FANTA III FOOD AND NUTRITION TECHNICAL ASSISTANCE Manual for Country-Level Nutrition Advocacy Using PROFILES and Nutrition Costing 1 1 3 Multi-Sectoral Nutrition Stakeholder Costing Involvement Nutrition 2 4 Advocacy PROFILES Workshop Workshop and Materials Development Food and Nutrition Technical Assistance III Project (FANTA) 1825 Connecticut Avenue, NW Washington, DC 20009 T: 202-884-8000 [email protected] www.fantaproject.org MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING This guide is made possible by the generous support of the American people through the support of the Office of Maternal and Child Health and Nutrition, Bureau for Global Health, U.S. Agency for International Development (USAID, under terms of Cooperative Agreement No. AID-OAA-A-12-00005, through the Food and Nutrition Technical Assistance III Project (FANTA), managed by FHI 360. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government. April 2018 Recommended Citation Sethuraman, Kavita; Kovach, Tara; Oot, Lesley; Sommerfelt, A. Elisabeth; and Ross, Jay. 2018. Manual for Country- Level Nutrition Advocacy Using PROFILES and Nutrition Costing. Washington, DC: FHI 360/Food and Nutrition Technical Assistance III Project (FANTA). Contact Information Food and Nutrition Technical Assistance III Project (FANTA) FHI 360 1825 Connecticut Avenue, NW Washington, DC 20009-5721 T 202-884-8000 F 202-884-8432 [email protected] www.fantaproject.org MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING Contents Introduction .................................................................................................................................... 1 STEP 1: Form a Multisectoral Core Working Group and Conduct a Stakeholder Meeting on Nutrition Advocacy Planning ............................................................................................................................. 7 Session Plans ................................................................................................................... 12 STEP 2: Conduct a PROFILES Workshop to Generate Estimates for Nutrition Advocacy Planning ........................................................................................................................... 21 Facilitator’s Guidance ...................................................................................................... 27 Session Plans ................................................................................................................... 96 STEP 3: Develop Cost Estimates for Nutrition Service Delivery, Present Preliminary Results, and Develop a Report Planning ......................................................................................................................... 139 Guidance on Undertaking Costing as an In-Country Nutrition Advocacy Planning Process ............................................................................................................ 143 STEP 4: Conduct a Workshop on Nutrition Advocacy Planning and Finalize a National Nutrition Advocacy Plan and Materials Planning........................................................................................................................ 161 Session Plans ................................................................................................................ 167 Templates, Handouts, and Scoreboards All Templates, Handouts, and Scoreboards ................................................................. 198 i MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING Introduction What is the purpose of the manual? What is nutrition advocacy? The Food and Nutrition Technical Assistance III Project (FANTA), funded by the U.S. Agency for Nutrition advocacy is a platform to create International Development and managed by FHI movement toward greater political and social 360, has created this manual for facilitation at the commitment for nutrition in a country. It is a country level of a comprehensive and consultative planned, systematic, and deliberate process nutrition advocacy planning process using that is defined and shaped by the specific PROFILES and nutrition costing. Using a collaborative approach, FANTA has facilitated country context. nutrition advocacy in several developing countries. During the past decade, the global nutrition The nutrition advocacy planning process used by FANTA as outlined in this manual was developed, community has been converging on a common expanded, and field-tested over several years to agenda to improve nutrition, built on be as effective and comprehensive as possible. previously separate efforts related to This nutrition advocacy planning process is based micronutrient deficiencies, breastfeeding on completing three key elements at various time promotion, complementary feeding, and points in the process. others. Efforts such as the World Bank’s What is included in the manual? strategy on “Repositioning Nutrition As Central to Development” in 2006, along with The manual includes tools in each step such as: the establishment of the U.N. Secretary- • Planning and facilitation notes General’s High-Level Task Force on Food and • Session plans for workshop and meeting Nutrition Security, the Copenhagen Consensus facilitators (which concluded that nutrition interventions • PowerPoint presentations were among the most cost-effective in • Templates and handouts for workshop and meeting participants development), and the Lancet series on • Timeline and staff needs maternal and child nutrition (which provided a • PROFILES Spreadsheet Workbook new evidence base for action on nutrition)—all in 2008—helped drive the formation of these Who should use this manual? movements. Specifically, initiatives such as the This manual is designed to be used by practitioners Scaling Up Nutrition Movement (SUN), REACH who work with government and nongovernment (Renewed Efforts Against Child Hunger), and institutions who are invited to undertake a the 1,000 Days Campaign have aspired to nutrition advocacy planning process in a given support country-owned, country-led strategies country. A key element of the process is to build consensus among stakeholders in country for a for addressing undernutrition. shared