Increasing funding for nutrition: The role of advocacy and communication in Senegal

Ambarka Youssoufane, ENN’s Regional Knowledge Management Specialist, interviewed Abdoulaye Ka, National Coordinator of Cellule de Lutte Contre la Malnutrition (CLM), the Malnutrition Management Cell in Senegal since 2011, and its Head of Operations from 2002. He is a public health and social development specialist.

Listen to the interview with Aboulaye Ka by Ambarka Youssoufane (podcast) on ENNs MediaHub

Background

Financing for nutrition is a current ‘hot topic’ receiving much attention among country actors involved in scaling up nutrition. Senegal has made significant progress not only in government nutrition budget commitments, but in ensuring that the promised funding is delivered.

The Government’s budget increased from CFA¹ 172 million (US$295,000) in 2002 to about 2.5 billion CFA (US$4.27 million) in 2016, a fourteen-fold increase over a decade and a half. This was achieved through a long process of advocacy and communication by a number of nutrition partners, notably the Cellule de Lutte Contre la Malnutrition (CLM), the Malnutrition Management Cell in Senegal.

Ambarka Youssoufane, ENN’s Regional Knowledge Management Specialist, interviewed Abdoulaye Ka, CLM’s National Coordinator since 2011, about the organisation’s role in supporting the process, with the view that actors currently working on nutrition budgeting in other countries would be interested in hearing about Senegal’s experience.

1. Can you tell me about the evolution of nutrition policy and programming in Senegal?

The Senegal nutrition policy approach has evolved through three main phases:

1. The first phase covering the period 1950-1970 can be referred to as the technological era, with a focus on surveys and research on food composition, etc.

2. The second phase, from 1995 to 2000, was called the ‘project approach’ and focused on urban nutrition interventions following devaluation of the national currency. Most of the projects were funded by the World Bank and overseen by the Presidency.

3. From 2000, a new nutrition approach emerged with the nutrition enhancement programme (NEP), which involved more actors and more sectors. The CLM was created and attached to the Prime Minister’s Office in 2001, with a multi-sector approach and aiming to be a multi-actor coordination committee. A new funding mechanism was also put in place and consisted of co-funding from the World Bank and the Government.

In Senegal, the nutrition budget increase was a long process. Initially it was a requirement from the World Bank (the main donor for nutrition) to secure government funding for nutrition, and it was further highlighted by a 2006 evaluation of the NEP, which concluded that more funding was needed (the evaluation was prompted by the results of the Demographic and Health Survey (DHS) conducted by the Government in 2005).

In response, CLM wrote a communication strategy highlighting positive results from phase one in consultation with nutrition stakeholders, which was used to mobilise resources. Improved advocacy (see question 4 for more details) brought about an increase in the Government’s allocation for nutrition from CFA 172 million (US$295,000) to CFA 1.7 billion (US$2.9 million) by 2007. From 2011, the nutrition budget increase has been institutionalised, with the Government’s nutrition budget line increasing by CFA 500 million (US$854,000) each year. It should reach CFA 3 billion (US$5.12 million) by 2017. We will have an exact idea of what proportion of the national nutrition plan this covers by the end of the year once we finish costing the next strategic plan.

2. Can you tell me about the background of the CLM and where it is positioned within government?

The high-level coordination for nutrition was established in the Presidency in 1995 with a National Commission overseeing the implementation of the Projet de Nutrition Communautaire (PNC) in 1995-2000. The PNC aimed at preventing high-level urban malnutrition following the FCFA currency devaluation. When the CLM was created

and attached to the Prime Minister’s Office in 2001, it also marked the move from the project to the programme approach. The CLM has 40 staff and is funded by government and development partners.

3. Do you think the structure and position of the CLM has been an important factor in Senegal’s achievements in nutrition?

Yes, the position and organisation of the CLM have been very important in mobilising resources through the national budget. Indeed, the CLM sitting in the Prime Minister’s Office can easily convene the other Ministries (Agriculture, Health etc.), which are members of the CLM. The CLM is made up of a planning committee where all relevant

ministries have a representative, including the Ministry of Finance. Each year, the committee members meet for costing, planning and budgeting all nutrition activities to be implemented during the year. All members take an active part in this exercise, which is transparent and participative. Because the Ministry of Finance is fully involved in nutrition budgeting, it is more accepting of the budget.

4. How have you succeeded in ensuring the release of funds committed for nutrition in Senegal?

It is true that funding commitment by the Government is not enough and one has to struggle to get funds released. Sometimes, the more funding is committed, the more difficult it is to release the funding. In Senegal, multi-sector planning and coordination with the Ministry of Finance was the first step that created an enabling environment for adequate budgeting and release of funding for nutrition.

Another step was working with the Treasury to ensure good understanding of needs and a better coordination mechanism. First, the CLM carried out an orientation session with the Treasury, where it presented all the planned activities for nutrition and the process of implementation. This allowed the Treasury to understand what the money is to be used for and why it is important to avoid bottlenecks in the release of the funding for good quality implementation. Secondly, a field visit was organised to show the Treasury how activities are carried out and how important it is to continue these activities.

Another important measure taken by the CLM was the annual audit of its management procedures. This brought about transparency and confidence in the way money is being used in the CLM. So far, this strategy has allowed it to 100% of the money committed by the Government.

5. How do you make sure you are spending all the funding provided?

In Senegal, we have innovated by working directly with civil society organisations (CSOs) as implementing partners. The CSOs are selected and a three-party contract is set up with the Government, the local Government (commune) and the community executive council to implement the nutrition activities based on government funding and priorities set out in the national nutrition action plan. So far, 18 executive councils are contracted by government and implementation reaches up to 400 communes. This system has ensured maximum delivery and each year up to 99% of funding provided is spent. The CLM management system has been recognised as the best management system by the World Bank and Ministry of Finance.

6. What are the main areas of spending for this nutrition budget?

A wide range of activities is implemented through the mechanism described above. This includes: community- based management of acute malnutrition (CMAM), vitamin A and iron and folic acid supplementation for pregnant women; deworming; food fortification and a wide range of nutrition-sensitive activities, such as a food security support project for households and WASH interventions.

7. Is the funding sufficient to cover all strategic priority programmes for Senegal?

The funding provided is not sufficient to cover the needs. Actually, nutrition interventions are implemented in 400 communes out of the 570 communes that exist in the country. There are therefore about 170 communes yet to be covered. Also, in the 400 covered communes, not all interventions are scaled up to all potential beneficiaries. Growth promotion, for example, reaches only 40% of potential beneficiaries and CMAM reaches about 80%. There is a need for more funding to take nutrition interventions more deeply and widely, and we are actively looking for this.

8. What advice would you give to nutrition leaders who are trying to secure a budget line for nutrition or release the money committed by the Government?

Every country has a unique history. It’s important to learn from your own country’s history about opportunities and factors for change. In Senegal, the most important opportunity was our experience in malnutrition management and prevention. Since the early 80s, there has been a critical mass of national experts working in malnutrition management and prevention. The work has been continuous, allowing the country to benefit from the experiences and use the knowledge to move forward. We also capitalised on our work with CSOs and high-level management and coordination expertise at government level, which give us a huge implementation capacity. We also built on partnerships with various agencies, including UNICEF, the World Bank, etc. This makes it easier to mobilise resources and to ensure quality in implementation. This is a process on which we keep building and learning from.

¹ Senegal’s national currency is the franc CFA (FCFA) (Communauté Financière d’Afrique or Financial Community of Africa).