Republic of Kenya

Ministry of Health

DONOR SUPPORT TO THE NUTRITION SECTOR IN KENYA

Faith M. Thuita, PhDMQSUN Consultant to the SUN Donor Convenor, Kenya

MAPPING REPORT

ii

ABOUT MQSUN MQSUN aims to provide the Department for International Development (DFID) with technical services to improve the quality of nutrition-specific and nutrition-sensitive programmes. The project is resourced by a consortium of seven leading non-state organisations working on nutrition. The consortium is led by PATH.

The group is committed to:

• Expanding the evidence base on the causes of undernutrition • Enhancing skills and capacity to support scaling up of nutrition-specific and nutrition-sensitive

programmes • Providing the best guidance available to support programme design, implementation, monitoring

and evaluation • Increasing innovation in nutrition programmes • Knowledge-sharing to ensure lessons are learnt across DFID and beyond.

MQSUN PARTNERS ARE:

Aga Khan University Agribusiness Systems International ICF International Institute for Development Studies Health Partners International, Inc. PATH Save the Children UK

CONTACT

PATH, 455 Massachusetts Avenue NW, Suite 1000 Washington, DC 20001 USA Tel: (202) 822-0033 Fax: (202) 457-1466

ABOUT THIS PUBLICATION This report was produced by Faith M. Thuita, PhD, for the government and the SUN Donor network in Kenya through the UK Government’s Department for International development (DFID)-funded MQSUN project.

This document was produced through support provided by UKaid from the Department for International Development. The opinions herein are those of the author and do not necessarily reflect the views of the Department for International Development.

iii

ACKNOWLEDGEMENTS

I am indebted to Dr Hjordis Ogendo, the SUN donor convenor in Kenya (2013 – 2016) for providing exemplary leadership to the SUN donor network, and to this activity in particular. All support extended to me in the course of planning, information gathering and dissemination of findings is warmly acknowledged.

I gratefully acknowledge the support of Dr Samora Otieno, DFID Kenya humanitarian advisor, and technical assistance provided by Mr Albert Webale.

Special appreciation is extended to members of the donor network representing different donor agencies who provided the information that forms the basis of this report.

iv

Table of Contents

MQSUN partners are:...................................................................................................................................ii

Contact.........................................................................................................................................................ii

About this publication..................................................................................................................................ii

Acknowledgements...............................................................................................................................iii

TableofContents..................................................................................................................................iv

Acronyms...............................................................................................................................................v

Background............................................................................................................................................1

About the donor mapping...................................................................................................................1

Purpose and scope of the Mapping.....................................................................................................1

Scaling up Nutrition in Kenya............................................................................................................2

Overview of the Nutrition Situation in Kenya....................................................................................3

The Policy Framework and Coordination of the Nutrition Sector......................................................4

Government Commitments to Improve the Nutrition Situation.........................................................5

Donor support to the nutrition sector in Kenya..................................................................................6

Findings..................................................................................................................................................9

Nutrition sensitive Programmes.......................................................................................................11

Nutrition Sensitive and Specific Interventions supported by donors in Kenya................................12

Kenya Agricultural Value Chains Enterprises Project.........................................................................20

Conclusions..........................................................................................................................................30

Recommendations................................................................................................................................31

v

Acronyms

ASDS Agricultural Sector Development Strategy

AMREF African Medical and Research Foundation

AMPATH Academic Model for Prevention and Treatment of HIV

APHIAplus AIDS, Population and Health Integrated Project plus

ASAL Arid and Semi Arid Lands

CDC Centers for Disease Control and Prevention

CfP Calls for Proposals

CHMT County Health Management Team

CRW Crisis Response Window

DEVCO Development Corporation

DFID Department for International Development

ECHO European Community Humanitarian aid Office

EmOC Emergency Obstetric Care

EDE Ending Drought Emergencies

EU European Union

FAO Food and Agriculture Organization

FCI Family Care International

FHI Family Health International

FNSP Food and Nutrition Security Policy

FtF Feed the Future

GIZ Gesellschaft für Internationale Zusammenarbeit

GNR Global Nutrition Report

GOK Government of Kenya

HINI High Impact Nutrition- specific Interventions

IDA International Development Assistance

IMAM Integrated Management of Acute Malnutrition

JHPIEGO Johns Hopkins Program for International Education in Gynaecology and Obstetrics

KHSSP Kenya Health Sector Support Project

MoDP Ministry of Devolution and Planning

MDG Millennium Development Goal

IFPRI International Food Policy Research Institute

INGO International Non Governmental Organization

KCL Kings College London

KHP Kenya Health Programme

MCHIP Maternal and Child Health Integrated Program

MNCH Maternal Newborn Child Health

vi

MoDP Ministry of Devolution and Planning

MOPHS Ministry of Public Health and Sanitation

MQSUN Maximising the quality of scaling up nutrition

MTEF Mid-Term Expenditure Financial

MTIP Mid-Term Investment Plan

MOH Ministry of Health

NACS Nutrition Assessment Counselling and Support

NASCOP National AIDS and STI control Programme

NHP Nutrition and Health Program

NICC Nutrition Interagency Coordinating Committee

NSI Nutrition-Specific Interventions

NNAP National Nutrition Action Plan

NCD Non Communicable Disease

NDU Nutrition and Dietetics Unit

NGO Non Governmental Organization

NTWG Nutrition Technical Working Group

OVC Orphans and Vulnerable Children

PEPFAR President's Emergency Plan for AIDS Relief

PSI Population services International -

SAM Sévère Acute Malnutrition

SHARE Supporting Horn of Africa Resilience

SMART Standardized Monitoring & Assessment of Relief & Transitions

SQEAUC Semi-Quantitative Evaluation of Access and Coverage

SUN Scaling Up Nutrition

TN Transform Nutrition

UNICEF United Nations Children's Fund

USG United States Government

USAID/ K United States Agency for International Development Kenya

WASH Water Sanitation and Hygiene

WHO World Health Organization

1

Background

About the donor mapping

The Donor Network is one of six key networks supporting Scaling up Nutrition (SUN) efforts in Kenya. Currently, the European Union Delegation serves as the donor convenor with responsibility for coordination of donors supporting the nutrition sector in Kenya. The SUN donor convener functions as a catalyst, with actual implementation of SUN initiatives being the responsibility of the government and individual donors through implementing agencies. In addition, the convenor liaises with the SUN secretariat to ensure that all efforts are linked and coordinated with the work of other SUN networks.

To support the roles and functions of the donor convenor, the MQSUN project contracted a nutrition consultant to provide technical assistance to the EU delegation from September 2014. The key role of the consultant was to support the SUN Donor Convenor to act as an enabler and catalyst for other donors, government, and SUN networks for accelerated action to scale up of nutrition in Kenya. One of the activities for this consultancy was the mapping of nutrition programmes funded by development partners in the country with a view to gauging the contribution of development partners in Scale up of Nutrition in the country. It was also envisaged that the mapping exercise would lead to enhanced coordination and harmonization of donor funding to the sector.

The donor contribution to SUN in a country is intended to be measured through a series of agreed upon indicators including;

• Percentage of SUN donors that incorporate nutrition within their country plans in at least two sectors.

• Percentage of SUN donors that release funding according to schedule in a given year.

• Percentage of SUN donors that integrate indicators to measure nutrition results

• Percentage of SUN donors that implement programmes that are harmonised and aligned with national nutrition policies and strategies.

The above indicators are designed to be as broad as possible in order to factor in the fact that the needs of individual SUN countries are diverse and donor inputs and resources will be used to fund a variety of programmes and initiatives that respond to an individual country’s needs. The donor coordination group is expected to measure progress against these indicators in collaboration with the Government SUN Focal Point and to report on an annual basis to the international SUN Donor Network.

Purpose and scope of the Mapping

The mapping exercise sought to estimate donor support to the nutrition sector in Kenya with a view to identify critical gaps, potential or existing overlaps and to guide harmonization and future planning. The assessment also aimed at generating information for the government and other sector partners on current and planned investments to the nutrition sector. It is anticipated that information on the level of resources available and partners implementing funded programs will also be important for county level coordination, planning, budgeting and tracking. These findings could also inform the Mid Term Expenditure Financial (MTEF) reporting and planning.

2

Scaling up Nutrition in Kenya In August 2012, Kenya joined the global SUN movement, setting out the approach in the National Nutrition Action Plan (NNAP) which was approved in November, 20121. This signalled Kenya's commitment to undertaking coordinated actions to improve the status of nutrition in the country. Key achievements since the launch of SUN in Kenya include adoption of a set of High Impact Nutrition Interventions (HINIs) and enhanced government leadership of the nutrition sector, which has resulted in improved coordination of actors and a more coordinated approach to implementation and monitoring of nutrition programmes2. This is evidenced by inclusion of the nutrition indicators in the County Health Information System, Annual Operational Plan, and Medium-Term Expenditure Framework. In addition, the nutrition budget is now aligned to the government’s broader Medium-Term Development Plan. The government, UN, donor and Civil Society networks are also in place. Individual networks meet on a quarterly basis, while all networks are convened by the SUN Government Focal Point twice a year. In 2014, the First Lady came on board as the national nutrition patron. It is anticipated that this will lead to increased visibility of nutrition translating to stronger political and funding commitments to the sector. Despite these achievements at the national level, the nutrition sector continues to face several challenges. The inter-sectoral linkages to address malnutrition are poor and low priority is accorded to nutrition issues in national and county development plans, which leads to insufficient budget allocation for nutrition-specific and nutrition-sensitive interventions. On-going advocacy efforts to increase visibility of nutrition are yet to translate into political commitment and accountability towards improved allocation of resources to tackle malnutrition in the country. SUN has largely focused on rolling out the high impact nutrition interventions as envisaged in the NNAP which to date remains a priority. This has however experienced some lag occasioned by challenges related to devolution. Over the past 2 years, Kenya has undergone significant devolution. Financial and decision making authority now resides in 47 county level administrations. Kenya’s 47 counties are however at different levels in terms of resource mobilisation and support from partners. The level of support for programmes that address malnutrition also varies from county to county. While a few counties have effective coordination structures in place and have marshalled support to develop county-specific nutrition action plans, many are still grappling with inadequate funding resources, weak coordination of stakeholders and technical capacity to implement nutrition specific and sensitive interventions. Developing capacity of county nutrition technical teams to identify nutrition priorities, develop nutrition action plans with benchmarks to track progress and advocate for allocation of resources to fund implementation of activities will be important for scale up of nutrition at county level. The National Nutrition Action Plan (NNAP-2013-2017) sets out the activities for at-scale implementation of high impact nutrition-specific interventions (HINI). The cost of the NNAP over five years is estimated to be KES 70 billion or US$824 million, (87% for nutrition specific, 3% nutrition sensitive and 10% for governance). The GoK has committed to spending KES 6 billion (US$70 million) over five years for the NNAP which is to be shared across various ministries including health, agriculture, water and irrigation, fisheries development, and national planning and development. Donors are aligning behind the government’s leadership on issues related to nutrition. DFID has committed Kshs. 2.29 billion (£16 million) to assist in scaling up nutrition in three arid, chronically nutrition-insecure counties: Turkana, Wajir, and Mandera between 2012 and 2016. The

1MOPHS (2012) National Nutrition Action Plan; available http://scalingupnutrition.org/wp---content/uploads/2013/02/Kenya_KNN_Action---Plan_2012_2017.pdf.) 2For more details on the GOK’s involvement with SUN, visit: http://scalingupnutrition.org/suncountries/Kenya

3

European Union has also committed to funding the €250 million (£196 million) Supporting Horn of Africa Resilience (SHARE) initiative, which is designed to help people in the Horn of Africa to recover from drought, as well as strengthen the population and regional economy to better withstand future crises. Information on current and projected funding levels to the nutrition sector, types of programmes funded and partners implementing these programmes in the country is important for planning at both the national and county government levels. It is particularly important to profile funding support targeted at both nutrition specific and nutrition sensitive programmes as both are critical if the persistent challenge of malnutrition in the country is to be addressed effectively.

