Update on the implementation of the Multisectoral Convergence

Update on the implementation of the Multisectoral (Convergence) Food and Nutrition Security Action Plan at both national and provincial levels Current Progress, Challenges, Measures and Way Forward Dr. Khamseng Philavong Deputy Director Center for Nutrition Round Table Provincial Consultation Saravane Provice – 15 th-17 th September 2014

Outline of the presentation 1. A brief overview of the Multisectoral (Convergence) Food and Nutrition Security Action plan 2. Progress of the implementation of the Action Plan at national and provincial levels 3. Challenges 4. Way forward

1. A brief overview of the Multisectoral (Convergence) Food and Nutrition Security Action plan • Plan is based on the multisectoral “convergence approach” used with great success in Peru, Brazil and Bangladesh. In Peru and Bangladesh, the convergence approach has resulted in annual decreases of chronic malnutrition exceeding 4 percentage points • The approach involves the co-location of nutrition-specific and nutrition-sensitive interventions in the same geographic areas (targeted by food insecurity and malnutrition prevalence) with multisectoral planning and review but sectoral implementation. • After the Round Table Provincial Consultation in Luang Namtha, the Government of Lao PDR has applied convergent approach to address food and nutrition security in Lao PDR by creating the Multisectoral Food and Nutrition Security Action Plan in July 2013 -

Coordination mechanism In place and operational In place and not yet operational District Coordination Structure Not yet in place and not yet operational

Update priority interventions in Lao PDR under the convergence action plan • Health and WASH 14 interventions • Agriculture 4 interventions • Education 4 interventions

Update 14 Priority interventions for Health & WASH No Intervention 1 Iron supplement weekly for reproductive women and daily for pregnant women 2 Vit A supplementation for children under 5 3 Deworming supplementation for children under 5 4 Universal Salt Iodization 5 Breastfeeding Infant Young Child Feeding promotion counseling 6 Food supplementation pregnant &lactating women 7 Food supplementation for children under 2 years 8 Food safety and fortification 9 Management of acute malnutrition in facility community-based 10 Education community program for out of school girls through LWU and other community networks 11 Growth monitoring among children under 5 (for individual counseling (link to act. 5) 12 Capacity building from community to central level 13 Strengthening specific nutrition surveillance reporting system 14 Strengthening water supply systems in health centers, communities, household, school WASH

Update 4 Priority Interventions for Agriculture No Intervention 1 Production and promotion of diversified crop production (incl. homegarden, herbboxes, bean production, etc) and agriculture-linked nutrition education Production and promotion of small and healthy livestock (focus poultry, pigs, etc) 2 3 Improve post-harvest handling and promoting food processing to improve year-round food security 4 Support and promotion of income generating activities (IGAs), for example agricultural products as well as non- timber forest product (NTFP) including traditional herbs and education on wise spending of money

Update 4 Priority interventions for Education No 1 Intervention Provision of school lunch 2 School based gardens combined with nutrition education (with encouragement of school children as change agents) 3 Inclusion of nutrition in the primary, secondary and high school curriculum 4 Using education as a delivery platform for nutrition specific interventions (deworming iron folic acid for school age students )

Implementation Phases Phase 1 – Pilot phase in 2014 -2015 Coverage: 1. Convergent implementation at scale of 22 selected nutrition-specific and nutritionsensitive interventions in vulnerable provinces and districts : Luangnamtha (Nalae, Vienphoukha and Oudomxay (Parkbeng, Hun), and Saravane (Lao. Ngam, Taoy) Phase 2 – Extension in 2016 -2020 - Review existing intervention to reflect based on lesson learn for the pilot phase 2014 -2015. - Scale up of convergence approach to a total of 7 provinces (PSl, LNT, ODX, HP, XHK, SRV, SK) in 26 districts

