National Nutrition Action Plan 2012-2017: Strategic Objectives and Activities, Summaries of Nutrition

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Nutrition Matters, Your Right, Your Role, Act Now MINISTRY OF PUBLIC HEALTH AND SANITATION REPUBLIC OF KENYA National Nutrition Action Plan 2012-2017 Nutrition is Key, take up your role, Act now iii List of Abbreviations and Acronyms ACSM Advocacy Communication and Social Mobilization AWP Annual Work Plan COTU Central Organization of Trade Unions BCC Behavior Change Communication BFCI Baby Friendly Community Initiative BFHI Baby Friendly Hospital Initiative BMI Body Mass Index CBO Community Based Organization CHANIS Child Health and Nutrition Information System CHEWs Community Health Extension Workers CHMT County Health Management Committee CHW Community Health worker CSO Civil Society Organization EBF Exclusive Breastfeeding ECD Early Childhood Development ERS Economic Recovery Strategy FKE Federation of Kenya Employers FNSS Food and Nutrition Security Strategy GoK Government of Kenya HIV Human Immunodeficiency Virus HMIS Health Management Information Systems HW Health Worker ICN International Conference on Nutrition IDA Iron Deficiency Anemia IEC Information, Education and Communication IFA Iron Folic Acid IYCF Infant and Young Children Feeding iv National Nutrition Action Plan 2012-2017 IYCN Infant and Young Children Nutrition KARI Kenya Agricultural Research Institute KDHS Kenya Demographic and Health Survey KEBS Kenya Bureau of Standards KEMRI Kenya Medical Research Institute KEPSA Kenya Private Sector Alliance KIHBS Kenya Integrated Household Budget Survey KIRDI Kenya Industrial Research and Development Institute KNBS Kenya National Bureau of Statistics M&E Monitoring and Evaluation MDG Millennium Development Goals MOA Ministry of Agriculture MOF Ministry of Fisheries MOGC&SS Ministry of Gender, Children and Social Development MOH Ministry of Health MOLD Ministry of Livestock Development MOT Ministry of Trade MTEF Medium Term Expenditure Framework MTP Medium Term Plan MUAC Mid-Upper Arm Circumference NFNSP National Food and Nutrition Security Policy NGO Non-Governmental Organization NNAP National Nutrition Action Plan SO Strategic Objective UN United Nations UNICEF United Nations Children Fund VAD Vitamin A Deficiency Nutrition is Key, take up your role, Act now v Foreword Malnutrition in Kenya remains a big public health problem. Kenya has high stunting rates (35%) and is currently experiencing a rise in diet-related non-communicable diseases, such as diabetes, cancers, kidney and liver complications that are attributed to the consumption of foods low in fibre and high in fats and sugars. This double burden on malnutrition is serious and without deliberate and concerted effort, will lead to increased loss of productivity and lives. The high burden of malnutrition in Kenya is not only a threat to achieving Millennium Development Goals (MDGs) and Vision 2030 but also a clear indication of inadequate realization of human rights. Reducing malnutrition in Kenya is not just a health priority but also a political choice that calls for a multi- sectoral focus driven by a political will that acknowledges the integral role that nutrition plays in ensuring a healthy population and productive workforce. Communities must be empowered to claim their right to good nutrition and guided to play their role towards realizing this right. The solutions to malnutrition are practical, basic and have to be applied at scale and prioritized in the national development agenda. Kenya has shown renewed commitment to nutrition which is well articulated in the Food and Nutrition Security Policy and Kenya Health Strategic Plan. Therefore, development of this National Nutrition Action Plan (NNAP) provides practical guidance to implementation of Kenya’s commitments to nutrition. The NNAP provides a framework for coordinated implementation of high impact nutrition intervention by government and nutrition stakeholders for maximum impacts at all levels. Most of these interventions are part of Scaling Up Nutrition (SUN) actions that are being implemented globally to accelerate efforts towards meeting MDG 4 and 5. The NNAP is aligned to government’s Medium Term Plans (MTPs) to facilitate mainstreaming of the nutrition budgeting process into national development plans, and hence, allocation of resources to nutrition programmes. The Ministry of Public Health and Sanitation shall be directly in charge of coordinating the implementation of the plan at the national level. However, under the new governance system in Kenya, there will be devolved coordination systems at the county levels, which will feed into the national level coordination unit. At each of the two levels, nutrition stakeholders will play a crucial role in execution of the plan. I call upon all of us to take action now. Hon. Beth Mugo E.G.H., MP Minister for Public Health and Sanitation viii National Nutrition Action Plan 2012-2017 The 14 priority nutrition areas spelt out in the Food and Nutrition Security Strategy (FNSS) provided a conceptual guide to the development of this Plan of Action, which further identifies 11 strategic objectives each with corresponding activities and expected outcomes as follows: i. Improve nutritional status of women of reproductive age (15-49 years): Improving the health of women of reproductive age is prioritized against the backdrop of worrying health trends among women. Nationally, one-quarter (25%) of women aged 15-49 are overweight or obese. This condition is largely associated with non-communicable dietary diseases such as hypertension and diabetes mellitus. Other nutritional conditions of concern among women include micronutrient deficiency. Intervention activities contributing to this strategic objective include; carrying out nutrition education on consumption of healthy foods during pregnancy and strengthening supplementation of iron and folate in pregnant women. These activities are expected to result in; reduced mortality, anemia, micronutrient deficiency, low birth weight and obesity. ii. Improve nutrition status of children under five: This is to be achieved through lead activities such as enhanced exclusive breastfeeding, timely introduction of complementary foods and micronutrient supplementation. The expected net effect of these interventions is reduced stunting, wasting, anemia, obesity, underweight and ultimately, infant mortality. iii. Reduce the prevalence of micronutrient deficiencies in the population: Prevalence of micronutrient deficiencies in the population is becoming a matter of concern to the government. This concern is the basis of inclusion of this strategic issue in the plan. Among the activities to be implemented to respond to this issue include; creating awareness on food fortification, supplementation and food based approaches as well as scaling up fortification of widely consumed food stuffs. Nutrition is Key, take up your role, Act now ix iv. Prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies. The population in ASAL areas, whom a large proportion are nomadic livestock keepers, are almost wholly dependent on their livestock for food security. In order to address the underlying causes of food insecurity and vulnerability for these populations, activities must be implemented which take into account the seasonality of food availability and the extent to which the health of livestock, conflict and migratory patterns influence their nutritional status. Some of these activities could include supplementation of livestock feed and water to enhance milk production and working closely with other ministries to enhance livelihood diversification and the safeguarding of animal health. v. Improve access to quality curative nutrition services. Nutrition care and support during illness is a key component of care which aims at preventing further deterioration of nutritional status and saving lives of persons affected. There is need to strengthen the capacity of institutions to provide optimal curative nutrition services. vi. Improve prevention, management and control of diet related NCDs. The Kenya Health Sector Development Plan has outlined a key objective on halting and reversing the rising burden of non communicable conditions. This it is to be achieved by ensuring clear strategies for implementation to address all the identified non communicable conditions in the country. It has been recognized that some of these NCDs are diet related and hence the need to provide guidance on prevention and control measures to reduce morbidity and mortality and save on health costs. vii. Improve nutrition in schools and other institutions: Improved nutrition in schools and other institutions is expected to contribute to the overall national efforts of promoting optimal nutrition. The activities proposed for action include; conducting a situation analysis on school/ institutional feeding and reviewing existing guidelines for school/institutional feeding to promote adequate nutrition. x National Nutrition Action Plan 2012-2017 viii. Improve knowledge, attitudes and practices on optimal nutrition: The importance of this strategic issue is to have provision of information as a precursor in adoption of positive attitude and practices on optimal nutrition by Kenyans. This is to be realized through development, dissemination and implementation of a national nutrition Information, Education and Communication/Behavior Change Communication (IEC/BCC) strategy. In addition, this would involve training service providers on IEC/BCC and advocacy skills. This strategic issue is expected to contribute to improved