1. KENYA Nutrition Deep Dive 11 th MAY, 2016 USAID PREG Meeting

2. National Overview of Nutrition Situation and Nutrition Information Sources Reduction in stunting from 35.3% to 26%, however huge disparities exist among counties, with some rates exceeding 40% MDG target for underweight (11%) achieved. Only 1 country—Kenya—is on course for all five WHA undernutrition targets. Nutrition Information Sources: Seasonal Assessments District Health Information System (DHIS) Cross Sectional SMART surveys Rapid Assessments Sentinel surveillance – MUAC Data KAP Surveys National Surveys (KDHS, MICS etc.) Coverage Surveys Special Studies and Operational Research

3. Nutrition Situation, February 2015Nutrition Situation, August 2015 The analysis shows an improvement in the overall acute nutrition situation. The SRA Feb 2016 showed improvement across all livelihoods, notably in West Pokot, Isiolo, Kajiado, Narok, Garissa, Meru North, Kitui. The situation is stable in Turkana, Marsabit, Mandera and parts of Wajir, however high rates of malnutrition still persist due to chronic underlying factors and of worry is the cholera and measles outbreaks reported in these vulnerable counties Nutrition Situation Trends in Vulnerable Areas Nutrition Situation, February 2016

4. Acute Malnutrition Burden Importance of highlighting chronically high caseload in ASAL even with good food security outcomes – need to focus on targeted nutrition resilience to address underlying vulnerabilites Importance of highlighting chronically high caseload in Nairobi urban – yet very limited focus or resources

5. Treatment of Acute Malnutrition 2015 and January to March 2016 SAM children reached: 40,829 SAM cases admitted from Jan to Dec 2015 in ASAL and Urban counties and 10,258 in January to March 2016 10,242 SAM cases reached in Refugee Settings Jan-Oct 2015 Between January and December 2015, UNICEF distributed 18,732 cartons of RUTF from FFP, contributing 30% of the overall RUTF released by UNICEF Kenya over the same period

6. SAM program coverage based on coverage surveys is approximately 50%, except in Mandera and East Pokot The main barriers affecting coverage include distance to the treatment center, lack of awareness, insecurity affecting quality of service and staffing, population movements, and staff shortages. UNICEF is supporting MoH and partners to implement social behavior and change communication and advocacy to county governments to address health system bottlenecks. What opportunities exist to increase access to health services through the PREG programme?? Treatment of Acute Malnutrition: SAM Programme Coverage Lands (ASAL)

7. Estimated Caseloads of SAM 2012 to 2015

8. Importance of Addressing Undernutrition– Child Mortality Due to Nutritional Disorders Nutritional Disorders Attributable deaths with UN prevalences* Proportion of total deaths of children younger than 5 years Fetal growth restriction (<1 month) 817,00011.8% Stunting (1-59 months) 1,017,000*14.7% Underweight (1-59 months) 999,000*14.4% Wasting (1-59 months) Severe Wasting (1-59 months) 875,000* 516,000* 12.6% 7.4% Zinc deficiency (12-59 months) 116,0001.7% Vitamin A deficiency (6-59 months) 157,0002.3% Suboptimum breastfeeding (0-23 months) 804,00011.6% Joint effects of fetal growth restriction and suboptimum breastfeeding in neonates 1,348,00019.4% Joint effects of fetal growth restriction, suboptimum breastfeeding, stunting, wasting, and vitamin A and zinc deficiencies (<5 years) 3,097,00044.7%

9. Framework for Actions to Achieve Optimum Fetal and Child Nutrition and Development 9 Lancet Series June 2013

10. Importance of Investing in Nutrition – Lancet Research Key Messages Short stature, low BMI and vitamin and mineral deficiencies in pregnancy contribute to maternal morbidity and mortality, fetal growth restriction, infant mortality and stunted growth and development Stunting of growth in the first 2 years of life affects 165 million children who have elevated risk of mortality, cognitive deficits and increased risk of adult obesity and non-communicable diseases Vitamin A and zinc deficiencies in young children increase the risk of death from infection and other micronutrients have important developmental consequences This new evidence strengthens the case for a continued focus on the critical 1,000 day window during pregnancy and the first two years of life, highlighting the importance of intervening early in pregnancy and even prior to conception

