)Linkage is poor among some developments 41and the County due to poor entry structure FY3)There 19 Q3April is duplication-June Quarterly of activities Report among the development partners at the sub county level
3.1.3 USAID investments in programs aimed at improving food security and nutrition are strengthened and coordinated During the quarter the program continued to invest in promotion and adoption of interventions aimed at improving access to diversified and quality foods through production and food preparation technologies.
Home gardening/dietary diversity demonstration gardens Knowledge and skills development for production of diversified foods for food and nutrition security can only be achieved through ‘doing’. The program has continued to invest in supporting dietary diversity demonstration gardens from where the group members, during regular meetings, and community, during outreach practice, learn different contextualized production technologies for onward adoption on their farms. Adoption is admirable in most counties, highest being Busia followed by Kitui, Tharaka Nithi, Marsabit and Samburu in that order. These technologies include water harvesting, production of drought tolerant crops, intensive home gardening like vertical bags, raised bed, Mandala garden, keyhole garden and sunken bed. Chicken rearing technology (synchronization model), rabbit rearing, gooseberry and groundnut production and WASH were also promoted across counties.
In Busia agri-nutrition trainings were done on promotion of crop production especially groundnut value chain and vegetables (spinach, kales, nightshade, coriander, pumpkins, cow peas). Groundnuts were bought for bulking and tested for aflatoxin. The results indicated acceptable level of aflatoxin implying good agricultural practices in place. Practical skills were imparted through demonstrations on vegetable production, seed bed construction and aflatoxin management. During these trainings 10 new dietary diversity demonstration gardens were established with emphasis on good agricultural practice. Other activities included maintenance of existing dietary diversity demonstration gardens in the sub county and follow up on uptake of production technologies through home visit by Champion mothers and MOALF, household dissemination of climate change adaptation practices, promotion of DTCs and water harvesting technologies.
In Kitui County, promotion and adoption of intensive home gardening technologies like vertical bags and zai pits have been on-going for improving access to vegetables. There is a considerable rate of adoption among members inspite of the water and pest attack challenges on their enterprises. During the period 10 new dietary diversity demonstration gardens were established 4 in Ngomeni and 6 in Tseikuru in Mwingi North subcounty.
Outcome Example - Penina Wanza, a mother of three, is a member of Tuvila mother to mother support group. She has adopted kitchen gardening where she has set up a vertical bag and in it planted kales and spinach. Her family has enough supply for their consumption improving the dietary diversity. She has fenced the kitchen garden to protect the vegetables from chicken and goat destruction
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There has been persuasion of men to join in the agri-nutrition efforts for improved DD for women and children.
Outcome Peter Munyaka, a retired teacher aged 61 years, lives with his wife Jane and three children in Kivutini ward, Kitui East sub county. He has been supporting his wife at the household in land preparation, choosing what to plant and when to plant depending on the season and rain pattern. Peter accompanies his wife Jane to the Mwaani mother to mother support group and together they’ve learnt the importance of planting drought tolerant crops such as the different varieties of millet, sorghum, green grams, cowpeas and pigeon peas.
In Marsabit county there has been diversification of activities due to drought. Some lucky groups and members with access to water make maximum use of the resource despite scarcity.
Outcome
Butiye CHVs agri-nutrition group dug a shallow well within the group farm as a means to ensure that the transplanted seedlings do not dry up. Their plot is doing well with a number of food crops and fruits grown e.g. kales, beans, spinach, peppers, watermelon, cilantro (Dania), peanuts, onions and sugarcanes. Currently, the shallow well is providing enough water for the planted vegetables. However, key challenges exemplified include: frequent water shortages for both human and agricultural use, pest and diseases affecting both crops and livestock, high illiteracy level within the group members and lack of larger market access e.g. for the groups engaging in meat business Two groups in Golbo invest in local poultry keeping following the insufficient rains which dried their transplanted seedlings. Each of the groups now have 25 chicken which are doing well despite the drought with benefits being consumption as well as selling of the eggs for nutrition and income.
In Loiyangalani a remote poverty ridden area in Marsabit county, women were educated on maternal nutrition education by HCW’s with focus on iron absorption enhancers;- vitamin C rich foods, oranges, lemon, iron absorption inhibitors; the habits of taking food with tea, food consumption frequencies for women e.g. for pregnant and lactating woman. 10 food groups were demonstrated with locally available food products and how women can easily achieve the minimum of 5 food groups in a day. In this ward two mother-to-mother support groups (MtMSG) (Afya Yetu and Jukumu Letu) with some community land near Loiyangalani Primary School have collaborated with 4K club in the school to put up a dietary diversity demonstration garden. The beneficiary team has 60 mothers and 58 pupils. The locals and the students have received numerous trainings from the CHV on the importance and benefits of intercropping. The aim was to demonstrate that cowpeas and green grams can thrive in this harsh soil and climate. On the demo plot that measures about an acre they have raised vegetables (cow peas and green grams), a fruit (watermelon) and one type of cereal (sorghum). Guided by the CHV’s the team have a schedule where each group has specific days to tend the portion of land and irrigate the crops since they require a lot of water to grow on daily basis.
Outcome The cowpeas and green grams are doing well, and the beneficiaries are quite excited about the outcome. They can access vegetables and pulses as well as learn about recipes related to the outputs of the demo. Different recipes targeting DD for children and women are demonstrated
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Cowpea crop in Loiyangalani and students and some women group members on demo plot
Vertical bag and sunken bed adopter in Kitui County
Peter Munyaka with wife Jane at their farm in Kitui County and a cowpea demo plot in Busia County
Cooking/Food Preparation demonstrations To achieve nutrition security through dietary diversity access to diversified and quality foods is not enough. Consumption of the diverse foods is the game changer which calls for behavior change among the communities. The program during the quarter continued to promote behavior change in feeding through nutrition education and appropriate food preparation and cooking demonstrations to households. In focus were nutritious diversified foods available locally for ease
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of access. Recipes varied per county targeting mostly complementary foods for children over 6 months. Emphasis was on enriching baby foods especially with vegetables and animal source foods following gaps identified during surveys. The Kenya Recipe Booklet printed by the program was used for reference. Alongside these demos were food processing and preservation activities to increase shelf life and nutrient bio-availability. Table13 Summarizes the cooking/food preparation activities in the counties.
Table 13: Cooking/Food Preparation Activities Conducted in the Focus Counties County Objective and description of activity Busia Value addition and promotion of Vitamin A improvement through mandazi, chapati, juice, cassava and cassava products, pumpkin drying, fruits drying, mangoes and pawpaw puree. Complimentary food enrichment with legumes, orange fleshed sweet potatoes –juice making and preparation of its by-products., preparation of vegetable powder and assorted vegetables, dried meat powder preparation, peanut and egg yolk enrichments of porridge for children Value addition of root crops, vegetables, fruits, and legumes. Vitamin A enrichment with legumes, green grams, and beans to enhance quality food consumption and improved diversified diets for PLW Samburu Cooking demonstration on porridge fortification with eggs, sorghum utilization, fish and vegetables preparation WASH and importance of dietary diversity were the key topics covered Kitui Using drought resistance crops and milling them to enrich the porridge. Sample A cowpeas 20% and Maize flour 80%, sample B Green grams 20% and maize flour 80% enriching the porridge with milk, kales/cowpeas leafy powder and oil then adding sugar to taste and emphasis on the consistency of porridge. Marsabit Complementary feeding; Demonstration on right amount, consistence, frequency, variety, responsive feeding and timely introduction of food (adequate in nutrients and energy) for age cohorts. Making food into thicker consistency—preparation of porridge (of different flour) and how to mash food to right consistence and enriched porridge with margarine/cooking oil, sugar, and salt. Demonstration on sorghum utilization which is locally available and the different ways on how to utilize it e.g. in making sorghum porridge, sorghum pilau & sorghum githeri. Tharaka Food preparation demonstrations of different complementary foods recipes using Nithi locally available food materials to promote dietary diversity and behaviour change in consumption in the community.
Nutrition education and demonstration of food groups for children and women for DD in Busia
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Nutrition education and children enjoying the meal prepared during the cooking demonstration in Marsabit
Cooking and kale preservation and drying demonstrations for use to prepare flour that can be used in cooking porridge in Marsabit
Women preparing sorghum porridge and sorghum pilau during a cooking demonstration in Goro Rukesa community unit in Marsabit
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Food safety The program during the period conducted tests on various food samples for levels of aflatoxins as an indication of the pre-and post-harvest food handling efforts. Groundnut, the most susceptible was used in this test. The counties under observation were Tharaka Nithi (Tharaka North and Tharaka South sub-counties), Busia (Teso North sub-county) and Kitui (Kitui East Sub-county). Table 14 is a summary of the findings for aflatoxin load in ppb and moisture content of the sample in percentage.
Table 14: Food Samples (Groundnuts) Aflatoxin Load by County County Sub-county Food Total Aflatoxin, ppb Moisture, % Samples Tharaka Nithi Tharaka North & Tharaka 1 1.7 4.72 South 2 2.4 4.64 3 2.2 4.57 4 3.2 4.72 5 3.6 4.89 6 7.5 4.90 7 1.6 4.76 8 4.8 4.77 9 4.2 4.77 10 7.0 4.61 11 4.3 4.67 12 4.2 4.96 Busia Teso North 1 1.5 8.91 2 1.5 8.91 3 1.2 6.17 4 1.1 6.06 5 2.5 5.77 6 1.7 7.06 7 2.0 5.86 8 1.2 6.33 9 1.6 5.07 Kitui Kitui East 1 12.7 4.9 2 11.8 5.23 3 12.3 4.82 4 14.8 5.01 5 2.5 4.58 6 9.7 5.23 7 3.8 4.88 8 6.3 4.94 9 2.1 4.61 10 11.8 4.95
The results reveal that Busia county produces very clean groundnuts with all samples having less than 3.0 ppb compared to the other two counties with findings as high as 7.5 ppb for Tharaka Nithi and even higher at 14.8 in Kitui. The recommended threshold for human consumption is 10.0 ppb meaning Kitui produce is unsafe for human consumption while Tharaka Nithi one is just a few ranks below the threshold. On moisture content which determines the ecosystem for the mycotoxin to thrive showed Busia with very high moisture content of 8.91% MC for some samples despite its low aflatoxin levels while Kitui East and Tharaka Nithi both had less than 5.5% MC.
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The recommended threshold for groundnuts is 7.5%. Against this background efforts must be made through exchange learning and experience sharing in good agricultural practices for Busia to lower the moisture content and Tharaka Nithi and Kitui to lower aflatoxin load.
Wayforward/Outcome
Based on the reports the program is working with KALRO and ICRISAT to find lasting solutions to the problem especially in Kitui and Tharaka Nithi where the results are depressive. The program will support sensitization sessions for growers in Kitui and Tharaka Nithi targeting reduction in aflatoxin loads through preventive path at production and
harvesting time. Promotion on use of aflasafe will be in focus as a preventive measure at production.
WASH Activities Water Sanitation and Hygiene (WASH) practices are a key appendage of nutrition education if the gains for nutrition are to be upheld and sustained. This component aims at breaking the cycles of environmental contamination and disease that stem from dirty water, inadequate sanitation, and poor hygiene. During the quarter WASH activities were conducted across all counties to complement dietary diversity, food and nutrition security and income generation interventions for improved nutrition.
In Kitui with support from CHVs in Ikanga, most project members now have tippy taps installed in their homes. The tippy tap is the most efficient way of handwashing especially in rural areas where water is scarce. Esther Musya is one of the many beneficiaries and she is happy to be part of it.
Esther Musya demonstrates hand washing using a tippy tap in Kitui South sub county
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In Busia the interventions supported during integrated outreaches included key WASH messages such as hand washing at critical times, use of latrines, safe waste disposal, water treatment technology and water catchment for domestic and kitchen gardening and plastic gender friendly latrine bowls to modernize latrines.
In Marsabit WASH messages were demonstrated for hygiene as well as food safety before food handling
Hand washing before the women start to participate in the cooking demonstration in Manyatta Ilman in Marsabit
3.2 Increased Resilience of Vulnerable Households and Communities
The program continued to support a community driven development approach to enhance social, economic, and environmental resilience, through effectively linking vulnerable clients with food security, livelihood and economic support that is relevant to local contexts. Towards responding to enhanced human capacity for increased agriculture sector productivity outcome, capacity building of human resource at the counties for program implementers and partners was carried out for effective service delivery. Reference tools for frontline staff like the dialogue cards and the National Agri-nutrition Resource Manual were also distributed as part of capacity building initiatives. Efforts were also directed towards building capacity for communities to increase resilience through trainings and other resilience supporting initiatives alongside capacity building communities on adoption of climate change adaptation practices. Other activities included screening for malnutrition as part of early warning surveillance and income generating activities and financial inclusion forming part of the resilience building initiatives to cushion communities against shocks and fluctuating food prices.
3.2.1 Strengthening community-based early warning surveillance of nutrition, linked to animal health and other trigger indicators
Building resilience through PREG partnerships The program continued to play an active and pivotal role in participating in Partnership for Resilience and Economic Growth (PREG) activities both at National and county levels. PREG brings together humanitarian and development partners to build resilience among vulnerable pastoralist communities in northern Kenya. Participants include both USAID programs and implementing partners working with the Kenya National Drought Management Authority
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(NDMA) and county governments to coordinate resilience and economic growth activities. At county level the program continued as chair and deputy chair of Marsabit and Samburu counties PREG committees respectively. While PREG county leadership is 2 year rotational, the program has held the position for two and half years. The overall goal PREG leadership is to strengthen coordination and linkages among USAID and other partners in resilience building and food and nutrition security platform.
Community Screening for Malnutrition and Referrals to the Health facilities Screening for children and pregnant and lactating women in the zones of influence (ZOI) during field days and outreaches forms part of surveillance and early warning system strengthening. Identified cases are referred to nearest facilities for attention and followed up. During Malezi Bora within the quarter, the program supported all the health facilities in all counties with the goal of increasing utilization and improving delivery of routine health and nutrition services targeting pregnant women, children under 5 years of age and lactating mothers. A total of 15,569 children with 6,142 under 2 years, 9,427 children 2-5 years and 1,271 pregnant/lactating mothers were screened during routine and Malezi Bora outreaches. The exercise took place in Busia and Kitui counties as summarized in Table 14.
Table 15: Summary of the Screening Activities in Kitui and Busia Counties Beneficiary Type of County Sub-county Number reached Category benefit Male Female Total Children Growth Busia Butula 87 93 180 under 2 years Monitoring Teso North 1618 1786 3404 (0-23 Months) Teso South 155 350 505 Nambale 73 109 182 Samia 171 210 381 Kitui Kitui East 532 546 1078 Kitui South 108 164 272 Mwingi North 59 66 125 Mwingi Central 8 7 15 Total 2811 3331 6142 Children 24-59 Growth Busia Butula 25 49 74 Months Monitoring Teso South 106 220 326 Teso North 2912 2859 5771 Nambale 217 435 652 Samia 212 594 806 Kitui Kitui East 678 699 1377 Kitui South 94 155 249 Mwingi North 68 88 156
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Mwingi Central 8 8 16 Total 4320 5107 9427 Pregnant/Lact Growth Busia Butula 228 228 ating Mothers Monitoring Teso North 75 75 Nambale 89 89 Samia 87 87 Kitui Kitui East 335 335 Kitui South 215 215 Mwingi North 210 210 Mwingi Central 32 32 Total 1,271 1,271
Climate change adaptation To foster food security in the wake of climate change new appropriate mechanisms need to be promoted to ensure sustained production for improved access to quality and safe foods. The program supports interventions and trainings that increase awareness and adoption of climate change adaptation practices to mitigate against climate change effects on agricultural production. These practices include water harvesting technologies, promotion of drought tolerant value chains, early planting and timely management practices. On livestock are practices like water storage, fodder preservation, small stock rearing, livestock uptake among others benefitting 3,905 households. Table 15 shows the contextualized practices.
Table 16: Contextualized climate change adaptation practices per county County Objective and description of activity # Beneficiary Households Busia Production and consumption of drought tolerant value 757 chains. Production interventions include Zai pit, sunken beds, retention ditches, Mandalla gardens, vertical bags, run off harvesting Samburu Preparation of recommended supplementary and 23 complementary diversified diets for children above six months and below 5years of age to get the required dietary nutrients in hygienic condition and diets for women of reproductive age Kitui Promotion of production and consumption of drought resistant 2,685 crops. Consumption include green grams, samosa and millet/sorghum, blended flours for porridge in the wake of climate change and climate change adaptation practices Marsabit Promotion and adoption of drought tolerant crops, intensive 440 production technologies for dietary diversity crops and rearing of small stock especially chicken Demonstration on sorghum utilization which is locally available and the different ways on how to utilize it e.g. in making sorghum porridge, sorghum pilau & sorghum githeri. Total 3,905
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3.2.2 Reduced number of households with moderate or severe hunger The program has been promoting improvement in dietary diversity for women of reproductive age and children under 5 years. Alongside this was a broader goal of ensuring food security that promoted adoption of technologies and interventions both in crops and livestock. The aim was to improve production of a variety of value chains and food availability through production. Based on agro-climatic zones contextualized packages were disseminated for specific target regions. More emphasis was on water harvesting technologies, drought tolerant species for livestock and crops considering climate change. The youth were also involved at school level and were sensitized on the why and how of food security and dietary diversity in line with the government policy of competence-based curriculum.
Youth involvement in food and nutrition security Waye Godha Primary School Environmental club and Butie CHV group in Marsabit county have against all odds tried to raise cops in vertical bags and established demonstration gardens to impart production skills among youth and the pastoral community.
Waye Godha Primary Environmental club in their school farm learning about vertical bag gardening.
Butiye CHVs agri-nutrition dietary diversity plot and a sweet potato bulking plot in Busia
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Sunken bed with vegetables and visitors seeing retention ditch with bananas technology in Busia
Promotion of Drought Tolerant Value Chains In all counties to mitigate against climate change for improved food security, sorghum, millet, cowpeas, green grams and cassava value chains in line with the big four national agenda were promoted. This advocacy has led to significant behavior change by farmers to take up these value chains in place of the ever-failing maize crop. Small animals especially chicken and to some extent rabbits were promoted for adoption.
In Busia county there was extra effort in promoting rainwater harvesting technologies especially using sunken beds, zai pits, retention ditches, mandala gardens, mulching and conservation agriculture for improved moisture retention hence food production.
In Kitui conservation agriculture, sunken beds and zai pits technologies that significantly contribute to soil moisture retention and consequently improved production were given prominence.
Food Preparation, Cooking, Preservation and Storage In all the counties promotions were carried out on appropriate food post-harvest handling, preservation and storage ensuring increased shelf life and minimal spoilage significantly improving food availability. To complete the cycle the households are taken through appropriate food preparation technologies on different recipes to promote consumption of the DTCs through change in feeding and consumption behaviors. This involves often changing the form of the product by formulating more attractive recipes like sorghum pilau, cowpea and green gram samosa, sorghum mandazi, cassava chapati and such like recipes of same locally known products but in different forms.
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Vegetable preservation process demonstration in Busia (left) and Marsabit (right) counties
Alternative livelihoods, Economic Empowerment, Financial Inclusion and Resilience building Enhanced purchasing power of the vulnerable communities provides cushion against shocks such as price fluctuations during food product scarcity. Capacity building on economic empowerment, financial inclusion that provides avenues for alternative livelihoods considerably builds the beneficiary resilience. During the quarter these efforts have been on going benefitting 1,311 households. Majority of the beneficiaries have taken up income generating activities at their households at different success levels and magnitude.
The Kyatune C a Baby Friendly Community Initiative (BFCI) mother to mother support group consisting of fifteen members have started table banking where each member contributes Fifty (50) Kenya Shillings every time they meet. The chairlady prepares fifteen paper cuttings with only one numbered and every member gets a chance to pick each a paper. The lucky member to get a numbered paper goes home with all the money contributed on that day and chooses what to do with it. The member who carries money home is not allowed to participate in the raffles during the next meeting. Through table banking, most mothers have bought poultry from which they get eggs, some for the family’s consumption and the surplus for sale, utensils and furniture. The mothers share experiences and knowledge amongst themselves and support other mothers outside the group.
In Teso North Busia county 735 (561F, 174M) care givers benefitted from income generating activities skills on making soya beverage, soya milk and liquid soap for both commercial and home use.
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In Marsabit county Godoma didiko group through IGA trainings continued to engage in goat meat business i.e. slaughtering and selling goat meat to the community members. Currently, they have approximately KSH 100,000 in their bank account. The group is also contemplating to venture into the Poultry keeping.
