CALL TO ACTION

THE REPUBLIC OF NUTRITION CHALLENGES/ GAPS CALL FOR ACTION RESPONSIBLE GOVERNANCE AREA OFFICE Coordination and Low engagement of district Conduct regular stakeholder mapping (biannually) DNFP, CAO DISTRICT LOCAL GOVERNMENT partnerships: IPs in multi-sectoral nutrition and orientation of new stakeholders on DNCC and activities. e.g. DNCC meetings multisectoral nutrition implementation ADVOCACY BRIEF ON STRENGTHENING NUTRITION GOVERNANCE FOR MULTI-SECTORAL RESPONSE and joint monitoring of activity Establish joint planning and strategic coordination implementation at district and mechanisms amongst partners with the district subcounty level to reduce on duplication of resources and achieve sustainable results Systems capacity Lack of clarity on nutrition Orientation of nontraditional departments on DNFP, CAO Building (functional, sensitive programming for the nutrition sensitive approaches/actions to ensure their institutional and nontraditional departments implementation in the district Human capacities) (Community Based Services, Educ, Prod, Systems capacity building (functional, be used as a baseline to compare progress institutional and Human capacities) in achievement of health, nutrition and WASH 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, indicators in subsequent FSNAs. Annual FSNAs Adjumani district local government was Multisectoral nutrition action. as National Health Policy (NHPII), Health Sector DHO, DPO will be conducted to assess annual progress. supported to build the capacity of the Development Plan (HSDP II) 2015/16–2019/20, Integrated Early Childhood Development (NIECD) Policy coordination structures at district level and The Adjumani DNCC has been trained on (2016), Presidential Initiative on healthy eating and respective lower local governments to plan, nutrition governance and supported to use healthy lifestyles (July, 2019) National Agriculture Policy budget, implement, and monitor multisectoral reporting templates and monitoring tools (NAP) of 2013 and the Agriculture Sector Strategic nutrition actions. 15 staff District Nutrition previously developed as part of the Standard Plan (2015/16-2020/20) and Food Security Strategy, Coordination Committee (DNCC) were trained Operating Procedures for nutrition governance. the Education Sector Strategic Plan (ESSP) (20017- to develop their DNAPs while 165 staff from The reporting templates and monitoring tools 2020) and Guidelines on Parent led School Feeding and Nutrition (2012),the Social Development Sector are currently in use by the district for program ten sub counties and one town council were Plan (2015/16 - 2019/20), the National Community supported to develop their SNAPs and TNAPs implementation. Development Policy for Uganda (2015) and the Water respectively. The DNCC, SNCC and TNCC conducts monthly and Environment Sector Development Plan (2015/16- 2019/20) and the UNAP during joint multisectoral monitoring and supervision visits and quarterly forums with the DNCC and IPs in the district MOYO Policy development, implementation and meetings to assess progress of program DISTRICT PROFILE District should align the DNAP 2020-25 with the KOBOKO LAMWO legal framework implementation. YUMBE POPULATION 231,623 Adjumani DDP III Adjumani district is in the north-western region of The District Nutrition Coordination Committee of Information Inadequate use of nutrition data Building capacity of nutrition focal persons and nutrition Bio-stat, District Uganda, lying on the eastern bank of the Albert 52.2% 47.8% Adjumani district developed a District Nutrition Financial and resource mobilization management & other monitoring data within programmers to make better use of nutrition data Planner, DNFP Nile, which is its common border with Moyo Female Male Action Plan (DNAP) aligned to the Uganda The DNCC was supported to develop annual (monitoring, the departments. district. It borders the districts of Amuru in the evaluation, KITGUM Nutrition Action Plan 2. The DNAP was also workplans for implementation of multisectoral Inadequate information Creation of regular fora at district level specifically CAO, DNFP surveillance and MARACHA south and east, and Yumbe in theADJUMANI west, and approved by the District Council. nutrition actions. The 2019/2020 annual workplan sharing between all partners for sharing of information/data/results from various Moyo in the North. Adjumani is one of the districts Infants Orphans research) on research, evaluation and surveillance and research work conducted by the <1 year was signed by the Chief Administrative Officer that form Uganda’s common border with the <18 years Ten sub counties and one town council surveillance work carried out district and Ips. developed Subcounty Nutrition Action Plans and and is under implementation. within the district Republic of in the northeast. 