rwanda stakeholder & action mapping 2014 15

Stakeholder & Action Mapping for Rwanda 2014/15Using the Scaling Up Nutrition Planning & Monitoring Tool

August 2015

Compressed version of the slide deck

Rwanda Stakeholder & Action Mapping 2014-15 - Compressed deck.pptx

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Disclaimer for the Stakeholder & Action Mapping

It is important to note what the Stakeholder & Action Mapping is, and what it is not.

The Rwanda Stakeholder & Action Mapping intends to help improve nutrition coordination and scale-up discussion by providing an indicative overview of who the key stakeholders in nutrition are, where they are working, and an estimate of how many they are reaching, on a chosen few Core Nutrition Actions.

However, the Stakeholder & Action Mapping is not research or exact science. Both the geographical and beneficiary coverage are estimates based only on the information provided by the organizations who have reported. The coverage is therefore not to be considered as exhaustive or exact. Moreover, it is voluntary to report, and not necessarily all stakeholders have been identified or have chosen to contribute.

Also, the Stakeholder & Action Mapping is only focusing on the chosen Core Nutrition Actions. Other organizations may be working on other nutrition actions that have not been included. Furthermore, the Stakeholder & Action Mapping is not assessing the quality or accuracy of the reported coverage.

The Stakeholder & Action Mapping only represents a snapshot of the situation in Rwanda. Partners, projects, programs and funding change continuously, and thus also the support and coverage will change. The coverage data is provided for 2014, i.e. the last full calendar year.

The Stakeholder & Action Mapping should thus only be interpreted as indicative and directional, and should not be used for other purposes, nor should estimated coverage under any circumstance be used or referred to as publicly approved or validated data.

IMPORTANT TO READ


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Executive Summary for the Stakeholder & Action Mapping

Chronic malnutrition (stunting) is still a major public health concern in Rwanda• Despite progress over the last decade, Rwanda is still in the high severity zone as defined by WHO• Progress in stunting reduction is consistent, but slow compared to targets set by the Government of Rwanda• On the positive side, the MDG targets for underweight reduction was achieved, and acute malnutrition

(wasting) is in low severity zones as defined by WHO

There are gaps both in geographical coverage and beneficiary coverage of the Core Nutrition Actions (CNAs)

• There are many partners supporting the fight against malnutrition in Rwanda, including ministries, donors, catalysts and field implementers. The scale and support varies across the different stakeholders

• The level of support and coverage of the CNAs also varies among different districts both in number of partners supporting the district, the number of CNAs implemented, and the coverage of beneficiaries for these CNAs

Further scale-up is needed to accelerate the reduction of stunting in Rwanda• Geographic coverage of the CNAs should be increased so that more CNAs are reaching all areas of Rwanda• Beneficiary coverage of the CNAs should be improved so that more CNAs are reaching a higher proportion of

their target groups• The quality of the coverage needs to be ensured, so that we are not only reaching more beneficiaries, but also

ensuring a level of quality that makes the interventions efficient and sustainable

All partners need to cooperate and contribute to further scale-up nutrition interventions in Rwanda• The findings in the Stakeholder & Action Mapping can help inform such scale-up discussions


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The Stakeholder & Action Mapping report is structured according to the following topics and key questions

Introduction, background and objectives of the Stakeholder & Action Mapping

Recap of the food and nutrition situation in Rwanda – highlights from the Nutrition Analysis• What is the food and nutrition situation nationally?• What is the food and nutrition situation per district?

Stakeholder & Action Mapping methodology and approach

Stakeholder & Action Mapping overview and analyses• Who are the main stakeholders working with nutrition in Rwanda?• What are the main programs?• What core nutrition actions are the stakeholders working on?• Where are we working?• How many are we reaching?

Implications of the findings from the Stakeholder & Action Mapping• Where and what are the gaps?• What recommendations for planning and scale up can be made?

Appendix

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2

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AgendaIntroduction, background and objectives of the Stakeholder & Action Mapping



Stakeholder & Action Mapping overview and analyses• Who are the main stakeholders working in nutrition in Rwanda?• What are the main programs?• What core nutrition actions are the stakeholders working on?• Where are they working?• How many are they reaching?

Implications of the findings from the Stakeholder & Action Mapping• Where and what are the gaps?• Main recommendations and findings for scaling up

Appendix

http://ppt/slides/slide11.xml















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Introduction to the Stakeholder & Action Mapping 2014/15

Objectives of Stakeholder & Action Mapping• To decide on the prioritized core nutrition actions (CNAs) in Rwanda

• To get a better overview of who is doing what and where in nutrition in Rwanda

• To be better able to identify gaps in coverage of target population and geographies of core nutrition actions

• Ultimately to help inform & improve planning of core nutrition actions, to scale up and eliminate malnutrition

Background for Stakeholder & Action Mapping• Request by the Social Cluster Ministries and the FNTWG to update the stakeholder mapping from 2012

• Redefining of previous mapping efforts to better understand the coverage of target populations and geographic areas of CNAs (using updated and improved SUNPMT tool)

What data is collected, and how?• The mapping exercise collects coverage data directly from key nutrition stakeholders

– Template input from stakeholders on which CNAs they are implementing or supporting and where

– Interview-based data collection for further details on CNAs (including beneficiary coverage)

• The data collected include the following: Organization and program contact details, actions / interventions being conducted, target group(s), delivery mechanisms, period of program operation, geographic regions of operation, number of beneficiaries reached


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What can the Stakeholder & Action Mapping help you with?

For Ministries

Get a better overview of who the partners are and what they do

Identify potential gaps in geographic coverage

Identify potential gaps in action coverage

Help planning & scale-up of nutrition actions

For Districts

See what partners are working with food & nutrition in your district

Get info on what actions are being conducted, and where

How many people are being reached by different actions, what needs to be scaled up

For UN & NGOs

Enhance coordination though better info on what organizations are working in the same districts and/or on the same actions

Identify what districts need further support

See what actions need to be scaled up, and where

For Donors

Identify what districts need further support

See what actions need more funds to scale up

Help identify what organizations can cover different actions and districts

Improve coordination among partners, and help inform planning and scale up of nutrition actions in Rwanda


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Updating the Rwanda Stakeholder Mapping, using an upgraded and more comprehensive M&E tool from REACH

2012: General overview of who does what and where within nutrition in Rwanda

2015: Map coverage of core nutrition actions to better inform nutrition planning and scale-up


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The 23 Core Nutrition Actions agreed to map in Rwanda (1/2)How do they link to the NFNSP, and who are the main target groups

Strategic Direction & Output1 1 2 3 4 5 6 7

Core Nutrition Actions (CNAs) Target group(s)

Promote optimal breastfeeding practices Promote optimal complementary feeding practicesProvide specialized nutritious products for complementary feeding (e.g. CSB)Provide Fe+FA supplementsProvide MNP supplements (Ongera)Provide Vit A supplementsProvide deworming tabletsProvide diarrhoea treatment (w/ ORS/ORS-zinc)Provide treatment of SAMProvide & support treatment of MAMConduct child growth monitoring / screeningPromote/Provide ANC visits (4+)

2.1&3 4.22.1&3 4.23.5

5.34.32.3

4.32.3

5.34.32.3

5.34.32.3

4.12.1 6.22.1&3 4.1 5.3

4.22.3

2.3

PLW & HHs w/ ch. u5PLW & Households

w/ children under 56-23 months & PLW

in Ubudehe 1 & 2Pregnant Women6-23 months6-59 months12-59 mths & 5-15 yrsu5 w/ severe diarrhoeau5 with SAMu5 with MAM6-59 monthsPregnant Women

4.12.1 6.2

6.2MIY

CN

Mic

ro-n

utr

ient

sM

anag

e di

seas

eM

AM

/SA

MM

NC

H

1. Refers to the Strategic Directions and Outputs of the National Food & Nutrition Strategic Plan (2013-18) Explanations: PLW = Pregnant and Lactating Women, HHs = Households, PW = Pregnant Women, LW = Lactating Women, SAM = Severe Acute Malnutrition, MAM = Moderate Acute Malnutrition, u5 = children under 5 years, ANC = Ante-Natal Care, MNP = Micronutrient Powders, CSB = Corn Soya Blend, ORS = Oral Rehydration Salts/Solution, Fe+FA = Iron & Folic Acid supplements

3.5


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Strategic Direction & Output1

The 23 Core Nutrition Actions agreed to map in Rwanda (2/2)How do they link to the NFNSP, and who are the main target groups

1 2 3 4 5 6 7Target group(s)

Provide materials and technology for small-scale horticulture (e.g. kitchen gardens)Promote food preservation and storageProvide animals for small-scale husbandryProvide input for production and consumption of bio-fortified crops (e.g. beans, sweet potato)Carry out nutrition education (e.g. cooking demonstrations)2 Carry out nutrition education at school (e.g. school gardens)Provide/Support improved water sourceProvide/Support improved sanitationPromote hygiene / hand washing Provide conditional social safety net actions (VUP)Provide school feeding (e.g. One Cup of Milk)

2.1&3 5.13.2

5.1

2.3 5.34.5

2.3 5.34.5

2.3 5.34.5

2.3 3.5

5.2

Households with children under 5

Farming householdsHouseholds Ub. 1&2Households with

children under 5Mothers / caregivers

(w/ children under 5)Schools

Households + schoolsHouseholds + schoolsPLW + schoolsHouseholds Ub. 1&2Primary school children

2.3 3.1

2.3 3.2

2.3 3.5

2.3 4.33.4

Food

& a

gric

ultu

reN

utrit

ion

educ

atio

nW

ASH

Soci

al

prot

.