Agri-business and Inclusive Value Chain Development (IVCD) Training for KCDMS Implementers The program provided TA to an implementing partner RTI/KCDMS where 26 private sector and civil society implementers benefitted from an intensive 3-day training on Agri-business and Inclusive Value Chain Development in Kisumu. The participants were drawn from RTI/KCDMS clients from Kisumu, Busia, Homa Bay, Migori, Kisii, Siaya and Bungoma counties. This follows one that was done for Makueni, Taita Taveta, Kitui and Nairobi where some groups in Makueni have formed common interest group and aggregating their produce together for consolidated market. The western region trainees were as summarized in Table 17
Table 17: NHPplus/KCDMS Western Region IVCD Training Participants Sector Gender County Total Private Male Female Kisumu Civil Society 2 0 2 Private Sector 4 0 4 Busia Government 2 0 2 Homa Bay Private Sector 5 0 5 Migori Private Sector 3 1 4 Kisii Civil Society 0 1 1 Private Sector 2 0 2 Siaya Private Sector 2 1 3 Bungoma Private Sector 1 2 3 Total 21 5 26
Tharaka Small Business Management Skills Training- A Community Focused Approach The Small Business Management Skills (SBMS) training for the community support groups was conducted in Tharaka Nithi county necessitated by the need to equip the groups with the basic business skills at their level. SBMS is meant for those already doing group or individual businesses but also recommended for startups. The main output of the training was for the participants to be able to come up with own simple business plans which they could present to a financial institution for credit. Linkages were created with financial sector players the microfinance institutions (MFIs), Women Enterprise Fund (WEF), UWEZO Fund and Centenary SACCO who were able to tap into a large market, namely the low-income households and the community support groups. The financial intermediaries facilitated some of the training sessions. Additionally during the training, the participants were linked to the Climate Pal project to benefit from the improved and energy efficient cooking stoves. Seventy (70) people (55F, 15M) benefitted from the training
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3.2.3 Enhancing Human Capacity for Increased Agriculture Sector Productivity The program conducted trainings to some staff during the quarter in different fields to contribute towards building capacity for increased agricultural sector productivity. The beneficiaries were both government and private sector players benefiting 96 people (60F, 36M). Table ….. summarizes the activities.
Table 18: Summary of Trainings for Staff by County and Gender Type of Training County Participants Totals F M Agri-Business and Inclusive Value Chain Kisumu, Busia, Homa 5 21 26 Development Bay, Migori, Kisii, Siaya and Bungoma Small Business Management Skills Training- A Tharaka Nithi 55 15 70 Community Focused Approach Total 60 36 96
The National Agri-Nutrition Resource Manual To promote implementation of agri-nutrition interventions at community level, the program during the quarter supported in the printing of 600 agri-nutrition dialogue cards a product of the National Agri-nutrition Resource Manual. The cards were distributed to the counties at a rate of two cards per active group to be used by CHVs and champion mothers to reach the households. The distribution was as summarized in Table 19.
Table 19: Agri-nutrition Dialogue Cards Distribution by County County Sub-counties Active groups No. of cards
Busia Samia, Teso North 46 100 Kitui Kitui East, Kitui South, Mwingi 110 230 North, Mwingi Central Marsabit Moyale, Laisamis, Saku 30 65 Tharaka Nithi Thraka North, Tharaka South 41 85 Samburu Samburu East, Samburu Central, 20 45 Samburu North Total 247 525
In the coming quarter plans are underway to support development of the curriculum for in-service training in Agri-nutrition to be hosted at Kenya School of Agriculture.
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4.0 Monitoring and Evaluation 4.1 Facility Reporting During the quarter a total of 522 of the designated delivery points submitted service and commodity data to the program for archiving, quality control, reporting support and quantification and rationalization of commodity supplies, accounting for 95.2% reporting rate (n=548). On average, supported facilities submitted their data 2.12 days after the agreed deadline with a minimum of -14 and maximum of 23 days after the deadline.
The program supported nutrition assessments for a total of 204,594 clients, against a quarterly target of 96,250. In comparison to the preceding quarter, the increase in assessed patients represented a decrease by 14.1% The program also supported a total of 37,081 malnourished client with nutrition commodities, against a quarterly target of 36,070 clients, during the reporting period. A summary of client assessments and commodity interventions are shown in Tables 20 and 21.
Table 20: Summary of Total Number of Patients Assessed Reporting Yearly October- January- July- Total April-June Year Target December March September Achievement 2014-2015 196,800 34,695 45,002 33,306 40,466 153,469 2015-2016 140,122 83,292 103,783 108,281 39,104 334,460 2016-2017 350,000 88,254 118,249 188,221 146,757 541,481 2017-2018 385,000 201,603 226,246 215,352 246,379 889,580 2018-2019 385,000 223,628 238,194 204,594 666,416 Total 1,456,922 631,472 731,474 749,754 472,706 2,585,406
Table 21: Summary of Total Number of Patients Provided with Commodities Reporting Yearly October- January- July- Total April-June Year Target December March September Achievement 2014-2015 120,000 10,666 8,290 8,962 11,928 39,846 2015-2016 99,885 18,316 26,882 30,361 32,908 108,467 2016-2017 109,874 24,089 24,773 34,538 25,968 109,368 2017-2018 144,278 37,812 36,456 42,647 47,046 163,961 2018-2019 144,278 39,399 47,180 37,081 123,660 Total 618,315 130,282 143,581 153,589 117,850 545,302
4.2 Electronic Nutrition Reporting
NHPplus continued to provide technical support to health facilities both on request and on need assessment basis. The preferred method used to offer technical assistance during this quarter was through site visits, telephone, email and TeamViewer. Health facilities supported were classified as both in Kenya NHPplus five (5) focus counties and other counties around the country. In Focus counties the technical assistance was mainly supported by the project personnel on the ground. The project continued working through collaborations with other implementing partners such as the Academic Model for Providing Health Care Plus (AMPATHplus), Lea Toto, Afya Uzazi, and East Deanery AIDS Relief Program (EDARP), NHPplus to reach the rest of forty-two (42) counties. The project was able to build technical capacity of Public Health Centers and
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Dispensaries who do not have in house personnel trained in IT, by taking them through simple preventive and troubleshooting tips as they were fixing technical issues raised.
4.3 Nutrition Portal Kenya NHPplus program continued offering support to Nutrition and Dietetics Unit in updating of the national nutrition portal. During the Quarter the program continued working closely with the Ministry of Health, Human Nutrition and Dietetics Unit to add new updates from the nutrition activities reported across the counties. The essence of the portal is to encourage information sharing and amongst the nutrition sector players by offering a platform where they can easily access information on nutrition activities within the country. The new updates done on the portal in April- June 2019 quarter were; • Integrated SMART survey guidelines • Short Rains Assessment (SRA) 2019 brief and full situation reports • MIYCN-E rapid assessment guideline
4.4 SMART Surveys During the quarter, the project supported execution of annual SMART surveys in two counties (Marsabit and Samburu). A total of 2,677(2,065-Marsabit, 612-Samburu) households were assessed. Anthropometric measurement of 2,024 (1,520-Marsabit, 504 -Samburu) children under 5 years were done. Some of the key findings were as follows; Nutritional status of under five The assessment results indicated that the prevalence of stunting stood at in Marsabit stood at 21.1% as compared to 28.3% in the previous year, while in Samburu there was a drop from 35.8% in the previous year to 29.3%. The global acute malnutrition (GAM) rates remained high in both counties with the rates rising form 12.4% in 2018 to 18% in 2019. The deterioration can be attributed to Laisamis and North Horr. The GAM rate in Samburu remained constant at 15.8% (as compared to 15.7% in 2018). The prevalence of underweights remained high in both counties.
Table 22: Nutritional Status of children under five in Marsabit and Samburu counties
North Horr Moyale Saku Laisamis Marsabit county Status Samburu county (398) (n=403) (n=216) (n=503) (n=1520) (n=504) Global Acute 25.1 % 9.0 % 9.5 % 30.7 % 18% 15.8 % Malnutrition (20.0 - 31.0) (6.1 - 13.0) (4.8 - 18.0) (26.0 - 35.9) (15.6 - 20.7) (12.7 - 19.5) (GAM) Severe Acute 3.1 % 1.2 % 1.0 % 6.4 % 2.9% 2.4 % Malnutrition (1.7 - 5.5) (0.5 - 3.3) (0.2 - 3.8) (4.2 - 9.8) (2.1 - 4.0) (1.4 - 4.2) (SAM) Global 16.7 % 19.6 % 19.2 % 28.3 % 21.1% 29.3 % Stunting (13.7 - 20.2) (15.7 - 24.3) (13.9 - 25.9) (24.2 - 32.8) (18.9 - 23.4) (25.1 - 33.9) Severe 2.3 % 3.8 % 3.8 % 8.7 % 4.7% 8.3 % Stunting (1.1 - 4.9) (2.2 - 6.6) (1.9 - 7.6) (6.0 - 12.4 (3.5 - 6.3) (6.0 - 11.5) Global 27.2 % 13.7 % 14.2 % 39.6 % 23.1% 28.2 % underweight (21.9 - 33.3) (9.7 - 18.9) (7.9 - 24.4) (35.8 - 43.5) (20.4 - 26.1) (24.1 - 32.7) Severe 5.1 % 2.2 % 3.3 % 10.2 % 4.9% 6.6 % Underweight (3.3 - 7.8) (0.9 - 5.2) (1.0 - 10.5) (7.9 - 13.0) (3.8 - 6.3) (4.7 - 9.2) Details of nutritional status of children is summarized in Table 22 demonstrate significant heterogeneity of prevalence of GAM and underweight in Marsabit. The prevalence of stunting in
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Laisamis closely compared with that of Samburu county. With respect to trend a downward trend in the prevalence of stunting since 2016 to 2019 is evident in Marsabit and in Samburu from 2018 to 2019. However, the GAM rates in both counties have remained high as shown in figures 4 and 5 below.
Samburu Under five Nutrition status-Trend 40 35 34.8 35.8 29.3 30 31.6 28.2 25 25.7 20 15.7
15 14.5 15.8 Prevalence 10 5 0 2016 2018 2019 Year GAM Stunting Underweight
Figure 4: Samburu County Under five Nutrition Status-Trend
Marsabit Under five Nutrition status-Trend
40 35 30 28.8 28.3 25 28.2 23.1 20 21.4 21.1 18 15 Prevalence 12.4 10 14.4 5 0 2016 2018 2019 Year GAM Stunting Underweight
Figure 5: Marsabit County Under five Nutrition Status-Trend
From prevalence data in table 22, it is statistically reasonable to pool data from Moyale and Saku and data from North Horr and Laisamis. Analysis of weight for age Z-scores demonstrated early onset of underweight status which remained relatively stable during infancy. Among 12 to 59 month-olds, the mean Z-scores decreased with increasing age. Peculiar loss of weight gain is evident after infancy in Laisamis children. The distribution of mean height for age Z-score was consistent with loss in growth velocity peaking at 18-23 months and subsequent recovery tendencies that manifest as downward trend in the mean Z-score. The proportions of children who experienced positive weight for age Z scores were 5.9%, 17.6% and 11.5% in
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Lasisamis/North Horr, Saku/Moyale and Samburu in that order. Similarly, 13.6%. 19.4% and 17.1% of the children had positive height for age Z-scores.
Mean Z score for Weight for Age Age in months
6 to 8 9 to 11 12 to 17 18 to 23 24 to 35 36 to 47 48 to 59 0.00
-0.20
-0.40
-0.60
-0.80 -0.77 -0.82 -0.85 -1.00 -0.90 -0.88 -0.99-1.00-1.03 -1.07 -1.06 -1.20 -1.13 Mean Z Score Score (WAZ) Mean Z -1.14 -1.40 -1.28 -1.31
-1.60 -1.51 -1.51 -1.61 -1.68 -1.80 -1.72 -1.73 -1.78 Laisamis_North Horr (Mean) Moyale_Saku (Mean) Samburu (Mean)
Mean Z score for Height for Age Age in months
6 to 8 9 to 11 12 to 17 18 to 23 24 to 35 36 to 47 48 to 59 0.00
-0.20
-0.40 -0.33
-0.60 -0.59 -0.64 -0.80 -0.82
Mean Z Score Score (HAZ) Mean Z -1.00 -0.92 -0.94 -0.96 -0.97 -1.00 -0.98 -1.20 -1.08 -1.16 -1.14 -1.24 -1.26 -1.25 -1.28 -1.40 -1.34 -1.32 -1.39 -1.36 Laisamis_North Horr (Mean) Moyale_Saku (Mean) Samburu (Mean)
Figure 6: Mean Z score for Weight for Age and Height Age in Samburu and Marsabit Counties
Women Dietary Diversity Score The findings on women dietary diversity using five food groups cut-off point varied in Marsabit county (13.9% in Laisamis, 44.9% in Moyale, 21.7% in North Horr and 21.7% in Saku). Overall, 28% of women interviewed in Marsabit county consumed less than 5 food groups out of the 9
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food groups as compared to 31% in Samburu county. The dietary diversity scores are illustrated in figure 7.
Women Minimum dietary diversity 100.0% 90.0% 86.1% 78.3% 78.3% 80.0% 72.0% 69.0% 70.0% 60.0% 55.1% 50.0% 44.9% 40.0% 28.0% 31.0% 30.0% 21.7% 21.7% 20.0% 13.9% 10.0% 0.0% Laisamis Moyale North Horr Saku Marsabit County Samburu county
<5 food groups 5 and more food groups
Figure 7: Women Minimum dietary diversity-Marsabit and Samburu Counties
Food groups consumed by Women
95.6% All starchy staple foods 92.9%
57.3% Beans and peas 77.0%
48.4% Dairy (Milk) 60.4%
45.8% Other Vegetables 54.1%
34.5% Flesh foods 37.6%
47.6% Vitamin A rich dark green leafty Vegetables 26.1%
20.2% Eggs 9.9%
12.1% Other Vitamin A rich vegetables and fruits 9.6%
10.7% Other fruits 9.3%
2.2% Nut and seeds 1.5% Samburu Marsabit
Figure 8: Food groups consumed by women in Marsabit and Samburu Counties
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Further analysis showed that all starchy staple foods and legumes are the most consumed food groups across the two counties while other fruits and nuts and seeds are the least consumed as shown in the figure 8.
12.3% and 10% women of reproductive age in Samburu and Marsabit were found to be malnourished (MUAC<210mm). However, the study did not cover the infant and young child feeding practices which would could have been one of indication in terms of the improvement in feeding practices and also shade light on the reasons why the prevalence of stunting has reduced while the GAM rates are still high.
Household Dietary Diversity Score Based on the findings as indicated in figure 9, there were most of the household (77%) in Marsabit consumed 6 or more food groups as compared 37.6% for Samburu county. This indicates that food security situation in Samburu households is not good at all.
Household Dietary Diversity Score
Samburu 9.4% 53.0% 37.6%
Marsabit 1.0% 22.0% 77.0%
<3 food groups 3 to 5 food groups >5 food groups
Figure 9: Household Dietary Diversity Score-Marsabit and Samburu Counties
I. ACTIVITY PROGRESS – QUANTITATIVE IMPACT
The NHPplus performance monitoring and evaluation (PMEP) provides for specific indicators and their targets for which progress by the end of Quarter 3 (April – June 2019) is summarized below. Detailed performance monitoring data is presented in the ANNEX I.
Number of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance at national level:
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To strengthen coordination and implementation of activities for improved nutrition outcomes, the program supported fora at different levels namely; national, county and sub county levels. Multi sectoral County Nutrition technical Fora were held in 4 counties (Marsabit, Samburu, Kitui and Busia). At national level, the project participated in the following platforms; MIYCN, Nutrition Information Working Group, Nutrition Research, FtF Partners Ag Nut TWG, PREG, HIV Commodities TWG, HIV Nutrition TWG and MOALFI – Third Agri Nutrition Conference Planning secretariat
Number of individuals receiving nutrition-related professional training through USG- supported programs (RAA): During the quarter the program continued investing in skills building for health care workers to improve nutrition service delivery and demand creation. Furthermore, as part of journey to self- reliance a total of 31 (4 M, 27 F) individuals received nutrition related professional training supported by USG. The trainings mainly dwelt on the nutrition assessment and counselling (NACs) targeting the newly recruited nutritionists in Kitui county. The aim of the training was to ensure that the new recruits were able to gain knowledge and skills for improved service delivery. During the year a total of 1,151 (419 M, 732 F) individuals were reached with nutrition-related professional training against a target of 1,200.
Number of children under 5 yrs. who received Vitamin A from USG supported programs: During this financial year, the program is expected to support Vitamin A supplementation for a total of 440,389 children under 5 years. During the quarter, a total 383,625 under-fives were reached with Vitamin A supplements.
Number of children under five who are underweight: Overall, the program seeks to support identification of 28,292 under 5’s who are underweight within the focus counties. During the quarter, through program activities such as growth monitoring a total of 19,100 underweight children were identified within the focus counties.
Percentage of PLHIV who are nutritionally assessed using anthropometric measurement: Cumulatively, the program targets to conduct nutrition assessment for a total of 385,000 clients. During the quarter, a total of 204,594 out of a target of 96,250 clients were nutritionally assessed using anthropometric measurements.
