USAID Kenya Nutrition and Health Program pluspdf.usaid.gov/pdf_docs/PA00MN92.pdfDHIS District Health...

USAID Kenya Nutrition and Health Program plus

QUARTER FY Progress Report

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USAID KENYA Nutrition and Health Program plus

QUARTER 1 FY 2015/2016 PROGRESS REPORT 01 October l – 31 December 2015 Award No: AID-615-H-15-00001

Prepared for Ruth Tiampati United States Agency for International Development/Kenya C/O American Embassy United Nations Avenue, Gigiri P.O. Box 629, Village Market 00621 Nairobi, Kenya

Prepared by: Nutrition and Health Program plus 2nd Floor Chancery Building, Valley Road P.O Box 38835 00623 Nairobi, Kenya

The authors’ views expressed in this report do not necessarily reflect the views of the United States

Agency for International Development or the United States Government.

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Table of Contents

ACRONYMS AND ABBREVIATIONS .................................................................................. III

I. EXECUTIVE SUMMARY ............................................................................................... 5

II. KEY ACHIEVEMENTS (QUALITATIVE IMPACT) ......................................................... 8

I. IMPROVING ACCESS AND DEMAND FOR QUALITY NUTRITION INTERVENTIONS AT COMMUNITY AND

FACILITY LEVELS ................................................................................................................................... 8 1.1 Strengthening Leadership, Advocacy and Policy Planning ............................................... 8 1.2 Improving Nutrition Service Delivery Management, Coordination and Implementation .... 9 1.3 Improving Nutrition Related Behaviour ............................................................................. 9 1.4 Increasing opportunities for learning and sharing of best practices in nutrition .............. 10 1.5 Increasing knowledge and skills of Health Care Workers in nutrition ............................. 11

2. STRENGTHENING NUTRITION COMMODITY MANAGEMENT ................................ 12

2.1 Improving Production, Supply and Distribution of Nutrition Commodities ...................... 12 2.2 Improving Quality and Safety of Food Commodities and Agricultural Products ............. 14 2.3 Improving Quality and Safety of Food Commodities and Agricultural Products ............. 15

3. IMPROVING FOOD AND NUTRITION SECURITY ..................................................... 15

3.1 Increasing Market Access and Consumption of Diverse and Quality Foods .................. 15 3.2 Increasing Resilience of Vulnerable Households and Communities ............................... 17

4. MONITORING AND EVALUATION ............................................................................. 19

III. PROGRAM PROGRESS (QUANTITATIVE IMPACT) .................................................... 23

SERVICE UTILIZATION, COMMODITY PRODUCTION AND DELIVERY .......................................................... 23 Reported Consumption (Prescription) ..................................................................................... 24

V. PROGRESS ON LINKS TO OTHER USAID PROGRAMS ............................................. 35

VI. PROGRESS ON LINKS WITH GOK AGENCIES ........................................................... 35

VII. SUBSQUENT QUARTER’S WORK PLAN .................................................................... 36

VIII. FINANCIAL INFORMATION ....................................................................................... 43

XI. ACTIVITY ADMINISTRATION ....................................................................................... 43

PERSONNEL ........................................................................................................................................ 43

ANNEX 1: SCHEDULE OF FUTURE EVENTS ................................................................... 44

ANNEX 2: SUMMARY OF TRAININGS .............................................................................. 45

ANNEX 3: PERFORMANCE DATA TABLES ...................................................................... 48

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Acronyms and Abbreviations

AIDS Acquired Immune Deficiency Syndrome

AMPATH Academic Model for Providing Access to Healthcare

APHIAplus AIDS, Population and Health Integrated Project

ART Antiretroviral Therapy

CBO Community-Based Organization

CCC Comprehensive Care Centers

CDC Centers for Disease Control

CHANIS Child Health and Nutrition Information System

CHEW Community Health Extension Worker

CHV Community Health Volunteer

CLTS Community-Led Total Sanitation

CNTF County Nutrition Technical Fora

CO Country Office

COP Chief of Party

CRISP Central Regional Integrated Program

CU Community Health Unit

DCOP Deputy Chief of Party

DHIS District Health Information System

EDL Economic Development and Livelihoods

EmOC Emergency Obstetric Care

EMR Electronic Medical Records

EMMP Environmental Mitigation and Monitoring Plan

ENA Essential Nutrition Actions

EPZ Export Processing Zone

FAFSA Food Aid and Food Security Assessment

FANTA Food and Nutrition Technical Assistance Project

FAO Food and Agriculture Organization

FBF Fortified Blended Food

FBP Food by Prescription

FFP Food for Peace

FHI Family Health International

FtF Feed the Future

GAIN Global Alliance for Improved Nutrition

GIS Geographic Information System

GMP Good Manufacturing Practice

GOK Government of Kenya

HACCP Hazard Analysis and Critical Control Points

HEA Household Economic Assessment

HFP Household Food Production

HiNi High impact Nutrition interventions

HIV Human Immunodeficiency Virus

HNDU Human Nutrition and Dietetics Unit

HTC HIV Testing and Counseling

IMAM Integrated Management of Acute Malnutrition

IP Implementing Partner

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IR Intermediate Result

IYCF Infant and Young Child Feeding

IYCN Infant and Young Child Nutrition

KARI Kenya Agriculture Research Institute

KEBS Kenya Bureau of Standards

KDHS Kenya Demographic and Health Survey

KEMSA Kenya Medial Supplies Authority

KFDA Kenya Food and Drug Administration

KHCP Kenya Horticultural Competitiveness

KNDI Kenya Nutritionists and Dieticians Institute

KPPB Kenya Pharmacy and Poisons Board

LMIS Logistics Management Information System

M&E Monitoring and Evaluation

MEDS Mission for Essential Drugs and Supplies

MIYCN Maternal and Child Health Integrated Program

MNCH Maternal Newborn and Child Health

MOH Ministry of Health

MT Metric Ton

NACS Nutritional Assessment, Counseling and Support

NASCOP National AIDS and STI Control Program

NFSNSC National Food and Nutrition Security Secretariat

NHP Nutrition and HIV Program

NHPplus Nutrition and Health Program Plus

NICC Nutrition Interagency Coordinating Committee

NNAP National Nutrition Action Plan

NSR Nutrition Service Register

OR Operations Research

ORT Oral Rehydration Therapy

OVC Orphans and Vulnerable Children

PEPFAR President’s Emergency Program for AIDS Relief

PLHIV People Living with HIV

PAC Project Advisory Committee

PMEP Performance Monitoring and Evaluation Plan

PMTCT Prevention of Mother-To-Child Transmission of HIV

QA/QI Quality Assurance / Quality Improvement

RUTF Ready-to-use Therapeutic Food

SBC Social Behavior Change

SCNTF Sub-County Nutrition Technical Fora

SMT Senior Management Team

SUN Scaling Up Nutrition

TA Technical Assistance

TWG Technical Working Group

WASH Water, Sanitation and Hygiene

WFP World Food Program

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I. EXECUTIVE SUMMARY

The overall goal of the Kenya Nutrition and Health Program plus (NHPplus) is to improve the

nutrition status of Kenyans through improving access and demand for quality nutrition

interventions at facility and community levels; strengthening nutrition commodities

management; and improving food and nutrition security. The five-year program which started

in January 2015 is in its second year of implementation and the current report refers to its 5th

quarter (January – March, 2016) of implementation. The program is addressing undernutrition

through interventions that focus on both the immediate and basic contributors to malnutrition.

Key among NHPplus activities include capacity strengthening, technical assistance and data

management/M&E support to health managers and workers at National and County levels;

support for efficiencies in nutrition commodity procurement, management, distribution, quality

control and safety; partnering with stakeholders to impact good nutrition for mothers and

children; and working with Feed the Future (FtF) and other agri-nutrition partners to devise

innovative approaches to reduce stunting during the first 1,000 days “window of opportunity

and increase resilience of vulnerable households in the five focus counties of Busia, Kitui,

Marsabit, Samburu and Tharaka Nithi.

During the quarter, the program provided Maternal Infant and Young Child Nutrition (MIYCN)

Technical Working Group (TWG) with both technical and financial support to re-design and

review the National Policy on MIYCN. NHPplus also supported the National Nutrition

Technical Forum (NTF) secretariat to host a quarterly meeting and Samburu County Nutrition

Technical Forum (CNTF) secretariat to host a meeting to develop its terms of reference.

The program sensitized 227 health care workers from 80 health facilities, in the 6 counties of Nairobi, Narok, Nakuru, Kitui, Homabay and Migori, on Nutrition Assessment Counselling and Support (NACS). The program also conducted facility assessment in Kitui County using HiNi-OJT tool and identified 54 facilities for subsequent capacity building on management of acute malnutrition. In Kitui County, the program conducted a CME on “In-patient Management of Severe Acute Malnutrition” with a focus on triage and admission criteria for 27 health care workers in Katulani Health centre.

To contribute towards improving nutrition related behaviours, the reference charts for Nutrition Diagnosis and Protocol for Food by Prescription was revised to integrate key messages on maternal nutrition, IYCF, WASH and Agri-Nutrition for piloting in the subsequent quarters. Social mobilization activities for Vitamin A Supplementation were conducted in Busia County, Matayos Sub-County and covered 5 wards Burumba, Bukhayo, Busibwabo, Matayos and Lunga. 69 ECDE centres were targeted and 8,000 children <5years old were exposed to key messages. 60 ECDE teachers and 50 CHVs were provided with information on the importance of vitamin A supplementation, with supplementation of children >2 years old as the priority behaviour promoted. The program has also initiated discussions with mother support groups in Tharaka Nithi on interventions to address nutrition related behaviours.

During the reporting period, NHPplus participated and supported one Nutrition Officers from MOH to participate in the annual East and Southern Africa Region Multisectoral Nutrition Global Learning and Evidence Exchange (MSN- GLEE) forum in Dar es Salaam, Tanzania. During the forum, countries shared experiences and exchanged evidence based on best practices. New indicators to monitor progress towards achievement of USAID Multisectoral Nutrition Strategy goals, were also disseminated.

The program continued to work closely with Equatorial Nut Processors (ENP) Ltd to ensure that quarterly targets for production and distribution of nutrition commodities are achieved, and stock outs and incidences of expired commodities are minimized. The program facilitated

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trainings on quantification and reporting on nutrition commodities in 6 counties. Site visits to health facilities were conducted to nurture facility level inventory management and use of data collection tools for nutrition commodities. Discussions are at advanced stage for ENP to employ six regional representatives to monitor and track FBF availability, requisitions and expiry in the country. We have continued to monitor the manufacturing of FBF through regular monitoring visits to ENP and post batch testing to ensure high quality and safe nutrition commodities.

NHPplus procured 534 MT of FBF, over 100% of the quarterly target (to include buffer stock) comprising 334.4 MT (18,556 cartons) for adults, 127.2 MT (7,067 cartons) for Children and 72.4 MT (4,022 cartons) for pregnant and post-partum mothers. 760.63 MT of FBF, including buffer stocks from the previous quarter, were distributed to 350 health as 464.25MT (25,792 cartons) for adults, 204.87MT (11,382 cartons) for children and 91.51MT (5,084 cartons) for pregnant/postpartum mothers. The program did not distribute any RUTF during the quarter due to customs clearance challenges. However, KEMSA through Global Fund procured 46.3MT of RUTF of which 18.6 MT (40%) was distributed.

To expand the food manufacturers’ base, the program continues to explore the market with an objective to identifying additional FBF food processors. During the reporting period, the program visited Stawi Foods, a local food processor involved in milling of nutritious porridge flours for the national and international markets. The plant’s operations were, however, found to be mostly manual and of very small magnitude (an output of 15-20 MT per month); and the only analysis done on the grains was moisture content.

During the quarter the program, jointly with FAO, carried out a baseline survey in Marsabit County to obtain food mapping and consumption data, as well as data on prevalence of children 6-23 months receiving minimum acceptable diet (FtF indicator 3.1.9.1(1)), prevalence of HH with moderate or severe hunger (FtF indicator 3.1.9.1(3)) and total quantity of targeted nutrient rich value chain commodities set aside for home consumption by direct beneficiary producer (FtF indicator 4.5.2.8). The data analysis is ongoing.

Towards improving food diversification, complementary feeding for children <5 years and resilience of vulnerable households, the program trained 47 MOH staff from key facilities in Kitui County on diversification of foods and utilization of local nutrient dense foods; and on developing linkages with agriculture and existing food safety net programs in the county. In Busia County, the program leveraged on Vitamin A Supplementation sensitization, to provide information to 17 MOH, 7 MOALF and 2 MOEST officers on Vitamin A dense foods available in the County. The program is exploring on using kitchen gardens available in the County to conduct field demonstrations on the production techniques for target vitamin A rich value chains as well as supporting food preparation demonstrations to address diet diversification. In a mapping exercise, the program identified 5 CBO networks, 180 CUs, 406 ECDE centres and 45 agriculture extension workers in Busia County as possible collaboration platforms for implementation of multisectoral nutrition programming activities.

On data reporting, monitoring and evaluation, the program supported 609 (62.8%) health facilities from 40 counties, a 38.4% (n=970) increase compared to the previous quarter. Client assessments were 73,608, relatively similar to preceding quarter, of which 18,285 malnourished clients received commodity nutrition interventions. An additional 8,263 client records were in the process of being inputted into the electronic system during compilation of this report. Newly assessed clients accounted for 54.3% of total assessments. Of the total assessed clients, 73.1% and 26.9% were children and adult clients respectively. Among clients with complete client category data, pregnant and post-natal women comprised 4.9% of the adult population while under 5-year-old children comprised 68.9% of the child population.

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To enhance data quality and reporting, 16 facilities were supported with customized nutrition electronic systems and their HCWs were inducted on its use. Overall, there was increased facility reporting of 38.8% from the preceding quarter (609 vs 373). However, the program identified lack of a coordinated departmental approach to the portal development as a hindrance in its successful deployment, an activity that was identified as an essential Rapid Results Initiative (RRI).

BMI reporting rate for non-PPP clients was at 94.4%. Of the newly enrolled non-PPP adult clients with “Client Category” classification, 7.4% were severely malnourished. Clients with BMI>18.5 at enrollment 70.8% of non-PPP clients. 60.1% of PPP clients supported during the reporting period were newly enrolled clients. Newly enrolled child clients accounted for 54.6% of all assessed children during the quarter.

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II. KEY ACHIEVEMENTS (Qualitative Impact)

1. Improving Access and Demand for Quality Nutrition

Interventions at Community and Facility levels

1.1 Strengthening Leadership, Advocacy and Policy Planning

Nutrition and Health program plus on request, internally reviewed 10-day course offered by the African Nutrition Leadership Programme (ANLP) with the intention of using this course as an approach to building nutrition leadership in Kenya. The ANLP 10-day course covers advocacy, leadership values, communication skills, management skills and theory of change. The ANLP is a needs based leadership program focused on developing the abilities of individuals to lead implementation of nutrition related interventions as part of multisectoral teams or groups at national or county level. Nutrition and Health Program plus has initiated engagements with the trainers of the ANLP to determine viability of hosting 10-day course locally. When implemented the African Nutrition Leadership Programme will strengthen the leadership capabilities of the national level nutrition and agriculture program managers

During the quarter, Nutrition and Health Program plus supported the Maternal Infant and Young Child Nutrition (MIYCN) TWG to re-design and review the National policy on MIYCN. The National MIYCN policy statement standardizes care practices for health workers providing maternal and child health services in every health facility. It also provides guidelines for infant and young feeding practices in the context of HIV. The National policy statement encourages mothers to breastfeed exclusively for 6 months, introduce appropriate, adequate and safe complementary foods. Mothers are also encouraged to breastfeed for at least 2 years and beyond. Printing and dissemination of this policy will be done in subsequent quarter. When printed the National policy on MIYCN will be distributed to all counties. When implemented the policy will contribute towards improving exclusive breastfeed and on appropriate use of complementary feeding.