Core Nutrition Actions (CNAs)

1. Refers to the Strategic Directions and Outputs of the National Food & Nutrition Strategic Plan (2013-18) 2. Should avoid overlap with "Promote optimal breastfeeding practices", "Promote optimal complementary feeding practices" and "Promote hygiene / hand washing"Explanations: Ub. 1&2 = Ubudehe 1 and 2 categories – the poorest households, VUP = Vision 2020 Umurenge Program – the social security programme of MINALOC


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Appendix
















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Appendix
















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Key messages on the nutrition situation in Rwanda

While there have been marked reductions in the prevalence of chronic malnutrition (stunting) over the last decade, stunting in Rwanda still remains in high severity zone as a major public health concern1

• Nearly 600,000 children under 5 (38%) are chronically malnourished• There is still a large gap to reach the targets set in the HSSP-3 and NFNSP (18% in 2018)• Very high1 stunting levels (>40%) persist in 1 of 3 of the country’s districts, and only 3 districts are below 30%• Further action and scale up is needed to address and accelerate the rate of reduction

Wasting (2.2%) is below the critical thresholds set by WHO (5%), but Severe Acute Malnutrition (0.6%) is still a public health concern1 (>0.1%)

• Underweight targets as set in the Millennium Development Targets were reached (target 14.5%, now 9% prevalence among under5s), but there is still a gap to the targets set in HSSP-3 and NFNSP (4% in 2018)

Anemia among children 6-59 months has decreased (down from 38.1% in 2010 to 36.5% in 2014/15), while anemia among women 15-49 years has increased (17.3% in 2010 to 19.2% in 2014/15)

• Both are still far from normal levels1 (<5%), and anemia thus needs to be further addressed

Several core indicators to reduce stunting are showing slow progress, such as Food Consumption Scores, Minimum Acceptable Diet and WASH indicators

• Indicates that further focus and scale up is needed

1. As defined by WHOSource: DHS 2014/15, DHS 2010, HSSP-3, NFNSP


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Situation Analysis Dashboard (National Level)What is the nutrition situation stakeholders need to address?

Iron deficiency

Underweight

Stunting

Care

Wasting

Food security

Underweight prevalence among children 0-59 mo. old

Stunting prevalence among children 0-59 mo. old

Anemia among women 15-49 yrs old (any anemia)

Indicator Status

SAM prevalence among children 0-59 mo. old

GAM prevalence among children 0-59 mo. old

Population living under national poverty linePopulation living in extreme poverty (national line)

Total fertility ratePercentage with unmet need for family planning

Gender

Poverty

Nu

trit

ion

al

imp

act

37.9%

2.2%

0.6%

9.3%

19.2%

Un

der

lyin

g

ca

use

s

Households with poor & borderline food cons. scoreGlobal Hunger Index rating

21.1%15.6

Population

Children 6-23 mo. old with min acceptable diet (MAD) 17.8%

Education

Bas

icca

use

s

Teenage pregnancy: women 15-19 with a live birthWomen who participate in major household decisionsGlobal Gender Gap ranking

44.9%24.1%

5.5%Xx.x%7 / 142

4.218.9%

Females that completed primary school or higher Literacy rate 15 years or more - Women

Xx.x%64.7%

44.2% (2010)

2.8% (2010)

0.8% (2010)

11.4% (2010)

17.3% (2010)

21.5% (2009)24.1 (2005)

16.8% (2010)

56.7% (2005/06)35.8% (2005/06)

4.7% (2010)58.7% (2010)N/A

4.6 (2010)18.9% (2010)

30.1% (2010)60.1% (2005/06)

Severity

N/A

N/A

N/AN/A

N/AN/AN/A

N/AN/A

N/AN/A

SourceDHS

DHS

DHS

DHS

DHS

DHS

EICVEICV

DHSDHSGGGI

DHSDHS

DHSEICV

CFSVAGHI

Year2014/15

2014/15

2014/15

2014/15

2014/15

Health & Sanitation

Under 5 mortality rate (deaths per 1,000 live births)Low birthweight prevalence (<2,500g)Women 15-49yrs with problems accessing health care Household access to improved water source Household access to improved sanitation facilities

50X.x%Xx.x%74.2%74.5%

76 (2010)6.2% (2010)61.4% (2010)70.2% (2005/06)58.5% (2005/06)

N/AN/A

N/A

DHSDHSDHSEICVEICV

2014/152014/152014/152010/112010/11

2014/15

2010/112010/11

2014/152014/152014

2014/152014/15

2014/152010/11

20122014

Infants 0–5 mo. exclusively breastfed Timely initiation of solid or semi-solid foods (6-8 mo)

87.3%55.8%

84.9% (2010)62.1% (2010)

N/AN/A

DHSDHS

2014/152014/15

Anemia among children 6-59 mo. old (any anemia) 36.5% 38.1% (2010)DHS 2014/15

Trend

Low

Medium

High

Severity:Improvement (blue arrow)

No change (yellow arrow)Worsening (red arrow)

Trend:

Households with handwashing facility, soap & water Xx.x% 2.1% (2010)N/ADHS 2014/15

Vit A deficiency Vitamin A deficiency among children 0-59 mo. old N/A 6.4% (1996)N/A N/A

Iodine deficiency Iodine deficiency among children 6-12 years old N/A N/AN/AN/A N/A

Note: Missing information to be updated as soon as the full Rwanda DHS 2014/15 is released


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Significant reductions in stunting, wasting and underweightStunting remains a public health concern, while wasting & underweight are below critical thresholds

Stunting Wasting UnderweightPrevalence among children under 5

2005 2010

DHS

20001992 2014/15

WHOseveritythreshold

20051992 2010

WHOseverity threshold

2014/152000

DHS

Prevalence among children under 5

2000 2005 20101992 2014/15

WHOseverity threshold

DHS


Note: Prevalence for 1992. 2000 and 2005 have been recalculated using 2006 WHO growth standardsSource: Rwanda DHS, WHO classification of malnutrition severity


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While MDG target is achieved, only wasting seems to be on track to meet 2018 targets set in the HSSP III and the NFNSP

Stunting Wasting UnderweightPrevalence among children under 5

2005 2010

DHS

20001992 2014/15

2018TargetHSSP318%

20051992 2010

2018TargetHSSP32%

2014/152000

DHS


2000 2005 20101992 2014/15

2018TargetHSSP34%

DHS


Note: Prevalence for 1992. 2000 and 2005 have been recalculated using 2006 WHO growth standards. HSSP3 = Health Sector Strategic Plan 3 from 2013-2018Source: Rwanda DHS, WHO classification of malnutrition severity

Backup

MDG target14.5%


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There are still nearly 600,000 stunted children in Rwanda

Population of selected target groups Number of malnourished children

Note: Census data from 2012 adjusted using the Census' medium growth estimates to get 2014 estimatesSource: Rwanda DHS 2014/15, Rwanda National Census 2012

6,000

10,000

4,000

2,000

12,000

8,000

0

641

9,127

10,997

2,536

1,554

Rural population

33014%

83%

6%

Pregnant Women

Children under 2

Households

3%

Children under 5

Population in '000s

Total population

700

600

0

400

500

200

300

100

Malnourished children under 5 years old in '000s

38%

34

UnderweightWasting

144

Stunting

9%2%

589


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Stunting increases drastically from a child is 6 to 24 months oldNutritional status of children by age from DHS 2014-15


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Minimum Acceptable Diet (MAD) rates among children 6-23 months are still very low, and progress is slow

Backup

1. Given the standard deviations and confidence interval, this is not a statistical significant improvementNote: Minimum Acceptable Diet is a composite indicator building on both Minimum Meal Frequency and Minimum Diet DiversitySource: Rwanda DHS 2010 and 2014/15

18-23 months Total

+1.0

% of children 6-23 months with Minimum Acceptable Diet

9-11 months 12-17 months6-8 months

Age groups

DHS 2010

DHS 2014/15

Only 1%-point improvement over 5 years1


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Anemia rates are still high, and reduction is slow for anemia among children, while anemia among women is increasing

Two provinces with increased anemia among children 6-59 months

Anemia among women is increasing – only Kigali and East with reduction

+1.8

-3.5

+3.0

-7.5

-3.9

Anemia prevalence among children 6-59 months

West

-1.6

Kigali City

South North EastRwanda

DHS 2014/15

DHS 2010

Province

North

+3.8

EastSouth West

+1.9

-1.0

Kigali City

-3.2

+5.5

+2.6

Rwanda

Anemia prevalence among women 15-49 years

Backup

Source: Rwanda DHS 2010, Rwanda DHS 2014/15


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Food security as measured with acceptable Food Consumption Score is improving, but slowly

Backup

-0.4%

3.8%

% of population

+0.4%

Acceptable FCS Poor FCSBorderline FCS

2012

2009

1. Given the standard deviations and confidence interval, this is not a statistical significant improvementNote: CFSVA/NS data from 2015 will be added when availableSource: Rwanda CFSVA/NS 2012

Only 0.4%-point improvement over 5 years1


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WASH related indicators are at a low level, and improvement is limited and behind targets

2017/18 Target

EDPRS2

WATSAN 2014

2010/11 EICV3

25%

Households with access to improved water source

Still large gap to reach targets for access to improved water

Less than half of households are using appropriate water

treatment methodsOnly 2% have a handwashing

facility with soap & water

Households using an appropriate water treatment method

N/A

DHS 2014/15DHS 2010

10%

Hand washing facility

No water

or soap

Households with place for washing hands

Soap only

0%

Water & soap

Water only

Backup

Note: DHS 2014/15 data will be added when availableSource: EICV3, WATSAN 2014, EDPRS2, DHS 2010


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Appendix
















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Stunting levels are high throughout the country with nearly 1 of 3 districts exceeding the 'very high' severity threshold

1. Among children 0-59 monthsNote: Will be updated to DHS 2014/15 data when available. NB! Confidence intervals are rather large on a district levelSource: Rwanda National Nutrition Screening 2014, WHO classification of malnutrition severity

Prevalence of stunting among children under 5 years old

Nyagatare37%

Gatsibo37%

Kayonza33%

Karongi42% Bugesera

41%

Rusizi36%

Nyamasheke39%

Kirehe40%

Ngoma35%

Rwamagana33%

Nyaruguru38%

Nyamagabe40%

Rulindo34%

Gicumbi38%

Huye30%

Nyanza31%

Musanze33%

Burera38%

Gakenke38%

Ngororero48%

Nyabihu46%

Ruhango37%

Muhanga43%

Kamonyi39%

Gisagara36%

Rubavu48%

City of KigaliRutsiro

51%

City of KigaliKicukiro

28%

Gasabo32%

Nyarugenge26%

20% - 29%30% - 39%>40%

Stunting prevalence1 <20%


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Vast regional disparities in anemia levels, spanning nearly 30 point range (52.7% to 23.0%)

40% of the districts in Rwanda had anemia levels above (≥40%) in 2010 (12 out of 30 districts)

The urban district of Kicukiro is above (≥ 40%) , which shows that anemia is also a latent urban problem.