Overview of the Nutrition Situation in Kenya Over the past 20 years, the picture of the nutritional landscape of Kenya, as portrayed by the indicators of children under five has been grim. However, statistics from 2013/14 Kenya Demographic Health Survey (KDHS) indicate that there has been a remarkable improvement in the last five years. Previously identified as one of the 36 countries that carry 90% of the global stunting burden, the latest demographic health survey indicates that a reduction in stunting levels, a trend that had previously remained relatively stagnant over the past two decades.

The figure below shows the trend in nutritional status of under fives over the past decade.

Sources: KDHS 2003, 2008-09, 2014

Stunting and wasting levels have reduced from 35.3% to 26% and 6.7% to 4% respectively. Even more noteworthy is Kenya's attainment of the World Health Assembly underweight target of 11%. This improvement in nutritional indicators is indeed remarkable.

At county level, Turkana and West Pokot counties have the worst under five nutritional indicators. West Pokot County has the highest stunting (45.9%) and underweight (38.5%) rates. Turkana on the other hand is the county with the highest rate of wasting (23%) and the second leading in underweight (34%). The top nine counties with the worst wasting rates are in the arid and semi arid lands (ASAL). However, it is interesting to note that Garissa, although in the ASAL, is the county with the second lowest stunting rates in the country. The top three counties with the lowest rates of underweight are

4

Nyeri, Nairobi and Kiambu. These three countries are also among the top four with the lowest rates of stunting, with Nyeri being in the lead.

According to the KDHS 2014, mothers living in rural areas are more likely to have stunted children than those living in urban areas. In addition, level of education and wealth quintile are inversely correlated with risk of stunting. These factors were found to interact in a similar fashion with wasting and underweight indicators in the 2014 KDHS.

Five years ago, Kenya adopted a package of eleven high impact nutrition interventions recommended by the WHO following research findings of the 2008 Lancet series, and further research by the World Bank in 2009 which identified 13 highly cost- effective interventions. Although it may be too early to attribute the improvement in some of the indicators to implementation of the HINI, it is worthwhile to highlight the current situation.

The KDHS collected data on three of the eleven HINI, namely exclusive breastfeeding, optimal complementary feeding and zinc treatment for diarrhoea. Sixty one percent of mothers of infants less than six months are exclusively breastfeeding. This is a tremendous improvement and has surpassed the Ministry of Health's (MOH) 2016/ 17 target. However, the percentage of children receiving a minimum acceptable diet3 declined from 39% in 2008/ 09 to 21% in 2014. The rate of breastfeeding between 18- 23 months also decreased from 59.3% to 51%. According to the Lancet, breastfeeding could reduce child mortality by about 13%, and improved complementary feeding would reduce child mortality by about 6%. (Jones et al, 2013). Although the rate of optimal complementary feeding practices has declined, it is encouraging to note that over the past five years, the under five- and infant mortality rates have decreased from 74 to 52 deaths and 52 to 39 deaths per 1,000 live births in 2008/ 09 and 2014 respectively. These decreases in mortality are an indicator of a reversal of trends seen in the last twenty years.

Zinc treatment for diarrhoea is the third HiNi that was accessed during the last KDHS. Diarrhoea, a preventable and treatable disease, is a leading cause of malnutrition and deaths of children under five years (WHO, 2013). Appropriate treatment of this condition is therefore a vital component in prevention of under five deaths. The rate of zinc treatment for diarrhoea has improved from 0.2% in 2008/09 to 8%. Although this is way below MOH's target of 80% by 2016/17, it is anticipated that with the rolling out of HINI countrywide that these statistics will improve.

The Policy Framework and Coordination of the Nutrition Sector Kenya has a number of policy instruments to help expedite the country’s social and human development. The right of ‘every child to basic nutrition, shelter and health care’ is enshrined in the Government of Kenya’s constitution that was promulgated in 2010. The government also has a well-articulated multi-sectoral Food and Nutrition Security Policy (2011), a National Nutrition Action Plan7 (2012-17) and a draft Food Security and Nutrition Strategy. Further, the government has enacted laws for mandatory fortification of cereal flours and vegetable oils as well as a commitment to the protection and promotion of appropriate infant feeding practices through passing of the Breastmilk Substitutes Regulation and Control Law (2012). The devolution of functions like health and the semi-autonomous nature of counties however means that the national government is not in a position to enforce the implementation of policies and plans at county level. ASAL counties are reportedly more engaged in the National Nutrition Action Plan although their engagement reportedly varies as nutrition competes with other county level priorities

3 Minimum acceptable diet is indication of the proportion of children in a population who receive the minimum dietary diversity and minimum meal frequency

5

The creation of a multi-sectoral Food Security and Nutrition Secretariat to ensure broad based, cross-sectoral coordination and monitoring of nutrition initiatives was envisaged as a key structure in the Food and Nutrition Security Policy. This has however not been established to-date. The Nutrition Interagency Coordinating Committee (NICC)4 which is chaired by the Head of the Nutrition and dietetics Unit in the MoH oversees progress with the implementation of the NNAP. Thus, nutrition specific actions are well coordinated. There however is no coordination mechanism for nutrition - sensitive actions. The Nutrition and dietetics Unit (NDU) does not have convening power over other line ministries and their attendance at NICC meetings is voluntary. In recognition of the need for much greater inter- ministerial engagement in nutrition, the MoH recently wrote to nine nutrition - relevant ministries to request that they nominate a Nutrition Focal point in order to help generate a stronger discourse concerning nutrition- sensitive approaches. The SUN networks in Kenya under the leadership of the SUN focal point seek to obtain political commitment and accountability for addressing malnutrition and raising the profile of nutrition by emphasising its role in ensuring overall health and well-being. A recent development is that the Nutrition and Dietetics Unit, with support of the main development partners, successfully secured the agreement of the First Lady to act as Nutrition Patron in Kenya.

Government Commitments to Improve the Nutrition Situation Kenya launched Vision 2030 in 2008 as the country’s long- term development blueprint. The purpose of vision 2030 was to transform Kenya into a middle income country. This was achieved in September 20145. Although Vision 2030 does not include nutrition as a developmental outcome, this is addressed in a number of subsequent government policies detailed below: The Kenya National Food and Nutrition Security Policy (FNSP 2011) has three major objectives namely: 1. To achieve adequate nutrition for optimum health of all Kenyans; 2. To increase the quantity and quality of food available, accessible and affordable to all Kenyans at all times; and, 3. To protect vulnerable populations using innovative and cost-effective safety nets linked to long-term development. The National Nutrition Action Plan (NNAP-2013-2017) sets out the activities for at-scale implementation of high impact nutrition-specific interventions (HINI). The high impact nutrition interventions are incorporated into the health system and are the backbone of the NNAP led by the MoH. At present, this provides the strongest links with nutrition of all government led programmes. Development partners are providing important support too, an example being Health Systems Strengthening that is supported by a number of donors. DFID supports HINI systems strengthening in 11 Counties (Turkana, Mandera, Wajir, Garissa, Tana River, Baringo, Marsabit, Samburu, West Pokot, Laikipia and Isiolo) over 4 years (2012 -2016). The government actively seeks to reduce vulnerability to droughts and risk of emergencies in 23 Arid and Semi Arid (ASAL) by 2022 through sustainable development as opposed to repeatedly reacting to the effects of droughts. This is articulated in the Common Programme Framework for Ending Drought Emergencies (EDE)6. Nutrition is given serious attention in the EDE as a key to building

4The NICC has four steering committees: Maternal Infant and Young Child Nutrition, Food Security and Emergency Nutrition Task Force, Micronutrient Deficiency Control Council And the Healthy Diets and Lifestyles Steering Committee5WorldBank,Kenya:ABigger,BetterEconomy,September30,2014http://www.worldbank.org/en/news/feature/2014/09/30/kenya-a-bigger-better-economyaccessedon2ndApril20156RepublicofKenya(2014)Ending Drought Emergencies Common Programme Framework

6

resilience and thus reducing vulnerability to future droughts. The EDE therefore has the potential to operationalise comprehensive approaches to addressing undernutrition that combine nutrition-sensitive and nutrition- specific interventions. The Agricultural Sector Development Strategy (ASDS) aims to achieve an agricultural growth rate of 7% per year between 20013- 17. The ASDS Mid-Term Investment Plan (MTIP) for 2013 -2017 has a number of references to food and nutrition security and has earmarked KES 20 million to the FNSP (approximately €194,000) out of a total MTIP budget of KES 460.2 million (i.e. roughly 4% of the total budget). Against this backdrop, this mapping exercise sought to profile the investment that development partners are making to the nutrition sector to complement government efforts in addressing the nutrition challenges that face the country.

Donor support to the nutrition sector in Kenya Nutrition specific interventions Timely nutrition-specific interventions (NSI) at critical points in the lifecycle can have a dramatic impact on reducing malnutrition globally if taken to scale in high-burden countries. If scaled to 90 percent coverage, it is estimated that the following 10 evidence-based, nutrition-specific interventions could reduce stunting by 20 percent and severe wasting by 60 percent7: Management of severe acute malnutrition; Preventive zinc supplementation; Promotion of breastfeeding and Appropriate complementary feeding; Management of moderate acute malnutrition; Peri-conceptual folic acid supplementation or fortification; Maternal balanced energy protein supplementation; Maternal multiple micronutrient supplementation; Vitamin A supplementation and maternal calcium supplementation. Nutrition sensitive Interventions

These are interventions that target the underlying and basic causes of malnutrition. Such interventions have the potential to reduce malnutrition through improved diets and health especially of young children. The 2013 lancet series on maternal and child nutrition shows that nutrition-sensitive interventions and programmes in agriculture, social safety nets, early child development and education have enormous potential to enhance the scale and effectiveness of nutrition specific interventions while improving nutrition can in turn help nutrition- sensitive programmes achieve their own goals. Nutrition-specific interventions on their own cannot eliminate under-nutrition; however, in combination with nutrition-sensitive interventions, there is enormous potential to enhance the effectiveness of nutrition investments in the country.

There are, however, a lot grey areas in determining nutrition sensitivity of programmes. Lack of clear criteria/guidance on methodology of determining nutrition sensitivity in programmes gives room to high level of subjectivity in designing nutrition sensitive projects. Formal guidance is urgently needed to strengthen nutrition-sensitive programming. According to the Lancet Series 20138, there are 9 pathways and interventions that are considered nutrition sensitive: Agriculture& food security, Social safety nets, Early Child development, maternal mental health, Women’s empowerment, Child protection, Classroom education, Water and sanitation, Health and family planning services. 7Zulfiqar A. Bhutta, Jai K Das, Arjumand Rizvi, et al. Maternal and Child Nutrition 2: Evidence- based interventions for improvement of maternal and child: what can be done and at what cost? Lancet 2013; 382: 452- 778The Lancet, Maternal and Child Nutrition, Executive Summary of The Lancet Maternal and Child Nutrition Series 2013

7

FAO has further elaborated on these pathways, particularly with a focus on improving nutrition through agriculture9 by stating that (relevant to these DEVCO projects)

‘Agriculture and rural (urban) development have enormous potential to influence nutrition positively-they can do so most effectively if nutrition relevant outcomes are clearly articulated in the design of a project or policy, and if activities and indicators follow suit’.

The Lancet series (2013) and FAO elaboration (above) provide a framework to try and categorise these projects in terms of their nutritional sensitivity or otherwise. A key challenge is the low understanding of linkages between food security, basic education and water and sanitation strategies on one hand, and nutrition on the other. Furthermore, programme strategies are vertical in nature and lack nutrition as an outcome indicator. As a result, there is need to sensitize policy makers and programmers on the causal factors of malnutrition and influence them to address malnutrition in a holistic approach and broad manner.

