CALL TO ACTION

THE REPUBLIC OF NUTRITION GOVERNANCE CHALLENGES/ GAPS CALL FOR ACTION RESPONSIBLE AREA OFFICE

Coordination and Inadequate capacity to support Mentorship and coaching of the DNCC especially CAO, DNFP DISTRICT LOCAL GOVERNMENT partnerships: collaborations and coordination the DNFP to coordinate multi-sectoral nutrition of multi-sectoral nutrition engagements at district level. ADVOCACY BRIEF ON STRENGTHENING NUTRITION GOVERNANCE FOR MULTI-SECTORAL RESPONSE activities in the district. Systems capacity Building Lack of clarity on nutrition Orientation of nontraditional departments on DNFP, CAO, (functional, institutional sensitive programming for the nutrition sensitive approaches/actions to ensure SAS and Human capacities) nontraditional departments their implementation in the district subcounty, (Community Based Services, division and municipality level. Education, Production) at district, subcounty, division and municipality level. Policy and legal Limited awareness on available Support the wide dissemination of DNFP, CAO, framework policies, guidelines that support sectoral(departmental)policies and guidelines such DEO, DCDO, Multisectoral nutrition action as National Health Policy (NHPII), Health Sector DHO, DPO Development Plan (HSDP II) 2015/16–2019/20, Integrated Early Childhood Development (NIECD) Policy (2016) , Presidential Initiative on healthy eating and healthy lifestyles (July, 2019) National Agriculture Policy (NAP) of 2013 and the Agriculture Sector Strategic Plan (2015/16-2020/20) and Food Systems capacity building (functional, the food and nutrition security situation and to Security Strategy, the Education Sector Strategic Plan (ESSP) (20017-2020) and Guidelines on Parent explore the causal pathways for malnutrition in institutional and Human capacities) led School Feeding and Nutrition (2012),the Social the district. Data from the NCA will be/ is being local government was supported Development Sector Plan (2015/16 - 2019/20),the used to support program implementation. to build the capacity of the coordination National Community Development Policy for Uganda structures at district level and respective lower Koboko was also supported to conduct a Food (2015) and the Water and Environment Sector MOYO local governments to plan, budget, implement, Security and Nutrition Assessments (FSNA). Development Plan (2015/16-2019/20) and the UNAP during joint multisectoral forums with the DNCC and KOBOKO LAMWO and monitor multisectoral nutrition actions. 15 FSNA data was not available previously YUMBE IPs in the district DISTRICT PROFILE staff members of District Nutrition Coordination unavailable therefore this first FSNA data will Committee (DNCC) were trained to develop their be used as a baseline to compare progress District should align the DNAP 2020-25 with the Koboko is one of the Districts in the North Western DNAPs while 150 staff from Six sub counties, in achievement of health, nutrition and WASH Adjumani DDP III Region and was curved from and started POPULATION 239,300 three divisions and one municipality were indicators in subsequent FSNAs. Annual FSNAs Information management Inadequate knowledge on use of Mentorship of all DNCC members on use of OPM, MoLG effective operations in August 2005. Koboko KITGUM supported to develop their SNAPs, DiNAPS and will be conducted to assess annual progress. (monitoring, evaluation, the recently developed nutrition Nutrition governance reporting tools in the SOPs. is situated on the extreme cornerADJUMANI of North Infants Orphans MNAPs respectively. surveillance and research) governance reporting tools. Western part of Uganda as shown on the map of The Koboko DNCC has been trained on nutrition <1 year <18 years Uganda above. It is bordered by the Republic of governance and supported to use reporting Communication (for Inadequate knowledge on the Identifying and use of Nutrition champions for DCDO, DHO, 10,290 19,240 Policy and Legal Framework templates and monitoring tools previously Nutrition behavior change