The most alarming districts with ≥ 45% of children with anemia are: Rusizi, Nyamagabe, Gatsibo, Ngoma, Kirehe, Gisagara and Nyamasheke

Anemia is a critical public health concern, with 40% of the districts in Rwanda with anemia levels above (≥ 40%)

Backup

Note: Will be updated to DHS 2014/15 data when available NB! Confidence intervals are rather large on a district levelSource: Rwanda DHS 2010, Rwanda Nutrition Situation Analysis


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Districts with different level of development on key indicatorsRanked by weighted development score (constructed composite index)

<30 30-40 >40Weighted development score:

Note: Weighted development score is a composite indicator that consists of stunting prevalence, poverty rates, food security scores, minimum acceptable diet, improved water & improved sanitation. The chosen weights are shown on top. All indicators are adjusted so that lower is better. Source: DHS 2010, EICV3 2010-11, CFSVA/NS 2012, National Screening 2014


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Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


Districts in South and West are the least developed

City of KigaliKicukiro

Gasabo

Nyarugenge

<30 30-40 >40Weighted development score:

Note: Weighted development score is a composite indicator that consists of stunting prevalence, poverty rates, food security scores, minimum acceptable diet, improved water & improved sanitation. The weighted development score is indicative only, and should not be used for other purposes. Source: DHS 2010, EICV3 2010-11, CFSVA/NS 2012, National Screening 2014 NB! Confidence intervals are rather large on a district level

Weighted development score per district


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Appendix
















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High-level approach for the Stakeholder & Action Mapping

Time estimate

Activities

Preparation

1-3 months2

• Introducing the tool & approach

• Discussing and deciding on the Core Nutrition Actions (CNAs1)

• Preparing templates & letters

Data collection

2-4 months3

Quantitative analysis

~1+ month

Datainterpretation

~1+ month

Mapping process

Note: The Stakeholder & Action Mapping can be conducted quicker than the timeline above now that it has already been conducted and the tool and templates have been developed and customized for Rwanda. Also, the timeline has been stretched due to multiple parallel priorities (one resource working ~30% on the Stakeholder & Action Mapping, not 100%)1. CNA = Core Nutrition Actions 2. Depending on time to get agreement and sign-off on CNAs and Rwanda specifics in tool 3. Depending on number of districts mapped, the number of participating organizations, the data availability and the time and resources committed to data collection

Dat

a di

ssem

inat

ion

Sta

keho

lder

dia

logu

e on

sca

ling

up n

utrit

ion

• Templates & letters sent out

• Templates filled in and returned by stakeholders

• Beneficiary coverage meetings set up and conducted

• Clean and quality check data

• Remove potential duplicates

• Add situation indicators (DHS)

• Analyze data and make analysis output

• Interpret coverage data with situation indicators

• Identify potential coverage gaps

• Make recommendations

• Compile report / presentation

Jan-Mar Apr-Jul Aug Sep

Iteration


30

The preparation phase consisted of three main deliverablesCustomizing tool to country specifics must be conducted and agreed before starting data collection

Country specifics to customize tool

Rwanda nutrition stakeholder overview

External data input for population & indicatorsA B C

GeographyGeography of mapping exercise

A1

Core nutrition actionsE.g. exclusive breastfeeding,

biofortification, ...

A2

Delivery mechanismsE.g. health centers, radio, ...

A3

Target groupsE.g. pregnant & lactating women,

households, ...

A4

Combine / LinkRelevant target groups, del.

mech. & indicators per action

A6

Situation indicatorsE.g. wasting, anemia, ...

A5

Long-list of all stakeholders• Who they are, where they

work, what they work on• Contact details

Draft stakeholder profile for the key stakeholders:

B1

B2

Population data • Per district• Per target group

Data on situation indicators per district

• Wasting, stunting, etc.

C1

C2

For each year and geography mapped, what is the population size of

each target group?

For each year and geography mapped, what are the situation indicator

levels?

Preparationphase


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Population data was mainly collected from the 2012 Census

Preparationphase

C1

Target group

Population groups• Entire population• Children 6-23 months• Children 0-59 months (u5)• Children 6-59 months• Children 12-59 months• Children 5-15 years• Pregnant women (PW)• Lactating women (LW)

Households• Households• Households with children u5

(Mothers/Caregivers w/ ch. u5)• Farming households• Households Ubudehe 1&2

Schools• Schools• School children• Primary schools• Primary school children

Children with illness• Children u5 with SAM• Children u5 with MAM• Children u5 with severe diarrhea

Sources

Rwanda Population and Household Census, 2012, NISR

• Population by district• Population by single age and

sex• Population growth projections

(medium growth)

Rwanda Population and Household Census, 2012, NISR

• EICV 3, Thematic Report Agriculture, 2012, NISR

• MINALOC Ubudehe cat. 2014

Rwanda Education statistics, MINEDUC 2013/14

• School overview MINEDUC• Education statistics for 2013

DHS & National Screening data• MAM & SAM prevalence from

DHS 14/15 & Nat. Nutr. Scr.• Severe diarrhea from DHS

Methodology

Using population data by district, by single age and by sex

• Adjusting 2012 figures to 2014 figures by using medium growth projections in the Census

• PW in 2014 estimated by the number of children 0 to 1 year in 2015 (estimate)

• LW estimated by the number of children 0-23 months in 2014

Same as above, but with additional data• Dividing u5 with 1.5 (based on average

birth spacing) to get HHs with childr. U5• % farming households from EICV3• % of HHs in U1&2 from MINALOC data

Using Rwanda Education statistics• MINEDUC provided number of schools• Number of school children from statistics• Schools split by type of school• School children split by type of school

Multiplying prevalence by age group• Children u5 multiplied by prevalence of

MAM and SAM (from DHS14/15 & NNS)• U5 multiplied by severe diarrhea prev.

Note: Target group size in SUNPMT may not match with target group sizes used by other organizations if sources and way of estimating differs


32

Data collection was conducted in two steps

Who is doing what and where Coverage for 23 core nutrition actions1 2

Mapping of nutrition stakeholders in Rwanda – who is doing what and whereObjective

Mapping beneficiary coverage for 23 selected core nutrition actions

What to map

Long-list of nutrition stakeholders and their contribution to the core nutrition actions

• Indicate which of the core nutrition actions are they working with

• Report their organization role and their partners for each of the actions

• Report what districts and sectors they are supporting for each of the actions

Map action coverage for the 23 core nutrition actions (CNAs)

• How many of the target groups are we covering for each action, in each district?

• Focus on mapping beneficiaries coverage• Also get information on project duration,

donors, implementing partners and delivery mechanism

Data collection method

Self-reporting by the stakeholders• Template was sent out, filled and returned• Acted as information input for step 2

Collect coverage data using SUNPMT tool• Interview based data collection• Careful preparation from stakeholders

Who to collect

data from

Template sent out to all known nutrition stakeholders in Rwanda

Selected stakeholders working with the core nutrition actions (informed by step 1)

Qualitative view Quantitative view

Data collection


33

Some of the coverage data is provided directly by ministries

Data collection Backup

Data collection sourceCore nutrition actions

Promote optimal breastfeeding practices Promote optimal complementary feeding practicesProvide specialized nutritious products for complementary feedingProvide Fe+FA supplementsProvide MNP supplementsProvide Vit A supplementsProvide deworming tabletsProvide diarrhoea treatment (w/ ORS/ORS-zinc)Provide treatment of SAMSupport and provide treatment of MAMConduct child growth monitoring / screeningPromote/Provide ANC visits (4+)Provide materials and technology for small-scale horticulture (Kitchen gardens)Promote food preservation and storageProvide animals for small-scale husbandryProvide input for production and consumption of biofortified crops (e.g. beans, sweet potato)Carry out nutrition education (e.g. cooking demonstrations) Carry out nutrition education at school (school gardens)Provide/Support improved water sourceProvide/Support improved sanitationPromote hygiene / hand washing Provide conditional social safety net actions (VUP)Provide school feeding (One Cup of Milk)

MoH (and partners)MoH (and partners)Implementing PartnersMoHImplementing PartnersMoHMoHMoHMoHMoH (and partners)MoHMoHImplementing partners

MINAGRI (and partners)Implementing partnersMINAGRI (and partners)

Implementing partnersMINEDUCImplementing partnersImplementing partnersImplementing partnersMINALOCMINAGRI (and partners)

MIY

CN

Mic

ro-n

utr

ient

sD

i-se

ase

MA

M/

SAM

MC

HFo

od &

A

gric

ultu

reN

ut.

Edu.

WA

SHSo

c.

Sec.

Comments

Split in two target groupsSplit in two target groups

From campaign dataFrom campaign dataHealth facilities treatment dataHealth facilities treatment dataOther partners also supportingOther partners also supportingOther partners also doing promotingNo data available from MINAGRI

No data available from MINAGRI

Other partners also doing SILC


34

How is the population coverage calculated by the tool?

