A catalyst for scale-up in SUN countries: Experiences of technical assistance for Tajikistan and the Philippines

ENN's SUN Knowledge Management team with contributions from Nutrition International (NI) and Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+)

One of the added benefits for countries who are part of the SUN Movement is access to free technical assistance (TA) to support them in their efforts to institutionalise nutrition and accelerate achievements towards reducing malnutrition. One important TA provision in the current phase of the SUN Movement (2016-2020) is the Technical Assistance for Nutrition (TAN) programme funded by the UK Department of International Development (DFID).

What is the TAN Project?

The TAN project includes two TA providers - the Maximising the Quality of Scaling Up Nutrition Plus (MQSUN+) consortium led by PATH; and Nutrition International (NI, formerly Micronutrient Initiative). The TAN project also provides knowledge management support to the SUN Movement through ENN.

Assistance under TAN covers all aspects of nutrition support, such as nutrition policy and legal framework analysis; nutrition stakeholder mapping; costing nutrition plans; monitoring and evaluation; and the development of a common results frameworks (CRF)¹ or the design and operationalisation of multi-sector nutrition action plans. TAN partners provide technical assistance to countries both remotely or in country and TA can be either short-term or delivered through a longer-term, phased approach providing sequenced support over time (see Tajikistan example below).

Requests for TA under TAN are usually generated by the SUN Government Focal Point, with other key members of the national multi-stakeholder platform for nutrition, including SUN network convenors. After this, the country begins a process of discussion with the TA provider to ensure country needs are well understood and requests are broken down into specific deliverables. The MQSUN+ consortium receives TA requests via the SUN Movement Secretariat (SMS), whereas NI works directly with countries supported by their network of country and regional offices².

How do countries access TAN?

The TAN is a demand-driven model in that TA providers can respond to country needs via requests from SUN countries. The support is tailored to the specific country context and challenges of a given country and ensures there is opportunity for in-depth consultation with local stakeholders and collaboration on outputs and delivery.

With the SUN Movement now including 60 member countries plus three states of India (as of November 2017), there is significant diversity across the Movement, with countries tackling malnutrition in unique ways and working within a range of institutional, political and social contexts. While generic guidance is available and much can be learnt from the experiences of other SUN countries, there is demand for TA that provides specific support to countries especially on issues such as introducing national targets, scaling up effective programmes, working and coordinating different sectors, supporting the operationalisation of national nutrition-related plans and developing action plans to address malnutrition, and being able to measure the status of malnutrition and progress. At the end of a TA delivery, the country government who requested the TA owns all outputs, including national plans, tools, frameworks and guidance produced.

Tajikistan: Support for a Common Results Framework by MQSUN+

The Republic of Tajikistan joined the SUN Movement in September 2013. Since independence in 1991, Tajikistan had developed a number of laws and adopted strategic documents to improve on health, nutrition and food security. The country had also established the Food Security Council of the Republic of Tajikistan (FSCT) to coordinate strategic decision-making concerning national food security. The SUN Government Focal Point is the Deputy Minister of the Ministry of Health and Social Protection of the Population within government. Prevalence of stunting among children under five years of age is 27 per cent (2012) and 10 per cent of children are affected by wasting (GNR 2017a).

In 2017 MQSUN+ provided TA to support the Government of Tajikistan in developing a CRF, which is in the process of being translated into a multi-sector nutrition plan of action. The request came through the SMS in January 2017. As with all requests, it was formalised into a terms of reference (TOR) to outline the TA approach and work plan and deliverables. Once the TOR is finalised, it is approved by the SUN Focal Point, SMS and DFID. The timing of this process can vary significantly, depending on the accessibility of all stakeholders, including government and SUN multi-sector platforms. The Tajikistan TOR was finalised in early March 2017 and implementation started the same month.

Between March and June 2017, an MQSUN+ international expert and a national consultant - working alongside UNICEF Tajikistan (the SUN donor co-convener) - supported the SUN Focal Point and the Ministry of Health and Social Protection of the Population (MoHSPP) to facilitate policy and strategy dialogue within and between different sectors.

The 2017 TA involved:

• Developing a CRF roadmap;
• Getting consensus on the roadmap from the multi-sector platform;
• Conducting stakeholder meetings to review relevant policies and strategies; and
• Developing working groups to identify gaps and recommendations.

Box 1: Previous technical assistance in Tajikistan

MQSUN (the predecessor of MQSUN+, also led by PATH) had already provided TA support to Tajikistan, so existing contacts and experiences were leveraged to respond to this new request. The previous work included a nutrition policy review and strategy alignment and a nutrition gap analysis and stakeholder mapping in 2015-2016. MQSUN also supported a multi-sector workshop for an initial dialogue around a CRF, the outcome of which was an agreed goal: the reduction of stunting.

These activities culminated in a two-day workshop in May 2017, where over 60 government officials from different sectors, development partners, private sector and civil society representatives came together to discuss and agree a draft CRF for Tajikistan.

