USAID Kenya Nutrition and Health Program Plus
QUARTERLY PROGRESS REPORT
January 01 to March 31, 2017
OCTOBER 2016
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 3 QUARTER 2 PROGRESS REPORT
January 01– March 31, 2017
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.
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TABLE OF CONTENTS
TABLE OF CONTENTS ...... II ACRONYMS AND ABBREVIATIONS ...... IV EXECUTIVE SUMMARY ...... 6 I. INTRODUCTION ...... 8 II. PROJECT IMPLEMENTATION PROGRESS AND KEY ACHIEVEMENTS...... 8 1 IMPROVED ACCESS AND DEMAND FOR QUALITY NUTRITION INTERVENTIONS AT COMMUNITY AND FACILITY LEVELS ...... 8
1.1 STRENGTHENED LEADERSHIP, ADVOCACY AND POLICY PLANNING ...... 8 1.2 IMPROVED NUTRITION SERVICE DELIVERY MANAGEMENT, COORDINATION AND IMPLEMENTATION ...... 10 1.3 IMPROVED NUTRITION RELATED BEHAVIOR ...... 12 1.4 INCREASED OPPORTUNITIES FOR LEARNING AND SHARING OF BEST PRACTICES IN NUTRITION ...... 12 1.5 INCREASED KNOWLEDGE AND SKILLS OF HEALTH CARE WORKERS IN NUTRITION ...... 13 2 STRENGTHENED NUTRITION COMMODITY MANAGEMENT ...... 15
2.1 IMPROVING PRODUCTION, SUPPLY AND DISTRIBUTION OF NUTRITION COMMODITIES ...... 15 2.2 IMPROVING QUALITY AND SAFETY OF FOOD COMMODITIES AND AGRICULTURAL PRODUCTS ...... 17 2.3 STRENGTHENING SUSTAINABILITY & INNOVATION IN NUTRITION COMMODITY DEVELOPMENT AND MANAGEMENT ...... 21 3 IMPROVED FOOD AND NUTRITION SECURITY ...... 21
3.1 INCREASING MARKET ACCESS AND CONSUMPTION OF DIVERSE AND QUALITY FOODS ...... 21 3.2 INCREASING RESILIENCE OF VULNERABLE HOUSEHOLDS AND COMMUNITIES ...... 22 4 MONITORING AND EVALUATION ...... 26
4.1 FACILITY REPORTING ...... 26 4.2 ELECTRONIC NUTRITION REPORTING ...... 27 4.3 NUTRITION PORTAL ...... 27 III. ACTIVITY PROGRESS – QUANTITATIVE IMPACT ...... 28 IV. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING ...... 35 V. PROGRESS ON LINKS TO OTHER USAID PROGRAMS ...... 35 V. PROGRESS ON LINKS TO OTHER GOK AGENCIES ...... 35 VI. SUBSEQUENTQUARTER’S WORKPLAN ...... 36 VII. PROJECT ADMINISTRATION ...... 39 VIII. PROJECT ADMINISTRATION ...... 42 VIII.1 CONSTRAINTS ...... 42 ANNEXES: PERFORMANCE DATA TABLES ...... 43
ANNEX 1: SUMMARY OF COMMODITIES DISTRIBUTED ...... 43 ANNEX 2: NUMBER OF PLHIV NUTRITIONALLY ASSESSED VIA ANTHROPOMETRIC MEASUREMENT ...... 45 ANNEX 3: NUMBER OF HIV POSITIVE CLINICALLY MALNOURISHED CLIENTS WHO RECEIVED THERAPEUTIC AND/OR SUPPLEMENTARY FOOD ...... 47 ANNEX 4: NUMBER OF CHILDREN UNDER 5 WHO RECEIVED VITAMIN A FROM USG SUPPORTED PROGRAMS .... 49 ANNEX 5: NUMBER OF PEOPLE TRAINED IN CHILD HEALTH AND NUTRITION THROUGH USG-SUPPORTED PROGRAMS) ...... 50 ANNEX 6: NUMBER OF CHILDREN UNDER FIVE (0-59 MONTHS) REACHED WITH NUTRITION SPECIFIC INTERVENTIONS BY USG-SUPPORTED NUTRITION PROGRAMS ...... 51
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ANNEX 7: NUMBER OF PREGNANT WOMEN REACHED WITH NUTRITION-SPECIFIC INTERVENTIONS THROUGH USG-SUPPORTED PROGRAMS (RAA) ...... 52 ANNEX 8: COMPREHENSIVE NACS IMPLEMENTED PROVIDING SERVICES BEYOND CCC/ART SITES ...... 53 ANNEX 9: QUARTERLY REVIEW MEETING (JULY – SEPTEMBER 2016) ACTION POINTS ...... 54
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ACRONYMS AND ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome Ag-Nut Agriculture and Nutrition AMPATH Academic Model for Providing Access to Healthcare APHIAplus AIDS, Population and Health Integrated Project ART Antiretroviral Therapy AWP Annual Work Plan BFCI Baby Friendly Community Initiative CBO Community-Based Organization CCC Comprehensive Care Centers CDC Centers for Disease Control CHANIS Child Health and Nutrition Information System CHEW Community Health Extension Worker CHMT County Health Management Team CHV Community Health Volunteer CLTS Community-Led Total Sanitation CME Continuous Medical Education CNTF County Nutrition Technical Fora CO Country Office COP Chief of Party CRISP Central Regional Integrated Program CU Community Health Unit DCOP Deputy Chief of Party DHIS District Health Information System EDL Economic Development and Livelihoods EmOC Emergency Obstetric Care EMR Electronic Medical Records EMMP Environmental Mitigation and Monitoring Plan ENA Essential Nutrition Actions EPZ Export Processing Zone FAFSA Food Aid and Food Security Assessment FANTA Food and Nutrition Technical Assistance Project FAO Food and Agriculture Organization FBF Fortified Blended Food FBP Food by Prescription FFP Food for Peace FHI Family Health International FNSP-IF Food and Nutrition Security Policy Implementation Framework FtF Feed the Future GAIN Global Alliance for Improved Nutrition GIS Geographic Information System GMP Good Manufacturing Practice GOK Government of Kenya HACCP Hazard Analysis and Critical Control Points HEA Household Economic Assessment HFP Household Food Production HiNi High impact Nutrition interventions HIV Human Immunodeficiency Virus HNDU Human Nutrition and Dietetics Unit HTC HIV Testing and Counseling IFAS Iron Folic Acid Supplementation IMAM Integrated Management of Acute Malnutrition IP Implementing Partner iv
IR Intermediate Result IYCF Infant and Young Child Feeding IYCN Infant and Young Child Nutrition KARI Kenya Agriculture Research Institute KEBS Kenya Bureau of Standards KDHS Kenya Demographic and Health Survey KEMSA Kenya Medial Supplies Authority KFDA Kenya Food and Drug Administration KHCP Kenya Horticultural Competitiveness KNDI Kenya Nutritionists and Dieticians Institute KPPB Kenya Pharmacy and Poisons Board LMIS Logistics Management Information System MAM Moderate Acute Malnutrition M&E Monitoring and Evaluation MEDS Mission for Essential Drugs and Supplies MCH Maternal Child Health MIYCN Maternal and Child Health Integrated Program MNCH Maternal Newborn and Child Health MOALF Ministry of Agriculture Livestock and Fisheries MOH Ministry of Health MT Metric Ton NACS Nutritional Assessment, Counseling and Support NASCOP National AIDS and STI Control Program NDMA National Drought Management Authority NFSNSC National Food and Nutrition Security Secretariat NHP Nutrition and HIV Program NHPplus Nutrition and Health Program Plus NICC Nutrition Interagency Coordinating Committee NNAP National Nutrition Action Plan NSR Nutrition Service Register OJT On Job Training OR Operations Research ORT Oral Rehydration Therapy OVC Orphans and Vulnerable Children PEPFAR President’s Emergency Program for AIDS Relief PLHIV People Living with HIV PAC Project Advisory Committee PBB Program Based Budgeting PMEP Performance Monitoring and Evaluation Plan PMTCT Prevention of Mother-To-Child Transmission of HIV QA/QI Quality Assurance / Quality Improvement RUTF Ready-to-use Therapeutic Food SAM Severe Acute Malnutrition SBC Social Behavior Change SDG Sustainable Development Goals SCNTF Sub-County Nutrition Technical Fora SMT Senior Management Team SUN Scaling Up Nutrition TA Technical Assistance TWG Technical Working Group USAID United States Agency for International Development WASH Water, Sanitation and Hygiene WFP World Food Program v
EXECUTIVE SUMMARY
The Kenya Nutrition and Health Program plus has been under implementation since January 2015. The overall goal of the program is to improve the nutrition status of Kenyans through increasing access and demand for nutrition services at facility and community levels, strengthening nutrition commodity management and, working with Feed the Future partners in Busia, Tharaka Nithi, Kitui, Samburu and Marsabit counties, improving food and nutrition security. In Busia, Tharaka Nithi, Kitui and Samburu, the program is implementing maternal, newborn and child health nutrition-related activities that aim at ending preventable child and maternal deaths and contribute to reduction of chronic malnutrition (stunting) by 10% in its zones of influence. Kenya Nutrition and Health Program plus (NHPplus)uses an integrated approach to address both the underlying and systemic causes as well as immediate determinants of malnutrition. The approach encompasses capacity building for strengthened leadership in the nutrition sector, advocacy and well-coordinated multi-sectoral and integrated responses; strengthening capacity for nutrition services delivery in high volume facilities in areas with the highest burden of human immunodeficiency virus; provision of nutrition commodities; promotion of multi-sectoral agri- nutrition approaches founded on food production, income generation and women empowerment as pathways for improved food and nutrition security; nutrition sensitive and social behavior change interventions through the Nutrition Assessment, Counselling and Support (NACS) framework, as well as Maternal Child Health and community platforms. This report describes the project’s progress and accomplishments during the period of January 1 through March 31, 2017. During the reporting period, with support from the program, two senior health officers from Kitui and Tharaka Nithi Counties successfully completed senior management training at Kenya School of Government. These officers are providing requisite nutrition leadership and advocacy in respective counties. In addition, the program facilitated and supported the Nutrition Interagency Coordinating Committee at national level and multi-sectoral technical working group meetings at county level to hone coordination among health and non-health sector ministries, partners, programs and projects for improved implementation of nutrition activities. Key deliverables from these events included review of a policy to formally include vitamin A supplementation of children among community health volunteers’ activities and development of a multi-sectoral action plan for the sector. Furthermore, the program facilitated training of County Health Management Team (CHMT) members in Busia county on Program Based Budgeting to strengthen County Department of Health capacity. A draft health Annual Work Plan for the county with well-defined and costed nutrition activities in both curative and preventive services was developed. To improve knowledge and skills of health care workers, 318 workers were trained using the standardized approved national curricula on iron and folic acid supplementation (IFAS), and Baby Friendly Community Initiative (BFCI) to ensure sustained quality of nutrition services at facility level. In this respect, the program produced and distributed standardized IFAS materials for health care workers training in Busia County. These activities contributed to improvement of capacity of counties, implementing partners and community based organizations to implement effective nutrition Social Behavior Change Communication activities. To increase coverage across service points for quality NACS including High Impact Nutrition Interventions, the program conducted joint facility assessment with CHMT members from focus counties. A total of 72 facilities with high potential to support management of acute malnutrition were identified. Action plans developed jointly with the sub – county teams to close identified gaps in each facility will be executed in subsequent quarters to improve service delivery. BFCIs were also initiated in Kitui and Tharaka Nithi counties to strengthening county capacity for Maternal, Infant and Young Child (MIYCN) service delivery. A total of 52 community groups were identified and profiled in the focus counties. The program further conducted joint vitamin A and immunization target setting workshops in Tharaka Nithi County to serve as reference for campaigns in subsequent quarter. 6 FY 17 Q2 Jan – March Quarterly Report
In contributing to continuous strengthening of facility-community bi-direction referral and community case finding, the program facilitated training of NDMA field monitors and community health volunteers on screening for acute malnutrition in Marsabit county. During post training period, a total of 104 cases of severe and 439 cases of moderate acute malnutrition were identified and referred to health facilities for treatment. During the reporting period, the program procured 30,500 cartons (549 Metric Tons - MT) of Fortified Blended Flours (FBF) comprising of 65.6% Adults’, 26.2% Children’s and 8.2% Pregnant and Postpartum mothers’ FBF. A total of 13,555 cartons FBF was delivered directly to 548 facilities across 37 counties, representing an increase in delivery points of 2.5% from previous quarter. 4,082 cartons of Ready to Use Therapeutic Food (RUTF) equivalent to 55.2 MT was distributed to 248 Level 4 and Level 5 health facilities. Overall, 483 health facility delivery points submitted service and commodity data reports to the program, that is, 88.1% reporting rate (n=548). The program supported nutrition assessments for a total of 118,249 clients, against a quarterly target of 62,285. A total of 24,773 malnourished clients received nutritional commodities. The target for the quarter was 24,971. Notable challenges related to facility reporting of service delivery and data management included incomplete datasets and data recording, timeliness, data summary/tallying inconsistencies, human resources constraints and infrastructural and logistical challenges. To improve data quality, reporting and use of service and commodity data at facility and county level, NHPplus conducted joint site supervision visits and Data Quality Assessment in 99 health facilities in 6 counties. It was observed that the facilities improved on overall reporting both at facility and national levels. However, additional effort will be required to improve overall county reporting rates especially for Kitui, Samburu, Kiambu and Machakos counties. NHPplus also provided 166 MOH 734 registers (Facility Consumption Data Report and Request) to West Pokot and Baringo counties. During the quarter, the program focused on implementation of the agri-nutrition package comprising food security interventions, nutrition security messages, WASH activities, income generation and financial inclusion at the community level. Supported activities focused on training of 139 frontline staff, identification and profiling of 64 community groups who will spearhead agri-nutrition messaging. In addition, the program also facilitated review of the National Agri- Nutrition manual. Validation of the draft will be carried out by stakeholders in the subsequent quarter. It is envisaged that these activities will contribute to improved food and nutrition security at community levels. The program has also embarked on Community Managed Disaster Risk Reduction trainings in the focus counties to empower communities for early preparedness and implementation of risk reduction actions to improve resilience to climate change. For example, in Tharaka Nithi, 37 people (28 males and 9 female) from key stakeholder entities among them Governance, Health, MOALF and NDMA were trained. After this training, Sub-Counties prepared disaster risk reduction plans that analyze specific potential events for cascading to the community level. Overall, a review of progress indicators for the year indicates that the program is on track. There were, however, implementation and reporting challenges experienced due to health care workers strikes and drought especially in Marsabit, Tharaka Nithi and Samburu counties.
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I. INTRODUCTION
The Kenya Nutrition and Health Program plus, is a five-year program running from January 1, 2015 to December 31, 2019. Funded by the USAID, it has multiple funding streams including the President’s Emergency Plan for AIDS Relief (PEPFAR), Feed the Future (FtF) initiative and Maternal, Newborn and Child Health (MNCH). The overall goal of the program is to improve the nutrition status of Kenyans through increasing access and demand for nutrition services and health facility and community levels, strengthening nutrition commodity management, and working with FtF partners in the counties of Busia, Tharaka Nithi, Kitui, Samburu and Marsabit to improve food and nutrition security. In the counties of Busia, Tharaka Nithi, Kitui and Samburu the program is implementing 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. The program is expected to contribute to reduction of stunting by 10% in its zones of influence.