To have consistent results, it is important to consistently map the actions at the same geographic level

Number of beneficiaries in the target group covered by the

action, in the selected geography

Population size of the target group, in the selected

geography

Interview database

Popula-tion

Two sources are used as input for thepopulation coverage calculation Concrete example

Provide vitamin A supplements to children6-59 months in Gasabo, in 2014

Sum of all beneficiaries covered per action where• Country = Rwanda• Province = Kigali City• District level = Gasabo• Action = Provide vitamin A supplements• Target group: Children 6-59 months• At least 1 month of 2014 is included in timeframe

Population size where• Country = Rwanda• Province = Kigali City• District = Gasabo• Target group: Children 6-59 months

Quantitative analysis


35

Important limitations to note on Stakeholder & Action Mapping

Not all nutrition stakeholders have participated in the

mapping

Stakeholder & Action Mapping does not cover all organizations working with nutrition in Rwanda• Focus has been on capturing data from the largest stakeholders, not all stakeholders• We have sent requests to all known stakeholders, but there may be other organizations that we do not

yet know about that have not been reached out to• It is voluntary to provide input on the mapping, and some stakeholders have chosen not to participate

Not all stakeholders have good data or data

at all

Even for the stakeholders who have participated, there is sometimes limitation in data availability• Not all stakeholders have collected coverage data for their programs and projects (this is for example

a problem for some of the ministries, e.g. MIGEPROF)• Some have collected the data, but the data quality is not good enough• Some organizations are very large and are doing many programs and projects. There may then be

nutrition activities conducted that they have not reported

Missing input from most WASH

stakeholders

There has been limited participation from WASH stakeholders in the Stakeholder & Action Mapping• WASH is very important for stunting reduction, and three of the CNAs are related to WASH• However, WASH is coordinated in separate technical working groups, and have less interaction with

the Food & Nutrition Technical Working Groups than what would be ideal• The mapping request was therefore also shared with the WASH TWGs, but very few stakeholders

participated in the mapping, meaning that there are large gaps in the completeness of WASH actions

We do not know the quality of the

coverage or actions conducted

When providing data of the number of beneficiaries reached with different actions, we do not necessarily know the quality of these actions

• For example, if one partner have done one large meeting with 500 participants, the quality of the sensitization may not be as good as if one organization is following 500 beneficiaries individually

• Or for kitchen gardens, the quality and how functional the kitchen garden is may differ• Coverage is still counted equally, though the quality of the coverage may differ

Data interpretat.

Note: See also Disclaimer slide


36






Appendix
















37






Appendix
















38

37 food & nutrition stakeholders have provided mapping inputStakeholder profiles have been made for these organizations

Government

UN Agencies

Research / Academia2

NGOs

• Ministry of Agriculture and Animal Resources (MINAGRI)

• Ministry of Education (MINEDUC)• Ministry of Gender and Family

Promotion (MIGEPROF)• Ministry of Health (MoH)• Ministry of Local Government

(MINALOC)• Food & Agriculture Organization (FAO)• One UN REACH• International Fund for Agricultural

Development (IFAD)1 • United Nations Children's Fund

(UNICEF)• World Food Programme (WFP)• World Health Organization (WHO)• World Bank1

• Catholic University of Rwanda (CUR) • International Center for Tropical

Agriculture (CIAT)2 • University of British Columbia (UBC)

• The Access Project (AP)• Adventist Development and Relief

Agency (ADRA)• AVSI Foundation RWANDA (AVSI)• Caritas International Rwanda (Caritas)• Catholic Relief Services (CRS)• Clinton Health Access Initiative (CHAI)• Concern Worldwide Rwanda (CWR)• Cooperative for Assistance and Relief

Everywhere (CARE)• Family Health International 360

(FHI360)• Gardens for Health International (GHI)• Global Communities (GC)• Glocal Forum YaLa Africa (GFYA)• Heifer International Rwanda (HIR)• International Rescue Committee (IRC)• Partners In Health (PIH)• Peace Corps Rwanda (PCR)3 • Rwanda Nutrition Society (RNS)2 • Send a Cow Rwanda (SaCR)• Society for Family Health (SFH)• WaterAid Rwanda (WaterAid)• World Relief Rwanda (WRR)• World Vision Rwanda (WVR)

1. IFAD and the World Bank have provided input on some of their nutrition sensitive programs, but not directly on the core nutrition actions 2. CIAT and RNS have provided input on research support, but not directly on the core nutrition actions 3. Peace Corps is a new partner and the Peace Corps Volunteers will start working with food & nutrition from August 2015


39

An additional 40+ food & nutrition stakeholders have been mentioned in the mapping by other partners

Government

Bi-/Multilateral

• Canadian Department of Foreign Affairs, Trade and Development (DFATD)

• Canadian Food Grain Bank (CFGB)• Embassy of the Kingdom of Netherlands

(EKN) / Government of Netherlands• European Union (EU)• Irish Aid (Irish DFAT)• Korea International Cooperation Agency

(KOICA)• Swiss Agency for Development and

Cooperation (SDC)• UK Department for International

Development (DFID) / UK AID• United States Agency for International

Development (USAID)

• Ministry of Disaster Management and Refugee Affairs (MIDIMAR)

• Rwanda Agricultural Board (RAB)• Rwanda Education Board (REB)• Rwanda Biomedical Center (RBC)• Local Administrative Entities

Development Agency (LODA)• National Women Council (NWC)• Districts• Health Facilities• Schools

NGOs & Foundations

Field implementers:• ADEPR• African Evangelist Enterprice (AEE)• Association for Humanitarian Peace (APH)• Association Rwandaise pour la Promotion

du Development Integre (ARDI)• Benishyaka Association• Caritas Kabgayi & Gikongoro• COFORWA (Compagnons Fontainiers du

Rwanda)• Farming cooperatives• DUHAMIC ADRI• Eglise Presbytérienne au Rwanda (EPR)• Mouvement de Lutte contre la Faim au

Monde (MLFM)• Rwanda Rural Rehabilitation Initiative

(RWARRI)• Save the Children Rwanda (StC)• SDA Iriba

Donor organizations:• CIFF – Children's Investment Fund Found.,

Global Giving, Oxfam, Gates Foundation, Keurig Green Mountain (KGM), Fondation d'Harcourt, CASASCHI, FONERWA, SUN Multi-Partner Trust Fund, Starbucks, African Development Bank (AfDB)


40






Appendix
















41

Overview of large nutrition specific and sensitive programsKey programs being implemented in country – see more details in next slides

Nutrition specific programs

EKN/GoN Nutrition Program• Lead by UNICEF• 18 districts (all sectors)• 2014-17

One UN Joint Nutrition Program• Lead by WFP• 2 districts (all sectors)• 2013-16

CIFF Food & Nutrition Program• Lead by MoH & MINAGRI• 4 districts (all sectors)• 2015-18

USAID INWA Program• Lead to be decided• 8 districts (all sectors)• 2016-20

EU Nutrition Budget Support• Direct budget support to MoH,

MINAGRI and MINEDUC• 2013-16

Will in 2016 cover all 30 districts

Programs with food & nutrition component

USAID Gimbuka Program• Lead by Caritas• 9 districts (21 sectors)• 2012-15

USAID Ejo Heza Program• Lead by Global Communities• 8 districts (all sectors)• 2011-16

USAID Higa Ubeho Program• Lead by Global Communities• 10 districts (89 sectors)• 2009-15

USAID Twiyubake Program• Lead by Global Communities• 4 districts (all sectors)• 2015-20

Nutrition sensitive agriculture program

USAID Shisha Wumwa Program• Lead by Land O'Lakes• 2012-16

Land, Water, Hillside (LWH) program• Funded by WB, IDA, CIDA, US, ++• 2010-17

Rural Sector Support Program• Funded by World Bank• 2001-16

Post-harvest & Agribusiness Support Project

• Funded by IFAD• 2014-19

Rural Income through Exports• Funded by IFAD• 2011-18

Kirehe Watershed Mgmt Project• Funded by IFAD• 2009-16

A B C

A1

A2

A3

A4

A5

B1

B2

B3

B4

C1

C2

C3

C4

C5

C6

Note: Overview is not exhaustiveSource: Stakeholder interviews


42

Nutrition specific programs will in 2016 cover all districtsBut from 2017, many districts will be without funding support unless funding is extended

Province District Organization Donor(s) Implementing partner 2014 2015 2016 2017 2018 2019 2020

Kigali CityNyarugenge USAID USAID TBD (INGO)Gasabo UNICEF GoN, USAID, IKEA WRR (from 2015)Kicukiro USAID USAID TBD (INGO)

South

Nyanza USAID USAID FXBGisagara UNICEF EKN CWR (ARDI)Nyaruguru UNICEF EKN CWR (ARDI)Huye CIFF CIFF MoH & MINAGRINyamagabe UNICEF EKN, SDC (One UN) WRR, WVRRuhango USAID USAID CaritasMuhanga UNICEF EKN CRS (Caritas Kabgayi)Kamonyi UNICEF EKN ADRA

West

Karongi UNICEF EKN CRS (EPR)Rutsiro UNICEF EKN, SDC (One UN) WRR, WVR, CaritasRubavu UNICEF GoN, USAID APNyabihu USAID USAID TBD (INGO)Ngororero CIFF CIFF MoH & MINAGRIRusizi UNICEF GoN WRR (from 2015)Nyamasheke UNICEF EKN, IKEA WVR

North

Rulindo CIFF CIFF MoH & MINAGRIGakenke UNICEF GoN, USAID, IKEA APMusanze UNICEF GoN, USAID APBurera UNICEF GoN Dir. district supportGicumbi UNICEF EKN, IKEA WVR

East

Rwamagana USAID USAID AEENyagatare CIFF CIFF MoH & MINAGRIGatsibo UNICEF EKN ADRAKayonza USAID USAID TBD (INGO)Kirehe UNICEF GoN Dir. district supportNgoma USAID USAID TBD (INGO)Bugesera UNICEF GoN, USAID AP

Note: Timeline showing approximate start and end dates with current funding Source: Stakeholder interviews


43

Other partners and programs are also present in the districts

Province District Organization Donor(s) Implementing partn. Other stakeholders working in district1

Kigali CityNyarugenge USAID USAID TBD (INGO) GFYA (FAO, GG)

Gasabo UNICEF GoN, USAID, IKEA WRR (from 2015) GFH (GHI), GFYA (FAO, GG), SFH (USAID), WVR (WVI), GC (USAID/HU closed 2015, T from 2015)