2. Progress of the implementation of the Action Plan at national and provincial levels National level - 2014 work plan of the secretariat developed: Organization, capacity building, coordination, M&E. - Implementation plan and costing of nutrition specific interventions developed (for sensitive intervention need to be specified in focus on convergence area) - Funding gap analysis for nutrition specific interventions conducted and national budget requested by MOH to fill in the immediate gaps for nutrition commodities and operational costs for delivery of nutrition specific services through integrated outreach Sub-national level - Salavan: Multi-sectoral planning workshop - Odoumxay: Convergence workshop with mapping and budgeting and pilots ongoing in 6 villages - Luang Namtha: Pending - GOL, EU, UN agencies, MMG, selected NGOs have committed resources and provide support for scaling up nutrition interventions with focus on 3 convergent provinces -

Lessons learnt from the 4 Northern Provinces (Phongsaly, Oudomxay, Luang Namtha, Bokeo 2011 -2012 (Government process)

Implemmenating arrangment) Government process( Assessment (evluation) based on MUAC, W/A Malnutrition for Children under five year of age Chronic mulnutrition Malnutrition – middle level Food supplement at household level Chronic Malnutrition – with no food suppliement Chronic malnutrition- with food supplement Food supplement and treatment at hospitals

Results 170 77 70 34 16 7 0

Summary of results (before and after) Normal malnutrition ລ/ດ Province 1 Phongsaly 2 Bokeo 3 Oudomxay 4 Laung Namtha Total Chronic malnutrition Total Better Death Total Better Deat h 77/295 61 (79. 3%) 0 5/295 5 (to normal) 0 170/485 136 (80%) 7/485 5 (to normal) 0 0 1 (to normal) 70 (91%) 0 4/185 70/229 70 (100%) 0 2/229 2 (normal) 0 400/1194 (33. 5%) 267/317 (84%) 0 17/1194 (1. 4%) 12/809 86)%( 0 77/185 0

Implementation of multisectoral approach in Saravane province Phase 1 (ongoing) Implementation at scale of specific nutrition interventions in health sector: – Micronutrients (Vitamin A, Micronutrient Powders, perinatal Iron Folic Acid, Iron Folic Acid for women of reproductive age, Universal Salt Iodization) – Deworming of children under-5 – Management of acute malnutrition – Infant and Young Child Feeding (breastfeeding and complementary feeding counselling; hygiene promotion, household water storage and management, appropriate disposal of child faeces) Implementation at scale of nutrition interventions in education: – School-based deworming – School based iron folic supplementation of girls – School meals/school feeding

Implementation of multisectoral approach in Saravane province Phase 2 (started) Progressive implementation of WASH interventions starting from selected districts and villages – Water supply systems in the community – Community led total sanitation – WASH in schools (hygiene promotion + sanitation facilities) Plans to expand the implementation of agricultural interventions once these are clearly defined

Summary report: Saravan planning workshop (1) Positive developments Issues discussed/challenges Recommendations Provincial level coordination mechanism formally established just before the workshop How to best link food security and nutrition coordination to subnational planning and budget processes coordinated by planning department and overseen by the Governors? Clarify linkages to the national and subnational planning and budget processes How to establish linkages to 8 th NSEDP and sectoral strategic planning? Provincial health director is the chair Questions on ‘why and how coordinate activities among sectors’? Clarify linkages b/w national and ODA planning/budget processes Consider district governor as the chair of the multi-sectoral mechanism at the district level Further clarify roles and responsibilities of different sectors/institutions, as well as national and subnational levels for (1) operationalizing nutrition interventions and for (2) coordination, joint planning, joint monitoring, etc.

Summary report: Saravan planning workshop Positive developments Issues discussed/challenges Recommendations Improved understanding of food and nutrition security interventions and of geographical ‘convergence’ principle by the end of the workshop Some agenda items (eg activity planning and costing) could not be completed and planned outputs have not been fully achieved Before next planning workshops complete and clarify the following: Geographical mapping of interventions completed – many nutrition specific interventions have universal coverage Insufficient clarity and lack of standardization for some interventions Low coverage with WASH and agriculture interventions Inadequate budgets to either maintain current level of implementation for certain interventions or to improve coverage -Technical and implementation brief for each intervention -Intervention readiness for implementation and the level of collaboration required for different interventions