Proportion of clinically undernourished PLHIV who received therapeutic or supplementary food: Cumulatively, the program targets to provide direct commodity support to a total of 144,278 malnourished adult, pregnant-post natal and child clients. During the quarter, a total of 37,081 out of a target of 36,070 clients were nutritionally assessed and provided received commodity support
Percentage of female direct beneficiaries of USG nutrition-sensitive agriculture activities consuming a diet of minimum diversity (RAA). On the SMART survey results for the two counties (Marsabit and Samburu), the proportion of women who were consuming a diet of minimum diversity were 28% and 31% for Marsabit and Samburu counties respectively
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Table 23: Summary Results to Date
IR 2018-2019 Indicator Achievement Target Q1 Q2 Q3 Q4 IR1: Improved Access and Demand for Quality Nutrition Intervention at Community and Facility Levels IR1.1: Strengthened Leadership, Advocacy and Policy Planning 1.1.1 # of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance (e.g. forum, working group, MOU, shared plans, associations, budgeting work planning, projects) Note 10 10 7 11 that it is important to identify best practices as they emerge. C4.0 Development of budget lines for nutrition in county work plan 3 - - - 1.1.3 4.5.1(24) Numbers of Policies/Regulations/Administrative Procedures in each of the following stages of development as a result of USG assistance in each case: Stage 1: Analyzed; Stage 2: Drafted and presented - - - - - for public/stakeholder consultation; Stage 3: Presented for legislation/decree; Stage 4: Passed/approved; Stage 5: Passed for which full and effective implementation IR1.2: Improved Nutrition Service Delivery Management, Coordination and Implementation 1.2.1 3.1.9.2(2) Number of health facilities with established capacity to manage acute undernutrition (S) 160 11 - - C5.0 Comprehensive NACS implemented at health facilities (beyond CCC/ART sites) 400 400 400 400 1.2.3 (DO 2; 2.2.1; (2)) % of facilities submitting timely, complete and accurate information - (These are among 92% 96.5% 90.1% 95.2% 3.1.9.2(2) Number of health facilities with established capacity to manage acute undernutrition (S)) 1.2.5 Percentage of PLHIV who are nutritionally assessed via anthropometric measurement (FN_ASSESS) 385,000 223,628 238,194 204,594 1.2.6 Proportion of clinically undernourished PLHIV who received therapeutic or supplementary 144,278 39,399 47,180 37,081 food(FN_THER) HL.9-1 Number of children under five (0-59 months) reached with nutrition specific interventions by USG- 440,389 351,456 55,666 383,625 supported nutrition programs 1.2.7 3.1.9.2(3): Number of children under 5 who received Vitamin A from USG supported programs 440,389 351,456 55,666 383,625 HL9-2 Number of children under 2 (0-23 months) reached with community level nutrition interventions 60,358 9,767 10,582 23,124 through USG-supported programs (RAA) HL9-3 Number of pregnant women reached with nutrition-specific interventions through USG-supported 100,887 21,702 22,061 21,450 programs (RAA) Custom Custom: Number of children under five who are Underweight (WAZ) 28,292 13,866 16,455 19,100 1.2.9 IR1.3: Improved Nutrition Related Behavior C6.0 Number of standardized SBC nutrition materials distributed (and revised if necessary) to community 3 - - health and agricultural extension workers supported by USAID IP’s IR1.4: Increased Opportunities for Learning and Sharing of Best Practices in Nutrition Number of implementation science questions answered 4 2 - - identified
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IR 2018-2019 Indicator Achievement Target Q1 Q2 Q3 Q4 IR1.5: Increased Knowledge and Skills of Health Care Workers (HCW) in Nutrition HL9-4 Number of individuals receiving nutrition-related professional training through USG-supported 1,200 327 793 31 programs (RAA)
IR Indicator 2018-2019 Achievement Target Q1 Q2 Q3 Q4 IR2: Strengthened Nutrition Commodity Management IR2.1: Improved Production, Supply and Distribution of Nutrition Commodities 2.1.3 SC_STOCK: The percentage of storage sites where commodities are stored according to plan, by level in supply 100% 100% 100% 100% system. C8.0 Diversification and capacity building of nutrition commodity producers. NHPplus # of Nutrition commodities procured by type (FBF) 1,683.9 424.8 531.9 515.70 NHPplus # of Nutrition commodities distributed to active health facilities points by type (FBF) 1,683.9 214.2 532.48 316.53 C9.0 % of nutrition commodity distribution (procured by NHPplus) managed by KEMSA NA NA NA NA C2.0 # of active health facilities reporting stock outs for FBF and RUTF in the preceding six months) <20% <20% <20% <20% IR2.2: Improved Quality and Safety of Food Commodities and Agricultural Products 2.2.1 44.5.1(24) Numbers of Policies/Regulations/Administrative Procedures in each of the following stages of development as a result of USG assistance in each case: Stage 1: Analyzed; Stage 2: Drafted and presented for - - - - public/stakeholder consultation; Stage 3: Presented for legislation/decree; Stage 4: Passed/approved; Stage 5: Passed for which full and effective implementation 2.2.2 4.5.2 [42] number of private enterprises producer organizations, water user’s associations, women’s groups, trade and business associations and community-based organizations [C0Bs] that applied improved technologies or 2 2 3 3 management practices as a result of USG assistance [RiA] [ IR2.3: Strengthened sustainability and innovation in nutrition commodity development and management C1.0 Reduction in the cost of production of commodities 2% NA NA NA NA IR3: Improved Food and Nutrition Security IR3.1: Increased Market Access and Consumption of Diverse and Quality Foods 3.1.1 # of people trained. Mentored, provided TA at National/County Level on SCALE, Household Food Production, TA to develop effective strategies and approaches on improving food utilization and dietary diversity, Diet 230 177 19 diversity in community settings, Food preparation and safety, Ag practices that assist in responding to identified 45 environmental threats; Food recipe manuals reviewed/developed 3.1.1.1 # of partners within the 5 focus counties trained on SCALE+ 11 9 8 - 3.1.1.2 # of FBF value chain players (processors, aggregators, farmers) from 5 focus counties trained on SCALE+ 120 4 87 19
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IR Indicator 2018-2019 Achievement Target Q1 Q2 Q3 Q4 3.1.2 # of county/sub-county TOTs trained on agri Nutrition including agri-business 21 125 96 3.1.3 # of CHVs/FEWs/ECDEs trained on agri nutrition at community level 0 0 3.1.4 # of mothers and child care givers trained on agri-nutrition dietary diversity household activities at community 8,504 19,839 9,366 10,754 level 3.1.5 # of hearth sessions (cooking demos) conducted disaggregated by ward/county and gender 3,100 373 3,884 4,647 3.1.6 # of demonstration gardens established within the 5 focus counties 50 - - 19 3.1.7 # of HH visits conducted disaggregated by group and ward/county 19,839 8,504 9,366 10,754 C7.0 Collaborations across MNCH, HIV/AIDS and FtF partners and government partners utilizing SCALE methodology for advocacy and planning 3 0 1 1 C3.0 Effective linkages with service delivery providers: 3 1 1 1 C10.0 Technical assistance to FtF partners to expand number of poor small-scale farmers through value chain analysis >100% 50% 0 63% (7/11) (16/11) C6.0 # of standardized SBC materials distributed (and revised if necessary) to community health and agricultural 3 2 - 1 extension workers supported by USAID IPs. C11.0 Technical assistance to support FtF partners to adapt existing agri nutrition tools to include HH production and consumption of nutritious food 15 17 - IR3.2 Increase resilience of vulnerable households and communities E.G.3.3- Percentage of female direct beneficiaries of USG nutrition-sensitive agriculture activities consuming a diet of 28% 10 minimum diversity (RAA) 52% Marsabit, 50% NA (646/1,248) 31% Samburu 3.2.9 EG.11-6: Number of people using climate information or implementing risk reducing actions to improve 1400 1,697 1,321 3,211 resilience to climate change as supported by USG assistance 3.2.11 # of tools/templates/models provided by target institutions in order to facilitate devolution at the local level as a 1,000 879 20 525 result of USG assistance 3.2.3 # of 5-member teams consisting of 1 CHEW, 1 Home Econ, 1 Extension services, 1 ECDE trained on Agri 0 0 0 Nutrition including agri-business 3.2.4 # of communities supported to conduct participatory disaster risk reduction assessments 20 0 6 0 3.2.5 # of households screened at least twice during the year 2,944 26 1,403 1,271 3.2.6 # of community members trained on income generating activities at community level 7,108 1,641 1,437 1,311
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II. RESEARCH AND DEVELOPMENT Strengthening National Flour Blending Policy Outcome monitoring activities conducted in FY19 Q1&Q2 revealed that the thresholds of minimum acceptable diets (MAD; > 4 groups) for children in Kitui, Busia and Tharaka Nithi Counties remained relatively low. In Busia, Kitui and Tharaka Nithi County MAD rates ranged between 28% and 42%, 27% and 39%, and 20% and 42% in that order. Inclusion of legumes was estimated at 27% in Busia county, 61.7% in Tharaka Nithi and 45% in Kitui.
To promote consumption of legumes, the program engaged the county Ag-Nutrition staff that had been trained in the Kenya School of Agriculture in sensory evaluation of cereal-legume blended flours. The drought tolerant crops (DTC), cowpeas and green grams were selected because of availability, affordability of prices, absence of protease inhibitors and easier to cook. The cereal - legume flour blend was used to prepare porridge recipes, which were enriched with milled vegetable powder, milk powder and sweetened with sugar and allowed to cook in about 30 minutes. The second recipe comprised the same ingredients but included cooking oil and was pan flied to form roasted pre-cooked micro-lumps. The pre-cooked mixture was dispersed in water and used to prepare porridge whose cooking time was about 10 minutes. Majority of the participants were mothers aged between 25 and 40 years and their children. About 3% of participants were men.
The findings of the sensory evaluation in Kitui East suggested – 1. Based on a ratio of maize to legume flour ratio of 70:30, that was enriched with dried milk powder and sugar? The likelihood of cow pea acceptability was evident. The likelihood of acceptance of green grams (“Nylon”) variety was low given the consistent dislike of the odor and taste characteristics (Table 24). Analysis of variance of ranked scores demonstrated that cow peas received significantly better rating than green grams enriched porridge (p< 0.002); (Figure 10) Table 24: Sensory Evaluation Results Legume % of Colour Aroma Taste Aftertaste Cow peas (n=159) 66.7 57.8 73.6 74.2 Green grams - Nylon variety 65.4 33.3 27.7 27.6
Regarding green grams varieties, the “cotton” variety (Figure 12), preliminary findings suggest that its flour blend obtained acceptance equivalent to that of cow peas. The difference underscores the importance of identifying strains that are most compatible with proposed expansion of the policy on flour blending to include the legumes and also achieve the MAD and WDD faster. The cotton strain of green grams that has a brown outer skin showed comparable acceptability with the cow peas.
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Cowpeas Green Grams
3.40 3.37 3.13 3.03 2.89
2.18 2.06 2.06
COLOR ODOUR TASTE AFTER TASTE
Figure 10: Mean score of assessed sensory characteristics show higher acceptability of cow pea -maize flour blend
Figure 11:Green grams (Nylon) variety
Figure 12: Green (brown) grams (Cotton) variety
The color of the flour from two legumes has green tinge and cannot be distinguished from color alone.
Other activities: 22 millers were sensitized about good milling practices with reference to legumes and food safety. The millers who were sensitized on techniques of milling legumes were encouraged to promote the milling and consumption of cow peas and cotton variety of green grams.
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The findings of the feasibility work were presented to Kitui multi-sectoral forum. The County director of Agriculture adopted the approach to expanding consumption DTCs to young children and increase overall consumption in the county. The agriculture sector extension officers were encouraged to promote adoption of the recipes that were demonstrated in their respective sub counties and Wards. A task team was appointed committee to coordinate response to emerging issues and consolidate the case to facilitate scaling up consumption of the cereal-legume blended flours in the county. During Q4, the program will sensitize retailers to start stocking cow peas and cotton variety flours for blending with maize and preferred sorghum flours.
Revisiting the safety of eggs in early childhood complementary feeding
Recent findings of a randomized controlled trial (RCT) on impact of linear and ponderal growth during early childhood demonstrated 47% reduction of stunting and 74% reduction in underweight among 6-9-month-old Ecuadorian children who were fed with one egg per day1. However, the general community belief system associate’s consumption of eggs in early childhood with delayed speech development (anecdotal evidence) and complications during childbirth. Cursory enquiries of cultural factors relevant to consumption of animal source foods in Busia and Kitui counties raised the same concerns. The outcome monitoring activities conducted in FY19 Q1&Q2 estimated the use of eggs in complementary feeding between 5.7% and 6.8% among communities who had been sensitized on the importance of animal source foods in Kitui, Busia and Tharaka Nithi Counties. Interestingly, team members of the RCT recently reported the feasibility of egg consumption among pregnant women residing in Nairobi peri-urban areas2. Against this background, local understanding of plausible nutrient factors that could be associated with the development and evolution of the cultural beliefs system is needed prior to mounting an effective advocacy for adoption of recommendations of the RCT – “one egg daily”.
Through elimination, the high content of pre-formed vitamin A in egg yolk is a possible risk factor for hypervitaminosis A among older infants and toddlers with high breast-milk intake. Hypervitaminosis A is associated with several negative impacts among them, softening of the skull bone; bulging of the soft spot on the top of an infant’s skull (fontanel); double vision/bulging eyeballs; inability to gain weight, coma. Acute toxicity leading to bulging of fontanels is an early sign of elevated intra-cranial pressure (ICP) and associated symptoms among them transient loss of speech that may be noticed following intake of supplements containing high levels of pre- formed vitamin A. WHO guidelines observe that mild symptoms of intolerance such as loose stools, headache, fever and irritability may be experienced by less than 10% of children who receive supplements. These side effects disappear within 24 to 48 hours without special treatment3. It is estimated that among infants and toddlers whose mothers have good vitamin A nutrition status, high breast-milk intake adequately meets daily requirements. In contrast 6-8-month-olds infants with low and average breast-milk intake have vitamin A gap of 164 mcg RE/d and 13 mcg RE/d respectively4. The corresponding deficits for 9-11-month-olds and 12-23-month-olds with
1 Iannotti LL, et al; Eggs in Early Complementary Feeding and Child Growth: A Randomized Controlled Trial. PEDIATRICS Volume 140, number 1, July 2017:e20163459 2 Schnefke CH et al; Is it possible to promote egg consumption during pregnancy? Findings from a study on knowledge, perceptions, and practices in Kenya. Food and Nutrition Bulletin (40(2), 2019. 3 WHO Guideline (2011) -Vitamin A supplementation for infants and children 6-59 months of age 4 WHO. Complementary feeding of young children in developing countries. WHO/NUT/1998 70 FY 19 Q3April-June Quarterly Report
low breast-milk intake are 214 mcg RE/d and 313 mcg RE/d respectively. The 9-11-month-olds and 12-23-month-olds with average breast-milk intake may experience 42 mcg RE/d and 126 mcg RE/d respectively.
According to the Kenya Food Composition tables, the mean concentration of Vit A in boiled hen yolk is about 427 mcg/100 g. Analysis of egg yolks from three different farms and sold in retail outlets indicate average values of 474 mcg/100 g, 753 mcg/100 g and 897 mcg/100 g. The higher values of vitamin A content are consistent with higher dietary intake from feeds5. Assuming a typical medium size yolk weighs about 15 g, available evidence suggests that consumption of one medium size egg per day will provide between over 60 mcg per egg and 135 mcg/egg. Given the daily requirements of average breast-milk intake, consumption of one egg per day is likely to increase the risk of hypervitaminosis A among 6-11-month-olds. However, all low breast-milk intake 6-23-month-olds are unlikely to experience hypervitaminosis A, conditional that correct vitamin A dietary targeted counseling is achieved. It is plausible to hypothesize that regular consumption of several eggs along with other vitamin A rich foods among breastmilk feeding infants increases the likelihood of disruption of speech development associated with ICP due to hypervitaminosis A. From the standpoint of public health intervention, recent evidence on population level vitamin A nutrition status, vitamin A supplementation history and dietary intake especially of pre-formed Vitamin A should be considered in promotional activities and counselling of care givers.
Given the practicality of scaling up use of eggs to provide nutrients required to avert stunting and underweight, is it possible to improve the safety of eggs within home settings? Since vitamin A is highly susceptible to ultra-violet light, exposure of boiled egg yolks described above to sunlight demonstrated on average 43% and 64% reduction in vitamin A content after 3 hours and 7 hours respectively (Figure 13). It is feasible to reduce vitamin exposure through inactivation of yolks by sunlight.
5 Mendonca Jr CX et al. Effect of Dietary Vitamin A on Egg Yolk Retinol and Tocopherol Levels. J. Appl. Poult. Res. 11:373–378; 2002
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20 0 1 3 7 18 16 14 12 10 8 6
Vit Vit mcg A RE/g Yolk of 4 2 0 GYE YYE FOE CE Source of eggs -GYE, YYE & FOEAxis bran Titleds and Complementary Food, CE
Figure 13:The density of pre-formed vitamin A decreased with increasing exposure to sunlight
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III. PROGRESS ON LINKS TO OTHER USAID PROGRAMS
To leverage on USG resources at National and county level the program engaged with other USG implementing partners in several activities.
National • As the secretariat of the USAID Agri-Nutrition TWG for FtF partners the program facilitated bi-monthly meetings where nutrition learning question was mainly discussed. • As the secretariat to the Third Agri-nutrition Conference, the program facilitated the conference planning meetings during the quarter. The key achievements development and sharing the concept note and call for abstracts.
County Level At county level, the program collaborated with other USG implementing partners in the quarterly PREG activities in Marsabit and Samburu. During the quarter the program also leveraged on USG resources for the SMART survey in Samburu county.
IV. PROGRESS ON LINKS TO OTHER GOK AGENCIES
The program collaborated with other government agencies and non-USAID implementing partners for several activities.
KNAP Launch Activities The program participated in the planning meetings for the launch of KNAP 2018 – 2023 at Afya House. The launch will be done during the health summit at KICC Nairobi in August 2019. Other implementing partners facilitating launch activities include UNICEF, WFP and Nutrition international. Other ministries include Education, Devolution and ASAL and Agriculture.
CNAP Development The program developed a joint work plan with Nutrition international to facilitate the development of County Nutrition Action Plans in Busia and Tharaka Nithi. To leverage on resources, Nutrition International will facilitate consultants to assist in development while NHPplus will facilitate all development activities including inception meeting, three write-shop and launch activities. In Kitui, Marsabit and Samburu, the program is collaborating with other partners to develop and finalize CNAPs by end of September. For example, in Kitui the program is working with Afya Halisi; in Samburu with World Vision Kenya and Marsabit with UNICEF.
COHA Kenya Study The program participated in the National Implementation Team (NIT) activities for the development of the COHA Kenya model. This is collaborative activity led by the National Treasury and supported by Ministry’s of Health, Education, Labour, Devolution and development partners including WFP, UNICEF; and State Agencies i.e. KIPPRA. The final report of COHA Kenya is on course for completion in September 2019.
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V. IMPLEMENTATION CHALLENGES
During Malezi bora and Growth Monitoring promotion activities several implementation challenges were encountered. • Displacement of communities due to inter clan conflict: In Marsabit during Malezi Bora health facilities were not able to achieve targets due to displacement of communities. For example, in Sagante ward, Saku and North Horr several health facilities were not operational as a result of conflict. • Poor latrine coverage in Loyangallani: The lack of clean water as well as water resources and open defecation contributed to high incidence of diarrhea in the sub county. This affected Malezi bora and Growth monitoring outreach activities as most children under two required management for diarrhea. • Poor telephone network coverage: In Counties of Kitui, Samburu and Marsabit the vast arid areas are poorly served by mobile network carriers; during mobilization “trigger” activities using CHVs, communication between various teams is hampered leading to low coverage due to poor mobilization. • Drought situation in ASAL: In some parts of Samburu and Marsabit, the situation has deteriorated due to drying up of water resources and pasture. These zones are currently under emergency status and hence supplementation and mass screening are the only activities allowed by the county.
VI. LESSONS LEARNT
Several lessons have been learned over the course of implementing activities such as Malezi bora, BFCI and Growth monitoring and promotion. For BFCI: the design of the program at community level is a function of routine household mapping to identify cohorts of children within four age bands 0 (newborns), 1 – 5.9; 6 – 7.9 and 8 – 11.9 months. The number of children 0 – 11.9 months is a dynamic number that changes every month. The decrease in coverage of BFCI is an indication of lack of institutionalized routine mapping and shortfalls in the management by the community mother supports groups. Malezi bora and growth monitoring are key preventive and promotive activities to improve child nutrition and require a target driven approach at all levels from Sub county, ward, Health facility and village. This awareness is a key driver to improving coverage for these high impact interventions. The approach of creating ownership and responsibility by communities for targets for interventions leads to better outcomes and reach for interventions.