Working with Nutrition and Dietetics Unit, the program also supported the secretariat of National Nutrition Technical forum (NTF) to host a quarterly technical forum on March 15, 2016. Three key presentations were made during the meeting (1) Citizen Voice and Action by World Vision, (2) Integrated Human Resource Information System (iHRIS) by Funzo Kenya and (3) Capacity development for nutrition by MOH. 25 participants attended the NTF representing ACF, Hellen Keller International, World Vision, GAIN, FAO, IMC, UNICEF, Funzo, NHPplus and MOH. Key output during the forum included adoption of the terms of reference.

Within the key focus counties, the program supported County Nutrition Technical Forums in Samburu County where the secretariat developed terms of reference for the forum. Additionally, the secretariat was supported to host one-day meeting. During this meeting 6 participants drown from MOA, MOH, WFP, IMC, World Vision and UNICEF were in attendance. The objective of this meeting was to plan and coordinate multisectoral county activities for the year. The CNTF approved terms of reference will govern the Nutrition future activities in Samburu.

In Marsabit, the program disseminated project work plan for the county during the technical forum. The CNTF was attended by 17 participants representing MOH, and partners including UNICEF, Concern World Wide and FHK. The outcome from this meeting was a harmonized county quarterly activity plan that included NHPplus activities.

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1.2 Improving Nutrition Service Delivery Management, Coordination

and Implementation

During the quarter, the program trained 227 healthcare providers on Nutrition Assessment Counselling and Support (NACS) covering 6 counties of Nairobi (25), Narok (33), Nakuru (57), Kitui (46), Homabay (30) and Migori (36). The training was coordinated with close collaborations with County Nutrition Coordinators, Afya Jijini, APHIAplus Rift, APHIAplus Eastern, and APHIAplus Western. Included in the training were 9 APHIAplus Nutrition technical officers drawn from each APHIAplus zone.

The approach used for training was visual interactive and participatory learning where case studies, brainstorming and buzz groups were used. Two training modules, Module 1 – Standard Treatment Guide (3 hours) and Module 3 – Nutrition Commodity Management (3.5 hours), were used in the one-day training. The key outcomes include developing the capacity of 80 health facilities and 227 health care to provide nutrition assessment and counselling. It is expected that this will lead to improved nutrition service delivery and management within the facilities covered and better nutrition outcomes for the patients.

Towards establishing the capacity of the facilities to manage acute malnutrition, the program conducted facility assessment in Kitui County using HiNi-OJT tool. 54 facilities were identified using the selection criteria based on (1) Presence of MNCH services, (2) Established community unit and (3) located at sub-county or ward levels. The identification of facilities at Marsabit, Samburu, Busia and Tharaka Nithi counties will be conducted in the subsequent quarter.

To improve Vitamin A for ECDE Supplementation using multisectoral approach, the program conducted training for 26 officers from MoH (17), MoEST (2) and MoALF (7) in Matayos Sub county of Busia County. The training was conducted using multisectoral package drawn from existing vitamin A and Agri-nutrition materials. As a result of the ownership and supervision efforts of the Matayos multisectoral team, 6,082 children were supplemented with Vitamin A. In Samburu North, Samburu County, the program trained 271 ECDE teachers and 81 primary school heads on Vitamin A strategies including dietary diversity and documentation using ECDE register.

To improve nutrition assessment and accurate diagnosis and prescriptions, the program has initiated the process of procuring anthropometric equipment for service delivery points offering nutrition services. This will address assessment data gaps currently being experienced such as in Narok County, where the facilities do not measure MUAC for pregnant and postpartum mothers due to lack of adult MUAC tapes. It is expected that distribution will be carried out in the coming quarter.

1.3 Improving Nutrition Related Behaviour

To improve the nutrition related behaviours, the program conducted social mobilization activities for Vitamin A Supplementation in Matayos Sub-County of Busia County. The uptake of vitamin A supplementation in Matayos is 39% and is primarily due to lack of knowledge amongst the caregivers of children above 9 months. The social mobilization covered 5 wards Burumba, Bukhayo, Busibwabo, Matayos and Lunga. To address the poor attitude and

Cadre of HCW Trained Number

County HRIO 1

Clinical officer 14

County Nutrition Coordinator 3

HRIO 54

Nursing Officer 43

Nutrition Officer 75

Pharm Tech 12

Pharmacist 2

M&E officer 3

Sub County HRIO 5

Sub County Nutrition Officer 13

Sub County Community Health Nurse 2

Total 227

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behaviour for vitamin A supplementation, 69 ECDE centres were targeted where 60 ECDE teachers and 50 CHVs were provided with information on the importance of vitamin A supplementation. The priority behaviour promoted was vitamin A supplementation of children above 2 years old, and how this is linked to better education outcomes. Through this process, 8,000 children under five years have been exposed to key messages during social mobilization in Matayos.

To address cultural behaviours, beliefs and practices that affect infant and young child feeding, the program worked together with Kibugua Mother to Mother Support Group in Tharaka Nithi County to provide information and practical support to mothers who are breastfeeding and/or weaning infants. During the one-day meeting, 41 mothers attended meeting and were provided with practical information on issues of insufficient breastmilk, timely introduction of complementary foods, locally available foods that can be used for complementary feeding and preparation of porridge for infants.

The main objective of the support group is to provide information and practical support to mothers who are breastfeeding and/or weaning infants. This support group is linked to Kibugua Health centre located in Meru south sub county of Tharaka Nithi County. It has established a demonstration kitchen garden within the Kibugua Health centre farm. The program will continue working together with the women group to conduct cooking demonstrations and to improve the demonstration garden to make it a model for the community.

1.4 Increasing opportunities for learning and sharing of best

practices in nutrition

During the quarter, the program supported 2 Nutritionist that included the Program Nutrition Specialist and Nutrition Officer from the Nutrition and Dietetics Unit (NDU) to attend the annual East and Southern Africa region-Multisectoral Nutrition Global Learning and Evidence Exchange (MSN- GLEE) forum held in Dar es Salaam, Tanzania on March 8-10th 2016. This forum was attended by USAID country missions from Tanzania, Uganda, Rwanda, Ethiopia, Malawi, Zambia, Mozambique, Zimbabwe, and Kenya. Also in attendance were USAID funded implementing partners e.g., SPRING, FANTA III, Community connector, University of California Davis, Manoff Group, International Potato Centre, Catholic Relief Services, Save the Children, GAIN, DFID, EAC, Concern Worldwide and Media for Development The MSN-GLEE is a regional forum where countries share experiences, learn and exchange evidence based on best practices. The forum brings USAID Bureau and Mission staff together with experts and field practitioners working on agriculture, economic growth, WASH, nutrition, and health Programs. The GLEE forum contributes to country-led improvement efforts to lay out the foundational elements that make up effective multi-sectoral nutrition programs. The forum provided an opportunity for learning from other counties and experts towards the country-led improvement efforts for effective multi-sectoral nutrition programs. The program, also showcased Kenyan’s efforts towards implementing multi-sectoral nutrition Strategy and provided technical expertise during the plenary sessions. During the meeting new indicators to monitor the progress towards achievement of USAID Multisectoral Nutrition Strategy goals, were disseminated. countries will begin reporting on these indicators beginning FY2016/17.

Figure 1: Kibugua Mother to Mother Support Group Meeting

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During the quarter, the program also participated in the National Demographic Health Survey dissemination meeting in Nairobi. The objective of the dissemination meeting was to review country progress based on the Kenya Nutrition Action Plan (KNAP 2012 – 2017) monitoring and evaluation framework. This framework identifies 9 indicators with national targets that direct activities towards achievement of KNAP goals. During the meeting key determinant for positive outcome for any nutrition indicator was noted to be level of education of women where the survey indicated that women who exclusively breastfeed for 6 months had attained secondary education or higher. The program will work towards ensuring and tracking the identified 9 indicators within its key focus counties of Tharaka Nithi, Kitui, Busia, Marsabi and Samburu.

1.5 Increasing knowledge and skills of Health Care Workers in

nutrition

During the quarter Nutrition and Health Program plus Nutrition specialist and Technical officer participated in the WHO-Infant and Young Child Feeding Regional Piloting of Training Manual in Nairobi. This field testing workshop was in Nairobi from March 22 – 26, 2016. The piloting of the manual was based on new training methodologies that advocates for use of visualization in participatory learning, buzz groups, brainstorming, role plays, drama, case study, demonstration with return demonstration and field practice. All these approaches were used and tested with master trainers who provided feedback on how to improve specific methodology based on content of training session. The field practice sessions were conducted at New Born Unit in Kenya National Teaching and Referral Hospital (KNH). Nutrition and Health Program plus Nutrition specialist was part of the team that moderated all activities during day one which covered introduction to IYCF, importance of breastfeeding, how breastfeeding works, assessing a breastfeeding session, listening and learning, positioning baby at breast and use of growth charts. Participants included master trainers from Brazil, USA, Philippines, Ghana, Ethiopia, Zambia, Swaziland, and host country Kenya. The key outcome from this training was a reviewed and updated IYCF trainer’s guide and counselling card.

In Kitui, the program conducted CME for 27 health care workers in Katulani Health centre. The topic covered during the CME was “In-patient Management of Severe Acute Malnutrition” with a focus on triage, admission criteria and 10 step approach. The CME is part of the peer to peer learning that promotes learning by doing, in this case the 10 step approach used for inpatient management of severe acute malnutrition was discussed. This was followed up by learning sessions conducted during routine ward rounds. This learning approach will ensure health workers competence on inpatient management of SAM improves the cure rates of these patients.

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2. Strengthening Nutrition Commodity Management

During this reporting period, program continued to undertake activities towards strengthening nutrition commodity management at health facility level. The program has continued to work closely with Equatorial Nut Processors Ltd to ensure that quarterly targets for production and distribution of nutrition commodities are achieved, with 350 facilities receiving nutrition commodities directly from the program. The program also facilitated trainings on quantification and reporting on nutrition commodities in 6 counties. Site visits to health facilities were conducted with the main focus on facility level inventory management and use and availability of data collection tools for nutrition commodities.

2.1 Improving Production, Supply and Distribution of Nutrition

Commodities

The program continued to conduct factory visits and meetings with Equatorial Nut Processors with the main aim of ensuring continuous production of high quality fortified blended flours. Discussions focused on aligning program projections with those of raw materials required for manufacturing nutrition commodities procured through the program to avoid stock outs and to ensure on-time delivery to the target facilities.

Additionally, discussions are at advanced stage for Equatorial Nut Processors to employ six (6) regional representatives to monitor and track FBF availability, requisitions and expiry in the country as a value-addition to the program. When implemented this will improve FBF availability and reporting, minimize stock outs and reduce incidences of expired commodities through re-distribution before the expiry period in the country

During the quarter, the procured 29,645 cartons of FBF exceeding the quarterly target with over 100%. Part of this procurement was for buffer stock for the coming quarter. The FBF procured comprised of 18,556 cartons for adults, 7,067 cartons for Children and 4,022 cartons for pregnant and post-partum mothers. It is estimated that the procured nutrition commodities will cover 12,385 adults, 7,067 children and 2,681 pregnant/postpartum mothers for 3 months.

During the quarter the program distributed 25,792 cartons of FBF Adults, 11,382 cartons of FBF Children and 5,084 cartons of FBF pregnant/postpartum mothers to 350 health facilities that included health facilities supported by AMPATH plus and APHIA plus Nyanza/Western.

Due to Customs clearance challenges the program did not distribute RUTF during the quarter. Customs clearance is a requirement prior to collecting commodities from the Export Processing Zone (EPZ) where the food processor, Insta Products (EPZ) Ltd is located. The necessary documentation has been obtained and it is expected that distribution will be conducted during FY 16 Quarter 3. Of importance to note is that KEMSA through Global Fund procured 46.3MT of RUTF of which 18.6 MT (40%) was distributed by the end March.

Table 1: Summary of commodity procured and distributed FBF Type

Apr- Jun 2015 Jul-Sep 2015 Oct-Dec 2015 Jan-Mar 2016

Procured Distributed Procured Distributed Procured Distributed Procured Distributed

FBF Adults

182.4 151.49 318 262.98 381.6 328.82 334.4 349.06

FBF Children

91.2 74.83 159 122.79 190.8 151.17 127.2 195.45

FBF Mothers

30.04 50.11 53 36.81 63.6 64.72 72.4 216.12

TOTAL (FBF)

304 276.43 530 422.58 630 544.70 534 760.63

RUTF 0 0 0 0 110.4 27.6 0 0

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To expand food manufacturers’ base, the program has continued to explore additional FBF processors in the market. Stawi Foods has been identified as an emerging food processor. A factory visit was conducted at Stawi Foods on January 15, 2016. During the factory visit it emerged that Stawi Foods is a local food processor primarily involved in milling of nutritious porridge flours for the national and international markets. Stawi Foods began operations in 2011 mainly milling banana flour for export and has progressed to processing of porridge flours for the domestic market. Stawi Foods contracts farmers in Meru region for supply of bananas. However, in 2014 company experienced banana drying challenges at source that brought the banana milling operations to a halt. Currently, the food processor is focusing on porridge flours with the main ingredients being maize, soya beans and millet. The plant’s operations are of a small magnitude compared to the other food processors engaged through the program. Cleaning and roasting of the grains is a manual process resulting to low output of 15-20 MT per month. Maize is analyzed for moisture only on receipt from suppliers. In-depth analysis is done on the finished product where samples are taken to KEBS for microbial and chemical tests.

Following the visit, the program will explore potential areas of collaboration, specifically on supporting the food processor in achieving a HACCP certificate after a Supplier Quality Audit is conducted. The program will continue to hold discussions with the food processor and will include Stawi Foods in the subsequent SQA.

During the quarter, the program conducted trainings on quantification and reporting on nutrition commodities in Narok, Nakuru, Kitui, Homabay and Migori counties. During the training, there was emphasis on quantification of nutrition commodities, good storage practices and timely reporting to avoid stock out incidences. Additionally, the program sort and received feedback from the facilities on:

a) Wider coverage in distribution of commodities within the counties: the program will work closely with the county nutrition coordinators and the implementing partners within the counties to ensure that all satellite health facilities supported by the program are provided with nutrition commodities directly and that the facilities receive technical assistance in commodity management and tracking.

b) Packaging of food commodities: The health facilities are generally satisfied with the current food packaging with the exception of Suba where the staff feel that the outer carrier bag should be translucent due to stigma. In Narok County, there was a suggestion to integrate key WASH messages in the outer carrier bags of FBF, for example washing hands before preparation of FBF and feeding children under 2 years. The program will work with the food processor to review the current packaging particularly on food preparation instructions to include key WASH messages.

c) Service and Commodity Data collection tools: The health facilities had adequate stocks of data collection tools with the exception of Migori County. The County was provided with all the tools with the exception of MOH 733B that was out of stock at central level. The data collection tool will be availed to the health facilities in the coming quarter.