Given the multi-factorial etiologies of malnutrition, the Kenya Nutrition and Health Program plus is designed to use an integrated approach to address the underlying, systemic and immediate predictors of malnutrition. Hence the multi-prong program approach encompassing capacity building for strengthened nutrition leadership, advocacy and well-coordinated multi-sectoral and integrated response; increasing nutrition services to high volume facilities in areas with the highest burden of HIV; provision of nutrition commodities; promotion of a multi-sectoral agri-nutrition approach founded on food production, income generation and women empowerment as pathways for improved food and nutrition security; nutrition sensitive and social behavior change interventions through the NACS framework as well as MCH and community platforms. The program is in its third year of implementation and this report describes in detail the project’s planned activities, accomplishments and challenges faced during the period of January 1 through March 31, 2017.
II. PROJECT IMPLEMENTATION PROGRESS AND KEY ACHIEVEMENTS
The project implementation progress and key achievements under each result and sub-result area are presented conferring to specific project required outcomes.
1 Improved Access and Demand for Quality Nutrition Interventions at Community and Facility levels
In order to increase access to quality nutrition services, NHPplus worked at both national and sub- national levels to increase the profile of nutrition as a core service. Key areas of focus include strengthening leadership, advocacy, policy and coordination, as well as improving service delivery, nutrition related behavior, opportunities for learning, and knowledge and skills of health care workers.
1.1 Strengthened Leadership, Advocacy and Policy Planning
NHPplus seeks to strengthen long term capacity of GOK and other stakeholders to direct, manage and finance nutrition programs. Regarding this, two senior county officers were supported to undertake senior management course at Kenya School of Government. The County Director of Health, Kitui, and Deputy County Nutrition Coordinator, Tharaka Nithi, successfully completed the 6-week course. The subject areas covered during the course include: (1) management principles and practice; (2) development planning and public policy; (3) management communication; (4) 8 FY 17 Q2 Jan – March Quarterly Report
effective leadership; (5) governance and sustainable development; (6) public resource management, and (7) public sector and emerging issues. The two officers passed and were awarded certificates of completion.
The program facilitated training of 32 Busia county and sub county Health Management Team (HMT) members on Program Based Budgeting (PBB) for the County Department of Health to strengthen county capacity for multi-sectoral planning processes and establishing linkages between strategic planning, budgeting and resource use. A draft health Annual Work Plan (AWP) containing well defined and costed nutrition activities in both curative and preventive services for the county was developed. The training was facilitated by representative from the Policy and Planning Division, MOH. In Kitui, the program provided technical support in the development of budget lines for nutrition in the county health budget for 2017. Consequently, the Nutrition department in the county was allocated Kes. 3.96 Million for activities outlined in the work plan as follows: Coordination - Kes. 280,000; Printing and information supplies – Kes. 800,000; Training expenses – Kes. 960,000; Specialized food supplements and micronutrients – Kes. 1Million; and Medical equipment – Kes. 1.5 Million. This creation of this budget line is a significant development since its segregation from the health department resource envelope in every sense translates to an affirmative action.
Several national and county level forums were facilitated to strengthen coordination with non- health sector ministries, partners, programs and projects for improved nutrition. At national level the program facilitated 4 coordination activities namely MIYCN – TWG, SUN TWG, Ag- Nutrition TWG and quarterly Nutrition Interagency Coordination Committee (NICC) meeting. The key agenda of the MIYCN – TWG was the finalization of the Baby Friendly Community Initiative (BFCI)Trainers guide and updates to the MIYCN counselling cards. A task force was constituted to finalize the trainers, participant and community health volunteer’s guides. Also, discussed was the finalization of the BMS Act regulations. The SUN TWG key agenda included adoption of the draft TOR for the working group and review of the draft Food and Nutrition Security Policy Implementation Framework (FNSP-IF). A task force was constituted to review the FNSP-IF. The FtF partners Agriculture and Nutrition (Ag-Nut) TWG key agenda was to schedule activities for the year and share upcoming key activities as part of bi-monthly joint work planning.
The NICC meeting, chaired by the Head of Preventive and Promotive Services, was attended by 29 representatives from the Ministries of Health, Labor, Water and Irrigation, European Union Delegation, USAID, WFP, UNICEF, ECHO, WHO, GAIN, CIFF, Map International, AMREF and Micronutrient Initiative. The key achievement from this meeting was the approval of the launch of Kenya National Micronutrient Survey (2011) and commissioning of the team to initiate planning for next survey. Review of the Vitamin A policy to allow for use of CHVs to dispense the supplements was proposed during the meeting. The committee however recommended the need for operations research on this to guide the policy review process. Given the cross-cutting nature of nutrition activities during implementation, a consensus that the nutrition sector should develop a multi-sectoral action plan as opposed to current Nutrition action plan was reached during the meeting.
At the county level, three coordination meetings in Kitui, Marsabit and Samburu counties were facilitated. In Kitui, the program participated in the joint work planning activities for January to March with MOH and other implementing partners who included Kenya Red Cross, IMC, PS- Kenya, and CISP. The joint work plan mapped out partner activities in different sub counties to allow for synergies and avoid duplication. In Marsabit, the program supported the monthly CNTF where coverage of Vitamin A and deworming coverage was reviewed based on semester 2 Malezi bora activities. The program also participated in the emergency response planning activities in the County Steering Group meeting (CSG) where the mapping of the outreaches in hard to reach areas 9 FY 17 Q2 Jan – March Quarterly Report
was shared to ensure coverage with drought response activities. In Samburu, the program supported one CSG meeting to assist in coordination of drought response activities. The meeting was attended by county departments, NDMA, Kenya Red-Cross, WFP, IMC and other implementing partners. Key agenda for this meeting was status report on drought response activities and approval of cash transfers to households in areas classified as critical.
To strengthen effective linkages with other implementing partners the program had a joint planning meeting with Afya Timiza to share information on status of implementation of nutrition activities in the counties and identify areas where activities can be sequenced or layered to enhance synergy and effective use of donor funds. Several joint activities were identified for collaboration for example, joint support supervision for NACS in Samburu and Turkana, BFCI training, distribution of equipment and mother child handbook, sensitization of ECD teachers and layering of community related activities.
To strengthen capacity for policy makers to advocate for nutrition, the program participated in the final stakeholder review of the FNSP-IF. The framework integrates policies, strategic objectives, programs, institutional structures and related actions into a coordinated and cohesive approach to the multifaceted challenges of food and nutrition security. It provides guidance to all stakeholders for implementation of the National FNSP for the period 2016 to 2020. It is therefore recommended for developing effective programs, strategies, or action plans. Good progress can only be achieved with better coherence of initiatives, effective collaboration and coordination of all actors to gain the desired momentum and synergy.
1.2 Improved nutrition service delivery management, coordination and implementation
Towards increasing coverage of quality Nutrition Assessment, Counselling and support (NACS) and High Impact Nutrition Interventions (HiNi) at health facility level, the program conducted joint support supervision for nutrition services with respective sub county health management team members using revised NACS support supervision tool. Subsequently, the sub – county teams developed a follow up action plan based on gaps identified in each facility. Table 1 provides the list of facilities where support supervision was conducted in four Counties during the quarter. Areas identified for improvement are provision of nutrition guidelines, anthropometric equipment, reporting of service utilization and commodity management data. Some of the key follow up actions were targeted CMEs and OJT on proper use of NACS-FBP protocol, inventory management, documentation and reporting for nutrition services. For example, in Kitui, a CME was conducted for 9 health workers after the support supervision activities in AIC Zombe Health center on use of the NACS-FBP protocol during nutrition service delivery.
Table 1: Sub Counties and Number of Facilities Covered with NACS Assessment County Sub Counties covered Number of Facility Assessed Busia Bunyala, Butula, Matayos, Nambale, Samia, Teso North and South 35 Kitui Kitui Central, Kitui East, Kitui West, Mwingi North, Mwingi 11 Central, Mwingi West, and Kitui Rural Marsabit Saku, North Horr, Laisamis, Moyale 7 Samburu Samburu Central, Samburu East, Samburu North 8
In Tharaka Nithi County, the program facilitated a one-day workshop on vitamin A supplementation and immunization in the four sub counties of Maara, Chuka IgambaNgombe, Tharaka North and Tharaka South. The objective of the meeting was to develop immunization and vitamin A supplementation targets for each facility in the respective sub counties. A total of 147 participants attended these workshops and targets were set as summarized in Table 2. The
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targets set for Vitamin A and immunization for each of the four sub counties for 2017 are presented in Table 3.
Table 2: Sub County Participation in Vitamin A and Immunization Target Setting Workshop for 2017, Tharaka Nithi County Sub County Number of Health Care Workers Participating Chuka Igambang'ombe 48 Maara 45 Tharaka North 21 Tharaka South 33 Grand Total 147
Table 3 Vitamin A and Immunization Targets for Children in Tharaka Nithi County Vitamin A Targets Immunization Sub County 6 - 11 months 12 - 59 months old Targets Chuka 2,168 17,539 4,123 Igambang'ombe Maara 1,827 14,782 3,400 Tharaka North 1,107 8,959 1,864 Tharaka South 1,775 14,360 2,991 Grand Total 6,877 55,640 12,378
The key actions for the sub-county HMTs from the target setting workshop were updating the respective facility immunization and vitamin A charts, regular data quality audits to verify data and ensure facility in-charges collect vitamin A stocks to prevent stock-outs.
The program conducted two Baby Friendly Community Initiative trainings in Kitui and Tharaka Nithi counties to strengthen capacity at community, dispensary and health centre MIYCN service delivery. Subsequently, the program collaborated with Mwingi central sub county team and Waita Health centre in Kitui County to initiate community mobilization activities. The nursing officer in- charge conducted an orientation for the Assistant County Commissioner and chiefs on the BFCI approach including their respective roles and responsibilities during implementation of BFCI activities. Later, a chief's baraza was held in Waita Ward where 110 residents were sensitized on BFCI. During the meeting, a community mother care group of 9 mothers was formed for Waita ward. As part of BFCI implementation activities, the community mother care group conducted household mapping in Karuri Village, Waita Ward, to identify households with children under 2 years and pregnant mothers. Some selected population characteristics from the household mapping are shown in Table 4.
Table 4: Selected Population Characteristics in Karuri Village, Waita Ward, Kitui County Characteristic Total Number Number of HHs 8,390 Mothers with children under 2 years old 1,221 Number of pregnant women 347 Facility Mother to Mother support group 28 Number of CHVs in Waita Community Unit (CU) 16 Community Mother to Mother support groups formed 1
Similarly, Kibugua Health Centre mother care group was identified after BFCI orientation of health care workers in Tharaka Nithi. In the subsequent quarters, the program will work with the mother care groups to increase demand and coverage of exclusive breastfeeding for the first six months and other high impact nutrition interventions targeting the critical 1000-day window of 11 FY 17 Q2 Jan – March Quarterly Report
opportunity in the community. These community groups shall be targeted for capacity building on BFCI and implementation of the 8-point plan to achieving Baby Friendly Certification.
During the quarter, the program identified and profiled community groups in Kitui, Busia , Samburu and Marsabit Counties as summarized in Table 5. The community groups will be used as platforms for implementation of nutrition specific and agri–nutrition program activities. The program will build their capacity to mobilize communities to demand quality nutrition services with a focus on adolescent girls, women of reproductive age and under–five children.
Table 5: Number of Health Facility and Community Groups Identified and Profiled in Focus Counties and Sub Counties County Sub Counties Number of Groups Profiled Busia Teso North 23 Kitui Kitui South, Mwingi North, Mwingi Central 14 Samburu Samburu Central, Samburu North 8 Marsabit Moyale 7
In contributing to continuous strengthening of facility-community linkages through cross-referrals to facility, a total of 104 cases of severe and 439 cases of moderate acute malnutrition were referred to health facilities for treatment in Marsabit as part of the IMAM case referrals (Table 6).
Table 6: IMAM Case Referrals in Marsabit County Sub-county SAM referrals MAM referrals Moyale 89 341 Saku 9 89 North Horr 6 9 Total 104 439 (Source DHIS2)
1.3 Improved Nutrition Related Behavior
NHPplus seeks to promote evidence-based interventions focused on the 1,000-day “window of opportunity” that result in improvements of maternal nutrition, appropriate infant and young child feeding young child feeding, WASH practices that lead to sustained change in critical nutrition care practices. During the reporting period, the program concentrated on improving capacity of counties, implementing partners and community based organizations to implement effective nutrition SBCC activities. The program printed and distributed a package of standardized IFAS materials for health care workers training. In Busia, a total of 36 IFAS Health care worker counseling guide, 15 IFAS calendars for promoting adherence, 36 Mothers leaflet to guide interpersonal communication on IFAS, 36 IFAS trainers guide and 36 IFAS participant guides were distributed to various sub county teams.
1.4 Increased opportunities for learning and sharing of best practices in nutrition
Through this component NHPplus pursues to improve overall nutrition services and the impact of nutrition program interventions by supporting learning, information use and sharing of best practices. To support the learning agenda through implementation of operations research and experience sharing forums, the program has initiated preliminary discussions and activities in the following areas: MIYCN: 1. Baby Friendly Community Initiative: Understanding the adequacy of mother-care group approach to improve minimum acceptable diet in Tharaka Nithi County 12 FY 17 Q2 Jan – March Quarterly Report
2. Adolescent nutrition: Maternal nutrition along with family planning option for adolescent girls in Busia County 3. Maternal nutrition: Understanding the extent to which women empowerment contributes to their nutrition status in Kitui County. NACS: • Nutrition counselling: Effect on treatment time for patients on FBP • Nutrition assessment: An entry point into HIV care and treatment for vulnerable populations in arid and semi-arid regions with Samburu County as reference. Nutrition sensitive agriculture: • Nutrition resilience: Measuring household resilience using minimum acceptable diets and women dietary diversity in Marsabit County.
The program reviewed the process of rolling out Community of Practice forums, From the review two communities of practice or “shared interest groups” focusing on the Baby Friendly Community Initiative and Agri-Nutrition will be initiated and supported during the 3rd quarter.. The communities will provide a platform for practitioners to share their experiences and resources, seek recommendations and build each other’s capacity through online and face-to-face interaction. The communities of practice will be established using guidance from the USAID Health Communication Capacity Collaborative (HC3) project. It is hoped that as the communities of practice develop, their evolving discussions will inform an expanded learning agenda. In the subsequent quarter achievements towards establishment of these two communities will be tracked and progress reported. An M&E framework will be developed to guide assessment of the groups.
To program drafted a framework for communication support activities to fast track knowledge translation and management, documentation of success stories and progress updates.
1.5 Increased knowledge and skills of Health Care Workers in nutrition
Increased nutrition knowledge and skills of healthcare workers is expected to contribute to improving quality of nutrition services at facility level. In this regard, the program conducted three training activities for health care workers using standardized approved national curricula on Iron Folic Acid Supplementation (IFAS), BFCI and HINI as summarized in Table 7.