SUN Donor Resource Tracking and attendant challenges

It is noteworthy that there is no common, agreed-upon approach to track resources for nutrition-sensitive development assistance, which aims to leverage investments in sectors beyond health where most nutrition sensitive interventions are nested. In 2013, a SUN Donor Network working group on resource tracking developed a methodology for tracking financial investments in nutrition to increase accountability and improve tracking of external development assistance for nutrition. The methodology focused on developing an approach to quantify nutrition-sensitive spending. This was rooted in a decision by the SUN donor group to find an improved way to track nutrition resources, primarily those resources allocated through other sectors besides health where nutrition is typically nestled. The methodology for calculating nutrition-sensitive investments is complex. The donor methodology states that investments can only be classified as nutrition-sensitive if a project includes a nutrition objective or indicator, contributes to nutrition outcomes and aims to improve nutrition for women, children or adolescent girls. Since there is no single sector code for nutrition-sensitive programmes, a list of codes that relate to nutrition was combined with keyword searches to identify programmes that warranted further investigation. Each programme that might be nutrition-sensitive was manually assessed by checking project documents. This methodology was used to gauge nutrition investments by the SUN Donor Network among 9 bilateral donors, the European commission and two foundations (CIFF and Bill Melinda gates) between 2010 (Baseline for when the SUN Movement began); and 2012 which provides a comparative year. Findings showed an overall increase in spending from 2010 to 2012 for both nutrition specific and nutrition sensitive categories. Total nutrition specific investments (disbursements) among reporting donors increased from USD 325 million (2010) to USD 411 million (2012), representing 27%. For nutrition-sensitive investments, there was an increase from USD 937 million (2010) to USD 1.1 billion (2012), representing 19% excluding the US who did not use the methodology.

9Herforth A, Jones A and Pinstrup- Andersen P. Prioritizing Nutrition in Agriculture and Rural Development: Guiding Principles for Operational Investments. The World Bank. November 2012

8

This evaluation however faced several challenges with application of the methodology and recognizes its limitations as follows:

• Stringent nutrition-sensitive criteria sometimes excluded projects that were clearly nutrition-sensitive due to their lack of focus on actions “aimed at individuals” (e.g. advocacy and research, nutrition tracking systems, nutrition products);

• An inefficient keyword search that failed to identify significant additional spending;

• Variability among donors in the size, number and type of components within projects and

whether these projects should be classified as nutrition-specific only, sensitive or have relevant portions allocated to each category.

• Given the wide range of challenges and unique reporting approaches of individual donors, no standard approach was applied; however, donors agreed to ensure that such projects are not double-counted to maintain consistency in the application of the methodology.

• Although partially mitigated by a detailed methodology with stringent criteria for inclusion,

the approach is still inherently subjective.

• Individual donor agencies are different in their objective, organizational structure and tracking and reporting mechanisms, and therefore it is inherently challenging to create a single reporting methodology that can be universally applied.

Based on these challenges, the SUN Donor Network has discussed possible revisions to the methodology: for example, developing descriptions to clarify what classifies as a nutrition objective or indicator and a standardized list of types of objectives, outcomes, indicators and activities that are nutrition-sensitive to avoid inconsistent classification. Due to the resource-heavy and time-consuming nature of the exercise, donors have also begun to discuss ways to make the process more manageable, including potentially altering the frequency of reporting from every year to alternate years. Donors have also discussed how they can use the data to discuss the specifics of how to work together to make investments in other sectors more sensitive to nutrition Despite these challenges, the methodology represents an approach for donors to track external nutrition development assistance in a transparent, consistent/comparable manner. Improved tracking of donor spending on nutrition is important not only for accountability purposes but also to measure progress in mobilizing resources and to improve the quality of nutrition aid by highlighting gaps and inspiring changes to investments in other sectors in a way that will impact nutrition outcomes. Despite methodology limitations, the Donor Network feels this is a significant step forward on tracking resources and developing a common approach.

9

Categorization of Budget allocations Budget allocations categorized as “nutrition-sensitive” Categorization of budget allocation requires provision of the programme description to get a better understanding on how the programme contributes to nutrition-sensitive outcomes, which are explicit in the design through activities, indicators, expected results or target populations. Budget allocations that are relevant to nutrition are those that clearly mention a nutrition objective and/or outcome and/or action as part of an integrated program or as part of a department mandate. Interventions or programmes are categorized as “nutrition-sensitive” if they address the underlying determinants of foetal and child nutrition and development— food security; adequate caregiving resources at the maternal, household and community levels; and access to health services and a safe and hygienic environment—and incorporate specific nutrition goals and actions. Nutrition-sensitive programmes can also serve as delivery platforms for nutrition-specific interventions, potentially increasing their scale, coverage, and effectiveness. Examples include : agriculture and food security; social safety nets; early child development; maternal mental health; women’s empowerment; child protection; schooling; water, sanitation, and hygiene; health and family planning services.

Findings

The mapping exercise sought to profile donor support to the nutrition sector in Kenya with a view to identifying critical gaps, potential or existing overlaps and to guide harmonization and future planning. The assessment also aimed at generating information that may be useful for the government and other sector partners on current and planned investments to the nutrition sector. It is anticipated that information on level of resources available and partners implementing funded programs will be important for county level coordination, planning, budgeting and tracking. These findings could also inform the MTEF reporting and planning processes. Findings on the key types of nutrition programs supported by donors and extent to which these are aligned to the national nutrition programme priorities as espoused in the National Nutrition Action Plan (NNAP) are presented. Delivery strategies and the geographical focus of programmes supported by donors are also presented.

Coverage

A total of 12 donor agencies were covered in the mapping and are discussed in this report. They are; DFID Kenya, EU, USAID Kenya, CIFF, Norwegian Ministry of Foreign Affairs, German Development Cooperation (GIZ), French Ministry of Foreign Affairs, World Bank, JICA, DANIDA, Finish Ministry of Foreign Affairs and CIDA. Only three of these agencies: EU, CIFF and World Bank are multi-lateral donors. The rest are all bilateral donors. Findings of the mapping show that majority of the donors are supporting potentially nutrition sensitive programmes. Cumulatively, the donors are supporting 32 major programmes/overall initiatives that are nutrition or nutrition related in nature. Typically, funds for these programmes from donors are disbursed 1) Through bilateral agreements with UN agencies who may contract implementing partners and 2) Directly to INGOs/NGOs. Table 1 below summarizes the overall categorization of the different programmes supported by the donors

10

Table 1: Overall categorization of programmes/Interventions Donor Programme supported Overall

categorization of Programme

DFID Enhancing Nutrition Surveillance, Resilience and Response (ENSuRRe) Programme

Nutrition specific

Kenya Health Programme Nutrition sensitive Programme on Reducing Maternal and Newborn Deaths in Kenya

Nutrition sensitive

Kenya Social Protection Programme II Nutrition sensitive Hunger Safety Net Programme Phase 2 (HSNP 2) Nutrition sensitive Arid Lands Support Programme (ASP) Nutrition sensitive Refugee programme Nutrition sensitive

European Union ECHO Nutrition specific Agriculture and rural development Nutrition sensitive Maternal and child nutrition programme under SHARE Nutrition specific MCH Nutrition sensitive

USAID NHPplus Nutrition sensitive FFP Nutrition specific OFDA Nutrition specific

Kenya Agricultural Value Chains Enterprises Project (KAVES)

Nutrition Sensitive

Resilience and Economic Growth in the Arid Lands-Increased Resilience (REGAL-IR)

Nutrition sensitive

Water and sanitation programmes Nutrition sensitive CIFF De-worming programme Nutrition sensitive GIZ Food Security and Drought Resilience Programme Nutrition sensitive

Food Security through improved Productivity Programme Nutrition sensitive GIZ-Health Sector Programme Nutrition sensitive SIF Project Nutrition sensitive

Norwegian Ministry of foreign affairs – Nairobi

Micronutrient powder Nutrition specific

JICA Maternal and child health programme Nutrition sensitive DANIDA Maternal and child health programme

Nutrition sensitive

Non Communicable Diseases Nutrition sensitive Finish Ministry of FA - Nairobi

Food security Nutrition sensitive Cash transfer Programme Nutrition specific

CIDA Vitamin A supplementation Nutrition specific World Bank HSSF including scaling-up of RBF Nutrition sensitive

(ii) Governance and stewardship including a. scaling up of HISP and b. county capacity building

Nutrition sensitive

Supply of Nutrition commodities Nutrition specific Essential Medicines and Medical Supplies including warehousing and procurement reforms

Nutrition sensitive

As seen in the table 1, the programmes being supported by the donors have been categorized broadly into nutrition specific and nutrition sensitive with most of the major donors supporting nutrition sensitive programmes. It is note-worthy that out of the 33 programmes supported by the donors, 24 of them are categorized as nutrition sensitive. The budgetary implication is presented elsewhere in this report. Whereas it is easy to categorize nutrition specific programmes in the sense that all the

11

resources are used for improvements in the nutritional outcomes, there continues to be a need for clearer technical guidance on definition and categorization of nutrition sensitive programmes.

Nutrition sensitive Programmes This section provides a synopsis of the context of nutrition sensitivity in programming as compared to nutrition specific programming. It should be appreciated that there is still a lot of ground to be covered in defining and determining nutrition sensitivity of programmes. According to the Lancet Series 201310 there are about nine possible pathways, commonly referred to as nutrition sensitive interventions: • Agriculture& food security • Social safety nets • Early Child development • Maternal mental health • Women's empowerment • Child protection • Classroom education • Water and sanitation • Health and family planning services Nutrition sensitive interventions and programmes are commonly perceived as those that address the underlying determinants of malnutrition especially among vulnerable population sub-groups. These include interventions on agriculture and food security, social safety nets, early childhood development, maternal mental health, women’s empowerment, child protection, schooling, health and family planning services, WASH, as well as technical and financial support given at national levels for development of policies. Conversely nutrition specific interventions refer to interventions that directly address inadequate dietary intake or disease. According to Lancet 2013, interventions and programmes termed as nutrition specific are those that address the immediate causes of malnutrition (classification according to UNICEF conceptual framework). Consequently interventions focusing on maternal and child- health, nutrition, dietary or micronutrient supplementation including food fortification, promotion of optimum breastfeeding; complementary feeding and responsive feeding practices and stimulation; dietary supplementation, disease prevention and management as well as nutrition in emergencies can all be classified as nutrition specific interventions. It is however recognized that these two approaches/categorizations are in essence complementary with nutrition sensitive programmes doubling up as delivery platforms for nutrition specific programmes. Agriculture and other rural development programmes though with enormous potential to influence nutrition positively can only do so most effectively if nutrition relevant outcomes are clearly articulated in the project design and if relevant activities and indicators for realization and evaluation of stated outcomes are also included in programme design. Example: Whereas improving agricultural productivity is potentially nutrition sensitive, it is important to articulate and mainstream nutrition outcomes in the programme design and implementation. This will enhance potential for realization of the stated nutrition objectives that should be accompanied by indicators to measure progress at the output, outcome or impact levels to make a given programme ‘qualify’ as nutrition sensitive.

