1. The importance of engaging in Health systems strengthening to ensure Nutrition interventions are truly delivered within the health system TECHNICAL MEETING ON NUTRITION-OXFORD-2014

2. A new role for INGOs: addressing nutrition in health. As part of the evolution of SAM management, the goal of treating of SAM for INGOS has expanded ACF revised nutrition and health strategy  A specific focus on nutrition is maintained while ensuring that basic health essential interventions are made available and delivered at health centres (diagonal approach).  It is a complex issue that requires new skills, new ways of working, tools, research and longer timeframes. 12 juin 20162

3. ACF approach towards HSS  Step by step approach to health system and community assessment and programming undertaken at district level.  The aim of the assessment is to get a snapshot of the health system and the community structure and to understand their strengths and weaknesses (diagnosis phase)  It will help determine the priority actions required for the development of a health system and community strengthening strategy (programming phase) 12 juin 20163

4. Objective of the Method Clearly the diagnosis phase is not expected to highlight bottlenecks that are not already known by the health actors. The aim of the diagnosis phase is: -To create a common vision amongst partners at district level, -To create a consensus on priority actions to be taken and -To gather information to create a baseline that will allow monitoring and evaluation of the programmes developed to strengthen the health system. 12 juin 20164

5. The programming step of ACF approach does not promote the creation of a parallel mechanism for health planning. Its aim is to introduce the Health system strengthening thinking within the district health planning agenda. 12 juin 20165

6. Key elements of the approach  A Process oriented approach: ACF guide promotes a process, not a model. What does it means concretely?  Partnership is the key but also the challenge: A Health System Strengthening strategy can only be developed if all actors are involved (from all elements of the service delivery- not only Nutrition).  Think horizontal &/or diagonal but not vertical: This approach promotes a horizontal and/or diagonal diagnosis and programming process. What does it mean concretely? 12 juin 20166

7. What has been done so far? In 2014 first semester in link with MoH ACF has proposed and carried out diagnosis and programming exercises in several districts of Afghanistan, Burkina Faso, Bangladesh, Senegal, Niger and Sierra Leone… 12 juin 20167

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9. Burkina Faso Experience 12 juin 20169

10. Lessons learned- Burkina Faso experience 12 juin 201610  On the scope and the essential principles  Important engagement by MoH and partners  Adaptation to the context and partners availability and competencies: can be challenging (Time-consumming)  Difficulty to Abandon the vertical approach  On the 6 steps  Exchange between higher level and lower level (authorities, technicians…)  Primary data collected by a mutliactor team. Authorities engaged in the analysis  Challenge on the scoring of the benchmark: results biased for certain Building blocks (Governance, supply)  Difficulty to articulate the results and the district planning Way forward Workshop organised at national level ECHO request for the methodology to be adopted amongts all partners and by MoH (2015)

11. Lessons learned- Bangladesh experience 12 juin 201611

12. Lessons learned- Bangladesh experience 12 juin 201612 On the scope and the essential principles  Important engagement by MoH and partners  Horizontal approach adopted.  Necessity to train the participants on key Health system concepts prior to the exercise. On the steps  Same Feedback as for BF.  Necessity to improve inclusion of community members and “users” to the entire exercise  Necessity to improve the ABC programming method WAY FORWARD  Long term commitment from Govt., NGO and donor is essential  Follow up the outcomes of doing an HSS exercise after 3 months, 6 months

13. Way forward In general  A significant part of the priorities identified through the exercise also require intervention at central level=> Inclusion of an advocacy training to the method  IT IS A PILOT! it is a long process that will require long term engagement of health and nutrition actors at district level and thorough monitoring.  Need to sensitize the donors on the methodology and request their engagement to fund the common programming generated with all partners during this exercise 12 juin 201613 Method update and further development  Revision of the step by step method (V2 end of nov 2014)  Development of an implementation guide fosusing on each of the building blocks & the ABC methodology  Development of a project to monitor the effectiveness of the approach and its impact on the availability of basic health services with a specific focus on nutrition essential interventions.

14. Thank you for your attention! 12 juin 201614