Table 7: Health Care Workers Trained in Nutrition Specific Areas in Focus Counties Focus Sub Counties Participating Training Number of HCWs Trained County Female Male Total Busia Bumula, Bunyala, Matayos, IFAS Training for HCWs 148 57 205 Nambale, Samia, Teso North and Teso South Kitui Mwingi Central BFCI Training for HCWs 12 8 20 Tharaka Chuka, Igambangombe, BFCI Training for HCWs 23 8 31 Nithi Maara, Muthambi, Tharaka North and Tharaka South Chuka, Igambangombe, BFCI Sensitization for 13 16 29 Maara, Muthambi, Tharaka Sub county HMTs North and Tharaka South Chuka, Igambangombe, HINI Sensitization for 13 20 33 Maara, Muthambi and Tharaka Sub County HMT North Grand Total 209 109 318
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To strengthen inclusion of nutrition modules in in-service training curricula, the program supported a five-day workshop of a task force of the MIYCN TWG to review, update and finalize the BFCI Trainers and Participant Guide. The BFCI in-service course includes 13 units and is 28 hours 10 minutes long as outlined below:
1. Introduction to BFCI [110 Minutes] • Global and National strategy on MIYCN • BFHI – 10 steps to successful breastfeeding • Introduction BFCI 2. Food and Nutrients [45 Minutes] 3. Maternal Nutrition [80 Minutes] 4. Feeding Infants 0 – 6 months [380 Minutes] • Importance of breastfeeding • How Breastfeeding works • Breastfeeding techniques • Common Breastfeeding difficulties • Expressing Breast Milk and Cup feeding • Breast conditions related to breastfeeding 5. Counseling Skills [105 Minutes] • Listening and learning • Building confidence and giving support 6. Complementary Feeding [330 Minutes] • Importance of Complementary Feeding • Foods to fill energy, iron, and vitamin A gaps • Quantity, Variety and Frequency of feeding • Food modification and fortification 7. Breast Milk Substitute (Regulation and Control) Act 2012 Monitoring [45 Minutes] 8. Food Safety and Hygiene [45 Minutes] 9. Growth Monitoring and Promotion (GMP) [210 Minutes] • Introduction to Growth Monitoring and Promotion • Importance of GMP • Measuring weight, length/height and MUAC • Plot a Growth chart • Interpreting plotted points for growth indicators • Classification of Malnutrition • Early Childhood Development and Stimulation 10. Household Food and Nutrition Security [40 Minutes] 11. Establishing Baby Friendly Communities [30 Minutes] 12. Monitoring and Evaluation [150 Minutes] 13. Practical Session [120 Minutes]
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2 Strengthened Nutrition Commodity Management
2.1 Improving Production, Supply and Distribution of Nutrition Commodities
Production and distribution of nutrition commodities Through this component NHPplus pursues to ensure efficiency in all nutrition commodity procurement, management and distribution, and addresses quality control and safety of food products. Towards improving efficiency and availability of nutrition commodities and products that meet country quality and standards required to deliver NACS, NHPplus observed that the distribution surge of 804.3 MT of Fortified Blended Flours (FBF) during the first quarter, demand for restock sites decreased significantly during the quarter. The FBF commodities comprised 65.6% of Adults’, 26.2% of Children’s and 8.2% of Pregnant and Postpartum mothers’ formulations. The demand for restocking was a low of 30% volume distributed during preceding quarter.
FBF distributed during the quarter, amounting to 13,555 cartons (243.99 MT), was delivered to facilities across 37 counties as shown in Figure 1. Total number of facilities receiving commodities directly was 548, a 2.5% increase from previous quarter attributed to upgrade of thirteen (13) health facilities in Tharaka-Nithi from satellite to central sites with the aim of improving nutrition service coverage, delivery management, coordination and implementation in focus county.
600.0 549.4 500.0 400.0 300.0 255.2 254.9 212.0 202.1 211.9 212.4 194.4 200.0 100.0 49.6 Metric Metric Tons (FBF) - -
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July
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November September Y2-Q3 Y2-Q4 Y3-Q1 Y3-Q2 FBF MT 2017
Figure 1: Summary of FBF Commodity Distribution
During the quarter 4,082 cartons (55.2 MT) of Ready to Use Therapeutic Food (RUTF) was distributed to 248 Level 4 and Level 5 health facilities. In March, distribution the transition of distribution services to a new transportation company, Sai Cargo Masters Ltd necessitated temporary hold to the distribution of commodities. The distributor was contracted for a period of one year unlike previously where distribution was awarded on purchase order basis. This action will ensure continuous/uninterrupted supply of nutrition commodities to the health facilities.
National Pipeline Sub Committee NHPplus participated and contributed to the National Pipeline Subcommittee meeting held in January 2017. The main agenda for the meeting was too review the commodity status for the 3 pipelines (NHPplus, KEMSA and MOH through KEMSA) to inform mitigation measures that the MOH/GOK would undertake in the drought stricken counties. It was noted that, in addition to 15 FY 17 Q2 Jan – March Quarterly Report
the 4,082 cartons distributed by NHPplus, UNICEF had 19,000 cartons (256.5MT) of RUTF in stock, with an additional 17,000 cartons (229.5MT) expected in February 2017. These quantities were projected to cover the period January to June 2017. With World Bank funding MOH was in the process of procuring 6,075 cartons (82 MT) which would be distributed through KEMSA from March 2017. NASCOP had in stock 368 MT. Except for NASCOP and NHPplus, the commodities targeted children under 5 years in Arid and Semi-Arid Lands (ASAL) counties hence commodities procured were not adequate for all target groups/all counties. It was agreed that there is need to harmonize distribution plans to avoid duplication of efforts in the counties. Other key highlights of the meeting included review and alignment of LMIS training curriculum and development of Standard Operating Procedures (SOPs) for nutrition commodities to inform procurement, specifications, safety and inspection. NHPplus and other stakeholders will support the process and disseminate the SOPs to health facilities. The program continued to provide commodity summary data (stock status at central stores, issues to health facilities and pending procurement) and to participate in the monthly NASCOP Commodity Security Steering Committee meetings. Strengthening LMIS system for commodity management In the continued process of national harmonization and integration of nutrition commodity pipelines (data capture and reporting), NHPplus provided 166 MOH 734 registers (Facility Consumption Data Report and Request) to West Pokot and Baringo counties following a request by UNICEF, the main partner in the 2 counties. It is worthwhile to note that NHPplus supports 11 facilities in the 2 counties. Site Support Visits NHPplus conducted joint site supervision visits in 99 health facilities in 6 counties with the aim of increasing data collection and use to inform strategic plans for improved commodity management. The teams included NHPplus staff and Sub County Health Management Teams (SCHMT). Through data quality audits, it was observed that the facilities have improved in reporting (see Table 8) both at facility and national level (through DHIS and at program level). Table 8: Trends in Average Rate of Reporting after Joint Site Supervision by County County Average Reporting Reporting Rate, Observation Rate 2016 (%) February 2017 (%) Busia 80.6 96.3 There was overall increase in Kitui 36.2 62.5 reporting from the 6 counties, Samburu 25.0 72.7 however, there is need to Kiambu 71.1 71.4 improve on reporting rates, Machakos 62.7 74.1 timeliness of reporting and Muranga 92.8 100 data quality
There is still need to improve on timeliness of uploading/sending reports and reporting rates especially in Kitui, Samburu, Kiambu and Machakos to at least >80%. Data quality was also noted as a major challenge from the data cross checks. Facilities were encouraged to collect and upload accurate data which can be used in forecasting and quantification of nutrition commodities ensuring that facilities are not overstocked or understocked. In addition, data is constantly required at county level (through the sub county/county nutrition coordinators) to lobby for additional budget allocation for nutrition commodities. Further, proper record keeping also ensures that there is no wastage of commodities in the facilities as they can track “soon to expire” commodities and plan to re-distribute the excess within the sub counties or counties. For example, in Kitui county, the team re-distributed FBF for children from Kyuso DH to Muthale Mission Hospital and Zombe Health Centre within the county as the commodities were set to expire in 2 months.
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Low staffing level was identified as a major contributing factor in sites with less than 80% reporting rates within the counties visited. In Kitui County, nutritionists in the facilities (except Migwani SCH, Mwingi SCH and Mutitu SCH) had their contracts terminated towards end of last quarter following the exit of ICAP, the local implementing partner. This affected nutrition commodity uptake adversely and the facilities/sub county nutrition coordinators were urged to encourage task shifting through On Job Trainings (OJTs) to HTC counsellors and peer educators who can assist in assessment and dispensing of commodities whereas the clinical officers and nurses are tasked with prescribing, summarizing and uploading of monthly reports. The facilities visited and general observations are summarized in Table 9. 2.2 Improving Quality and Safety of Food Commodities and Agricultural Products During the quarter, a Supplier Quality Auditor was identified and contracted to conduct quality audit for Equatorial Nut Processors, Insta Products (EPZ) Ltd and Soy Afric Ltd. The main objective of this activity is to ensure that the food processors are on track with improvement plans as agreed upon during the last audit. In addition, the auditor will conduct a full audit in the new RUTF manufacturing plant at Insta Products (EPZ) Ltd. This activity will address the required outcomes: a) Increased capacity of private sector partners in the food industry to self-regulate for safety and quality of food manufactured and; b) Expanded manufacturing base for nutritious commodities by the private sector. Food processors with capacity to produce nutrition commodities that meet minimum requirements are identified through this process. A score of 75% and above in the Supplier Quality Audit (SQA) will guarantee food processors consideration during procurement of nutrition commodities and/or recommendations to other stakeholders (MOH, IPs). Final SQA reports will be shared in the coming quarter. NHPplus identified two (2) small food processors for support to get the KEBS Certification within Marimanti Location, Tharaka South Sub County in Tharaka Nithi County. The Marimanti Rural Training Centre process honey while Tharaka Green Gold undertakes the following: • Juice Extraction – from Mango, Baobab and Tamarind(Ukwanju) • Vegetable Drying – Cow Peas (Kunde), Amaranthus (Terere) and Moriga leaves • Flour Making – Bananas, Cassava, Millet and Sorghum flour The program will engage the enterprises that have milling capacity to influence them about food fortification and food safety certification. Discussions with the group will be initiated in the coming quarter with the view to link with KEBS later in the year.
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Table 9: General Observations and Action Points for Health Facilities Supervised by County County Health Facilities Observations Action Points
Samburu Central Sites: None • 10 sites (all satellite sites) visited • CNC to follow up on storage for the 3 Satellite Sites: Marti Dispensary; Lesirkan Health • Main service points for nutrition services include MCH, facilities CCC, TB, Inpatient and Outpatient except for Suguta, Centre; South-Horr GOK Dispensary; Kisima Model • NHPplus to provide adult MUAC Wamba Health Centre and Sereolipi where nutrition Health Centre; Suguta Health Centre; Wamba Tapes to all facilities by end April 2017. Catholic Hospital; Archers-post Health Centre; services are accessed through nutrition clinic Sereolipi • All facilities had adequate data collection and reporting tools; NACS/FBP Protocol reference desktop flipcharts • Adequate FBF stocks from NHPplus, and other partners (UNICEF and WFP) • Adequate storage for nutrition commodities including pallets for Marti dispensary, Lesirkan, Wamba Health Centre and Wamba Hospital. • All the facility reported stock out of adult MUAC tapes. Kitui Central Sites: Kitui County Hospital; AIC Zombe • 11 facilities visited (all central sites) • Mutitu SCH have identified space, Health Centre; Mutito Sub County Hospital; Kyuso • 91% of the visited facilities had nutrition commodities. needed approval from the hospital Sub District Hospital; Tseikuru Sub District Hospital; The facility that did not have any nutrition commodities management Katse Health Centre; Mwingi Sub County Hospital; was AIC Zombe HC. • NHPplus Field Officer to work closely Migwani Sub County Hospital; Kauwi Sub County • Kitui DH, Mutito SCH, Kyuso SDH and Kauwi SDH not with different sub county and facility Hospital; Nyumbani Village dispensary; Kwa Vonza have adequate storage space for nutrition commodities. Dispensary teams in ensuring that all the facilities • Facilities with no pallets were Kitui DH, AIC Zombe HC, have enough and consistent stock of Mutito SDH, Katse HC and Kauwi SDH. nutrition commodities, data collection, • 64% of the visited facilities have staff who have been reporting tools as well as job aids and trained on NACS beyond HIV. The facilities that are yet anthropometric equipment. to receive trainings and OJTs are AIC Zombe HC (former trained staff left), Tseikuru SDH (staff on contract and • NHPplus to assist the county in was trained left), Nyumbani Village dispensary (New staff) lobbying for more nutritionists through and Kwa Vonza Dispensary (former trained staff left). close collaboration with local • 100% of the visited facilities lacked Mother and Child implementing partners.