10http://www.unicef.org/ethiopia/Lancet_2013_Nutrition_Series_Executive_Summary.pdf

12

Nutrition Sensitive and Specific Interventions supported by donors in Kenya The section below provides an overview of each donor agency outlining the kind of programmes being supported and specific types of interventions being implemented. Overall funding levels, geographical outlay and approximate time frames for funding are indicated. DFID Kenya DFID’s support to nutrition in Kenya is through four programmes namely: 1. Enhancing nutrition surveillance, response and resilience in the arid and semi-arid lands of Kenya; 2. The Kenya Health Programme; 3. The Social Protection Programme and 4. The Refugee Progamme a) Enhancing Nutrition Surveillance, Resilience and Response (ENSuRRe) Programme Through the programme, DFID made a financial commitment of up to USD 30,223,188 between 2012 and March 2016 to support the scale up of nutrition-specific interventions in the arid and semi-arid lands (ASALs) of Kenya through Government-led health systems. This includes USD 12 million to a consortium of NGOs to support the delivery of nutrition services in the counties of Mandera, Wajir and Turkana. It also includes USD 17,583,188 allocated to UNICEF to support: i) the delivery of nutrition services through its NGO partners in the other ASAL areas; and ii) system strengthening activities and coordination of the nutrition sector at county and national level. There is a further USD 474,000 to support all monitoring and evaluation programme activities. The context in which this support is being provided remains similar to that originally stated in the sense that the ASAL areas of Kenya continue to have particularly high levels of need, yet have some of the lowest capacities to respond. The prevalence of acute malnutrition is routinely above the WHO 'emergency' threshold of 15%, and in 2014, the nutrition situation deteriorated further in many counties (e.g. Turkana North). The causes of elevated levels of malnutrition (wasting) continue to be complex and can be quite specific to local areas. Underlying causes include: recurrent drought, long term household food insecurity; high incidence of diseases; low access to health services; poor hygiene and sanitation; and sub-optimal maternal, infant and young child feeding practices. Fundamental causes include poverty (96% of the Turkana population for instance lives below the national poverty line), conflict and insecurity, and low levels of formal education. This overall programme is nutrition specific since all the budget is allocated purely for the achievement of nutritional objectives. The nutrition specific interventions that are implemented include; treatment of childhood illnesses and supplementation for pregnant and lactating women with acute and moderate malnutrition, micro-nutrient supplementation, promotion and support of appropriate Infant and Young Child Feeding practices, strengthening nutrition information systems, capacity building and support in nutrition programme planning, support in advocating for increased budget allocations to the health sector (nutrition included) and some minimal sanitation initiatives.

13

Kenya Health Programme The DFID Kenya Health Programme (KHP) is a five-year programme that began in October 2009. The programme end date has been extended to December 2015. Current partners include Population services International - PSI, World Health Organization - WHO, Family Care International - FCI MENTOR Initiative and Kings College London (KCL) who have made good progress in programme delivery working in close partnership with the Kenyan Ministry of Health (MOH). For the Kenya Health Programme (KHP), DFID committed USD 167.9 million over a period of 5 years (2010-2015). Of this, USD 74.7 million is for malaria control; USD 35.6 million for condom distribution and family planning; and USD 19.7 million for strengthening Health Systems. USD 31.6 million has provisionally been ear-marked for support to local Health facilities. From a nutritional perspective, the amounts allocated to family planning and strengthening of the health care systems at national and county level are of interest as these two programs have potential to improve nutritional outcomes given the role that large household size and poor access to health care play in causation of malnutrition. The programme aims to increase access to affordable and quality basic health services through funding support to several health components that include;

1. Improving health systems and accountability mechanisms 2. Increased and consistent use of Family Planning commodities to improve family planning 3. Improving the efficiency of government health facilities 4. Social Marketing of condoms to reduce HIV infection

Besides the recognizable systems strengthening initiatives in a few counties, support is being extended in establishment and orientation of county health management teams (CHMT) beside reviewing the planning templates and providing orientation to all 47 counties on their applications. Support for the programme is being channeled through proven international and local NGOs, United Nation partners and other Development Partners. This overall programme is classified as nutrition sensitive in the sense that the interventions being supported have the potential to influence the underlying causes of malnutrition. The interventions are clustered around; capacity building for health professionals on Maternal and Neonatal Health, increasing community-based maternal and new-born child healthcare services in Kenya using faith-based organizations, training, empowering and employing mothers living with HIV to improve access to HIV prevention and support services for women and children, operations research on family planning and safe abortion services as well as food and livelihood security programmes for people living with HIV/AIDS .

b) Programme on Reducing Maternal and Newborn Deaths in Kenya

The UK has invested up to 118 million for 5 years since 2013, hence the support running up to 2018, to reduce maternal and newborn deaths in Kenya by increasing access to and uptake of quality maternal health care. USD 14.7 million is allocated for health workers training, USD 76.9 million is allocated for county level health systems strengthening and testing of innovative approaches, USD 2.2 million is allocated for national level health systems strengthening, USD 18 million is allocated for supporting access to services for the poorest women and USD 2.7 million is allocated for monitoring and evaluation with the remaining balance set aside as contingency.

14

This is specifically going towards scaling up of training for public sector doctors, nurses and clinical officers in emergency obstetric and neonatal care, health systems strengthening in three counties (Homa Bay, Bungoma and Turkana), provision of technical assistance for health systems strengthening to the Ministry of Health at national level, supporting demand-side financing strategies, such as output-based aid (OBA) in the same three counties to access services at subsidised rates and improve the responsiveness and quality of services. A service provider has been contracted to support health systems strengthening and demand-side interventions in Bungoma while UNICEF Kenya is implementing the same interventions in Turkana and Homa bay.

c) Kenya Social Protection Programme II

The Social Protection Programme Phase II (SPP II, 2013-17), supports two outputs: 1. The development of a national social protection system, led by the Government of Kenya (GoK), through technical assistance (TA) to GoK’s new National Safety Net Programme (NSNP); and 2. Expansion of the Cash Transfer to Orphans and Vulnerable Children Programme (CT-OVC), a central component of the NSNP, and its transition to more sustainable GoK funding. DFID support is required to help deliver improved social protection to an increased number of households with orphans and vulnerable children, and to help Kenya build its own welfare system to increasingly provide this support itself. SPP II is USD 60.4 million: USD 26.8 million of this was already approved under the original SPP1 in 2007 and has been rolled into SPP2. An additional USD 33.6 million was added to deliver the results under SPP2. Funding goes through the World Bank (WB). This social protection programme has the potential to contribute to nutrition outcomes since it directly deals with the empowerment of the vulnerable particularly orphaned children. d) Hunger Safety Net Programme Phase 2 (HSNP 2) The Hunger Safety Net Programme Phase 2 (HSNP 2) has two outputs namely that: 1. Government of Kenya (GoK) supports cash transfers to help meet chronic and acute needs in the arid and semi-arid lands, which are integrated within the wider National Safety Net Programme; and 2. HSNP households receive timely, predictable electronic cash transfers. HSNP Phase 1 (HSNP 1) was piloted as one component of DFID Kenya’s larger Social Protection Programme Phase 1 (2007-13). HSNP1 spent USD 63.9 million and tested an alternative approach to food aid in four of the poorest and most vulnerable counties of Northern Kenya: Marsabit, Mandera, Wajir and Turkana. Under HSNP 2, the UK is expanding and increasing support in the four counties and building sustainability through the GoK which, for the first time, is also co-funding HSNP in line with its proposed medium term plan. The total DFID funding that stretches from 2014 to 2017 is to the tune of USD 134 million. Funding comprises: Electronic cash transfers going directly to beneficiary bank accounts (82% of total funds), support to an internationally procured Project Implementation and Learning Unit (PILU) within the National Drought Management Authority (12% of total funds) and a DFID held contingency (6% of total costs).

15

e) Arid Lands Support Programme (ASP) DFID provide USD 22.6 million over four years from 2012 to 2016, to build more resilient livelihoods for some of the poorest people in northern Kenya. This programme complements the Hunger Safety Net Programme (HSNP), to ensure longer-term resilience to drought and other shocks in the four counties of Turkana, Marsabit, Mandera and Wajir. The funding goes towards improving government coordination and planning in the region (USD 2.95 m), supporting existing community-level adaptive initiatives (USD 12.7 m), scaling up a livestock insurance scheme (USD 2.16 m) and creating a fund, designed to improve rapid disaster response and reducing risks associated with shocks such as droughts (USD 4.77 m). The Arid Lands Support Programme (ASP) use Hunger Safety Net Programme mechanisms, such as the existing payment platform. ASP indicators are fed into a common monitoring and evaluation framework for both ASP and HNSP. The ASP also supports institutional strengthening of the Government of Kenya in coordination, policy development and monitoring and evaluation f) Refugee Programme DFID is providing USD 69.5 million over three years (2012-2015) for refugees in Dadaab and Kakuma camps in Kenya. This includes USD 56.9 million as part of the original business case primarily aimed at supporting Somali refugees in Dadaab, and an additional USD 12.6 million approved in 2013/14 to support increasing needs in Kakuma, and bridge funding gaps for adequate food distribution and nutrition within the wider Kenya refugee programme. This overall package of funding supports: • Treatment of acutely and moderately malnourished children • Improved access to primary healthcare • Improved essential sanitation and hygiene services • Contribute to general food distributions to avoid severe ration cuts and protect nutrition gains. • Enhanced protection services for refugees European Union Delegation The European Union Delegation has increased funding support to the nutrition sector in Kenya over time, especially over the last 4-5 years. The scope of support extended spans both nutrition sensitive and nutrition specific programmes. The mode of funding has taken on various formats as follows: direct funding of NGOs through calls for proposals; supporting a maternal and young child nutrition programme through an agreement involving the Kenya government, EU and UNICEF; through the Agriculture and rural development programme under SHARE; via humanitarian support through ECHO. Since 2007, the EU Delegation in Kenya has launched five calls for proposals (CfP). The first two calls launched in 2008 and 2009 focused on maternal and child health, vocational training, income generating activities and governance. These had a budget allocation of USD 3.87 million and USD 3.99 million respectively. The third, fourth and fifth CfP launched in 2010, 2012 and 2013 had budget allocation of USD 3.99 million, USD 11.4 million and USD 2.85 million respectively. These calls adopted a more integrated approach by focusing on maternal and child health combined with nutrition and family planning.

16

The current support is therefore a culmination of the fifth call for proposals that was launched in 2013 with a budget allocation of USD 2.85 million. Like the previous calls, it adopted a more integrated approach by focusing on maternal and child health combined with nutrition and family planning. It targets urban informal settlements in Nairobi, Mombasa and Kisumu counties. The four main results expected are:

• Reduced Child and Maternal mortality ratios • Improved nutrition status of mothers, new-born and children under five years • Improved uptake of family planning • Improved capacity of health-care delivery systems

The nutrition interventions hinge around increasing access to nutrition services for mothers, new-borns and children under five. The rest focus on broader health outcomes particularly targeting improvement of women’s health and service delivery systems. They include; Interventions towards behavior change in health seeking practices, Capacity building for communities and service providers, family planning and reproductive health interventions. Special attention is given to strengthening healthcare delivery systems including improving health information system for monitoring and evaluating MCH activities. It is noteworthy that the EU Delegation is planning to launch the sixth call for proposals before the end of the year for a further USD 4.56 million. This call will focus exclusively on support for nutrition. This is because the EU recognizes that under-nutrition has not been adequately addressed and has therefore stepped up global efforts to eradicate hunger and under-nutrition in the world, particularly focusing on reducing the number of undernourished children. Subsequently, the EU committed to meet at least 10% of the World Health Assembly's global target to reduce stunting of 70 million children by 2025, pledging to help reduce this number by at least 7 million. The decision was also informed by the realization that multi-sectoral nutrition interventions have a strong potential to support achievement of MDG 4 and 5 on child health and maternal mortality which are not likely to be achieved in 2015. Importantly, the EUD has also committed to enhance mobilization and political commitment for nutrition through political dialogue and advocacy in close collaboration with the SUN Movement. Currently, EU Delegation is the SUN donor convener in Kenya. a) Maternal and Child Nutrition Programme The EU is currently supporting a maternal and young child nutrition programme through an agreement between GoK-EU-UNICEF. The project that is funded to the tune of USD 30 million for 48 months from November 2014 to October 2018 has the purpose of strengthening community resilience to handle shocks and stress through improved access, provision and monitoring of health, nutrition and sanitation status of the most deprived populations (women and children) in nine counties in the Arid and Semi- Arid Lands (ASAL). The specific overall objective is to improve maternal and child nutrition in deprived communities in Mandera, Wajir, Turkana, West Pokot, Tana River, Samburu, Kitui, Kwale and Kilifi counties. The broad implementation strategies include;

• Creating increased demand for health services • Facilitating access and utilization of basic social services • Evidence base and knowledge management • Leveraging resources for progressive investment