Similar issues have arisen during the health facilities’ site visits conducted in 5 health facilities namely Maragua Sub County Hospital (Muranga), St. Elizabeth Hospital Chiga (Kisumu), Nakuru County Referral Hospital (Nakuru), Katulani Sub County Hospital (Kitui) and Matayos Health Centre (Busia).

In addition, observations have been made on caving in of FBF cartons when 4 cartons are stacked on top of each other. This results in loss/damage of the nutrition commodities and need for more storage space. Considering that ENP instructions are to stack up 9 cartons on

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each other, discussions are ongoing on changing the instructions or strengthening the cartons.

During quarter, the program continued to provide commodity information and to participate in the monthly NASCOP Commodity Security Steering Committee meetings. The main highlights in the reporting quarter were for the program to work closely with NASCOP in 1) procurement and quality assurance activities for nutrition commodities, 2) capacity building of NASCOP staff and health facilities on Logistical Management Information Systems (LMIS) data collection tools and 3) ensure that all facilities have adequate data collection tools. In addition, there is need to strengthen commodity data reporting on DHIS so that all partners can use just one platform to access all commodity data information they require from the health facilities.

During quarter, the program continued to distribute commodity data collection tools to health facilities (also including facilities supported by AMPATH plus and APHIA plus Western programs) as summarized in Table 2. The program is planning to print and distribute additional tools in the coming quarter.

Table 2: Summary of service and commodity data collection tools distributed Item Description MOH

407A MOH 407B

MOH 409

MOH 732

MOH 733A

MOH 733B

MOH 734A

MOH 734B

Appointment Cards

Total Printed 2,000 2,000 2,000 7,000 100 1,100 100 1,100 200,000

FY 16 Q1 Distribution

1,198 1,229 592 3,465 26 761 33 794 162,500

FY 16 Q2 Distribution

267 200 212 524 0 59 0 225 26,650

Balance in stock 535 571 1,196 3,011 74 280 67 81 10,850

% Distributed 73.25% 71.45% 40.20% 56.99% 26.00% 74.55% 33.00% 92.64% 94.58%

2.2 Improving Quality and Safety of Food Commodities and

Agricultural Products

The program continues to monitor the manufacturing of FBF through regular monitoring visits to Equatorial Nut Processors Ltd to ensure high quality and safety nutrition commodities. During one such factory visits conducted on January 19, 2016, it was observed that food temperature after packaging was higher than expected. Recommendations were made on improving the cooling mechanism for the finished products. This would ensure that the nutrition commodities maintain high quality throughout the shelf life. It was also noted that cartons were bulging in the food processors warehouse, further giving prominence to observations made during health facility visits. The program is working together with the food processor to review the specifications for the cartons to ensure that they can withhold pressure as per the minimum requirements.

The program has continued to conduct post batch laboratory testing through use of accredited food laboratories to ensure that FBF procured meets the agreed standards and quality. Test results have continued to indicate that the nutrition commodities were within the set parameters.

15

2.3 Improving Quality and Safety of Food Commodities and

Agricultural Products

To support a more active private sector in creation of additional innovations, options and competition, and approval is received to contract Equatorial Nut Processors Ltd, NHPplus will work closely with the food processor to explore various options/innovations in production of nutrition commodities. The food processor will be expected to develop and submit a concept paper for enhancement of existing and/or development of alternative FBF for management of moderate malnutrition. The concept paper will clearly outline the process and activities that will be carried out including a comprehensive methodology of 1) how the food processor will develop the proposed products including formulation of premixes in line with WHO/CODEX recommendation for new micronutrient formulation for specialized FBF products, 2) how the data that will be gathered or used, 3) how the subcontractor will analyze the data; and 4) how the data and analytic method will be used to scale up the new product.

3. Improving Food and Nutrition Security

During the quarter, the program continued with activities geared towards improving Food and Nutrition Security within the key focus counties of Kitui, Tharaka Nithi, Busia, Samburu and Marsabit. Activities conducted during the quarter included trainings, providing technical assistance during workshops and meetings, baseline surveys performance and strengthening Community support and linkages.

3.1 Increasing Market Access and Consumption of Diverse and

Quality Foods

Towards improving food diversification and utilization of local nutrient dense foods for complementary feeding for children under 5 years, the program conducted a training on diversification of foods and utilization of local nutrient dense foods in Kitui. 47 MOH staff drawn from key facilities in Kitui Central, Kitui South, Kitui East, Kitui West, Mwingi Central, Mwingi North and Mwingi West Sub-counties were trained. The training focused on developing nutrition linkages with agriculture and facility referral systems to the existing food safety net programs in Kitui county. The existing safety net programs identified included:

Cash Transfer for Orphans and Vulnerable Children (CTOVC)

Program for Persons with Severe Disabilities (PPSD)

Older Persons Cash Transfer Program (OPCT)

Urban Food Subsidy Program (UFSP)

Hunger Safety Net Program (HSNP).

The newly incoming National Safety Net Program (NSNP) was also discussed. In subsequent quarter, the program will liaise with MOH to collect names of vulnerable clients who can be linked to with existing safety net programs and with relevant livelihood and economic empowerment activities within the community. This will contribute to building their resilience for food and nutrition security.

Cadre of HCW Sensitized Number


Clinical officer 6


Health records and information officer (HRIO)

10

Sub County HRIO 5

Total 47

16

Fig. 2 Group Discussions and plenary presentations during the Kitui training

In Busia, the program leveraged on Vitamin A Supplementation training to provide information to 17 MOH, 7 MOALF and 2 MOEST officers on Vitamin A dense food available in Busia. Through community kitchen gardens and demonstration gardens found in ECDE centres, 4K clubs and health facility compounds the program is exploring on how to use the available kitchen gardens to conduct field demonstrations on the production techniques for target vitamin A rich value chains as well as supporting food preparation demonstrations on the target value chains to address diet diversification within the community. This kind of integrated training will be conducted in all the 5 focus counties targeting nutrition-specific and nutrition-sensitive activities at community level.

During the quarter, the program also conducted mapping exercise for CBO, CU, ECDE Centres and Agriculture extension workers in Busia County to identify possible platforms for leveraging agri-nutrition activities. Five CBO networks (Family Life Education Program – FLEP, Busiada Tusonge Mbele, Tazama Bujibo, Tsovo Twaweza and Spider Development Network) with agri-nutrition potential have been identified. A total of 180 CUs, 406 ECDE centres and 45 agriculture extension workers have also been identified. During the subsequent quarters the program will hold further consultations for possible areas of collaborations with the identified CBO, CU, ECDE Centres and Agriculture extension workers. A similar activity has been conducted in Marsabit county where 41 CUs and 27 CHEWS have been identified.

During the quarter, the program participated in a 5-day multi-stakeholder Kenya Food Composition Tables Review workshop in Machakos organised by MOH. The objective of the workshop was to review the list of foods to be included in the revised food composition tables, to prioritize foods for nutrient analysis and to develop sampling plans for foods to be analyzed. The reviewed food composition tables will be adapted and contextualized as a resource for Food Recipe Manuals for the 5 focus counties of Busia, Tharaka Nithi, Kitui, Samburu and Marsabit.

The program in collaboration with MOALF and other partners carried out a food mapping exercise for Kitui County to establish food varieties and dietary diversity in the ecological zones for the purpose of developing contextualized food recipes to address complementary feeding practices. the food mapping exercise reviewed that the main food crops grown are Maize, Sorghum, Millet, Beans, Cowpeas and Green Grams. Common vegetables and fruits in the region includes Kales, Tomatoes, Onions, Cowpea leaves, and Water Melons. These findings concur with the NHPplus/FAO baseline report finding carried out in July 2015. The program The food mapping exercise will be followed by contextualization of the already existing Standard National Agri-Nutrition Manual development by MOALF and MOH. The contextualized product will be county specific based on the mapped locally available foods.

17

The different food recipes for different categories of target groups will be a component of the contextualized product…….

This would ensure optimal nutrition status by improving, dietary diversity, food consumption and utilization at the household level, all contributing to reduction in stunting.

3.2 Increasing Resilience of Vulnerable Households and

Communities

During the quarter the program jointly with FAO carried out a baseline survey in Marsabit County with the aim of obtaining food mapping and consumption data, prevalence of children 6-23 months receiving minimum acceptable diet (FtF indicator 3.1.9.1(1)), prevalence of households with moderate or severe hunger (FtF indicator 3.1.9.1(3)) and total quantity of targeted nutrient rich value chain commodities set aside for home consumption by direct beneficiary producer (FtF indicator 4.5.2.8). The baseline survey was conducted between February 16th - March 14th 2016 and covered the entire Marsabit County where 306 clusters of households were surveyed. The methodology used during the survey included personal interviews through paper assisted questionnaires, computer assisted interviews and focus group discussions. The data analysis is ongoing and result will be reported at a later date.

FAO & NHPplus at Loiyangalani Chief’s office & FAO Nairobi Team with El Molo Chief

(striped)

Supervisors planning meetings at Laisamis and El Molo (L. Turkana in background)

18

Focus Group Discussions in El Molo (left) and Maikona (right)

Rendille women in FGD in Laisamis Individual interview in Moyale

During the quarter under review, the program supported Tharaka Nithi County to develop long rains contextualized production planner/calendar for dissemination to farmers. This process supported community driven development approach in enhancing social, economic and environmental resilience through effectively linking vulnerable clients with food security, livelihood and economic support. The down-scaling/contextualization process was done by a technical team from departments of Agriculture, Livestock, Health, Meteorological, NEMA and NDMA. This seasonal document is critical in providing farmers with information to improve production for food and nutrition security. The package developed from the process contains technical information and recommendations to farmers in different languages. Appropriate time of planting, correct choice of varieties of seeds based on duration of the rains, soil and water conservation practices, livestock offtake period are some of the critical technical information delivered through the process. This document will be disseminated to grass roots by FEWs and other stakeholders. The advisories developed was also translated into Kiswahili and the local languages and disseminated and communicated to the local communities through a wide range of channels, including local public meetings, extension forums, radio and other media. This empowers farmers to adapt to the emerging climatic changes.

During the quarter, the program also participated in ILRI-AVCD organized PREG Mapping tool training. The one-day training exposed participants to a simple tool that can allow access to the USAID supported partners in different ASAL counties, their activities and level of investment. Partnership for Resilience and Economic Growth (PREG) mapping tool is to support sequencing, layering and integration in the 9 Arid Counties. The Resilience Program focusses on 5 of these counties namely Garissa, Isiolo, Marsabit, Wajir and Turkana.

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4. Monitoring and Evaluation

During the reporting period, the program continued to support County governments in data management and reporting with approximately 609 health facilities from 40 counties supported, representing a 38.4% (n=970) increase from preceding quarter. Overall client assessments remained relatively similar to preceding quarter with a total of 73,608 assessments recorded. Of these, a total of 18,285 malnourished clients were provided with commodity nutrition interventions during the quarter.

With support from the CNCs, the program will schedule targeted site support and mentorship visits to mitigate against identified data quality issues. In addition, the program is also working to strengthen the NACS M&E module to include guidance on addressing data quality issues.

To further enhance data quality and reporting, sixteen (16) facilities were supported with customized nutrition electronic systems and HCWs responsible for delivery of NACS services inducted on its use. However, challenges relating to source documentation errors, high staff turnover, and acceptance of EMR system and existence of parallel partner reporting systems were reported.

During the quarter, the program identified lack of a coordinated departmental approach to the portal development as a hindrance to successful deployment. This activity was identified as an essential Rapid Results Initiative (RRI) activity that will guarantee development of a more robust nutrition portal. To ensure user acceptability and ownership, the development process is guided by user feedback and current technological trends. The revision and deployment of content will also take cognizance of current NDU communication/advocacy strategy and guidelines. The portal will also ensure efficiency in information sharing, data utilization, communication, accountability and advocacy across the nutrition spectrum.

Facility Electronic Nutrition Reporting

In addition to general technical assistance to 118 facilities currently utilizing the nutrition EMR system, the program continued to identify facilities with requisite ICT capacity for potential installation and sensitization. The program strategy has been to collaborate with other implementing partners supporting nutrition activities in identification of potential facilities and in provision of routine TA.

Leverage on APHIA plus support and collaboration

During the quarter, the program identified 69 facilities from Western and Nyanza regions currently receiving ICT support from APHIAplus Western/Nyanza. Only 43 of these facilities have been trained previously on NACS/FBP protocol. It was hoped that the program would provide all the raw and compiled source code, associated user/system manuals in addition to capacity building APHIAplus M&E/ICT staff on use of the nutrition reporting software for subsequent rollout to the identified facilities. After consultations with APHIAplus Western/Nyanza, the program could not proceed with installation to the 69 facilities as the nutritionists did not have access to the computers. The available computers are utilized in the management of other HIV/AIDS and non HIV/AIDS related services and commodity data. As the teams continue to explore other options, the program is providing technical assistance to APHIAplus in the rollout of the nutrition commodity electronic E-CDRR. It is expected that this tool will provide supported facilities with a more efficient platform for commodity management and rationalization of monthly orders.

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Scale up of facility electronic reporting

In support of enhanced provision of NACS at facility level, the program supported electronic nutrition reporting scale up in 16 high volume facilities. Of these, 8 facilities Bungoma DH, Butere DH, Siaya CRH, Nandi Hills DH, Kapsabet DH, Kangema SDH, Chuka SDH and Athi River HC received both HW and SW support from the program. In addition, the program also successfully installed the nutrition reporting software in an additional 8 facilities, AIC Litein, ST Marys Hospital, Kibera Community HC, Kianjokoma SDH, Karurumo HC, Kibugu HC, Nembure HC and Karau HC from Nairobi and Embu County.

Overall, a total of 35 HCWs comprising of 32 nutritionists, 2 records officers and 1 pharmacy staff from all the 16 supported high volume facilities were trained on the use of the electronic reporting system.

Installation at AIC Litein did not proceed as scheduled as the base OS was not compatible with the current version of the nutrition EMR. The facility is in the process of upgrading their in-house OS software to allow installation.

The customized nutrition reporting system will continue to support management of both service and commodity functions relating to delivery of NACS at facility level. In built validation checks and use of relational database architecture ensures only high quality data is reported. In addition, the system generates monthly service and commodity reports, by facility for upload into DHIS. An encrypted copy of the data set is also submitted to the program for archiving. The system also ensures accountability of delivered commodities by rationalizing facility orders based on their reported consumption.

Procurement of an additional 30 laptop computers to support high volume facilities in provision of NACS services is in progress.

Challenges experienced during implementation include:

Documentation errors upon introduction of the EMR for Nutrition Services. Some records were not successfully saved into the system since the cases violated validation rules inbuilt in the system.

Continuity of electronic system use affected by high staff turn-over of the trained staff.

Resistance/Slow acceptance of staff to the automated system.