Following the workshop, MQSUN+ held further consultations with government ministries to finalise sector roles and define nutrition-specific and nutrition-sensitive interventions. In June 2017, a draft of the CRF (not yet costed) was completed and shared with UNICEF Tajikistan and with MoHSPP Tajikistan by the MQSUN+ team. The draft was translated into Russian and a presentation was held with the SUN Focal Point and multi-sector platform later that same month during the Nutrition Forum for endorsement.

The Tajikistan CRF covers the period 2018-2022, outlining the goal and the strategic objectives for the plan, which are based on the World Health Assembly (WHA) targets (adopted by Tajikistan) and the Sustainable Development Goal (SDG) 2 targets. The CRF is divided into four strategic objectives, each one broken down by results, indicators, means of verification, lead agency and contributing sector. In some cases specific targets have been set, such as coverage for vitamin A supplementation and salt iodisation.

While this TA is completed and a CRF has been developed and is in the process of being approved, the phased approach taken by MQSUN+ allows for existing work to be built on and a follow-on TA assignment is already planned. The next phase will see the operationalisation of the CRF. This includes an assessment of capacity-building needs, working with sectors to integrate relevant components into sector planning, costing activities and defining financial mechanisms, and developing the M&E framework.

Philippines: Support for development of the Philippines Plan of Action for Nutrition 2017-2022

Philippines joined the SUN Movement in March 2014 with the commitment to end hunger and malnutrition in all its forms and ensuring that every Filipino enjoys his/her right to good food and good nutrition. Undernutrition in the Philippines remains a serious problem with 30 per cent of children under five years of age (CU5) affected by stunting (2013) and 8 per cent CU5 by wasting (2013) (GNR 2017b).

In 2016 NI completed one of its first TA tasks under TAN, providing support to the Government of the Philippines to develop the Philippines Plan of Action for Nutrition (PPAN) 2017-2022, the blueprint for addressing nutrition problems in the country.

The request for the TA came through the National Nutrition Council (NNC), the lead policy and coordinating agency for nutrition in the Philippines responsible for developing the PPAN. The objectives of the TA were to conduct a situational analysis to:

• Analyse the nutrition situation in the country;
• Provide a set of recommended and priority nutrition actions, along with nutrition targets for various sectors and stakeholders;
• Assist in the formulation of the final plan, including costing of the priority interventions and a CRF; and
• Support sector partners to assess their budgetary allocations and availability, compare against the commitments and additional resource requirements, and explore ways to meet the resource gaps identified.

To respond to the request for TA support, NI worked closely with the NNC and UNICEF using a cost-sharing approach and contracted an experienced consultant who led a team on a short-term basis to deliver this TA between August to December 2016. The team consisted of a lead consultant, two member consultants and two support staff. A core group was formed to work on the plan, including the consultants and representatives from multiple sectors/agencies; government departments (health, agriculture, social welfare and development, and education); the National Economic and Development Authority; the Food and Nutrition Research Institute; and the NNC.

The TA team completed a situational analysis of the nutrition landscape through consultations, key informant interviews and focus group discussions in the capital city and six regions within four months. Sector and national-level consultative workshops were then held to disseminate and discuss key findings and feed into the development process of the CRF that was linked to the national plan. The team met with stakeholders through sector and national-level consultations to draft and finalise the plan, which was officially launched by the Government in May 2017.

The plan consists of 46 projects under 12 programmes as a framework for actions to be undertaken by member agencies of the NNC, other national government agencies and local units, non-governmental organisations, academic institutions and development partners over a six-year period. Eight of the programmes are nutrition-specific, one is nutrition-sensitive and three support initiatives to build an enabling environment.

The next stage is to build on the work completed under this TA with the formulation of regional and sector action plans. NI and other TA providers, along with the NNC, recognise that there is a need for a capacity building of the NNC to guide the regional administrations and sector partners in effectively designing, delivering and tracking priority nutrition actions at the regional level. There also is a need to build and enforce effective coordination among multiple nutrition agencies and partners. This next phase of TA will be long-term (24 months, ending December 2019) to operationalise the PPAN and advance the nutrition agenda and will be provided with support from NI, UNICEF and the NNC.

For more information on the Tajikistan Common Results Framework (CRF) visit this link.

For more information on the Philippines Plan of Action for Nutrition (PPAN: 2017-2022) visit this link.

References

GNR 2017a. Global Nutrition Report Nutrition Country Profile 2017: Tajikistan. Development Initiatives Poverty Research Ltd, UK. 2017 Global Nutrition Report - Global Nutrition Report

GNR 2017b. Global Nutrition Report Nutrition Country Profile 2017: Philippines. Development Initiatives Poverty Research Ltd, UK. https://www.globalnutritionreport.org/2017-country-profiles-asia/

¹Visit ENN's media hub for a podcast series on CRFs www.ennonline.net/mediahub/crf1 

²Countries covered by NI include: Bangladesh, Burkina Faso, DR Congo, Ethiopia, Indonesia, Kenya, Lao PDR, Malawi, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Philippines, Rwanda, Senegal, Tanzania, Uganda and Zambia.