Education 5 53 104 63 Taoy 56 41 64 56 54 34 58 38 103 8 104 8 56 6 64 6 54 0 58 0 Loua. Gnum 103 X 104 94 Taoy 56 X 64 57 54 X 58 53 Loua. Gnum 103 X 104 Taoy 56 X 64 64 54 X 58 58 Loua. Gnum 4 103 Samoy 3 coverage of School(%) Samoy 2 School Loua. Gnum School meals coverage of villages(%) Samoy 1 Intervention villages Loua. Gnum N 103 0 104 0 56 0 64 4 54 0 58 7 Districts Promotion / support to Taoy school garden Samoy Nutrition education of school children Primary school deworming Iron folate fro secondary Taoy school girls Samoy

Health 1 N 1 Intervention District Weekly iron for reproductive age women Loua. Gnum 12 -45 Years Taoy N. Of Village Implemented Village 81 NA Loua. Gnum 97 97(100%) 56 56(100%) 81 NA 97 97(100%) 56 56(100%) Samoy 4 (100%)56 Samoy 3 56 Taoy Daily Iron Folic Acid to pregnant women 0 Samoy 2 97 81 NA Loua. Gnum 97 97(100%) Taoy 56 56(100%) Samoy 81 NA Vitamin A supplementation of children 6 - Loua. Gnum 59 mo old Taoy Deworming for children 12 -59 mo old and school children

Health 2 N 5 Intervention Infant and Young Child Feeding promotion and counselling District N. Of Village Implemented Village Taoy 56 56(100%) 81 No Data 97 On going 56 On going 81 No Data Loua. Gnum 97 0 Taoy 56 0 Samoy 8 97(100%) Samoy 7 97 Samoy 6 Loua. Gnum 81 0 Loua. Gnum 97 0 Taoy 56 56(100%) Samoy 81 No Data Micronutrient in-home fortification Loua. Gnum of children 6 -23 mo old Taoy Community-based nutrition counselling programs to women of reproductive age Food supplementation (children under 2 years)

Health 3 N 9 Intervention Micronutrient support 6 -59 mo old District N. Of Village Implemented Village 56(100%) 81 No Data Loua. Gnum 97 97(100%) 56 56(100%) Samoy Health education to change behavior 56 Taoy 11 97(100%) Samoy Management of acute malnutrition 97 Taoy 10 Loua. Gnum 81 No Data Loua. Gnum 97 0 Taoy 56 0 Samoy 81 No Data

Health 4 N 12 Intervention Strengthening of capacity building of Health provider District N. Of Village Implemented Village 14 0 Taoy 56 0 81 No Data Loua. Gnum 97 0 Taoy 56 0 Samoy Stengtherning of Surveillance and report of Nutrition 97 Samoy 13 Loua. Gnum 81 No Data Loua. Gnum 97 Water Supply for: Health Center, Village School 4 0 17

Health 5 N 14. 1 Intervention District N. Of Village Implemented Village Sanitation: -Health Center, Loua. Gnum 97 - 4 HC -Village - 2 Village -School -17 school Sanitation: -Health Center, Taoy 56 - 6 HC -Village - 2 Village -School -10 Schools Sanitation: -Health Center, -Village -School Samoy 81 Not received data

Agriculture ລ/ດ 1 Intervention Home gardens promotion (Including drip irrigation) District N. Of Villages Inplemented Village Women’s employment generation through agricultural value chain and non-timber forest products No data Loua. Gnum 97 17(17. 52%) 56 13(23. 21%) 81 No data Loua. Gnum 97 6(6. 18%) 56 9(16. 07%) 81 No data Loua. Gnum 97 0(0%) 56 0(0%) Samoy 5 81 Taoy Food processing, preservation, storage 23(41. 07%) Samoy 4 56 Taoy Animal vaccinations Taoy Samoy 3 06(6. 18%) Taoy Small animal raising 97 Samoy 2 Loua. Gnum 81 No data Loua. Gnum 97 10(10. 30%) Taoy 56 2(3. 57%) Samoy 81 No data