Existence of parallel partner reporting systems

Access to internet connectivity

Facility training on electronic reporting

In an effort to continuously support of improved data quality and timeliness, increase data use at facility and county/sub-county levels, the program conducted a re-training of six (6) health facilities within Nairobi, Muranga and Embu counties primarily due to staff re-deployment. Table 4 below highlights the number of facilities and staff trained by quarter.

Table 4. Number of facilities and staff sensitized on electronic reporting

Period Number of Facilities Trained Number of Personnel Trained

FY2-Q1 Oct-Dec 2015 13 36

FY2-Q2 Jan-Mar 2016 20 37

21

In Kibera South HC and Langata HC, a total of four (4) facility nutritionists were re-inducted on use of the nutrition reporting system both for service and commodity data. Kibera South HC has since been consistently submitting electronic data sets cutting their reporting times by approximately 1 month.

Kariobangi HC, Muranga CRH, Maragua SCH and Embu CRH were also re-trained during this period with a total of four (4) nutritionists being sensitized.

Despite the program having supported successful installation of the nutrition EMR at Memorial AF Hospital and training of the nutritionist on use of the system for both service and commodity data reporting, the program will schedule additional training session in the next quarter to mitigate against the high staff turnover. Target trainees will comprise of nurses and clinical officers from Memorial AF Hospital to assist with provision of services when designated staff are deployed out on official duties.

Facility support for electronic reporting

Lea Toto As an action point from the recent Dagoretti county training, the program conducted a site support visit at Lea Toto Kawangware to follow up on electronic service and commodity reporting status and provide mentorship for commodity management. Lea Toto Kangemi also supports six (6) other facilities (Kibera, Kangemi, Kariobangi, Dandora, Mwiki, and Mukuru) in provision of NACS services.

The following observations were made:

EMR Reporting module: Despite fresh re-installation and re-training of staff in late 2015, Dandora and Dagoretti / Kawangware sites were still not able to generate utilization reports or export monthly data files.

Main store counter requisitions: Discrepancies noted in the stock control module at the main store.

Delivery notes: The delivery note used by the distributors do not conform to the form on the electronic reporting system.

Commodity storage: o The containers have not been

fabricated into a store room, hence are not well ventilated

o The storage area was clean and commodities staked according to type

o No bin cards were available

o Stacking of FBF above the

recommended four levels and buckling was evident

o Acha mum (RUSF), USAID RUTF and Plump sup were found in stock

Recommendations

Additional OJT especially for nutritionists and M&E staff on use of the nutrition reporting system will be scheduled for the next quarter. In addition, in collaboration with the sub-county teams, DQA activities will also be scheduled to ensure quality and consistency across data reported to both the program and national systems, DHIS.

22

Nutrition information portal

During the quarter, the program identified the lack of a coordinated departmental approach to the portal development as a hindrance in its successful deployment. During subsequent discussions with NDU, the unit identified enrichment of the existing web portal as an essential Rapid Results Initiative (RRI) activity that will guarantee development of a more robust nutrition portal. To ensure user acceptability and ownership, the development process is guided by user feedback and current technological trends. The revision and deployment of content will also take cognizance of current NDU communication/advocacy strategy and guidelines. The portal will also ensure efficiency in information sharing, data utilization, communication and accountability. The current portal, was launched in 2014 and is administered by the monitoring and evaluation section within NDU.

Results from the survey administered by NDU indicated that, 28.6%, 27.1%, 18.6% and 12.9% of the responses were received from NGO, County Govt, UN and National Govt respectively. It was observed that 50.0% and 29.0% of the respondents utilize the portal based on “need” and “very rarely” respectively. 56.7% of the respondents said the portal information is not up-to-date while 68.7% of the respondents indicated that they did not know the portal address.

Some key recommendations that will be considered by the program to guide portal developments are as below:

Create more awareness on portal existence to potential users (include portal address in all communication and IEC materials)

Ensure availability of comprehensive up to date and relevant TWG, local and international content/information in appropriate format(s)

Provide access for key high priority users e.g. CNCs and SCNOs for them to access summary county information

Improve and simplify visual display/interface taking cognizance of diverse range of audience.

Include updated links to other programmes, partners and stakeholders

Include comprehensive county factsheets, if possible to ward level

Include interactive interfaces for data manipulation and content search

Include summarized information, preferably graphical/visual for consumption by non-technical users.

Develop guidelines for information sharing, upload and download

Develop guidelines/TOR/SOPs for editorial/review committee

Develop multiple access levels for shared portal management to reduce delays noted with moderated portals and ensure currency of information

Prioritize of nutrition relevant content

Encourage advocacy and information sharing by county governments through the portal

Establish links with authentic, relevant social media feeds and websites

Develop an integrated information portal containing information from key collaborating sectors/programs

Align reporting to objectives in the nutrition strategic plan

Include relevant information from academia and research

Include email alerts on addition of new content or materials

Include portal domain suffix as part of MoH staff emails to support awareness and exposure

Benchmark with other stakeholder websites

Assign personnel to run and maintain the website on a continuous basis

Capacity building of the website management team

23

Ensure portal is highly ranked in popular search engines to ensure inclusion among the top searches listed when users search for nutrition information

Include shared calendars for standardized all-inclusive to events in addition to sharing of meeting notes

III. PROGRAM PROGRESS (Quantitative Impact)

Service Utilization, Commodity Production and Delivery

Nutrition Service Reporting

During the quarter, the program supported a total of 609 health facilities with data management and reporting representing an overall reporting rate of 62.8% (609/970) of target facilities. Overall, there was increased facility reporting of 38.8% from the preceding quarter (609 vs 373). As summary of County reporting rates is highlighted in Annex 3. To ensure improved facility reporting rates in subsequent quarters, the program will continue to engage with CNCs and facility contact persons through provision of feedback reports to facilities in addition to scaling up of electronic reporting and strengthening of internal program commodity and service reporting systems. The program will also seek to promote previously designated “satellite sites” to delivery points to ensure wider reach in provision of NACS. The program is currently in the process of procuring the second batch of 30 additional laptop computers for deployment to high volume facilities.

Some of the data quality challenges observed from facilities include:

• Inconsistency in commodity reporting: not all clients on FBF issued with prescription hence inconsistency when tallying MOH407 vs MOH732

• Inconsistency of summary section vs the actual count for MOH 407A/B

• Errors in reported computations relating to MOH734 for non-EMR sites

• Incomplete variables

• Adherence to standardized unit of issue during reporting

• Inadequate data management support at facility level

Service Utilization

Assessments

Overall client assessments remained relatively similar to preceding quarter with a total of 73,608 assessments recorded. An additional 8,263 client records were in the process of being inputted into the electronic system during compilation of this report. Total number of assessments by County are shown in Annex III (Performance Data Tables).

Newly assessed clients accounted for 54.3% of total assessments. CCC clinics recorded the largest catchment of patients seeking nutrition services at 69.5% (n=55,557). Approximately 4.8% and <2% (n=55,557) of the patients sought services from MCH and Inpatient/Other clinics.

Of the total assessed clients, 73.1% and 26.9% were children and adult clients respectively. Among clients with complete client category data, pregnant and post-natal women comprised 4.9% of the adult population while under 5-year-old children comprised 68.9% of the child

24

population. The table 4 below provides distribution profiles of the clients undergoing nutrition assessment within the health facilities.

Table 4: Distribution of assessed clients

Client category Number* of clients %

Adults Adult PLHIV 38,481 95.1

Pregnant 1,968 4.9

Sub Total 40,449 100.0

OVC OVC 6-59 months 11,577 68.9

5-17 years 5,234 31.1

Sub Total *16,811 100.0

*13,363 adult and 2,985 child clients missing client-category information

Reported Consumption (Prescription)

During the quarter, a total of 18,285 patients were provided with prescriptions through the supported facilities, representing a 17.0% (18,285 vs 15,170) increase in reporting. A profile of clients receiving prescriptions is shown in Table 7.

Table 7: Number of clients receiving commodities by “client category”

Client category Number* of clients (%)

Adults Adult PLHIV 8,003 92.1%

Pregnant 686 7.9%

Sub Total 8,689 100.0%

OVC OVC 6-59 months 4,728 82.6%

5-17 years 993 17.4%

Sub Total 5,721 100.0%

* 378 and 149 Child and Adult clients respectively did not have categorization data.

Figure 4 highlights the trend in service uptake between April 2015 and March 2016 in relation to commodities distributed within the same period.

25

Figure 42: Service uptake and commodity distribution

Nutritional Status of Clients

Adult Clients

BMI reporting rate for non-PPP clients was at 94.4% (n=38,481). Of the newly enrolled non-PPP adult clients with “Client Category” classification, 7.4% (n=26,194) were reported to be severely malnourished (BMI<16) (Table 5). Clients with BMI>18.5 at enrollment was reported at 70.8% of non-PPP clients (n=26,194).

Table 5: Nutrition Status of Non-PPP Adult Clients

BMI Category New Visit Revisit Total

<16 1,938 (7.4%) 845 (8.3%) 2,783 (7.7%)

16-17 1,801 (6.9%) 883 (8.7%) 2,684 (7.4%)

17-18.5 3,918 (15.0%) 2,129 (21.0%) 6,047 (16.6%)

>18.5 18,537 (70.8%) 6,284 (62.0%) 24,821 (68.3%)

Total 26,194 (100.0%) 10,141 (100.0%) *36,335 (100.0%)

*2146 clients records missing BMI data

Of the 1,968 PPP clients supported during the reporting period, 60.1% were newly enrolled clients. Overall MUAC reporting rate for PPP clients was recorded at 46.4%. It was noted that 31.1% (314) of newly enrolled PPP clients were enrolled with MUAC reading >23.

Child Clients

Overall, newly enrolled child clients accounted for 54.6% (n=19,796) of all assessed children during the quarter. Table 6 shows the weight-for-height status of newly enrolled children aged 6-59 months

128.8

106.0

41.6

151.0 136.1 135.5

211.9

241.9

90.9

349.1

195.5 216.1

-

1,000

2,000

3,000

4,000

5,000

-

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

Dec

em

ber

Jan

uar

y

Feb

ruar

y

Mar

ch

Y1-Q3 Y1-Q4 Y2-Q1 Y2-Q2

2016

Nu

mb

er o

f P

atie

nts

Met

ric

Ton

s (F

BF)

FBF MT FBFNew FBFRevisits

26

Table 6: Nutrition Status of Newly Enrolled Under 5 Year Old Clients

WHZ 6-24 months 24-59 months Total

< -3 784 (15.1%) 210 (7.9%) 994 (12.7%)

-3 to -2 932 (18.0%) 269 (10.1%) 1,201 (15.3%)

-2 to -1 1,222 (23.6%) 418 (15.7%) 1,640 (20.9%)

> -1 2,238 (43.2%) 1,761 (66.3%) 3,999 (51.0%)

Total 5,176 (100.0%) 2,658 (100.0%) 7,834 (100.0%)

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IV. PERFORMANCE MONITORING

IR Indicator Definition Indicator Source

2015 2016

Year 2 achievement

Yr. 2 Target

Target Achieved Target Achieved Target

Oct-Dec Oct-Dec Jan-Mar Jan-Mar Apr-Jun

IR1: Improved Access and Demand for Quality Nutrition Intervention at Community and Facility Levels

IR1.1:Strengthened Leadership, Advocacy and Policy Planning

1.1.1 # of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance( e.g. forum, working group, MOU, shared plans, associations, budgeting work planning, projects) Note that it is important to identify best practices as they emerge.

The indicator measures the frequency of support for national level and county level technical forums. Finer disaggregation by type of meeting: NICC, NICC-TWG, NICC-TWG Subcommittees, CNTF

USAID/MSI 28 7 0 7 0 7 0

1.1.1 # of people trained. Mentored, provided TA at National Level.

This indicator measures the number of Nutrition Dietetic Unit Officers and county nutrition coordinators who have received training on strategic leadership and governance and are duly certified by KSG

USAID/MSI 4 0 0 2 0

0

1.1.6 4.5.1(24) Numbers of Policies/Regulations/Administrative Procedures in each of the following stages of development as a result of USG assistance in each case: Stage 1: Analyzed; Stage 2: Drafted and presented for public/stakeholder consultation; Stage 3: Presented for legislation/decree; Stage 4: Passed/approved; Stage 5: Passed for which full and effective implementation(CDCS IR1.2: Number of policies affected by USG supported efforts and advocacy campaigns)

This indicator measures the stage of support in the policy dissemination process and number of policies relating to Nutrition that are disseminated by the program. This will include frequency of dissemination meetings at policy level to sensitize policy makers and opinion leaders.

Derived from FtF and CDCS

2

0 1 1

1

IR1.2: Improved Nutrition Service Delivery Management, Coordination and Implementation

1.2.1 3.1.9.2(2) Number of health facilities with established capacity to manage acute undernutrition (S)

# of facilities and community units that have standard package of nutritional supplies for NACS inclusive of HINI and beyond HIV care/treatment. Facilities will have all appropriate tools for anthropometric measurements include board for incumbent length measurements, height scales, baby weighing scales and weighing scale. This indicator measures the readiness of sites to deliver nutrition services.

Derived from FtF

54

62 62

62

28

1.2.3 (DO 2; 2.2.1; (2)) % of facilities submitting timely, complete and accurate information - ( These are among 3.1.9.2(2) Number of health facilities with established capacity to manage acute undernutrition (S))

Measure of facilities utilizing revised tools for reporting. Indicative of completion of revision, reproduction, distribution of tools in addition to capacity building and mentorship to facilities. Denominator: Facilities inducted on use of revised tools and supplied with revised tools. Numerator: number actively using revised tools for reporting. Further disaggregation will be done to establish distribution of service outlets providing nutrition services. Denominator: Number of PMTCT/MNCH/Child Welfare Clinics that are in inducted facilities. Numerator: number of service points providing nutrition services

CDCS 92.0% 92.0% 38.2% 92.0% 39.2% 92.0% 19.4%

1.2.6 (3.1.9(1) Number of people trained in child health and nutrition through USG-supported programs) # of people trained. Mentored, provided TA at National/County Level.