Kicukiro USAID USAID TBD (INGO) GFYA (FAO, GG), SFH (USAID/EH), WVR (WVI)

South

Nyanza USAID USAID FXB SFH (USAID), GC (USAID/EH), AVSI (3x), SaCR (Oxfam,SaC,DFID GPAF)

Gisagara UNICEF EKN CWR (ARDI) SFH (USAID), GC (USAID/EH), CUR (CUL)

Nyaruguru UNICEF EKN CWR (ARDI) Caritas (USAID), SFH (USAID), GC (USAID/EH), WVR (WVI), SaCR (Oxfam,SaC,DFID GPAF)

Huye CIFF CIFF MoH & MINAGRICWR (IA cl.'15), SFH (USAID), GC (USAID/EH & T 2015), WVR (WVI), CUR (CUL), CRS (KGM-cl.2014)

Nyamagabe UNICEF EKN, SDC (One UN) WRR, WVR CWR (IA cl.'15), Caritas (USAID), One UN (SDC), WVR (SDC), GC (USAID/EH), CRS (KGM-cl.2014)

Ruhango USAID USAID Caritas Caritas (USAID), SFH (USAID), AVSI (3x), GC (USAID/HU closed 2015)

Muhanga UNICEF EKN CRS (Caritas Kabgayi) Caritas (USAID), SFH (USAID), GC (USAID/HU closed 2015)

Kamonyi UNICEF EKN ADRA CARE (USAID - closed Mar 2015), Caritas (USAID), SFH (USAID), AVSI (3x), GC (USAID/HU cl. 2015)

West

Karongi UNICEF EKN CRS (EPR) Caritas (USAID), SFH (USAID), GC (USAID/EH), WVR (WVI)

Rutsiro UNICEF EKN, SDC (One UN) WRR, WVR, Caritas Caritas (USAID), SFH (USAID), One UN (SDC, EKN), GC (USAID/EH), WVR (WVI, Koica)

Rubavu UNICEF GoN, USAID AP SFH (USAID), GC (USAID/HU closed 2015)

Nyabihu USAID USAID TBD (INGO) GC (USAID/HU closed 2015)

Ngororero CIFF CIFF MoH & MINAGRI Caritas (USAID), SFH (USAID), GC (USAID/EH)

Rusizi UNICEF GoN WRR (from 2015) FHI360 (USAID), SFH (USAID)

Nyamasheke UNICEF EKN, IKEA WVR SFH (USAID)

North

Rulindo CIFF CIFF MoH & MINAGRI SFH (USAID), WVR (WVI), SaCR (UKAID,Oxfam,Gates Fundation,SaC), GC (USAID/HU closed 2015)

Gakenke UNICEF GoN, USAID, IKEA AP SFH (USAID), WVR (WVI), GC (USAID/HU closed 2015)

Musanze UNICEF GoN, USAID AP GFH (GHI), SFH (USAID), GC (USAID/T - from 2015)

Burera UNICEF GoN Dir. district support PIH (PIH), GC (USAID/T - from end 2015)

Gicumbi UNICEF EKN, IKEA WVR SFH (USAID), AVSI (3x), GC (USAID/HU closed 2015)

East

Rwamagana USAID USAID AEE SFH (USAID), SaCR (Oxfam,SaC,FONERWA)

Nyagatare CIFF CIFF MoH & MINAGRI SFH (USAID), GC (USAID/HU closed 2015)

Gatsibo UNICEF EKN ADRA Caritas (USAID), AVSI (3x), WVR (WVI)

Kayonza USAID USAID TBD (INGO) ADRA (CFGB), SFH (USAID), WVR (WVI) PIH (PIH), SaCR (UKAID,Oxfam,Gates Fundation,SaC)

Kirehe UNICEF GoN Dir. district support SFH (USAID), PIH (PIH)

Ngoma USAID USAID TBD (INGO) IRC (EU), SFH (USAID)

Bugesera UNICEF GoN, USAID AP WaterAid (WaterAid UK), SFH (USAID), WVR (WVI), SaCR (UKAID,Oxfam,Gates Fundation,SaC)

Backup

Note: Overview showing main catalysts and implementing leads only (with donor in parentheses), but not local implementing partners 1. NB! Overview is not exhaustive


44

Program overview from 2016 – with implementing partners

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of KigaliKicukiroNyarugenge

USAIDCIFF

UNICEF

GasaboWRR'15

8 districts4 districts18 districts

WVR

WRR'15

CWR

CWR

WRR, WVR

CRS

WRR, WVR

AP

APDS

AP

CRSADRA

AP DS

ADRAWVR

FxB

TBD

TBDAEE

TBD

Caritas

TBD TBD

DS

DS

DS

DS

Note: DS = Direct Support, TBD = To Be DecidedSource: Stakeholder interviews


45

USD 30+ million in nutrition specific funding on these programs alone

DonorTotal funding in USD

Years of funding

Funding per year in USD

EKN 17,720,000 3 5,906,667

GoN 6,550,000 4 1,637,500

USAID 1,800,000 3 600,000

IKEA 524,000 2 262,000

UNICEF RR 800,000 4 200,000

SDC 4,900,000 3 1,633,333

USAID 28,800,000 5 5,760,000

CIFF 16,450,000 4 4,112,500 Total nutrition program funding 77,544,000 20,112,000

EU (Budget support) 33,000,000 3 11,000,000 Total incl. EU budget support 110,544,000 31,112,000

Over USD 30 million in yearly funding for next year.. …or ~20 USD per child u51

Pregnant & Lactating Women

Target group USD per

year

USD per year

Children u5

Children u2

640'

970'

1,550'

Total #

1. Graph is showing total funding per year divided by total target group, so can not add together figures for Children u2, PLWs and Children u5Source: Stakeholder interviews, Rwanda National Census


46






Appendix
















47

Overview of core nutrition action categories and roles (1/2)

DonorsCatalysts Field implementersAction categoryResponsible

Ministries

MIYCN

MoH

(MIDIMAR – refugee camps)

UNICEF, WHO, WFP, UNHCR, StC, CRS, IRC, CHAI

CWR, Caritas, GHI, FHI360, SFH, PIH, GC, ADRA, Care, WVR, WRR, CUR, EPR, DUHAMIC ADRI, ADEPR, AEE, BENISHYAKA, RWARRI

EKN, Irish Aid, SDC, USAID, GHI, PIH, EU, CFGB, WVI, IKEA, Koica, WRI, CUL, UNICEF

Micronutrient supplementation

MoH UNICEF, UBC, CRS

ADRA, AP, CWR, WVR, WRR, Caritas, EPR

EKN, Irish Aid, SDC, WVI, IKEA, UNICEF

Management of MAM/SAM

MoH

(MIDIMAR – refugee camps)

UNICEF, WHO,WFP, UNHCR

CWR, Caritas, GFYA, FHI360, PIH, ADRA, WVR, RWARRI

Irish Aid, USAID, FAO, GG, PIH, CFGB, WVI, Koica, EKN, UNICEF, IKEA, GoN

Disease Prevention / Management

MoH UNICEF, WHO

Several NGOs support campaigns, e.g. ADRA, CWR and WVR

UNICEF

Maternal, Neonatal &

Child Health

MoH UNICEF, WHO, CRS, GC, AP, IRC

Caritas, GHI, FHI360, SFH, PIH, ADRA, CARE, WRR, BENISHYAKA, RWARRI, EPR, WIF, DUHAMIC-ADRI, ADEPR + several supporting screening

USAID, GHI, PIH, EU, CFGB, MoH, UNICEF, GoN, EKN, WRI, SDC, IKEA

Note: For explanation on abbreviations, see the full list of stakeholders Source: Rwanda Stakeholder & Action Mapping 2014/15


48

Overview of core nutrition action categories and roles (2/2)

DonorsCatalysts Field implementersAction categoryResponsible

Ministries

Food & Agriculture

MINAGRI FAO, UNICEF, RCA, CRS, CWR, IRC, GC, CIAT

EKN, Irish Aid, GHI, USAID, FAO, GG, KGM, PIH, EU, AVSI, FdH, CFGB, WVI, IKEA, Koica, WRI, SDC, Oxfam, SaC, DFID, UKAID, Gates, Fonerwa, IFAD, UNICEF,CASACHI,DFATD, ADB

Nutrition education

MoH, MINEDUC, MINAGRI

UNICEF, WHO, CRS, AP, IRC, GC, StC

CWR, Caritas, GHI, GFYA, FHI360, SFH, PIH, GC, AVSI, ADRA, CARE, WVR, WRR, SaCR, CUR, EPR, RNS, DUHAMIC ADRI, ADEPR, AEE, BENISHYAKA, RWARRI, WIF

EKN, Irish Aid, GG, USAID, GHI, FAO, KGM, SUN, PIH, EU, FdH, AVSI, CFGB, CASASHI, WVI, Koica, IKEA, WRI, UNICEF, SDC, Oxfam, SaC, DFID, UKAID, Gates, Fonerwa, CUL, ADB

WASH

MoH (hygiene) MININFRA (water & sanit.)MINEDUC (schools)

UNICEF, WHO, CRS, StC, WaterAid, AP, GC

EKN, WaterAid, Irish Aid, WVI, USAID, GHI, KGM, FdH, AVSI, CASASHI, CFGB, WRI, UNICEF, SDC, GoN, IKEA, Oxfam, SaC, Fonerwa, UKAID, Gates, DFID

Social Protection

MINALOC,

(MINAGRI & MINEDUC for school feeding)

UNICEF, WFP, CRS, RAB

CWR, EPR, Caritas, SDA Iriba EKN, Irish Aid, KGM, EU, DFID

WaterAid, CWR, Caritas, GHI, FHI360, SFH, GC, AVSI, ADRA, CARE, WRR, SaCR, WVR, EPR, COFORWA, ADEPR, DUHAMIC ADRI, AEE, MLFM, APH, RWARRI, WIF, SNV

Caritas, GHI, GFYA, FHI360, PIH, GC, AVSI, ADRA, CARE, WVR, WRR, SaCR, EPR, ARDI, KOAKAKA Local cooperatives, DUHAMIC ADRI, HIR, ADEPR, AEE, BENISHYAKA, RWARRI, ICYUZUZO, SINAPISI, WIF