9,960 18,622 Town council Nutrition Action Plans respectively The Adjumani District Nutrition Action Plan Advocacy (for Lack of explicit budgets Conducting a budget expenditure analysis to identify CFO, DNFP, The 2014 Population and Housing Census Children Women of reproductive aligned to the Adjumani District Nutrition Action AMURU under 5 years (2020-2025) to support the implementation of planning, budgeting allocated for nutrition actions / available and funding gaps for nutrition actions. DNFP, CAO, establishedARUA the total population of Adjumani PADERage 15-49 years plan. multisectoral nutrition actions was approved by and resource interventions in the district. DEO, DCDO, District at 231,623. The district also has a refugee’s 40,997 mobilization) DHO, DPO 46,788 AGAGO the District Council. DNCC meetings are separate Continuous engagement with district political and population of 209,048 (OPM data, March 2017). from the TPC meetings technical leadership to ensure that nutrition issues are Information management (monitoring, The district is comprised of ten sub-counties ChildrenGULU Ten sub counties and one town council all included on the agenda of TPC/council meetings. DNCC Pregnant women evaluation, surveillance and research) and one town council, a Town Board of Pakele below 18 years had their Nutrition Action plans approved by should be incorporated into the TPC. expected and proposed Town Board of Ciforo pending the 127,624 Adjumani district was supported carry out a their respective councils. Activities from their Communication (for Inadequate knowledge on the Identifying and use of Nutrition champions for positive DCDO, DHO, 11,581 Nutrition Causal Analysis (NCA) to understand approval of Minister of Local Government. The workplan are being implemented in the district. Nutrition behavior importance of nutrition in the behavior change communication. DEO, DPO, Adolescents the food and nutrition security situation and to change and practice) community and application of Administration lower Local Governments (LLGs) include: Adropi, Refugee NWOYA 10-24 years population explore the causal pathways for malnutrition in Communication for nutrition social behavior nutrition sensitive actions Support the training on nutrition packages across ZOMBO Pachara, Ciforo, Ukusijoni, Dzaipi, Arinyapi, Ofua, the district. Data from the NCA will be/ is being different departments such as training of VHTs on Itirikwa, Pakele and Adjumani Town Council. There 80,605 209,048 OTUKE change and Advocacy nutrition, training of CDOs, PDCs, FALs on KFCPs, used to support program implementation. are 54 parishesNEBBI and 206 villages. 256 FAL groups, PDCs and CDOs were trained training of agriculture extension workers on nutrition OYAM sensitive agriculture, training of schools on nutrition etc. Adjumani was also supported to conduct a on the Key Family Care Practices and are KOLE Food Security and Nutrition Assessments supporting communities implement nutrition This publication was produced with the financial support of the European Union. Its contents are the sole responsibility of UNICEF (FSNA). FSNA data was not available previously sensitive actions. unavailable therefore this first FSNA data will and do not necessarily reflect the views of the European Union. DEVELOPMENT INITIATIVE FOR NORTHERN UGANDA EUROPEAN UNION NUTRITION GOVERNANCE ACTIVITIES SUPPORTED IN THE DISTRICT NUTRITION, WASH AND HEALTH STATUS OF THE DISTRICT Coordination and Partnerships Results from the stakeholder mapping conducted in Adjumani district show that the district has 29 stakeholders either overseeing or implementing Nutrition specific and sensitive interventions as well as NUTRITION STATUS FSNA baseline (2019) Desired situation (2025) HEALTH INDICATORS FSNA baseline (2019) Desired situation (2025) creating an enabling environment for Nutrition implementation within the district. In total, 16 (55.2%) are for Nutrition specific, 4 (13.8%) are in Nutrition sensitive and 3 (10.3%) are for governance interventions. Six (6) Common childhood illnesses in Adjumani district include; Acute stakeholders are implementing both specific and sensitive. of households of households Respiratory are food insecure have food stocks 55.2% ADJUMANI DISTRICT MAP SHOWING DISTRIBUTION OF NUTRITION 77% 34% Malaria Diarrhea Infections 34% 7% 4% Nutrition specific SPECIFIC, NUTRITION SENSITIVE AND GOVERNANCE INTERVENTIONS