Number of participants (health professionals, primary health care workers, community health care workers, volunteers, mothers/caregivers, policy makers, researches and other non-health personnel) in child health care and child nutrition training provided through USG supported programs during the reporting year. Disaggregate by sex (CHV training will include BFCI, CMAM and NACS)

Derived from FtF

215 54 14 54 227 54 241

1.2.14 Percentage of PLHIV who are nutritionally assessed via anthropometric measurement (FN_ASSESS)

Clients/patients assessed and categorized according to the guidelines. [Number of PLHIV who were nutritionally assessed via anthropometric measurement]/[Number of HIV positive adults and children who received care and treatment services]

PEPFAR L2, Care and Support

140,122 62,285 66,793 62,285 73,608 62,285 140,401

207,504 51,876 19,574 51,876 24,941 51,876 44,515 78.9% 78.9% 99.3% 78.9% 77.5% 78.9% 87.1%

1.2.15 Proportion of clinically undernourished PLHIV who received therapeutic or supplementary food(FN_THER) (HIS031:Percentage of children under five years of age who are underweight)

Clients/patients assessed and nutrition services provided through selected service points according to the guidelines. [Number of clinically undernourished PLHIV that received therapeutic or supplementary food]/[Number of PLHIV that were nutritionally assessed and found to be clinically undernourished]

PEPFAR L1, Care and Support

99,885 24,971 14,908 24,971 13,614 24,971 28,522

126,654 51,876 19,374 51,876 24,941 51,876 44,315

78.9% 48.1% 76.9% 48.1% 54.6% 48.1% 64.4%

1.2.20 3.1.9.2(3): Number of children under 5 who received Vitamin A from USG supported programs ( The vitamin A report here excludes Malezi bora

Number of children under five years of age who received Vitamin A form USG-supported programs in the last 6 months from the time this data is collected. In

FtF 72,387 18,097

18,097 6,781 18,097 6781

29

campaigns, this is 'Therapeutic Vitamin A) (S)

order to reduce Vitamin-A deficiency most effectively, children need two rounds of coverage in one year. In order to not double count children, please only report the number done in the last 6 months. [Data summarized from routine facility data, indicating Therapeutic utilization]

IR1.3: Improved Nutrition Related Behavior

1.3.1 # of Advocacy guides on IYCF developed

This indicator measures the number of materials developed on IYCF to guide mass mobilization campaigns using radio or TV spots. This guide standardizes messages on EBF and Complementary feeding

1

1 0

1.3.3 # of communication materials updated and distributed for HCWs, CHVs and mass mobilization;

Materials Distributed to Community, Health and Agricultural Extension Workers supported by USAID IPs

19,320 4,830

4,830

4,830 0

IR1.4: Increased Opportunities for Learning and Sharing of Best Practices in Nutrition

1.4.3 % of county officials trained who demonstrate increased knowledge in training as result of USG support

This indicator measures the number of abstracts, posters, papers developed by MOH-NDU/County partners through technical assistance form NHPplus.

USAID/MSI 1

1

0

NHPplus # of CPDs developed and posted online

This indicator measures the number of CPDs content developed and uploaded online for use

Internal 2

IR1.5: Increased Knowledge and Skills of Health Care Workers (HCW) in Nutrition

1.5.1 (3.1.9(1) Number of people trained in child health and nutrition through USG-supported programs (S)) # of people trained. Mentored, provided TA at National Level.

Finer disaggregation will measure the number of TOTs trained in NACS, BFCI and Standardized Nutrition care at National and county levels

Derived from FtF

380 95

95

95 0

IR2: Strengthened Nutrition Commodity Management

IR2.1: Improved Production, Supply and Distribution of Nutrition Commodities

NHPplus # of Nutrition commodities procured by type

Observations of storage site and level-specific quantity of stock should be available through one or several of the following: program monitoring reports, an existing logistics management information system, stock status reports/stock keeping records/regular physical counts, order forms from the central/regional/district/other levels, or regular supervision visits.

Internal 1,850 463 630.0 463 534.0 463 1,164.00

NHPplus # of Nutrition commodities distributed to active health facilities points by type

Quantities of FBF and RUTF produced and distributed (in MT) to service points/by type in good time and amount of nutrition commodities distributed to health facilities. Measures commodity flow and

Internal 1,850 463 544.7 463 760.6 463 0

30

anticipated demand estimates. Denominator: Amount of commodity produced

IR2.2: Improved Quality and Safety of Food Commodities and Agricultural Products

2.2.1 4.5.1(24) Numbers of Policies/Regulations/Administrative Procedures in each of the following stages of development as a result of USG assistance in each case: Stage 1: Analyzed; Stage 2: Drafted and presented for public/stakeholder consultation; Stage 3: Presented for legislation/decree; Stage 4: Passed/approved; Stage 5: Passed for which full and effective implementation

Measures the level of sensitization to create awareness on KS EAS 782:2012 and monitor manufacturers adopting the standard. Denominator: Number of registered food manufacturers

Derived from FtF

1

1 1

1

2.2.2 4.5.2 [42] number of private enterprises producer organizations, water users associations, women’s groups, trade and business associations and community based organizations [C0Bs] that applied improved technologies or management practices as a result of USG assistance [RiA] [WOG] page number 52.

To improve quality and safety of food commodities the program will support Supplier Quality Audits to assess application of improved management practices. The program will also keep track of manufacturers attaining ISO certification. Denominator: Number of food manufacturers meeting national and international quality standards

Derived from FtF

2

0

IR2.3: Strengthened sustainability and innovation in nutrition commodity development and management

NHPplus # of types of quality innovations resulting in diversified products for nutrition interventions

Number of innovations supported through food manufacturers for food products

Internal

NHPplus # of local suppliers of raw materials This indicator measures number of local suppliers of raw materials (for the existing food manufacturers) prequalified by KEBS.

Internal 2

0

NHPplus % change of cost for nutrition commodities

This indicator will be a measure for tracking cost of production of nutrition commodities annually

Internal

IR3: Improved Food and Nutrition Security

IR3.1: Increased Market Access and Consumption of Diverse and Quality Foods

3.1.1 # of people trained. Mentored, provided TA at National/County Level on SCALE, Household Food Production, TA to develop effective strategies and approaches on improving food utilization and dietary diversity, Diet diversity in community settings, Food preparation and safety, Ag practices that assist in responding to identified

This indicator will measure the number of intergovernmental forums supported by USG to bring together national and county governments; # of policies that have been improved (either in terms of policy change or implementation) to support devolution as a result of USG assistance; # of tools/templates/models provided by target institutions in order to facilitate

USAID/MSI 300 30 31 30

120 31

31

environmental threats; Food recipe manuals reviewed/developed

devolution at the local level as a result of USG assistance

3.1.2 # of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance( e.g. forum, working group, MOU, shared plans, associations, budgeting work planning, projects) Note that it is important to identify best practices as they emerge.

Measures the success of SCALE training at the focus counties by identifying number of counties adopting SCALE methodology

USAID/MSI 3

1

1 0

3.1.3 # of mechanisms created to facilitate coordination on an ongoing basis as a result of USG Assistance( e.g. forum, working group, MOU, shared plans, associations, budgeting work planning, projects) Note that it is important to identify best practices as they emerge

Measures success of effective linkages, TA support and capacity building through # of joint work plans addressing: promoting nutrition at HH level, increasing HH income for vulnerable farmers, and strengthening linkages between vulnerable farmers and market actors/private sector

USAID/MSI 2

0

1 0

IR3.2 Increase resilience of vulnerable households and communities

3.2.1 3.1.9(11): Prevalence of stunted children under five years of age ( R) (HIS032: Percentage of children less than five (< 5) years who are stunted)

% of children 0-59 months who are stunted, as defined by a height for age Z score < -2. Although different levels of severity of stunting can be measured, this indicator measures the prevalence of all stunting, i.e. both moderate and severe stunting combined. Numerator: is the total number of children 0-59 months in the sample with a height for age Z score < -2. Denominator: is the total number of children 0-59months in the sample with height for age Z score data. Disaggregate by: Sex: Male, Female

FtF 2%

Samburu baseline

2014 (UNICEF) 24.9 %,

Boys 28.3 %, Girls 21.7 %

-

0.3

0.8

3.2.2 3.1.9(15):Number of children < 5 years reached by USG supported nutrition programs (S)

Number of children under five years of age reached during the reporting year by USG-supported activities with nutrition objectives, which can include behavior change communication interventions, home or community gardens, micronutrient fortification or supplementation, anemia reduction packages, growth monitoring and promotion and management of acute malnutrition. Implementing mechanisms should count children reached by the mechanism only once regardless of the number of interventions the child received from the activity.

FtF 90,484 22,621

22,621 7,895 22,621 7,895

3.2.3 3.1.9(12):Prevalence of wasted children under five years of age ( R)

% of children 0-59 months who are acutely malnourished, as defined by a

FtF 1.50% 0.2

0.3

0.5

32

(HIS033:Percentage of children under the age of five years, who are wasted)

weight for height Z score < -2. Although different levels of severity of wasting can be measured, this indicator measures the prevalence of all wasting, i.e. both moderate and severe wasting combined. Numerator: is the total number of children 0-59 months in the sample with a weight for height Z score < -2. Denominator: is the total number of children 0-59 months in the sample with weight for height Z score data. Disaggregate by: Sex: Male, Female

3.2.4 3.1.9(13):Prevalence of underweight women ( R)

% of non-pregnant women of reproductive age (15-49 years) who are underweight, as defined by a body mass index (BMI) < 18.5. Numerator: is the number of non-pregnant women 15-49 years in the sample with a BMI < 18.5. Denominator: is the number of non-pregnant women 15-49 years in the sample with BMI data. Disaggregate by: No disaggregation

FtF

-

-

-

3.2.5 3.1.9(16):Prevalence of underweight children under five years of age ( R)

% of children 0-59 months who are underweight, as defined by a weight for age Z score < -2. Although different levels of severity of underweight can be measured, this indicator measures the prevalence of all underweight, i.e. both moderate and severe underweight combined. Numerator: is the total number of children 0-59 months in the sample with a weight for age Z score < -2. Denominator: is the total number of children 0-59 months in the sample with weight for age Z score data. Disaggregate by: Sex: Male, Female

FtF 2%

Samburu 2014

(UNICEF) baseline 27.4 %

Boys 28.2 % Girls 26.6 %

0

0.5

0.9

3.2.6 3.1.9.1(1):Prevalence of children 6-23 months receiving a minimum acceptable diet (RiA)

Proportion of children 6-23 months of age who receive a minimum acceptable diet (MAD), apart from breast milk. The “minimum acceptable diet” indicator measures both the minimum feeding frequency and minimum dietary diversity, as appropriate for various age groups. Disaggregate by: Sex: Male, Female

FtF Kitui July 2015

Breastfeeding 35%

Non-breastfeeding 40%

-

-

- -

3.2.7 3.1.9.1(3):Prevalence of households with moderate or severe hunger (RiA)

% of households experiencing moderate or severe hunger, as indicated by a score of 2 or more on the household hunger scale (HHS). Measurement of household hunger provides a tool to monitor global

FtF TBD -

-

- -

33

progress of USG supported food security initiatives. Numerator: is the total number of households in the sample with a score of 2 or more on the HHS. Denominator: is the total number of households in the sample with HHS data. Disaggregate by: Gendered Household type: Adult Female no Adult Male (FNM), Adult Male no Adult Female (MNF), Male and Female Adults (M&F), Child No Adults (CNA) approximately every two years subsequently.

3.2.8 3.1.9.1(4):Prevalence of exclusive breastfeeding of children under six months of age (HIS029: Percentage of infants less than 6 months old on Exclusive Breastfeeding)

% of children 0-5 months of age who were exclusively breastfed during the day preceding the survey. Numerator: is the total number of children 0-5 months in the sample exclusively breastfed on the day and night preceding the survey. Denominator: is the total number of children 0-5 months in the sample with exclusive breastfeeding data. Disaggregate by: Sex: Male, Female.

FtF TBD -

-

- -

3.2.9 4.5.2(34) Number of people implementing risk-reducing practices/actions to improve resilience to climate change as a result of USG assistance (S)

# of Nutrition Education (incl. WASH) guide for CHWs, households addressing three dimensions of resilience ( coping, adapting and transforming) targeting children U5, pregnant, lactating mothers, & PLHA reviewed and distributed to target clients; Indicates the delivery of the targets for reviewing/developing, producing and distributing Nutrition Education (incl. WASH) guide for CHWs and households that address three dimensions of resilience ( coping, adapting and transforming) targeting children U5, pregnant, lactating mothers, & PLHA

FtF 14,001 -

4,667

4,667

3.2.10 # of people trained. Mentored, provided TA at National/County Level.

Measures the number of people/TOTs trained in SBC strategies, dietary diversification and financial inclusion, L/FFS, Food nutrition resilience, Income generating value chains targeting women

USAID/MSI 2 -

1

- -

3.2.11 # of tools/templates/models provided by target institutions in order to facilitate devolution at the local level as a result of USG assistance

This includes # of contextualized calendars, job aids developed to assist CHWs in targeting and identifying vulnerable groups using nutritional indicators (stunting, wasting, micronutrient deficiencies),

USAID/MSI 4500 -

1500

1500 -

34

Note: NK = Not Known; TBD = To Be Determined

Note: Kitui HH with children 6-23 months was 67 out of 423 hence may need backup

35

V. PROGRESS ON LINKS TO OTHER USAID PROGRAMS

With ILRI/AVCDP USAID we continue providing technical support in nutrition. With APHIAplus programs Nutrition and Health Program continues to engage with the programs in training of the HCW in NACS, commodity management and facility reporting. With APHIAplus-Imarisha we continue working together in the counties of Samburu and Marsabit. This linkage provided an avenue for scale up of best practices in the counties. In Samburu we collaborated with APHIAplus IMARISHA to conduct ECDEs teachers’ sensitization and MALEZI Bora Activities and provision of TA to the CCC at Maralal County referral. In both Samburu and Marsabit, NHPplus is collaborating with APHIAplus Imarisha to build capacity on NACS, IMAM, MIYCN, agri-nutrition and electronic data transmission.

VI. PROGRESS ON LINKS WITH GOK AGENCIES

National level, linkages have been created with Kenya Meteorological Services (KMS). The KMS is providing the program with the National Seasonal forecast for use to downscale and prepare the seasonal contextualized production calendar/planner for the counties. Linkages have been developed with Agriculture Sector Development Support Program (ASDSP) of the MOALF which is the coordinating the seasonal planner and dissemination of the contextualized weather forecast information to the grassroots for use by farmers to improve food production during long rains season.

The program partnered with NDMA in supporting the contextualization of seasonal calendar and in planning capacity building of NDMA field monitors to be used for identifying vulnerable clients in the communities and linking them to various safety net programs. During Food Composition Tables Review workshop by MOH linkages were established with the National Nutrition Labs that are critical in food analysis.

