Federal Democratic Republic of Ethiopia Ministry of Health
Nutrition Resource Mapping in Ethiopia Across Sectors
2nd NIPN Global GatheringMay 22 – 24 2019 Amsterdam
Federal Democratic Republic of Ethiopia Ministry of Health
Agenda
1. Describe the role and efforts in multi-sectoral resource tracking to support national nutrition efforts in Ethiopia
2. Present approach and illustrative analysis results from 2015/16 – 2018/ 19 as examples to inform decision-making
3. Highlight lessons learned which may be helpful to other countries looking to implement a similar process
4. Present areas for collaboration with NIPN
Federal Democratic Republic of Ethiopia Ministry of Health
Background and objectives
Federal Democratic Republic of Ethiopia Ministry of Health
In the last 5 years, Ethiopia’s fight against malnutrition has moved forward with political will, policy and financing
Seqota
declaration
National Nutrition
Program-II (NNP-II)
Food and
Nutrition
Policy
Comprehensive
nutrition resource
tracking exercise
Routine national
resource mapping
system (FMOH)
Routine regional resource
mapping system (Seqota
PDUs)
NNP-II cost estimationCost of
Hunger report
Seqota Declaration
PDUs established
National Nutrition
Strategy
National Nutrition
Program (NNP)
Food and
Nutrition
Strategy
Po
licie
s a
nd
Stra
teg
ies
Co
stin
g/fin
ancin
g in
itiativ
es
NIPN launched
Federal Democratic Republic of Ethiopia Ministry of Health
Routine nutrition resource mapping across sectors is essential for national planning and priority setting
Routine multi-sectoral reporting, consolidated across
sectors, to monitor progress against national strategies
Strategic priority setting and governance
NATIONAL
NUTRITION
COORDINATION
BODY (NNCB)
EDUCATION
HEALTH
NUTRITION-
SENSITIVE
AGRICULTURE
WATER,
HYGIENE
& SANITATION
SOCIAL
PROTECTION
Information can be used to inform allocative decisions to: scale-up high-impact
interventions in areas most in need
enhance the enabling environment for nutrition, including by making large-scale programs more nutrition-sensitive
Federal Democratic Republic of Ethiopia Ministry of Health
Routine nutrition resource mapping within sectors is essential for sectoral budget management
Policy Review
Strategic Planning
Cost Estimation
Prioritisation
Budget Formulation
Budget Execution
Resource Mapping and Monitoring
Audit and Evaluation
Adapted from SUN guidance on
planning & implementation
Federal Democratic Republic of Ethiopia Ministry of Health
FMOH has taken leadership in tracking resources for nutrition against the NNP-II framework
FMOH (Nutrition Case Team) oversaw the first comprehensive multi-sectoral resource tracking effort, for 2014/15 - 16/17
FMOH (Partnership Cooperation Directorate) has mapped nutrition resources from health sector partners over a number of years through annual resource mapping exercise, as well as some non-health sector spending
FMOH implemented a supplemental tool to more fully capture non-health spending on nutrition for 2016/17-2018/19
FMOH’s annual resource mapping exercise has now fully integrated the supplemental non-health categories and non-health donors/IPs for EFY 2019/20 and future nutrition tracking
1
3
2
4
Federal Democratic Republic of Ethiopia Ministry of Health
Multi-sectoral analysis: total funding increasing in most sectors, but nutrition-specific funding in 2015/16 no higher than 2013/14
350
500
50
400
250
100
150
200
300
450
119
$181 M
EFY 2008(2015-16)
1340
18
38
2564
54
EFY 2006(2013-14)
69
EFY 2007(2014-15)
90
142
36
54
43
58
$330 M
$455 M
School health & nutrition
Other
PSNP nutrition-sensitive component
Nutrition & WASH
Nutrition & infectious disease
Nutrition-sensitive agriculture
Emergency food support
Emergency management of acute malnutrition
Nutrition-specific direct interventions
Mil
lio
ns
of
US
D
Estimated nutrition
expendituresEstimated nutrition
budgets
Do the results suggest nutrition-specific programs are not
receiving high enough priority? What are the causes?8
Federal Democratic Republic of Ethiopia Ministry of Health
Funding for national strategic priorities: despite positive trend overall, not all objectives are receiving increasing funding
50
150
250
100
200
300
350
36
Mil
lio
ns o
f U
SD
80
11492
320
15 12 7
59
167
27 37
EFY 2007 expenditures
EFY 2006 expenditures
EFY 2008 budgets
Obj 5: Improve multi-
sectoral
nutrition coordination &
capacity to implement NNP
Obj 4: Strengthen
implementation
of nutrition-sensitive
interventions
across sectors
Obj 3: Improve nutrition
services for communicable
and non-communicable/
lifestyle related diseases
Obj 1 & 2: Promote
nutrition for
Women, adolescents and
children
Mainly health sector Multi-sectoral
Trends in NPP-II Obj.1,2,3 are not very positive - is more funding needed for these
from GoE and/or external sources?
