CALL TO ACTION

THE REPUBLIC OF NUTRITION GOVERNANCE CHALLENGES/ GAPS CALL FOR ACTION RESPONSIBLE AREA OFFICE Coordination and Inadequate Mechanisms to foster Ensure functionality of the coordination CAO/DNFP partnerships: sufficient information sharing structures at the district and subcounty level DISTRICT LOCAL GOVERNMENT between all partners by institutionalizing mechanisms to foster regular engagements e.g. meetings to allow ADVOCACY BRIEF ON STRENGTHENING NUTRITION GOVERNANCE FOR MULTI-SECTORAL RESPONSE joint planning, monitoring, Technical support and reporting, Joint reviews, from various stakeholders Integrate Multisectoral nutrition coordination events in the district annual calendar of activities Systems capacity Building Lack of clarity on the contribution Conduct in-service training on nutrition Administration/ (functional, institutional to nutrition sensitive programing sensitive programming for the following DNCC and Human capacities) for the nontraditional frontline carders; community development departments (community-based officers, agricultural extension officers and services, education, water, Veterinary assistants, health assistants production, commercial services) Avail Monitoring, supervision and reporting tools to support Coordination structures at different levels of the local government in doing their work Nutrition Coordination structures district for benchmarking information, and the Develop Capacity development plan for (committees) were established at the district key findings of which have been used to inform Nutrition based on the priority gaps identified (kotido DNCC), and respective 6 lower level nutrition programming in the district. Periodic and Support trainings on governance for local governments. These include the Kotido assessments/surveys will also be conducted respective lower level local governments municipality NCC, and the Subcounty NCCs of annually to assess progress. Policy and legal framework Inadequate awareness about Orientation of New DNCC/SNCC members CAO, DNFP, Kacheri, Kotido, Nakaperimolu, Panyangara, and The Link Nutrition Causal Analysis (Link NCA) relevant policies, and guidelines in nutrition governance and respective legal HRO, DCDO Rengen. that support multisectoral policy frameworks study was also conducted, to identify the nutrition programing contextual major causal pathways leading to Support wide district level dissemination of MOYO UNAP II, approved Kotido DNAP, UBOS Gender DISTRICT PROFILE Systems capacity building (functional, wasting, stunting and anaemia among the most KOBOKO LAMWO institutional and human capacities) issues report, and the IMAM guidelines to YUMBE POPULATION 181,050 vulnerable populations, and results of which increase their adoption for use in the district is one of the districts of Capacity of the respective Nutrition coordination have been used to adapt programming in order service delivery Karamoja sub-region named after its ‘chief 26,181 51.8 to propose more targeted nutrition sensitive 2 structures (built) to plan, budget, implement, Information management Districts departments not Support the wide roll out of Standard operating DNFP town’ Kotido, where the district headquarters Households People/km and monitor Multisectoral nutrition actions. 15 interventions. (monitoring, evaluation, reporting nutrition related procedures (SOPs) and use of templates are located. The District is bordered by KITGUM of members of Kotido DNCC, and 10 members surveillance and research) indicators and unaware of their generated in those SOPs to the north, Moroto DistrictADJUMANI to the from the municipality Nutrition coordination Financial and resource mobilization tangible program contribution Infants Women of reproductive east, District to the south, <1 year committees were oriented on their roles in age 15-49 years The district was supported to develop a Five- Financial and resource Limited Commitment by Highlight nutrition among priority issues in high Administration, to the west and Agago and Kitgum Districts context of Nutrition governance. mobilization stakeholders to budget for level development framework like DDP3 