At county level, we have developed linkage and good working relationships with the County governments of Marsabit, Samburu and Tharaka Nithi and Busia. The program is working with the ministries of health and agriculture to foster an integrated approach to addressing malnutrition by strengthening mutisectoral forums, conducting joint capacity building sessions (integrating nutrition, WASH and agri-nutrition) and providing integrated support during national nutrition events. NHPplus will also provide support for government forums advocating for, more resource allocation for nutrition activities. In Busia and Samburu counties, linkages were created with Ministry of Education at ECDE level and Primary schools sensitizing teachers on Vit. A supplementation and growing Vit. A dense value chains with demonstrations in ECDE centres and 4K clubs

36

VII. SUBSQUENT QUARTER’S WORK PLAN

Table 8: Progress to date Planned Activities from previous quarter Actual Status this Quarter-

completed, ongoing on or not done

Explanation for deviation

1.0 Improved Access and Demand for Quality Nutrition Services at Community and Facility Levels

1.1 Strengthened Leadership, Advocacy And Policy Planning

1.1.1 Support tuition expenses for 3 NDU officers and 5 County nutrition coordinators from the focus Counties to attend a 6 weeks course on project management offered at Kenya School of Government

On going Consensus on course selection and selection criteria

discussions

1.1.2 Support Quarterly NICC secretariat meeting as scheduled Meeting cancelled by NDU NDU is restructuring NICC

1.1.3 Provide technical assistance to NICC/NTF secretariat to develop two - pager for sharing with the Head of Preventive and Promotive services on nutrition sector progress towards achievement of targets

One meeting held

1.1.4 Support key TWG sub - committee meeting that have specific deliverables for NHP plus MIYCN, nutrition information, clinical nutrition and dietetics)

Attended 3 meeting

1.1.5 Support establishment County nutrition technical forums and meetings as scheduled in the focus Counties 2 CNTF meeting supported

1.1.6 Provide technical assistance to CNTF secretariat to develop focused agenda items and share one page summary report of CNTF deliberations with CEC Health - Focus Counties

2 counties supported Tharaka Nithi, Busia and Kitui awaiting inception meeting

1.1.7 Support finalization of County Nutrition Action Plan Implementation framework in focus counties, where not available

Only Kitui is on course 4 other counties do not have finalized drafts of County Nutrition action plan

1.1.8 Support County and Sub - County Nutrition Officers to develop AWPs, Indicator matrix and budget One county on course

1.2 Improved Nutrition Service Delivery Management, Coordination And Implementation

1.2.1 Mapping and selection of functional community health units for BFCI and nutrition assessment (community nutrition module) training in the focus Counties

Done assessment for nest quarter

Identification done, assessment in quarter 3

1.2.2 Train community health assistants (CHAs) and CHVs from selected functional community health units (CHUs) on BFCI , IFAS guidelines and nutrition assessment (community nutrition module)

Identification and mapping on going

1.2.3 Train community health assistants (CHAs) and CHVs on MUAC screening, categorization and referral of undernourished patients

Module development ongoing

1.2.4 Design and adaptation of the ECDE Vitamin A supplementation permanent register Done. Using existing ECDE register

1.2.5 Mapping of ECDE centers in the focus Counties Done

1.2.6 Sensitization of ECDE teachers and CHVs on Vitamin A supplementation (and deworming) in ECDE centers Sensitization conducted in Busia and Samburu

1.2.7 Facilitate Vitamin A supplementation (and deworming) in ECDE centers. Done in Busia

1.2.8 Provision of MUAC tapes and CHV nutrition screening, diagnosis and referral job aids Awaiting procurement finalization

Tenders for MUAC tapes received were not as per the tech specs

1.2.9 Mapping of anthropometric equipment needs at MCH and CCC service points at health facility Identification complete To be done as part of facility assessment in quarter 3

1.2.10 Distribution of anthropometric equipment to health facility to support accurate nutrition assessment Awaiting procurement finalization

Evaluation of bids on going

1.2.11 Conduct HCW sensitization on growth monitoring and promotion and documentation on mother child booklet at facility level

Quarter 3 activity

1.2.12 Conduct HCW sensitization on nutrition assessment of adults and pregnant mothers including documentation in MoH 257 (CCC blue card) and mother child booklet at facility level

227 trained

37

1.2.13 Print and distribution of NACS - FBP desktop flip to health facilities Awaiting procurement finalization

At bidding stage

1.2.14 Review of NACS - FBP desktop flipchart to update, harmonize and align assessment cut - offs with IMAM and ART guidelines

Completed Awaiting graphic design

1.2.15 Strengthen health facility capacity on inventory management of nutrition commodities and reporting of consumption data

88 facilities trained

1.2.16 Strengthen health facility capacity on electronic data collection, reporting and use of information for decision making On going

1.2.17 Develop standard checklist for support supervision based on SIMS, revised HINI OJT and NHP commodity tools On going

1.2.18 Develop content for health facility CMEs for standardized delivery across the Counties On going

1.2.19 Provide list of County, Sub - County nutrition officers and CCC nutritionist (s) in the high volume health facilities Done

1.2.20 Build capacity of County and Sub - County nutrition officers to support health facility CMEs, mentorship and OJT activities

Combined with training activities in 2.12

1.2.21 Conduct on - the - job training and mentorship to build capacity of additional health facilities to provide comprehensive nutrition services (NACS including HINI) and report nutrition service and commodity consumption data

Done for EMR facilities

1.2.22 Conducting annual data workshop for CHRIOs, CNCs, APHIAplus partners and USG service IPs Meeting

1.3 Improved Nutrition Related Behavior

1.3.1 Conduct MIYCN KAP survey in the five focus Counties

1.3.2 Conduct group counseling on MIYCN in the MCH service points and MtMSGs in the focus Counties Done in Tharaka Nithi only 4 counties conducting mapping

1.4 Increased Opportunities For Learning And Sharing Of Best Practices In Nutrition

1.4.2 Identify opportunities for operations research Draft from Academic science and learning under review

1.4.3 Facilitate NDU staff to analyze and present findings in nutrition and agriculture workshops This activity has been

1.4.4 Conduct nutrition data management clinics in the focus Counties

1.4.5 Training of NHP plus staff on documentation of success stories Done in April

1.4.6 Training of HCWs and CHVs on documentation of success stories Not done Based on

1.5 Increased Knowledge And Skills Of Health Care Workers In Nutrition

1.5.1 Conduct ToT training in NACS at National and County level done

1.5.2 Conduct ToT training in BFCI for County and Sub - County community strategy focal persons and community health assistants in the focus Counties

Quarter 3

1.5.3 Build capacity of County and Sub - County nutrition officers to support health facility CMEs, mentorship and OJT activities

Quarter 3 To be actualized based on project calendar of CMES

1.5.4 Conduct health facility level CMEs, mentorship and OJT ( MIYCN, IFAS, NACS, documentation and reporting of nutrition services and commodity data, nutrition assessment and documentation (Mother child booklet and MoH 257 Blue card)

Quarter 3 Awaiting assessment of 54 facilities

2 Strengthened Nutrition Commodity Management

2.1 Improved Production, Supply and Distribution of Nutrition Commodities

2.1.1 Procurement of nutrition commodities of 462.5 MT of FBF and 75 MT of RUTF Done

2.1.2 Distribution of Nutrition commodities to the health facilities 462.5 MT of FBF and 75 MT of

FBF: Done RUTF: Not done

DA1 approval not received within the quarter

2.1.3 Finalize contract for food processors and KEMSA On-going

2.1.4 Provide data for the monthly Nutrition workbook compiled by NASCOP Done

2.1.5 Procure and distribute additional data collection tools On-going

2.1.6 Conduct facility support supervision Done

38

2.1.7 Procure and distribute anthropometric equipment to the health facilities

2.2 Improved Quality and Safety of Food Commodities and Agricultural Products

2.2.1 Conduct Post batch testing of nutrition commodities Done

2.2.2 Monitor compliance of food processors in testing agricultural raw materials used in RUTF and FBF. Done

2.3 Strengthened Sustainability and Innovation in Nutrition Commodity Development and Management

2.3.1 Track market prices of locally sourced agricultural raw materials used in manufacture of nutrition commodities Quarter 3

2.3.2 Tracking proportion of locally sourced agricultural raw materials used in FBF and RUTF procured through NHPplus

Quarter 3 Discussions with food processor held focusing on documentation of this component

3.0 Improved Food and Nutrition security

3.1 Increased market access and consumption of diverse and quality foods

3.1.1 Conduct rapid/baseline assessment on health and nutrition status in 5 focus counties On-going ·Done for Kitui and Marsabit ·Other remaining 3 counties data will be acquired from existing reliable sources and where not available quick rapid assessments will be carried out

3.1.4 Create linkages between key stakeholders and county governments On-going ·Near completion ·Activity is a continuous process and accomplished for 4 county governments remaining Kitui

3.1.6 Develop contextualized community Complementary Feeding Guide on NACS & MIYCN On-going ·Process on course started with food mapping for counties

3.1.7 Support capacity building to conduct SMART surveys at county level Not done Postponed to be combined with training for NDMA Field monitors

3.1.8 Support dissemination of SMART survey result Not done Awaiting training and survey

3.1.9 Capacity build county designated CUs/CBOs/CHVs on nutrition and on patient follow up On-going Started with Kitui with training of 47 MOH staff who will oversee the CUs/CBOs/CHVs

3.1.10 Courtesy calls and introduction of NHPplus to county governors offices in 5 key focus counties On-going ·Complete for 4 counties ·The remaining Kitui county postponed by the county to next quarter

3.1.11 Review County SMART survey and other assessments reports to inform baseline surveys On-going Task on-going mandated to FTOs who are reviewing for specific counties

3.1.12 Procure electronic data collection equipment Completed The planned 30 tablets procured

3.1.13 Revise the standard KAP data collection tool to include FtF indicators On-going Tool circulated to technical staff for careful study and review, on course

3.1.14 Hold county specific consultative meetings with government and partners to refine the revised draft KAP data collection tools

Not done Awaiting review of tool

3.1.15 Develop the baseline assessment manual/protocol Not done Exiting manuals being sort

3.1.16 Upload the electronic data collection system/questionnaire On-going Configuration of the tablets near completion

3.2 Increase resilience of vulnerable households and communities

3.2.1 Develop crop production calendar for focus county nutrition value chains based on NDMA and Meteorological department early warning systems for one county

Done Provided contextualization technical team with facilitation for one meeting along the process for Tharaka Nithi county

39

3.2.2 Disseminate crop production calendar for focus county nutrition value chains based on NDMA and Meteorological department early warning systems for one county

Done Was done through production of the contextualized calendar during the meeting

3.2.3 Identify and package critical county focused information on resilience based on early warning system(s) reports Partly done Information included in the one county contextualized information calendars

3.2.4 Disseminate key agri-nutrition information through established institutions & groups e.g., Ministry of Education officials and Faith Based Organizations

On-going Done through integrated activity with Vit. A supplementation training with IR1 for MOE officials in Busia the others lined up quarter 3

3.2.5 Ground activity planning meeting with IPs, MOH & MOALF technical staff in 5 counties On-going ·Completed for 3 counties ·Kitui and Busia planned for quarter 3

3.2.6 Review NDMA early warning and Meteorology report and commence preparation of food production calendar in 1 county

Done Provided contextualization technical team with facilitation for one meeting along the process for Tharaka Nithi county

3.2.7 Workshop to review draft calendar Done Other processes supported by other partners

3.2.8 Printing of calendars & pamphlets Not done ·Planned for next season ·Other partners supported

3.2.9 Dissemination of early warning seasonal report and the production calendar in 1 county Not done Planned for next season Other partners supported

40

A review of the entire work plan activities was done with some dropped or modified along the way. This was prompted by the outcomes of the inception meetings with stakeholders in the counties where the activities needed to be aligned with the county priorities and gaps. The new look also reflects the new Multi-Sectoral Nutrition approach mirrored by USAID for improved nutrition outcomes. Table 8 outlines extracts of activities from the main work plan lined up for Quarter 3.

Table 8: Subsequent quarter’s work plan

1.0 Improve access and demand for Quality Nutrition Interventions at Community and Facility levels FY 16 QUARTER 3

1.1 Strengthened leadership, advocacy and policy planning A M J

1.1.1 Support expenses for multi-stakeholder one day planning meeting for PROFILES activities with core group

1.1.11 Participate and support meeting expenses monthly MIYCN TWG

1.1.12 Participate and support monthly Food and Nutrition Linkages TWG

1.1.13 Support meeting expenses and participate in the national Nutrition commodity pipeline subcommittee

1.1.14 Support meeting expenses and participate in Quarterly National Commodity steering committee

1.1.15 Support meeting expenses and participate in the Nutrition Information TWG meetings

1.1.16 Support meeting expenses and provide TA Clinical Nutrition and Dietetics TWG

1.1.17 Support meeting expenses for County Nutrition technical forum (CNTF) meetings in Marsabit, Samburu, Tharaka-Nithi, Kitui and Busia

1.2.1 Support expenses for review of training materials, job aids and NACS protocols beyond HIV, to include, HiNi, Agri-Nutrition messages and linkages to livelihood activities

1.2.2 Facilitate training expenses for Training of USG IP's including FtF Partners using the revised NACS curriculum

1.2.3 Conduct training at County level to build capacity of additional health facilities to provide NACS services beyond HIV and report service and consumption data

1.2.4 Support upgrade of High volume lower level facilities to delivery points (desk review no cost activity)

1.2.5 Support logistics expenses (lunch & transport) for health facility HiNi gap assessment in 5 focus counties

1.2.11 Support Quarterly OJT and mentorship activities with sub-county teams in focus counties

1.2.17 Support Training of data officers for piloting of Nutrition monitoring and reporting system into an interoperable web based system

1.2.18 Rollout of web based system to 100 facilities into electronic nutrition reporting system

1.2.19 Revision of existing Nutrition portal into a robust/scalable interoperable platform to support KM/KT to support a multi sectorial nutrition programming

1.2.20 Analyze data for submission of APR PEPFAR Report

1.2.21 Conduct quarterly joint data quality facility assessments and mentorship visits

1.2.25 Distribute NACS inclusive of HiNi job aid (desktop flip chart)

1.3.9 Support expenses for identified National MNCH/ Nutrition activities & county festivals/ shows

1.3.9.1 MALEZI BORA

Printing of branded materials: t-shirts, caps, banners, leso, posters

Support planning meeting for Malezi Bora at sub-county level

Conduct social mobilization at community level (5 day maximum)

Facilitate cooking demonstration expenses at the community & Malezi Bora Day (ECDE/CU)

Malezi bora Post review meeting at sub county level

1.5.4 Support NACS training expenses for IPs and MOH

2.1.1 Facilitate procurement and distribution of 424MT (23,556 Cartons) of FBF comprising:

41

FBF Adults: 254MT (14,133 cartons)

FBF Children: 127.2 MT (7,067 cartons)

FBF Pregnant/postpartum: 42.4 MT (2,356 cartons)

2.1.2 Print Data Collection/Reporting tools

MOH 407A: 1,000

MOH 407B: 1,000

MOH 733B, 900

MOH 734B: 900 and

Appointment Cards: 100,000

2.1.3 Print 2,000 copies of NACS/FBP Desktop job aids

2.1.4 Distribute job aids and data collection/reporting tools

2.1.5 Procure and distribute anthropometric equipment for MCH service point in level 4 facilities

2.1.6 Participate and contribute to development of Quantification plan for Nutrition Sector

2.1.7 Participate and contribute to development of procurement plan for Nutrition Sector

2.1.8 Roll-out of Electronic CDRR to all nutrition service points

2.1.9 Contribute to the Monthly NHPplus Supply chain Information workbook for NDU/NASCOP

2.1.10 Provide service and commodity data for the monthly Two page summary for NDU pipeline subcommittee & NASCOP

2.1.11 Participate and/or support in the nutritional commodity security technical working group

2.1.12 Conduct facility monitoring visits

2.2.1 Conduct Supplier Quality Audit for Equatorial Nut Processors and Insta Products

2.2.2 Conduct post procurement batch testing

2.3.2 Track proportion of locally sourced agricultural raw materials used in FBF and RUTF procured through NHPplus

3.1 Increased market access and consumption of diverse and quality foods

3.1.1 Conduct consultative meetings with focus counties

3.1.2 Conduct inception meetings in the FtF focus counties with multisectoral stakeholders and partners at county & sub-county levels

3.1.3 Conduct baseline/ Mid-term assessment on multisectoral nutrition programing (health, agriculture, WASH and nutrition) 5 focus counties i.e. Zones of influence (including SBCC, food varieties, consumption patterns, nutrition status, social economic status, demographics)

Training of enumerators

3.1.4 Identification of zones of influence

3.1.5 Conduct Identification of community groups (women, youth, Mother to mother support groups, farmer groups)

3.1.6 Conduct contextualization workshop for Applied Basic Agri-Nutrition Manual (KHCP Manual) for Busia, Kitui, Marsabit, Samburu & Tharaka Nithi