11. So what needs to be done – what does a Nutrition Resilience / Risk Informed Nutrition Specific Programme Look Like…. Evidence and knowledge to guide programmes to adopt a context specific risk based aproach to nutrition resilience. Inclusion of resilience and emergency managment in nutrition leadership and governance structures. Expanded CMAM Surge Model Contextual risk assessment for household and community strategies for mitigation, adaptation and transformation. 1. Community. Prevention, promotion and referral 2. Facility Based Services. Supply, demand, coverage and quality of services 3. Knowledge Management. 4. Leadership and Governance. SUN and Nutrition Sensitive. Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

12. Improve patient flow IMAM Surge Model emergency serious alert Time Exhaustive house-to-house MUAC screening incl. coverage information Clinic to revise protocols Ambulance for SC referrals Height on admission & monthly visit only Mass awareness campaign Preposition drugs & RUTF Incentives for volunteers for increased work Increase # volunteers helping out at HF Increase supervision & OJT Increase frequency of district coordination meetings Revise OTP schedule (daily vs. weekly) Outreach/ mobile clinics Increase # paid comm. Mob. Store RUTF in communities Increase defaulter follow up Introduce SMS fast track supply order system for drugs/RUTF Increase # of sites Increase H&N community sessions Increase # nurses/ HW Increase # of volunteers Train add. staff Compile data weekly instead of monthly Conduct emergency coordination meetings Additional supervision (fuel & allowances Deliver emergency stocks to HFs Simplify HF reporting Monthly HF review meetings Weekly monitoring of admissions Ensure minimum buffer stock of drugs/ RUTF baseline Capacity of government health system External support to government Move from weekly to daily OTP services Change to MUAC only admission Number new admissions into OTP Normal nutritional operating environment Expected seasonal spike Bi-weekly OTP follow up visit Refresher trainings HF/ DHMT capacity assessment Review meeting SMART survey MoU with surge component (DHMT, HF)

13. NUTRITION RESILIENCE THOUGH NUTRITION SENSITIVE PROGRAMMING - EXAMPLE 1 1.Reliable water source available throughout the year  Risk Informed. 2.Water close to women  Women’s workload 3.Small ruminants for women  Women’s empowerment and workload 4.Milk used for complementary feeding throughout the year  Complementary Feeding  Risk Informed Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

14. NUTRITION RESILIENCE THROUGH NUTRITION SENSITIVE PROGRAMMING Example 1 - Indicators 1.Reliable water source available throughout the year  % Functionality over time. (WASH) 2.Water close to women  15 minutes from women (WASH/FS) 3.Small ruminants for women  Numbers of animals. Milk production throughout year. (FS) 4.Milk used for complementary feeding  MDD-I (Nutrition & FS & WASH) Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

15. NUTRITION RESILIENCE THROUGH NUTRITION SENSITIVE PROGRAMMING - EXAMPLE 2 1.Seasonally and shock adapted Women’s Savings and Loans Groups.  Livelihoods and Food Security  Women’s Empowerment 2.Child Friendly  Livelihoods and Food Security 3.Improved income and income control used for complementary feeding throughout the year  Livelihoods and Food Security  Nutrition  Objectives and Indicators Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

16. NUTRITION RESILIENCE THROUGH NUTRITION SENSITIVE PROGRAMMING EXAMPLE 3 1.Increased production of diverse and quality foods.  Home Gardens 2.Child Friendly  Crops grown adapted to 6-23 months nutritional needs.  Crops grown adapted to research e.g. Optifoods  Objectives and Indicators MDD-I and MDD-W 3.Sustainable water for irrigation  Women’s Empowerment  Risk Sensitive  Objectives and Indicators Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

17. Nutrition Resilience programming  Does not need to be a fully integrated programme.  Can be intrasectoral implementation.  Needs integrated planning for joint objectives and shared M+E plan.  Can address Chronic AND Acute Nutrition Deprivation.  Nutrition Sensitive.  Not only integration of behaviour change Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015

18. NUTRITION RESILIENCE AND RESILIENCE FOR NUTRITION Bottom Line…. We need BOTH Nutrition specific and sensitive Programming to be designed, planned, implemented and monitored together targeting those most nutritionally vulnerable!! Well nourished people are more resilient = Nutrition Resilience. More resilient people are better nourished = Resilience for Nutrition The measure of success of a resilience programme are reduced caseloads of acute and chronic malnutrition Ref: CHC, & UNICEF Kenya, Nutrition Resilience Policy Brief June 2015