importance of nutrition in the positive behavior change communication. DEO, DPO, in the North, in the and practice) community and application of Administration East, Democratic Republic of Congo in the West and Children The District Nutrition Coordination Committee developed as part of the Standard Operating Support the training on nutrition packages across Women of reproductive nutrition sensitive actions Maracha District in the South. Koboko town is the AMURU under 5 years of Koboko district developed a District Nutrition Procedures for nutrition governance. The different departments such as training of VHTs on ARUA PADERage 15-49 years Administrative and commercial headquarters of the Action Plan (DNAP) aligned to the Uganda reporting templates and monitoring tools are nutrition, training of CDOs, PDCs, FALs on KFCPs, 42,356 District and it is 574 kilometers away from , 48,339 AGAGO Nutrition Action Plan 2. The DNAP was also currently in use by the district for program training of agriculture extension workers on nutrition Uganda’s capital city, only 3kms from DRC boarder Children approved by the District Council. implementation. sensitive agriculture, training of schools on nutrition GULU Pregnant women etc. and 18kms from that of South Sudan. The district below 18 years expected The DNCC, SNCC, DiNCC and MNCC conducts Six sub counties, three divisions and one Advocacy (for planning, Lack of explicit budgets Conducting a budget expenditure analysis to identify CFO has a total land area of 820.8 km2.Koboko District 131,854 monthly monitoring and supervision visits 11,965 municipality developed Subcounty Nutrition budgeting and resource allocated for nutrition actions / available and funding gaps for nutrition actions. comprises of two counties; namely Koboko County Action Plans (SNAPs), Division Nutrition Action and quarterly meetings to assess progress of mobilization) interventions and Koboko North County, 6 Sub-counties, 41 Adolescents Source: Uganda National Plans (DiNAP) and Municipality Nutrition Action program implementation. parishes, 357 villages, one Municipality,NWOYA 3 Divisions, 10-24 years Population and Housing DNCC meetings are separate Continuous engagement with district political and DNFP, CAO ZOMBO Plans (MNAP)respectively aligned to the Koboko 10 wards and 36 cells. The district has two town 83,276 Census 2014 OTUKE Communication for nutrition social behavior from the TPC meetings technical leadership to ensure that nutrition issues District Nutrition Action plan. are included on the agenda of TPC/council meetings. boards namelyNEBBI and Keri Town boards. change and Advocacy DNCC should be incorporated into the TPC. OYAM KOLE Information management (monitoring, 164 FAL groups, PDCs and CDOs were trained evaluation, surveillance and research) on the Key Family Care Practices and are This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of UNICEF Koboko district was supported carry out a supporting communities implement nutrition and do not necessarily reflect the views of the European Union. DEVELOPMENT INITIATIVE sensitive actions. Nutrition Causal Analysis (NCA) to understand FOR NORTHERN UGANDA EUROPEAN UNION NUTRITION GOVERNANCE ACTIVITIES SUPPORTED IN THE DISTRICT NUTRITION, WASH AND HEALTH STATUS OF THE DISTRICT Coordination and Partnerships Stakeholder mapping: Results from the stakeholder mapping conducted in Koboko District Local Government FSNA baseline (2019) Desired situation (2025) showed that the district has 24 stakeholders either overseeing or implementing Nutrition specific and sensitive NUTRITION STATUS FSNA baseline (2019) Desired situation (2025) HEALTH INDICATORS interventions as well as and creating an enabling environment for Nutrition implementation within the Common childhood illnesses in Koboko district include; district. In total, 11 (45.8%) are for Nutrition specific, 10 (41.7%) are in Nutrition sensitive and 1 (4.2%) are for Acute governance interventions. Two (2) stakeholders implement both specific and sensitive interventions. of households of households Respiratory KOBOKO DISTRICT MAP SHOWING DISTRIBUTION OF NUTRITION are food insecure have food stocks Malaria Diarrhea Infections SPECIFIC, NUTRITION SENSITIVE AND GOVERNANCE INTERVENTIONS 58% 40% 34% 4% 1% 8.3% 4.2% Nutrition specific Governance & Sensitive