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VII. SUBSEQUENT QUARTER’S WORKPLAN
Status of Activities Planned for the Reporting Period IR1 Improved access and demand for quality nutrition interventions at community & facility levels Month Activity Status Explanation Busia Apr HINI/NACS CME & on job training Completed County Multisectoral Nutrition Technical Completed forum BFCI Monthly review meetings for Completed Changara, Madende, Ikonza, Bumutiri, Siakarira and Nangina Annual Work Planning for Department of Completed Health May Malezi Bora activities Completed CNAP Inception meeting Completed June Facility in-charges meeting for Matayos, Completed Pending for Teso North, and Samia Teso South, Nambale and Butula ECDE Growth Monitoring Outreaches Completed Kitui Apr BFCI External Assessment – Mwingi Completed Kitui South and Kitui central & Mwingi North East scheduled for Q3 Kitui CNAP secretariat inception meeting Completed
May Malezi Bora activities Kitui county Completed Kitui CNAP Development – Inception Completed workshop June NACS & IMAM Training Completed Growth Monitoring and Promotion/Child Completed Growth Assessment Marsabit May County Nutrition Technical Forum Completed Planning for SMART survey Malezi Bora Activities Completed June Growth Monitoring and Promotion Completed activities SMART survey Marsabit Completed
Samburu May CNAP Consultative workshop Completed Growth Monitoring and Promotion Completed Activities Malezi Bora Semester 1 activities Completed
June SMART survey Completed Tharaka Nithi Apr Quarterly Indicator Review Meeting Completed Malezi Bora Planning meeting Completed May Malezi Bora Activities Completed June BFCI Assessment activities Completed 75 FY 19 Q3April-June Quarterly Report
IR2 Strengthened Nutrition Commodity Management
Planned Activity Status at Explanation for end of Q3 Deviation Procurement and Distribution: Nutrition commodities, Data collection tools to be In data collection and summary tools procured in the coming progress quarter Participate in Commodity Pipeline Sub Committee monthly meetings (NDU) and Commodity Steering Not done Meetings not convened Committee (NASCOP) Conduct Site Supervision visits/data review meetings in To be done in the coming Not Done focus counties, Kisumu, Homabay and Kakamega quarter Follow up with KEBS on review of composite flours Done policy Conduct Supplier Quality Audits Activity will not be Not Done conducted as procurement ends by September 2019 Transitioning Procurement, Warehousing and In
Distribution to KEMSA progress Quantification of Nutrition Commodities (NASCOP) Done Final report to be done in the coming quarter
IR3 Improved Food and Nutrition Security Planned Activity Status at end Explanation for of Q3 Deviation National level From the developed new National Agri-nutrition Resource Manual develop the facilitators guide, job aids Ministry had some In progress and participants manual and curriculum for in-service commitments trainees Support national forums that improve collaboration, Done adaptation of best practices and improve learning County level Conduct Scale+ county level training for stakeholders (processors, aggregators, farmers), IPs and government Done staff Facilitate Quarterly SCALE + Meetings Done Facilitate exchange visit of staff across counties County logistical Suspended problems Ward/Community/Household level Deliver 2 high impact practical nutrition sensitive Done interventions (specific per county as in the county plans) through the contextualized agri-nutrition package complete with WASH and IGAs to the households through champion mother’s model/outreaches targeting mothers and child care givers through value chain approach targeting improved access and consumption of diversified nutrient dense foods Support CHVs/CHEWs/FEWs to deliver specific Done practical high impact specified packages Establish and brand 10 dietary diversity demonstration Done gardens Promote any two cottage level technologies among Done Supported brick cooler Wetmiling, groundnut milling, solar drying technologies technology and vertical bag manufacturing to HHs in ZOI 76 FY 19 Q3April-June Quarterly Report
Planned Activity Status at end Explanation for of Q3 Deviation Promote poultry value chain to improve access and Done consumption of eggs to children under the one egg per child per day agenda Facilitate Community Managed Disaster Risk Reduction Not done NDMA involved in Training for sub-county officers/frontline extension other activities (work providers from MOH, MOALF and MOE in ASAL planning) counties Facilitate community sensitization on climate change Done adaptation practices in all counties Facilitate dissemination of seasonal weather forecast Partially Unpredictable season recommendations in 3 ASAL counties one season each onset so mostly done at group level under climate change adaptation Conduct Mass screening of children and mothers during Done hot spot areas confined during the SMART survey and other outreach activities Training community members on income generating Done activities and financial inclusion Capacity building communities on appropriate food production technologies through promotion of DTCs, Done water harvesting technologies among others Documentation of at least 2 good practices On going
Planned Activities for the Subsequent Quarter
Explanations for Planned Activities for Quarter 4 Deviations IR 1 – Improve Access and Demand for Quality Nutrition Interventions Busia County July Facilitate meeting for development of a joint work plan with clear integrated activities Quarterly multisectoral nutrition forum BFCI internal assessment in Changara and Nangina Conduct NACS support supervision and use of SIMs tool BFCI Monthly Meeting August 3-day stakeholder meeting CNAP review Health facilities in charges indicator review meetings for Nambale, Butula Samia and Teso north HINI Gaps Assessment 5-day CNAP write workshop CNAP stakeholder validation meeting CNAP 3-day final write up validation BFCI External Assessment September CNAP launch BFCI Bi-Monthly outreaches BFCI Integrated outreach Kitui July NACS Supportive supervision 77 FY 19 Q3April-June Quarterly Report
Explanations for Planned Activities for Quarter 4 Deviations BFCI Monthly review meetings August CNTF Meeting HINI Gaps assessment Sub county HMT BFCI supportive supervision World Breastfeeding week activities CNAP Validation workshop September BFCI community dialogue days Health facilities in charges meeting 4 sub counties CNAP Final consolidation write-shop
Marsabit July Sub County Nutrition Technical forums BFCI CHV Monthly Household visits BFCI Community dialogue days August CNAP two stakeholder meeting World Breastfeeding week CNAP five-day workshop Quarterly multisectoral CNTF Growth monitoring activities September CNAP five-day Finalization write shop CNAP launch BFCI Monthly review meetings County Bi-Annual indicator review meeting
Samburu July HINI gap Assessment for 22 Health facilities from Samburu North, East and Central Sub- counties Community and Facilities Data Review Meetings- CHS. -CHEWs and Community Focal Persons for Samburu North, East and Central
NACS DQA August BFCI Assessment in Kisima and Lorubae and Lderkesi CNTF quarterly meeting CNAP five day Write shop BFCI Monthly review meetings September BFCI bi-monthly outreach activities Familia Bora Trainings for TOT and CHVs from CUs- (Kisima, Lorubae and Lderkesi, South-Horr
Tharaka Nithi July CNAP inception meeting HINI Gaps assessment BFCI assessment results dissemination August CNAP Stakeholder meeting CNAP writeshop Sub county support supervision for BFCI September CNAP validation meeting CHIS data review meetings CNAP finalization write shop BFCI monthly review meetings 78 FY 19 Q3April-June Quarterly Report
IR2 Strengthened Nutrition Commodity Management Planned Activity July – September 2019 Procurement and Distribution of Nutrition Commodities Finalization of Quantification Report Transition to KEMSA activities (meetings, factory visits) Data Quality Meetings – Kisumu, Kiambu, Homabay/Siaya Follow-on Meetings with KEBS (Revision of Standards)
IR3 Improved Food and Nutrition Security Planned Activity July – September 2019 Facilitate MOALFI to develop in-service agri-nutrition curriculum and other accompanying tools Facilitate MOALFI to finalize the Agri-nutrition framework Training and demonstration of 2 IGA mushroom production units Support to Food blending initiative Support 3rd National Agri-nutrition Conference County level Support SCALE+ initial pick-up activities in all counties Facilitate exchange visit of staff across counties Ward/Community/Household level Continue promoting delivery of 2 high impact practical nutrition sensitive interventions (specific per county as in the county plans) through the contextualized agri-nutrition package complete with WASH and IGAs to the households through champion mother’s model/outreaches targeting mothers and child care givers through value chain approach targeting improved access and consumption of diversified nutrient dense foods Support CHVs/CHEWs/FEWs to in Busia to establish some Agri-nutrition Field Schools Promote brick cooler demonstration Support to flour blending initiative at community level for dietary diversity Establish and brand 10 dietary diversity demonstration gardens Promote cottage level manufacturing of vertical bags Promote interventions to improve access and consumption of animal source foods Facilitate Community Managed Disaster Risk Reduction Training and climate change adaptation practices for food and nutrition secuirty Conduct Mass screening of children and mothers during hot spot areas confined during the SMART survey and other outreach activities Training community members on income generating activities and financial inclusion Capacity building communities on appropriate food production technologies through promotion of DTCs, water harvesting technologies among others Documentation of at least 3 good practices
VIII. FINANCIAL INFORMATION
NHPplus is a five-year combination award consisting of a Cost-Plus-Fixed-Fee (CPFF) completion type contract line item (CLIN 0001) and an Indefinite Delivery/Indefinite Quantity (IDIQ) type contract (CLIN 0002). The total estimated cost for the performance of the work required under CLIN 0001, exclusive of fee (if any), is $ 36,942,927. The total fixed fee under CLIN 0001 (if any)
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is $1,192,206. The total estimated cost-plus fixed fee amount for CLIN 0001 is $38,135,134. During the quarter additional obligations of $1,872,000 for the Nutrition component of the project was received bringing total obligated funds to $ 31,248,449 with $17,226,449 being from PEPFAR, $5,000,000 from Feed the Future and $9,022,000 from Nutrition component. The total contract time which has so far lapsed is 54 months (85% of LOP). The project has not implemented any activity in CLIN 0002 hence this financial report is only for CLIN 0001.
The project uses Cost Point Accounting system for financial reporting and the report has been presented using the US$ currency.
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35,000,000
1,161,159
2,223,456 30,000,000 1,470,831 31,248,449
25,000,000
20,000,000
27,039,357 15,000,000
10,000,000
5,000,000
-
Obligated Funds Cummulative Expenditure -Prior Fiscal Years Q1/FY19 Actual Expenses Q2/FY19 Actual Expenses Q3/FY19 Actual Expenses
Figure 14:Comparison between Obligations, Actual and Accrued Expenses T.E.C.: $38,135,135 Cum Obligation: $31,248,449 Cum Expenditure: $ 27,039,357 (87% of the obligated funds)
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Table 25:Expenditure by Contract Line Item Number (CLIN 001)
Pipeline (committed Expenditure Total LOP Total funds Total funds Total funds Total funds funds minus as a Budget (Part committed to expended from expended for expended from expended percentage of B.4 of the date by USAID inception to the Quarter inception to June funds) approved Contract Line Item Description Contract) June 30, 2019 March 31,2019 (Apr - Jun 2019) 30, 2019 June 30, 2019 budget
CLIN 001 A B C D = B + C E = D/A
CLIN 001a Direct Costs 10,360,930 8,249,402 562,770 8,812,172 85% Commodity Procurement and CLIN 001b Distribution 22,554,542 14,365,326 368,061 14,733,386 65%
CLIN 001c Indirect Costs 4,027,456 3,263,471 230,328 3,493,798 87%
CLIN 001d Total Fixed Fee 1,192,206 - - -
CLIN 001 Total 38,135,134 31,248,449 25,878,198 1,161,159 27,039,357 4,209,092 71%
Table 26:Expenditure by Funding Stream
Total funds Total funds committed to expended from Obligation date by USAID inception to Balances at Budget Line Item June 30, 2019 June 30, 2019 June 30, 2019 A B C = A-B
PEPFAR 17,226,449 15,450,226 1,776,223
Nutrition 9,022,000 7,125,305 1,896,695
FtF 5,000,000 4,463,826 536,174
Total 31,248,449 27,039,357 4,209,092
Table 27:Burn rate per month
Burn Rate/Month Amount US$ Actual to June 2019 27,039,357 A Number of Months since inception to June 2019 54 B Burn rate/ Month 500,729 C=A/B
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The project’s cumulative expenditure from inception to June 2019 is $ 27,039,357 with contract budget balance of $11,095,776 over the remaining LOP. The current quarter actual expenses are $ 1,161,159. The actual expenditure is 87% of the contract budget amount and the current burn rate is $500,729/ month. There was a decline in overall burn rate during the quarter due to decline in the procurement and distribution of nutritional commodities.
Detailed explanation for Table 25 above of the expenditure by the contract line items is as follows;
Direct Costs: The costs under this budget line item comprise all project related costs other than commodity procurement and distribution, the indirect costs and fixed fees. The costs covered under this contract line item include personnel and fringe, consultancy, travel and transportation and other direct costs (ODC). Total expenditure to-date is $ 8,812,172 which is 85% of the CLIN 001a line contract budget.
Commodity Procurement and Distribution: The costs under this budget line comprise direct costs for the procurement and distribution of nutritional commodities as well as operational costs and other direct costs related to the activity. Vendors subcontracted for food production are Equatorial Nut Processors Ltd and INSTA Products Ltd for the manufacture of FBF and RUTF respectively. The program procured and distributed only FBF commodities during the quarter. Total actual costs under this budget line for the quarter is $ 368,061 and from inception to-date is $ 14,733,386 which is 65% of the CLIN 001b line contract budget.
Indirect Costs: The overhead costs are based on predetermined rates and appropriate bases as per the signed contract (Clause B5: Indirect Costs). The total actual costs under this contract line item for the quarter is $ 230,328 and from inception to-date are $3,493,798 representing 87% of the CLIN 001c line contract budget.
Fixed Fees: The fees are billed upon achieving performance target as per the contract and the status is as per table below - PAYMENT OF FIXED FEE – Schedule and Performance
IX. PROJECT ADMINISTRATION INFORMATION
During the quarter 12 Data Clerks were hired for 3 months on a temporary basis to support the digitization of the MOH registers in order to ensure that all the data are captured in the central data basis for further analysis. The project also hired a temporary Finance and Administrative Assistant on a 3 months contract to support the Finance functions of the program.
The contracts for the 58 interns hired during the previous financial year was extended for a further 5 months to end in November 2019. This followed the end of their 9-month initial contracts which lapsed on May 2019. Salaries for the interns was also increased by 5% effective June 2019. Currently the project operates with full capacity of 58 interns under the same sub-contract arrangement with LAN-X Africa Ltd.
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A meeting between LAN-X and FHI360 was also held during the quarter. The purpose of the meeting was to discuss the progress of the internship program including evaluations of their performances. This had so far be done successfully and follow on meeting was to be held in the next period.
During the period, one of the Monitoring and Evaluation officer resigned and the position is yet to be filled.
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X. PAYMENT OF FIXED FEE – SCHEDULE AND PERFORMANCE
Table 28:Status of Fixed Fee Indicators
Indicator Baseline Performance target MOV Status 1 Reduction of the cost of FBF 2% Reduction for each Program budget production of commodities =$1070 type & Reports RUTF =$4027 2 No stock-outs for 6 Varies Stock outs in ordering Facility consecutive months between (central) sites <20% of all commodity 80-100% commodities associated reports & with production gaps tracking report 3 Effective linkages with 0 Number of linkages with Joint Work Plan Achieved service delivery providers National & County IPs development/i (APHIA+ & FtF) mplementation 4 Development of budget 0 Five priority Counties County budget Achieved lines for nutrition in county include nutrition in their review workplans budgets 5 Comprehensive NACS 400 400 facilities with Facility Visit and Achieved implemented at health MNCH/CW units reports facilities (beyond implementing NACS3 comprehensive care clinic (CCC)/ART sites) 6 Number of standardized 0 8 SBCC Tools Materials Achieved SBC nutrition materials distributed - MIYCN, printed and distributed (and revised if WASH IEC, NACS/FBP, distributed necessary) to community HH Food production health and agricultural manual, Nutritious Food extension workers Recipe booklet, Vit A, supported by USAID IPs IFAS) 7 Collaboration across 0 5 counties using SCALE SCALE training MNCH, HIV/AIDS & FtF methodology to facilitate & TA reports partners & GOK partners collaboration to ensure using SCALE methodology nutrition services across for advocacy and planning multiple sectors 8 Diversification & capacity 1 3 manufactures achieving Producer Achieved building of nutrition higher level of certification commodities producers certification than currently from KEBS and obtained from national ISO and international bodies 9 % of nutrition commodities 0% 90% of commodities Commodity distribution (produced by produced by NHPplus reports NHPplus) managed by distributed KEMSA 10 Technical assistance 0 100% of FtF partners Training and TA Achieved provided to FtF partners to trained and provided TA reports expand number of poor on inclusion of poor small scale farmers through farmers in value chain tool value chain analysis 11 TA support to FtF partners 0 100% FtF partners trained Training TA Achieved to adapt existing agriculture and provided TA on tool reports review tool to include HH production & consumption of nutritious foods
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XI. SUCCESS STORIES
1. Group promotes good nutrition and economic empowerment
What started as a nutrition education group evolved to include a savings scheme that is building community assets and empowering women economically. It all began in early 2017, a group of 30 women in Ndandini village of Athi Ward in the southern part of Kitui County formed a group after attending a training session on good nutrition in 2017.Their objectives was to support one another practice what they had learnt in the training by the loal community health volunteer (CHV). Within a short time Woni women’s group was 30 members. To join the group, one had to either be pregnant or have a child aged under two years. Samson Nyamai who visited to educate the on nutrition is one of the community health volunteers trained in agrinutrition in a joint intervention by USAID’s Kenya Nutrition and the ministries of agriculture and health. Topics covered in the training include type of foods to consume, exclusive breastfeeding, complementary feeding, preservation of vegetables, water, sanitation and hygiene (WASH), growing drought resistant crops such as millet and green grams. The women also learnt how to start and manage income-generating activities so that they could earn money to provide for their families’ diets and for other needs. Members of the group meet regularly to share experiences and learn from one another. They also make contributions to a savings scheme. By the end of 2018, the group had saved Sh96,000 with which they bought a goat for each member. The goats provide milk for their children and have the potential to multiply the household assets as they reproduce. The group’s next target is to save enough money to buy each member a water tank. This will enable them harvest rainwater for domestic use and to irrigate their kitchen gardens during the dry season, ensuring families can grow own vegetables all year round.
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2. Father of six see the value of kitchen garden Bosco Wanyama Ojiambo (right), a father of six, is a farmer at Serekelesi village in Samia sub-county. He is a member of Mwenda Pole, a local community group whose members were trained in agrinutrition.
USAID’s NHPplus partnered with the Ministry of Agriculture to train Bosco and other members to grow a variety of nutritious foods using intensive farming techniques that increase production. Bosco used to mainly maize and sugarcane for money, leaving little space for other crops. Now he sets aside enough farmland to grow crops such as spinach, collard greens, pumpkin and arrowroots to enrich his family’s diet. He no longer buys vegetables. Instead, he often has a surplus that earns him income.
“Many people do not get the information they need to produce the best crops. Since I joined Mwenda Pole group, I have seen changes in my garden,” says Bosco. 3. Two mothers and their gardens that thrive in water-scarce area
Anastasia Mulwa and Mary Munyao tend to their kitchen gardens in Kanguu village, Kitui East Sub-County.
Vegetables are an important part of healthy eating and are a source of many nutrients, including iron, folate, potassium, and vitamins A, E and C. Yet many families do grow because they lack the knowhow or cannot afford to buy vegetables due to the high cost, especially during the dry season.
USAID’s Kenya Nutrition and Health Program Plus (NHPplus) is working with the Ministry of Agriculture to promote appropriate dryland technologies for water-scarce areas that can enable families grow their own vegetables even when the rains fail.
In Kanguu village, Kitui County, Anastasia Mulwa and Mary Munyao have adopted simple farming techniques and now produce vegetables to improve their families’ diets, saving money in the process.
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Following the advice of community health volunteers (CHVs) that the project trained, the two women grow a variety of vegetables in vertical gardens, sucken beds and plastic containers.
The role of CHVs is mainly to educate the community of how to prevent diseases and to refer people who require services to health facilities. However, their close contact with communities makes CHVs important change agents in many areas.
To leverage the power of CHVs, NHPplus partnered with the ministries of health and agriculture to train them on agrinutrition, so that they could encourage families to grow their foods that diversity their diets and keep livestock for eggs, milk and meat.
The number of kitchen gardens in homesteads has increased through the use of vertical bags, shamba and seedlings distributed by agricultural officers. Being a semi-arid area, irrigation is used to ensure constant supply of vegetables for families.
“Growing of vegetables has high nutritional value to our well-being and we will make sure to include them in our daily meal for our children to get all the nutrients needed in their growth,” says Mary, who, like Anastacia, has a son under the age of five. 4. Mothers get nutrition education and economic benefits
Members of the Kyatune C mother to mother support group in Kyatune Ward, Kitui South
The Kyatune C is a mother-to-mother support group consisting of 15 members formed as part of the Baby Friendly Community Initiative (BFCI) in Kitui.
Through the group, the mothers have learned about good nutrition for pregnant women, mothers and young children. They meet monthly to continue learning from each other by sharing experiences and from health workers, led by the local community health extension worker (CHEW) and community health volunteers (CHEWs). 88 FY 19 Q3April-June Quarterly Report
The group’s benefits go beyond nutrition. Members have started table banking to strengthen their common bond and empower themselves economically. At every meeting, members contribute Sh50 each, which is given to one member by ballot.
With the cash received from the group, most members have bought chickens from which get eggs for the family and for sale. Others have bought utensils and furniture. 5. Mothers get nutrition education and economic benefits A first-time mother, Sharon Nabwire has benefited from a support group that promotes good nutrition for mothers and their babies, including exclusive breastfeeding for the first six months, Busia County, western Kenya. When she health workers introduced her to the group, 18-year-old Sharon was uneasy, but she soon became an active members after realizing the benefits. “At first I was scared to join the group because I was the youngest, but I later realized I could learn a lot from the members,” says Sharon. “I practice everything I am taught.” Sharon says her baby is healthy and strong because of exclusive breastfeeding.”
Sharon’s group is called Malezi Bora. It is one of 175 mother-to-mother support groups with formed across Busia with the support of health workers trained by USAID’s Kenya Nutrition and Health Program Plus. Similar groups have been formed in four other counties the program supports. The groups play an important role in empowering mothers under the Baby Friendly Community Initiative, a health intervention that promotes good nutrition and childcare the first two years of life.