nutrition practices in the lifecycle/lifespan. ix. Strengthen the nutrition surveillance, monitoring and evaluation systems: Nutrition monitoring and evaluation systems will be strengthened to enhance benefits of standardized M&E tools for effective reporting and planning. Among the activities to be implemented include finalizing M & E framework for the nutrition sector based on this National Nutrition Action Plan (2012-2017). x. Enhance evidence-based decision-making through operations research: Evidence-based decision-making through operations research is to be enhanced for purposes of strengthening the foundation of informed nutrition programme development and service provision. xi. Strengthen coordination and partnerships among the key nutrition actors: The importance of harnessing synergy in the efforts of the nutrition stakeholders is recognized in this strategic issue. Identification of partners in WASH, education, health and livelihoods sectors with which partnerships can be formed will result in greater impact of nutrition activities implemented across the stakeholder sectors. All of the strategic issues presented as strategic objectives, their corresponding activities, indicators, implementers and time-frame are detailed in the matrix (Annex 1) in the plan. Chapter 1.0 Introduction 1.1 National Context Policy Framework Since the year 2003, Kenya has been building a solid foundation of becoming globally competitive and prosperous in its economy. These efforts have been realized through implementation of the Economic Recovery Strategy (ERS) covering the period 2003-2007. This strategy focused on restoration of economic growth, rehabilitation and expansion of infrastructure, equity and poverty reduction, and improving governance. It is the successful implementation of ERS that paved way for Vision 2030, which aims to transform Kenya into a globally competitive and prosperous nation with a high quality of life. The Vision 2030 has social, political governance and economic pillars. Under the social pillar, the health sector is identified as critical in maintaining a healthy working population, necessary for the increased labor production that Kenya requires in order to match its global competitors. Similarly, Kenya’s commitment to the realization of health-focused Millennium Development Goals (MDGs) 1, 3, 4, 5, 6 and 7 is expected to contribute to the goal of having a healthy population. Nutrition is critical for survival, health and development. Investing in nutrition will enable the country to make significant progress in achieving targets of MDGs 1, 4, 5, and 6 which are directly related to improvement of nutrition status of children and women the political governance pillar too, has direct bearing on the Kenyans’ health in general and nutrition in particular. One of the pillar’s successful flagship projects has been promulgation of the new constitution. Under the economic and social bill of rights, every Kenyan has a right to adequate food of acceptable quality as well as clean and safe water in adequate quantities. Further, the constitution stipulates that every child has the right to basic nutrition, shelter and healthcare. Enshrining the right to food, basic nutrition and healthcare in the constitution marks a radical shift in programme development and implementation around these issues. And the government takes greater responsibility in ensuring that the right is enjoyed by the Kenyans. Government of Kenya has developed the food and nutrition security policy an overarching policy to address nutrition security in the country. This policy places nutrition central to human development in the country; emphasizes the need to ensure of right to nutrition as a constitutional right, recognizes disparities in nutrition and provides relevant policy directions; ensures multi-sectoral approach to addressing malnutrition in the country; ensures life-cycle approach to nutrition security and ensures evidence based planning and resource allocation. The KHSSP’s goal is ‘accelerating attainment of health impact goals’. The sector aims to attain this through focusing on implementation of a broad base of health and related services that will impact on health of Kenya. Indeed the main emphasis will be placed on implementing interventions, and Nutrition Matters, Your Right, Your Role, Act Now 1Nut ition Ma ters, Your Right, Your Role, Act Now 2 National Nutrition Action Plan 2012-2017 prioritizing investments relating to maternal and newborn health, as it is the major impact area for which progress was not attained in the previous strategic plan. This Nutrition action plan recognizes the importance of the first 1000 days of a child’s life and aims to prioritize high impact nutrition interventions which will impact on reduction of morbidity and mortality. The High impact Nutrition interventions are recommended as part of Scaling Up Nutrition (SUN) Framework, with evidence from the Lancet series 2008 of well tested and low cost interventions which protect the nutrition of vulnerable individuals and communities and benefit millions of people if incorporated in food security, agriculture, social protection, health and educational programmes. With the growing burden of over nutrition, Kenya is committed to the 63rd WHA resolution to reduce 25% of premature deaths as result of NCDs by 2025, promote active aging and engage in partnerships to reduce NCDs. Reversing NCDs is also central to the KHSSP III health outcomes. 1.2 Nutrition Situation in Kenya According to the 2008-09 Kenya Demographic and Health Survey (KDHS), 35% of children under age of five years are stunted, 16% are underweight and 7% are wasted. Figure 1 indicates the trends of malnutrition among children under the age of five years from 1993 to 2008/09 which shows little or no improvement. Today in Kenya, an estimated 2.1 million children are stunted which is a serious national development concern as these children will never reach their full physical and mental potential. Regional disparities in nutrition indicators in Kenya are significant with North Eastern province having the highest proportion of children exhibiting severe wasting (8%) while Eastern province has highest level of stunted children (44%). As in many other parts of the world, children living in rural areas and children from poorer households in Kenya are more likely to be malnourished (KDHS 1998- 2008). In addition the proportion of wasted and underweight children is negatively correlated with the level of education, wealth and nutrition status of the mother. Figure 1: Malnutrition trends in Kenya by gender 0 10 20 30 % < 5 M al no ur is he d 40 35.2 32.9 30.8 22 22 20.7 5.9 6.4 6.7 30.8 27.7 28.3 22 17.7 19.8 6.2 4.8 4.9 KDHS 1998 KDHS 2003 KDHS 2008 KDHS 1998 Male Female KDHS 2003 UnderweightStunting Wasting KDHS 2008 KDHS 1998 KDHS 2003 KDHS 2008 Nutrition is Key, take up your role, Act now 3 Kenya is increasingly faced with diet-related non-communicable diseases, especially in urban areas. These are mainly caused by excessive energy intake associated with purchased meals and processed foods, and decreasing levels of physical activity in urban settings. Changing lifestyles and eating habits have resulted in non-communicable diseases including cardiovascular, cancers, diabetes which are closely related to obesity and represent a significant development challenge. The health consequences of obesity related diseases range from premature death to disabilities that reduce the quality of life. Evidence from the KDHS (2008-09) indicates increasing prevalence of overweight and obesity. Analysis of obesity among pre-school children indicates that approximately 18% are overweight while 4% are obese. The proportion of women aged 15-49 who are overweight and obese has increased from 23% in 2003 to 25% in 2008-09. Nairobi has the highest prevalence of overweight and obese at 41% among women and 3rd to 5th wealth quintile being the most affected. Being overweight and obese are risk factors for non-communicable diseases such as hypertension, diabetes and cardiovascular diseases. According to WHO 28 % of all deaths result from NCD’s. Currently, the prevalence of diabetes is 4.2%, while 12.7% of the population is hypertensive. Cancer incidence is estimated to be 28,000 annually, while the annual mortality is 21,000 people. Micronutrient deficiencies are highly prevalent among children under the age of five years and women. According to 1999 national micronutrient survey in Kenya, the most common deficiencies include vitamin A deficiency (VAD), iron deficiency anemia (IDA), iodine deficiency disorders (IDD) and zinc deficiency. Data on these deficiencies is as presented in figure 2. VAD among under fives (84.4%); IDA among 6-72 month olds (69%) and among pregnant women (55.1%); IDD (36.8%); and zinc deficiency among mothers (52%) and among children under 5 years (51%). Iron deficiency is emerging as the most common condition among non-target groups with the prevalence of the deficiency among adolescents in refugee camps estimated at 46% and 21.1% among school girls in western Kenya. Figure 2: Micronutrient Deficiencies in Kenya (National Micronutrient survey 1999) 100 0 10 20 30 40 50 60 70 80 90 35% 6% 55% 48% 73% 76% Stunting <5 yrs Goitre Anaemia Pregnant Women Anaemia Women (15-49 yrs) Anaemia <5 yrs Vitamin A Deficiency <5 yrs nN = =) 9 a ~ ° 1 < iy a Chapter 2 Nutrition Action Plan (2012-2017) 2.1 Background Information Since independence in 1963, the government of Kenya (GoK) has developed policies and programmes to address nutrition issues based on the national situation analysis. International initiatives, too, have been