Booklets. • NHPplus Field Officer to work closely • 18% of the visited facilities did not have all the basic with different sub county and facility nutrition data collection and reporting tools. Facilities Kitui (Cont’d) teams in planning continuous OJTs, affected were Katse HC (lacking MOH 733B) and Kwa mentorships and trainings to improve Vonza dispensary (lacking MOH 732 – prescription on capacity to perform accurate data booklets). collection and reporting in all the
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• On anthropometric equipment, 91% of the facilities nutrition tools by the end of the coming visited did have all basic required anthropometric quarter. equipment. AIC Zombe HC lacked Adult MUAC Tapes • NHPplus to provide Mother and Child and Height board for children. Booklets and MUAC Tapes especially • On job aids, 18% of the facilities that were visited did not for Adults in April 2017. have enough job aids for nutrition. These facilities were Mutito SCH (lacked NACS/FBP Protocol Reference Chart on one of the service points) and Katse HC lacked the updated desktop flipchart. • Data cross checks across the visited facilities indicated that 36% of the facilities did accurate, consistent and reliable data in data collection and reporting tools. Facilities with consistent data were Kyuso SDH, Katse HC, Mwingi DH and Kwa Vonza dispensary. • Inadequate Nutrition Staff in almost all the facilities visited especially Kitui DH. Busia Central Sites: Bungoma CRH; Port Victoria; • 17 central sites and 12 satellite sites visited. • SCNOs tasked with mentoring the Mukhobola, Bumula A, Khunyangu, Bumula B; satellite sites within their sub counties Matayos; Nambale SCH; Lupida HC; Madende • Challenges of distributing commodities, training and data by end March 2017. Model HC; Amukura HC; Alupe SCH; Lukolis collection tools were reported. Model HC; Teso North SCH; Moding HC; Angurai • Follow up on mentorship to be done • Anthropometric equipment – Bumula A, Bumula B and HC in the coming quarter by NHPplus Ikonzo lacked baby weighing scales. Lack of Adult Satellite Sites: Rukala Model HC; Ikonzo Model MUAC tapes in all facilities • Data collection tools and job aids HC; Sikarira Dispensary; Busibwabo; Munongo provided to the sub counties by • Dispensary; Masewa HC; Igara Dispensary; Malanga Storage is limited in the satellite facilities and this NHPplus Dispensary; Amaase Dispensary; Malaba Dispensary; contributes to the stock out situation • Kamolo Dispensary; Changara Dispensary NHPplus to fast track procurement and distribution of anthropometric equipment • SCNOs to lobby to additional space within the sub counties where the satellite sites can draw commodities Machakos Central Sites: Kangungo Level 4 Hospital; The observations below cover the 3 counties; Machakos, Kiambu • Provide missing data collection tools Ndunduni Dispensary; Nguluni Health Centre; and Muranga and job aids. Machakos Level 5 Hospital; Athi River Health • Centre; Kathiani Level 4 Hospital; Mwala Level 4 80 facilities visited within the 3 counties. Of the facilities visited, 51 receive direct supply of commodities
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Hospital; Matuu Level 4 Hospital; Katangi Health • 12.5% of facilities visited had stock outs –(Kathiani L4, • Provide commodities to all the Centre Kalimoni MH, Ruiru SDH, Tigoni L4, Ndeiya HC, facilities that had stock outs by April Satellite sites: Matungulu Health Centre; Mutituni Ting’ang’a Catholic Dispensary, PCEA Kikuyu Hospital, 2017 Gaicanjiru MH, Nyakianga HC) Health Centre; Mulolongo Health Centre; Mitaboni • Reference charts sent to the affected Health Centre; Ithaeni Dispensary; Masii Health • Data collection tools and NACS/FBP Protocol facilities Centre; Wamunyu Health Centre; Ikombe Reference charts were available. However, Mutituni • Program to work with the local IP and Dispensary; Kithimani Dispensary; Kisiiki Health Centre lacked the desktop flipcharts. CNC to lobby for additional Dispensary; Masinga Sub County Hospital; anthropometric equipment and support • Inadequate/non-functional Anthropometric equipment Kithyoko Health Centre for redistribution of commodities especially floor scales, Adult MUAC Tapes, BMI Wheels Central sites: Ngoliba HC; Makongeni HCentre; • CNCs to lobby for additional staff Munyu HC; St. Mulumba MH; Thika L5; Thika • Staffing constraints (nutritionists) especially in Kangundo through the county governments Nursing Home; Kiandutu HC; Kilimambogo HC; L4, Nguluni HC, Matungulu HC, Mutituni HC and the Kiambu and/or local IPS Gachororo HC; Juja Farm HC; Kalimoni MH; dispensaries JKUAT Hospital; Ruiru SDH; Tigoni L4; Nazareth • NHPplus together with CNC/SCNCs • Reports and registers were up to date; data cross checks Hospital; Lari SCH; Wangige SCH; Lussigetti SCH; to plan for OJTs/CMEs within the indicate there is need for OJT/CMEs especially in the PCEA Kikuyu MH; Gatundu L4 county by end of coming quarter. health centers and dispensaries to enable the facilities Satellite Sites: Igegania SCH; Gitare HC; Karatu make accurate projections for nutrition commodities. • Cost benefit analysis to be carried out
HC; Ng’enda HC; Uthiru HC; Nyathuna SDH; by the program to determine efficacy • Distribution of nutrition commodities to the satellite Muranga Gichuru L2; Githunguri HC; Kigumo L4; Sacred of additional facilities for direct supply Heart Dispensary; Ting’ang’a Catholic Dispensary; sites was cited as a major challenge especially in AIC Kijabe (Mariira Clinic); Kamirithu HC; Limuru Machakos County. Nursing Home; Ndeiya HC; Limuru HC; Nazareth Ruiru Clinic; St. Jospeh Catholic Dispensary Central sites: Gaicanjiru MH; Gatura HC; Githumu MH; Gitugi HC; Ithanga HC; Kandara SCH; Kangari HC; Kangema SDH; Kanyenyaini HC; Kigumo SCH; Kihoya HC; Kiriani MH; Kirwara SCH; Makuyu HC; Maragua Ridge HC; Maragua SCH; Muranga CRH; Muriranjas SCH; Nyakianga HC; Saba Saba HC
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2.3 Strengthening Sustainability & Innovation in Nutrition Commodity Development and Management
NHPplus followed up with ENP on the possibility of the food processor procuring sorghum from farmer groups within Tharaka Nithi County. Noteworthy is that ENP, together with East Africa Breweries Ltd (EABL), have taken steps in ensuring that prices are regulated within the county as this had been cited as the main bottleneck in engaging the farmers. ENP has an outlet/depot in Meru town where they source sorghum from individual farmers, brokers and agents – not organized into farmer groups. Further, ENP has another depot in Chuka town which mainly deals with macadamia nuts. During this quarter, the food processor did not procure raw materials within this county because unavailability and aflatoxin contamination. The program will work closely with the communities from areas where sorghum is grown and create linkages with the food processor. This will partly address the required outcome on effective linkages established with private sector for a value chain approach to production and processing of quality and safe nutritious foods. During the quarter, ENP reported decrease in maize purchases from 570MT in the previous quarter to 360MT. This was attributed to scarcity of maize in the local market driven by poor rainfall in the last planting season. In addition, the poor rainfall necessitated Tanzania to close cross border importation of maize to Kenya. However, compared to same period in 2016, high maize prices were recorded at Ksh. 47.59 per kg from Ksh. 35.23 in the preceding quarter. These challenges of constraint maize supply have been recently addressed through the Government of Kenya’s decision in early April authorizing the National Cereals and Produce Board (NCPB) to sell maize to millers as a way of mitigating escalating cost of food in Kenya. ENP Fortified is therefore in the process of securing supply line for maize from the NCPB. We note that ENP decision in 2015/2016 to stock pile Soya beans has helped ease challenges and will sustain until the next season in July/August. We therefore anticipate good production and supply situation in the next two quarters.
3 Improved Food and Nutrition Security The objective of this component is to improve food and nutrition security of vulnerable individuals and groups in focus counties through promotion of prevention of recurrent malnutrition by breaking its cycle. Alongside this is to reduce stunting, through targeted interventions and smart integrations and linkages with other partners as well as building resilience of the communities. During the reporting, period the program focused on implementation of the agri-nutrition package at the community level. Activities concentrated on frontline staff (CHVs/CHEWs/FEWs/ECDE staff, Community Resource Persons) training and formation of community groups to be used as platforms for agri-nutrition messaging. Linkages with National Government, County Governments of Busia, Kitui, Marsabit, Samburu and Tharaka Nithi and other implementing partners were also established to provide synergies and leverage on existing opportunities aimed at addressing community nutrition concerns. Possibilities of leveraging, layering and integration were also explored arising from the linkages.
3.1 Increasing Market Access and Consumption of Diverse and Quality Foods
Following the training on Agri-nutrition that have previously been undertaken, the program delivery platform for this component is community groups with at least 70% women of reproductive age, 15-49 years. The entire agri-nutrition, package contextualized to the sub- counties, aims to deliver activities within the three proven pathways of improved food production, income generation and women empowerment. In addition, behavior change communication strategies will be targeted to transform the communities to embrace good agri-nutrition practices
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for improved food and nutrition security. During the reporting period, a total of 64 groups were identified/established and profiled as shown in Table 10.
Table 10: Number of Community Groups Identified and Profiled in the Focus Counties County No. of No. of groups No. of CHVs/ FEWs/ECD members identified/established teachers/ ward Busia 336 24 6 Kitui 364 14 80 Marsabit 110 7 16 Samburu 218 18 55 Tharaka Nithi 30 1 3 TOTAL 1058 64 160
3.2 Increasing Resilience of Vulnerable Households and Communities
NHPplus, in collaboration with FtF and OPH IPs, is working 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. The program also works toward the establishment of effective referrals and linkages for vulnerable households and communities to resilience supporting initiatives. A key required outcome is enhanced human capacity for increased agriculture sector productivity. In regard to this, the program in collaboration with MOALF commenced the review process of the National Agri-Nutrition Manual and conducted intensive training of frontline extension staff (CHEWs, FEWs, CHVs, ECDE staff and Community Resource persons) in the focus counties to disseminate the agri-nutrition package to the community through group platform. The sub-county specific contextualized package at the minimum delivers the following; • Food security intervention strategies and technologies • Nutrition security messages, strategies and practices • WASH • Income generation • Financial inclusion
Review of the National Agri-Nutrition Resource Manual NHPplus facilitated MOALF to start the process of reviewing the existing National Agri-Nutrition manual. A technical team of 11 drawn from MOALF, MOH, MOE, Kenyatta University, KIWASH, AVCD, K-RAPID, KAVES, FAO and WFP developed the technical content of the revised draft manual through identifying and addressing the gaps in the existing document. The draft document is ready for subjection to a wider multi-sectoral stakeholder validation forum to be conducted in the subsequent quarters.
Training of CHEWs, FEWs and ECDE staff on Agri- nutrition for community level implementation During the period under review the program’s county and sub-county level ToTs conducted Technical Team Reviewing Agri-nutrition Manual Multi-Sectoral Agri-Nutrition training for the frontline extension staff from the MOALF, MOH and MOE who would directly pass the key messages to the agri-nutrition groups at the community level. A total of 139 frontline staff from Marsabit, Kitui and Samburu (see Table 11) 22 FY 17 Q2 Jan – March Quarterly Report
and 12 sub-county staff from Kitui were trained. The training was based on a contextualized package containing food and nutrition security mitigation strategies specific to wards. The overall expected outcome is improving access to quality and diverse foods as well as improving overall food and nutrition security and resilience building. The intermediate outcome for the quarter was to enhance the frontline staff agri-nutrition skills, knowledge and dissemination capacity. In the roll out plan the frontline staff mobilize 310 community groups and disseminate the agri-nutrition package. The groups comprise 15-25 people with mothers of reproductive age of which 10 champion mothers per group would be assigned 10 households each to disseminate the package ultimately reaching 31,000 households.
Table 11: Number of Frontline Staff Trained on Agri-Nutrition by Gender and County County Number of frontline staff trained Female Male Total
Marsabit 10 6 16 Kitui 30 38 68 Samburu 30 25 55 TOTAL 70 69 139
Participants in plenary presentations of group work in Marsabit Training for frontline staff
Multi-sectoral Agri-nutrition work plan In Marsabit county, following the multi-sector agri-nutrition training for the field extension workers, the TOTs for the Moyale sub-counties developed an integrated work plan to be implemented at the ward level. This has since been shared with other USAID partners within the county for possible collaboration to increase the coverage of the activities. The trained FEWs will MOALF facilitator during the training train community through group approach to uptake agri-nutrition messages and actions expected to improve community nutrition outcomes, food and nutrition security and resilience.
Strengthening Early Warning and the Bi-directional Referral System To contribute to equipping the communities with necessary knowledge and skills in community managed disaster risk reduction, climate change adaptation and provide a timely tool in the phase of climate change, improving food and nutrition security and building community resilience, the program conducted the activities outlined below.
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Community Managed Disaster Risk Reduction (CMDRR)Training for Stakeholders In Tharaka Nithi county the program facilitated the CMDRR training for 37 people (28 males and 9 female) from key stakeholders (Governance, Health, MOALF and NDMA) from the County. After the training, as part of disaster preparedness process, all the Sub-Counties prepared disaster risk reduction plans that analyzed specific potential events or emerging situations that might threaten society or the environment and established arrangements in advance to enable timely, effective and appropriate responses to such events and situations. The training empowers the community to understand expected hazards such as drought, its characterization, how it affects households and community, the cause/origin from the fore-warning signs like reduced volumes of water in the rivers, shedding off leaves by certain indigenous trees, migration of bees, presence of certain birds, outbreak of water borne diseases, migration of animals, dried seasonal rivers among others. Once the community’s capacity is built on this early preparedness they can employ disaster risk reduction actions when they start to observe early warning signs and in the event, that the disaster strikes, they can mitigate and reduce the risks and negative impact that significantly contributes to malnutrition. The required outcome of these trainings is increased number of people using climate change information or implementing risk reduction actions to improve resilience to climate change.
Bi-directional Referral System As reported in Sub-IR1.2, a total of 543 acute malnutrition case referrals have been made from the community level in Marsabit during the reporting period. The program contributed to this through training of NDMA field monitors and community health volunteers on screening for acute malnutrition. The challenge however is the availability of MOH 100 referral tool which would have aided proper referrals for purposes of documentation at the catchment health facilities. MUAC screening from the NDMA bulletin March 2017 showed that 20.1% of the children screened are at the risk of Malnutrition (MUAC<135 MM) showing a slight increase when compared to the previous month of February.
In Samburu county through use of NDMA early warning field monitors trained by the program on MUAC screening and use of MOH 100 referral tool 1 female child with a MUAC of 11.7 cm from Arsim was referred from the community to Arsim dispensary for nutrition support. Follow up of the referred cases is there after done to ensure adherence to the referral recommendations.
Strengthening collaboration between partners During the quarter towards strengthening collaboration and coordination between partners the following were undertaken; • NHPplus was appointed as county PREG coordinator in Marsabit. During the period, the program spearheaded different PREG activities including; 2 monthly meetings, USAID field monitoring visits and one joint work planning workshop for the USAID partners. Key outcomes include; partners developed strong understanding of the PREG standard operating principles for collaboration and partnership, joint workplans were prepared to ease implementation and tracking. PREG team also agreed to conduct periodic monitoring visits on quarterly basis. This is expected to enhance better understanding of each other’s project hence seizing any opportunities available for sequencing, layering and integration. • The program also initiated the process of layering with REGAL-AG in the Moyale Livestock Market seeking to provide the nutrition component to the community through establishing a dietary diversity demonstration garden • In Samburu county, exchange visits were made between the program and other USAID partners. The program visited APHIA plus Imarisha borehole and demonstration garden project at Archers Post in Samburu benefitting 40 orphans through 32 women OVC care givers from the community. The Marsabit CNC and a World Vision Staff accompanied the team.
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The project branding Mega bags technology used as multi-storey units
The Garden Nutrient Dense Crops – Spinach Amaranthus crop in the garden
Observations • The current crop had reached its end of production stage hence group organizing to change cycle • Group advised to stagger the next cycle so that at any time the garden ahs crops at different stages • Group advised to liaise with local MOALF to advise on the shade net density in the next cycle • The use of mega-plastic tubes a wonderful technology for commercial multi-storey gardens
Way Forward • NHPplus to replicate this technology to the agri-nutrition groups in the ASAL counties • NHPplus to adopt the group in the event the current partner winds up • NHPplus layering on nutrition component for the group and fill any existing gaps
Income generation and economic empowerment During the reporting period, the program organized a two-day training in Tharaka Nithi county on Financial inclusion for women economic empowerment where 30 members of the Kibugua Mother-to-Mother Support Group were trained. The training facilitated by Officers from the department of Agriculture and Trans National Sacco empowered members in entrepreneurial skills, financial inclusion for economic empowerment and group dynamics. The aim being guiding them towards obtaining extra monetary income to buy foods they can’t produce and consequently increase their market and economic access as well as build resilience. Linkage to micro-credit facilities was also covered.