Arinyapi

Pacara LOW BIRTH WEIGHT Ciforo Dzaipi 10% 38 Adjumani TC IMMUNISATION (DPT3) VIT A SUPPLEMENTATION (12-23mo) STAKEHOLDERS overseeing / implementing 13.8% Ofua 10% 98% 71% Adropi STUNTING interventions Nutrition sensitive 70% 80% Pakele 15% ANAEMIA IN WOMEN Itirikwa 20% 27% Ukusijoni 12% 20.7% 10.3% <=14 interventions DEWORMING (12-23 mo) Nutrition specific Governance 15 - 19 interventions Source: Food Security and Nutrition Assessment in 10 & sensitive ANAEMIA IN CHILDREN 69% >= 20 interventions WASTING districts of Northern Uganda and West Nile 2019, Makerere 5% 70% 100% University School of Public Health. INTERVENTIONS TARGET GROUP ADJUMANI 4% 25% Promote, protect and support breast feeding Pregnant and lactating women, Adolescents Girls (10-19Yrs) INFANT AND YOUNG CHILD FEEDING PRACTICES FSNA baseline (2019) Desired situation (2025) NUTRITION GOVERNANCE Promote age appropriate complementary feeding Mothers / caregivers 75% practises Min. acceptable diet Min. diet diversity (6-23mo) Min. meal frequency WHAT IS NUTRITION GOVERNANCE AND WHY IS IT IMPORTANT? Promote optimal nutrition Children with special needs 0-11 months Promote adolescent nutrition Adolescents (Boys & Girls) 25.9% 30.4% 46.1% Good nutrition governance entails making adequate policy decisions in a timely manner, committing the necessary Vitamin A supplementation to children Children 0-59 months, postpartum women 100% 40% financial and organizational resources to their effective implementation, i.e. ensuring that benefits reach most of the population, preferably the most vulnerable. It also entails a sustained political commitment to ensure that nutrition Iron and Folic supplementation Pregnant women (15-49) programs and policies can withstand threats and constraints from changes in district leadership, political and Outpatient management of acute malnutrition Children 0-59 months, Pregnant women (15-49 ) 25% Continued breast feeding (2yr) Exclusive breast feeding Breast feeding within first 1 hour socioeconomic upheavals (Solon 2007). Inpatient management of acute malnutrition Children 0-59 months, Pregnant women 30% 54.4% 64.7% 67.3% Management of moderate acute malnutrition (MAM) Children 0-59 months 40% NUTRITION GOVERNANCE FRAMEWORK Provide deworming tablets to children (1-14yrs) Children 12-59 months 75% 80% 80% 80% 100% PILLARS OF GOVERNANCE Deworming for pregnant women Pregnant women (15-49yrs) IPT of malaria (IPT and IPTs2) for Pregnant women Pregnant women (15-49yrs) 75% Intersectoral Cooperation Diahorrea with ORS & Zinc Children 0-59 months 65% FSNA baseline (2019) Desired situation (2025) WASH STATUS Long lasting insecticide treated nets (LLINs) Pregnant & Lactating women, Children 80% Policy Technical Treatment of malaria All 80% Frame Capacity Sustainable Funding Nutrition Works Outcomes Recommended vaccines in the national schedule by Children 0-59 months, Pregnant women 75%

Monitoring recommended age

Stakeholders Vertical Partnership Building Promote PMCT /EMCT of HIV Pregnant & Lactating mothers 15-49years with HIV 75% Frame work Information Financial and Communication Management Coordination Coordination and Policy and legal System Capacity

Resource Mobilization Provide ARV medication All HIV +VE incld Pregnant & Lactating mothers 75% Advocacy LATRINE COVERAGE SAFE WATER ACCESS Diet therapy into routine disease therapy Children 12-59 months with special needs (Nutrition Behavior Change. Advocacy) 98% 98% Prevention and Management of diet-related NCDs Women of reproductive age 15-49 yrs 25%

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