Photo credit: Vilaxay Intaxoun USAID Nurture Annual Report, Year 4: FY2019: October 1, 2018 to September 30, 2019 Cooperative Agreement Number: No. AID-486-A-16-00001 USAID/RDMA, Attn: Kongchay Vongsaiya, AOR Submitted October 31, 2019 by Delailah Borja, USAID Nurture Chief of Party Revised Submission December 13, 2019 [email protected] Contents Contents ....................................................................................................................................................................... 2 Acronym List ............................................................................................................................................................... 3 USAID Nurture Summary ........................................................................................................................................ 6 Results During The Reporting Period ................................................................................................................... 7 IR1: Improved IYCF and WASH Behaviors ................................................................................................. 7 IR2: Improved use of quality nutrition and nutrition-sensitive WASH services/facilities................. 9 Cross-cutting Approach: Improved Enabling Environment for Multi-Sectoral Nutrition and WASH Programs among Government Officials, Service Providers, and Communities ................. 9 Major Impacts and Accomplishments by Intermediate Result ....................................................................... 10 IR1: Improved IYCF and WASH Behaviors ............................................................................................... 10 IR 2: Improved Use of Quality Nutrition and Nutrition-Sensitive WASH Services/Facilities ....... 11 Crosscutting Approach: Improved Enabling Environment for Multi-Sectoral Nutrition and WASH Programs among Government Officials, Service Providers, and Communities ................. 20 New and Existing Sub-Award and Contract Status .......................................................................................... 25 Challenges and Mitigation ....................................................................................................................................... 25 Environmental Compliance .................................................................................................................................... 28 Science, Technology, and Innovation ................................................................................................................... 28 Stakeholders Participation and Involvement ...................................................................................................... 28 Sustainability, Local Solutions, and Partnerships ............................................................................................... 30 Cost Sharing ............................................................................................................................................................... 31 Planned Tasks/Interventions for the Next Reporting Period ........................................................................ 31 Appendix 1: List of Private Vendors .................................................................................................................... 34 Appendix 2: ODF Verification Tool ..................................................................................................................... 35 Appendix 3: Cover Pages of Tools for Endorsement and Publication ......................................................... 38 Appendix 4: Small Doable Actions (SDAs) ......................................................................................................... 40 Appendix 5: Pictures of USAID Nurture Activities .......................................................................................... 41 Appendix 6: Completed iNuW Phasing Strategy (Village Visit Plan) ............................................................ 42 Appendix 7: Sales Flipcharts (cover page) .......................................................................................................... 43 Appendix 8: Success Story about Change: Improving Newborn and Maternal Health and Nutrition in Laos .............................................................................................................................................................................. 44 Appendix 9: Success Story About Change: Lao Communities Make Progress Towards ODF Status 46 Appendix 10: Additional photos of breastfeeding, latrines, and hand washing .......................................... 48 2 ACRONYM LIST A&T Alive & Thrive ANC Antenatal Care AW Abundant Water Organization BFHI Baby-friendly Hospital Initiative BMS Breastmilk Substitute CF Community Facilitator CCEH Center of Communication and Education for Health COP Chief of Party DFO District Facilitator Officer DHC Department of Health Care DHHP Department of Hygiene and Health Promotion DHO District Health Office DHR Department of Healthcare and Rehabilitation DNC District Nutrition Committee DP Development Partner DPO District Project Officer DQA Data Quality Assessment EENC Early Essential Newborn Care EPI Expanded Program on Immunization EU European Union FY Fiscal Year GoL Government of Lao PDR IFA Iron and Folic Acid INGO International Non-Governmental Organization iNuW Integrated Nutrition and WASH IR Intermediate Result IYCF Infant and Young Child Feeding Lao PDR Lao People’s Democratic Republic LOA Life of Activity M&E Monitoring and Evaluation 3 MCH Maternal and Child Health MCHC Maternal and Child Health Center MEL Monitoring, Evaluation and Learning MIYCAN Maternal, Infant, Young Child and Adolescent Nutrition MIYCN Maternal, Infant and Young Child Nutrition MNV Model Nutrition Villages MoH Ministry of Health MoU Memorandum of Understanding Nam Saat National Center for Environmental Health and Water Supply NNC National Nutrition Center NNS National Nutrition Strategy NPAN National Plan of Action for Nutrition NSA Nutritional Sensitive Agriculture ODF Open Defecation Free PC Provincial Coordinator PNC Postnatal Care RDA Rural Development Agency RDMA Regional Development Mission for Asia RMNCH Reproductive, Maternal, Newborn and Child Health RMNCAH Reproductive, Maternal, Newborn, Child and Adoloscent Health SA Sales Agent SBCC Social and Behavior Change Communication SC Save the Children SCALING Sustainable Change Achieved Through Linking Improved Nutrition and Governance SCUS Save the Children, United States SDA Small Doable Action SI Social Impact SO Strategic Objective SUN Scaling Up Nutrition SUN CSA Scaling Up Nutrition Civil Society Alliance 4 ToR Terms of Reference ToT Training of Trainers UNICEF United Nations Children’s Fund USAID United States Agency for International Development VIC Village iNuW Committee WASH Water, Sanitation and Hygiene WFP World Food Programme WHO World Health Organization 5 USAID NURTURE SUMMARY Lao People’s Democratic Republic (PDR) experience some of the highest rates of child and maternal mortality and malnutrition in Southeast Asia. Lao children remain some of Asia’s most undernourished, with the national average prevalence of stunting at 33 percent, underweight at 21 percent, and wasting at 9 percent. In response, the USAID Nurture Activity, led by Save the Children (SC) and implemented in partnership with the Government of Lao PDR (GoL) aims at contributing to a reduction in young child stunting in two target provinces. USAID Nurture is being implemented across six districts of two provinces — Savannakhet and Khammouane — in the central region of Lao PDR. The approach focuses on: improving maternal, infant and young child and adolescent nutrition (MIYCAN) and water, sanitation and hygiene (WASH) behaviors in 1,000 Days Households (HHs) (with pregnant/lactating women and children under two); increasing access and use of quality nutrition, health services, and WASH facilities and products; and strengthening the enabling environment for improved nutrition and WASH through capacity building activities, multi-sectoral coordination and planning, particularly at provincial and district levels. This integrated delivery model supports the GoL in its implementation of the National Nutrition Strategy (NNS) to 2025, the National Plan of Action 2016-2020, and the National Social Behavior Change Communication (SBCC) Plan. SC and the GoL’s close collaboration during the first four years of the USAID Nurture Activity facilitated scale up in hard-to-reach communities. USAID Nurture received an extension in July 2018 to continue through September 2021. Over the next two years, USAID Nurture will build on the collaboration and interest of the GoL to improve nutrition and WASH practices and services in a way that builds on existing systems for better sustainability. In Years 5 and 6, USAID Nurture has an opportunity to continue its engagement at the community level to improve household and community adoption of practices and products for improved nutrition and WASH outcomes, strengthen links to health services, expand work to improve consumption of diverse diets, and provide an added focus on adolescent nutrition. It also gives more time to further strengthen the capacity and ownership by government partners and communities. In August 2019, USAID Nurture began discussions with the Ministry of Health (MoH) regarding the extension of the memorandum of understanding (MoU)