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4 Monitoring and Evaluation 4.1 Facility Reporting Overall, a total of 483 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 representing a 88.1% reporting rate (n=548). During the quarter, the program supported nutrition assessments for a total of 118,249 clients, against a quarterly target of 62,285. The program also supported a total of 24,773 malnourished clients with nutrition commodities, against a target of 24,971 clients, during the reporting period. Notable challenges related to facility reporting and data management included: i) Incomplete datasets: Facilities are expected to submit to the program a minimum of three (3) data sets monthly. These are MOH407A, MOH407B, MOH 734 and MOH 732. During the quarter, a total of 519 health facilities submitted both service (MOH407) and commodity data (MOH734). ii) Timeliness: Facilities are required to submit their service and commodity data-sets to NHPplus on-or-before the 10th of every subsequent month. This allows facilities to review the data internally and with respective SCNCs and CNSs before submission. On average, supported facilities submitted their data 5.8 days after the agreed deadline with a minimum of -14 and maximum of +56 days after the deadline. A total of 116 facilities from 21 counties submitted their reports 20 days after the deadline. E.g. Chulaimbo SDH which sent November 2016, December 2016 and January 2017 data during the month of February 2017. iii) Incomplete data recording: Facilities are required to complete all variables on the data capture and reporting tools by recording appropriate data coding values. However, routine quality check indicates that Mikinduri SCH, Nyatike H/C, Suguta H/C and Openda Dispensary in South Mugirango Sub County were noted to have submitted incomplete data sets. iv) Data summary/tallying inconsistencies: Hamisi Sub County Hospital and Thika Nursing Home were noted to have submitted inconsistent consumption data as compared to actual tallies from the source records, the MOH 407A and B. v) Human resources for health: Re-deployment of nutritionists to other service points and in-county transfers have created reporting gaps and data quality concerns for example in Bomu Medical Center. vi) Infrastructural and logistical challenges: Power outages reported in some facilities e.g. Bumula CRH (AMPATH supported). Some delays in submission were also noted due to satellite facilities submitting reports to NHPplus through their designated central sites. Internet connectivity and availability of facility based ICT personnel support was noted to be a challenge in seven (7) of the EMR supported sites namely Narok District Hospital, Baragoi Sub District Hospital, Bar Agulu Dispensary, Nyahera Sub District Hospital, AIC Litein Mission Hospital, Maragua District Hospital and Muriranjas Sub-District Hospital. In mitigation and to ensure sustainability of nutrition services, the program sought to strengthen linkages with stakeholders and partners, through joint activity planning, to enhance data quality, reporting and use at national, county and sub-county levels. The program routinely shares facility performance reporting data internally and with CNCs/SCNCs and IP contact persons from affected counties to inform mitigation measures and capacity building needs/gaps. The program will also continue to collaborate with IPs, who include Elizabeth Glaser Pediatric AIDS Foundation (Turkana), EDARP, Nyumbani, AMPATH and APHIA+ partners, to support infrastructural/logistical support, OJT/CME and mentorship of HCWs providing nutrition 26 FY 17 Q2 Jan – March Quarterly Report
services. Joint data review sessions and facility capacity to provide nutrition assessment were conducted in Kitui, Marsabit and Busia. These were conducted together with the responsible CNC, SCNC and local IP representative. Feedback from these assessment sessions will allow final revision of the Nutrition Service Facility Assessment tool for rollout to other non-focus counties. Determination of facilities requiring support will be based on: adherence to reporting rates; adherence to 10% threshold of ineligible clients getting support; adherence to 10% threshold of anthropometric data lying within set national/international SOPs; HRH (in-transfers, task shifting); data completeness; data tallying inconsistencies; geographical access to facilities by the catchment population; intra-facility access to anthropometric equipment. A comprehensive summary of service and commodity support supervision activities is contained in section 2.2: Strengthened Nutrition Commodity Management. The program also supported transition of twelve (12) high volume facilities to EMR status through provision of laptops and customized nutrition EMR reporting software. In addition, the program also supported four (4) high volume facilities with the customized software for nutrition reporting. The program is in the process of procuring an additional forty (40) laptop computers to support high volume facilities with data management and reporting. For program sustainability and improved reach within the devolved health provision framework, the program continues to identify, through structured assessment approaches, potential health facilities with capacity to provide NACS/FBP services beyond CCC service points. In view of this, the program has identified and begun direct delivery to 548 facilities primarily providing services through CCC and MCH. 4.2 Electronic Nutrition Reporting In efforts to increase coverage, streamline reporting and enhance data quality and use at county level, the program currently supports EMR reporting in 137 high volume health facilities. During the quarter, 109 of these facilities submitted nutrition service data reports to the program. Reporting delays, HCW re-deployment and in-county transfers of trained personnel were cited as factors preventing optimal reporting. During the quarter, the program supported scale up to EMR for an additional twelve high volume facilities from five counties through donation of laptops and customized nutrition EMR reporting software. These were, Kyuso Sub District Hospital and Migwani Sub District Hospital from Mwingi, Yatta Health Centre from Machakos, Mutitu Sub District Hospital and Kasaala Health Centre from Kitui, Maralal Referral Hospital, Baragoi Sub County Hospital and Wamba Health Centre from Samburu, Alupe Sub County Hospital, Amukura Health Centre, Sio Port Sub County Hospital and Lukolis Model Health Centre from Busia county. Re-sensitization due to staff re- deployment and diminished capacity was conducted for four facilities namely Busia CRH, Rabuor SCRH, Teso SCRH and Bumala HC. In total 44 HCWs were sensitized on use of the electronic system for reporting. These comprised of 1 Nurse, 5 HRIOs, 34 Nutritionists, 2 SCNCs, 1 Data Assistant and 1 Doctor. To allow for improved efficiency in management and technical support, the program sought to develop a web based version of the current nutrition reporting system. All functionality and basic modular design was retained to shorten learning curve related to adoption of the web system. The system can be deployed across both LAN and WAN architectures. The program is in the process of finalizing pilot testing of a web based reporting system at AMPATH and Leatoto. 4.3 Nutrition portal As one of the key Platforms for Information Sharing across the nutrition fraternity, the program continued to work with MOH-NDU to review and upload information received from various section heads. In the subsequent quarters, the program will sensitize the NDU-M&E personnel to be able to support information management and requests from users. The program will however continue to provide TA in the portals development. 27 FY 17 Q2 Jan – March Quarterly Report
III. ACTIVITY PROGRESS – QUANTITATIVE IMPACT Nutrition and Health Program plus PMP provides for specific indicators and their targets for which progress by the end of Quarter 2 (January-March 2017) is summarized below. Detailed performance monitoring data is presented in Annex 1. Number of health facilities with established capacity to manage acute under nutrition: The FY17 target for this indicator is 90 health facilities. Cumulatively, the program identified a total of 72 health facilities with capacity to manage acute malnutrition during the 2015/2016 reporting period. Additional facilities will subsequently be identified using the MIYCN assessment tool. Number of people trained in child health and nutrition through USG-supported programs: To ensure sustainability and continuity of care, the program plans to support training in child health and nutrition for at least 250 health care professionals during the 2016/2017 FY. During the quarter, the program conducted BFCI and IFAs training in Busia, Kitui and Tharaka for a total of 318 HCWs. Of these, 209 were female and 109 males. Cumulatively for the FY, the program has supported training for 353 HCWs. Number of children under five years reached by USG supported nutrition programs: The program envisages to reach a target of 114,521. The proposed targets will be consolidated from successes from: 1) Behavior change communication interventions that promote essential infant and young child feeding behaviors including Immediate, exclusive and continued breastfeeding, Appropriate, adequate and safe complementary foods from 6 to 24 months of age; 2) Vitamin A supplementation in the past 6 months 3) Zinc supplementation during episodes of diarrhea 4) Multiple Micronutrient Powder (MNP) supplementation 5) Treatment of severe acute malnutrition 6) Treatment of moderate acute malnutrition 7) Direct food assistance (DFA) of fortified/specialized food products (i.e. CSB+, Supercereal Plus, RUTF, RUSF, etc). During the quarter, a total of 125,057 (119,059VAS and 5,998 DFA) children under 5 years were reached through technical assistance for Vitamin A supplementation and direct food assistance. Number of children under 5 yrs who received Vitamin A from USG supported programs: During the current financial year, the program is expected to support Vitamin A supplementation for a total of 91,566 children under 5 years. During the November 2016 Malezi Bora activities, the program facilitated Vitamin A supplementation for a total 119,059 under-fives’. The program is in the process of finalizing logistics to support similar activities in the subsequent quarter. Number of children under five who are wasted: Overall, the program seeks to support identification of 3,384 under 5’s who are wasted within the focus counties. During the quarter, the program did not identify wasted children against a quarterly target of 846 due to lack of MCH booklets at the CWC in the counties. The program is facilitating procurement of these tools to enable consolidation of this data. Number of children under five who are underweight: Overall, the program seeks to support identification of 7,408 under 5’s who are underweight within the focus counties. Against the quarterly target of 1,852, the program did not identify any underweight children due to reason indicated above. Percentage of PLHIV who are nutritionally assessed using anthropometric measurement: Cumulatively, the program has supported nutrition assessment for a total of 206,503 clients against a target of 350,000 clients for the financial year. During the quarter, a total of 118,249 out of a target of 62,285 clients were nutritionally assessed using anthropometric measurements. Digitization will be completed for manually tallied records within the current financial year, once recruitment of suitable candidates is completed. Proportion of clinically undernourished PLHIV who received therapeutic or supplementary food: Cumulatively, has provided nutrition commodity support to a total of 48,862 malnourished adults, pregnant-post natal and child clients against an annual target of 28 FY 17 Q2 Jan – March Quarterly Report
109,874 for the financial year. During the quarter, a total of 24,773 out of a target of 27,971 clients were nutritionally assessed and received commodity support. Digitization will be completed for manually tallied records within the current financial year, once recruitment of suitable candidates is completed. Feedback on data quality concerns will also be shared with facility in charges, nutrition contact persons and respective CNC's for follow up. Number of pregnant women reached with nutrition-specific interventions through USG- supported programs (RAA): The program to support nutrition specific interventions for a total of 46,751 pregnant and post-partum women. Specifically, 1) Iron and folic acid supplementation 2) Counseling on maternal and/or child nutrition 3) Direct food assistance of fortified/specialized food products (i.e. CSB+, Super cereal Plus, RUTF, RUSF). During the quarter, the program supported commodity support to 189 PPP clients. Number of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance at national level: The program will continue to support MOH led multidisciplinary coordination meetings during this financial year as per required target. During the quarter the program supported four (4) coordination mechanisms namely, the MIYCN – TWG, SUN TWG, Ag-Nutrition TWG and quarterly Nutrition Interagency Coordination Committee meeting. Number of beneficiaries Trained, Mentored, provided TA at National Level: County Director of Health Kitui, Dr. David Silu and the Deputy County Nutrition Coordinator Lucy Wanyaga Njau completed the received a certificate for the Senior Management Course at the Kenya school of Government. County officials trained who demonstrate increased knowledge in training as result of USG support: The program in Tharaka Nithi county facilitated training of thirty-seven (37) key county staff on Community Managed Disaster Risk Reduction (CMDRR) as part of disaster preparedness process in the wake of climate change. These included 4 Assistant County Commissioners, 6 Agriculture Officers, 6 NDMA Field Officers, 4 Chiefs, 5 Assistant Chiefs, 3 County Ward Administrators and 9 Health Officers. Number of tools/templates/models provided by target institutions in order to facilitate devolution at the local level as a result of USG assistance: The program supported printing of 450 copies of Agri-nutrition tool kit and 450 copies of Community Health Volunteers (CHVs) module 8 for community implementation of the agri-nutrition package by FEWs in MOALF, MOH and MOE. Number of Household Food Production Facilitators Manuals contextualized to FtF regions reviewed/developed and distributed: The program is facilitating MOALF to review the existing National Agri-Nutrition manual. A technical team of 11 drawn from MOALF, MOH, MOE, Kenyatta University, KIWASH, AVCD, K-RAPID, KAVES, FAO and WFP were intensively involved in developing the technical content of the revised draft manual through identifying gaps in the existing document and plugging them in. The manual undergo further revisions before being subjected to a larger multi-sectoral stakeholder validation forum during the following quarter. Facilitator manual, participants guide and job aids will be derived from the document. Number of county/sub county TOTs trained on Agri Nutrition including agri-business: The program trained 151 sub-county and ward level frontline ToTs on Multi-Sectoral Agri- Nutrition training from the MOALF, MOH and MOE who would directly pass the key messages to the agri-nutrition groups at the community level. The contextualized package contains food and nutrition security mitigation strategies specific to wards. The outcome is improving access to quality and diverse foods as well as improving overall food and nutrition security and resilience building. 29 FY 17 Q2 Jan – March Quarterly Report
Number of HH visits conducted disaggregated by group and ward/county: Mapping and mobilization of community groups ongoing. Currently, 101 community groups (Busia 60, Kitui 14, Marsabit 7, Samburu 14, Tharaka Nithi 6) have been formed comprising of 1,359 members. Percentage of female direct beneficiaries of USG nutrition-sensitive agriculture activities consuming a diet of minimum diversity (RAA). Based on SMART survey results percentage of women beneficiaries linked to nutrition-sensitive agriculture consuming a diet of minimum diversity are Busia 44.3%, Marsabit 37.6%, Samburu 24.7%, Tharaka Nithi 63.6%. Kitui data did not capture this indicator. EG.11-6: Number of people using climate information or implementing risk reducing actions to improve resilience to climate change as supported by USG assistance. 37 key stakeholders in Tharaka Nithi county have been trained. Except for the Sub-county commissioners 33 trainees will cascade information to the community for implementation of actions. Number of communities supported to conduct participatory disaster risk reduction assessments: Key staff representatives from 5 different communities (Sub-locations) in Tharaka Nithi county trained on Community Managed Disaster Risk Reduction (CMDRR) as part of disaster preparedness process in the wake of climate change. Number of households screened at least twice during the year: In Marsabit county 2,701 households were screened during the period where SAM referrals were 104 and MAM 439. In Samburu county 2,318 children U5 and 420 PLW were screened where 134 and 110 cases were referred respectively. Number of community members trained on income generating activities at community level: 30 community members were trained on financial inclusion and income generating activities. Number of FtF partners, APHIAs and other partners provided with technical support to develop effective strategies and approaches on improving food utilization and dietary diversity: The program is on course in promoting and improving food utilization and dietary diversity for target communities. So far through agri-nutrition training for frontline ToTs, the program has provided technical support to 151 ToTs in 3 counties of Marsabit, Samburu and Kitui drawn mainly from MOALF, MOA, MOE and community resource persons. The training involved intensive exposition to the entire agri-nutrition package for food production, income generation and women/community economic empowerment with specially contextualized strategies. The FEWs will then deliver the contextualized packages to community level use groups as delivery platforms. Number of FtF partners provided technical assistance to adopt existing agri-nutrition tools to include HH production and consumption of nutritious foods. The program has been providing technical assistance to FtF partners through training to adopt existing agri-nutrition tools through the multi-sectoral nutrition strategy. Four (4) partners who received exposure of the tool during review of the National Agri-nutrition Resource manual include AVCD, K-RAPID, KIWASH and KAVES. AVCD were provided with actual training materials in Marsabit county. The package focused more to food production, income generation and women/community economic empowerment at community level. At household level the package included nutritious food production and preparation technologies for enhanced consumption and dietary diversity. Number of poor small scale farmers identified through value chain analysis in the 5 focus FtF counties. The program negotiation with FAO is at an advanced stage to conduct training for key FtF on Value Chain analysis. This would provide a comprehensive package that key partners will use for identifying small scale farmers based on value chain analysis hence programming for appropriate support. Previously using SMART surveys results 610 out 4,592 sampled families/households were identified as food poor since they fell in the category of moderate or severe hunger or at borderline and poor food consumption score.
