USAID Nurture Photo Credit: Jittinee Khienvichit, USAID Annual Report, Year 2: FY2017: October 1, 2016 to September 30, 2017 Cooperative Agreement Number: No. AID-486-A-16-00001 USAID/RDMA, Attn: Robin Martz, AOR Submitted by Kamden Hoffmann, Chief of Party, USAID Nurture [email protected] Contents Acronym List .......................................................................................................................................... iv Project Summary ..................................................................................................................................... 1 Results ..................................................................................................................................................... 2 New and Existing Sub-Award Status ....................................................................................................... 6 Major Impacts and Accomplishments by Intermediate Result ............................................................... 8 Intermediate Result 1: Improved IYCF and WASH Behaviors ............................................................. 8 Intermediate Result 2: Improved use of quality nutrition and nutrition-sensitive WASH Services/Facilities .............................................................................................................................. 11 Community Service Delivery ......................................................................................................... 11 WASH Product Delivery................................................................................................................. 11 Health Service Delivery ................................................................................................................. 13 Intermediate Result 3: Improved Enabling Environment ................................................................. 15 Implementation Challenges and Mitigation ......................................................................................... 16 Deviations from Expectations for Performance Indicators................................................................... 17 Integration of Crosscutting Issues and USAID Forward Priorities ......................................................... 18 Environmental Compliance ............................................................................................................... 18 Science, Technology, and Innovation ............................................................................................... 18 Planned Tasks/Interventions for the Next Reporting Period ................................................................ 19 ANNEXES ............................................................................................................................................... 20 Appendix1: iNuW Toolkit: Community Section Outline ................................................................... 21 Appendix 2: USAID Nurture Q&A for DFOs ....................................................................................... 24 Appendix 3: Cover Pages of Tools Being Developed ......................................................................... 27 Appendix4: Phasing Strategy for Scaling up of iNuW Districts ......................................................... 28 Appendix 5: WASH Marketing Roadmap .......................................................................................... 29 Appendix 6: Selected Creative Concept – Image 1 (updated version) ............................................. 30 Appendix 7: Updated Behavioral Objectives for USAID Nurture ...................................................... 31 Appendix 8: Success Story: Health Facility ........................................................................................ 33 Appendix 9: Success Story: Community ............................................................................................ 34 Figures Figure 1. Child-centered WASH-Nutrition Integration Visual……………………………………………………………..9 Figure 2. iNuW Community Process…………………………………………………………………………………………………10 Figure 3. iNuW Capacity Building…………………………………………………………………………………………………....11 ii Figure 4. National Counseling Competencies…….…………………………………………………………………………….14 Figure 5. USAID Nurture Nutrition Coordination Plan Support…………………………………………………………15 Figure 6. Adolescent Sensitive Approaches in Nutrition Counseling…………………………………………………18 Tables Table 1. Number of individuals receiving nutrition-related professional training……………………………….3 Table 2. Number of people trainined during the reporting period ........................................................ 4 Table 3. Gender Analysis Perceptions and Practices…………………………………………………………………………..8 Table 4. iNuW CF Formation…………………………………………………………………………………………………………….11 Table 5. 4S Model…………………………………………………………………………………………………………………………….13 Table 6. Yr2 Health Care Provider Capacity Building…………………………………………………………………………14 iii Acronym List A&T Alive & Thrive BFHI Baby Friendly Hospital Initiative BMS Breastmilk Substitute COP Chief of Party CLTS Community Led Total Sanitation CF Community Facilitator DHC Department of Health Care DFO District Facilitator Officer DHO District Health Office DHIS2 District Health Information System 2 DHHP Department of Hygiene and Health Promotion DNC District Nutrition Committee DP Development Partner EENC Early Essential Newborn Care EU European Union GLEE Global Learning and Exchange GoL Government of Lao PDR IYCF Infant and Young Child Feeding INGO Non-Governmental Organization Lao PDR Lao People’s Democratic Republic MCHC Maternal and Child Health Center MIYCN Maternal Infant and Young Child Nutrition M&E Monitoring and Evaluation MOH Ministry of Health MOU Memorandum of Understanding MSN Multi-sectoral Nutrition Strategy NNC National Nutrition Center Nam Saat National Center for Water Supply and Environmental Health, the Ministry of Health NNS National Nutrition Strategy NPA Non-Profit Agency iv NPAN National Plan of Action for Nutrition ODF Open Defecation Free PADTEC Participatory Development Training Centre PNC Provincial Nutrition Committee RDA Rural Development Agency RDMA Regional Development Mission for Asia RMNCH Reproductive, Maternal, Newborn and Child Health SBCC Social Behavior Change Communications SC Save the Children SCI Save the Children International SCUS Save the Children, United States SUN Scaling Up Nutrition TOT Training of Trainers UNFPA United Nations Population Fund USAID United States Agency for International Development VIC Village iNuW Committee WASH Water, Sanitation and Hygiene v Project Summary Laos experiences 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 national average rates of stunting at 35.6%, underweight at 25.5%, and wasting at 9.6%.1 In response, the U.S. Agency for International Development’s “Nurture” (USAID Nurture) aims to contribute to a reduction in young child stunting in targeted areas of Laos by improving: 1) infant and young child feeding (IYCF) and water, sanitation, and hygiene (WASH) practices; 2) the use of quality nutrition and WASH services/facilities; and 3) the enabling environment for improved nutrition. The project focus is on improving maternal and adolescent nutrition and IYCF and WASH practices targeting 1,000 Days households (households with pregnant women and mothers with children up to two years of age). USAID Nurture utilizes interpersonal communication, household-level support, and peer groups and links women and children with health services being improved by the project. USAID Nurture integrates nutrition and WASH through a community mobilization approach that incorporates a modified version of community-led total sanitation (CLTS). Communities are mobilized to assess and analyze their nutrition and WASH environment. This process spurs action to address nutrition-related issues resulting from poor IYCF practices and inadequate water, sanitation and hygiene, including environmental enteropathy, diarrhea and other conditions that limit nutrient absorption, a major driver of stunting. USAID Nurture leverages private sector relationships to facilitate supplies of products that support uptake of targeted WASH practices. Through its integrated delivery model, USAID Nurture supports the Laos government as it clarifies roles and responsibilities across national, provincial and district levels to help ensure consistency and ownership of these efforts in support of the National Plan of Action for Nutrition. USAID Nurture is implemented in six districts in Khammouane and Savannakhet provinces by Save the Children (SC) in collaboration with the Rural Development Agency (RDA). This partnership leverages both SC’s leadership in the implementation of large-scale integrated nutrition programs, and the RDA’s expertise in CLTS and community mobilization and facilitation. The project strengthens existing relationships with the Government of Lao PDR (GoL) to help ensure scale up in hard-to-reach communities. 12015 Lao Child Anthropometry Assessment Survey (LCAAS). 1 Results In Year (YR) 2, USAID Nurture achieved the following milestones: Project Management Signed the USAID Nurture Memorandum of Understanding (MOU) between the Ministry of Health (MoH) and Save the Children (SC). Held the Project Kick-off Meeting and produced the YR1 (2017) USAID Nurture work plan with national, provincial and district government counterparts.