Note: For explanation on abbreviations, see the full list of stakeholders Source: Rwanda Stakeholder & Action Mapping 2014/15


49

Explanation of stakeholder roles

Responsible Ministries – Responsible Ministries are the Ministries that take a lead role in management of a core nutrition action. The majority of actions are under the Ministry of Health as they are nutrition-specific or health related, but several are also under MINAGRI (food & agriculture), MINEDUC (schools & school children), MININFRA (water & sanitation) and MINALOC (social security)

Field Implementers – Field implementers are the organisations implementing a core nutrition action. A number of international and local NGOs are field implementers, often through public infrastructure and resources such as health facilities, community health workers and schools

Catalysts – Catalysts give support and overview to the organisations carrying out the core nutrition action. They can also be technical leads for several other organizations. The catalysts are comprised of a number of UN agencies and international NGOs supporting the government or subcontracting to other organisations

Donors – Donors provide financial support to allow core nutrition actions to be carried out. Key donors include multilateral and bilateral organisations, trusts and foundations and also include the government itself

Backup


50






Appendix
















51

Key messages on where the stakeholders are working

All districts have partners working on food & nutrition in their districts:• However, the number of partners supporting the districts varies widely (from 3 to 13 partners)

The number of Core Nutrition Actions supported by a partner varies substantially• Some partners are supporting up to 15 (of 23) different Core Nutrition Actions, while others are supporting only one Core

Nutrition Action• All Core Nutrition Actions are thus not conducted in all districts

There is large variation in the number of sectors that a partner is covering in a district• Some partners are covering all sectors in a given district, while others may only be supporting 1-2 sectors• Other partners are only supporting the central district level, e.g. central level coordination and capacity, not direct

implementation at the beneficiary level• Even though all sectors are covered, that does not necessarily mean that all Core Nutrition Actions are done in all sectors, that

all villages in each sector is supported, or that all beneficiaries are covered

The overview of what partners are working where is only a snapshot of the current situation• Some projects are being finalized, and others are starting up, so the situation is continuously changing

The geographical mapping builds on the qualitative reporting input provided by the stakeholders in the first phase of the mapping, and it will thus not necessarily be one to one with the quantitative mapping of beneficiary coverage

• This is e.g. because some districts where not supported in 2014, some CNAs were not carried out in 2014, some data is provided from central level, data may not be available, etc.

Source: Rwanda Stakeholder & Action Mapping 2014/15


52

What catalysts & implementers are working in which districts?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

GakenkeNyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge

UNICEFCIATGFYA

GFYASFH1 WVR

UNICEFCIATGHIGCGFYASFH1 WVR

UNICEFPIHSFH1 HIR

UNICEFCIATSaCRSFH1 AP

UNICEFFAOCIATSaCRSFH1 AP2 WaterAidWVRHIR

GCSaCRWVR

UNICEFADRA2 AVSICARECaritasCIATGCSFH1 HIR

UNICEFCaritasCIATCRS2 GCSFH1

UNICEFWFPFAOCURCWR2 GCSFH1

CURCIATCWRCRSGCSFH1 WVR

UNICEFWFPFAOCaritasCWR2 GCSaCRSFH1 WVR

One UN3 UNICEF3 WFP3 WHO3 FAO3 CaritasCIATCWRCRSGCSFH1 WRR4

WVR4

UNICEFFAOFHI 360SFH1 HIR

UNICEFFAOCIATGHIGCSFH1 AP2 HIR

UNICEFFAOGCSFH1 AP2

UNICEFFAOGCSFH1 APHIR

Note: The map shows all organizations that have provided mapping input, but it does not show whether they are using anyone asfield implementers in the different districts.

Color code explanations:Project end in 2015Mostly central district level support

1. SFH is mostly doing social marketing through local CBOs2. Implementing partner for UNICEF EKN/GoN program3. One UN Joint Nutrition Program (SDC funded)4. Implementing partner for One UN SDC program

Ngororero

CIATGCSFH1 HIR

ADRACIATPIHSaCRSFH1 WVRHIR

FAOCaritasGCSFH1 AP

UNICEFIRCSFH1 AP

UNICEFFAOAVSICaritasGCSFH1 HIR

UNICEFWFPFAOCaritasCIATCRS2 GCSFH1 WVR

One UN3 UNICEF3 WFP3 WHO3 FAO3 CaritasGCSFH1 WRR4 WVR4

AVSIGCSaCRSFH1 AP

UNICEFCIATGCPIH

UNICEFFAOGCSFH1 AP2 WVR

UNICEFWFPAVSICIATGCSFH1 WVR2

UNICEFWFPFAOADRA2 AVSICaritasCIATWVRHIR

UNICEFFAOSFH1 WVR2 HIR

NB! Only shows stakeholders who have reported


53

What catalysts & implementers are working in which districts?And how many Core Nutrition Actions (CNAs) are they conducting?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge

CIATGCSFH1 HIR


UNICEFCIATGFYA

GFYASFH1 WVR



UNICEFPIHSFH1 HIR


UNICEFIRCSFH1 AP



GCSaCRWVR





AVSIGCSaCRSFH1 AP


One UN3 UNICEF3 WFP3 WHO3 FAO3 CaritasCIATCWRCRSGCSFH1 WRR4 WVR4







UNICEFCIATGCPIH

FAOCaritasGCSFH1 AP


UNICEFFAOGCSFH1 AP2





CNAs covered:1 CNA2-4 CNAs5-9 CNAs10-15 CNAs16-23 CNAs



54

What catalysts & implementers are working in which districts?How many CNAs are they working on, and how many sectors are they covering?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge


% of sectors covered:

0-25% of sectors

26-50% of sectors

51-75% of sectors

76-99% of sectors

100% of sectors


UNICEFCIATGFYA

GFYASFH1 WVR



UNICEFPIHSFH1 HIR

UNICEFIRCSFH1 AP


GCSaCRWVR





AVSIGCSaCRSFH1 AP








FAOCaritasGCSFH1 AP

UNICEFFAOGCSFH1 AP2




CIATGCSFH1 HIR



UNICEFCIATGCPIH






55

What catalysts & implementers are working in which districts?How many CNAs are they working on, and what districts does not have support in all sectors?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge

CIATGCSFH1 HIR

UNICEFCIATGFYA

GFYASFH1 WVR



UNICEFPIHSFH1 HIR


UNICEFIRCSFH1 AP


GCSaCRWVR





AVSIGCSaCRSFH1 AP








FAOCaritasGCSFH1 AP

UNICEFFAOGCSFH1 AP2






% of sectors covered:

0-25% of sectors

26-50% of sectors

51-75% of sectors

76-99% of sectors

100% of sectors

Backup


UNICEFCIATGCPIH






56

What other implementing partners have they reported?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

GakenkeNyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge

SFH1: LCBOs

UNICEF:WRR'15

GC:ICYUZUZOSINAPISICRS

SFH1:LCBOs

SFH1:LCBOs

SFH1:LCBOs

UNICEF:AP2

WaterAid:COFORWA

SFH1:LCBOs

GC:DUHAMIC-ADRIWIFCRS

UNICEF:ADRA2:RWARIAVSI:MLFMGC:DUHAMIC-ADRI,EPR, CRSSFH1:LCBOs

UNICEF:CRS2 CaritasGC:DUHAMIC-ADRI, CRSSFH1:LCBOs

UNICEF:CWR2:ARDIGC:DUHAMIC-ADRIAEEADEPRStCSFH1:LCBOs

CWR:ARDISDA IRIBACRS:CaritasGC:DUHAMIC-ADRI. AEEADEPR,StCSFH1:LCBOs

UNICEF:CWR2 ARDISDA IribaGC:DUHAMIC-ADRI. ADEPR, StCSFH1:LCBOs

One UN3 WRR4

WVR4 CWR:ARDISDA IribaCRS:CaritasGC:DUHAMIC-ADRI. AEEADEPR,StCSFH1:LCBOs

UNICEF:WRR'15

FHI 360:Local Coops

SFH1:LCBOs

UNICEF:AP2 SNV

GC:ADEPRCRS

SFH1;LCBOs

UNICEF:AP2

GC:ADEPRCRS

SFH1:LCBOs

UNICEF:SNV

GC:ADEPRCRS

SFH1:LCBOs


Color code explanations:Catalyst / LeadProject end in 2015


Ngororero

GC:EPR

SFH1:LCBOs

ADRA:RWARRI

SFH1:LCBOs

GC:CaritasADEPRStC

SFH1:LCBOs

IRC:BENISHYAKA

SFH1:LCBOs

AVSI:MLFM

GC:DUHAMIC-ADRI, CRS

SFH1:LCBOs

UNICEF:CRS2 EPR

GC:CaritasADEPRStC

SFH1:LCBOs

One UN3:WRR4 Caritas'15WVR4 '15

GC:CaritasADEPRStC

SFH1:LCBOs

AVSI:MLFM

GC:DUHAMIC-ADRIADEPR, StC

SFH1:LCBOs

UNICEF:SNV

UNICEF:AP2

GC:ADEPRWIF, CRS

SFH1:LCBOs

UNICEF:WVR2

AVSI:MLFM, APH

GC:ADEPR, CRS

SFH1:LCBOs

UNICEF:ADRA2 RWARRI

AVSI:MLFM

UNICEF:WVR2

SFH1:LCBOs

Shows stakeholders who have reported to work with other implementing partners

Backup


57

Where are the ministries working?And how many Core Nutrition Actions (CNAs) are they conducting?

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


City of Kigali

Kicukiro

Gasabo

Nyarugenge

MoHMINAGRIMINALOCMINEDUCMIGEPROF































Backup

Note: The ministries are often working through their implementing agencies, such as RBC, REB, RAB, NWC and LODA, and through the public infrastructure (health facilities, schools, etc.)