30 FY 17 Q2 Jan – March Quarterly Report
Table 12: Summary Results to Date 2016-2017 IR Indicator Achievement Target Q1 Q2 IR1: Improved Access and Demand for Quality Nutrition Intervention at Community and Facility Levels IR1.1: Strengthened Leadership, Advocacy and Policy Planning # of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance (e.g. forum, 1.1.1 working group, MOU, shared plans, associations, budgeting work planning, projects) Note that it is important to 10 5 4 identify best practices as they emerge. C4.0 Development of budget lines for nutrition in county work plan 5 - 2 1.1.2 # of people trained. Mentored, provided TA at National Level. 3 0 2 HL9-4 Number of individuals receiving nutrition-related professional training through USG-supported programs (RAA) 368 - 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; 1.1.3 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) 90 72 - C5.0 Comprehensive NACS implemented at health facilities (beyond CCC/ART sites) 300 118 118 (DO 2; 2.2.1; (2)) % of facilities submitting timely, complete and accurate information - 1.2.3 92.0% 85.3% 88.1% ( These are among 3.1.9.2(2) Number of health facilities with established capacity to manage acute undernutrition (S)) 1.2.4 (3.1.9(1) Number of people trained in child health and nutrition through USG-supported programs) 250 35 285 1.2.5 Percentage of PLHIV who are nutritionally assessed via anthropometric measurement (FN_ASSESS) 350,000 88,254 118,249 1.2.6 Proportion of clinically undernourished PLHIV who received therapeutic or supplementary food(FN_THER) 109,874 24,089 24,773 HL.9-1 Number of children under five (0-59 months) reached with nutrition specific interventions by USG-supported HL.9-1 114,521 119,059 125,057 nutrition programs
31 FY 17 Q2 Jan – March Quarterly Report
1.2.7 3.1.9.2(3): Number of children under 5 who received Vitamin A from USG supported programs 91,566 119,059 -
Number of children under 2 (0-23 months) reached with community level nutrition interventions through USG- HL9-2 31,000 - - supported programs (RAA) HL9-3 Number of pregnant women reached with nutrition-specific interventions through USG-supported programs (RAA) 46,751 - 189 Custom Custom: Number of children under five who are wasted (WHZ) 3,384 - - 1.2.8 Custom Custom: Number of children under five who are Underweight (WAZ) 7,408 - - 1.2.9 IR1.3: Improved Nutrition Related Behavior Number of standardized SBC nutrition materials distributed (and revised if necessary) to community health and C6.0 2 - - agricultural extension workers supported by USAID IP’s IR1.4: Increased Opportunities for Learning and Sharing of Best Practices in Nutrition 1.4.3 % of county officials trained who demonstrate increased knowledge in training as result of USG support 1 - - IR1.5: Increased Knowledge and Skills of Health Care Workers (HCW) in Nutrition IR2: Strengthened Nutrition Commodity Management IR2.1: Improved Production, Supply and Distribution of Nutrition Commodities SC_STOCK : The percentage of storage sites where commodities are stored according to plan, by level in supply 2.1.3 700 524 548 system. C8.0 Diversification and capacity building of nutrition commodity producers. - - - NHPplus # of Nutrition commodities procured by type (FBF) 1,850 1,044 549 NHPplus # of Nutrition commodities distributed to active health facilities points by type (FBF) 1,850 804.27 244 C9.0 % of nutrition commodity distribution (procured by NHPplus) managed by KEMSA >90% NA NA C2.0 # of active health facilities reporting stock outs for FBF and RUTF in the preceding six months) <20% <20% <20% IR2.2: Improved Quality and Safety of Food Commodities and Agricultural Products 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: 2.2.1 Stage 1: Analyzed; - - - Stage 2: Drafted and presented for public/stakeholder consultation; Stage 3: Presented for legislation/decree;
32 FY 17 Q2 Jan – March Quarterly Report
Stage 4: Passed/approved; Stage 5: Passed for which full and effective implementation 4.5.2 [42] number of private enterprises producer organizations, water user’s associations, women’s groups, trade and 2.2.2 business associations and community based organizations [C0Bs] that applied improved technologies or management 2 2 - practices as a result of USG assistance [RiA] [WOG] page number 52. 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 IR3: Improved Food and Nutrition Security IR3.1: Increased Market Access and Consumption of Diverse and Quality Foods # 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 diversity in 3.1.1 300 0 0 community settings, Food preparation and safety, Ag practices that assist in responding to identified environmental threats; Food recipe manuals reviewed/developed 3.1.1.1 # of partners within the 5 focus counties trained on SCALE+ 30 0 0 3.1.1.2 # of FBF value chain players (processors, aggregators, farmers) from 5 focus counties trained on SCALE+ 30 0 0 3.1.2 # of county/sub-county TOTs trained on agri Nutrition including agri-business 64 182 151 3.1.3 # of CHVs/FEWs/ECDEs trained on agri nutrition at community level 2,200 618 151 3.1.4 # of mothers and child care givers trained on agri-nutrition dietary diversity household activities at community level 31,000 1088 0
3.1.5 # of hearth sessions (cooking demos) conducted disaggregated by ward/county and gender 3,100 0 0 3.1.6 # of demonstration gardens established within the 5 focus counties 230 3 0 3.1.7 # of HH visits conducted disaggregated by group and ward/county 31,000 0 0 Collaborations across MNCH, HIV/AIDS and FtF partners and government partners utilizing SCALE methodology C7.0 3 NA NA for advocacy and planning C3.0 Effective linkages with service delivery providers: 2 2 NA C10.0 Technical assistance to FtF partners to expand number of poor small scale farmers through value chain analysis 40% 80% 82%
# of standardized SBC materials distributed (and revised if necessary) to community health and agricultural extension C6.0 2 2 0 workers supported by USAID IPs. Technical assistance to support FtF partners to adapt existing agri nutrition tools to include HH production and C11.0 40% 80% 4 consumption of nutritious food
33 FY 17 Q2 Jan – March Quarterly Report
IR3.2 Increase resilience of vulnerable households and communities Busia 44.3%, Marsabit E.G.3.3- Percentage of female direct beneficiaries of USG nutrition-sensitive agriculture activities consuming a diet of minimum 37.6%, 50% - 10 diversity (RAA) Samburu 24.7%, Tharaka Nithi 63.6% EG.11-6: Number of people using climate information or implementing risk reducing actions to improve resilience to 3.2.9 1,400 461 0 climate change as supported by USG assistance # of tools/templates/models provided by target institutions in order to facilitate devolution at the local level as a result 3.2.11 4,500 425 415 of USG assistance # of 5 member teams consisting of 1 CHEW, 1 Home Econ, 1 Extension services, 1 ECDE trained on Agri Nutrition 3.2.3 2,200 0 80 including agri-business 3.2.4 # of communities supported to conduct participatory disaster risk reduction assessments 75 0 11 3.2.5 # of households screened at least twice during the year 1,500 677 2,701 3.2.6 # of community members trained on income generating activities at community level 31,000 51 111
34 FY 17 Q2 Jan – March Quarterly Report
IV. PROGRESS ON ENVIRONMENTAL MITIGATION AND MONITORING ENP installed additional storage containers specifically to allow isolation and storage of any suspect grain especially regarding potential pest infestation. In addition, ENP together with their contracted pest control service provider, reviewed processes that will ensure better preventive approaches on pest control issues with a view to reducing the need for use of pesticides in stored grain. This followed recommendations done after the Environment Monitoring Audit in the previous quarter. V. PROGRESS ON LINKS TO OTHER USAID PROGRAMS During the reporting period, the program conducted various activities on collaboration with other USAID programs and implementing partner at both county and national levels. In Marsabit county the program: • Coordinated development of joint activity work plan for Samburu County and Turkana County. • Trained 6 CHVs and 1 accountant attached to KIBA CBO which is supported by APHIAplus IMARISHA. • Supported AVCD program with the agri-nutrition training materials when they planned for the similar activities at the community level. • AVCD utilized the frontline extension workers trained by the NHP plus in Moyale sub- counties and this has prevented duplication of efforts hence encouraging passing of similar extension messaging • Following the joint work planning workshop, PREG partners now have a joint work plan which has created proper understanding of all the USAID supported activities within the county. In Kitui county NHPplus joined hands with APHIAplus in preparing for Site Improvement Monitoring system (SIMS) at Muthale Mission hospital who scored 95% on HIV services. NACS services at the facility are well integrated. In Samburu county, the program organized an exchange visit with APHIAplus Imarisha borehole and demonstration garden project at Archers Post benefitting 40 orphans through 32 women OVC care givers from the community. NHPplus in Busia engaged AVCD/CIP in the process of supporting NHPplus dietary diversity gardens with OFSP vines/planting materials At the national level the program: • Involved KIWASH, AVCD, KAVES, K-RAPID in the draft development of the revised National Agri-Nutrition Resource manual • Continued coordination of the FtF Nutrition partners Agri-Nutrition Technical Working Group V. PROGRESS ON LINKS TO OTHER GOK AGENCIES NHPplus continued to collaborate with government sectors at the County and National level. Towards this end the program at the county level; • Worked with NDMA in coordinating drought response activities in Samburu county. • Trained CHVs/CHEWs/PHOs and ECDE staff on Agri-nutrition using ToTs from MOA, MOE and MOH in Kitui, Samburu and Marsabit counties • Working with Department of Livestock and Fisheries development in Moyale sub-county towards establishing a dietary diversity demonstration garden within the REGAL-AG funded livestock market.
At the national level, NHPplus: • Participated in the EDE – Human Capital working group meeting chaired by NDMA and MOEST 35 FY 17 Q2 Jan – March Quarterly Report
• Supported MOALF in development of the draft revised National Agri-Nutrition Resource manual • Engaged MOALF, MOH, MOE and Kenyatta University in development of the draft revised National Agri-Nutrition Resource manual
VI. SUBSEQUENTQUARTER’S WORKPLAN
Table 12 shows the status of activities planned for the reporting period and explanations for observed deviations. Most of the planned activities were accomplished. The pending activities have been scheduled for implementation in the subsequent quarter.
Table 12: Status of Activities Planned for January – March 2017 Planned Activities from Previous Actual Status Explanations Quarter this Quarter IR1: Improved Access and Demand for Quality Nutrition Intervention at Community and Facility Levels Busia IFAS Training Done FY16 – Q4 activity Program based budgeting Done Finalized in Q4 Profiling of Community Groups in Samia Done Household mapping to follow and Matayos Sub – Counties Establishment of mother to mother In progress This is on-going and is partially support groups in community units linked accomplished. to the two BFCI facilities Kitui Establish and profile Mother-to-Mother On Going Focused on one ward Support Groups across 3 Wards ZOI. Support a CHMT meeting to disseminate Postponed to Q3 Competing county activities SMART survey results On the Job training and support done supervision Marsabit Marsabit County PREG monthly meeting Done Emergency response activities Done North Horr NACS site joint supervision/Assessments Done Group Profiling in North Horr and On going Laisamis sub-counties Samburu County stakeholders group meeting – done Supported 2 meetings Emergency response Support MUAC screening of households in Done critical wards Profiling of mother support groups done 9 identified Tharaka Nithi Orientation of C/SHMTs on BFCI and done HINI Training HCWs on BFCI Done Conduct BFCI Community Baseline Assessment Profiling of community groups On going Support supervision for NACS Not done On-going nurses strike National Support for 3 TWGs Done MIYCN 3 meetings, 2 SUN TWGs BFCI Trainers guide review workshop done
36 FY 17 Q2 Jan – March Quarterly Report
Planned Activities from Previous Actual Status Explanations Quarter this Quarter Workplace Support Guidelines for In progress Review workshop planned for Q3 Breastfeeding CEC Meeting Not done Guidance from USAID IR 2: Strengthened Nutrition Commodity Management
Conduct Site supervision visits - DQA Focus counties – Other Counties – on-going Done Participate and contribute to development On-going Competing priorities by MOH staff of procurement plan for Nutrition Sector (drought management and coordination); Staff re-deployment within MOH and UNICEF hence the report has not been finalized Roll-out of Electronic CDRR to additional On-going nutrition service points Contribute to the Monthly NHPplus Supply Done Chain Information workbook for NDU/NASCOP Conduct Supplier Quality Audit (SQA) On-going - Consultant identified - Audit to be done in the coming quarter Post Batch sampling and testing of On-going Sampling done nutrition commodities at health facility level Testing to be completed in the coming quarter Identification of small/medium On-going - Identification of small/medium manufacturing firms within the focus firms done in Tharaka Nithi counties to create linkage with Kenya - Process on going in the other Bureau of Standards (KEBS) through counties training and certification for minimum food safety standards IR3: Improved Food and Nutrition Security County level Establish 8 Mother-to-Mother Support 64 groups Other 21 at formative stages and Groups across 2 Wards in all 5 focus established process on-going counties Training of CHVs, FEWs, frontline 160 staff trained Tharaka Nithi and Busia yet to train implementers of agri-nutrition package in in three focus including diversity gardens counties Community Managed Disaster Risk 37 staff trained Training done for supervisory staff Reduction exposition training at ward level in Tharaka Nithi first County Meeting to disseminate SMART Done Done for Kitui and Tharaka Nithi Survey findings counties Establishment of the Demonstration Not done The Market Livestock Committee garden at Moyale livestock Market disbanded hence process started with new one Supporting Meeting expenses for PREG Done Done for Marsabit county monthly meeting Community implementation of agri- Done On-going for Kitui, Samburu and nutrition package Marsabit counties Conduct KAP/PROPAN study for Not done Postponed to Quarter 3 due to Tharaka-Nithi and Kitui Counties competing activities National level Facilitate MOALF to review the National Done Activity on course. Content Agri-Nutrition Manual validation has been done. 37 FY 17 Q2 Jan – March Quarterly Report
Planned Activities from Previous Actual Status Explanations Quarter this Quarter Support USG partners meeting Not done Scheduled for September
Key Activities in the coming quarter In addition to the on-going activities highlighted in Table 12, the following activities will be conducted in the coming quarter;
IR1: Improved Access and Demand for Quality Nutrition Intervention at Community and Facility Levels National level • Net Code Monitoring Training • Cost of Hunger Study – core team meeting • Workplace Support Guidelines for Breastfeeding • Establishment of community of practice for BFCI • Development of National research agenda • BFCI Training for USG Implementing partners
Focus Counties Busia • Conduct training on MUAC screening for Community Health Volunteers • Training on IFAS for Health care workers • NACS site joint supervision/Assessments • Support Dialogue and action days for Godoma Community Unit • Group Profiling in North Horr and Laisamis sub-counties Samburu • HINI gap Assessment with Afya Timiza focus Facility-Loosuk Health Centre • Support Dialogue and Action days in Lpashie and Ngilai in Samburu East. • Conduct MUAC screening of households in Nachola CU, Kisima CU and Lpashie CU • Sensitization of ECD teachers on Importance of Vitamin A Supplementation, deworming and MNCH services in Samburu East and Central. • Conduct BFCI training for Samburu County • Support vitamin A and Deworming of under 5 years • Support Multi-sectoral CNTF meetings expenses Tharaka Nithi • Support the County Steering Group (CSG) Meeting for the dissemination of SMART Survey findings at the County level • Support the County/Sub-County Health Management Team (C/SCHMT) Members Bench Marking Field Visit to Homabay County • Conduct BFCI Community Baseline Assessment • Conduct BFCI Service Providers Training for Health Workers from Kibugua Health Centre, Kibunga Health Centre and Muthambi Health Centre
IR 2: Strengthened Nutrition Commodity Management • Initiate Procurement of FBF and RUTF for the period January 2018 to December 2019 • Provide TA, Logistics assistance and participate in the National Quantification of Nutrition Commodities activity for FY17/18 and FY 18/19 spearheaded by Nutrition and Dietetics unit.