17

This is a nutrition specific programme with all interventions geared towards achieving nutrition objectives and outcomes. The interventions revolve around the following themes: • Behaviour change communication for creating the requisite demand for nutritional services • Enhanced advocacy and nutritional planning at all levels • Capacity building of key actors • Provision of technical support for instance for refining of the national nutrition survey guidelines

using SMART and SQEAUC methodology • Operation research in relevant areas such as formative analysis of underlying drivers of

malnutrition • Child survival interventions such as capacity development of county level health staff to plan,

cost, advocate for resources, implement and coordinate high impact child survival strategies • Enhancing community health communication strategy in order to fast-track the relevant social

change • Building partnerships between key stakeholders at all levels • Enhancement of social transfer innovations • Improving inter-sectoral planning, budgeting and coordination between nutrition, health and

WASH sectors b) Agriculture and Rural Development Programme Besides funding of the maternal and child nutrition programme, the agriculture and rural development projects funded under SHARE have also allocated a certain proportion of the budget for nutrition components which is a positive initiative. While it is difficult to gauge exact amounts, it is estimated that 30 – 40% of funds are allocated for nutrition activities in these projects. It is for this reason that this programme is designated as being nutrition sensitive. The bulk of the interventions are clustered around initiatives to promote food security and livelihoods in ASAL and non-ASAL areas and include; ASAL areas: • ASAL Agricultural Productivity Research Project • Index Based Livestock Insurance • Improving community drought response and resilience • Pastoralists livelihood improvement projects including promotion and strengthening enterprises

and market systems in drought prone areas • Water and Sanitation Services for the ASAL Areas Non-ASAL areas: • Coffee research • Kenya Cereal Enhancement Programme • Livelihood diversification programmes through promotion of sorghum, cassava and green grams

via the value chain development initiatives

18

ECHO ECHO is the arm of the EU that focuses on humanitarian aid. ECHO is a donor that does not function with multiyear funding. Instead it works with a yearly budget hence decisions on allocation is done every year. Therein is a clear disadvantage when dealing with protracted emergency situations. Since 2006, ECHO had steadily invested in policy, coordination, advocacy and integration of malnutrition in the health system although humanitarian funding should not be used to strengthen the health system but to respond to consequences of shocks that reach very high level when national capacities are overwhelmed the direction of which ECHO is now taking. Through ACF, Save the Children and Islamic Relief, ECHO is a nutrition specific programme supporting interventions geared towards achieving with purely nutrition objectives and outcomes. Such interventions include: prevention, early detection, and treatment of acute malnutrition among children under five and PLW; promoting and supporting optimal Infant and Young Child Feeding (IYCF) practices and maternal nutrition, WASH and livelihood activities as well as advocating for increased funding and commitment to nutrition and county drought contingency plans, health systems strengthening. As part of the DRR process, ECHO will be supporting CONCERN to work with the MOH and other partners to scale up the IMAM surge capacity model.

USAID Kenya USAID Kenya is supporting diverse nutrition specific and nutrition sensitive initiatives in Kenya through a variety of programmes implemented by a range of implementing partners as detailed below. a) Resilience and Economic Growth in Arid lands – Improving Resilience (REGAL-IR) The Resilience and Economic Growth in Arid Lands – Improving Resilience is a 5- year project (2012 – 2017) funded by the United States Agency for International Development. The project was designed to decrease vulnerabilities, build resilience, and stimulate growth in selected ASAL areas. The goal is to support Government of Kenya and donor efforts to work with pastoral and transitional communities to reduce hunger and poverty, increase social stability, and build strong foundations for economic growth and environmental resilience. The project targets at least 93,000 households (558,000 people), including children and women of reproductive age, as well as community structures. The project is being implemented in five counties in Northern Kenya, namely: Garissa, Isiolo, Marsabit, Turkana and Wajir. These counties have the highest number and percentage of households in need of food assistance across Kenya and thus offer the greatest opportunity for reducing the food assistance caseload in the arid lands.

The project approach entails support to community members and structures to strengthen social, economic, and environmental resilience. Focus areas include diversification of livelihood opportunities, community management of natural resources, improving livestock market access, disaster risk reduction, and improving nutritional outcomes. There project has a specific focus of improve awareness of good nutritional behaviours, access to and consumption of high-protein and nutrient-dense foods, targeting women of reproductive age and children in their critical first 1000 days implemented by the Global Alliance for Improved Nutrition (GAIN).

Overall, it is expected that the interventions will lead to improved resilience and reduced need for recurring humanitarian relief in five counties in Northern Kenya. Specifically, the project’s integrated approach will lead to increased household income owing to improved ability to engage in income generating activities and creation of vibrant centres that provide pastoralists with access to markets.

19

Livestock productivity will also be enhanced through support to livestock keepers, NGOs and CBOs utilizing improved rangelands and water resources practices. By the end of the project local structures and organizations such as water and drought management committees, peace committees, and other governance mechanisms will have been assisted and strengthened to improve resilience and further sustainable development. The combined effect of community empowerment, ownership of development activities and improved coordination will contribute to poverty reduction, and improved quality of life among pastoralist families.

b) Nutrition and Health Program Plus (NHPplus) Currently, USAID Kenya is supporting implementation of the Nutrition and Health Program Plus (NHPplus) which has a financial commitment of USD 42 million spread over 5 years. The programme aims at increasing access and demand for nutrition services, and improving food and nutrition security, as well as offering commodity management support. This program is aligned with the USAID/K Health Sector Five Year (2010-2015) Implementation Framework and the Kenya Multi-Year Feed the Future (FtF) strategy (2011- 2015). Programme activities and services are being delivered at national level, while others focus on FtF geographic counties that include; Busia, Kitui, Meru, Tharaka Nithi, Trans-Nzoia, Taita Taveta, Makueni, Kakamega, Vihiga and Samburu. Nutrition activities are also implemented in close partnership with MNCH activities aimed at ending preventable child and maternal deaths through scaling-up emergency obstetric care (EmOC). The four MNCH focus counties which NHPplus also provide support include Busia, Tharaka Nithi, Kitui and Samburu. In these counties, NHPplus collaborates with other USAID partners implementing MNCH interventions to ensure greater programme effectiveness for women and children under two years with regards to nutrition. Within FtF areas (Busia, Tharaka Nithi, Kitui, Samburu and Marsabit), NHPplus works directly with FtF partners to enhance the return on agricultural commodities along the value chain, support food safety and quality standards, strengthen the ability of communities and individuals to utilize food and diversify their diets as well as linking poor households vulnerable to under-nutrition and/or HIV with livelihood and economic opportunities. At national level, NHPplus is expanding NACS services beyond HIV, offering technical and financial support to roll-out NACS to include High Impact Nutrition Interventions (HINI). To achieve this, engagement is initiated at national and sub-national levels to create a heightened profile for nutrition and strengthen budgeting, planning and monitoring and evaluation (M&E) allowing the GOK to gradually manage nutrition service provision on its own. Commodity management support for vulnerable populations is carried out following PEPFAR Food and Nutrition guidance. A critical element of this work involve coordination with and strengthening of existing USAID/K efforts such as the APHIAplus and AMPATH projects working with different partners in five geographic areas of Kenya namely; • Pathfinder International (APHIA activities in Nairobi/Coast) • JHPIEGO (APHIA activities in Central/Eastern) • FHI360 (APHIA activities in Rift Valley) • PATH (APHIA activities in Nyanza) • AMREF (APHIA activities in Northern Arid Lands) Though the programme has clear nutrition objectives and outcomes, it is classified as being nutrition sensitive because of its integrated nature. The broad range of interventions include; those that

20

influence specific behavior changes in nutrition practices, building the capacity of health workers in nutrition beside improving the nutrition service delivery management, coordination and implementation, improving production, supply and distribution of nutrition commodities, increasing market access and consumption of diverse quality foods as well as increasing resilience of vulnerable households and communities.

Kenya Agricultural Value Chains Enterprises Project

The Kenya Agricultural Value Chains Enterprises is a five year (Jan 2011 – Jan 2018) US Presidents feed the future project with funding of 40 million US dollars. The project promotes value chain growth and diversification. It increases the productivity and incomes of smallholder farmers, and other actors along the value chain, who are working in the dairy, maize and other staple and horticulture sectors. The activity works with more than 30 Kenyan government and private sector organizations.

The project develops smallholder enterprises that combine maize, high - value horticultural crops, and dairy farming to generate wealth, thereby enhancing food security, improving nutrition, and increasing economic opportunities for women, youth, and other vulnerable populations. Engagement with the private sector in a meaningful, comprehensive way ensures the sustainability of the activity’s work. To improve nutrition and health, particularly for women and children, the project promotes good nutrition and hygiene practices and develops infrastructure to improve access to clean, safe drinking water. The activity builds the capacity of local organizations by providing hands - on technical, financial, and managerial training, so that local organizations can continue providing high - quality services to farmers beyond the life of the project. The activity also promotes sustainable natural resource management to help farmers adapt to the effects of climate. FINTRAC is the implementing partner with funding support extended through various organizations. The project is being implemented in 22 counties in high rainfall and arid and semi-arid areas including: Bomet, Trans Nzoia, Elgeyo-Marakwet, Uasin Gishu, Nandi, Kericho, Bungoma, Busia, Kakamega, Vihiga, Siaya, Homabay, Kisumu, Nyamira, Kisii, and Migori in the western region, and Meru, Tharaka, Machakos, Makueni, Kitui and Taita- Taveta in eastern regions of Kenya. Key partners include: Ministry of Agriculture, Livestock and Fisheries; County governments, Agricultural Sector Development Support Programme (ASDSP), Kenya Plant Health Inspectorate Services (KEPHIS), Pest Control Products Board (PCPB), Horticultural Crops Development Authority (HCDA), Kenya Agricultural Research Institute (KARI), public and private sector actors in the dairy, maize, and horticulture value chains. c) USAID/OFDA USAID/OFDA, as a humanitarian funder, is primarily response-driven. Funding support provided through OFDA is therefore for nutrition specific emergency programming responding to needs as they arise and/or reviewing funding levels on an annual basis. The level of funding from 2012 to 2014 was USD 6million and in 2015 it is USD 1.5 million. The focus of the support is geared towards preparing and responding to nutrition emergencies and accelerating recovery in the arid and semi-arid counties and urban informal settlements of Kenya. The objectives are as follows:

21

1. Increased access to and demand of quality high impact nutrition interventions, including management of acute malnutrition among the most vulnerable populations in arid and semi-arid counties and urban informal settlements in Nairobi

2. Strengthened nutrition capacities at the county level to support emergency response and preparedness

3. Enhanced coordination and nutrition information systems at both national and sub-national level for improved programming and early warning

The targeted population is women and children under five years in the arid and semi-arid counties and Nairobi as well as Kisumu urban informal settlements. d) AIDS, Population and Health Integrated Project plus (APHIAplus)

USAID’s AIDS, Population and Health Integrated Project plus (APHIAplus) is a five year (2011 – 2015). Through the APHIAplus project, USAID/Kenya supports an integrated service delivery model to improve the health of Kenyans across the country. APHIAPlus combines family planning, maternal/ child health, malaria, nutrition, tuberculosis and HIV/AIDS prevention, care, and treatment services to provide an integrated, high quality, equitable approach to sustain able services at the national, county, and community levels. Integrating these activities through one program (APHIAplus) provides more effective communication and coordination with county health administrators. Seamless services and technical support at the local level ensure health workers address the unique needs of each geographic area across the country. The goal of the project is to provide integrated health services for more than ten million people. Implementing partners work at a community level to improve the health and general well-being of families through increased access to food, water, sanitation, and hygiene, education, life skills and income generating activities. Regional partners implement nutrition programs as part of an integrated MNCH package in line with GOK’s priorities.