as District planner 5,416 36,573 year Kotido Nutrition Action Plan (DNAP) (2020- nutrition activities across sectoral guided by government budget call circular 2019 to the northwest. The district headquarters is 2025 with an incorporated financial estimates located approximately 100 kilometers (62 mi), Children PWDs >2 Policy development, implementation and workplans and NPA planning guidelines AMURU and mobilization plan there in, that was approved ARUA under 5 years PADERyears Train political leaders on nutrition advocacy and by road, northwest of Moroto. This location lies legal framework by the district council (2020-2025). monitoring approximately 430 kilometers (270 mi), by road, 31,416 11,472 AGAGO The DNCC was supported to develop an Inadequate use of nutrition data Building capacity of nutrition focal persons and Administration/ northeast of , the capital of Uganda. Annual Nutrition Workplan (FY 2019/20) and this Communication for nutrition behavior ChildrenGULU & other monitoring data within nutrition programmers to make better use of DNCC The coordinates of the district are: 2o 41’ N, 6-12 years Formal education level multisectoral workplan was approved by the change and advocacy of household head the departments nutrition data 3o15’N, 33o49’E and 34o351 E. It covers a Chief Administrative officer (CAO). 39,333 A number Frontline community structures were Lack of explicit budgets allocated Conducting a budget expenditure analysis to Administration/ total area of 3,610 Km2 with a density of 51.8 15% 7.7% Primary, O’level 3.2%, Other 4.2% The district was also supported to develop a trained in Key Family care practices, as change for nutrition actions /interventions identify available and funding gaps for nutrition DNCC people per Km2. It’s made up of 6 subcounties Five-year Nutrition Action Plan (DNAP) For 2020- agents for nutrition. These include 250 members actions NWOYA 60+ years ZOMBO including a municipality and 24 parishes. From 2025 and this was approved the district council. of Parish development committees (PDC) and Source: Uganda National Population Conducting a Joint Annual Nutrition Administration/ the national census of 2014 census projected 5,398 and Housing Census 2014 OTUKE Review; organizing learning and knowledge DNCC Functional Adult Literacy instructors (FALs) for 2018. dissemination for nutrition at different multi- NEBBI Information management (monitoring, as well as 412 Village health team members OYAM evaluation, surveillance and research) (VHTS). sectoral nutrition committees. KOLE A baseline food security and nutrition This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of assessment(FSNA) was conducted in Kotido UNICEF and do not necessarily reflect the views of the European Union. DEVELOPMENT INITIATIVE FOR NORTHERN UGANDA EUROPEAN UNION NUTRITION, WASH AND HEALTH STATUS OF THE DISTRICT NUTRITION GOVERNANCE ACTIVITIES SUPPORTED IN THE DISTRICT Coordination and Partnerships NUTRITION STATUS FSNA baseline (2018) Desired situation (2020) Stakeholder mapping exercise was conducted in Kotido district Local Government. The district had 37 HEALTH INDICATORS FSNA baseline (2018) Desired situation (2020) key stakeholders either overseeing or implementing Nutrition specific and sensitive interventions as well Almost 4 in every 10 children had stunted growth, 10 in every 100 children as and creating an enabling environment for Nutrition implementation within the district. In total, 20 (54%) had wasted bodies and 4 of every 10 children lacking enough blood (anaemic). Common childhood illnesses in include; is for nutrition sensitive intervention, 10 (27%) is for both Specific and sensitive interventions and 7 (19%) Acute implement all the interventions including governance interventions. The map below shows the distribution of of households of households Respiratory Nutrition specific, nutrition sensitive and governance interventions in the district 41% are food insecure 46% have food stocks 56% Malaria 39% Diarrhea 43% Infections KOTIDO DISTRICT MAP SHOWING DISTRIBUTION OF NUTRITION 15% SPECIFIC, NUTRITION SENSITIVE AND GOVERNANCE INTERVENTIONS All interventions