crucial in shaping the direction of nutrition efforts in the country. For instance, the International Conference on Nutrition (ICN) held in Rome in December 1992, provided an opportunity for re-assessment of Kenya’s nutrition strategies, thereby forming a strong basis for the development of 1994-1997 National Nutrition Action Plan (NNAP) for Kenya. Lessons learnt from the implementation of the 1994-1997 NPA as well as the assessment of the existing and emerging nutrition issues led to the formulation of the Food and Nutrition Security Policy (FNSP) and implementing of its strategy in the year 2008. The Food and Nutrition Security Strategy highlights fourteen (14) priority nutrition areas to be addressed towards achieving the bigger nutrition agenda in Kenya. The priority areas include; micronutrient deficiency prevention and control, nutrition promotion, Institutional feeding, nutrition and infection, diet- related non-communicable diseases, emergency management, recovery and long term management; and data collection and management on nutrition, cross-sectoral data analysis on food and nutrition and information, education and communication. The Strategy proposes implementation of nutrition interventions through a life-cycle approach. Lifecycle approach to nutrition challenges is defined as an evidence-based approach that explores nutritional foundations, the growth, development and normal functioning of individuals through each stage of life and/or at all age groups. The approach provides a detailed account of the nutritional needs throughout the life cycle and highlights the special nutritional features of each of these stages. The objectives of life cycle are to improve women’s nutrition throughout their lifecycle; promote optimal infant and young child feeding practices; promote appropriate nutrition for school children and adolescents; promote healthy lifestyles across the population; and improve nutrition care and support for the elderly. FSNS provides a conceptual guide to the development of this nutrition action plan which has further identified eleven (11) strategic objectives each with corresponding activity and expected outcomes. 7Nutrition Matters, Your Right, Your Role, Act Now 8 National Nutrition Action Plan 2012-2017 2.2 Rationale Situation analysis rates of child/infant mortality rates and maternal mortality) Maternal deaths have increased from 414/100,000 live births (KDHS 2003) to 488/100,000 live birth (KDHS 2008/9). No significant positive change is observed in most nutrition indicators over the last 10 years. This leads to not only mortality but also poor quality of lives. Improving nutritional status and reducing vitamin and mineral deficiencies are integral to achieving the Millennium Development Goals and the Kenya’s Vision 2030. While Kenya has adopted a set of high impact nutrition interventions1, the coverage of these interventions remains very low due to inadequate resources and low prioritization of nutrition as reflected by low investment in nutrition. Investment in nutrition programmes is not commensurate to its critical role in reducing child mortality. It has to be recognized that attainment of MDG Goals, meaningful economic development and achievement of the 2030 vision will not happen without an urgent improvement in nutrition. Nutrition interventions that have proven to be cost effective, feasible and to have impact by preventing malnutrition before it happens should be brought to scale. Therefore the Nutrition Action Plan is practical tool that presents an opportunity to accelerate action towards achieving MDGs and Vision 2030. The Nutrition Action Plan will also be used as a resource mobilization tool by nutrition stakeholders and a guide to investment to cost effective nutrition interventions. It is however appreciated that the achievement of the targeted MDGs by this Plan can only be realized if synergy in nutrition and other health programmes including water and sanitation, HIV&AIDS and malaria prevention and control is harnessed. This Plan is, therefore, to be implemented within the framework of integrated approach by the Ministry responsible for health. In addition, linkages with efforts in other development sectors notably agriculture, water, education and industry will be strengthened so as to contribute to the realization of targeted achievements by this Plan to address underlying causes of malnutrition. For each of the key intervention activities identified in the activity matrix of the Plan, there are lead implementing and supporting agencies. This is to ensure that lead agencies are held accountable for the implementation of the Plan. The Plan is aligned to the government’s Medium Term Plans (MTPs) to ensure that the government factors the Plan’s intervention activities into its planning and budgeting processes, leading to allocation of financial resources to nutrition programme activities. 1 High Impact Interventions adopted in Kenya include: Breastfeeding promotion, complementary feeding for infants after the age of six months, improved hygiene practices included hand washing, Vitamin A supplementation, zinc supplementation for diarrhea management, multiple micronutrient, de-worming, iron-folic acid supplementation for pregnant women, salt iodization , iron fortification of staple foods, prevention or treatment for moderate under nutrition and treatment of severe acute malnutrition 11Nutrition is Key, take up your role, Act now The main causes of malnutrition among WRA include sub-optimal feeding practices especially during pregnancy, heavy workload, and low micronutrient intake during pregnancy. The plan focuses on activities that will ensure that women of reproductive age receive adequate micro and macro nutrients. Priority Areas • Promote healthy dietary practices among WRA • Promote adequate micronutrient intake • Promote routine weight monitoring and appropriate counseling for pregnant women • Promote appropriate management of malnutrition of pregnant and lactating women • Ensure that all HIV positive mothers are counseled on good nutrition practices. • Strengthen the capacity of health facilities to adequately offer maternal nutrition services. Expected outcome: Improved nutritional status of women of reproductive age. 2.4.2 Strategic Objective 2 To improve the nutritional status of children under 5 years of age Malnutrition remains a major threat to the survival, growth and development of children in Kenya. Poor nutrition in infancy and early childhood increases the risk of infant child morbidity and mortality, diminished cognitive and physical development marked by poor performance in school. Malnutrition also impacts on productivity later in life. One of the indicators used to assess progress towards MDG 1 and 4 is the prevalence of underweight among children under the age of 5 years old. Malnutrition in children can be attributed to a variety of factors including poor infant and young child feeding practices, poor maternal nutrition, low access to adequate and diversified diets, childhood illnesses and inadequate access to health and nutrition services. This Plan focuses on activities that will contribute to the exploitation of the critical ‘window of opportunity’ from pre-pregnancy until two years of age as endorsed in the 2010 UN summit resolution on nutrition. According to Lancet Nutrition Series published in 2008, if the package of Essential Nutrition Interventions is effectively accessed by mothers from the conception period and children up to two years of age and implemented on a wider scale, in the short run, infant mortality would reduce by 25%, maternal mortality by 20% and chronic malnutrition/stunting in children by 30%. Priority Areas • Promote exclusive breastfeeding for the first six months of baby’s life • Promote optimal complementary feeding with continued breastfeeding for at least two years • Provide appropriate micronutrient supplements to children under five years • Strengthen growth monitoring and promotion for children under five years of age • Strengthen referral mechanism and linkage between the community and health facility. • Develop a national monitoring plan for nutrition commodities • Ensure food safety of nutrition commodities. 12 National Nutrition Action Plan 2012-2017 Expected outcome: Improvement in nutritional status of children under the age of five years. 13Nutrition is Key, take up your role, Act now 2.4.3 Strategic Objective 3 To reduce the prevalence of micronutrient deficiencies in the population Micronutrient deficiencies are of public health concern due to their devastating effect on the physical and mental well-being of the population. They are also a risk factor for increased morbidity and mortality among children under five years, pregnant and lactating women. The main causes of micronutrient deficiencies include poor dietary diversification, infections such as malaria and food insecurity. There are national micronutrient guidelines highlighting key strategies used in prevention and control of micronutrient deficiencies. These include supplementation, food fortification, and promotion of dietary diversification and public health measures such as de-worming and malaria control. The National Micronutrient Deficiency Control Council and the Kenya National Food Fortification Alliance are the national coordinating structures for the micronutrient deficiency control program. Some of the programmatic challenges experienced are inadequate resources, documentation and monitoring, stock outs of commodities and inadequate knowledge on importance of micronutrients among health service providers and the general population. This strategic objective, therefore, focuses on the need to ensure that the population receives adequate amounts of micronutrients, through dietary diversification, supplementation and fortification at all levels in the country. Priority areas • Review, develop and implement national micronutrient deficiency control strategy and guidelines • Capacity building of service providers on micronutrients deficiency prevention and control • Advocate and create awareness on food fortification, supplementation and dietary diversification • Strengthen the national food fortification program • Strengthen the national micronutrient supplementation program • Strengthen monitoring and evaluation systems for the micronutrient strategies • Integrate micronutrient prevention and control strategies in the community strategy Expected Outcome: Reduced prevalence of micronutrient deficiencies in the population. 