The Center for Disease Control and Prevention (CDC), with PEPFAR funding, supports the administrative capacity of NASCOP to manage HIV programs, including nutrition as a core component of HIV care and support. Children's Investment Fund Foundation (UK) (CIFF) The Children's Investment Fund Foundation (CIFF) supports de-worming as part of an integrated programme alongside supporting early childhood education, hence qualifying as a nutrition sensitive programme. It is a 5 year programme with a total investment of USD 23,463,000. Currently the programme is in its 3rd year and anticipating to start the 4th year in July 2015. Norwegian Ministry of foreign affairs Norway is providing support to the health/nutrition sector in Kenya through support to the Red Cross and the Norwegian Refugee Council, in addition to larger global agreements with the WFP and UNICEF. It is reported that Norway through international agreement is providing USD 2 million for micronutrient powders (MNPs) in the arid counties. The German Development Cooperation (GIZ) The German Development Cooperation (GIZ) is majorly supporting the implementation of food security programmes in Northern and Western Kenya.

22

a) Food Security and Drought Resilience Programme The objective of the food security and drought resilience programme supported to the tune of USD 3.42 million between 2014 and 2016 is to improve food security and drought resilience in Turkana and Marsabit Counties. The focus of this programme is on implementing reforms in the agricultural sector particularly strengthening drought resilience plus strengthening the respective county plans development and implementation. There are nutrition related activities that include strengthening investments in food security through technology transfer and training in nutrition security. b) Food Security through Improved Productivity Programme The focus of the food security through improved productivity programme in Bungoma, Kakamega, and Siaya supported to the tune of USD 7.29 million between 2014 and 2016 is on reforms in the agricultural sector particularly on irrigation agriculture and intensifying on small scale production systems. Nutrition related activities include: training on gender specific innovations to increase food production and increasing agricultural income of men and women. c) GIZ- Health Sector Programme The cooperation is supporting a GIZ- Health Sector Programme (for the same period of 2014 – 2016) to the tune of USD 798,000 in the counties of Kwale, Kisumu, Vihiga and Nairobi. This support is concerned with three key areas namely; Healthcare Financing, quality management and county support. Counties are supported in the areas of planning and budgeting, financial management and monitoring and evaluation of service providers. The nutrition related objectives in this sector support include:

i. Increasing the proportion of expectant women whose deliveries are undertaken by qualified personnel

ii. Increasing the proportion of women in their reproductive age who use contraceptives iii. Increasing the proportion of women in their reproductive age who have access to basic health

services to improve maternal and neonatal health. d) SIF Project The SIF project supported by the cooperation to the tune of USD 1,756,975 is implementing activities to improve the living conditions of the refugees and the local population in the host area of Kakuma in Turkana County between 2015 and 2017. The specific activities of the project include measures for increased food security for refugees and the local population, strengthening of conflict resolution mechanisms of the two groups, and strengthening of medical care for refugees and the local population. Nutrition specific and related activities include: • Improved access of women in refugee community and host population to supplementary feeding • Provision of training to health care workers in the area of undernutrition and malnutrition with

regard to pregnant and lactating women as well as children under five • Nutrition sensitive activities include: • Equipping of health facilities in refugee camp and host community with essential medical

equipment. • Improvement of quality of health care services in health facilities in refugee camp and host

community.

23

French Ministry of foreign affairs France through a call for proposals is funding an emergency intervention to provide food assistance and improve nutritional outcomes of vulnerable households affected by drought and displacement in Mandera County for a duration of 10 months (May 2015 – Feb 2016) totaling to USD 315,000. The targeted population is 500 vulnerable IDP households (3,000 individuals) and the programme objective is to improve food security and nutritional outcomes of these vulnerable households through delivery of Cash for Work programming with agricultural and livelihood support. Mpesa transfers will have a value of approximately 52 EUR. This will cover approximately 50% of the Minimum Expenditure Basket for one household (based on the recent market monitoring), providing sufficient funds for households to afford almost all of the Food Component of the Minimum Expenditure Basket. This will ensure that households are able to access sufficient food to meet minimum nutritional requirements, and will be able to use other sources of income to make small investments for example in non-food household items. There is possibility of a follow-on further call for proposals worth a similar amount (USD 315,000) in the course of 2015. This is classified as a nutrition specific programme. World Bank The World Bank support to the nutrition sector in Kenya is mainly through the Kenya Health Sector Support Project (KHSSP) which aims to improve (i) the delivery of quality essential health and nutrition services and utilization by women and children especially among the poor and drought affected populations; and (ii) the effectiveness of planning, financing, and procurement of pharmaceutical and medical supplies. ). The total IDA Credit of USD 197.8 million equivalents is complemented by a grant of USD 20 million from the Health Results Innovation Trust Fund (HRITF). The project has been on-going since January 2011and will close in December 2016. This project has been supporting: (i) delivery of essential health and nutrition services by financing, for example, Health Sector Services Fund nationwide; (ii) the emergency response to deliver essential health and nutrition services for the drought affected arid and semi-arid regions of Kenya including supply of nutrition commodities to manage acute malnutrition among children under five years and pregnant and lactating women and scaling up of results based financing in 20 ASAL counties; and (iii) scaling-up of ongoing activities to improve the availability of essential medicines and medical supplies at the primary health care facilities. The project is also supporting first phase of the health insurance subsidy for the poor (HISP) and building capacity of county health systems to better manage PFM for effective service delivery. Other Donors JICA, DANIDA and the Finish Ministry of Foreign Affairs shown in table 2 are supporting maternal and child health projects as well as food security projects through the Kenya Red Cross as the implementing partner. Table 2 – Summary of Donor Support Donor Total funding (USD) Funding period Targeted counties JICA 479,167 2015 – 2018 Isiolo DANIDA 927,083 2015 – 2018 Dadaab, Nairobi, Nyeri Finish Ministry of Foreign affairs

43,750 2015 Malindi

CIDA 929,989 2012 – 2015 -

24

Alignment of funding support to national nutrition priorities as espoused in the national nutrition action plan and the national food and nutrition security policy According to the National Nutrition Action Plan framework, the following constitute the national nutrition priority areas (both nutrition specific and nutrition sensitive interventions); 1. Improve nutritional status of women of reproductive age 2. Improve nutritional status of children under five 3. Reduce the prevalence of micronutrient deficiencies in the population 4. Nutrition in Emergencies 5. Management of IMAM/SAM or curative nutrition services 6. Improve prevention, management and control of diet related NCDs 7. Improve nutrition in schools and other institutions 8. Improve knowledge, attitudes and practices on optimal 9. Strengthen the nutrition surveillance, monitoring and evaluation 10. Enhance evidence-based decision-making through operations research 11. Strengthen coordination and partnerships for key nutrition actors 12. Food & agriculture 13. WASH 14. Social protection Table 1 and Figure 1 illustrate the extent to which the interventions the donor agencies are supporting reflect the national priorities. It is clear that almost all the national priority areas are included in the donor framework of support except two that are totally missing. The two are improving prevention, management and control of diet related NCDs and improving nutrition in schools and other institutions. However the extent of support varies with food security and social protection intervention being highly favoured followed by direct child and maternal health/nutrition interventions and research and information systems in that order.

Figure 1: Graphical representation of programme delivery strategies Policy level strategies refer to activities and engagement at the national level, health facility level refers to activities concentrated at the institutional level particularly capacity building for personnel while community level focuses more on active involvement of community members and activities occurring at community level as opposed to facility level.

25

Table 3: Number of interventions supported by each donor Type of interventions No. of interventions/programmes mentioned in each type of intervention

DFI

D

Nor

way

GIZ

Fren

ch

CID

A

Wor

ld

Ban

k

CIF

F

EU

Finl

and

USA

ID

JIC

A

DA

NID

A

TO

TA

L

Food security and social protection

3 1 3 1 25 1 5 39

Child and maternal health/nutrition

8 7 1 1 17

Research and information systems

5 15 20

Malnutrition treatment 5 1 1 3 10 Capacity building for community and workers

4 9 2 15

Systems support 1 3 7 4 15 Advocacy, coordination and partnership

1 5 6

Behaviour change 4 1 5 Nutrition planning 2 2 4 Scale up of HINI 4 1 4 WASH 5 5 Family planning 4 4 Micronutrient supplementation

2 1 3

26

Table 4: Geographical Spread of Donor Support by County County Relative frequency of counties (No. of times mentioned) ASAL counties: Wajir 15 Marsabit 14 Turkana 13 Mandera 12 Kitui 12 Samburu 11 Garissa 10 West Pokot 10 Isiolo 9 Kwale 8 Baringo 8 Kilifi 7 Tharaka Nithi 7 Machakos 6 Makueni 6 Tana River 6 Embu 6 Meru 6 Narok 6 Nyeri 6 Kajiado 5 Taita Taveta 5 Dadaab 3 Kakuma 2 Elgeyo Marakwet 1 Laikipia 1 Chogoria Hospital (Meru) 1 Total 196 High potential arable counties: Nairobi 8 Kakamega 5 Kisumu 4 Mombasa 4 Busia 3 Bungoma 3 Trans Nzoia 2 Kericho 2 Homa Bay 2 Vihiga 2 Kiambu Hospital (Kiambu county) 1 Thika 1 Nanyuki Hospital (Laikipia) 1 Mama Lucy Hospital (Nairobi) 1 Muranga 1 Nakuru 1 Malindi 1 Siaya 1 Nandi 1 Buret 1 Total 45

27

Funding Levels We focused on assessing current funding commitments and projections for the next 5 years. The funding reflected in table 6 below is based on the weighting of the overall programme budgets as reflected in table 5. Information on disbursements over the past few years is described where this was available. Analysis of funding data revealed that multi-year projects may be committed in one year but disbursed over several years. There is however some variation in how disbursements against multiannual commitments are reported. Table 5: Weighting of the overall programme budget** Donor Programme

supported Budget weighting (% going to nutrition)

Explanation for assigning the weightings as provided for in the methodology for tracking financial investment in nutrition

DFID Kenya

Kenya Health Programme

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

Enhanced nutrition surveillance, resilience and response programme

100 The entire programme aimed at achieving purely and clearly stated nutrition objectives, outcomes and specific interventions

Programme on Reducing Maternal and Newborn Deaths in Kenya

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

Hunger Safety Net Programme phase 2

25 The programme classified under nutrition sensitive but no stated nutrition objectives and outcomes

Arid Lands Support Programme

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

Kenya Social protection Programme 2

25 The programme classified under nutrition sensitive but no stated nutrition objectives and outcomes

Refugee programme 75 clearly stated nutrition objectives, outcomes and specific interventions but part of an overall integrated programme

European Union

ECHO 100 All interventions aimed at achieving purely and clearly stated nutrition objectives, outcomes and specific interventions

Agriculture and rural development

25 The programme classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

Maternal and child nutrition programme under SHARE

100 The entire programme is aimed at achieving purely and clearly stated nutrition objectives, outcomes and specific nutrition interventions

MCH 50 No stated nutrition objectives and outcomes but some specific nutrition interventions are mentioned

USAID NHPplus 75 clearly stated nutrition objectives, outcomes and specific interventions but part of an overall integrated programme

FFP 100 All interventions aimed at achieving purely and clearly stated nutrition objectives, outcomes and specific nutrition interventions

OFDA 100 All interventions aimed at achieving purely and clearly stated nutrition objectives, outcomes and specific interventions

Kenya Agricultural Value Chains Enterprises Project (KAVES)

25 Project classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

Resilience and Economic Growth in

25 Programme classified under nutrition sensitive but insufficient information to determine clarity on any

28

the Arid Lands-Increased Resilience (REGAL-IR)

nutrition objectives and outcomes

Water and sanitation programmes

25 Programmes classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

CIFF De-worming and early childhood education programmes

25 Interventions classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

GIZ Food security and drought resilience programme

50 No stated nutrition objectives and outcomes but some specific nutrition interventions are mentioned

Food security through improved productivity programme

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

GIZ-Health Sector programme

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

SIF Project 50 No stated nutrition objectives and outcomes but some specific nutrition interventions are mentioned

Norwegian Ministry of foreign affairs

Micronutrient powders 100 The entire programme aimed at achieving purely nutrition objectives, outcomes