38 FY 17 Q2 Jan – March Quarterly Report
IR3: Improved Food and Nutrition Security National level • Technical Team Review of the Agri-nutrition Resource manual content • Validation workshop for the Agri-nutrition Resource manual workshop • Finalization of the manual by the technical team and the editorial committee • Ratification of the manual by the Ministerial Publication Committee • Development of facilitators manual, participants guide and appropriate job aids • Pre-testing of manual in counties • Launch of the Manual • FtF partners workshop on value chain analysis and farmer linkages
Focus Counties • Establishment and Profiling of Community Groups in all 5 focus counties • Establishment of dietary diversity demonstration gardens in the community groups • Agri-nutrition implementation at community level • Cooking Demos during Malezi Bora in all 5 focus counties • Meeting sorghum and peanuts common interest farmer groups • Conduct agri - nutrition activities with community groups • Conduct training on MUAC screening of households for bi-directional referral system • Conduct Disaster Risk Reduction Training at community level • Conduct SCALE+ Training at county level • Conduct Propan studies in focus counties • Conduct Agri-Nutrition Trainings for FEWs, CHEWs, DICECEs, Community Resource Persons in Tharaka Nithi and Busia • Support meeting expenses for Samburu PREG partners • Support a CHMT meetings in counties to disseminate SMART survey results • Formation of Agri Nutrition Technical forum at the Sub county level • Dissemination of the contextualized Agri-Nutrition package to 150 community groups • Conduct training on financial inclusion/Income generating activities at community level • Follow up on establishment of Moyale livestock market dietary diversity demo garden.
VII. PROJECT ADMINISTRATION Personnel: The positions of the Chief of Party and the Field Technical officer for Busia focus county were filled during the quarter. The positions filled were a replacement of previous officer holders who had exited the program. During the quarter, the administrative officer for the program resigned. The program has initiated recruitment but changing the position to program assistant to be in line with the project needs and anticipates filling the position during the next quarter.
Busia Office: The lease agreement for the Busia county office is currently being reviewed and the program anticipates that this will be finalized in the next quarter. Plans are also underway to re-deploy a driver to the county and operationalize the office. 39 FY 17 Q2 Jan – March Quarterly Report
Table 16: Performance Targets Under the Fixed Fee Schedule
40 FY 17 Q2 Jan – March Quarterly Report
Indicator Baseline Performance target MOV Status 1 Reduction of the cost of FBF 2% Reduction for each Program budget Analysis completed. production of =$1070 type & Reports Submission to the client for commodities RUTF determination due in =$4027 Quarter 3, 2017. 2 No stock-outs for 6 Varies Stock outs in ordering Facility Target achieved in Quarter consecutive months between (central) sites <20% of all commodity 4 2016. Submission to the 80-100% commodities associated reports & client for determination due with production gaps tracking report in Quarter 3, 2017. 3 Effective linkages with 0 Number of linkages with Joint Work Plan Achieved during year 2 and service delivery National & County IPs development/i year 3 workplans. providers (APHIA+ & FtF) mplementation Submission for determination due in Quarter 3, 2017 4 Development of budget 0 Five priority Counties County budget Budget process for two lines for nutrition in include nutrition in their review focus counties is county workplans budgets completed.
5 Comprehensive NACS 400 400 facilities with Facility Visit Expansion of NACS implemented at health MNCH/CW units and reports delivery expanded to 118 facilities (beyond implementing NACS MNCH/CW sites. CCC/ART sites) 6 Number of standardized 0 8 SBCC Tools Materials Four Tools distributed SBC nutrition materials distributed - MIYCN, printed and (MIYCN Policy, distributed (and revised WASH IEC, distributed NACS/FBP, Vitamin A, if necessary) to NACS/FBP, HH Food IFAS) community health and production manual, agricultural extension Nutritious Food Recipe workers supported by booklet, Vit A, IFAS) USAID IPs 7 Collaboration across 0 5 counties using SCALE SCALE training Initial TOT training MNCH, HIV/AIDS & methodology to facilitate & TA reports completed. County FtF partners & GOK collaboration to ensure participants training due Q3 partners using SCALE nutrition services across & 4, 2017. methodology for multiple sectors advocacy and planning 8 Diversification & 1 3 manufactures achieving Producer Two FBF manufacturing capacity building of higher level of certification plants are ISO certified; 1 nutrition commodities certification than from KEBS and RUTF/ RUSF producers currently obtained from ISO manufacturing plant is ISO national and international certified. Modification of bodies the indicator is requested. 9 % of nutrition 0% 90% of commodities Commodity 100% of commodities commodities produced by NHPplus reports produced by NHPplus are distribution (produced distributed distributed by alternate by NHPplus) managed distribution services by KEMSA providers approved by USAID. Submission to the client for determination due in Quarter 3, 2017
41 FY 17 Q2 Jan – March Quarterly Report
10 Technical assistance 0 100% of FtF partners Training and Preliminary activities in provided to FtF partners trained and provided TA TA reports progress. Modification of to expand number of on inclusion of poor the indicator is requested. poor small scale farmers farmers in value chain through value chain tool analysis 11 TA support to FtF 0 100% FtF partners Training TA Ag-Nutrition manual partners to adapt trained and provided TA reports review drafting completed. existing agriculture tool on tool Development of Trainers to include HH guide underway. production & consumption of nutritious foods
VIII. PROJECT ADMINISTRATION Personnel: The positions of the Chief of Party and the Field Technical officer for Busia focus county were filled during the quarter. The positions filled were a replacement of previous officer holders who had exited the program. During the quarter, the administrative officer for the program resigned. The program has initiated recruitment but changing the position to program assistant to be in line with the project needs and anticipates filling the position during the next quarter. Busia Office: The lease agreement for the Busia county office is currently being reviewed and the program anticipates that this will be finalized in the next quarter. Plans are also underway to re-deploy a driver to the county and operationalize the office. VIII.1 Constraints Personnel: The focus counties do not have adequate staffing. The positions of the Office Assistants, Driver, Procurement Officer, Data Assistants, Logistics Officer, Program Assistant, Contract/Procurement Officer and Agri-Nutrition Technical Officer are yet to be filled. The program has initiated recruitment process and anticipates finalizing the same in the next quarter. Program Vehicles: The program has worked very closely with vehicle repairs and maintenance service providers to ensure a shorter turnaround time of the vehicle services. However, there have been cases of recurrent breakdowns since the vehicles are old and operate in harsh terrains. These frequent breakages have sometimes slowed down activity implementation in the field offices. To be able to operate optimally, the program requires at least two new 4-wheel vehicles. The project is in the process of informing USAID the need to secure two vehicles to overcome this challenge.
42 FY 17 Q2 Jan – March Quarterly Report
ANNEXES: PERFORMANCE DATA TABLES
Annex 1: Summary of commodities distributed
INDICATOR TITLE: Amount of Commodities Distributed INDICATOR NUMBER: SC_STOCK UNIT: DISAGGREGATE BY: COUNTY Geographic Location Activity Title Date M All counties except Mandera Reporting Results:
Additional Criteria Results Achieved Reporting Period Reporting Period Reporting Period Reporting Period If other criteria are important, Baseline FY 2017 Target add lines for setting targets (December Prior 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 and tracking 2014) Periods Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved County % N N N N N N N N N N N N Baringo 2.2% 1,506 452 575 302 575 150 575 575 2,301 452 Bomet 1.1% 769 442 294 442 294 - 294 294 1,175 442 Bungoma 1.2% 821 1,508 314 1,300 314 208 314 314 1,255 1,508 Busia 0.4% 250 4,290 96 2,930 96 1,360 96 96 383 4,290 Elgeyo Marakwet 0.5% 321 828 123 771 123 57 123 123 490 828 Embu 5.9% 3,999 868 1,527 868 1,527 - 1,527 1,527 6,110 868 Garissa 1.0% 691 71 264 71 264 - 264 264 1,056 71 Homa Bay 6.4% 4,279 4,684 1,634 3,235 1,634 1,449 1,634 1,634 6,536 4,684 Isiolo 0.7% 484 175 185 125 185 50 185 185 739 175 Kajiado 1.6% 1,054 917 403 817 403 100 403 403 1,610 917 Kakamega 2.5% 1,664 1,896 635 1,515 635 381 635 635 2,541 1,896 Kericho 3.1% 2,084 134 796 134 796 - 796 796 3,183 134 Kiambu 2.8% 1,912 1,488 730 1,180 730 308 730 730 2,921 1,488 Kilifi 1.5% 1,012 378 386 378 386 - 386 386 1,546 378 Kirinyaga 2.2% 1,500 2,229 573 1,774 573 455 573 573 2,291 2,229 Kisii 1.2% 818 522 313 497 313 25 313 313 1,250 522 Kisumu 5.4% 3,629 3,529 1,386 3,169 1,386 360 1,386 1,386 5,543 3,529 Kitui 1.3% 897 1,366 343 671 343 695 343 343 1,370 1,366 Kwale 0.6% 427 485 163 445 163 40 163 163 653 485 Laikipia 0.3% 202 208 77 208 77 - 77 77 309 208
43 FY 17 Q2 Jan – March Quarterly Report
Lamu 1.2% 798 497 305 320 305 177 305 305 1,219 497 Machakos 3.6% 2,416 1,811 923 1,326 923 485 923 923 3,691 1,811 Makueni 0.9% 634 1,298 242 831 242 467 242 242 968 1,298 Mandera 0.0% ------Marsabit 0.7% 463 198 177 96 177 102 177 177 707 198 Meru 2.0% 1,336 1,136 510 953 510 183 510 510 2,042 1,136 Migori 3.7% 2,500 2,612 955 2,232 955 380 955 955 3,820 2,612 Mombasa 7.1% 4,771 804 1,822 484 1,822 320 1,822 1,822 7,289 804 Murang'a 2.8% 1,878 1,116 717 1,111 717 5 717 717 2,870 1,116 Nairobi 8.3% 5,556 3,531 2,122 2,182 2,122 1,349 2,122 2,122 8,487 3,531 Nakuru 2.4% 1,592 1,499 608 1,341 608 158 608 608 2,433 1,499 Nandi 2.4% 1,594 609 609 509 609 100 609 609 2,435 609 Narok 1.0% 689 443 263 385 263 58 263 263 1,053 443 Nyamira 0.0% - 374 - 374 - - - - - 374 Nyandarua 2.4% 1,594 973 609 750 609 223 609 609 2,435 973 Nyeri 2.6% 1,783 745 681 729 681 16 681 681 2,723 745 Samburu 0.7% 481 750 184 550 184 200 184 184 734 750 Siaya 6.5% 4,359 3,844 1,665 2,492 1,665 1,352 1,665 1,665 6,658 3,844 Taita Taveta 1.7% 1,119 265 427 259 427 6 427 427 1,710 265 Tana River 0.1% 53 95 20 95 20 - 20 20 81 95 Tharaka Nithi 2.1% 1,392 535 532 206 532 329 532 532 2,126 535 Trans Nzoia 0.5% 359 1,051 137 729 137 322 137 137 549 1,051 Turkana 3.3% 2,233 3,169 853 2,716 853 453 853 853 3,411 3,169 Uasin Gishu 0.0% - 2,114 - 1,114 - 1,000 - - - 2,114 Vihiga 0.9% 625 1,860 239 1,778 239 82 239 239 955 1,860 Wajir 0.1% 93 58 35 58 35 - 35 35 142 58 West Pokot 0.4% 268 380 102 230 102 150 102 102 409 380 Blank 0.6% 373 - 143 143 - 143 143 570 - Total 67,278 58,237 25,694 44,682 25,694 13,555 25,694 - 25,694 - 102,778 58,237
44 FY 17 Q2 Jan – March Quarterly Report
Annex 2: 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 M ALL Data Management, Reporting Results: Additional Criteria Baseline Results Achieved Reporting Period Reporting Period If other criteria are important, add lines (January Prior Periods FY 2016/17 Target 31/Dec/16 31/Mar/17 for setting targets and tracking 2015) (Oct'15-Mar'16) Target Achieved Target Achieved Target Achieved County % N N N N N N N N Baringo 1.7% 4,904 3,779 709 606 709.46 894 2,838 1,500 Blank 0.4% 1,215 2,813 167 - 167 668 - Bomet 0.9% 2,504 2,828 376 408 375.59 1,306 1,502 1,714 Bondo - 1,780 - - - - - Bungoma 0.9% 2,674 8,553 376 3,964 375.59 4,034 1,502 7,998 Busia 0.3% 815 8,108 125 8,028 125 7,774 501 15,802 Elgeyo Marakwet 0.4% 1,045 1,033 167 222 167 933 668 1,155 Embu 4.6% 13,019 3,757 1,920 879 1,920 1,946 7,679 2,825 Garissa 0.8% 2,250 4,854 334 329 334 9 1,335 338 Homa Bay 4.9% 13,928 7,645 2,045 15,573 2,045 19,790 8,180 35,363 Isiolo 0.6% 1,575 2,059 250 509 250 207 1,002 716 Kajiado 1.2% 3,431 3,437 501 174 501 594 2,003 768 Kakamega 1.9% 5,415 5,563 793 4,683 793 7,177 3,172 11,860 Kericho 2.4% 6,782 1,839 1,002 - 1,002 1,717 4,006 1,717 Kiambu 2.2% 6,225 5,559 918 6,242 918 2,790 3,672 9,032 Kilifi 1.2% 3,293 2,190 501 61 501 1,518 2,003 1,579 Kirinyaga 1.7% 4,882 7,243 709 1,208 709 603 2,838 1,811 Kisii 0.9% 2,664 3,986 376 217 376 371 1,502 588 Kisumu 4.2% 11,812 7,482 1,753 5,920 1,753 7,384 7,011 13,304 Kitui 1.0% 2,919 1,147 417 1,795 417 570 1,669 2,365 Kwale 0.5% 1,391 647 209 20 209 312 835 332 Laikipia 0.2% 657 2,156 83 - 83 251 334 251
45 FY 17 Q2 Jan – March Quarterly Report
Lamu 0.9% 2,598 2,508 376 6 376 - 1,502 6 Machakos 2.8% 7,865 5,202 1,169 1,382 1,169 2,888 4,674 4,270 Makueni 0.7% 2,062 4,432 292 5,797 292 4,298 1,169 10,095 Mandera 0.0% - 1,434 ------Marsabit 0.6% 1,507 5,105 250 161 250 106 1,002 267 Meru 1.6% 4,350 1,669 668 537 668 503 2,671 1,040 Migori 2.9% 8,139 29,816 1,210 2,216 1,210 1,070 4,841 3,286 Mombasa 5.4% 15,531 9,987 2,254 999 2,254 4,280 9,014 5,279 Murang'a 2.2% 6,115 8,974 918 1,110 918 601 3,672 1,711 Nairobi 6.4% 18,084 44,090 2,671 1,352 2,671 21,345 10,684 22,697 Nakuru 1.8% 5,184 8,088 751 5,738 751 4,307 3,005 10,045 Nandi 1.8% 5,190 8,194 751 1,449 751 3,511 3,005 4,960 Narok 0.8% 2,244 395 334 837 334 856 1,335 1,693 Nyamira 0.0% - 2,092 - 65 - 126 - 191 Nyandarua 1.8% 5,188 1,038 751 707 751 481 3,005 1,188 Nyeri 2.1% 5,803 2,183 876 485 876 994 3,506 1,479 Samburu 0.6% 1,565 1,980 250 769 250 374 1,002 1,143 Siaya 5.0% 14,188 1,912 2,087 926 2,087 1,394 8,347 2,320 Taita Taveta 1.3% 3,643 3,163 543 66 543 27 2,170 93 Tana River 0.1% 172 572 42 3 42 16 167 19 Tharaka Nithi 1.6% 4,530 1,542 668 39 668 295 2,671 334 Trans Nzoia 0.4% 1,169 3,018 167 685 167 519 668 1,204 Turkana 2.6% 7,268 3,535 1,085 3,475 1,085 2,108 4,340 5,583 Uasin Gishu 0.0% - 8,265 - 3,944 - 3,600 - 7,544 Vihiga 0.7% 2,034 2,999 292 4,668 292 4,370 1,169 9,038 Wajir 0.1% 302 - 42 - 42 - 167 - West Pokot 0.3% 871 1,118 125 - 125 - 501 - Total 100.0% 219,000 251,769 32,301 88,254 32,301 118,249 350,000 206,503