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ANNEX I: PERFORMANCE DATA TABLES
Annex 1: Summary of commodities distributed INDICATOR TITLE: Amount of Commodities Distributed INDICATOR NUMBER: SC_STOCK UNIT: Activity Title Date M Sub-total Reporting Results: Additional Re-worked Reporting Period Reporting Period Reporting Period Reporting Period End of Project Criteria % FY 2019 Target 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 Target allocation County per county Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Baringo 2.2% 250 - 250 214 250 45 250 998 259 8,182 4,065 Bomet 1.1% 213 - 213 124 213 - 213 851 124 5,028 3,670 Bungoma 1.2% 585 482 585 842 585 440 585 2,338 1,764 8,654 11,574 Busia 0.4% 1,448 1,889 1,448 1,955 1,448 1,245 1,448 5,790 5,089 14,140 30,079 Elgeyo Marakwet 0.5% 205 - 205 108 205 25 205 820 133 3,256 3,355 Embu 5.9% 309 115 309 295 309 165 309 1,236 575 18,275 5,973 Garissa 1.0% 19 - 19 19 - 19 76 - 2,833 281 Homa Bay 6.4% 1,737 853 1,737 1,984 1,737 1,378 1,737 6,949 4,215 32,642 33,238 Isiolo 0.7% 114 - 114 81 114 58 114 454 139 2,991 2,274 Kajiado 1.6% 295 65 295 340 295 257 295 1,179 662 6,823 5,622 Kakamega 2.5% 626 141 626 514 626 347 626 2,505 1,002 12,146 11,904 Kericho 3.1% 114 - 114 172 114 60 114 455 232 8,943 3,460 Kiambu 2.8% 856 278 856 2,071 856 1,033 856 3,423 3,382 15,052 19,203 Kilifi 1.5% 221 - 221 505 221 202 221 884 707 6,051 4,320 Kirinyaga 2.2% 670 382 670 1,104 670 614 670 2,682 2,100 12,167 13,961 Kisii 1.2% 293 - 293 563 293 215 293 1,171 778 5,658 9,265 Kisumu 5.4% 1,407 1,145 1,407 1,376 1,407 872 1,407 5,628 3,393 27,110 28,176 Kitui 1.3% 610 513 610 1,702 610 1,812 610 2,440 4,027 8,521 16,696 Kwale 0.6% 178 - 178 65 178 70 178 711 135 3,441 3,563 Laikipia 0.3% 152 50 152 272 152 - 152 610 322 2,251 2,898 Lamu 1.2% 95 - 95 95 - 95 382 - 4,072 1,412 Machakos 3.6% 691 621 691 918 691 448 691 2,765 1,987 15,669 13,459 Makueni 0.9% 438 320 438 908 438 45 438 1,751 1,273 6,385 8,114
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INDICATOR TITLE: Amount of Commodities Distributed INDICATOR NUMBER: SC_STOCK UNIT: Activity Title Date M Sub-total Reporting Results: Additional Re-worked Reporting Period Reporting Period Reporting Period Reporting Period End of Project Criteria % FY 2019 Target 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 Target allocation County per county Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Mandera 0.0% ------Marsabit 0.7% 125 - 125 173 125 332 125 501 505 2,994 3,073 Meru 2.0% 421 122 421 878 421 811 421 1,683 1,811 9,158 8,772 Migori 3.7% 881 167 881 627 881 216 881 3,525 1,010 18,130 15,706 Mombasa 7.1% 417 - 417 183 417 67 417 1,669 250 22,225 6,709 Murang'a 2.8% 363 293 363 469 363 244 363 1,453 1,006 10,490 6,833 Nairobi 8.3% 1,634 865 1,634 1,064 1,634 1,328 1,634 6,535 3,257 36,617 30,038 Nakuru 2.4% 726 411 726 552 726 647 726 2,903 1,610 12,464 14,415 Nandi 2.4% 214 - 214 219 214 152 214 856 371 8,175 3,793 Narok 1.0% 321 98 321 275 321 81 321 1,282 454 5,510 7,656 Nyamira 0.0% 147 - 147 257 147 91 147 587 348 1,253 2,604 Nyandarua 2.4% 416 186 416 594 416 540 416 1,665 1,320 9,935 8,952 Nyeri 2.6% 369 113 369 609 369 254 369 1,474 976 10,426 7,068 Samburu 0.7% 409 382 409 1,393 409 - 409 1,638 1,775 5,658 8,797 Siaya 6.5% 1,404 451 1,404 1,400 1,404 614 1,404 5,617 2,465 30,378 24,591 Taita Taveta 1.7% 152 133 152 33 152 116 152 610 282 5,645 2,888 Tana River 0.1% 50 - 50 50 - 50 199 - 736 1,050 Tharaka Nithi 2.1% 297 165 297 736 297 554 297 1,188 1,455 8,020 6,757 Trans Nzoia 0.5% 321 397 321 626 321 44 321 1,282 1,067 4,222 6,441 Turkana 3.3% 927 901 927 1,324 927 1,143 927 3,710 3,368 17,517 19,556 Uasin Gishu 0.0% 523 237 523 1,216 523 356 523 2,092 1,809 4,876 11,216 Vihiga 0.9% 454 125 454 776 454 664 454 1,817 1,565 6,510 9,255 Wajir 0.1% 26 - 26 26 - 26 105 - 636 429 West Pokot 0.4% 100 - 100 65 100 - 100 401 65 1,987 1,482 Total 100% 22,222 11,900 22,222 29,582 22,222 17,585 22,222 - 88,889 59,067 465,278 444,640 Note: All Quantities in 18kg Cartons
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Annex 2: Number of HIV positive clinically malnourished clients who received therapeutic and/or supplementary food
INDICATOR TITLE: Number of HIV positive clinically malnourished clients who received therapeutic and/or supplementary food INDICATOR NUMBER:FN_THER UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M ALL Data Management, Reporting Results: Additional Criteria Results Baseline Achieved Reporting Period Reporting Period Reporting Period Reporting Period FY 2017/19 Target (January Prior 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 2015) Periods County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Baringo 2.2% 1,668 0 808 130 808 258 808 204 808 3,231 592 Bomet 1.1% 910 1 412 165 412 307 412 136 412 1,650 608 Bungoma 1.2% 356 3 440 875 440 1,323 440 685 440 1,761 2,883 Busia 0.4% 4,429 23 134 2,129 134 3,552 134 2,464 134 537 8,145 Elgeyo Marakwet 0.5% 766 1 172 150 172 84 172 130 172 689 364 Embu 5.9% 4,739 0 2,144 417 2,144 427 2,144 368 2,144 8,577 1,212 Garissa 1.0% 536 0 371 70 371 85 371 61 371 1,482 216 Homa Bay 6.4% 1,167 2 2,294 2,950 2,294 3,548 2,294 2,701 2,294 9,176 9,199 Isiolo 0.7% 1,842 0 259 252 259 236 259 151 259 1,037 639 Kajiado 1.6% 2,308 0 565 505 565 397 565 382 565 2,260 1,284 Kakamega 2.5% 2,118 1 892 873 892 689 892 967 892 3,568 2,529 Kericho 3.1% 1,120 0 1,117 371 1,117 219 1,117 221 1,117 4,468 811 Kiambu 2.8% 1,661 2 1,025 2,879 1,025 4,012 1,025 2,886 1,025 4,101 9,777 Kilifi 1.5% 906 1 542 243 542 419 542 349 542 2,170 1,011 Kirinyaga 2.2% 4,019 1 804 1,070 804 1,397 804 1,178 804 3,216 3,645 Kisii 1.2% 993 1 439 140 439 301 439 371 439 1,755 812 Kisumu 5.4% 473 1 1,945 881 1,945 1,474 1,945 1,875 1,945 7,782 4,230 Kitui 1.3% 224 2 481 1,971 481 1,638 481 2,351 481 1,923 5,960 Kwale 0.6% 884 0 229 162 229 257 229 26 229 916 445 Laikipia 0.3% 2,676 2 108 306 108 287 108 411 108 433 1,004 Lamu 1.2% 702 0 428 - 428 - 428 - 428 1,711 - Machakos 3.3% 513 1 1,187 873 1,187 1,194 1,187 1,059 1,187 4,749 3,126 Makueni 0.9% 1,480 3 340 524 340 972 340 814 340 1,359 2,310 Mandera 0.0% 2,769 ------
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INDICATOR TITLE: Number of HIV positive clinically malnourished clients who received therapeutic and/or supplementary food INDICATOR NUMBER:FN_THER UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M ALL Data Management, Reporting Results: Additional Criteria Results Baseline Achieved Reporting Period Reporting Period Reporting Period Reporting Period FY 2017/19 Target (January Prior 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 2015) Periods County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Marsabit 0.7% 5,284 0 248 428 248 699 248 375 248 993 1,502 Meru 2.0% 2,080 1 716 998 716 1,047 716 1,733 716 2,866 3,778 Migori 3.7% 6,153 1 1,341 682 1,341 557 1,341 418 1,341 5,362 1,657 Mombasa 7.1% 1,764 0 2,558 127 2,558 197 2,558 143 2,558 10,232 467 Murang'a 2.8% 1,766 0 1,007 1,015 1,007 979 1,007 631 1,007 4,028 2,625 Nairobi 9.1% 764 1 3,282 4,290 3,282 5,539 3,282 2,715 3,282 13,129 12,544 Nakuru 2.4% 1,765 2 854 1,824 854 1,794 854 934 854 3,415 4,552 Nandi 2.4% 1,974 0 855 269 855 460 855 598 855 3,419 1,327 Narok 1.0% 532 1 370 374 370 408 370 339 370 1,478 1,121 Nyamira 0.0% 4,827 - - 228 - 166 - 260 - - 654 Nyandarua 2.4% 1,239 1 854 494 854 982 854 859 854 3,418 2,335 Nyeri 2.6% 58 0 956 632 956 1,135 956 655 956 3,823 2,422 Samburu 0.7% 1,541 2 258 578 258 679 258 478 258 1,031 1,735 Siaya 6.5% 398 0 2,337 1,368 2,337 808 2,337 1,449 2,337 9,347 3,625 Taita Taveta 1.7% 2,473 0 600 120 600 125 600 177 600 2,400 422 Tana River 0.1% 692 0 28 - 28 - 28 - 28 113 - Tharaka Nithi 2.1% 103 0 746 1,380 746 1,871 746 152 746 2,984 3,403 Trans Nzoia 0.5% 296 3 193 469 193 527 193 280 193 770 1,276 Turkana 3.3% - 2 1,197 3,569 1,197 3,173 1,197 2,849 1,197 4,788 9,591 Uasin Gishu 0.0% - - - 1,653 - 1,858 - 899 - - 4,410 Vihiga 0.9% - 3 335 923 335 1,100 335 1,336 335 1,340 3,359 Wajir 0.1% - - 50 - 50 - 50 - 50 199 - West Pokot 0.4% 413 0 143 42 143 - 143 11 143 574 53 Total 100.0% 74,511 65 36,065 39,399 36,065 47,180 36,065 37,081 36,065 - 144,278 123,660
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Annex 3: Number of PLHIV nutritionally assessed via anthropometric measurement INDICATOR TITLE: Number of PLHIV nutritionally assessed via anthropometric measurement INDICATOR NUMBER: FN_ASSESS UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M ALL Data Management, Reporting Results: Additional Criteria Results Baseline Achieved Reporting Period Reporting Period Reporting Period Reporting Period (January FY 2017/19 Target Prior 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 2015) Periods County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Baringo 2.2% 4,904 8,198 2,155 1,672 2,155 2,559 2,155 2,374 2,155 8,621 6,605 Bomet 1.1% 2,504 4,138 1,100 1,080 1,100 2,405 1,100 1,301 1,100 4,402 4,786 Bungoma 1.2% 2,674 32,237 1,175 12,994 1,175 11,176 1,175 9,187 1,175 4,700 33,357 Busia 0.4% 815 60,700 358 8,860 358 16,639 358 9,678 358 1,433 35,177 Elgeyo Marakwet 0.5% 1,045 3,386 459 944 459 929 459 542 459 1,837 2,415 Embu 5.9% 13,019 4,546 5,722 1,381 5,722 1,213 5,722 820 5,722 22,887 3,414 Garissa 1.0% 2,250 1,829 989 684 989 881 989 689 989 3,956 2,254 Homa Bay 6.4% 13,928 152,961 6,121 33,525 6,121 30,009 6,121 25,870 6,121 24,485 89,404 Isiolo 0.7% 1,575 964 692 469 692 343 692 194 692 2,768 1,006 Kajiado 1.6% 3,431 4,319 1,508 1,358 1,508 614 1,508 1,496 1,508 6,032 3,468 Kakamega 2.5% 5,415 36,501 2,380 8,212 2,380 6,413 2,380 10,774 2,380 9,520 25,399 Kericho 3.1% 6,782 20,159 2,981 6,159 2,981 6,743 2,981 5,783 2,981 11,923 18,685 Kiambu 2.8% 6,225 52,650 2,736 10,788 2,736 16,773 2,736 16,597 2,736 10,943 44,158 Kilifi 1.5% 3,293 17,704 1,447 5,603 1,447 4,872 1,447 5,172 1,447 5,789 15,647 Kirinyaga 2.2% 4,882 7,963 2,146 2,177 2,146 2,416 2,146 2,013 2,146 8,582 6,606 Kisii 1.2% 2,664 1,896 1,171 336 1,171 547 1,171 564 1,171 4,683 1,447 Kisumu 5.4% 11,812 35,710 5,191 6,417 5,191 8,230 5,191 10,313 5,191 20,765 24,960 Kitui 1.3% 2,919 11,866 1,283 6,188 1,283 3,586 1,283 10,378 1,283 5,132 20,152 Kwale 0.6% 1,391 1,635 611 290 611 605 611 105 611 2,445 1,000 Laikipia 0.3% 657 2,986 289 1,890 289 2,236 289 4,712 289 1,156 8,838 Lamu 1.2% 2,598 - 1,142 - 1,142 - 1,142 - 1,142 4,567 - Machakos 3.3% 7,865 12,678 3,168 2,794 3,168 2,583 3,168 2,194 3,168 12,672 7,571 Makueni 0.9% 2,062 15,562 906 4,062 906 4,625 906 1,582 906 3,625 10,269 Mandera 0.0% ------Marsabit 0.7% 1,507 1,164 662 950 662 1,585 662 1,001 662 2,649 3,536
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INDICATOR TITLE: Number of PLHIV nutritionally assessed via anthropometric measurement INDICATOR NUMBER: FN_ASSESS UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M ALL Data Management, Reporting Results: Additional Criteria Results Baseline Achieved Reporting Period Reporting Period Reporting Period Reporting Period (January FY 2017/19 Target Prior 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 2015) Periods County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Meru 2.0% 4,350 7,245 1,912 2,259 1,912 2,260 1,912 2,923 1,912 7,648 7,442 Migori 3.7% 8,139 9,942 3,577 1,328 3,577 746 3,577 1,125 3,577 14,308 3,199 Mombasa 7.1% 15,531 11,324 6,826 3,497 6,826 829 6,826 398 6,826 27,303 4,724 Murang'a 2.8% 6,115 13,915 2,687 3,230 2,687 4,805 2,687 2,752 2,687 10,750 10,787 Nairobi 9.1% 18,084 129,073 8,759 29,135 8,759 33,234 8,759 17,553 8,759 35,035 79,922 Nakuru 2.4% 5,184 33,441 2,278 7,375 2,278 6,893 2,278 5,574 2,278 9,113 19,842 Nandi 2.4% 5,190 29,511 2,281 6,675 2,281 12,020 2,281 11,488 2,281 9,123 30,183 Narok 1.0% 2,244 17,108 986 3,174 986 3,101 986 2,656 986 3,945 8,931 Nyamira 0.0% - 4,089 - 4,900 - 5,083 - 6,019 - - 16,002 Nyandarua 2.4% 5,188 4,811 2,280 793 2,280 1,481 2,280 1,372 2,280 9,120 3,646 Nyeri 2.6% 5,803 8,361 2,550 2,132 2,550 3,126 2,550 1,976 2,550 10,202 7,234 Samburu 0.7% 1,565 1,919 688 953 688 1,213 688 928 688 2,751 3,094 Siaya 6.5% 14,188 8,529 6,236 2,121 6,236 1,054 6,236 1,812 6,236 24,942 4,987 Taita Taveta 1.7% 3,643 2,931 1,601 216 1,601 202 1,601 329 1,601 6,404 747 Tana River 0.1% 172 - 76 - 76 - 76 - 76 302 - Tharaka Nithi 2.1% 4,530 1,950 1,991 1,660 1,991 2,295 1,991 198 1,991 7,964 4,153 Trans Nzoia 0.5% 1,169 7,187 514 1,564 514 1,686 514 972 514 2,055 4,222 Turkana 3.3% 7,268 21,880 3,194 9,309 3,194 7,104 3,194 7,445 3,194 12,777 23,858 Uasin Gishu 0.0% - 43,582 - 13,841 - 11,430 - 5,225 - - 30,496 Vihiga 0.9% 2,034 39,941 894 9,342 894 11,650 894 10,294 894 3,576 31,286 Wajir 0.1% 302 - 133 - 133 - 133 - 133 530 - West Pokot 0.4% 871 1,089 383 1,291 383 - 383 216 383 1,532 1,507 Total 100.0% 219,000 889,580 96,238 223,628 96,238 238,194 96,238 204,594 96,238 - 385,000 666,416
95 FY 19 Q3April-June Quarterly Report
Annex 4: Number of children under 5 who received Vitamin A from USG supported programs
INDICATOR TITLE:3.1.9.2(3): Number of children under 5 who received Vitamin A from USG supported programs INDICATOR NUMBER:FtF UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M ALL Data Management, Reporting Results: Additional Criteria Baseline Results Reporting Period Reporting Period Reporting Period Reporting Period (December Achieved FY 2019 Target If other criteria are important, add 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 lines for setting targets and tracking 2014) Prior Periods Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved County % N N N N N N N N N N N N Busia - 100,730 122,840 137,957 19,045 137,059 137,957 137,957 156,104 Kitui - 88,085 137,564 160,232 19,661 136,346 160,232 160,232 156,007 Marsabit - 32,466 27,182 48,484 5,626 33,164 48,484 48,484 38,790 Samburu - 24,799 31,618 50,339 4,014 42,914 50,339 50,339 46,928 Tharaka Nithi - 38,958 32,252 43,376 7,320 34,142 43,376 43,376 41,462 Total - 285,038 351,456 440,389 55,666 383,625 440,389 440,389 439,291 Data reported here is based on bi-annual child health activities conducted in Nov 2018 and May 2019
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Annex 5: Number of people trained in child health and nutrition through USG-supported programs)
INDICATOR TITLE: (3.1.9(1) Number of people trained in child health and nutrition through USG-supported programs) INDICATOR NUMBER: USAID/MSI UNIT: Geographic Location Activity Title Date M Data Management, Reporting Results: Additional Criteria Baseline Reporting Period Reporting Period Reporting Period Reporting Period If other criteria are important, add (December FY 2019 Target 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 lines for setting targets and tracking 2014) County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N Busia 80 218 80 279 80 31 240 528 Kitui 80 80 165 80 240 165 Tharaka Nithi 80 61 80 114 80 240 175 Marsabit 80 48 80 107 80 240 155 Samburu 80 80 123 80 240 123 Total 400 327 400 788 400 31 1,200 1,146
97 FY 19 Q3April-June Quarterly Report
Annex 6: Number of children under five (0-59 months) reached with nutrition specific interventions by USG-supported nutrition programs
INDICATOR TITLE: 3.1.9(15): HL.9-1 Number of children under five (0-59 months) reached with nutrition specific interventions by USG-supported nutrition programs INDICATOR NUMBER: FtF UNIT: Geographic Location Activity Title Date M Data Management, Reporting Results: Additional Criteria Baseline Reporting Period Reporting Period Reporting Period Reporting Period If other criteria are important, add (December FY 2019 Target lines for setting targets and tracking 2014) 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 County Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved % N N N N N N N N N N N Busia - 122,840 137,957 19,045 137,059 137,957 137,957 156,104 Kitui - 137,564 160,232 19,661 136,346 160,232 160,232 156,007 Marsabit - 27,182 48,484 5,626 33,164 48,484 48,484 38,790 Samburu - 31,618 50,339 4,014 42,914 50,339 50,339 46,928 Tharaka Nithi - 32,252 43,376 7,320 34,142 43,376 43,376 41,462 Total - 351,456 440,389 55,666 383,625 440,389 440,389 439,291 Data reported here is based on dewormed children 12 – 59 months done bi-annually in November and May .