LOW BIRTH WEIGHT Ludara 10% IMMUNISATION (DPT3) VIT A SUPPLEMENTATION (12-23mo) Kuluba 10% 24 STUNTING 98% 65% STAKEHOLDERS overseeing / implementing 27% ANAEMIA IN WOMEN 70% 80% interventions 20% 20% Midia Kobko TC Abuku <=14 interventions 12% Lobule DEWORMING (12-23 mo) 41.7% 45.8% 15 - 19 interventions Source: Food Security and Nutrition Assessment in 10 Dranya WASTING ANAEMIA IN CHILDREN 58% Nutrition sensitive Nutrition specific >= 20 interventions districts of Northern Uganda and West Nile 2019, Makerere 3% 5% 100% University School of Public Health. INTERVENTIONS TARGET GROUP KOBOKO 4% 25% Scale up coverage of optimal breast feeding practises Pregnant and lactating women, Adolescents Girls (10-19Yrs) Promote infant and young child feeding practices Mothers / caregivers 75% Desired situation (2025) Promote optimal nutrition among pregnant women Children with special needs 0-11 months INFANT AND YOUNG CHILD FEEDING PRACTICES FSNA baseline (2019) Desired situation (2025) NUTRITION GOVERNANCE and lactating mothers Promote appropriate adolescent nutrition Adolescents (Boys & Girls) Min. acceptable diet Min. diet diversity (6-23mo) Min. meal frequency WHAT IS NUTRITION GOVERNANCE AND WHY IS IT IMPORTANT? Scale up & sustain effective coverage of vitamin A Children 0-59 months, postpartum women 100% supplementation to children 6-59 months 27% 27% 13% Good nutrition governance entails making adequate policy decisions in a timely manner, committing the necessary Iron and Folic Acid supplementation to pregnant Pregnant women (15-49) 85% 40% financial and organizational resources to their effective implementation, i.e. ensuring that benefits reach most of the women population, preferably the most vulnerable. It also entails a sustained political commitment to ensure that nutrition Outpatient management of severe acute malnutrition Children 0-59 months, Pregnant women (15-49 ) 30% programs and policies can withstand threats and constraints from changes in district leadership, political and without medical complication Continued breast feeding (2yr) Exclusive breast feeding Breast feeding within first 1 hour socioeconomic upheavals (Solon 2007). Inpatient management of severe acute malnutrition Children 0-59 months, Pregnant women 50% with medical complication 50% 54% 72% NUTRITION GOVERNANCE FRAMEWORK Management of moderate acute malnutrition (MAM) Children 0-59 months 25% 80% 80% 80% Provide deworming tablets to children (1-14yrs) Children 12-59 months 75% PILLARS OF GOVERNANCE Deworming for pregnant women Pregnant women (15-49yrs) 100% Intermittent prevention of malaria (IPT3??) for Pregnant Pregnant women (15-49yrs) 75% FSNA baseline (2019) Desired situation (2025) Intersectoral Cooperation WASH STATUS women Scale up and sustain effective coverage ORS-Zinc for Children 0-59 months 65% Policy Technical diahorrea Frame Capacity Sustainable Funding Nutrition Works Outcomes Scale up and sustain coverage of long lasting Pregnant & Lactating women, Children 75% insecticide treated nets (LLINs) Monitoring

Stakeholders Vertical Partnership Treatment of malaria All 85% Building Frame work Information Financial and Communication Management Coordination Coordination and Policy and legal 75% System Capacity Sustain universal coverage of available routine Children 0-59 months, Pregnant women Resource Mobilization LATRINE COVERAGE SAFE WATER ACCESS Advocacy immunization services Provide comprehensive EMCT services Pregnant & Lactating mothers 15-49years with HIV 75% 94% 81% (Nutrition Behavior Change. Advocacy) Provide ARV medication to HIV +VE All HIV +VE include Pregnant & Lactating mothers 80% 80% 87% Source: Institute of Development studies (IDS), 2013 Source: Nutrition Stakeholder Mapping for Uganda Report. 2019