3.1.7 Conduct county Validation workshops for the contextualized draft Agri-Nutrition Manual

3.1.8 Conduct meetings to develop contextualized recipe guides: e.g., maternal nutrition, complementary feeding (Vit. A, iron rich foods, other nutrient dense foods)

3.1.9 Conduct TOT Trainings for sub-county (FEWs, CHEWs, DICECEs, community resource persons) on use and adoption of appropriate technologies e.g., kitchen gardens, food preservation, water harvesting to increase household food production and consumption (ref 1.5 for MSN trainers guide)

3.1.10 Define a demonstration kit for the focus counties based on identified appropriate technologies

3.1.11 Conduct demonstrations to showcase the application of simple appropriate technologies for increasing household food production, consumption of iron, vit. A rich foods e.g., kitchen gardens, cooking demos, water harvesting to community groups

3.1.12 Train CHEWS/PHTs, ECDE teachers , and FEWS on Maternal nutrition, IYCF, dietary diversity (Iron & Vit A) and WASH, key messages for social mobilization

3.1.13 Sensitize NDMA field monitors, CHCs, CHVs on Maternal nutrition, IYCF, dietary diversity (Iron & Vit A) and WASH, key messages for social mobilization

42

3.1.14 Support community based resource persons ( FEWs, CHEWs, DICECEs,) to disseminate key agri-nutrition and WASH messages at sub-county level platforms e.g. Farmer Field schools, community units, chief barazas, MtMSGs, 4K clubs

3.2 Improved Resilience

3.2.1 Support workshop expenses for capacity building to conduct SMART surveys for 2 sub counties in selected focus counties

3.2.2 Support SMART survey expenses (transport & stationery) every 2 years in Marsabit, Samburu & Kitui

3.2.3 Support dissemination of survey results (Baseline/ Mid-term)

3.2.4 Map existing food security, livelihood and economic support in the focus counties/ zones of influence (desk review)

3.2.5 Support consultative meeting expenses to define contextualized food security, livelihood and economic support package

3.2.6 Collect and collate data on referral cases from 2 facilities per ward in 2 sub-counties per county

3.2.8 Support group meeting expenses for linked vulnerable households to economic strengthening activities

3.2.9 Support logistics expenses to identify vulnerable children/adults through NDMA sentinel site assessment (drought early warning & monitoring household questionnaire or Household Hunger score) tool

3.2.12 Support training expenses for (change agents) DICECEs, Gender & Social services agents and NDMA officers dealing with OVC, Older persons, People with disability cash transfers on key MIYCN messages for social safety net programs

3.2.13 Support logistics expenses for DICECEs, Gender social services, NDMA officers, FtF IPs to conduct community forums on how to effective use of cash transfers for improved nutrition

3.2.14 Support workshop expenses to develop food production and consumption pamphlet based on cash transfer amount to inform vulnerable households

3.2.15 Facilitate expenses for a TOT at sub-county level on community managed disaster risk reduction

3.2.16 Support meeting expenses conduct participatory disaster risk reduction assessment at ward level

3.2.17 Support meeting expenses for Dissemination of Disaster Risk Reduction plans at sub-county, ward levels

3.2.18 Support expenses to train NDMA early warning system field monitors on Nutrition screening & referral using MOH 100

3.2.19 Support printing of seasonal planner

3.2.20 Support the FEWs to conduct dissemination meetings of seasonal planner at the ward level

3.2.21 Support meeting expenses for PREG Monthly consultative forum

43

VIII. FINANCIAL INFORMATION

XI. ACTIVITY ADMINISTRATION

County Office

Vehicle availability to cover county activities

Sector wide coordination within the counties

Personnel

Staff numbers

Resignation of Busia county FTO

Recruitment of Nutrition Technical Officer and a driver

List of Deliverables

44

ANNEX 1: SCHEDULE OF FUTURE EVENTS

Table 9: Schedule of future events

Date Location Activity

May 2016 5 Focus Counties Malezi Bora Campaigns

May – June, 2016 ENP and INSTA Factories

SQA Assessment

May – July, 2016 5 Focus Counties Baseline assessments on multisectoral programming

June 2016 Marsabit SMART Survey

45

ANNEX 2: SUMMARY OF TRAININGS Table 10: Summary of training activities Quarter 2

Training Title Number Trained

ECDE Vitamin A supplementation sensitization

Busia

MOALF 7

MOEST 62

MOH 16

CULTURE & SOCIAL SERVICES 1

ECDE Vitamin A supplementation social mobilization sensitization

Busia

MOH 50

NACS Sensitization

Homabay

County MoH 1

Got Kojowi Health Centre 1

Homabay County Referral Hospital 4

Kabondo Sub County Hospital 4

Kendu Sub County Hospital 4

Matata Nursing Home 1

Mbita Sub County Hospital 3

Miriu Health Centre 1

Ndhiwa Sub County Hospital 2

Ober Health Centre 1

Othoro Sub County Hospital 1

Rachuonyo Sub County Hospital 1

Rangwe Sub County Hospital 3

Suba Sub County Hospital 3

Kitui

Kamutei Health Centre 1

Kanyunga Health Centre 2

Kanzika Health Centre 1

Katilini Health Centre 1

Katulani Sub county Hospital 2

Kitui County Hospital 3

Kitui East Sub County 1

Kitui South Sub County 6

Kitui Sub county Hospital 2

Kitui West Sub County 5

Kyatine Health Centre 1

Kyuso Sub county Hospital 5

Migwani Sub county Hospital 4

Mutha Health Centre 2

Muthale Hospital 2

Mutitu Sub county Hospital 1

Mwingi Sub county Hospital 4

Waita Health Centre 1

Yatta Health Centre 2

Migori

Awendo Sub County Hospital 2

CHMT 1

County Director of Health Office 1

Dede Health Centre 1

Karungu Sub-County Hospital 4

Kegonga Health Centre 2

Kenancha Sub County Hospital 1

Kuria County Hospital 1

Kuria East Sub County Hospital 1

Macalder Sub District Hospital 2

Masiwa Health Centre 1

Migori County Hospital 3

Othoro Sub County Hospital 3

Rongo Sub County Hospital 4

Siruti Dispensary 1

46

Sony Medical Centre 1

St Camillus Mission Hospital 2

St Joseph Mission Hospital 3

Suna East sub county 1

Uriri Health Centre 1

Nairobi

Chandaria Health Centre 2

Coptic Hospital 2

Dagoretti SCHMT 3

Dagoretti Sub county Hospital 1

Lea toto- Dagoretti 2

Lea toto- Kangemi 1

Lea toto-Kawangware 3

National spinal injury hospital 5

Riruta Health Centre 3

Waithaka Health Centre 3

Nakuru

APHIA Plus Rift 6

Bahati Sub - County Hospital 3

Elburgon Sub - County Hospital 3

FITC Dispensary 1

Gilgil Hospital 1

Gilgil Sub - County Hospital 4

Kapkures Health Centre 3

Langa Langa Sub - County Hospital 3

Mau Narok Health Centre 1

Molo Sub - County Hospital 2

Molo Sub County Hospital 1

Naivasha Hospital 6

Nakuru County Referral Hospital 5

Nakuru North Sub-county 1

Nakuru Sub - County Hospital 2

Njoro Sub -County Hospital 4

Olenguruone Sub County Hospital 3

Rhonda Dispensary 1

Rongai Health Centre 1

Rongai Sub-County Hospital 3

Subukia Sub - County Hospital 3

Narok

APHIA Plus Rift 1

CHP 2

Enabelbel Health Centre 1

Ewaso Ng'iro Health Centre 1

Mulot Health Centre 1

Nairagie Enkare Health Centre 5

Narok County Nutrition Coordinator 1

Narok County Referral Hospital 8

Narok North Sub County 4

Ntulele Health Centre 1

Olchoro Health Centre 2

Ololunga Sub - County Hospital 3

Sogoo Health Centre 3

Grand Total 363

Table 11: Summary of cadres trained quarter 2

Cadres per Training Number Trained

ECDE Vitamin A supplementation sensitization CHEW 7 County Director ECDE 1 County Nutrition Coordinator 1 ECDE Officer 1 ECDE Teacher 60 Miss World Busia County 1 Agriculture Officer 5

47

Sub County HRIO 1 Sub County Reproductive Health Nurse 1 Deputy County Nutrition Officer 1 Sub County Disease Surveillance Coordinator 1 Sub county Agriculture Officer 2 Sub County Public Health Officer 1 Sub County Community Strategy Coordinator 1 Sub County Nurse 1 County Disease Surveillance Officer 1

ECDE Vitamin A supplementation social mobilization sensitization CHV 50

NACS Sensitization CHRIO 1 Clinical officer 14 County Nutrition Coordinator 3 HRIO 54 Nursing Officer 43 Nutrition Officer 75 Pharm Tech 12 Pharmacist 2 M&E officer 3 Sub County HRIO 5 Sub County Nutrition Officer 13 Sub County Community Health Nurse 2

Grand Total 363

48

ANNEX 3: PERFORMANCE DATA TABLES

Number of PLHIV nutritionally assessed via anthropometric measurement

INDICATOR TITLE: Number of PLHIV nutritionally assessed via anthropometric measurement

INDICATOR NUMBER: FN_ASSESS

UNIT: DISAGGREGATE BY: COUNTY

Geographic Location W Activity Title M Sub-total

ALL Data Management, Reporting

Results:

Additional Criteria Baseline (December 2014)

Results Achieved Prior Periods

FY 2014/15 Target Reporting Period 31/Dec/15

Reporting Period 31/Mar/16

FY 2015/16 Target End of Project Target

County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved

N N N N N N N N N N N N

Baringo 2.2% 4,904 3,413 4,407 1,050 934 1,418 934 945 3,738 2,363 5,473 3,413

Blank 0.6% 1,215 6,082 1,092 3,269 232 1,644 232 1,169 926 2,813 1,356 6,082

Bomet 1.1% 2,504 5,750 2,250 4,028 477 714 477 1,008 1,909 1,722 2,794 5,750

Bondo 0.0% - 1,013 - - - 1,013 - - 1,013 - 1,013

Bungoma 1.2% 2,674 6,733 2,403 3,868 510 24 509 2,841 2,038 2,865 2,984 6,733

Busia 0.4% 815 5,830 733 440 155 1,524 155 3,866 621 5,390 910 5,830

Elgeyo Marakwet 0.5% 1,045 628 939 75 199 245 199 308 797 553 1,166 628

Embu 5.9% 13,019 10,317 11,699 7,545 2,481 2,550 2,481 222 9,923 2,772 14,529 10,317

Garissa 1.0% 2,250 4,485 2,022 3,013 429 1,175 429 297 1,715 1,472 2,511 4,485

Homa Bay 6.4% 13,928 5,900 12,516 2,445 2,654 75 2,654 3,380 10,617 3,455 15,544 5,900

Isiolo 0.7% 1,575 3,837 1,415 2,594 300 696 300 547 1,200 1,243 1,757 3,837

Kajiado 1.6% 3,431 2,317 3,083 332 654 1,985 654 2,615 1,985 3,829 2,317

Kakamega 2.5% 5,415 3,185 4,866 1,014 1,032 1,451 1,032 720 4,128 2,171 6,044 3,185

Kericho 3.1% 6,782 220 6,095 3 1,292 217 1,292 5,170 217 7,569 220

Kiambu 2.8% 6,225 8,270 5,594 4,851 1,186 1,557 1,186 1,862 4,745 3,419 6,947 8,270

Kilifi 1.5% 3,293 1,551 2,959 1,116 628 435 628 2,510 435 3,675 1,551

Kirinyaga 2.2% 4,882 4,335 4,387 842 930 2,334 930 1,159 3,721 3,493 5,448 4,335

Kisii 1.2% 2,664 2,429 2,394 1,259 508 963 508 207 2,030 1,170 2,973 2,429

Kisumu 5.4% 11,812 17,651 10,614 14,539 2,251 2,251 3,112 9,003 3,112 13,182 17,651

Kitui 1.3% 2,919 1,997 2,624 1,323 556 212 556 462 2,225 674 3,258 1,997

Kwale 0.6% 1,391 463 1,250 85 265 161 265 217 1,060 378 1,552 463

Laikipia 0.3% 657 2,973 591 995 125 1,805 125 173 501 1,978 734 2,973

Lamu 1.2% 2,598 2,564 2,334 827 495 1,737 495 1,980 1,737 2,899 2,564

Machakos 3.6% 7,865 17,051 7,068 14,528 1,499 181 1,499 2,342 5,995 2,523 8,778 17,051

49

Makueni 0.9% 2,062 2,394 1,853 529 393 271 393 1,594 1,572 1,865 2,301 2,394

Mandera 0.0% - 1,177 - - - 1,177 - - 1,177 - 1,177

Marsabit 0.7% 1,507 4,916 1,354 186 287 4,605 287 125 1,148 4,730 1,681 4,916

Meru 2.0% 4,350 1,863 3,909 1,536 829 829 327 3,316 327 4,855 1,863

Migori 3.7% 8,139 33,908 7,314 4,925 1,551 27,988 1,551 995 6,204 28,983 9,083 33,908

Mombasa 7.1% 15,531 23,820 13,956 16,801 2,960 1,592 2,960 5,427 11,838 7,019 17,332 23,820

Murang'a 2.8% 6,115 9,330 5,495 2,508 1,165 4,694 1,165 2,128 4,661 6,822 6,824 9,330

Nairobi 8.3% 18,084 118,980 16,251 97,200 3,446 3,446 21,780 13,785 21,780 20,182 118,980

Nakuru 2.4% 5,184 6,114 4,658 2,041 988 485 988 3,588 3,951 4,073 5,785 6,114

Nandi 2.4% 5,190 25,851 4,663 21,819 989 1,178 989 2,854 3,956 4,032 5,792 25,851

Narok 1.0% 2,244 926 2,017 757 428 428 169 1,711 169 2,504 926

Nyamira 0.0% - 1,061 - 2 - 1,059 - - 1,059 - 1,061

Nyandarua 2.4% 5,188 1,830 4,662 1,429 989 106 989 295 3,954 401 5,789 1,830

Nyeri 2.6% 5,803 6,870 5,215 6,016 1,106 25 1,106 829 4,423 854 6,476 6,870

Samburu 0.7% 1,565 1,182 1,406 186 298 794 298 202 1,193 996 1,746 1,182

Siaya 6.5% 14,188 4,036 12,750 2,880 2,704 442 2,704 714 10,815 1,156 15,834 4,036

Taita Taveta 1.7% 3,643 4,197 3,274 1,467 694 2,708 694 22 2,777 2,730 4,065 4,197

Tana River 0.1% 172 558 154 116 33 442 33 131 442 192 558

Tharaka Nithi 2.1% 4,530 2,794 4,071 2,167 863 863 627 3,453 627 5,056 2,794

Trans Nzoia 0.5% 1,169 608 1,050 10 223 223 598 891 598 1,305 608

Turkana 3.3% 7,268 10,132 6,531 8,514 1,385 1,385 1,618 5,540 1,618 8,111 10,132

Uasin Gishu 0.0% - 4,848 - 2 - - 4,846 - 4,846 - 4,848

Vihiga 0.9% 2,034 2,214 1,828 2,155 388 40 388 19 1,551 59 2,270 2,214

Wajir 0.1% 302 96 271 96 57 57 230 - 337 96

West Pokot 0.4% 871 1,058 783 - 166 1,044 166 14 664 1,058 972 1,058

Total 219,000 389,757 196,800 243,383 41,733 72,766 41,733 73,608 166,931 146,374 244,404 389,757