2.4.4 Strategic Objective 4 To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies The main catastrophes that lead to emergencies in Kenya include drought, flood, fires, landslides and internal and cross-border civil strife. These emergencies result in loss of human lives, livestock, and livelihoods, and deterioration of health and nutrition status of the affected population. Children, women and the elderly are most vulnerable groups during the crisis period and therefore require urgent attention. Nutrition Technical Forum (NTF) is the national coordinating structure for the food security and emergency nutrition program in the nutrition sector. At district level, the districts NTFs have the same mandate. However, these structures require strengthening for effective emergency preparedness and response. Other challenges that require attention include weak multi-sectoral coordination of efforts 16 National Nutrition Action Plan 2012-2017 2.4.6 Strategic Objective 6 To improve prevention, management and control of diet related Non Communicable Diseases The prevalence of diet related non-communicable diseases has been on the increase, especially in urban area. This increase has been caused by lifestyle changes characterized by excessive intake of highly refined and high-fat foods, sugar and salt, coupled with limited physical activity. As a result, the burden of morbidity, disability and mortality attributable to these diseases is high. Being overweight and obese are risk factors for non-communicable diseases such as hypertension, diabetes and cardiovascular diseases. Some of the key programmatic challenges include inadequate data collection and reporting, limited screening of the population, inadequate knowledge among health care provider and general population, resource constraints and lack of comprehensive strategy and guidelines for prevention, management and control of diet related NCD. This strategic objective addresses the need to promote healthy diets and physical activity across the population using the lifecycle approach with the view of reversing the rising trends of non communicable diseases. Priority Areas • Review, develop and implement comprehensive strategy and guidelines for prevention, management and control of diet related NCDs • Capacity building for service providers on prevention, management and control of diet related NCDs • Create public awareness on the importance of prevention, management and control of diet related NCDs using the national ACSM • Strengthen coordination mechanisms for healthy diet and lifestyle programs at national and county level • Strengthen monitoring and evaluation systems for diet related NCDs. Expected outcome: Improved prevention, management and control of diet related NCDs. 17Nutrition is Key, take up your role, Act now 2.4.7 Strategic Objective 7 To improve nutrition in schools, public and private institutions Though policies and guidelines exist, they are inadequate in coverage of the institutions. In addition, the guidelines are not adequately adhered to in realization of optimal nutrition in schools and other institutions in Kenya, therefore, presenting a serious challenge. This may partly be attributed to inadequacy in adherence to nutrition policies and guidelines that are in place. In addition, it is possible that there is inadequate knowledge on optimal nutrition within institutions. Malnutrition in early childhood affects school enrolment, retention, and overall performance. Good nutrition is therefore, essential to realize the learning potential of children and to maximize returns to educational investments. Nutrition education and promotion of good nutrition practices in schools are known to have a significant effect in fostering healthy eating habits. Schools provide an ideal setting to promote good nutrition practices early in life since they reach a high proportion of children and adolescents. The School Health and nutrition policy emphasizes the promotion of school gardens to enhance integration of nutrition interventions into routine school activities. However there is need to fully implement the school health and nutrition policy and scale up activities in the counties in order to strengthen the nutrition component. The nutritional challenge facing various institutional dietary needs are related to the quantities and types of food provided (quality). There is need to ensure that energy, protein, vitamin and minerals are provided in the diets, to meet the Recommended Dietary Allowances (RDA) of individuals. In the face of these challenges, schools and other institutions need support to provide effective nutrition knowledge, care and nutritious food. Working with local communities to involve administrators, civil society, private sector and media is also vital in addressing these challenges. 18 National Nutrition Action Plan 2012-2017 Priority areas • Review, develop and implement nutritional guidelines for schools and other institutions. • Mobilize nutrition stakeholders’ commitment towards sustaining institutional feeding programmes • Integrate nutrition education in school curriculum at all levels. • Mainstream basic nutrition training in all schools and other institutions • Implement appropriate nutrition interventions in schools and other institutions • Strengthen monitoring and evaluation of nutrition interventions in school and other institutions Expected outcome: Improved nutritional status of the population in schools and other institutions. 2.4.8 Strategic Objective 8 To improve nutrition knowledge attitudes and practices among the population Nutrition knowledge is a key aspect in confronting the problem of malnutrition at all levels of society and in all sectors. It enables families and individuals to enhance their understanding of the importance of nutrition and as a result to improve their nutritional situation. Myths and misconceptions about nutrition exist within the communities that affect the health of populations. There is often a misconception that food availability is equal to nutritional adequacy and better levels of nutritional status. There is inadequate understanding of appropriate care practices and linkage with actual illnesses and death, not only in the general community but also among health workers. Specifically, when children fall sick or die, the causes are not attributed to malnutrition but broadly associated with diarrhoea, pneumonia, infections or other cultural beliefs. 21Nutrition is Key, take up your role, Act now Implementation of nutrition interventions by different sectors is not well coordinated resulting in duplication of efforts. Nutrition programmes therefore need to look beyond the health sector and must be addressed through integrated approach for successful achievement of its goal. The success of this Nutrition Plan therefore depends, to a large degree, on multi-sectoral coordination of actions in nutrition at all levels. Priority Areas • Strengthen multi-sectoral coordination mechanisms and networks for nutrition at all levels. • Setting of clear mandates and responsibilities for nutrition stakeholders at different levels. • Advocate and mobilize financial and human resources for nutrition coordination and partnership activities at all levels • Hold and document regular joint planning and review meetings to align the annual nutrition planning process to the nutrition action plan. Expected outcome Increased human, financial and material resource allocation for nutrition interventions. 