JICA Maternal and child health

25 Interventions classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

DANIDA Maternal and child health Non Communicable diseases

25 Interventions classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

French Ministry of Foreign Affairs

Cash transfer programme

100 The objective of the entire programme is to achieve purely nutrition objectives, outcomes

Finish Ministry of Foreign affairs

Food security 25 Interventions classified under nutrition sensitive but insufficient information to determine clarity on any nutrition objectives and outcomes

World Bank HSSF including scaling-up of RBF

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

(ii) Governance and stewardship including a. scaling up of HISP and b. county capacity building

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

Supply of Nutrition commodities

100 The entire programme aimed at achieving purely nutrition objectives, outcomes

Essential Medicines and Medical Supplies including warehousing and procurement reforms

25 Interventions classified under nutrition sensitive but no stated nutrition objectives and outcomes

CIDA Vitamin A supplementation

100 The entire programme aimed at achieving purely nutrition objectives, outcomes

** Methodologyfor tracking financial investment in nutrition developedbytheSUN-Donor-Networkworkinggrouponresources

29

Table 6: Amount (Total and weighted allocations) and duration of funding by donors

Donor agency Level of funding (USD)

Number of overall

programmes supported

Total programme

funding

Estimated nutrition funding

Average yearly funding for nutrition

DFID 7 602,623,188 208,073,188 60,293,157 EU Delegation 4 60,384,708 42,954,177 18,554,177 USAID Kenya 6 92,087,164 52,787,164 19,170,721 GIZ 4 13,264,975 4,610,488 2,305,244 CIFF 1 23,463,000 5,865,750 1,173,150 Norweigian Ministry of Foreign Affairs

1 2,000,000 2,000,000 2,000,000

Finish Ministry of Foreign Affairs

1 43,750 10,938 10,938

JICA 1 479,167 119,792 29,948 DANIDA 2 927,083 231,771 57,943 French Ministry of Foreign Affairs

1 630,000 630,000 630,000

CIDA 1 929,989 929,989 309,996 World Bank 4 217,800,000 64,050,000 10,675,000 TOTAL 33 1,014,633,024 382,263,256 115,210,274

30

Table 7: Amount (Total and weighted allocations) – Specific verses Sensitive programmes

Total allocation Nutrition allocation Yearly estimate of nutrition

allocation

Nutrition Specific 93,514,341 93,514,341 31,162,447

Nutrition Sensitive 921,118,683 288,748,915 84,047,827

Total 1,014,633,024 382,263,256 115,210,274 The average duration for donor/commitment support is about 3 years (see detailed financial allocations annex 1 below). Realistic projections for the next five years can only be extrapolated on the basis of the total average yearly funding of USD 115 million (see table 6 above) bringing to USD 575 million as the projected total funding for nutrition support from all the donors assuming the current level of funding is maintained. Nb: ThisreportingdoesnotcapturecorefundingforUNagencieswhosupportmanynutritionprogrammesinKenya.

Conclusions • Most of the nutrition programmes supported by donors address the national nutrition priority

areas focused on scaling up of the high impact nutrition interventions. • Most donor funding (0ver 80 %) is going to programmes in counties within the ASAL areas with

multiple donor agencies funding nutrition programmes within the same counties. A good proportion of this funding is simultaneously addressing access to food and health services, building resilience of communities to cope with the cyclic effects of drought and strengthening government systems to deliver improved health services.

• Given the low government funding to the nutrition sector, donor funding is playing a central role in the country’s efforts to address malnutrition and in particular, meeting the funding gaps at national and county level.

• There is a relatively high level of funding dedicated to potentially nutrition sensitive programmes. The majority of these programmes do not however reflect systematic mainstreaming of nutrition in their design and implementation.

31

Recommendations

• While substantive funding is dedicated to potentially nutrition sensitive programmes by donor agencies, implementing partners need technical support to mainstream nutrition more robustly in programme design to enhance nutrition sensitivity of such programs. This should entail inclusion of specific nutrition outcomes supported by activities and indicators at the output and outcome levels. Donors should support government efforts aimed at strengthening programme design to enhance nutrition sensitivity of programmes.

• Harmonization of funding projections among donors is necessary to ensure more rational spread of available resources based on population size and stunting levels. Currently, some counties with high stunting rates in non ASAL areas are not supported or have minimal funding (Bomet (36%; Nyandarua (29%); Uasin Gishu (31%); Narok (33%)

• Findings of this mapping should be used to lobby donors to include nutrition as a focus area in specific donor country development agreements.

• Future mapping should cover county donor support for nutrition • Need for network/GoK to institute a tracking system for donor off budget support to the nutrition

sector • Need for further analysis to derive funding gap based on NNAP budget projections Verses off and

on-budget allocations

32

Annex 1: Detailed financial commitment by programmes Donor agency

Programme supported Level of funding (USD)

Duration in years

Total programme

funding

Estimated nutrition funding

Average yearly

funding for nutrition

DFID: Kenya Health Programme

3.7 167,900,000

41,975,000 11,344,595

Enhanced nutrition surveillance, resilience and response programme

3 30,223,188

30,223,188 10,074,396

Programme on reducing maternal and newborn deaths

5 118,000,000

29,500,000 5,900,000

Hunger safety net programme 2

3 134,000,000

33,500,000 11,166,667

Arid Lands Support Programme

4 22,600,000

5,650,000 1,412,500

Kenya Social protection programme

5 60,400,000

15,100,000 3,020,000

Refugee programme 3 69,500,000

52,125,000 17,375,000

Sub-total 602,623,188 208,073,188 60,293,157 EU Delegation:

Agriculture/Rural Development

1 19,440,708

4,860,177 4,860,177

Maternal and Child Nutrition under SHARE

4 30,000,000

30,000,000 7,500,000

MCH Programme 3 5,700,000

2,850,000 950,000

ECHO 1 5,244,000

5,244,000 5,244,000

Sub-total 60,384,708 42,954,177 18,554,177 USAID Kenya:

NHPplus 5 42,000,000

31,500,000 6,300,000

OFDA 4 7,500,000

7,500,000 1,875,000

FFP 3 4,187,164

4,187,164 1,395,721

Kenya Agricultural Value Chains Enterprises Project (KAVES)

1 12,000,000

3,000,000 3,000,000

Resilience and Economic Growth in the Arid Lands-Increased Resilience (REGAL-IR)

1 6,400,000

1,600,000 1,600,000

Water and sanitation programmes

1 20,000,000

5,000,000 5,000,000

Sub-total 92,087,164 52,787,164 19,170,721

33

GIZ Food security and drought resilience programme

2

3,420,000

1,710,000 855,000

Food security through improved productivity programme

2

7,290,000

1,822,500 911,250

GIZ-Health Sector programme

2

798,000

199,500 99,750

SIF Project 2

1,756,975

878,488 439,244

Sub-total 13,264,975 4,610,488 2,305,244 CIFF 5

23,463,000 5,865,750 1,173,150

Norweigian Ministry of Foreign Affairs

Micronutrient powders - 2,000,000

2,000,000 2,000,000

Finish Ministry of Foreign Affairs

Food security 1 43,750

10,938 10,938

JICA Maternal and child health 4 479,167

119,792 29,948

DANIDA Maternal and child health, Non communicable diseases

4 927,083

231,771 57,943

French Ministry of Foreign Affairs

Cash transfer programme 1 630,000

630,000 630,000

CIDA Vitamin A supplementation

3 929,989

929,989 309,996

World Bank

HSSF including scaling-up of RBF

6 58,600,000

14,650,000 2,441,667

Governance and stewardship including scaling up of HISP and county capacity building

6 48,285,000

12,071,250 2,011,875

Supply of Nutrition commodities

6 12,800,000

12,800,000 2,133,333

Essential Medicines and Medical Supplies including warehousing and procurement reforms

6 98,115,000

24,528,750 4,088,125

Sub-total 217,800,000 64,050,000 10,675,000 TOTAL 3.2 1,014,633,024 382,263,256 115,210,274

34

AN

NEX2:KEN

YANUT

RITIONDO

NORAN

ALYSIS

DO

NO

R

KEY

PR

OG

RA

MM

ES F

UN

DED

C

OU

NTY

/ R

EGIO

N

AN

ALY

SIS

OF

FUN

DIN

G S

UPP

OR

T –

Cur

rent

& P

roje

cted

D

FID

En

hanc

ing

nutri

tion

surv

eilla

nce,

resp

onse

and

re

silie

nce

In th

e ar

id a

nd s

emi-a

rid la

nds

of K

enya

U

SD 2

7.29

milli

on b

etw

een

2012

and

Oct

ober

201

5 U

SD 1

2.32

milli

on to

a c

onso

rtium

of N

GO

s fo

r nu

tritio

n se

rvic

es in

Man

dera

, Waj

ir an

d Tu

rkan

a, U

SD 1

4.97

milli

on a

lloca

ted

to U

NIC

EF to

sup

port:

i)

the

deliv

ery

of n

utrit

ion

serv

ices

thro

ugh

its N

GO

par

tner

s in

the

othe

r ASA

L ar

eas;

ii) s

yste

m

stre

ngth

enin

g ac

tiviti

es a

nd c

oord

inat

ion

of th

e nu

tritio

n se

ctor

at c

ount

y an

d na

tiona

l lev

el; i

ii) s

uppo

rt al

l m

onito

ring

and

eval

uatio

n pr

ogra

mm

e ac

tiviti

es)

Th

e D

FID

Ken

ya H

ealth

Pr

ogra

mm

e Sy

stem

s st

reng

then

ing

supp

ort i

s be

ing

exte

nded

in e

stab

lishm

ent a

nd o

rient

atio

n of

co

unty

hea

lth m

anag

emen

t tea

ms

(CH

MT)

and

pr

ovid

ing

orie

ntat

ion

to a

ll 47

cou

ntie

s on

the

plan

ning

tem

plat

es a

nd th

eir a

pplic

atio

ns

A fiv

e-ye

ar p

rogr

amm

e th

at b

egan

in O

ctob

er 2

009.

The

pro

gram

me

end

date

has

bee

n ex

tend

ed to

D

ecem

ber 2

015.

Of i

nter

est i

s th

e U

SD 3

5.55

milli

on fo

r fam

ily p

lann

ing;

and

USD

19.

75 m

illion

for

stre

ngth

enin

g H

ealth

Sys

tem

s.

Th

e So

cial

Pro

tect

ion

Prog

ram

me

Supp

orts

two

outp

uts

at th

e na

tiona

l lev

el:

1.de

velo

pmen

t of a

nat

iona

l soc

ial p

rote

ctio

n sy

stem

and

2. e

xpan

sion

of t

he C

ash

Tran

sfer

to

Orp

hans

and

Vul

nera

ble

Chi

ldre

n Pr

ogra

mm

e

Soci

al P

rote

ctio

n Pr

ogra

mm

e ph

ase

II is

sup

porte

d to

the

tune

of U

SD 6

0.4

milli

on: U

SD 2

6.8

milli

on

havi

ng b

een

alre

ady

appr

oved

und

er th

e or

igin

al S

PP1

in 2

007

and

has

been

rolle

d in

to S

PP2.

An

addi

tiona

l USD

33.

6 m

illion

was

add

ed to

del

iver

the

resu

lts u

nder

SPP

2. F

undi

ng g

oes

thro

ugh

the

Wor

ld

Bank

(WB)

.

Th

e re

fuge

e pr

ogra

mm

e C

over

s re

fuge

es in

Dad

aab

and

Kaku

ma

DFI

D is

pro

vidi

ng U

SD 6

9.5

milli

on o

ver t

hree

yea

rs (2

012-

2015

). Th

is in

clud

es U

SD 5

6.9

milli

on a

s pa

rt of

the

orig

inal

bus

ines

s ca

se p

rimar

ily a

imed

at s

uppo

rting

Som

ali r

efug

ees

in D

adaa

b, a

nd a

n ad

ditio

nal

USD

12.