LOW BIRTH WEIGHT VIT A SUPPLEMENTATION (12-23 MO) IMMUNISATION (DPT3) 10% 78% 90% Kacheri 10% Rengen STUNTING 70% 80% 37 Nakapelimoru 40% ANAEMIA IN WOMEN STAKEHOLDERS Kotido TC overseeing / implementing Kotido 20% 32% DEWORMING (12-23 mo) interventions 12% 71% Source: Food Security and Nutrition Assessment in 8 Panyangara districts of Karamoja 2018, Makerere University School 100% of Public Health. WASTING ANAEMIA IN CHILDREN 27% 54% 12% 53% Nutrition specific Nutrition sensitive <=14 interventions 15 - 19 interventions >=20 interventions & sensitive 4% 25% NUTRITION GOVERNANCE INTERVENTIONS TARGET GROUP KOTIDO Scale up coverage of optimal breast feeding practices Pregnant and lactating women, Adolescents Girls INFANT AND YOUNG CHILD FEEDING PRACTICES FSNA baseline (2019) Desired situation (2025) (10-19Yrs) WHAT IS NUTRITION GOVERNANCE AND WHY IT IS IMPORTANT FOR NUTRITION Promote infant and young child feeding practises Mothers / caregivers 50% Whereas most children are breastfed, 9 of 10 children do not get minimum acceptable diet (eat Promote optimal nutrition Children with special needs 0-11 months inadequate number of meals a day and less variety) for proper growth. OUTCOMES? Promote appropriate adolescent nutrition Adolescents (Boys & Girls) Governance can be defined with regard to institutional structures, relationships between actors and/or organizations, decision-making processes, and incentives. It involves the capacity to act, the power to act and the commitment to act. Scale up and sustain effective coverage Vitamin A supplementation Children 6-59 months, postpartum women 100% Min. acceptable diet Min. diet diversity (6-23mo) Min. meal frequency to children 6-59months 8% 10% 46% Good nutrition governance entails making adequate policy decisions in a timely manner, committing the necessary Iron and Folic supplementation to pregnant Pregnant women (15-49) 75% financial and organizational resources to their effective implementation, i.e. ensuring that benefits reach most of the Outpatient management of acute malnutrition without medical Children 0-59 months, Pregnant women (15-49 ) 25% 40% population, preferably the most vulnerable. It also entails a sustained political commitment to ensure that nutrition complication programs and policies can withstand threats and constraints from changes in district leadership, political and Inpatient management of acute malnutrition with medical Children 0-59 months, Pregnant women socioeconomic upheavals (Solon 2007). complication Continued breast feeding (2yr) Exclusive breast feeding Breast feeding within first 1 hour Management of moderate acute malnutrition (MAM) Children 0-59 months 60% 62% 100% 98% Provide deworming tablets to children (1-14yrs) Children 12-59 months 60% NUTRITION GOVERNANCE FRAMEWORK Deworming for pregnant women Pregnant women (15-49yrs) 100% 80% 80% 80% PILLARS OF NUTRITION GOVERNANCE Intermittent Prevention Treatment of malaria (IPT3???) for Pregnant Pregnant women (15-49yrs) 50% women Scale up and sustain effective coverage of ORS-Zinc for diahorrea Children 0-59 months WASH STATUS FSNA baseline (2018) Desired situation (2025) Intersectoral Cooperation Scale up and sustain coverage of long lasting insecticide treated Pregnant & Lactating women, Children 50% nets (LLINs)

Policy Treatment of malaria All 50% Technical Frame Capacity Sustainable Funding Nutrition Sustain universal coverage of available routine immunization services Children 0-59 months, Pregnant women Works Outcomes Promote EMCT services Pregnant & Lactating mothers 15-49years with HIV 50%

Monitoring Partnership Building Frame work Information Financial and Communication Management Coordination and Provide ARV medication to HIV+Ve All HIV +VE incld Pregnant & Lactating mothers 50% Stakeholders Policy and legal

Vertical System Capacity Coordination Resource Mobilization 15-49years with HIV LATRINE COVERAGE SAFE WATER ACCESS Diet therapy into routine disease therapy Children 12-59 months with special needs Advocacy 40% 98% (Nutrition Behavior Change. Advocacy) Prevention and Management of diet-related NDCs Women of reproductive age 15-49yrs 25%

80% 87% Source: Institute of Development studies (IDS), 2013 Source: Nutrition Stakeholder Mapping for Uganda Report. 2019