2.4 Coordination Coordination of implementation of this Plan shall fall within the coordination mechanism of the agreed upon Food and Nutrition Security Strategy 2012. Under this Strategy, the Ministry responsible for health shall be directly in charge of coordinating the implementation of this National Nutrition Action Plan at national level through Nutrition Interagency Coordinating Committee (NICC) and the technical working groups. However, under the new governance system in Kenya, there will be devolved coordination mechanisms at the county levels. Each county and ward will have its own Food and Nutrition Security Secretariats. The role of the county and ward Secretariats will be to coordinate and monitor all food and nutrition activities in their respective geographical areas. Ward secretariat will report to the County secretariat which in turn will report to the National Food and Nutrition Security Secretariat. At all the levels, nutrition stakeholders will play a crucial role in the execution of this NNAP through established coordination structures. The coordination activities will entail, among others; • Receiving progress report on the implementation of the Plan and organizing for dissemination among the stakeholders for informed decision-making • Organizing forums for experience sharing by the stakeholders on best-practices • Monitoring and Evaluation of the implementation of NNAP • Providing enabling environment for the implementation of the NNAP by the stakeholders; this will entail resource mobilization towards implementation of the Plan as well as influencing policies and legislations that support implementation of the Plan. 22 National Nutrition Action Plan 2012-2017 23Nutrition is Key, take up your role, Act now Chapter 3 Monitoring and Evaluation Plan A system for monitoring and evaluation (M&E) is a critical component of the implementation of this Action Plan as such a system will enable tracking of programme implementation. The Nutrition M&E framework 2012-2017 developed in line with this action plan will aim at meeting the information needs of different stakeholders; that is policy makers, donors, Civil Society Organization (CSOs), research and academic institutions, development partners, media and the general public. The objective of M&E is to inform decision-making in the areas of accountability, activity implementation, allocation of resources and policy at National, County, sub-county and Health facility level. In order to achieve this objective various stakeholders in the implementation of the Plan of Action, will be encouraged to; • Ensure timely availability of data • Analyze the data, disseminate and promote use of the findings • Ensure proper storage, reliable access and ease retrieval by different users Further, the M&E for this action plan; • Integrates and utilizes National M & E systems including District Health Information software (DHIS) and Kenya demographic health surveys (KDHS) to ensure adequate provision of more disaggregated data so as to facilitate monitoring and evaluation at all levels. • Aims to collect and analyze qualitative information and increase participatory monitoring. • Is guided by operational research and analysis programmes to evaluate changes towards desired outcomes and targets 3.1 Monitoring Monitoring is the process of collecting data on on-going programme/project/activity analyzing, interpreting and using it to modify implementation so that it (implementation) proceeds according to plan. Monitoring of the activities in the action plan will be done through routine collection, collation, analyzing, interpretation and dissemination of data using standardized tools. The frequency of monitoring the activities will be undertaken monthly, quarterly and annually. 26 National Nutrition Action Plan 2012-2017 27Nutrition is Key, take up your role, Act now Chapter 4 Annexes Annex 1: Activity Implementation Matrix Strategic Objective 1: To improve the nutritional status of women of reproductive age (15-49 years) Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % reduction of Vitamin A deficiency among women of reproductive age. % reduction of iron deficiency among women of reproductive age. % reduction of iodine deficiency among women of reproductive age. % reduction of overweight and obesity among women of reproductive age. % reduction of zinc deficiency among women of reproductive age. % reduction underweight among women of reproductive age. % of pregnant women who take iron and folic acid supplements for at least 90 days during pregnancy. • Provide IFA supplements to adolescent girls and pregnant women. County MOH MoE, Development , Implementing partners % of pregnant and lactating women with MUAC < 21 cm receiving supplementary food. • Provide supplementary foods to pregnant and lactating women according to the admission criteria on integrated management of acute malnutrition guidelines. County MOH KEMSA, Development , Implementing partners % of pregnant women monitored for their weight. • Conduct routine weight Monitoring and appropriate counseling for the pregnant women County MOH Development , Implementing partners, Proportion of health facilities with nutrition commodities and equipment for maternal nutrition interventions • Procure and distribute nutritional commodities and equipment to health facilities. National / County MOH KEMSA, Development , Implementing partners, • Conduct nutrition education on healthy dietary practices to Women of reproductive age. County MOH Development , Implementing partners, Media No. of maternal nutrition guidelines disseminated in use at county level • Review, develop, print and disseminate and distribute guidelines National MOH Development , Implementing partners, Media 28 National Nutrition Action Plan 2012-2017 Strategic Objective 2: To improve the nutritional status of children under 5 years of age Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % reduction of children <5 years with malnutrition (stunting, wasting, underweight , obesity) % reduction of children< 5 years who are micronutrient deficient ( iron, vitamin A, zinc, Iodine), % of Health facilities certified as Baby Friendly % of community units that are implementing Baby Friendly Community Initiative % of infants who are breastfed within one hour of birth % of children < 6 months who are breastfed exclusively % of companies/ suppliers complying with the Code of Marketing of Breast Milk Substitutes % of agencies/ companies which support breastfeeding in the workplace • Scale up Baby Friendly Hospital Initiative (BFHI) Health facility Community MOH Implementing & Development partners • Baby Friendly Community Initiative (BFCI) Health facility/ MOH Development , Implementing partners, Ministry of Gender & Social Services, Media Civil Society • Sensitize women of reproductive age (WRA) Community MOH Development , Implementing partners, Ministry of Gender & Social Services, Media Civil Society • Sensitization on the importance of exclusive breastfeeding for the first six months of baby’s life County MOH Development , Implementing partners, Ministry of Gender & Social Services, Media Civil Society • Support monitoring of the Code of Marketing of Breast milk Substitutes Health facility/ Community MOH Development , Implementing partners, Ministry of Gender & Social Services, Media, Justice Civil Society • Advocate workplace support of breastfeeding mothers. National /County MOH Development , Implementing partners, Ministry of Gender & Social Services, Media, Justice Civil Society 31Nutrition is Key, take up your role, Act now Strategic Objective: 3. To reduce the prevalence of micronutrient deficiencies in the population Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies decreased prevalence of micronutrients deficiencies decreased prevalence of Vitamin A deficiency by 5% decreased prevalence of iron deficiency by 10% decreased prevalence of iodine (goiter rate) deficiency by 1% Increase in the population knowledge on micronutrient deficiency and curative and preventive measures # of health workers at all levels trained on prevention, management and control of micronutrient deficiencies. • Review, develop and disseminate national micronutrient deficiency prevention and control strategy and guidelines. National and County MOH KEMRI, KNBS Institutions of Higher Learning, Development , Implementing partners, • Train service providers on micronutrients deficiency prevention and control strategies including logistic and supply chain management County MOH Institutions of Higher Learning, Development , Implementing partners No. of advocacy workshops on micronutrient interventions conducted at all levels No. of micronutrient intervention campaigns (Radio, TV, Community etc) launched. • Advocate and create public awareness on food fortification, supplementation and dietary diversification. County MOH KNFFA members, Media , Industry Proportion of U5 children who receive multiple micronutrient supplements % U5 children supplemented with vitamin A % of women of reproductive age supplemented with iron and folic acid • Scale up and strengthen the existing strategies of micronutrient supplementation at all levels. County MOH CHMT, County Government, MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners • Procure and distribute micronutrient supplements (VAS, MNPs and IFA). National and County MOH KEMSA, CHMT, County Government, Development , Implementing partners 32 National Nutrition Action Plan 2012-2017 Strategic Objective: 3. To reduce the prevalence of micronutrient deficiencies in the population Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies decreased prevalence of micronutrients deficiencies decreased prevalence of Vitamin A deficiency by 5% decreased prevalence of iron deficiency by 10% decreased prevalence of iodine (goiter rate) deficiency by 1% Increase in the population knowledge on micronutrient deficiency and curative and preventive measures % of households consuming adequately fortified foods in the country • Scale up fortification of widely consumed food stuffs. National /County Kenya National Fortifi- cation Alliance MOH, MOT, MOF, Media. % of widely consumed basic commodities which are fortified with necessary micronutrients No. of private sector actors/industries fortifying their foods products as per the national guidelines. • Monitor the quality of fortified foods regularly at all levels. National and County KEBS MOH, Media. • Conduct M&E of micronutrient deficiency prevention and control interventions County KEMRI MOH, CHMT, County Government, Development , Implementing partners • Train CHEWs and CHWs on micronutrient deficiency prevention and control strategies. County MOH CHMT, County Government, Academia, Development , Implementing partners • Review of policy to include use of CHWs in delivery of micronutrient supplements. National MOH Academia, Development , Implementing partners 33Nutrition is