98 FY 19 Q3April-June Quarterly Report
Annex 7: Number of pregnant women reached with nutrition-specific interventions through USG-supported programs (RAA)
INDICATOR TITLE: 3.1.9(15): Number of pregnant women reached with nutrition-specific interventions through USG-supported programs (RAA) INDICATOR NUMBER:FtF UNIT: Geographic Location Activity Title Date M Data Management, Reporting Results: Additional Criteria Baseline Reporting Period Reporting Period Reporting Period Reporting Period If other criteria are important, add lines (December FY 2019 Target for setting targets and tracking 2014) 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved County % N N N N N N N N N N N Busia - 7,438 6,082 7,438 6,726 7,438 7,207 7,438 29,750 12,808 Kitui - 9,524 6,731 9,524 7,073 9,524 6,183 9,524 38,097 13,804 Marsabit - 3,049 3,002 3,049 2,878 3,049 2,681 3,049 12,194 5,880 Samburu - 2,613 2,699 2,613 2,562 2,613 2,945 2,613 10,451 5,261 Tharaka Nithi - 2,599 3,188 2,599 2,822 2,599 2,434 2,599 10,396 6,010 Total - 25,222 21,702 25,222 22,061 25,222 21,450 25,222 100,887 43,763
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Annex 8: Comprehensive NACS implemented providing services beyond CCC/ART sites INDICATOR TITLE: 3.1.9(15): Comprehensive NACS implemented providing services beyond CCC/ART sites INDICATOR NUMBER: UNIT: Geographic Location Activity Title Date M Data Management, Reporting Results: Additional Criteria Results Baseline Achieved Reporting Period Reporting Period Reporting Period Reporting Period If other criteria are important, (December FY 2019 Target Prior 31/Dec/18 31/Mar/19 30/Jun/19 30/Sep/19 add lines for setting targets and 2014) tracking Periods County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved N N N N N N N N N N N N Busia 15.6% - 19 Kitui 41.0% - 26 Marsabit 13.3% - 7 Samburu 10.5% - 9 Tharaka Nithi 19.6% - 11 Total - 72 - -
100 FY 19 Q3April-June Quarterly Report
Annex 9: Vitamin A Supplementation Coverage of Under-fives by Sub-County in Focus Targets for Children under Performance for Semester 1 five 2019 % Counties Sub-County Children 6 – Children 12 – Children 6 - Children 12 - Coverage 11 Months 59 Months 11 Months 59 Months Bunyala 2,374 11,011 2618 10157 95% Butula 4,163 20,112 6932 16572 97% Matayos 3,804 18,374 7801 13319 95% Busia Nambale 3,233 15,618 2560 18004 109% Samia 3,194 15,430 2209 13449 84% Teso North 4,030 19,466 14102 9083 99% Teso South 4,682 22,618 3508 18271 80% Kitui Central 3,505 17,526 3200 15417 89% Kitui East 3,625 18,124 3354 16185 90% Kitui Rural 2,925 13,709 3398 14462 107% Kitui South 4,407 23,503 8447 13365 78% Kitui Kitui West 3,016 15,080 3949 11228 84% Mwingi Central 3,998 19,987 5122 17317 94% Mwingi North 3,962 19,811 9103 17804 113% Mwingi West 2,938 14,689 2129 16773 107% Laisamis 2,212 9,720 2360 7537 83% Moyale 3,496 15,363 2892 11069 74% Marsabit North Horr 2,533 11,130 1490 7320 64% Saku 1,566 6,883 2831 4431 86% Samburu 3,902 20,520 5849 20099 106% Central Samburu Samburu East 2,315 12,172 3457 7919 79% Samburu North 2,292 12,054 2941 10681 95% Chuka 2,196 10,776 1299 6573 61% Igambang'ombe 1,194 5,429 545 3482 61% 923 4,198 512 4061 89% Tharaka Muthambi Nithi Mwimbi 1,569 9,091 890 3696 43% Tharaka North 1,915 8,710 1954 8649 100%
Tharaka South 2,077 9,445 2510 11087 118% TOTAL 82,046 400,548 107,962 328,010 90% Counties
Annex 10: Number villages covered with BFCI activities and number of related CHVs by community unit, ward, sub-county and county County Sub County Ward Community unit # of villages # of CHVs covered Busia Nambale Bukhayo East Buyofu 9 10 Mungatsi A 9 9 Mungatsi B 10 10 Samia Nangina Budalangi 6 9 Bukhulungui 11 14 101 FY 19 Q3April-June Quarterly Report
County Sub County Ward Community unit # of villages # of CHVs covered Luchulilo 8 9 Sigulu 8 10 Sirekeresi 6 11 Wakhungu 12 13 Teso North Angurai East Akobwait 10 10 Aterait 10 10 Changara 10 10 kolanya 10 10 Kitui Kitui East Endau/ Malalani Katumbi/Koi 6 6 Ndetani 8 8 Yiuku/Kathua 5 5 Voo/Kyamatu Kasasi 13 13 Zombe/ Mwitika Kaumu 8 8 Kitui South Kyatune Kiangu 12 12 Kyatune 9 9 Kyoani 7 8 Lower Kituti 2 2 Makaiye 5 5 Upper Kituti 7 7 Mwingi Central Waita/Mwambui Mwambui 9 9 Thonoa 9 9 Waita 4 4 Miwingi North Kyuso Kimu 12 12 Mumoni Kakuyu/Kyanduli 22 22 Tharaka Gakombe 17 17 Marsabit Laisamis Loiyangallani Loiyangallani 28 28 Moyale Uran Golole 12 12 Saku Sagante Jaldesa Goro Rukesa 28 28 Samburu Central Lodekejek Kisima 17 17 East Wamba East Lpashie 7 23 Sordo - 9 40 Namunyak Waso Lderkesi 10 10 Lorubae 16 16 North Nyiro South Horr 19 22 Nachola Nachola 7 17 Tharaka Tharaka North Gatunga Kathangachini 29 29 Nithi Tharaka South Nkondi Matakiri 33 33
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ANNEX II: GIS INFORMATION ON AGRI NUTRITION GROUPS/ACTIVITIES
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Quarterly Indicator 4/30/2019 5/2/2019 Tharaka-Nithi 37.581700 -0.916000 Exact Location Tharaka-South Marimanti Marimanti Institutions Review Meetings BFCI Internal 5/6/2019 5/10/2019 Tharaka-Nithi 37.956944 -0.040278 Exact Location Tharaka-South Nkondi Matakiri Households Assessment BFCI Internal 5/6/2019 5/10/2019 Tharaka-Nithi 38.147090 -0.097560 Exact Location Tharaka-North Gatunga Kathangachini Households Assessment Food Preparation 5/13/2019 5/17/2019 Tharaka-Nithi 37.581700 -0.916000 Exact Location Tharaka-South Marimanti Marimanti Households Sessions
Food Preparation 5/13/2019 5/17/2019 Tharaka-Nithi 38.015650 -0.102570 Exact Location Tharaka-North Gatunga Gatunga Households Sessions Vitamin A 6/5/2018 10/5/2019 Tharaka-Nithi 37.655370 -0.329540 Exact location Chuka Karingani All Households Supplementation Vitamin A 6/5/2018 10/5/2019 Tharaka-Nithi 37.831230 -0.335420 Exact location Igambang'ombe Igambang'ombe All Households Supplementation Vitamin A 6/5/2018 10/5/2019 Tharaka Nithi 37.736510 -0.225130 Exact location Mwimbi Mwimbi All Households Supplementation Vitamin A 6/5/2018 10/5/2019 Tharaka Nithi 37.660540 -0.274570 Exact location Muthambi Muthambi All Households Supplementation Vitamin A 6/5/2018 10/5/2019 Tharaka Nithi 38.015650 -0.102570 Exact location Tharaka-North Gatunga All Households Supplementation Vitamin A 6/5/2018 10/5/2019 Tharaka Nithi 37.975010 -0.158020 Exact location Tharaka-South Marimanti All Households Supplementation ECDE Growth 5/13/2019 5/17/2019 Tharaka-Nithi 37.581700 -0.916000 Exact Location Tharaka-South Marimanti Marimanti Households Monitoring Promotion ECDE Growth 5/13/2019 5/17/2019 Tharaka-Nithi 38.015650 -0.102570 Exact Location Tharaka-North Gatunga Gatunga Households Monitoring Promotion Integrated Community 5/20/2019 5/24/2019 Tharaka Nithi 37.581700 0.916000 Exact location Tharaka-South Marimanti Marimanti Households Outreaches Integrated Community 5/20/2019 5/24/2019 Tharaka Nithi 38.015650 -0.102570 Exact location Tharaka-North Gatunga Gatunga Households Outreaches Growth Monitoring 6/10/2019 6/14/2019 Tharaka Nithi 37.581700 0.916000 Exact location Tharaka-South Marimanti Marimanti Households Promotion (GMP) Outreaches Growth Monitoring 6/10/2019 6/14/2019 Tharaka Nithi 38.015650 -0.102570 Exact location Tharaka-North Gatunga Gatunga Households Promotion (GMP) Outreaches Small Business mgt 6/24/2019 6/27/2019 Tharaka Nithi 37.581700 0.916000 Exact location Tharaka-South Marimanti Marimanti Households Skills Training for Community Support Groups
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Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Small Business 6/24/2019 6/27/2019 Tharaka Nithi 38.015650 -0.102570 Exact location Tharaka-North Gatunga Gatunga Households Management Skills Training for Community Support Groups Mother-to-Mother 4/1/2019 6/30/2019 Tharaka-Nithi 37.956944 -0.040278 Exact Location Tharaka-South Nkondi Matakiri Households Support Groups Meetings Mother-to-Mother 4/1/2019 6/30/2019 Tharaka-Nithi 38.147090 -0.097560 Exact Location Tharaka-North Gatunga Kathangachini Households Support Groups Meetings Intergrated outreach at 5/14/2019 5/14/2019 Samburu 37.660000 0.680778 4.7 Samburu East Wamba West Lolpuruai Households Lolpuruai Samburu east Intergrated outreach at 4/10/2019 4/10/2019 Samburu 36.823030 0.492000 9.1 Samburu Central Lodekejek Lowuabene Households lowuabene Growth Monitoring 6/18/2019 6/18/2019 Samburu 37.320100 0.974900 4.5 Samburu East Wamba East Lpashie Households
Growth Monitoring 6/17/2019 6/17/2019 Samburu 37.321400 0.979061 5.6 Samburu East Wamba East Ldupai Households Growth Monitoring 6/19/2019 6/19/2019 Samburu 37.334500 0.979571 5.5 Samburu East Wamba East Milimani Households Growth Monitoring 6/19/2019 6/19/2019 Samburu 37.321900 0.981580 5.8 Samburu East Wamba East Treetop Households Growth Monitoring 6/20/2019 6/20/2019 Samburu 37.321900 0.981950 5.8 Samburu East Wamba East Ntepes Households Growth Monitoring 6/11/2019 6/13/2019 Samburu 36.457200 0.522100 4 Samburu Central Lodekejek Lpetpet Households Growth Monitoring 6/11/2019 6/13/2019 Samburu 37.330700 1.002800 5.5 Samburu East Wamba East Ndikiir Households Growth Monitoring 6/12/2019 6/14/2019 Samburu 36.455200 0.522100 3 Samburu Central Lodekejek Naiborkeju Households Growth Monitoring 6/13/2019 6/15/2019 Samburu 36.542300 0.534100 Samburu Central Lodekejek Lkicheki Households Growth Monitoring 6/14/2019 6/16/2019 Samburu 36.689700 0.820810 4 Samburu Central Suguta Angata Rongai Households Growth Monitoring 6/17/2019 6/19/2019 Samburu 36.693800 1.096800 4 Samburu Central Maralal Lporos Households Growth Monitoring 6/18/2019 6/20/2019 Samburu 36.503800 1.723500 4 Samburu Central Maralal Centre Households Growth Monitoring 6/19/2019 6/21/2019 Samburu 36.532000 1.760000 4.5 Samburu Central Maralal Forest Households Growth Monitoring 6/20/2019 6/22/2019 Samburu 36.739300 1.100800 4.5 Samburu Central Maralal Rangau Households Growth Monitoring 6/21/2019 6/23/2019 Samburu 36.704000 1.104000 4.5 Samburu Central Maralal Central Households Growth Monitoring 6/22/2019 6/24/2019 Samburu 36.698700 1.108000 4.5 Samburu Central Maralal Allamano Households Growth Monitoring 6/23/2019 6/25/2019 Samburu 36.590000 1.023700 5 Samburu Central Loosuk Noompurenke Households Growth Monitoring 6/24/2019 6/26/2019 Samburu 36.583200 1.033700 5 Samburu Central Loosuk Lchingei Households Growth Monitoring 6/25/2019 6/27/2019 Samburu 36.316200 1.059800 4 Samburu Central Loosuk Nkopeliani Households Monthly CHV 6/7/2019 6/7/2019 Busia 34.328382 0.328510 Exact location Butula Marachi West Households Meetings Monthly CHV 6/4/2017 6/4/2019 Busia 34.229875 0.346391 Exact location Butula Maeachi North Households Meetings
104 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Kanjala CU Bi- 3/22/2019 3/22/2019 Busia 34.298056 0.309444 Exact location Butula Marachi North Kanjala Households Monthly Outreach Bukati CU Bi-Monthly 5/17/2019 5/17/2019 Busia 34.346843 0.352784 Exact location Butula Marachi North Bukati Households Outreach Monthly CHV 5/20/2019 5/20/2019 Busia 34.261876 0.370333 Exact location Butula Marachi Central Bumutiru Households Meetings Bimonthly Outreach 5/13/2019 5/13/2019 Busia 34.328382 0.328510 Exact location Butula Kingadole Dadira Households Bimonthly Outreach 5/14/2019 5/14/2019 Busia 34.229875 0.346391 community/village Butula Marachi North Sikarira Households Monthly CHV 6/26/2019 6/26/2019 Busia 34.261876 0.370333 Exact location Butula Marachi Central Bumutiru Households Meetings MtMSG Meeting 4/8/2019 4/8/2019 Busia 34.091483 0.282154 Exact location Samia Nangina Sirekeresi A Households (Pamoja group) MtMSG Meeting 4/15/2019 4/15/2019 Busia 34.101398 0.289656 Exact location Samia Nangina Nangina A Households (Amani group) MtMSG Meeting 4/16/2019 4/16/2019 Busia 34.115581 0.248892 Exact location Samia Nangina Sigulu A Households (Chipukizi group) MtMSG Meeting 4/17/2019 4/17/2019 Busia 34.102548 0.274689 Exact location Samia Nangina Nangina Households (Wekhonye group) MtMSG Meeting 4/23/2019 4/23/2019 Busia 34.124293 0.279693 Exact location Samia Nangina Bupala Households (Jivunie, Mafuno groups) MtMSG Meeting 4/23/2019 4/23/2019 Busia 34.134584 0.276878 Exact location Samia Nangina Segero Households (Khera Owasio) MtMSG Meeting 4/23/2019 4/23/2019 Busia 34.117005 0.270816 Exact location Samia Nangina Gulumoyo Households (Twaweza I and Tuinuane groups) MtMSG Meeting 4/24/2019 4/24/2019 Busia 34.088883 0.276695 Exact location Samia Nangina Ebwani Households (Tujitegemee) MtMSG Meeting 4/26/2019 4/26/2019 Busia 34.124093 0.279186 Exact location Samia Nangina Segero B Households (Malezi Bora group) MtMSG Meeting 4/28/2019 4/28/2019 Busia 34.115581 0.248892 Exact location Samia Nangina Bumenya A Households (Umoja ni Nguvu group) MtMSG Meeting 4/16/2019 4/16/2019 Busia 34.072467 0.296437 Exact location Samia Nangina Buraya Households (Umoja ni Nguvu group) MtMSG Meeting 4/16/2019 4/16/2019 Busia 34.123556 0.278634 Exact location Samia Nangina Bujibi A Households (Amani MtMSG, Bujibi A village) MtMSG Meeting 4/15/2019 4/15/2019 Busia 34.133163 0.258798 Exact location Samia Nangina Budobe Households (Joy Group)
105 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type MtMSG Meeting 4/17/2019 4/17/2019 Busia 34.129027 0.261781 Exact location Samia Nangina Bujibi A Households (Wekhonye women group, Bujibi A village) MtMSG Meeting 4/18/2019 4/18/2019 Busia 34.065293 0.279803 Near exact location Samia Nangina Budibia Households (Budibia MtMSG, Budibia village) MtMSG Meeting (Afya 4/24/2019 4/24/2019 Busia 34.087105 0.258680 Exact location Samia Nangina Burudu Households Bora women group) MtMSG Meeting (Okoa 4/24/2019 4/24/2019 Busia 34.126714 0.251422 Exact location Samia Nangina Malanga Households and Malezi Bora women groups) Malezi Bora Planning 5/6/2019 5/6/2019 Busia 34.133163 0.258798 Exact location Samia Nangina Funyula Households meeting Agri-nutrition meeting 5/7/2019 5/7/2019 Busia 34.081886 0.287968 Exact location Samia Nangina Oyato Households with Agriculture team MtMSG meeting 5/15/2019 5/15/2019 Busia 34.101398 0.289656 Exact location Samia Nangina Nangina 'A' Households (Amani group) MtMSG (MtMSG) 5/15/2019 5/15/2019 Busia 34.124095 0.269266 Exact location Samia Nangina Bolori Households meeting (Temakho group) MtMSG meeting 5/20/2019 5/20/2019 Busia 34.107075 0.268885 Exact location Samia Nangina Masiebi Households (Masiebi group) MtMSG meeting 5/21/2019 5/21/2019 Busia 34.081122 0.279804 Exact location Samia Nangina Munguko Households (Tushikane group) MtMSG Meeting 5/3/2019 5/3/2019 Busia 34.076913 0.293463 Exact location Samia Nangina Nakhasiko Households (Tusaidiane women group, Nakhasiko village) MtMSG Meeting 5/6/2019 5/6/2019 Busia 34.068279 0.278923 Exact location Samia Nangina Mumbao Households (Maendeleo ya wazazi, Mumbao village) MtMSG Meeting 5/6/2019 5/6/2019 Busia 34.073407 0.276808 Exact location Samia Nangina Sang'alo Households (Khukhonyane support group, Sang'alo village) MtMSG Meeting 5/7/2019 5/7/2019 Busia 34.083622 0.266584 Exact location Samia Nangina Dadira Households (Malezi Bora) MtMSG Meeting 5/10/2019 5/10/2019 Busia 34.089836 0.268457 Exact location Samia Nangina Oyato Households (Neema MtMSG) MtMSG Meeting 5/13/2019 5/13/2019 Busia 34.080936 0.273738 Exact location Samia Nangina Bufuma A Households (Upendo MtMSG, Bufuma A 1 village) MtMSG Meeting 5/17/2019 5/17/2019 Busia 34.094839 0.258235 Exact location Samia Nangina Siwongo A Households (Malezi Bora)
106 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Bi-Monthly Integrated 5/21/2019 5/21/2019 Busia 34.126714 0.251422 Near exact location Samia Nangina Malanga A Households Outreach MtMSG Meeting 5/21/2019 5/21/2019 Busia 34.102116 0.258591 Exact location Samia Nangina Sijowa Households (Sijowa MtMSG) Bi-Monthly Integrated 5/22/2019 5/22/2019 Busia 34.076642 0.271702 Exact location Samia Nangina Bufuma Households Outreach MtMSG meeting 5/22/2019 5/22/2019 Busia 34.102548 0.274689 Exact location Samia Nangina Nangina Households (Wekhonye MtMSG, Nangina village) MtMSG meeting 5/22/2019 5/22/2019 Busia 34.117005 0.270816 Exact location Samia Nangina Gulumoyo Households (Twaweza I and Tuinuane groups) MtMSG meeting 5/22/2019 5/22/2019 Busia 34.131566 0.268672 Exact location Samia Nangina Bumenya B Households (Tumaini group, Bumenya B village) MtMSG meeting 5/21/2019 5/21/2019 Busia 34.115581 0.248892 Exact location Samia Nangina Sigulu A Households (Chipukizi group) MtMSG meeting (Afya 5/22/2019 5/22/2019 Busia 34.087105 0.258680 Exact location Samia Nangina Burudu Households Bora Women Group) MtMSG meeting (Afya 5/22/2019 5/22/2019 Busia 34.098006 0.263620 Exact location Samia Nangina Siwongo B Households Yetu Jukumu Letu) MtMSG Meeting 5/22/2019 5/22/2019 Busia 34.129027 0.261781 Exact location Samia Nangina Bujibi A Households (Wekhonye Women group) MtMSG Meeting (Adui 5/23/2019 5/23/2019 Busia 34.077791 0.268237 Exact location Samia Nangina Bufuma B Households Mpende MtMSG) MtMSG Meeting 5/23/2019 5/23/2019 Busia 34.094460 0.251006 Exact location Samia Nangina Kang'ara Households (Bukhulungu MtMSGs) Bi-Monthly Integrated 5/24/2019 5/24/2019 Busia 34.089238 0.276699 Exact location Samia Nangina Ebwani Households Outreach MtMSG meeting (Sisi 5/24/2019 5/24/2019 Busia 34.112136 0.240845 Exact location Samia Nangina Namasumbi B Households kwa Sisi) MtMSG Meeting (Afya 5/24/2019 5/24/2019 Busia 34.088067 0.252092 Exact location Samia Nangina Bukhulungu D Households Yetu MtMsG) Bi-Monthly Integrated 5/27/2019 5/27/2019 Busia 34.097340 0.264532 Exact location Samia Nangina Siwongo B Households Outreach MtMSG Meeting 5/27/2019 5/27/2019 Busia 34.134901 0.286815 Exact location Samia Nangina Bupala A Households (Umoja MtMSG) Bi-Monthly Integrated 5/28/2019 5/28/2019 Busia 34.126274 0.273811 Exact location Samia Nangina Segero A Households Outreach CHVs Monthly 5/30/2019 5/30/2019 Busia 34.098273 0.277153 Exact location Samia Nangina Nangina Households Meeting
107 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type MtMSG Meeting 6/3/2019 6/3/2019 Busia 34.068279 0.278923 Exact location Samia Nangina Mumbao Households (Maendeleo ya wazazi, Mumbao village) MtMSG Meeting 6/5/2019 6/5/2019 Busia 34.081886 0.287968 Exact location Samia Nangina Emalaya Households (Neema group) MtMSG Meeting 6/7/2019 6/7/2019 Busia 34.105559 0.278553 Exact location Samia Nangina Nangina B Households (Tumaini group)