46 FY 17 Q2 Jan – March Quarterly Report
Annex 3: 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 M ALL Data Management, Reporting Results: Additional Criteria Baseline Results Reporting Period If other criteria are important, add (January Achieved Prior Reporting Period 31/Dec/15 FY 2015/16 Target 31/Mar/16 lines for setting targets and tracking 2015) Periods Target Achieved Target Achieved Target Achieved County % N N N N N N N N Baringo 1.7% 1,668 375 468 43 468 97 1,870 140 Blank 0.4% 852 219 110 - 110 440 - Bomet 0.9% 910 486 248 58 248 280 990 338 Bondo 277 ------Bungoma 0.9% 356 1,935 248 595 248 1065 990 1,660 Busia 0.3% 4,429 2,905 83 2,036 83 2076 330 4,112 Elgeyo Marakwet 0.4% 766 187 110 50 110 157 440 207 Embu 4.6% 4,739 1,163 1,265 203 1,265 594 5,060 797 Garissa 0.8% 536 111 220 12 220 9 880 21 Homa Bay 4.9% 1,167 6,584 1,348 4,073 1,348 2602 5,390 6,675 Isiolo 0.6% 1,842 811 165 151 165 66 660 217 Kajiado 1.2% 2,308 462 330 46 330 347 1,320 393 Kakamega 1.9% 2,118 1,353 523 428 523 684 2,090 1,112 Kericho 2.4% 1,120 144 660 - 660 308 2,640 308 Kiambu 2.2% 1,661 4,012 605 2,254 605 1483 2,420 3,737 Kilifi 1.2% 906 214 330 53 330 137 1,320 190 Kirinyaga 1.7% 4,019 2,187 468 757 468 375 1,870 1,132 Kisii 0.9% 993 881 248 173 248 230 990 403 Kisumu 4.2% 473 3,633 1,155 1,087 1,155 1423 4,620 2,510 Kitui 1.0% 224 1,118 275 1,248 275 389 1,100 1,637
47 FY 17 Q2 Jan – March Quarterly Report
Kwale 0.5% 884 324 138 1 138 94 550 95 Laikipia 0.2% 2,676 514 55 - 55 210 220 210 Lamu 0.9% 702 40 248 3 248 0 990 3 Machakos 2.8% 513 2,208 770 613 770 744 3,080 1,357 Makueni 0.7% 1,480 851 193 710 193 529 770 1,239 Mandera 0.0% 2,769 ------Marsabit 0.6% 5,284 427 165 106 165 43 660 149 Meru 1.6% 2,080 791 440 255 440 311 1,760 566 Migori 2.9% 6,153 2,931 798 1,068 798 732 3,190 1,800 Mombasa 5.4% 1,764 1,600 1,485 369 1,485 312 5,940 681 Murang'a 2.2% 1,766 947 605 227 605 332 2,420 559 Nairobi 6.4% 764 9,798 1,760 349 1,760 2166 7,040 2,515 Nakuru 1.8% 1,765 3,447 495 1,673 495 921 1,980 2,594 Nandi 1.8% 1,974 701 495 46 495 242 1,980 288 Narok 0.8% 532 22 220 184 220 131 880 315 Nyamira 0.0% 4,827 154 - 36 - 100 - 136 Nyandarua 1.8% 1,239 1,296 495 498 495 369 1,980 867 Nyeri 2.1% 58 1,864 578 203 578 602 2,310 805 Samburu 0.6% 1,541 604 165 652 165 259 660 911 Siaya 5.0% 398 2,442 1,375 713 1,375 996 5,500 1,709 Taita Taveta 1.3% 2,473 57 358 33 358 20 1,430 53 Tana River 0.1% 692 95 28 2 28 15 110 17 Tharaka Nithi 1.6% 103 1,817 440 19 440 264 1,760 283 Trans Nzoia 0.4% 296 885 110 139 110 380 440 519 Turkana 2.6% - 3,533 715 1,165 715 1155 2,860 2,320 Uasin Gishu 0.0% - 1,970 - 591 - 788 - 1,379 Vihiga 0.7% - 1,265 193 1,167 193 736 770 1,903 Wajir 0.1% - 5 28 - 28 0 110 - West Pokot 0.3% 413 14 83 - 83 0 330 - Total 100.0% 74,511 48,862 21,285 24,089 21,285 24,773 110,000 48,862
48 FY 17 Q2 Jan – March 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 If other criteria are important, add Reporting Period Reporting Period Reporting Period Reporting Period (December Achieved FY 2016/17 Target lines for setting targets and 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 2014) Prior Periods tracking Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved County % N N N N N N N N N N N N Busia 22.2% - 16,976 8,484 31,265 8,484 16,967 31,265 Kitui 38.9% - 29,778 14,622 47,911 14,622 29,243 47,911 Marsabit 10.1% - 7,745 13,711 12,076 13,711 27,423 12,076 Samburu 12.1% - 9,291 4,426 9,699 4,426 8,851 9,699 Tharaka Nithi 16.6% - 12,734 4,541 18,108 4,541 9,082 18,108 Total - 76,524 45,783 119,059 - - 45,783 - - - 91,566 119,059
No achievements reported during the January-March 2017 quarter. Scheduled activities resume in May to coincide with Malezi Bora.
49 FY 17 Q2 Jan – March Quarterly Report
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 2016/17 Target 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 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 50 205 50 205 Kitui 50 20 50 20 Tharaka Nithi 50 93 50 93 Marsabit 50 50 Samburu 50 50 Total 125 318 125 318
50 FY 17 Q2 Jan – March 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 2016/17 Target 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 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 22.2% - 8,484 31,265 - 2,504 8,484 16,967 33,769 Kitui 38.9% - 14,622 47,911 - 132 14,622 29,243 48,043 Marsabit 10.1% - 13,711 12,076 - 13,711 27,423 12,076 Samburu 12.1% - 4,426 9,699 - 4,426 8,851 9,699 Tharaka Nithi 16.6% - 4,541 18,108 - 27 4,541 9,082 18,135 Total - 45,783 119,059 - 2,663 45,783 - - - 91,566 121,722
January – March 2017 achievements reported only includes under 5 provided with direct food support in form of FBF.
51 FY 17 Q2 Jan – March 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 (December FY 2016/17 Target 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 lines for setting targets and tracking 2014) Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved County % N N N N N N N N N N N Busia 91.2% - 10,663 10,663 409 10,663 10,663 42,652 409 Kitui 0.9% - 111 111 18 111 111 443 18 Marsabit 3.1% - 360 360 4 360 360 1,440 4 Samburu 2.4% - 277 277 277 277 1,108 - Tharaka Nithi 2.4% - 277 277 277 277 1,108 - Total - 11,688 - 11,688 431 11,688 - 11,688 - 46,751 431
January – March 2017 achievements reported only includes PPPs provided with direct food support in form of FBF.
52 FY 17 Q2 Jan – March Quarterly Report
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 If other criteria are important, Achieved Reporting Period Reporting Period Reporting Period Reporting Period (December FY 2016/17 Target add lines for setting targets Prior 31/Dec/16 31/Mar/17 30/Jun/17 30/Sep/17 2014) and 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 3 3 14 19 Kitui 41.0% - 26 7 7 37 26 Marsabit 13.3% - 7 2 2 12 7 Samburu 10.5% - 9 2 2 9 9 Tharaka Nithi 19.6% - 11 4 4 18 11 Total - 72 - - 18 - 18 - 90 72
53 FY 17 Q2 Jan – March Quarterly Report
Annex 9: Quarterly Review Meeting (July – September 2016) Action Points No Action Responsible* Status 1 Front loading nutrition commodities in hot spots prior to the election period in conjunction with IR2 Projections have been done and shared with NASCOP and other relevant government agencies. food manufacturer; Briefing for CNCs/Local IPs and new distributor to be done by end April 2017 2 Update COR on drought status M COR has been updated as necessary 3 Review and realign program activities to respond to the current drought response All Activities were realigned in line with the program mandate. For example, facilitated screening for malnutrition in Marsabit and Samburu counties 4 Ensure that quarterly reports are proof read to ensure consistency with the contract M Implemented internally 5 Share HINI gap assessment with USAID Strategic Information (SI) Team IR1 Report is ready for sharing 6 Share with the COR the final HINI gap assessment report IR1 Report is ready for sharing 7 Append HINI gap assessment final report as annex to the quarterly report IR1 Report is ready and appended 8 Provide a HINI status update for priority health facilities in focus Counties as an annex to quarterly IR1 This will be implemented in subsequent reports quarter 9 Define Criteria for Nutrition Champions IR1 Criteria has been defined and is in circulation for discussion 10 Plan for a meeting between NDU and CECs by March 2017 IR1 Planning was endeavored but the meeting did not happen due to budgetary constraints 11 Expedite finalization of commodity quantification report IR2 Quantification of all nutrition commodities completed. Narrative report in progress. 12 Put in place the coordination structure for implementation of the agri – nutrition manual and IR3/1 Structure for implementation is in place with a involve the Food and Nutrition TWG technical team of 11 working on the revised agri-nutrition manual which has since been validated and now at the final stages of editing. The food and nutrition TWG has updated on the development and detailed implementation plan will be discussed in subsequent quarters 13 Hire the identified FTO for Busia County M FTO has been hired 14 Follow-up and document results of the KSG training of government staff in terms of improved IR1 Certification of the trainees has been received nutrition leadership and program is in the process of doing follow- up on the trainees for feedback
54 FY 17 Q2 Jan – March Quarterly Report
15 Send the PROFILES paperwork to the COR for approval IR1 Activity was planned but postponed for negotiation of costs 16 Ensure that A+ Kamili is participating in Kitui CNTF IR1 This has been effected 17 Consider strengthening community activities in lower level health facility the catchment areas IR1/3 Food and nutrition security as well as strengthening resilience activities at community level are ongoing. 64 community groups have presently been identified/ established in all counties. Dissemination of agri-nutrition and disaster risk reduction packages is under implementation.
BFCI activities has commenced in the counties. 18 Consider visiting A+ Kamili Archer’s post agri-nutrition site in the ASAL IR3 The site was visited by a team led by the agriculture specialist. Follow up for strengthened partnership, layering and replicating the good practice in other relevant counties /places is on course 19 Focus more on outcome level indicators during quarterly reporting and less on activities done/ All Under implementation output level indictors 20 Clearly outline the package of intervention and implementation strategy for MIYCN activities. IR1 This has been outlined 21 Expedite implementation of BFCI activities IR1 BFCI activities have commenced in the focus counties 22 Integrate patient numbers in the commodity distribution graph during presentation IR2 Electronic data from only approx. 100 facilities. All other facility data is tallied manually. Recruitment of DE assistants in progress to complete data backlog. Commodity distribution graph already integrated into the quarterly. Patient numbers to be integrated once data is entered 23 Share a summary on the proportion of patients the program is reaching against the national need 2 Summaries shared. Final report in progress. given the change in ART guidelines 24 Determine the % of ineligible patients receiving support IR2 Pending recruitment of DE assistants 25 Share the quantification report with the COR IR2 National Nutrition commodity quantification summary tables (spreadsheet) shared with COR). Narrative report still in progress.
55 FY 17 Q2 Jan – March Quarterly Report
26 Share with COR list of health facilities with high number of ineligible patients from the DQA IR2 Pending recruitment of DE staff. activities for USAID to follow – up with other IPs 27 Consider linking farmer producer groups supported by FtF partners with the ENP value chain IR 2/3 Discussions initiated with ENP on potential linkages with sorghum farmers in Tharaka Nithi and similar efforts for groundnut and soya bean farmers in Busia 28 Review target groups to include adolescent girls (possible platforms: 4K clubs) IR 3/1 Already reviewed and current group profiling tool capturing age to screen the different age groups captured 29 Have a greater conceptual framework to influence implementation science IR 1/3 OR areas have been identified and conceptual • Embed OR guidance is under development • Provide context – specific technical guidance (What needs to be done? e.g. PD hearth sessions; systemic activities) 30 Follow – up on the mapping of food varieties in the focus Counties IR 3 Done for Tharaka Nithi. For Kitui and Marsabit, this will be extracted from the collaborative survey reports with FAO. Samburu and Busia will source information from other partners 31 Identify the minimum cost effective package of interventions to influence MAD and address IR 3/1 This is being addressed through agri-nutrition quality of foods while the threshold population has been determined from the population in ZOI 32 Share training materials for house helps done in the church set – up M Following up on materials 33 Send letter of request for new vehicles to the COR M This was postponed pending request for budget realignment approval 34 Document the need for increased quantities of commodities due to the drought response for M Quantification done; working out modalities purposes; include effects of on-going strike on program deliverables. of food processor contract modification to accommodate the extra quantities 35 Make a procurement plan to cost all items and include timelines Procurement plan is in place 36 Convene a meeting with Lilian Mutea to discuss involvement in the MIYCN activities at national IR1 Initiated communication level and strengthen involvement in MIYCN TWG 37 Observe all contractual obligations including branding/signage of program offices, vehicles and This has been effected equipment etc. 38 Share with COR the program monthly/quarterly burn rate range Effected 39 Provide status update of pending and completed action points from the previous meeting with CD COP to follow-up the USAID 41 What has NHPplus done to strengthen sustainability? All Establishing linkages with other partners
56 FY 17 Q2 Jan – March Quarterly Report
Capacity building county government staff at grass root level to continuously pass food and nutrition security strategies to the communities through a multi-sectoral approach 42 What should be done to address adolescent nutrition to foster sustained maternal nutrition related IR 1/3 Can encourage county teams to target youth behavior change? groups alongside the rest of the community groups then use them as platforms for passing messages. Alternatively use MOE through the multi-sectoral platform to target Class 7 & 8 and F1 to 4 students. Can also use ROP platforms to pass reproductive health and nutrition knowledge and skills *M=Management
57 FY 17 Q2 Jan – March Quarterly Report