Key, take up your role, Act now Strategic objective 4: To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies Improved nutritional status of populations in emergencies. Reduced morbidity and mortality of the affected population Proportion of counties with emergency nutrition response plans • Build the capacity of the counties to develop nutrition response plans National and County MOH CHMT, County Government, Academia, Development , Implementing partners • Review, develop and disseminate guidelines for disaster preparedness, response and management of nutrition emergencies National and County MOH CHMT, County Government, Academia, Development , Implementing partners Number of counties reporting on a timely basis on nutrition surveillance • Conduct nutrition surveillance in emergency affected areas County MOH Implementing partners Number of counties holding regular coordination meetings. • Map partners, review and develop TORs County MOH CHMT, County Government, Academia, Development , Implementing partners • Hold and document regular joint planning and review meetings County MOH CHMT, County Government, Development , Implementing partners Proportion of facilities experiencing no stock-outs of essential nutrition commodities • Timely provision of food and non-food items County MOH MOF, KEMSA CHMT, County Government, Academia, Development , Implementing partners 36 National Nutrition Action Plan 2012-2017 Strategic objective 5: To improve access to quality curative nutrition services Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies Proportion of population accessing curative nutrition services Number of agencies integrating nutritional care standards in their plans Proportion of resources committed to nutrition care services Number of health workers trained on curative nutrition services Number of community individuals and private sector players sensitized on quarterly basis Proportion of health facilities providing curative nutrition services Proportion of facilities experiencing no stock-outs of essential nutrition commodities Reduced inpatient length of stay • Review, develop and disseminate national guidelines on nutritional care in the management of common diseases National MOH MOF, KEMSA, CHMT, County Government, MOF, MOA, MOE, MOW, Development , Implementing partners • Mobilize resources for nutritional care and treatment for common diseases National MOH CHMT, County Government, Academia Development , Implementing partners • Train health workers on clinical nutrition management National and County MOH MOF, CHMT, County Government, MOA, MOE, MOW, Development , Implementing partners • Procure and distribute essential nutrition commodities (micronutrient supplements, therapeutic milks and feeds) and equipments (anthropometric and others) National MOH MOF, KEMSA Development , Implementing partners National nutrition commodities monitoring plan developed and disseminated for use by the counties • Develop and disseminate nutrition commodities monitoring plan National MOH KEMSA, Development , Implementing partners 37Nutrition is Key, take up your role, Act now Strategic objective 5: To improve access to quality curative nutrition services Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies Proportion of population accessing curative nutrition services Proportion of counties implementing the nutrition commodities monitoring plan • Monitor food safety of nutrition commodities National and County MOH KEMSA, CHMT, County Government, Academia Development , Implementing partners • Conduct M&E of curative nutrition services County MOH KEMRI, Development , Implementing partners 38 National Nutrition Action Plan 2012-2017 Strategic objective 6: Halt and reverse the prevalence of diet related non communicable diseases. Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % reduction of incidences of non- communicable diseases. % of population screened for non- communicable diseases % reduction of population prevalence rates for obesity and overweight. % of population with normal range BMI. % of households consuming diversified diets. Proportion of counties implementing nutrition guidelines on NCDs Proportion of the population who are screened for non-communicable diseases. Proportion of Counties conducting sensitization meetings on healthy diets and physical activity % no. of population whose BMI is monitored regularly • Review, develop and disseminate a comprehensive strategy and guidelines for prevention, management and control of diet- related NCDs Health facility/ Community MOH Academia, MOA, Development , Implementing partners • Train service providers on prevention, management and control of diet- related NCDs Health facility/ Community MOH Academia, MOA, Development , Implementing partners • Create public awareness on the importance of prevention, management and control of diet- related NCDs County Health facility/ MOH Academia, MOA, Media Development , Implementing partners 41Nutrition is Key, take up your role, Act now Strategic objective 7: To improve nutrition in schools, public and private institutions Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % of pupils in Primary Schools with adequate nutrition status. % population in public institutions with adequate nutrition status Number of counties holding stakeholders’ meetings on sustainable institutional feeding programmes • Mobilize resources to sustain optimal institutional feeding programmes County MOE MOH, MOF, Children Department, Development , Implementing partners • Integrate nutrition education in school curricula at all levels National KIE MOH, MoE, Children Department, Development , Implementing partners Proportion of counties monitoring nutrition interventions in schools and institutions • Conduct M&E of nutrition interventions in schools and other institutions County MOE MOH, Children Department, Development , Implementing partners 42 National Nutrition Action Plan 2012-2017 Strategic objective 8: To improve nutrition knowledge attitudes and practices among the population Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % of population adopting healthy diets and lifestyle Formative and periodic assessment reports available and disseminated • Conduct situation analysis on school/ institutional feeding including the Early Childhood Development Education Centres(ECDE), Daycare centres National and County MOH KEMRI, KNBS Institutions of Higher Learning, Development , Implementing partners, Proportion of Counties implementing ACSM strategy • Develop, print and disseminate national nutrition advocacy, communication and social mobilization (ACSM) strategy at all levels National MOH Development , Implementing partners Proportion of service providers trained on nutrition communication and advocacy skills • Train service providers on communication and advocacy skills County MOH Development , Implementing partners Number and type of nutrition communication materials developed and disseminated at all levels • Review, develop, print, disseminate and distribute IEC materials National / County MOH Development , Implementing partners Proportion of counties marking Nutrition Days • Mark national/ international Nutrition Days (World Breastfeeding Week, African Food and Nutrition Security Day, Iodine Deficiency Disorders Day, Malezi Bora among others) National / County MOH Development , Implementing partners, Media Civil Society Proportion of media houses disseminating nutrition messages • Promote optimal nutrition through all channels of communication at all levels National and County MOH Development , Implementing partners, Media Civil Society 43Nutrition is Key, take up your role, Act now Strategic objective 9: To strengthen the nutrition surveillance, monitoring and evaluation systems Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies % health facilities nationwide conveying accurate and complete monitoring data to central level # Of core nutrition indicators included in HIS, NMEF, MTEF planning and budgeting framework. Coordination and information exchange strengthened among nutrition stakeholders. • Launch and Implement M & E framework for the nutrition sector National MOH KEMRI, KNBS Development , Implementing partners # Core nutrition indicators integrated into HIS, KNBS, NMEF for Vision 2030 • Define and Integrate core Nutrition indicators in HIS/ KNBS/NMEF- VISION 2030 National MOH KEMRI, KNBS Development , Implementing partners Surveillance protocol and reporting formats disseminated and implemented. • Review, develop and disseminate guidelines and tools on surveillance, M&E. National MOH KEMRI, KNBS Development , Implementing partners Surveillance protocol and M&E tools (reporting formats etc.) available online. • Conduct data audits at all levels. National and County MOH KEMRI, KNBS Development , Implementing partners Number of nutrition bulletins disseminated annually # of nutrition stakeholder forum held at county level to support and strengthens feedback mechanisms. • Develop and disseminate quarterly nutrition bulletins. National and County MOH KEMRI Development , Implementing partners • Hold feedback meetings among nutrition stakeholders at all levels National and County MOH Development , Implementing partners • Update and maintain national n utrition website National MOH Development , Implementing partners Number of nutrition M&E tools disseminated • Review, and disseminate Nutrition M&E tools based on new information. National MOH KEMRI Development , Implementing partners 46 National Nutrition Action Plan 2012-2017 Strategic objective 11: To Strengthen coordination and partnerships among the key nutrition actors Outcome Indicator Output