50

Number of HIV positive clinically malnourished clients who received therapeutic and/or supplementary food INDICATOR TITLE: Number of HIV positive clinically malnourished clients who received therapeutic and/or supplementary food

INDICATOR NUMBER: FN_THER


Geographic Location W Activity Title M


Results:



FY 2014/15 Target Reporting Period 31/Dec/15 Reporting Period 31/Mar/16

FY 2015/16 Target

County % Target Achieved Target Achieved Target Achieved Target Achieved

N N N N N N N N N N

Baringo 2.2% 1,668 132 2,687 64 570 570 68 2,279 68

Bomet 1.1% 852 712 1,372 440 291 144 291 128 1,164 272

Bungoma 1.2% 910 1,221 1,465 671 311 56 311 494 1,243 550

Busia 0.4% 277 782 447 219 95 152 95 411 379 563

Elgeyo Marakwet

0.5% 356 72 573 29 121 23 121 20 486 43

Embu 5.9% 4,429 1,468 7,134 1,132 1,513 249 1,513 87 6,051 336

Garissa 1.0% 766 57 1,233 57 261 261 1,046 -

Homa Bay 6.4% 4,739 3,617 7,632 971 1,618 1369 1,618 1277 6,473 2,646

Isiolo 0.7% 536 1,104 863 731 183 276 183 97 732 373

Kajiado 1.6% 1,167 132 1,880 91 399 41 399 1,595 41

Kakamega 2.5% 1,842 1,137 2,967 521 629 306 629 310 2,517 616

Kericho 3.1% 2,308 36 3,716 - 788 36 788 3,152 36

Kiambu 2.8% 2,118 2,827 3,411 1,348 723 433 723 1046 2,893 1,479

Kilifi 1.5% 1,120 230 1,804 104 383 126 383 1,531 126

Kirinyaga 2.2% 1,661 1,615 2,675 180 567 683 567 752 2,269 1,435

Kisii 1.2% 906 1,568 1,460 963 310 408 310 197 1,238 605

Kisumu 5.4% 4,019 5,760 6,472 3,994 1,372 756 1,372 1010 5,490 1,766

Kitui 1.3% 993 1,038 1,600 573 339 252 339 213 1,357 465

Kwale 0.6% 473 30 762 22 162 162 8 646 8

Laikipia 0.3% 224 802 360 488 76 182 76 132 306 314

Lamu 1.2% 884 134 1,423 94 302 40 302 1,207 40

Machakos 3.6% 2,676 3,195 4,310 1,933 914 639 914 623 3,656 1,262

Makueni 0.9% 702 199 1,130 81 240 52 240 66 958 118

Marsabit 0.7% 513 135 826 50 175 58 175 27 700 85

Meru 2.0% 1,480 1,302 2,384 940 505 139 505 223 2,022 362

Migori 3.7% 2,769 4,071 4,460 2,657 946 781 946 633 3,783 1,414

Mombasa 7.1% 5,284 2,080 8,510 1,269 1,805 372 1,805 439 7,218 811

Murang'a 2.8% 2,080 1,657 3,351 1,468 711 711 189 2,842 189

51

Nairobi 8.3% 6,153 14,095 9,909 8,296 2,101 3794 2,101 2005 8,405 5,799

Nakuru 2.4% 1,764 2,127 2,840 948 602 608 602 571 2,409 1,179

Nandi 2.4% 1,766 369 2,844 295 603 31 603 43 2,412 74

Narok 1.0% 764 113 1,230 109 261 261 4 1,043 4

Nyandarua 2.4% 1,765 957 2,842 427 603 343 603 187 2,411 530

Nyeri 2.6% 1,974 2,464 3,180 1,812 674 394 674 258 2,697 652

Samburu 0.7% 532 205 857 170 182 182 35 727 35

Siaya 6.5% 4,827 2,036 7,774 879 1,649 626 1,649 531 6,594 1,157

Taita Taveta 1.7% 1,239 221 1,996 164 423 51 423 6 1,693 57

Tana River 0.1% 58 54 94 30 20 24 20 80 24

Tharaka Nithi 2.1% 1,541 2,042 2,482 1,229 526 367 526 446 2,106 813

Trans Nzoia 0.5% 398 162 641 3 136 51 136 108 543 159

Turkana 3.3% 2,473 4,299 3,982 2,736 844 968 844 595 3,378 1,563

Vihiga 0.9% 692 443 1,115 274 236 169 236 945 169

Wajir 0.1% 103 77 165 72 35 35 5 140 5

West Pokot 0.4% 296 14 477 - 101 101 14 405 14

Bondo 0.0% - - - - - - - -

Mandera 0.0% - - - - - - - -

Nyamira 0.0% - 69 - 29 - 40 - - 40

Uasin Gishu 0.0% - 270 - - - - 270 - 270

Blank 0.6% 413 554 666 335 141 132 141 87 565 219

Total 74,511 67,684 120,000 38,898 25,447 15,171 25,447 13,615 101,787 28,786

52

Number of PLHIV that were nutritionally assessed and found to be clinically undernourished INDICATOR TITLE: Number of PLHIV that were nutritionally assessed and found to be clinically undernourished

INDICATOR NUMBER: FN_THER


Geographic Location

W Activity Title M


Results:


FY 2014/15 Target Reporting Period 31/Dec/15


FY 2016/17 Target

County % Target Achieved Target Achieved Target Achieved Target Achieved

N N N N N N N N N

Baringo 2.2% 1,930 2,687 319 570 360 570 218 2,279 578

Bomet 1.1% 985 1,372 1,034 291 333 233 179 1,164 512

Bungoma 1.2% 1,052 1,465 1,004 311 110 249 706 1,243 816

Busia 0.4% 321 447 418 95 243 76 1,078 379 1,321

Elgeyo Marakwet 0.5% 411 573 112 121 8 97 42 486 50

Embu 5.9% 5,124 7,134 2,390 1,513 693 1,210 90 6,051 783

Garissa 1.0% 886 1,233 867 261 26 209 121 1,046 147

Homa Bay 6.4% 5,481 7,632 962 1,618 990 1,295 1,289 6,473 2,279

Isiolo 0.7% 620 863 1,297 183 392 146 173 732 565

Kajiado 1.6% 1,350 1,880 645 399 51 319 1,595 51

Kakamega 2.5% 2,131 2,967 572 629 251 503 306 2,517 557

Kericho 3.1% 2,669 3,716 53 788 223 630 3,152 223

Kiambu 2.8% 2,450 3,411 1,714 723 919 579 1,084 2,893 2,003

Kilifi 1.5% 1,296 1,804 1,213 383 135 306 1,531 135

Kirinyaga 2.2% 1,921 2,675 246 567 763 454 731 2,269 1,494

Kisii 1.2% 1,048 1,460 736 310 272 248 172 1,238 444

Kisumu 5.4% 4,649 6,472 3,943 1,372 836 1,098 1,135 5,490 1,971

Kitui 1.3% 1,149 1,600 2,135 339 311 271 152 1,357 463

Kwale 0.6% 547 762 228 162 152 129 87 646 239

Laikipia 0.3% 259 360 440 76 - 61 196 306 196

Lamu 1.2% 1,022 1,423 487 302 25 241 1,207 25

Machakos 3.6% 3,095 4,310 2,844 914 647 731 744 3,656 1,391

Makueni 0.9% 812 1,130 1,361 240 239 192 243 958 482

Marsabit 0.7% 593 826 264 175 69 140 46 700 115

Meru 2.0% 1,712 2,384 841 505 172 404 240 2,022 412

Migori 3.7% 3,203 4,460 2,149 946 596 757 650 3,783 1,246

Mombasa 7.1% 6,112 8,510 4,849 1,805 1,225 1,444 975 7,218 2,200

53

Murang'a 2.8% 2,406 3,351 2,043 711 - 568 512 2,842 512

Nairobi 8.3% 7,117 9,909 7,349 2,101 4,185 1,681 2,903 8,405 7,088

Nakuru 2.4% 2,040 2,840 5,437 602 643 482 794 2,409 1,437

Nandi 2.4% 2,042 2,844 2,969 603 672 482 365 2,412 1,037

Narok 1.0% 883 1,230 1,315 261 - 209 34 1,043 34

Nyandarua 2.4% 2,042 2,842 433 603 265 482 187 2,411 452

Nyeri 2.6% 2,284 3,180 2,954 674 701 539 439 2,697 1,140

Samburu 0.7% 616 857 1,293 182 - 145 165 727 165

Siaya 6.5% 5,584 7,774 1,066 1,649 471 1,319 435 6,594 906

Taita Taveta 1.7% 1,434 1,996 1,065 423 34 339 188 1,693 222

Tana River 0.1% 68 94 167 20 12 16 80 12

Tharaka Nithi 2.1% 1,783 2,482 890 526 480 421 323 2,106 803

Trans Nzoia 0.5% 460 641 531 136 84 109 69 543 153

Turkana 3.3% 2,860 3,982 2,304 844 1,319 676 924 3,378 2,243

Vihiga 0.9% 801 1,115 2,905 236 149 189 5 945 154

Wajir 0.1% 119 165 683 35 - 28 140 -

West Pokot 0.4% 343 477 5 101 - 81 7 405 7

Bondo 0.0% - - 1,592 - - - - -

Mandera 0.0% - - - - - - - -

Nyamira 0.0% - - - - 25 - - 25

Uasin Gishu 0.0% - - 11 - - - 989 - 989

Blank 0.6% 478 666 516 141 295 113 280 565 575

Total 86,187 120,000 68,651 25,447 19,376 20,471 19,276 101,787 38,652

54

Number of facilities reporting by county

INDICATOR TITLE: :Number of facilities reporting by county

INDICATOR NUMBER: Internal


Geographic Location Activity Title Date M Sub-total


Results:

Additional Criteria No of Facilities (December 2014)


Reporting Period 31/Dec/15


Reporting Period 30/Jun/16

Reporting Period 30/Sep/17

FY 2016/17 Target End of Project Target

County % Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved Target Achieved

N N N N N N N N N N N N N N

Baringo 0.3% 3 100.0% 2 100.0% 2 100.0% 100.0% 2 100.0%

Bomet 2.3% 22 32% 13 31.8% 13 31.8% 32% 13 31.8%

Bungoma 1.8% 17 44% 10 11.8% 10 76.5% 44% 10 44.1%

Busia 0.5% 5 60% 3 20.0% 3 100.0% 60% 3 60.0%

Elgeyo Marakwet

0.7% 7 100% 4 100.0% 4 100.0% 100% 4 100.0%

Embu 1.4% 14 14% 8 7.1% 8 21.4% 14% 8 14.3%

Garissa 1.0% 10 10% 6 0.0% 6 20.0% 10% 6 10.0%

Homa Bay 6.7% 65 39% 39 72.3% 39 6.2% 39% 39 39.2%

Isiolo 0.8% 8 69% 5 37.5% 5 100.0% 69% 5 68.8%

Kajiado 1.5% 15 50% 9 60.0% 9 40.0% 50% 9 50.0%

Kakamega 3.8% 37 41% 22 54.1% 22 27.0% 41% 22 40.5%

Kericho 2.5% 24 60% 14 20.8% 14 100.0% 60% 14 60.4%

Kiambu 4.9% 48 10% 29 12.5% 29 8.3% 10% 29 10.4%

Kilifi 1.2% 12 71% 7 41.7% 7 100.0% 71% 7 70.8%

Kirinyaga 1.4% 14 29% 8 35.7% 8 21.4% 29% 8 28.6%

Kisii 3.3% 32 22% 19 3.1% 19 40.6% 22% 19 21.9%

Kisumu 7.1% 69 10% 41 8.7% 41 11.6% 10% 41 10.1%

Kitui 1.4% 14 57% 8 14.3% 8 100.0% 57% 8 57.1%

Kwale 1.9% 18 33% 11 27.8% 11 38.9% 33% 11 33.3%

55

Laikipia 0.9% 9 50% 5 0.0% 5 100.0% 50% 5 50.0%

Lamu 0.9% 9 11% 5 11.1% 5 11.1% 11% 5 11.1%

Machakos 1.5% 15 47% 9 26.7% 9 66.7% 47% 9 46.7%

Makueni 1.1% 11 50% 7 36.4% 7 63.6% 50% 7 50.0%

Mandera 0.1% 1 0% 1 0.0% 1 0.0% 0% 1 0.0%

Marsabit 0.4% 4 0% 2 0.0% 2 0.0% 0% 2 0.0%

Meru 2.8% 27 37% 16 25.9% 16 48.1% 37% 16 37.0%

Migori 6.4% 62 35% 37 33.9% 37 35.5% 35% 37 34.7%

Mombasa 3.0% 29 14% 17 10.3% 17 17.2% 14% 17 13.8%

Murang'a 3.0% 29 21% 17 0.0% 17 41.4% 21% 17 20.7%

Nairobi 5.8% 56 29% 34 25.0% 34 33.9% 29% 34 29.5%

Nakuru 3.8% 37 43% 22 37.8% 22 48.6% 43% 22 43.2%

Nandi 0.7% 7 100% 4 100.0% 4 100.0% 100% 4 100.0%

Narok 1.0% 10 5% 6 0.0% 6 10.0% 5% 6 5.0%

Nyamira 0.8% 8 56% 5 12.5% 5 100.0% 56% 5 56.3%

Nyandarua 1.2% 12 42% 7 75.0% 7 8.3% 42% 7 41.7%

Nyeri 2.6% 25 38% 15 40.0% 15 36.0% 38% 15 38.0%

Samburu 0.3% 3 50% 2 0.0% 2 100.0% 50% 2 50.0%

Siaya 10.7% 104

68% 62 50.0% 62 85.6% 68% 62 67.8%

Taita Taveta 2.3% 22 66% 13 59.1% 13 72.7% 66% 13 65.9%

Tana River 0.3% 3 100% 2 100.0% 2 100.0% 100% 2 100.0%

Tharaka Nithi 1.2% 12 63% 7 66.7% 7 58.3% 63% 7 62.5%

Trans Nzoia 0.5% 5 50% 3 40.0% 3 60.0% 50% 3 50.0%

Turkana 1.2% 12 79% 7 58.3% 7 100.0% 79% 7 79.2%

Uasin Gishu 0.1% 1 50% 1 0.0% 1 100.0% 50% 1 50.0%

Vihiga 1.5% 15 37% 9 73.3% 9 0.0% 37% 9 36.7%

Wajir 0.1% 1 50% 1 0.0% 1 100.0% 50% 1 50.0%

West Pokot 0.7% 7 14% 4 14.3% 4 14.3% 14% 4 14.3%

Total 970 43.7% 582 33.1% 582 54.4% -

- -

- 43.7% 582 43.7%

Date post:	21-Mar-2018
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USAID Kenya Nutrition and Health Program pluspdf.usaid.gov/pdf_docs/PA00MN92.pdfDHIS District Health...

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