10 villages in Houn District 10 villages in Pak. Beng District Initial # of 1850 Households Implementation of multisectoral approach in

Convergence mapping of interventions at District level (example Houn District) Note: Vit. A, deworming, daily Fe-folic acid, iodized salt are covered district wide

Responding to root causes of malnutrition disability Malnutrition Coordination Low nutrient supported by intake SSSJ Inadequate food security MAF/SSSJ IFAD Inadequate mother and child care Mo. H, WFP, LWU, SSSJ, KOICA, PInt, ADRA death Diseases WASH and health Mo. H, LWU, ADRA, Plan Int. Individual level Low education Mo. ES, MOCI, LWU, SSSJ, WFP, ADRA, Plan Int Household / community level

In-adecuate food security leading to insufficient nutrient intake RESPONSE: Increase availability of and access to nutritious food at local level Implementing partners: DAFO, LWU, WFP, SSSJ Main activities: vegetable gardens, herb-boxes, fruit trees, poultry raising, bean production, NTFPs, improved storage facilities etc.

In-adequate Mother & Child Care RESPONSES: Upgrading Health Centres, growth monitoring and councelling, vaccination , micronutrients supplementation Implementing partners: Do. H, LWU, KOICA, WFP, SSSJ, ADRA, Plan International Activities: support to Health Centres, regular growth monitoring/counselling, distribution plumby-doz, vaccination campaigns, Vit A, Daily and weekly iron folic acid, deworming, iodized salt, complementary feeding CU 2, etc.

Limited Wash and Health services/facilities RESPONSE: Increase and improve WASH and Health services and facilities Implementing partners: Mo. H, ADRA, Plan International, SSSJ Activities: community water supply and hygiene education, latrines using CLTS approach

Low education and awareness Response: increase awareness and knowledge levels regarding nutrition, WASH, health, MCH and inter-linkages Implementing partners: Mo. ES, Mo. H, DIC/ radio stations ODX, LWU, WFP, SSSJ, ADRA, Plan International Activities: nutrition education, cooking lessons, radio spots, facilitated VDO nights with targeted & multi-langual VDO messages, etc.

Monitoring and evaluation - Draft multisectoral monitoring and evaluation plan developed - Subnational Nutrition Survey planned to set the baselines in convergent areas - Plans to document Lao experience and learning with multisectoral approaches to nutrition

3. Key challenges o Some interventions are not yet clearly defined or standardized. Development of technical and implementation guidelines for each intervention -- which is necessary to inform planning and costing of the plan – will take more time, especially for Education, Agriculture and WASH o To improve the effectiveness of multisectoral work, interventions requiring participation of more than one sector need to be clearly specified o Limited experience of the secretariat with the ‘convergence’ approach o Frequent changes in representatives of other ministries in core group meetings limits the effectiveness of coordination work and causes discontinuation of discussions.

3. Key challenges (2) We need to recognize that Food and Nutrition Security has implications for other off track MDGs – in particular. • Child malnutrition is damaging to the future capacity of the nation • Malnutrition is associated with high child mortality • Poor nutrition amongst women causes poor health and contributes to high maternal mortality • Women’s empowerment in education and income contribute to better nutrition for children • A more educated and healthier population means improved productivity of the work force. Therefore, discussions over food and nutrition security need to be systematically fed into overall development agenda in particular the MDGs and the NSEDP.

4. Next steps • - Finalize monitoring and evaluation plan for multisectoral action on food and nutrition security • - Compile monitoring data, organized joint monitoring visits and prepare periodic progress reports on the implementation of nutrition specific interventions and convergence approach • - Complete technical and implementation brief for all the interventions that are not clearly defined and identify interventions requiring collaboration of more than one sector • - Keep supporting planning, costing, monitoring and documentation of learning in convergent provinces which will be fed into the formulation of the next five year plan (NSEDP 2016 -2020) • - Galvanize efforts from both the Government and Development Partners in particular high commitment and increasing support for the implementation of the Multisectoral (Convergence) Food and Nutrition Security Action Plan

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