Indicator Activity Implementation level Lead Agency Other Agencies Increased human, financial and material resources allocation by government and partners to support nutrition activities. Number of inter- and intra-sectoral coordination meetings held at all levels • Map partners, review and develop TORs National and County MOH MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners Number of functional nutrition coordination committees in place and executing their mandates at all levels Number of new partners supporting nutrition activities at all levels. Proportion of counties integrating nutrition priorities in their county plans • Hold and document regular joint planning and review meetings to align the annual nutrition planning process to the nutrition action plan. National / County MOP MOH, MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners % of the resource mobilized for nutrition activities from government and partners against the budget activities. • Mobilize financial and human resources for nutrition interventions at all levels National / County MOH CHMT, County Government, MOA, MOL, MOF, MOW, MoGC&SS, MoE, Development , Implementing partners Nutrition is Key, take up your role, Act now 47 Annex 2: Performance Monitoring and Evaluation Plan Output indicators Outcome indicators Baseline Year Baseline Value 2011/12 Target 2012/13 Target 2013/14 Target 2014/15 Target 2015/16 Target 2016/17 Target Source of data % of children < 5 years stunting 2008/9 35 30 25 20 15 14 14 KDHS 2008/9 WHO 2010 MDG status report 2010: p9 % of children < 5 years wasting 2008/9 6 5 4 3.5 3 2 2 KDHS Under- weight lev- els among children <5 years 2008/9 16 15 13.5 12 11.5 10.5 10 KDHS Children <5 years with obes- ity 2008/9 22 22 21.8 21.6 21.3 21.0 19.5 KDHS Iron deficiency among children <5 years 1999 69 50 45 40 35 30 25 MI Survey * Targets to be set based on findings of proposed MI survey of 2011 Vitamin A deficiency among children<5 years 1999 84.4 60 50 40 30 20 15 MI surveys * Targets to be set based on findings of proposed MI survey of 2011 Zinc deficiency among children<5 years 1999 51 45 40 35* 30 25 20 MI surveys * Targets to be set based on findings of proposed MI survey of 2011 48 National Nutrition Action Plan 2012-2017 Output indicators Outcome indicators Baseline Year Baseline Value 2011/12 Target 2012/13 Target 2013/14 Target 2014/15 Target 2015/16 Target 2016/17 Target Source of data % of health facilities that are BFHI certi- fied Carry out baseline as- sessment Set base- line value based on the assess- ment 8 12 16 20 24 28 Periodical nutrition assess- ments. -IYCF draft strat- egy (2011- 2015) % com- munity units that are imple- menting BFCI Carry out baseline as- sessment baseline value based on the assess- ment 8 12 16 20 24 28 Periodical nutrition assess- ments -% of infants initiated on breastfeed- ing within one hour of birth 2008/09 58 64 66 68 70 72 74 Periodical nutrition assess- ments; KDHS -% of children under six months on exclusive breastfeed- ing 2008/09 32 41 44 47 50 53 56 Periodical nutrition assess- ments KDHS % of chil- dren (6-8) months) who are introduced to com- plementary foods 2008/09 83.9 88 89.7 91.4 93.1 94.8 96.5 Periodical nutrition assess- ments % of chil- dren 6 to 23 months consum- ing 3+ or 4+ food groups in a day (dietary diversity) 2008/09 39 49.5 53 56.5 60 63.5 67 Periodical nutrition assess- ments KDHS % of children contin- ued with breastfeed- ing up to 24 months 2008/09 Periodical nutrition assess- ments % of chil- dren under five years whose growth is tracked by health facilities Carry out assess- ment to determine baseline Set base- line value from as- sessment Set AWP targets towards achieving year 2015 target Health fa- cilities track growth of 15 % of the under five children Set AWP target towards year 2017 target Health fa- cilities track growth of 18 % of the under five children Periodical nutrition assess- ments Nutrition is Key, take up your role, Act now 51 Output indicators Outcome indicators Baseline Year Baseline Value 2011/12 Target 2012/13 Target 2013/14 Target 2014/15 Target 2015/16 Target 2016/17 Target Source of data % of preg- nant and lactating moth- ers with MUAC< 21cm receiving supple- mentary food Conduct baseline as- sessment Establish baseline value from the assess- ment Set AWP targets towards achieving year 2015 target 12% of pregnant and lactating mothers (MUAC<21cm) having received supple- mentary food for the last six months preceding the assess- ment Set AWP targets towards achieving year 2017 target 12% of pregnant and lactating mothers (MUAC<21cm) having received supple- mentary food for the last six months preceding the assess- ment Periodical nutrition assess- ments % of people who adopt positive nutrition practices Conduct baseline assess- ment to determine KAP on nutrition Set nutri- tion KAP baseline value from the assess- ment 3% of the popula- tion adopt positive nutrition practices Set AWP targets towards achieving year 2017 target 4% of the popula- tion adopt positive nutrition practices KDHS Number of nutrition service providers trained and carrying out nutri- tion IEC/ BCC and advocacy activities Conduct inventory of nutrition service providers trained and car- rying out nutrition IEC/BCC activities Set baseline value from inventory 15% nutri- tion service providers trained and carrying out IEC/ BCC activi- ties 20% nutri- tion service providers trained and carrying out IEC/ BCC activi- ties Periodical nutrition surveys Reviewed national nutrition M & E framework in place Fully-func- tional M&E framework is in place Pro- gramme imple- mentation Progress reports Core nutrition indicators integrated into HMIS/ KNBS/ MEF-Vision 2030. Core nutri- tion indica- tors in identified national M&E sys- tems Pro- gramme imple- mentation Progress reports Surveil- lance guidelines developed & dissemi- nated All surveil- lance guidelines developed Pro- gramme imple- mentation Progress reports Guide- lines on validation, dissemina- tion and utilization of surveil- lance results in place All guide- lines in place Pro- gramme imple- mentation Progress reports 52 National Nutrition Action Plan 2012-2017 Output indicators Outcome indicators Baseline Year Baseline Value 2011/12 Target 2012/13 Target 2013/14 Target 2014/15 Target 2015/16 Target 2016/17 Target Source of data A func- tional M&E website in place Func- tional M&E website in place Pro- gramme imple- mentation Progress reports Number of tools designed and utilized All target tools developed and being used Pro- gramme imple- mentation Progress reports Number of nutrition managers and service providers trained and using M&E tools Open inventory of nutrition managers and service providers who will use the M&E tools Set the baseline from the inventory Set AWP targets towards achieving year 2015 target 7% of the nutrition managers and service providers using the M&E tools Set AWP targets towards achieving year 2017 target 10 % of the nutrition managers and service providers using the M&E tools Pro- gramme imple- mentation Progress reports Number of pupils and in-mates in institu- tions who receive nu- tritionally adequate meals Carry out baseline assessment to establish current prison and pupil population Set base- line value based on baseline as- sessment 5% of pupils and in-mates in institu- tions each receive nu- tritionally adequate meals at all times Set AWP targets towards achieving year 2017 target 10 % of pupils and in-mates in institu- tions each receive nu- tritionally adequate meals at all times KDHS, Periodical nutrition assess- ments Teachers pre-service curriculum with basic nutrition compo- nent Teachers pre-service Curriculum with basic nutrition compo- nent in place Periodical nutrition assessment Number of ECD cent- ers carrying out growth monitoring Carry out baseline as- sessment Set base- line value based on baseline as- sessment Set AWP targets towards achieving year 2015 target 7 % of ECD centers carrying out growth monitoring Set AWP targets towards achieving year 2017 target 10 % of ECD cent- ers carrying out growth monitoring KDHS, Periodical nutrition assess- ments Number of functional nutrition coordinat- ing com- mittees in place and execut- ing their mandate Open invention of nutrition coordinat- ing com- mittee and executing their man- date Set base- line based on the inventory 75% of coordinat- ing com- mittees in place and execut- ing their mandate Set AWP targets towards achieving year 2017 target 100% of commit- tees in place and execut- ing their mandate Pro- gramme progress imple- mentation reports Nutrition is Key, take up your role, Act now 53 Output indicators Outcome indicators Baseline Year Baseline Value 2011/12 Target 2012/13 Target 2013/14 Target 2014/15 Target 2015/16 Target 2016/17 Target Source of data Amount of different kinds of resources (funds* and human) available for imple- mentation of the Plan of Action Open in- ventory of resources (human and finan- cial) going towards imple- mentation of Action Plan Set base- line based on the inventory Set AWP targets towards achieving year 2015 75 % of the resources needed available for imple- mentation of the Plan of Action Set AWP targets towards achieving year 2017 target 85 % of the resources needed available for imple- mentation of the Plan of Action Pro- gramme progress imple- mentation reports * refer to the budget of the Plan of Action Number of nutrition networks established at national and county levels Conduct rapid assess- ment to determine status of networks Establish the base- line from assessment 75% of the target nutrition networks to have been formed at national and county levels Set AWP