6 m

illion

app

rove

d in

201

3/14

to s

uppo

rt in

crea

sing

nee

ds in

Kak

uma

Pr

ogra

mm

e on

redu

cing

m

ater

nal a

nd n

ewbo

rn d

eath

s H

oma

Bay,

Bun

gom

a an

d Tu

rkan

a Th

e U

K ha

s in

vest

ed u

p to

118

milli

on fo

r 5 y

ears

sin

ce 2

013,

hen

ce th

e su

ppor

t run

ning

up

to 2

018,

H

unge

r saf

ety

net p

rogr

amm

e 2

Mar

sabi

t, M

ande

ra, W

ajir

and

Turk

ana

The

tota

l DFI

D fu

ndin

g th

at s

tretc

hes

from

201

4 to

201

7 is

to th

e tu

ne o

f USD

134

milli

on.

Ar

id L

ands

Sup

port

Prog

ram

me

Turk

ana,

Mar

sabi

t, M

ande

ra a

nd W

ajir

DFI

D p

rovi

de U

SD 2

2.6

milli

on o

ver f

our y

ears

from

201

2 to

201

6

Euro

pean

Uni

on

Del

egat

ion

The

fifth

cal

l for

pro

posa

ls th

at

adop

ted

a m

ore

inte

grat

ed

appr

oach

by

focu

sing

on

mat

erna

l and

chi

ld h

ealth

co

mbi

ned

with

nut

ritio

n an

d fa

mily

pla

nnin

g

Targ

ets

urba

n in

form

al s

ettle

men

ts in

Nai

robi

, M

omba

sa a

nd K

isum

u co

untie

s Th

e cu

rrent

sup

port

is a

cul

min

atio

n of

the

fifth

cal

l for

pro

posa

ls th

at w

as la

unch

ed in

201

3 w

ith a

bud

get

allo

catio

n of

USD

2.8

5 m

illion

. The

Del

egat

ion

is p

lann

ing

to la

unch

the

sixt

h ca

ll fo

r pro

posa

ls b

efor

e th

e en

d of

the

year

for a

furth

er U

SD 4

.56

milli

on. T

his

call

will

focu

s ex

clus

ivel

y on

sup

port

for n

utrit

ion

Mat

erna

l and

chi

ld n

utrit

ion

prog

ram

me

Nin

e co

untie

s in

the

Arid

and

Sem

i- Ar

id L

ands

(M

ande

ra, W

ajir,

Tur

kana

, Wes

t Pok

ot, T

ana

Riv

er, S

ambu

ru, K

itui,

Kwal

e an

d Ki

lifi)

The

prog

ram

me

is fu

nded

to th

e tu

ne o

f USD

1 2

1.66

milli

on fo

r 48

mon

ths

from

Nov

embe

r 201

4 to

O

ctob

er 2

018

Agric

ultu

re a

nd ru

ral

deve

lopm

ent p

roje

cts

Spre

ad a

cros

s AS

AL a

nd N

on-A

SAL

area

s na

mel

y Tu

rkan

a, W

est P

okot

, Bar

ingo

, M

arsa

bit,

Sam

buru

, Isi

olo,

Man

dera

, Waj

ir,

Gar

issa

, Tan

a R

iver

, Lam

u, K

ilifi,

Kwal

e, T

aita

Ta

veta

, Kitu

i, M

akue

ni, E

mbu

, Tha

raka

Nith

i, M

eru,

Lai

kipi

a, N

yeri,

Kaj

iado

, Nar

ok, T

hika

, Ke

richo

, Bur

et, B

ungo

ma,

Kak

ameg

a, N

akur

u,

Nan

di, T

rans

Nzo

ia a

nd M

acha

kos

It is

est

imat

e th

at 3

0 –

40%

of f

unds

are

allo

cate

d fo

r nut

ritio

n ac

tiviti

es in

thes

e pr

ojec

ts w

hich

tran

slat

e to

ab

out

USD

6.8

4 m

illion

in

the

curre

nt y

ear

ECH

O

ECH

O a

ctiv

ities

are

con

cent

rate

d in

the

ASAL

co

untie

s of

Man

dera

, Waj

ir, T

urka

na, W

est

Poko

t, M

arsa

bit a

nd D

adaa

b re

fuge

e ca

mp

ECH

O d

oes

not f

unct

ion

with

mul

tiyea

r fun

ding

inst

ead

it w

orks

with

a y

early

bud

get e

stim

ated

at U

SD

4.56

milli

on th

at b

asic

ally

goe

s to

war

ds h

uman

itaria

n su

ppor

t par

ticul

arly

the

scal

ing

up o

f hig

h im

pact

nu

tritio

n in

terv

entio

ns

GIZ

Fo

od s

ecur

ity a

nd d

roug

ht

resi

lienc

e pr

ogra

mm

e Tu

rkan

a an

d M

arsa

bit c

ount

ies

USD

3.4

2 m

illion

bet

wee

n 20

14 –

201

6

35

Fo

od s

ecur

ity th

roug

h im

prov

ed

prod

uctiv

ity p

rogr

amm

e

In B

ungo

ma,

Kak

ameg

a, a

nd S

iaya

cou

ntie

s Su

ppor

ted

to th

e tu

ne o

f USD

7.2

9 be

twee

n 20

14 –

201

6

G

IZ- H

ealth

Sec

tor P

rogr

amm

e In

the

coun

ties

of K

wal

e, K

isum

u, V

ihig

a,

Nai

robi

Su

ppor

ted

for t

he p

erio

d of

201

4 –

2015

to th

e tu

ne o

f USD

798

,000

SI

FT p

roje

ct

Ref

ugee

s an

d th

e lo

cal p

opul

atio

n in

the

host

ar

ea o

f Kak

uma

in T

urka

na c

ount

y Su

ppor

ted

to th

e tu

ne o

f USD

1,7

56,9

75 b

etw

een

2015

and

201

7

CIF

F D

e-w

orm

ing

and

Early

C

hild

hood

Edu

catio

n

It is

a 5

yea

r pro

gram

me

with

a to

tal i

nves

tmen

t of U

SD 2

3,46

3,00

0. C

urre

ntly

the

prog

ram

me

is in

its

3rd

year

and

ant

icip

atin

g to

sta

rt th

e 4t

h ye

ar in

Jul

y 20

15

Nor

way

m

icro

nutri

ent p

owde

rs (M

NPs

) Ar

id c

ount

ies

Nor

way

thro

ugh

inte

rnat

iona

l agr

eem

ent i

s pr

ovid

ing

USD

2 m

illion

JIC

A M

ater

nal a

nd c

hild

hea

lth

prog

ram

me

Isio

lo

USD

479

,167

bet

wee

n 20

15 -

2018

DAN

IDA

Ref

ugee

and

mat

erna

l and

chi

ld

heal

th p

rogr

amm

e D

adaa

b, N

airo

bi, N

yeri

USD

927

,083

bet

wee

n 20

15 -

2018

Fini

sh M

inis

try o

f Fo

reig

n af

fairs

Fo

od s

ecur

ity

Mal

indi

U

SD 4

3,75

0 fo

r 201

5

Fren

ch M

inis

try o

f Fo

reig

n af

fairs

N

utrit

ion

emer

genc

y M

ande

ra c

ount

y U

SD 3

15,0

00 fo

r the

yea

r 201

5/20

16. T

here

is a

pos

sibi

lity

of fu

rther

sup

port

of U

SD 3

15,0

00 fo

r thi

s ye

ar

USA

ID K

enya

N

utrit

ion

and

Hea

lth P

rogr

am

Plus

(NH

Pplu

s)

Prog

ram

me

activ

ities

and

ser

vice

s ar

e be

ing

deliv

ered

at n

atio

nal l

evel

, whi

le o

ther

s fo

cus

on

FtF

geog

raph

ic c

ount

ies

that

incl

ude;

Bus

ia,

Kitu

i, M

eru,

Tha

raka

Nith

i, Tr

ans-

Nzo

ia, T

aita

Ta

veta

, Mak

ueni

, Kak

ameg

a, V

ihig

a, S

ambu

ru

and

Mar

sabi

t.

This

pro

gram

is a

ligne

d w

ith th

e U

SAID

/K H

ealth

Sec

tor F

ive

Year

(201

0-20

15) I

mpl

emen

tatio

n Fr

amew

ork

and

the

Keny

a M

ulti-

Year

Fee

d th

e Fu

ture

(FtF

) stra

tegy

(201

1- 2

015)

with

an

annu

al fi

nanc

ial

com

mitm

ent o

f abo

ut U

SD 9

.12

milli

on

O

FDA

Res

pons

e dr

iven

- nu

tritio

n sp

ecifi

c em

erge

ncy

prog

ram

min

g Th

e le

vel o

f fun

ding

from

201

2 to

201

4 w

as U

SD 6

milli

on a

nd in

201

5 it

is U

SD 1

.5 m

illion

.

Fo

od F

or P

eace

(FFP

) -

Fina

ncia

l com

mitm

ent o

f USD

4,1

87,1

64 b

etw

een

2012

and

201

5

Ke

nya

Agric

ultu

ral V

alue

C

hain

s En

terp

rises

Pro

ject

(K

AVES

)

22 C

ount

ies

in h

igh

rain

fall

and

arid

and

sem

i ar

id a

reas

incl

udin

g: B

omet

, Tra

ns N

zoia

, El

geyo

-Mar

akw

et, U

asin

Gis

hu, N

andi

, Ker

icho

, Bu

ngom

a, B

usia

, Kak

ameg

a, V

ihig

a, S

iaya

, H

omab

ay, K

isum

u, N

yam

ira, K

isii,

and

Mig

ori i

n th

e w

este

rn re

gion

, and

Mer

u, T

hara

ka,

Mac

hako

s, M

akue

ni, K

itui a

nd T

aita

- Tav

eta

$40

milli

on (J

an 2

013-

Jan

201

8)

Annu

al c

omm

itmen

t of U

SD 1

2,00

0,00

0 fo

r 201

5

R

esilie

nce

and

Econ

omic

G

row

th in

the

Arid

Lan

ds-

Incr

ease

d R

esilie

nce

(REG

AL-

IR) t

hrou

gh A

DES

O

Prog

ram

me

activ

ities

in 5

ASA

L co

untie

s –

Isio

lo, M

arsa

bit,

Turk

ana,

Waj

ir an

d G

aris

sa

Annu

al c

omm

itmen

t of U

SD 6

,400

,000

for 2

015

W

ater

and

san

itatio

n pr

ogra

mm

es

-TBD

An

nual

com

mitm

ent o

f USD

20,

000,

000

for 2

015

CID

A Vi

tam

in A

sup

plem

enta

tion

- Fi

nanc

ial c

omm

itmen

t of U

SD 9

29,9

89 b

etw

een

2012

and

201

5

Wor

ld B

ank

Keny

a Es

sent

ial P

acka

ge fo

r H

ealth

and

Nut

ritio

n se

rvic

es

drou

ght a

ffect

ed a

rid a

nd s

emi-a

rid re

gion

s of

Ke

nya

Supp

ort o

f USD

12.

8 m

illion

. The

pro

ject

has

bee

n on

-goi

ng s

ince

Jan

uary

201

1. W

as e

xten

ded

to

Dec

embe

r 201

6.

Pr

ogra

mm

e on

ava

ilabi

lity

of

esse

ntia

l med

icin

es a

nd

med

ical

sup

plie

s

enha

nced

focu

s on

the

drou

ght a

ffect

ed

coun

ties

Fina

ncia

l com

mitm

ent o

f USD

44

milli

on. T

he p

roje

ct h

as b

een

on-g

oing

sin

ce J

anua

ry 2

011.

Was

ex

tend

ed to

Dec

embe

r 201

6.

Sc

ale

up a

ctiv

ities

and

re

stru

ctur

ing

due

to d

evol

utio

n

Fina

ncia

l com

mitm

ent o

f 61

milli

on u

p to

Dec

embe

r 201

6

Donor Support to the Nutrition Sector in KenyaMapping Report