58






Appendix
















59

Key messages on coverage of Core Nutrition Actions

Geographic coverage of Core Nutrition Actions (CNAs):• 14 of 23 CNAs are being conducted in all districts• 6 of 23 CNAs are conducted in 15-29 districts• 3 of 23 CNAs are conducted in less than 10 districts• South, West and North with the most support and highest coverage• Low coverage in Kigali City, but also because people here tend to be better off (high development score)

Beneficiary coverage• Only 5 CNAs have more than 75% of beneficiaries covered• 4 CNAs have between 50-75% coverage, 4 CNAs have between 25-50% coverage, and 4 CNAs have below

25% coverage• 6 CNAs are measured as additional %-points reached, ranging from 1 to 8 additional %-points reached

Action category coverage• Health categories in general have the highest coverage, though some CNAs are lagging behind also here

(e.g. diarrhoea treatment, 4+ ANC visits and SAM/MAM treatment)• Nutrition education, including promotion of breast feeding, complementary feeding, and promotion of

hygiene and hand washing have lower coverage than ideal, and should be increased• WASH has in general low coverage, but that may also be due to low participation rates from WASH partners• Delivery mechanism analysis could be one source of information to discuss how to best scale up CNAs



60

What % of the target group is covered nationally and how? (1/2)

Country relevant actions# of districts

covered Key delivery mechanisms

CHWs, HFs, Women/Mother groups, Mass campaigns, PD/H

CHWs, Health centers, UN agencies, NGOs

CHWs, Health centers, UN agencies

CHWs, Health centers, Mass campaigns

CHWs, Health centers, Hospitals

Health centers, Hospitals

CHWs, Health centers, PD/H, Women/Mother groups

CHWs, Health centers, NGOs

Target groups (TG)Pregnant & lactating womenHHs with children u5 (CBNP)

% of TG covered

Children 6-23 months


Children 0-59 months with severe diarrhoea

Children 0-59 months with SAM

Children 0-59 months with MAM


CHWs, HFs, Women/Mother groups, Mass campaigns, PD/H

20 / 30

23 / 30

4 / 30

7 / 301

30 / 30

30 / 30

30 / 30

30 / 30

Promote optimal breastfeeding practices

Provide spec. nutritious products for CF

Promote optimal compl. feeding practices

Provide Fe+FA supplements

Provide deworming tablets

Provide diarrhoea treatment (w/ ORS/zinc)

Provide MNP supplements (Ongera)

Provide treatment of SAM

Support and provide treatment of MAM

MIY

CN

Dis

ease

pr

ev./m

gmt

Mic

ronu

trie

nt

supp

lem

enta

tion

MA

M/S

AM

Provide Vitamin A supplements

CHWs, Health centers, Mass campaigns30 / 30

Conduct child growth monitoring / screening

Promote/Provide ANC visits (4+)

MC

H

CHWs, Health centers, HospitalsPregnant women30 / 30

CHWs, Health centers, HospitalsPregnant women30 / 30

Pregnant & lactating womenHHs with children u5 (CBNP)

6-23 months in Ubudehe 1&2PLW in Ubudehe 1&2

Children 12-59 monthsChildren 5-15 years

0-25% 26-50%

51-75%

76-100%

1 / 30

30 / 30

30 / 30

1. MNP program (Ongera) is being scaled up, and is in the 2nd half of 2015 in 18 districts

30 / 30

As reported in SUNPMT tool


61

What % of the target group is covered nationally and how? (2/2)

Country relevant actions# of districts

covered Key delivery mechanisms

FFLS, Agriculture village promotors, Coops, RAB

FFLS, Agriculture village promotors, CHWs, Coops, NGOs

CHWs, Agriculture village promotors, FFLS, Mass campaigns, PD/H

Pre-schools, Primary schools, Secondary schools

Districts, UN agencies, NGOs, CHCs, Women/mother groups

CHWs, CHCs, FFLS, Community meetings, PD/H, Mass campaigns

VUP, Social services, FFLS, Community leaders

Primary schools

Target groups (TG)% of TG covered1

Smallholder farming households

Households in Ubudehe 1 & 2

Mothers / Caregivers

Schools


FFLS, Agriculture village promotors, CHWs, Coops, PD/H, NGOs30 / 30

27 / 30

28 / 30

29 / 30

30 / 30

30 / 30

15 / 30

Provide materials & techn. for small-scale horticulture

Provide animals for small-scale husbandry

Promote food preservation and storage

Provide input for production & cons. of biofortified crops

Provide/Support improved water source

Provide/Support improved sanitation

Carry out nutr. education (e.g. cooking demos)

Promote hygiene / hand washing

Provide conditional social safety net actions (VUP)

Food

& A

gric

ultu

reW

ASH

2 N

utrit

ion

educ

atio

n

Carry out nutr. education at school (e.g. school gardens)

Districts, UN agencies, NGOs, Community leaders

Provide school feeding (One Cup of Milk)

Soci

al

secu

rity

FFLS, Agriculture village promotors, CHWs, Coops, NGOsHousehold with children under 530 / 30

Household with children under 5

HouseholdsSchools

HouseholdsSchools

Pregnant & lactating womenSchools

Primary school childrenPrimary schools

+8%

+3%

+5%

+4%

+1% 0%

+1% +1%

0-25% 26-50%

51-75%

76-100%

9 / 30

21 / 30

28 / 305 / 30

1 / 30

4 / 30

1. Beneficiary coverage displayed as "+X%" represents the additional %-points of households reached over the last calendar year (2014).2. Have received limited input from WASH stakeholders (who have separate technical working groups), and actual geographic and beneficiary coverage is probably higher3. Not all Households in Ubudehe 1 & 2 are targets for the Vision Umurenge 2020 Program (aiming mostly for those without employment), so not necessarily aiming for 100% coverage here



62

What % of the target group is covered per province? (1/2)

Country relevant actionsTarget groups

(TG)PLW

HHs w/ children u5



Children 0-59 mths with severe diarrhoea

Children 0-59 months with SAM

Children 0-59 months with MAM


Promote optimal breastfeeding practices

Provide spec. nutritious products for CF

Promote optimal compl. feeding practices

Provide Fe+FA supplements

Provide deworming tablets

Provide diarrhoea treatment (w/ ORS/zinc)

Provide MNP supplements (Ongera)

Provide treatment of SAM

Support and provide treatment of MAM

MIY

CN

Dis

ease

pr

ev./m

gmt

Mic

ronu

trie

nt

supp

lem

enta

tion

MA

M/S

AM

Provide Vitamin A supplements

Conduct child growth monitoring / screening

Promote/Provide ANC visits (4+)

MC

H

Pregnant women

Pregnant women

PLWHHs w/ children u5

6-23 months in U1&2PLW in U1&2

Children 12-59 mthsChildren 5-15 years

0-25% 26-50%

51-75%

76-100%


Rwanda total Kigali City South West North East

1. MNP program (Ongera) is being scaled up, and is in the 2nd half of 2015 in 18 districts

3 actions are being implemented at scale across all

provinces


63

What % of the target group is covered per province? (2/2)

Country relevant actionsTarget groups

(TG)

Smallholder farming households


Mothers / Caregivers

Schools


Provide materials & techn. for small-scale horticulture

Provide animals for small-scale husbandry

Promote food preservation & storage

Provide input for prod. & cons. of biofortified crops



Carry out nutr. educ. (e.g. cooking demos)


Provide conditional social safety net actions (VUP)3

Food

& A

gric

ultu

reW

ASH

2 N

utrit

ion

educ

atio

n

Carry out nutr. educ. at school (school gardens)


Soci

al

secu

rity



HouseholdsSchools

HouseholdsSchools

PLWSchools

Pri. school childrenPrimary schools

1. Beneficiary coverage displayed as "+X%" represents the additional %-points of households reached over the last calendar year (2014).2. Have received limited input from WASH stakeholders (who have separate technical working groups), and actual geographic and beneficiary coverage is probably higher3. Not all Households in Ubudehe 1 & 2 are targets for the Vision Umurenge 2020 Program (aiming mostly for those without employment), so not necessarily aiming for 100% coverage here


Rwanda total Kigali City South West North East

0-25% 26-50%

51-75%

76-100%

+8%1

+3%1

+5%1

+4%1

+1%1

+1%1

+2%1

+14%1

+7%1

+6%1

+7%1

+8%1

+5%1

+5%1

+2%1

+2%1

+1%1

+5%1

+7%1

+7%1

+1%1

+6%1

+2%1

+1%1 0%1

+1%1 +1%1

+1%1

+1%1 +3%1

+2%1

+1%1 +4%1

+1%1 0%1

+4%1

There is the strongest support for food & agriculture actions in

the South compared to other provinces


64

What % of the target group is covered per district?

0-25% coverage

Additional %-points reached

25-50% coverage

50-75% coverage

75-100% coverage

100+% coverage

Backup As reported in SUNPMT tool

Source: Stakeholder & Action Mapping 2014/15


65

Leverage mapping findings on delivery mechanisms to identify opportunities for both scale up and synergies of the CNAs

Scale up

Synergies

For the actions with few delivery mechanisms, is there potential to increase reach by extending delivery to other delivery mechanisms?

For delivery mechanisms that are less commonly used, is there potential to strengthen scale up through these delivery mechanisms?

Could some delivery mechanisms be in danger of becoming over utilized or exhausted? Is it possible to increase capacity of such delivery mechanisms?