targets towards achieving year 2017 target 85% of the target nutrition networks to have been formed at national and county levels Pro- gramme progress imple- mentation reports Number and type of nutrition priority research studies conducted and dis- seminated among relevant nutrition stakehold- ers Carry out assess- ment to determine baseline situation Set base- line value based on assessment Research carried out on 40% of priority nutrition areas and the find- ings dis- seminated among nutrition stakehold- ers Set AWP target towards achieving year 2017 target Research carried out on 60% of priority nutrition areas and the find- ings dis- seminated among nutrition stakehold- ers Periodical nutrition pro- gramme assess- ments Number of institu- tions using evidence- based data for decision- making and program- ming on nutrition Carry out assess- ment to determine baseline situation Set base- line value based on assessment 45% of institutions make deci- sions on nutrition program- ming based on informa- tion from nutrition operations research Set AWP targets towards achieving year 2017 target 55% of institutions make deci- sions on nutrition program- ming based on informa- tion from nutrition operations research KDHS Periodical nutrition pro- gramme assess- ments Number of nutrition- based decisions made by agencies using in- formation generated through operations research Carry out assess- ment to determine baseline situation on key nutrition decisions made Set base- line value based on assessment 45% of nutrition based deci- sions made by agen- cies are informed by findings of nutrition operations research Set AWP targets towards achieving year 2015 target 65% of nutrition based deci- sions made by agen- cies are informed by findings of nutrition operations research KDHS Periodical nutrition pro- gramme assess- ments 56 National Nutrition Action Plan 2012-2017 Annex 3: Financial Resources Input in Kenya Shillings in Million Activities 2012/13 2013/14 2014/15 2015/16 2016/17 TOTAL Strategic Objective 1: To improve the nutritional status of women of reproductive age (15-49 years) Provide IFA supplements to adolescent girls and pregnant women. 275 305 315 315 315 1525 Provide supplementary foods to pregnant and lactating women according to the admission criteria on integrated management of acute malnutrition guidelines. 530 850 770 690 600 3440 Conduct routine weight Monitoring and appropriate coun- seling for the pregnant women 105 160 155 120 130 670 Procure and distribute nutritional commodities and equip- ment to health facilities. 950 1,400 1,300 1,300 1,150 6,100 Conduct nutrition education on healthy dietary practices to Women of reproductive age. 20 20 20 10 10 80 Review, develop, print and disseminate and distribute guidelines 25 30 20 20 10 105 Strategic Objective: 2. To improve the nutritional status of children under 5 years of age Scale up Baby Friendly Hospital Initiative (BFHI) 200 200 80 60 50 590 Baby Friendly Community Initiative (BFCI) 250 200 150 100 100 800 Sensitize women of reproductive age (WRA) on the impor- tance of exclusive breastfeeding for the first six months of baby’s life 35 30 30 30 25 150 Support monitoring of the Code of Marketing of Breastmilk Substitutes 10 6 7 8 10 41 Advocate workplace support of breastfeeding mothers. 20 10 10 10 10 60 Train and equip health workers to promote appropriate infant and young child feeding practices 200 110 115 120 125 670 Provision of BCC/IEC (ACSM) materials to the Health facili- ties and communities. 70 50 30 10 10 170 Sensitize WRA on timely introduction of optimal comple- mentary foods with continued breastfeeding for at least two years. 160 160 120 110 130 680 Promote proper hygiene practices, and timely seeking of health care. 25 25 25 25 25 125 Train HWs, CHEWs and CHWs on new growth standards and CHANIS 25 40 45 40 45 195 Equip Health Facilities and community units with anthropo- metric equipment 350 460 500 520 493 2,323 Provide monitoring and reporting tools (CHANIS, MCH booklet and job aids). 22 30 30 30 30 142 Increase coverage of children aged 6-59 months receiving Vitamin A supplements 80 120 140 130 140 610 Provide multiple-micronutrients powder for children under five years 500 650 680 750 753 3,333 Review, develop, print and disseminate and distribute guidelines 25 35 20 15 15 110 Train all health managers and service providers on use of DHIS and interpretation of M&E data 200 100 100 100 100 600 Conduct support supervision at all level. 100 50 50 50 50 300 Procure and distribute equipment (Computers, printers, copiers, scanners and external hard discs) 200 150 150 50 50 600 57Nutrition is Key, take up your role, Act now Strategic objective 3: To reduce the prevalence of micronutrient deficiencies in the population Review, develop and disseminate national micronutrient deficiency prevention and control strategy and guidelines. 5 5 0 0 0 10 Train service providers on micronutrients deficiency pre- vention and control strategies including logistic and supply chain management 100 100 100 50 50 400 Advocate and create public awareness on food fortification, supplementation and dietary diversification. 20 15 10 5 5 55 Scale up and strengthen the existing strategies of micronu- trient supplementation at all levels. 100 150 150 100 100 600 Procure and distribute micronutrient supplements (VAS, MNPs and IFA). 1,800 2,000 2,100 2,300 2,500 10,700 Scale up fortification of widely consumed food stuffs. 152 204 356 508 660 1880 Monitor the quality of fortified foods regularly at all levels. 20 25 30 40 50 165 Conduct M&E of micronutrient deficiency prevention and control interventions 10 5 200 5 5 225 Train CHEWs and CHWs on micronutrient deficiency pre- vention and control strategies. 100 100 90 90 50 430 Review of policy to include use of CHWs in delivery of micronutrient supplements. 5 5 0 0 0 10 Strategic objective 4: To prevent deterioration of nutritional status and save lives of vulnerable groups in emergencies Build the capacity of the counties to develop nutrition response plans 50 50 0 0 0 100 Review, develop and disseminate guidelines for disaster preparedness, response and management of nutrition emergencies 30 35 15 15 10 105 Conduct nutrition surveillance in emergency affected areas 70 80 90 100 110 450 Map partners, review and develop TORs 12 2 2 2 3 21 Hold and document regular joint planning and review meetings 30 30 30 30 30 150 Timely provision of food and non-food items 950 1,200 1,350 1,400 1,350 6,250 Scale up delivery of essential nutrition services (High Impact Nutrition Interventions) 80 120 140 150 140 630 Capacity strengthening of health workers to provide nutri- tion care and support at all levels 50 60 60 80 80 330 Mobilize resources for emergency response 7 5 5 6 7 30 Develop, disseminate and implement the national monitor- ing plan for nutrition commodities in emergency 5 0 0 0 0 5 Monitor food safety of nutrition commodities for use in emergencies 10 5 5 10 10 40 Create public awareness on importance of nutrition in emergencies 5 2 3 3 3 16 Activities 2012/13 2013/14 2014/15 2015/16 2016/17 TOTAL 58 National Nutrition Action Plan 2012-2017 Strategic Objective 5: To improve access to quality curative nutrition services Review, develop and disseminate national guidelines on nutritional care in the management of common diseases 25 30 20 20 10 105 Mobilize resources for nutritional care and treatment for common diseases 5 3 4 5 6 23 Procure and distribute essential nutrition commodities (micronutrient supplements, therapeutic milks and feeds) and equipments (anthropometric and others) 2,300 2,600 2,700 2,900 3,130 13,630 Monitor food safety of nutrition commodities 8 5 5 5 5 28 Conduct M&E of curative nutrition services 11 7 8 9 10 45 Strategic objective 6: Halt and reverse the prevalence of diet related non communicable diseases. 0 Review, develop and disseminate a comprehensive strategy and guidelines for prevention, management and control of diet-related NCDs 25 25 15 20 20 105 Train service providers on prevention, management and control of diet-related NCDs 100 100 100 50 50 400 Create public awareness on the importance of prevention, management and control of diet-related NCDs 150 150 150 75 75 600 Map partners, review and develop TORs 10 0 0 0 0 10 Hold and document regular joint planning and review meetings 10 5 0 0 0 15 Conduct M&E of diet related NCDs 15 15 15 15 10 70 Conduct screening for non communicable diseases. 150 150 100 100 100 600 Scale up community screening for BMI and waist circumfer- ence 150 150 150 150 150 750 Strategic Objective 7: To improve nutrition in schools, public and private institutions Conduct situation analysis on school/ institutional feeding including the Early Childhood Development Education Centres(ECDE), Daycare centres 12 2 2 2 2 20 Review, develop and disseminate nutrition guidelines for school and other institutions 30 30 20 10 10 100 Mainstream basic nutrition training in all schools and other institutions 10 10 0 0 0 20 Implement appropriate nutrition interventions (school meals, micronutrient supplementation, nutrition assess- ment, de-worming among others) in schools and other institutions 700 800 500 500 500 3,000 Mobilize resources to sustain optimal institutional feeding programmes 8 7 5 3 3 26 Integrate nutrition education in school curricula at all levels 10 10 0 0 0 20 Conduct M&E of nutrition interventions in schools and other institutions 25 25 25 25 20 120 Activities 2012/13 2013/14 2014/15 2015/16 2016/17 TOTAL Nutrition is Key, take up your role, Act now 61 62 National Nutrition Action Plan 2012-2017 References 1. 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