MtMSG Meeting 6/10/2019 6/10/2019 Busia 34.091483 0.282154 Exact location Samia Nangina Sirekeresi A Households (Pamoja group) MtMSG Meeting 6/12/2019 6/12/2019 Busia 34.112487 0.257105 Exact location Samia Nangina Magogongo Households (Magogongo group) Cooking demonstration 6/17/2019 6/17/2019 Busia 34.081368 0.224416 Exact location Samia Nangina Bujibo Households (Bujibo) MtMSG Meeting 6/14/2019 6/14/2019 Busia 34.101398 0.289656 Exact location Samia Nangina Nangina A Households (Amani group) MtMSG Meeting 6/17/2019 6/17/2019 Busia 34.131566 0.268672 Exact location Samia Nangina Bumenya B Households (Tumaini group, Bumenya B village) MtMSG Meeting 6/21/2019 6/21/2019 Busia 34.934710 0.293191 Exact location Samia Nangina Sirekeresi B Households (Bwambani group) MtMSG Meeting 6/24/2019 6/24/2019 Busia 34.083035 0.266022 Exact location Samia Nangina Dadira Households (Malezi Bora group, Dadira) MtMSG Meeting 6/24/2019 6/24/2019 Busia 34.088883 0.276695 Exact location Samia Nangina Ebwani Households (Tujitegemee group) Cooking demonstration 6/26/2019 6/26/2019 Busia 34.071325 0.271086 Exact location Samia Nangina Mumbao Households BFCI mentorship and 4/2/2019 4/2/2019 Busia 34.251700 0.441500 Exact location Teso North Angurai East Changara Households support CHV monthly meeting 4/29/2019 4/2/2019 Busia 34.244600 0.447000 Exact location Teso North Angurai East Changara Households BFCI household 4/30/2019 4/30/2019 Busia 34.353100 0.451900 Exact location Teso North Angurai East Apokor Households individual visits and screening for undernutrition BFCI household 4/30/2019 4/30/2019 Busia 34.255000 0.433300 Exact location Teso North Angurai East Koitamer/Akoret Households individual visits and screening for undernutrition BFCI household 5/1/2019 5/1/2019 Busia 34.253000 0.443200 Exact location Teso North Angurai East Kopiya/Asinge Households individual visits and screening for undernutrition
108 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type BFCI household 5/1/2019 5/1/2019 Busia 34.253700 0.433210 Exact location Teso North Angurai East Osia/Abulei Households individual visits and screening for undernutrition BFCI individual 5/2/2019 5/2/2019 Busia 34.253000 0.443200 Exact location Teso North Angurai East Akadoot B/ Aleles B Households household visits BFCI individual 5/2/2019 5/2/2019 Busia 34.241100 0.445600 Exact location Teso North Angurai East Apopong/Kolanya Households household visits Malezi bora and vas 5/8/2019 5/8/2019 Busia 34.163500 0.381600 Exact location Teso North Malaba Central Malaba Households supplementation for children under 5 years in ECDE centres Malezi bora and vas 5/9/2019 5/9/2019 Busia 34.153500 0.373500 Exact location Teso North Malaba Central Amoni Households supplementation for children under 5 years in ECDE centres BFCI bimonthly 5/13/2019 5/13/2019 Busia 34.224900 0.433000 Exact location Teso North Angurai East Aloete Households outreach BFCI bimonthly 5/15/2019 5/15/2019 Busia 34.255000 0.433300 Exact location Teso North Angurai East Koitamer/Akoret Households outreach BFCI bimonthly 5/16/2019 5/16/2018 Busia 34.252500 0.442600 Exact location Teso North Angurai East Kopiya Households outreach Cooking demonstration 5/21/2019 5/21/2019 Busia 34.205000 0.382000 Exact location Teso North Malaba Central Amagoro Households Cooking demonstration 5/22/2019 5/22/2019 Busia 34.194000 0.412400 Exact location Teso North Angurai South Atekwa Households Cooking demonstration 5/24/2019 5/24/2019 Busia 34.201400 0.384100 Exact location Teso North Malaba Central Okuleu Households CHV monthly meeting 5/27/2019 5/27/2019 Busia 34.244800 0.447000 Exact location Teso North Angurai East Akichelesit A Households Cooking demonstration 5/29/2019 5/29/2019 Busia 34.172700 0.362900 Exact location Teso North Malaba South Kasingalo Households Cooking demonstration 5/30/2019 5/30/2019 Busia 34.173500 0.351400 Exact location Teso North Malaba South Kodedema Households Planning meeting for 6/10/2019 6/10/2019 Busia 34.195600 0.374200 Exact location Teso North Malaba Central Amagoro Households growth monitoring MtMSG meeting 6/11/2019 6/11/2019 Busia 34.254100 0.443500 Exact location Teso North Angurai East Asinge, Kopiya And Women Kamnyongole, MtMSG meeting 6/11/2019 6/11/2019 Busia 34.255000 0.433300 Exact location Teso North Angurai East Akoret, Koitamer Women And Osia MtMSG meeting 6/12/2019 6/12/2019 Busia 34.353100 0.451900 Exact location Teso North Angurai East Kishiombe, Korisai, Women Apokor and Aterait MtMSG meeting 6/12/2019 6/12/2019 Busia 34.244800 0.447000 Exact location Teso North Angurai East Akichelesit And Women Abulei MtMSG meeting 6/13/2019 6/13/2019 Busia 34.242500 0.444700 Exact location Teso North Angurai East Akobwait Women MtMSG meeting 6/24/2019 6/24/2019 Busia 34.242500 0.444700 Exact location Teso North Angurai East Alupe A Women MtMSG meeting 6/25/2019 6/25/2019 Busia 34.254100 0.443500 Exact location Teso North Angurai East Asinge A Women
109 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type CHV monthly meeting 6/26/2019 6/26/2019 Busia 34.244800 0.447000 Exact location Teso North Angurai East Changara Households MtMSG meeting 6/27/2019 6/27/2019 Busia 34.252500 0.442600 Near exact location Teso North Angurai East Kamnyongole Women Agri nutrition field day 7/2/2019 7/2/2019 Busia 34.244600 0,4471 Near exact location Teso North Angurai East Akichelesit Farmers MtMSG meeting 4/1/2019 4/1/2019 Busia 34.328476 0.482458 Exact location Nambale Bukhayo East Emunyenya Households MtMSG meeting 4/2/2019 4/2/2019 Busia 34.364169 0.459022 Exact location Nambale Bukhayo East Madende B Households MtMSG meeting 4/2/2019 4/2/2019 Busia 34.349250 0.519930 Exact location Nambale Bukhayo East Sianda Households MtMSG meeting 4/3/2019 4/3/2019 Busia 34.250908 0.450251 Exact location Nambale Bukhayo East Buyofu A Households MtMSG meeting 4/4/2019 4/4/2019 Busia 34.150330 0.442701 Exact location Nambale Bukhayo East Elwanikha B Households MtMSG meeting 4/4/2019 4/4/2019 Busia 34.184400 0.275800 Near exact location Nambale Bukhayo East Madende B Households MtMSG meeting 4/5/2019 4/5/2019 Busia 34.189800 0.279100 Exact location Nambale Bukhayo East Okatekok Households MtMSG meeting 4/8/2019 4/8/2019 Busia 34.326080 0.472700 Exact location Nambale Bukhayo East Namulolwe A Households MtMSG meeting 4/9/2019 4/9/2019 Busia 34.334846 0.462142 Exact location Nambale Bukhayo East Madende A Households MtMSG meeting 4/10/2019 4/10/2019 Busia 34.360290 0.496070 Exact location Nambale Bukhayo East Fatana Households MtMSG meeting 4/15/2019 4/15/2019 Busia 34.182600 0.272400 Near exact location Nambale Bukhayo East Busakadi A Households MtMSG meeting 4/16/2019 4/16/2019 Busia 34.323610 0.479530 Exact location Nambale Bukhayo East Emasinde B Households MtMSG meeting 4/17/2019 4/17/2019 Busia 34.388987 0.504197 Exact location Nambale Bukhayo East Buyofu B Households MtMSG meeting 4/18/2019 4/18/2019 Busia 34.191100 0.281900 Near exact location Nambale Bukhayo East Mungatsi B Households MtMSG meeting 3/24/2019 3/24/2019 Busia 34.292510 0.459330 Near exact location Nambale Bukhayo East Khwirale Households MtMSG meeting 3/25/2019 3/25/2019 Busia 34.192000 0.282000 Near exact location Nambale Bukhayo East Ekitale Households MtMSG meeting 3/26/2019 3/26/2019 Busia 34.181900 0.274200 Exact location Nambale Bukhayo East Busakadi B Households CHV Monthly Meeting 4/30/2019 4/30/2019 Busia 34.331210 0.463109 Exact location Nambale Bukhayo East Madende Model Households Health Centre Malezi Bora Planning 5/6/2019 5/6/2019 Busia 34.238882 0.455156 Exact location Nambale Township Nambale Sub-County Households Meeting Hospital Outreach Planning 5/13/2019 5/13/2019 Busia 34.225670 0.454671 Exact location Nambale Township Nambale Sub-County Households Meeting Hospital Buyofu C.U Outreach 5/15/2019 5/15/2019 Busia 34.377600 0.489074 Exact location Nambale Bukhayo East Buyofu Dispensary Households
Mungatsi B C.U 5/16/2019 5/16/2019 Busia 34.121740 0.457429 Exact location Nambale Bukhayo East Nakhoma Village Households Outreach MtMSG meeting 6/3/2019 6/3/2019 Busia 34.328904 0.482067 Exact location Nambale Bukhayo East Emunyenya Households MtMSG meeting 6/3/2019 6/3/2019 Busia 34.348950 0.475710 Exact location Nambale Bukhayo East Madende Households MtMSG meeting 6/4/2019 6/4/2019 Busia 34.360250 0.496120 Exact location Nambale Bukhayo East Fatana Households MtMSG meeting 6/4/2019 6/4/2019 Busia 34.317393 0.471829 Exact location Nambale Bukhayo East Mungatsi Upper Households MtMSG meeting 6/5/2019 6/5/2019 Busia 34.352125 0.480531 Exact location Nambale Bukhayo East Sianda Households MtMSG meeting 6/6/2019 6/6/2019 Busia 34.387910 0.490340 Exact location Nambale Bukhayo East Liyala Households
110 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type MtMSG meeting 6/6/2019 6/6/2019 Busia 34.315535 0.480765 Exact location Nambale Bukhayo East Okatekok Households MtMSG meeting 6/7/2019 6/7/2019 Busia 34.369940 0.498210 Exact location Nambale Bukhayo East Buyofu A Households MtMSG meeting 6/10/2019 6/10/2019 Busia 34.360960 0.489676 Exact location Nambale Bukhayo East Elwanikha B Households MtMSG meeting 6/10/2019 6/10/2019 Busia 34.325616 0.477634 Exact location Nambale Bukhayo East Emasinde A Households MtMSG meeting 6/11/2019 6/11/2019 Busia 34.386096 0.496737 Exact location Nambale Bukhayo East Buyofu B Households MtMSG meeting 6/11/2019 6/11/2019 Busia 34.314493 0.471626 Exact location Nambale Bukhayo East Mungatsi Lower Households MtMSG meeting 6/12/2019 6/12/2019 Busia 34.386503 0.442278 Exact location Nambale Bukhayo East Nakhoma Village Households MtMSG meeting 6/12/2019 6/12/2019 Busia 34.335850 0.474660 Exact location Nambale Bukhayo East Madende A Households MtMSG meeting 6/13/2019 6/13/2019 Busia 34.326072 0.473251 Exact location Nambale Bukhayo East Namuolwe Households MtMSG meeting 6/13/2019 6/13/2019 Busia 34.312498 0.466246 Exact location Nambale Bukhayo East Namaindi Households MtMSG meeting 6/14/2019 6/14/2019 Busia 34.373210 0.495320 Exact location Nambale Bukhayo East Makutani Households MtMSG meeting 6/14/2019 6/14/2019 Busia 34.308187 0.449878 Exact location Nambale Bukhayo East Busakadi A Households MtMSG meeting 6/17/2019 6/17/2019 Busia 34.386430 0.442476 Exact location Nambale Bukhayo East Busakadi B Households MtMSG meeting 6/18/2019 6/18/2019 Busia 34.330860 0.463110 Exact location Nambale Bukhayo East Makaka Households MtMSG meeting 6/18/2019 6/18/2019 Busia 34.326961 0.467606 Exact location Nambale Bukhayo East Namwolwe B Households MtMSG meeting 6/19/2019 6/19/2019 Busia 34.337912 0.476417 Exact location Nambale Bukhayo East Namunene Households MtMSG meeting 6/19/2019 6/19/2019 Busia 34.312530 0.477535 Exact location Nambale Bukhayo East Mandizini Households MtMSG meeting 6/20/2019 6/20/2019 Busia 34.332119 0.472843 Exact location Nambale Bukhayo East Namulolwe B Households MtMSG meeting 6/21/2019 6/21/2019 Busia 34.307201 0.470671 Exact location Nambale Bukhayo East Nakhoma Village Households MtMSG meeting 6/25/2019 6/25/2019 Busia 34.322482 0.467231 Exact location Nambale Bukhayo East Ekitale Households CHV Monthly Meeting 6/28/2019 6/28/2019 Busia 34.331210 0.463109 Exact location Nambale Bukhayo East Madende Households ECDE Growth 4/1/2019 4/1/2019 Kitui 38.002210 -0.672000 Exact location Mwingi North Mumoni Kalatine Households monitoring ECDE Growth 4/2/2019 4/2/2019 Kitui 38.044997 -0.668384 Exact location Mwingi North Mumoni Kasyalani Households monitoring ECDE Growth 4/3/2019 4/3/2019 Kitui 38.004500 -0.673200 Nearest Town Mwingi North Mumoni Katuuni Households monitoring coordinate Support Agri nutrition 4/3/2019 4/3/2019 Kitui 38.063466 -0.534204 Near exact location Mwingi North Mumoni Kamathitu Households Growth Monitoring 4/1/2019 4/1/2019 Kitui 38.098315 -0.732482 Exact location Mwingi North Waita Muunguu Households and Promotion Growth Monitoring 4/2/2019 4/2/2019 Kitui 38.179929 -0.875326 Exact location Mwingi North Waita Mutwangombe Households and Promotion Growth Monitoring 4/3/2019 4/3/2019 Kitui 38.134454 -0.741892 Exact location Mwingi North Waita Maongoa Households and Promotion CHV Review Meeting 4/11/2019 4/11/2019 Kitui 38.094500 0.780172 4.5 Mwingi North Waita Waita Households CMSG Review Meeting 4/11/2019 4/11/2019 Kitui 38.094500 0.780172 4.5 Mwingi North Waita Waita Households
111 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.150907 -0.567583 Community/Village Mwingi North Kyuso Ndathani Households CHEW to supervise Coordinate CHVs & MtMSG BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.151146 -0.568553 Community/Village Mwingi North Kyuso Ndathani Households CHEW to supervise Coordinate CHVs & MtMSG BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.153709 -0.559174 Community/Village Mwingi North Kyuso Ndathani Households CHEW to supervise Coordinate CHVs & MtMSG BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.153546 -0.561755 Community/Village Mwingi North Kyuso Ndathani Households CHEW to supervise Coordinate CHVs & MtMSG BFCI Supervision for 4/17/2019 4/17/2019 Kitui 38.045835 -0.680933 Exact location Mwingi North Mumoni Kalatine B Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/17/2019 4/17/2019 Kitui 38.045944 -0.680662 Exact location Mwingi North Mumoni Kalatine B Households CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.095844 -0.518713 Exact location Mwingi North Tharaka Kalamba Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/29/2019 4/29/2019 Kitui 38.094583 -0.516937 Exact location Mwingi North Tharaka Kalamba Households CHEW to supervise CHVs & MtMSG BFCI Supervision for 5/2/2019 5/2/2019 Kitui 38.015700 -0.335740 Near exact location Mwingi North Tharaka Kamatere B Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/18/2019 5/3/2019 Kitui 38.029459 -0.324889 Exact location Mwingi North Tharaka Gakombe E Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 5/3/2019 5/3/2019 Kitui 38.024279 0.I133008752 Exact location Mwingi North Tharaka Gakombe E Households CHEW to supervise CHVs & MtMSG BFCI Supervision for 5/18/2019 5/18/2019 Kitui 38.013184 -0.288389 Exact location Mwingi North Tharaka Gakombe Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/15/2019 4/15/2019 Kitui 38.041761 -0.300177 Exact location Mwingi North Tharaka Nkoru Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 4/16/2019 4/16/2019 Kitui 38.026890 -0.320204 Exact location Mwingi North Tharaka Gankanga Groups CHEW to supervise CHVs & MtMSG BFCI Supervision for 5/2/2019 5/2/2019 Kitui 38.015808 -0.338262 Exact location Mwingi North Tharaka Kamatere B Households CHEW to supervise CHVs & MtMSG
112 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type CHV Review meeting 5/8/2019 5/8/2019 Kitui 38.024973 -0.310012 Exact location Mwingi North Tharaka Tharaka Households
CHV Review meeting 5/10/2019 5/10/2019 Kitui 37.999468 -0.669133 Exact location Mwingi North Mumoni Kalatine Households Growth Monitoring 6/17/2019 6/17/2019 Kitui 38.424070 -0.690593 Community/Village Mwingi North Ngomeni Makuka Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/18/2019 6/18/2019 Kitui 38.453193 -0.655616 Community/Village Mwingi North Ngomeni Ikime Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/19/2019 6/19/2019 Kitui 38.452405 -0.645625 Community/Village Mwingi North Ngomeni Mangombo Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/20/2019 6/20/2019 Kitui 38.322594 -0.558813 Community/Village Mwingi North Ngomeni Mavauni Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/21/2019 6/21/2019 Kitui 38.256840 -0.269534 Community/Village Mwingi North Ngomeni Ngalange Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/22/2019 6/22/2019 Kitui 38.256023 -0.302184 Community/Village Mwingi North Ngomeni Ngalange Households and monitoring/ Coordinate Cooking demos Growth Monitoring 6/25/2019 6/25/2019 Kitui 38.252648 -0.336462 Community/Village Mwingi North Ngomeni Ngalange Households and monitoring/ Coordinate Cooking demos BFCI 6/14/2019 6/14/2019 Kitui 38.146608 -0.656065 Community/Village Mwingi North Kyuso Itiva Nzou Households MTMSG/Nutrition Coordinate assessment of under 2s BFCI 6/18/2019 6/18/2019 Kitui 38.150354 -0.567489 Community/Village Mwingi North Kyuso Ndathani Households MTMSG/Nutrition Coordinate assessment of under 2s BFCI 6/25/2019 6/25/2019 Kitui 38.108556 -0.545966 Community/Village Mwingi North Kyuso Mbangwani Households MTMSG/Nutrition Coordinate assessment of under 2s BFCI 6/26/2019 6/26/2019 Kitui 38.136424 -0.603941 Community/Village Mwingi North Kyuso Kombiio Households MTMSG/Nutrition Coordinate assessment of under 2s BFCI 6/27/2019 6/27/2019 Kitui 38.129587 -0.576543 Community/Village Mwingi North Kyuso Kalima Mundu Households MTMSG/Nutrition Coordinate assessment of under 2s CHEW Support 5/22/2019 5/22/2019 Kitui 38.094500 -0.780172 4.5 Mwingi Central Waita Karuri Groups Supervision Karuri Village CHEW Support 5/23/2019 5/23/2019 Kitui 38.063770 -0.816347 4.5 Mwingi Central Waita Kaulyambu Groups Supervision Kaulyambu Village
113 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Chew Support 5/24/2019 5/24/2019 Kitui 38.053966 -0.811025 4.5 Mwingi Central Waita Ikuusya Groups Supervision Ikuusya Village CHV Review Meeting 6/3/2019 6/3/2019 Kitui 38.094500 -0.780172 4.5 Mwingi Central Waita Waita Households
Community Nutrition 6/10/2019 6/10/2019 Kitui 38.101541 -0.785333 4.5 Mwingi Central Waita Katothya Households Assessment Katothya Village OJT On BFCI /Familia 6/11/2019 6/11/2019 Kitui 38.094500 -0.780172 4.5 Mwingi Central Waita Waita Households Bora For New CHVs Muunguu Community 6/12/2019 6/12/2019 Kitui 38.154975 -0.739823 4.5 Mwingi Central Waita Muunguu Households Nutrition Assessment Maongoa Community 6/13/2019 6/13/2019 Kitui 38.134454 -0.741892 4.5 Mwingi Central Waita Maongoa Households Assessment Katluni Community 6/17/2019 6/17/2019 Kitui 38.020798 -0.781668 4.5 Mwingi Central Waita Katuluni Households Nutrition Assessment OJT On BFCI/Familia 6/18/2019 6/18/2019 Kitui 38.094500 -0.780172 4.5 Mwingi Central Waita Waita H/C Households Bora For New CHVs Ilianzi/Ndithi 6/19/2019 6/19/2019 Kitui 38.142652 -0.776261 4.5 Mwingi Central Waita Ndithi Households Community Nutrition Assessment Nzaalani Community 6/19/2019 6/19/2019 Kitui 38.154946 -0.739836 4.5 Mwingi Central Waita Nzaalani Households Nutrition Assessment Karuri/Waita 6/20/2019 6/20/2019 Kitui 38.094242 -0.779694 4.5 Mwingi Central Waita Karuri Households Community Nutrition Assessment Mwambui Community 6/24/2019 6/24/2019 Kitui 38.027568 -0.754476 4.5 Mwingi Central Waita Mwambui Households Nutrition Assessment Kitumbi Community 6/25/2019 6/25/2019 Kitui 38.129887 -0.814008 4.5 Mwingi Central Waita Kitumbi Households Nutrition Assessment Masaki Community 6/25/2019 6/25/2019 Kitui 38.124019 -0.838129 4.5 Mwingi Central Waita Masaki Households Nutrition assessment Kithambangii Nutrition 6/26/2019 6/26/2019 Kitui 38.075083 -0.802403 4.5 Mwingi Central Waita Kithambangii Households Assessment Mutwangombe 6/27/2019 6/27/2019 Kitui 38.179929 -0.875326 4.5 Mwingi Central Waita Mutwangombe Households Community Nutrition Assessment Ikuusya Community 6/27/2019 6/27/2019 Kitui 38.053830 -0.811031 4.5 Mwingi Central Waita Ikuusya Households Nutrition Assessment Yumbe Communnity 6/28/2019 6/28/2019 Kitui 38.077949 -0.768477 4.5 Mwingi Central Waita Yumbe Households Nutrition Assessment CHV Review Meeting 5/2/2019 5/2/2019 Kitui 38.094500 0.780172 4.5 Mwingi Central Waita Waita Households