vision for nutrition. Practitioners who FANTA’s nutrition advocacy planning process would like to facilitate the nutrition advocacy planning process using this approach in a specific complements these and other nutrition country should follow the steps in this manual. The advocacy initiatives and can help streamline skills and expertise required to conduct each step existing efforts in country by working with SUN in this manual vary and are identified at the networks and other program efforts to beginning of each step. improve nutrition. This planning process is 1 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING meant to be the initial phase of a broader nutrition advocacy process, followed by implementation of advocacy activities in country. What is FANTA’s nutrition advocacy planning process, and what are the key elements? FANTA’s nutrition advocacy planning process engages national stakeholders by using a participatory and consensus-building approach toward a shared national vision for nutrition. It can support a given country at any stage along the way to providing nutrition services and reducing malnutrition. A central focus of this process is to promote accountability for nutrition and strengthen nutrition governance. For example, it can serve to support the development of a nutrition policy, increase investment of resources to strengthen and expand implementation of nutrition services, and promote greater coordination between government and nongovernmental organizations that play a role in providing nutrition services across a country. By examining the context of the nutrition situation and tailoring advocacy needs to that situation, advocacy can be more effective in igniting change and making strides toward the desired outcome. The three key elements of FANTA’s nutrition advocacy planning process are: The VIPP Method 1. Nutrition Advocacy Plan and Material Development The visualization in 2. PROFILES participatory programs 3. Nutrition Costing (VIPP) method is referred to throughout the manual. It Each element builds on and mutually reinforces the others. was chosen as a facilitation For each of these elements, the guiding principles are that: method to promote a consensus-based and 1. A consensus-building and participatory approach is used participatory approach and at the country level to promote a shared vision for achieving to ensure that “everyone’s nutrition objectives and to use the most credible data and voice is heard” throughout information available as identified by in-country the process. stakeholders, which lends credibility to the process and VIPP materials needed and results. information on how to use the method are included in 2. The process considers the country context, and materials each session plan. Other are tailored accordingly. participatory methods can 3. All the steps are completed to ensure a systematic and also be used. impactful process. 2 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING The four steps in FANTA’s nutrition advocacy planning process are: Step 1: Convene a multisectoral core working group and then conduct a stakeholder meeting on nutrition advocacy using PROFILES and nutrition costing. Step 2: Conduct a PROFILES workshop, present preliminary results, and develop reports. Step 3 (optional): Develop cost estimates for nutrition service delivery, present preliminary results, and develop a report. Step 4: Conduct a national nutrition advocacy planning workshop and finalize a national nutrition advocacy plan and materials. The order in which Steps 2, 3, and 4 are completed can vary depending on the country context. Although Steps 2 and 3 generate estimates, the estimates by themselves have little value if they are not used and embedded within a broader nutrition advocacy planning process. Therefore, Step 4 is essential to complete. In fact, for a nutrition advocacy tool like PROFILES, the key lesson learned from past implementation was that the estimates alone have limited use and impact in moving the nutrition agenda forward without a strategic nutrition advocacy plan and related materials. Step 3 on nutrition costing is optional as the nutrition advocacy process may be completed with or without nutrition costing. In the templates included in this manual, instructions related to nutrition costing are italicized and in brackets so that they can easily be taken out if not being done in a specific country. The process outlined within each step, however, should not vary in order to ensure that each step results in the intended outcome. What is nutrition advocacy plan and material development? A nutrition advocacy plan is developed to identify key audiences to be targeted by nutrition advocacy and determine a specific call to action for each. This is a critical step in the process as the plan lays out how to conduct nutrition advocacy in a systematic and coordinated way with all partners in country. In addition, the plan identifies monitoring and evaluation (M&E) indicators to track progress in achieving nutrition advocacy outcomes. Nutrition advocacy materials that support implementation of the nutrition advocacy plan are then developed, building upon and using results from the estimates generated from PROFILES and nutrition costing. What is PROFILES? PROFILES is a spreadsheet-based nutrition advocacy tool used to calculate consequences if malnutrition does not improve or change over a defined time period and the benefits of improved nutrition over the same time period, including lives saved, disabilities averted, human capital gains, and economic productivity gains. PROFILES also includes a section where estimates are calculated for two risk factors of stunting. PROFILES estimates are based on reduction in the prevalence of several nutrition problems, such as iron deficiency anemia; low birth weight; vitamin A deficiency; iodine deficiency; suboptimal breastfeeding practices; and childhood stunting, underweight, and wasting. The stunting risk factor estimates are based on a 3 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING reduction in a suboptimal complementary feeding practice (inadequate dietary diversity) and a reduction in teenage pregnancy. To calculate