Major use of channel (75-100% of implementors)

Substantial use of channel (50-75% of implementors)

Some use of channel (25-50% of implementors)

Low use of channel (0-25% of implementors)


66






Appendix
















67






Appendix
















68

Key messages on gaps

Only a few Core Nutrition Actions (CNAs) have full coverage• Most CNAs needs to be further scaled up• There may need to be a discussion of priorities on what CNAs to scale up, and where• E.g. on cost of scaling up versus effect and how accurately the main target group is addressed (e.g. school

feeding vs actions focusing more directly on children under 5 or under 2)

There is not necessarily a clear link between the districts with the highest stunting rates and the corresponding action coverage per district

• There may need to be a discussion on what districts to prioritize first, e.g. by investing in more core nutrition actions and higher coverage

Most districts have a stunting prevalence and a corresponding action coverage where further scale up is needed

• Should discuss how to best ensure this, e.g. by securing that all districts have dedicated partners and proper funding (may improve already with the CIFF and USAID INWA programs)

Continued focus on stunting reduction is needed• Some key situation indicators are on a low level and showing slow progress, e.g. anemia, food consumption

score, minimum acceptable diet and WASH


69

Only a few of the core nutrition actions have full coverage

Iron and folic acid supplements

Biofortified crops

Food storage & preservation

MNP supplements (Ongera)4

Small scale horticulture

(kitchen gardens)

Small scale animal husbandry

Improved water source2

Diarrhoea treatment

Vitamin A supplements

Hygiene and hand washing

Treatment of SAM

Child growth monitoring / screening

Deworming tablets

Social safety net actions (VUP)3

Optimal compl. feeding Nutrition education

at schools (school gardens)

Improved sanitation2 Treatment of MAM

ANC visits (4+)

Specialized nutritious food for

complementary feedingSchoold feeding (One Cup of Milk)

Nutrition education

Optimal breast feeding

+1%-points1

+1%-points1

+3%-points1

+4%-points1

+8%-points1

+5%-points1

Source: Stakeholder & Action Mapping Rwanda 2014/15

0-25% 26-50% 51-75% 76-100%

1. Beneficiary coverage displayed as "+X%-points" represents the additional %-points of households reached over the last calendar year (2014)2. Have received limited input from WASH stakeholders (who have separate technical working groups), and actual coverage is probably higher 3. Not all Households in Ubudehe 1 & 2 are targets for the Vision Umurenge 2020 Program, so not necessarily aiming for 100% coverage here 4. MNP program (Ongera) is being scaled up, and is in the 2nd half of 2015 in 18 districts


70

Prevalence of stunting varies across districts, and not all the districts with high stunting have all core nutrition actions

Stunting strongly prevalent in most districts, especially in the West & South-East

All districts with 15 or more CNAs, but only one district with all 23 CNAs

1. NB! Confidence intervals are rather large on a district levelSource: Rwanda National Nutrition Screening 2014, Rwanda Stakeholder & Action Mapping 2014/15

10-1415-19

2320-22

# of Core Nutrition Actionsbeing conducted per district

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


20% - 29%30% - 39%>40%

Stunting prevalence among children 0-59 months 1

<20%


71

Only one district have an action intensity where more than 75% of core nutrition actions reach at least 30% of target population

Stunting strongly prevalent in most districts, especially in the West & South-East

Only one district with more than 75% of actions reaching over 30% of target population

0% - 25%26% - 50%

76% - 100%51% - 75%

% of actions with at least 30%2 of target population covered

1. NB! Confidence intervals are rather large on a district level 2. 30% of target population covered or more than 1%-points additional beneficiaries covered (for Food & Agriculture and WASH infrastructure)Source: Rwanda National Nutrition Screening 2014, Rwanda Stakeholder & Action Mapping 2014/15

Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


Nyagatare

Gatsibo

Kayonza

KarongiBugesera

Rusizi

Nyamasheke

KireheNgoma

Rwamagana

Nyaruguru

Nyamagabe

Rulindo

Gicumbi

Huye

Nyanza

MusanzeBurera

Gakenke

Ngororero

Nyabihu

Ruhango

MuhangaKamonyi

Gisagara

Rubavu


Nyamagabe is also the only district where

all 23 core nutrition actions are being

implemented

20% - 29%30% - 39%>40%

Stunting prevalence among children 0-59 months 1

<20%


72

What actions are not being conducted and where?

Backup

1. MNP program (Ongera) is being scaled up, and is already now (2nd half 2015 in 18 districts)Source: Stakeholder & Action Mapping Rwanda 2014/15


73

Monitor Maintain

Scale up Investigate

Many districts are not adequately addressed, and scale-up discussion in these districts may be necessary

60%

70%

40%

0%

30%

50%

30%

80%

40%

0%

50%

60%

Gatsibo

GicumbiNyagatare

Rwamagana Kayonza

Musanze

Ngororero

Nyamagabe

Kirehe

Ruhango Nyarugur

u

Muhanga

RubavuRutsiro

BugeseraNyabihu

Stunting prevalence1

% of actions with at least 30%2 of target population covered

GakenkeNyamashekeNgoma Rulind

o Rusizi

Burera

Huye

KarongiKamonyi

Gisagara

NyanzaKicukiro Gasabo

Nyarugenge

1. Among children 0-59 months old. NB! Confidence intervals are rather large on a district level2. 30% of target population covered or more than 1%-points additional beneficiaries covered (for Food & Agriculture and WASH infrastructure)Source: Stakeholder & Action Mapping Rwanda 2014/15, Rwanda National Nutrition screening 2014

WestNorth

South

East

Kigali City


74






Appendix
















75

Summary of initial recommendations on planning and scale-up

Increase geographic

reach

Improveaction &

beneficiary coverage

Focus on stunting and on improving

core indicators

Main issues

Some districts have limited support, leaving gaps in geographic coverage

Some partners seem to be spread thinly (e.g. covering some sectors and villages here and there) instead of focusing their efforts

Initial recommendations

Secure that all districts have dedicated partners in fighting malnutrition

Encourage partners to focus efforts more geographically (cover all villages & sectors in an area) to simplify coordination & increase efficiency

Several CNAs are not present in all districts, and many are just done in some sectors and villages Beneficiary coverage is low for many of the CNAs – large parts of the target groups are not reached

Many core nutrition actions should be scaled up to cover more districts, sectors and villages

When core nutrition action is present in districts, coverage of the target groups needs to be improved

Stunting is still high, and rate of reduction is slow

Main indicators are lagging behind, like Minimum Acceptable Diet, Food Consumption Scores and WASH access

Continue focus on reducing chronic malnutrition, but accelerate scale-up

Complementary feeding practices, food diversity & availability, and water source, sanitation and hygiene needs to be further improved

A

B

C

✗ ✓



76

Increase geographic reach, but don't spread resources too thin

A

Large differences in district supportEven with many partners,

some are only covering a few sectors

Secure that all districts have dedicated partners in fighting malnutrition

Encourage partners to cover all villages and sectors in a district to simplify

coordination and increase efficiency

# of districts supported

Avg % of sectors

Number of partners per district

Averagepartners:6

Districts Each point represent an implementing partner



77

Improve action & beneficiary coverage

B

Some CNAs are only present in a few districts

Beneficiary coverage for many of the CNAs are too low

Scale up core nutrition actions to cover more districts, sectors and villages

(e.g. by piggybacking on other programs)

Improve CNA coverage of the target groups, while also focusing on the

quality of the action coverage

Provide specialized nutritious products for CF

Provide micronutrient suppl. (MNPs/Ongera)1




Promote food preservation and storage


Provide animals for small-scale animal husbandry

Carry out nutrition education (e.g. cooking demos)

50%

0%

100%

Growth monitoring / screening

Iron and folic acid

Spec. products for CF (e.g. CSB)

Nutr. education (e.g. cooking demos)

School feeding (One Cup of Milk)

MNPs (Ongera)Diarrhoea treatment

(ORS/zinc)

Deworming tabletsVitamin A

supplements

Social safety net actions (VUP)

ANC visits (4+)Hygiene / hand washing

Nutr. educ. school (School gardens)

Small-scale horticulture (Kitchen gardens)

Improved sanitation

Food preservation & storage

Biofortified crops (beans, sweet potato)

Small-scale animal husbandry

Improved water source

Treatment of SAM

Optimal BF practicesOptimal CF practices

Treatment of MAM

# of districts per CNA:

Beneficiary coverage per CNA:

>75%50-75

%25-50%

<25%+%-pt

s

30 districts

<30 districts



78

Focus on stunting and main lagging indicators

C

Stunting progress is still too slow Main indicators showing limited progress

Continue focus on stunting reduction and the 1st 1000 days windows of opportunity,

but significant acceleration is needed

Complementary feeding practices, food diversity & availability,

and WASH should be further improved

Stunting prevalence1 among children under 5 years

-20

-7

-6

2018 target22005 2010 2014/15

Min. Acc. Diet1 +1.0

75.2%5

Anemia 6-59 mths1

Improved water

+0.4Acceptable FCS3

74.5%4

-1.6

+0.7

20102014/15

(2009)

(2012)

(2010/11)

Source: 1. Rwanda DHS 2010 & DHS 2014/15 2. HSSP-3 3. CFSVA/NS 2009 & 2012 4. EICV3 2010/11 5. WATSAN 2014


79

Progress from 2010 to 2014/15 is far from sufficient to reach 2018 target

40%

60%

20%

30%

0%

50%

Rwanda stunting prevalence

18.0%

2018 target

51.0%

37.9%

24.5%

Year

18.0%

-15.0%

2014-15

33.0%

44.2%

2005

44.2%

2010

HSSP III target trajectory

2014/15-18 target trajectory

2005-10 actual

2005-10-14/15-18 trajectory

2010-14/15 actual

Immediate scale-up of nutrition interventions is needed to accelerate stunting reduction

Current trajectory leads to estimated 33% stunting

prevalence in 2018, a 15%-point gap from

the HSSP III target

Source: Rwanda DHS 2010 & DHS 2014/15, HSSP-3


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Rwanda is still far behind some of the best practice countries in stunting reduction

Rw

anda

BrazilG

ambia

Vietnam

Peru

Mauritania

Maharashtra

Countries

Average Annual Rate of Reduction1 in stunting (in %2)

Average:4% AARR

Africa

average

1. Average Annual Rate of Reduction (AARR) is calculated from the 4-6 best consecutive years of reduction for each country from 1995 – 2015. 2. In %, not %-pointsNote: Rwanda calculated from DHS 2010 to DHS 2014/15 Source: WHO/UNICEF/World Bank database

Backup

Other countries' success show that there is potential to further accelerate stunting reduction in Rwanda


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Appendix















rwanda stakeholder & action mapping 2014 15

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