114 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Malembwa Agri- 6/24/2019 6/24/2019 Kitui 38.346979 -1.566703 Nearest Town Kitui East Voo/Kyamatu Malembwa Households Nutrition MtMSG coordinate Meeting Kalundu Agri-Nutrition 6/25/2019 6/25/2019 Kitui 38.346979 -1.566703 Exact location Kitui East Voo/Kyamatu Kyamatu Town Households MtMsG
Katundu Agri- 6/26/2019 6/26/2019 Kitui 38.196567 -1.660387 Exact location Kitui East Voo/Kyamatu Katundu Households Nutrition MtMsG Kavasya Agri-Nutrition 6/27/2019 6/27/2019 Kitui 38.259229 -1.646791 Exact location Kitui East Voo/Kyamatu Imale Households MtMsG Agri nutrition Food 6/18/2019 6/18/2019 Kitui 38.105268 -1.363047 Exact location Kitui East Chuluni Kanzooko Households Demonstration Agri nutrition Food 6/27/2019 6/27/2019 Kitui 38.152637 -1.575969 Exact location Kitui East Chuluni Umiisyo Households Demonstration Malatani Agri-nutrition 6/25/2019 6/25/2019 Kitui 38.244541 -1.435640 Exact location Kitui East Zombe/Mwitika Malatani Households MtMSG Haki Yetu Integrated 6/28/2019 6/28/2019 Kitui 38.170670 -1.435315 Exact location Kitui East Zombe/Mwitika Mang’ola Households MtMSG Kikuu Integrated Agri- 6/27/2019 6/27/2019 Kitui 38.309300 -1.450222 Exact location Kitui East Zombe/Mwitika Kikuu Households nutrition Kathande Integrated 6/27/2019 6/27/2019 Kitui 38.162993 -1.426441 Exact location Kitui East Zombe/Mwitika Kathande Households Agri-Nutrition MtMSG Yamasau BFCI Agri- 6/17/2019 6/17/2019 Kitui 38.327665 -1.663438 Nearest Town Kitui East Voo/Kyamatu Yamasau Households Nutrition MtMSG coordinate Meeting Maskalini Agri- 6/18/2019 6/18/2019 Kitui 38.447413 -1.587799 Exact location Kitui East Voo/Kyamatu Maskalini Households Nutrition MtMSG Meeting Ikyatine Agri-Nutrition 6/19/2019 6/19/2019 Kitui 38.364357 -1.546234 Exact location Kitui East Voo/Kyamatu Ikyatine Households MtMSG Ndulani Agri-Nutrition 6/20/2019 6/20/2019 Kitui 38.415725 -1.670293 Exact location Kitui East Voo/Kyamatu Ndulani Households MtMSG Kaling'A Agri-Nutrition 6/19/2019 6/19/2019 Kitui 38.302496 -1.522253 Exact location Kitui East Zombe/Mwitika Kaling'A Households MtMSG Mavia Maiu Agri- 6/20/2019 6/20/2019 Kitui 38.341120 -1.518283 Exact location Kitui East Zombe/Mwitika Mavia Maiu Households Nutrition MtMSG Kavaani Agri-Nutrition 6/21/2019 6/21/2019 Kitui 38.236055 -1.380288 Exact location Kitui East Zombe/Mwitika Kavaani Households MtMSG Agri nutrition Food 6/6/2019 6/6/2019 Kitui 38.116170 -1.509120 Exact location Kitui East Chuluni Ngomango Households Demonstration Agri nutrition Food 7/6/2019 7/6/2019 Kitui 38.114920 -1.532770 Exact location Kitui East Chuluni Mumbuni Households Demonstration Agri nutrition Food 6/10/2019 6/10/2019 Kitui 38.115778 -1.523193 Exact location Kitui East Chuluni Kanzauwu Households Demonstration
115 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Agri nutrition Food 6/11/2019 6/11/2019 Kitui 38.104950 -1.497834 Exact location Kitui East Chuluni Kaluva Households Demonstration Agri nutrition Food 6/12/2019 6/12/2019 Kitui 38.095543 -1.505007 Exact location Kitui East Chuluni Muthwani Households Demonstration Kathande BFCI 6/14/2019 6/14/2019 Kitui 38.165745 -1.429186 Exact location Kitui East Zombe/Mwitika Kathande Households Outreach Growth monitoring 6/5/2019 6/5/2019 Kitui 38.526258 -1.370982 4.551 Kitui East Endau/Malalani Mitaani Women activities
Growth monitoring 6/7/2019 6/7/2019 Kitui 38.489167 -1.324444 4.551 Kitui East Endau/Malalani Mutalani Households activities Growth monitoring 6/11/2019 6/11/2019 Kitui 38.466520 -1.286174 4.55 Kitui East Endau/Malalani Katooni Women activities Agri nutrition Food 6/10/2019 6/10/2019 Kitui 38.115778 -1.523193 Exact location Kitui East Chuluni Kanzauwu Households Demonstration Agri nutrition Food 6/11/2019 6/11/2019 Kitui 38.104950 -1.497834 Exact location Kitui East Chuluni Kaluva Households Demonstration Agri nutrition Food 6/12/2019 6/12/2019 Kitui 38.095543 -1.505007 Exact location Kitui East Chuluni Muthwani Households Demonstration Makutano and Wendo 5/18/2019 5/18/2019 Kitui 38.324039 -1.666415 Exact location Kitui East Voo/Kyamatu Voo Centre Households BFCI MtMSG Meeting Mwania Ng'ombe BFCI 5/17/2019 5/17/2019 Kitui 38.384228 -1.692747 Nearest Town Kitui East Voo/Kyamatu Mwania Ng’ombe Households MtMSG Meeting coordinate Malatani Agri-nutrition 5/23/2019 5/23/2019 Kitui 38.259719 -1.425455 Exact location Kitui East Zombe/Mwitika Malatani Households MtMSG Bidii BFCI MtMSG 5/23/2019 5/23/2019 Kitui 38.241064 -1.457813 Exact location Kitui East Zombe/Mwitika Kyangeni Households Kyululu Agri-nutrition 6/4/2019 6/6/2019 KITUI 38.274220 -1.453822 Exact location Kitui East Zombe/Mwitika Kyululu Households MtMSG Meeting Kaling'a Agri-nutrition 6/6/2019 6/6/2019 KITUI 38.302726 -1.522508 Exact location Kitui East Zombe/Mwitika Kaling'a Households MtMSG Meeting Kikuu Agri-nutrition 6/6/2019 6/6/2019 KITUI 38.309363 -1.494959 Exact location Kitui East Zombe/Mwitika Kikuu Households MtMSG Agri nutrition Food 5/31/2019 5/31/2019 Kitui 38.103015 -1.480876 Exact location Kitui East Chuluni Kiimani Households Demonstration Agri nutrition Food 4/6/2019 4/6/2019 Kitui 38.089191 -1.439375 Exact location Kitui East Chuluni Kyangamwe Households Demonstration Agri nutrition Food 5/21/2019 5/21/2019 Kitui 38.155413 -1.592612 Exact location Kitui East Chuluni Ndunga Households Demonstration Agri nutrition Food 5/22/2019 5/22/2019 Kitui 38.104046 -1.386772 Exact location Kitui East Chuluni Kiongwe Households Demonstration Agri nutrition Food 5/23/2019 5/23/2019 Kitui 38.125645 -1.381745 Exact location Kitui East Chuluni Kanguu Households Demonstration
116 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Agri nutrition Food 5/29/2019 5/29/2019 Kitui 38.128663 -1.442840 Exact location Kitui East Chuluni Kwa Mutei Households Demonstration Agri nutrition Food 5/28/2019 5/28/2019 Kitui 38.082032 -1.445669 Exact location Kitui East Chuluni Ithumula Households Demonstration Nzilani community 5/27/2019 5/27/2019 Kitui 38.188013 -1.470649 Exact location Kitui East Zombe/Mwitika Nzilani Households dialogue Day Yamasau BFCI 5/29/2019 5/29/2019 Kitui 38.327831 -1.663478 Nearest Town Kitui East Voo/Kyamatu Yamasau Households Mentorship coordinate Voo BFCI Review 5/31/2019 5/31/2019 Kitui 38.327831 -1.663478 Exact location Kitui East Voo/Kyamatu Voo Town Households Meeting Makutano and Wendo 5/18/2019 5/18/2019 Kitui 38.324039 -1.666415 Exact location Kitui East Voo/Kyamatu Voo Centre Households BFCI MtMSG Meeting Mwania Ng'ombe BFCI 5/17/2019 5/17/2019 Kitui 38.384228 -1.692747 Nearest Town Kitui East Voo/Kyamatu Mwania Ng’ombe Households MtMSG Meeting coordinate Malatani Agri-nutrition 5/23/2019 5/23/2019 Kitui 38.259719 -1.425455 Exact location Kitui East Zombe/Mwitika Malatani Households MtMSG Bidii BFCI MtMSG 5/23/2019 5/23/2019 Kitui 38.241064 -1.457813 Exact location Kitui East Zombe/Mwitika Kyangeni Households Agape BFCI MtMSG 5/9/2019 5/9/2019 Kitui 38.221197 -1.461825 Exact location Kitui East Zombe/Mwitika Kaumu Households Meeting Upendo BFCI MtMSG 5/10/2019 5/10/2019 Kitui 38.224956 -1.462417 Exact location Kitui East Zombe/Mwitika Kaumu Households Meeting Waani BFCI MtMSG 5/14/2019 5/14/2019 Kitui 38.384228 -1.692747 Near exact location Kitui East Voo/Kyamatu Waani Women Kemwaa MtMSG 5/15/2019 5/15/2019 Kitui 38.369106 -1.733956 Exact location Kitui East Voo/Kyamatu Kemwaa B Women Kyeni BFCI H/H 5/16/2019 5/16/2019 Kitui 38.294353 -1.668755 Exact location Kitui East Voo/Kyamatu Kyeni Households Visits BFCI MtMSG Meeting 5/3/2019 5/3/2019 Kitui 38.224448 -1.475497 Exact location Kitui East Zombe/Mwitika Kaumu Households BFCI April Review 5/29/2019 5/29/2019 Kitui 38.204023 -1.459914 Exact location Kitui East Zombe/Mwitika Kaumu Households Meeting BFCI Outreach 4/9/2019 4/9/2019 Kitui 38.234000 1.946250 4.55 Kitui South Ikutha Yumbu Households BFCI Outreach 4/10/2019 4/10/2019 Kitui 38.158600 2.210222 4.55 Kitui South Athi Ward Kamina Households BFCI Outreach 4/11/2019 4/11/2019 Kitui 38.152000 1.765119 4.55 Kitui South Ikanga Maimu Households BFCI monthly review 4/30/2019 3/30/2019 Kitui 38.1.289 2.130628 4.55 Kitui South Athi Ward Muangeni Households meeting BFCI monthly review 5/7/2019 5/7/2019 Kitui 38.181200 1.942572 4.55 Kitui South Ikutha Kyoani Households meeting Malezi Bora Support 5/9/2019 5/9/2019 Kitui 38.099900 2.018162 4.55 Kitui South Athi Ward Kalivu Households Supervision Malezi Bora support 5/9/2018 5/9/2019 Kitui 38.105630 1.982000 4.55 Kitui South Athi Ward Kakungula Households Supervision BFCI MtMSG 5/14/2019 5/14/2019 Kitui 38.234700 1.948000 4.55 Kitui South Ikutha Ngaasani Households monitoring and Mentorship
117 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type BFCI MtMSG 5/15/2019 5/15/2019 Kitui 38.142900 2.122860 4.55 Kitui South Athi Ward Mukonzo Households monitoring and Mentorship BFCI MtMSG 5/16/2019 5/16/2019 Kitui 38.200350 1.929640 4.55 Kitui South Ikutha Yanzate Households monitoring and Mentorship BFCI MtMSG 5/15/2019 5/15/2019 Kitui 38.571900 1.571900 4.55 Kitui South Ikutha Ngitini Households monitoring and Mentorship BFCI MtMSG 6/13/2019 6/13/2019 Kitui 38.105200 -1.563300 4.55 Kitui South Ikutha Kwambuu Households monitoring and Mentorship BFCI MtMSG 6/13/2019 6/13/2019 Kitui 38.111600 1.587000 4.55 Kitui South Ikutha Wiitu Households monitoring and Mentorship BFCI MtMSG 6/19/2019 6/19/2019 Kitui 38.144900 1.592300 4.55 Kitui South Ikutha Matikoni Households monitoring and Mentorship BFCI MtMSG 6/20/2019 6/20/2019 Kitui 38.131300 1.203200 4.55 Kitui South Ikutha Kyakavi Households monitoring and Mentorship BFCI support 6/18/2019 6/18/2019 Kitui 38.128900 -2.130600 4.55 Kitui South Athi Ward Muangeni Households Supervision and Mentorship Community Nutrition 6/19/2019 6/19/2019 Kitui 38.064900 -2.091800 4.55 Kitui South Athi Ward Katulu Households Assessment of Under 2's Community Nutrition 6/24/2019 6/24/2019 Kitui 38.176480 -2.159900 4.55 Kitui South Athi Ward Kasoka Households Assessment of Under 2's Community Nutrition 5/15/2019 5/15/2019 Kitui 38.165700 -1.793700 4.55 Kitui South Kyatune Ward Kawelu Households Assessment of Under 2's BFCI MTMSG 5/22/2019 5/22/2019 Kitui 37.923980 -1.688880 4.55 Kitui South Kyatune Ward Maimu Groups mentorship and Supervision Community Nutrition 6/24/2019 6/24/2019 Kitui 38.232800 -1.947600 4.55 Kitui South Ikutha Ward Yumbu Groups Assessment of Under 2's Community Nutrition 6/25/2019 6/25/2019 Kitui 38.194010 -2.253690 4.55 Kitui South Athi Ward Mwathe Households Assessment of Under 2's Community Nutrition 6/27/2019 6/27/2019 Kitui 38.260400 -2.130250 4.55 Kitui South Ikutha Ward Kasaala Households Assessment of Under 2's
118 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type BFCI support 6/19/2019 6/19/2019 Kitui 38.114402 -1.776450 Exact location Kitui South Kyatune Ward Kyatune Households Supervision and Mentorship BFCI support 6/19/2019 6/19/2019 Kitui 38.181200 -1.942572 Exact location Kitui South Ikutha Ward Kyoani Households Supervision and Mentorship Community Nutrition 6/26/2019 6/26/2019 Kitui 38.190020 -2.011490 Community/Village Kitui South Ikutha Ward Ndandini Households Assessment of Under Coordinate 2's BFCI MtMSG 5/24/2019 5/24/2019 Kitui 38.161100 2.080880 4.55 Kitui South Athi Ward Kyandula Households monitoring and Mentorship BFCI MtMSG 5/30/2019 5/30/2019 Kitui 38.119560 2.094380 4.55 Kitui South Athi Ward Kivovotwe Households monitoring and Mentorship BFCI Monthly Review 5/28/2019 5/28/2019 Kitui 38.128900 2.130628 4.55 Kitui South Athi Ward Muangeni Households Meeting BFCI Monthly Review 6/4/2019 6/4/2019 Kitui 38.181600 1.945600 4.55 Kitui South Ikutha Kyoani Households Meeting BFCI MtMSG 6/3/2019 6/3/2019 Kitui 38.119560 2.094380 4.55 Kitui South Athi Ward Kaunguni Households monitoring and Mentorship BFCI/Agri Nutrition 6/11/2019 6/11/2019 Kitui 38.153080 2.169600 4.55 Kitui South Athi Ward Ndandini Households Monitoring and Mentorship BFCI/Agri Nutrition 6/12/2019 6/12/2019 Kitui 38.157910 2.207700 4.55 Kitui South Athi Ward Kamina Households Monitoring and Mentorship Agri nutrition MTMSG 6/13/2019 6/13/2019 Kitui 38.153080 2.169600 4.55 Kitui South Athi Ward Ndandini Households Monitoring and Mentorship Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 38.055105 2.34109955 Exact location Saku Sagante Jaldesa Households and Promotion Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 37.893693 2.2119305 Exact location Saku Karare Households and Promotion
Malezi Bora 5/1/2019 5/31/2019 Marsabit Marsabit 38.055105 2.34109955 Exact location Saku Sagante Jaldesa Households Malezi Bora 5/1/2019 5/31/2019 Marsabit Marsabit 37.893693 2.2119305 Exact location Saku Karare Households
Cooking 6/13/2019 6/27/2019 Marsabit Marsabit 38.066896 2.3315739 Exact location Saku Sagante Jaldesa Households Demonstration Community Health 6/28/2019 6/28/2019 Marsabit Marsabit 38.066896 2.3315741 Exact location Saku Sagante Jaldesa Households Volunteer Monthly Meeting Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 38.693363 2.6950666 Exact location North Horr Turbi Households and Promotion
119 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Agri-Nutrition Group 5/24/2019 5/24/2019 Marsabit Marsabit 38.383759 3.591832 Exact Location Moyale Uran Households Activities Monitoring
Agri-Nutrition Group 5/24/2019 5/24/2019 Marsabit Marsabit 38.412600 3.3624 Exact Location Moyale Sololo Households Activities Monitoring
Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 38.383759 3.591832 Exact Location Moyale Uran Households
Cooking 6/24/2019 6/28/2019 Marsabit Marsabit 38.383759 3.591832 Exact Location Moyale Uran Households Demonstration MtMsG Meeting 4/29/2019 4/29/2019 Marsabit Marsabit 38.383759 3.591832 Exact Location Moyale Uran Households Agri nutrition- Visiting 4/5/2019 4/5/2019 Marsabit Marsabit 39.069831 3.5067092 Exact Location Moyale Golbo Households Galumate Arosa Group Farm Agri nutrition- 4/12/2019 4/12/2019 Marsabit Marsabit 39.053978 3.518387 Exact Location Moyale Butiye Households Attending Butiye CHV Group Meeting Regarding Farming Activities After the Training Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 39.054130 3.52172 Exact Location Moyale Moyale Township Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 39.054780 3.50979 Exact Location Moyale Butiye Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 39.071110 3.52435 Exact Location Moyale Heilu-Manyatta Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 39.095327 3.4768681 Exact Location Moyale Golbo Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 39.115620 3.50034 Exact Location Moyale Heilu-Manyatta Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 38.749900 3.51002 Exact Location Moyale Obbu Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 38.648300 3.5144 Exact Location Moyale Sololo Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 38.470370 3.34738 Exact Location Moyale Uran Households Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 38.759680 3.03433 Exact Location Moyale Uran Households
Agri-Nutrition Group 5/15/2019 5/15/2019 Marsabit Marsabit 39.053978 3.518387 Exact Location Moyale Butiye Households Activities Monitoring Agri nutrition-Butiye 5/16/2029 5/16/2019 Marsabit Marsabit 39.053978 3.518387 Exact Location Moyale Butiye Households Farming Demonstration Agri nutrition Group 5/17/2019 5/17/2019 Marsabit Marsabit 39.032074 3.5189053 Exact Location Moyale Butiye Households Activities Monitoring Agri-Nutrition Group 6/7/2019 6/7/2019 Marsabit Marsabit 39.251143 3.152901 Exact Location Moyale Golbo Households Activities Monitoring
120 FY 19 Q3April-June Quarterly Report
Activity Start Date End Date County Longitude Latitude GPS Accuracy Sub County Ward Village Beneficiary Type Agri nutrition- 5/21/2019 5/21/2019 Marsabit Marsabit 39.069831 3.5067092 Exact Location Moyale Butiye Households Galumate Arosa Farming Demonstration Agri nutrition-Butiye 5/27/2019 5/27/2019 Marsabit Marsabit 39.053978 3.518387 Exact Location Moyale Butiye Households Farm Inspection Growth Monitoring 6/17/2019 6/17/2019 Marsabit Marsabit 39.095327 3.4768681 Exact Location Moyale Golbo Households and Promotion Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 39.135370 3.47297 Exact Location Moyale Golbo Households and Promotion
Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 39.249402 3.147999 Exact location Moyale Golbo Households and Promotion
Malezi Bora 5/1/2019 5/30/2019 Marsabit Marsabit 36.713900 2.76 Near exact Laisamis Loiyangalani Households location Growth Monitoring 6/10/2019 6/14/2019 Marsabit Marsabit 36.713900 2.76 Exact location Laisamis Loiyangalani Households and Promotion
School Wash 5/24/2019 5/24/2019 Marsabit Marsabit 36.714571 2.7628 Exact location Laisamis Loiyangalani Households Programme MtMSG Monthly 7/1/2019 7/1/2019 Marsabit Marsabit 36.736500 2.76 Exact location Laisamis Loiyangalalani Households Meeting Participatory Cooking 6/20/2019 6/28/2019 Marsabit Marsabit 36.713900 2.76 Near exact Laisamis Loiyangalalani Households Demonstrations location
CHVs Monthly 5/30/2019 5/30/2019 Marsabit Marsabit 37.726906 1.423368 Exact location Laisamis Laisamis Households Meeting Growth Monitoring 6/17/2019 6/21/2019 Marsabit Marsabit 37.723039 1.4227707 Exact location Laisamis Laisamis Households and Promotion
CMSG Meeting 6/29/2019 6/29/2019 Marsabit Marsabit 37.726906 1.423368 Exact location Laisamis Laisamis Households M Ngamia MtMsG 6/24/2019 6/24/2019 Marsabit Marsabit 37.727729 1.4163579 Exact location Laisamis Laisamis Households Meeting
121 FY 19 Q3April-June Quarterly Report