estimates, PROFILES requires current country- specific information (e.g., nutrition, demographic, and employment data) that is identified and agreed upon in collaboration with stakeholders in country. What is nutrition costing? Nutrition costing estimates the costs of implementing a comprehensive set of nutrition programs or interventions in a country or prioritized geographic area over a specific time period. Nutrition costing is developed in country, considering the country-specific context, and is the result of a collaborative and participatory process during which multisectoral stakeholders define the assumptions on which nutrition costing is based—for instance, selecting necessary interventions and activities and defining a management structure for service provision—which in turn allows for the identification of the required inputs for each activity and estimation of the program cost for a specified time period. What is the difference between PROFILES and nutrition costing? The estimates generated using PROFILES or nutrition costing answer different questions. PROFILES answers the question: What are the consequences if nutrition does not improve over a given time period or conversely, what are the benefits if nutrition improves over the same time period? The PROFILES estimates are presented in terms of health and development outcomes, such as lives saved or economic productivity gains. PROFILES gives you estimates that support the argument for why investing in nutrition is important and helps raise national awareness that malnutrition is a problem in a given country. However, it does not tell you how much it will cost a country to provide nutrition services to improve the nutrition situation. In contrast, nutrition costing, like health costing, answers the question: How much will it cost to implement nutrition programs or interventions in a given country or prioritized geographic area over a specified time period? Costing in general is a useful approach for forecasting and planning the budget allocation required for specific services, but it is also useful for advocacy to increase the funding allocated to nutrition. As such, nutrition cost estimates complement PROFILES estimates. In fact, relative to PROFILES estimates, cost estimates are more tangible in that they provide policymakers with an estimate for how much they need to invest in nutrition each year in local currency amounts. Like PROFILES estimates, nutrition cost estimates can also be projected to a population level over multiple years. 4 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING PROFILES and nutrition costing Advocacy processes for Tools such as PROFILES and are helpful in situations nutrition need to be: nutrition costing promote: where: •The prevalence of many forms •Based on a sound •Insight for action of malnutrition are high understanding of the current •Consensus-building and a •Investment, commitment, country context for nutrition shared vision for nutrition governance, and •Systematic, planned, and (“one voice”) accountability for nutrition are deliberate •Accountability and goal- low •Part of a collaborative setting for investment in •Nutrition services are multisectoral effortincluding nutrition across the life cycle, fragmented and not holistic government and including services along a nongovernment stakeholders continuum of care for the •Targeted at key audience prevention and treatment of segments that are influential malnutrition and can promote accountability and good governance How long does the nutrition advocacy planning process take, and what are the follow-up steps? The length of time this nutrition advocacy planning process takes depends on the country context. However, most countries typically take between 1 year and 18 months, depending on whether nutrition costing is part of the process. Nutrition costing typically takes about 12–18 months to complete due to the need to identify and use locally available data to develop cost estimates. Once the nutrition advocacy planning process has been completed in a country, support for the implementation of the nutrition advocacy plans may be needed depending on the country context. The four steps in this manual are the initial planning phase for nutrition advocacy in a country, and they allow for strategic and coordinated nutrition advocacy outreach to be completed over several years as a next step. In order to move the nutrition agenda forward in a country, it is essential to implement the nutrition advocacy plans after these initial four steps are completed. Also, nutrition advocacy plans and materials may need to be updated every 2–5 years depending on the country context, while PROFILES and nutrition costing estimates should be updated every 5 to 10 years (depending on country needs and the availability of new survey data). Even though new survey data may be released more frequently than 5-10 years, often the prevalence estimates for various nutrition conditions change slowly. In addition, population growth in many developing countries is high; for PROFILES estimates that are calculated based on population projections, the implication of this is that the estimates may not be that different from year to year—so repeating PROFILES in given country more often than 5-10 years often adds little value to the broader nutrition advocacy efforts, particularly given that this can be a resource intensive and expensive process. More information on timing can be found in Steps 2–4. 5 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING Illustrative Timeline and Key Steps for Nutrition Advocacy Planning Process Using PROFILES and Nutrition Costing What final documents are developed as part of the nutrition advocacy process? 1. PROFILES final reports 2. Nutrition costing final report 3. National Nutrition Advocacy Plan and corresponding nutrition advocacy materials (targeted to audiences identified in the Nutrition Advocacy Plan) 6 MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING: STEP 1 Form a Multisectoral Core Working Group and Conduct a Stakeholder Meeting on Nutrition Advocacy STEP 1 Form a Multisectoral Core Working Group and Conduct a Stakeholder Meeting on Nutrition Advocacy PLANNING 7