Federal Democratic Republic of Ethiopia Ministry of Health
Regional analysis: is funding being allocated in proportion with stunting burden?
31
14
80
9
55
20 22
90
63
30
2
60
20
10
50
30
70
40
80
90
Average budget
allocation per
stunted child
under 5
Region HRegion A Region B Region C Region KRegion D Region E Region F Region G Region I Region J
Illustrative EFY 2008 budget allocations per
stunted child under five (USD)
Higher
stunting
Lower
stunting
10
If these differences across regions were seen, could more
money be mobilized for those regions being left behind?
Federal Democratic Republic of Ethiopia Ministry of Health
The approach built on the annual FMOH health resource mapping process to include additional nutrition-sensitive investments across sectors
The annual resource mapping process captured mainly nutrition-specific investments through the health sector…
In 2018, supplemental tool developed to capture multi-sectoral investments from non-health partners
Respondents for both include both donors and implementing partners
Present status: One tool
FMOH tool updated with multi-sectoral categories and non-health partners to
capture nutrition investments
Federal Democratic Republic of Ethiopia Ministry of Health
Illustrative data analysis using FMOH’s routine annual health resource mapping tool + supplemental tool for multi-sectoral partners
The full set of sample analyses is available with FMOH in the slide deck “FMOH-R4D nutrition resource mapping in Ethiopia preliminary analysis deck v16Dec”
Federal Democratic Republic of Ethiopia Ministry of Health
Example analysis (1) : multi-sectoral coordination and capacity-building both becoming less prominent in EFY 2011 health sector programs for nutrition
-
5
10
15
20
25
EFY 2010 Expectedexpenditure
EFY 2011 Commitments
USD
Mill
ion
s
Nutrition specific expenditure & commitments (EFY 2010-2011, USD, %)
Other Nutrition/Not disaggregated
Research, knowledge management anduse of data for decision making
Multi-sectoral coordination for nutrition
Capacity building for nutrition programimplementation
Nutrition Supplies and logistics
Women/adolescent nutrition
Micronutrients
Comprehensive community basednutrition
Management of malnutrition
Infant and Young Child feeding
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
EFY 2010 Expectedexpenditure
EFY 2011 Commitments
Source: IP data from routine FMOH tool
Federal Democratic Republic of Ethiopia Ministry of Health
Example analysis (2): changing mix of spendingby NNP-II strategic objectivesFuture efforts could track Food & Nutrition Strategy priority areas
Notes: Finances for SO 3: improve the delivery of nutrition services for communicable and non-communicable/lifestyle related diseases was not reported period by the IPs through either tools. To some extent, these may embedded under other program areas such as HIV/AIDS, TB, diabetes
Expected expenditures (EFY 2010) and budget commitments (EFY 2011) by NNP-II strategic objective reported by IPs through FMOH tool
0 5 10 15
Other
SO1 & 2: Promotion of nutrition for women and adolescentgirls; Improve the nutritional status of children from birth…
SO2: Improve the nutritional status of children from birthup to 10 years
SO4: Strengthen implementation of nutrition sensitiveinterventions across sectors
SO5: Improve multisectoral nutrition coordination andcapacity to implement NNP
USD MillionsEFY 2010 Expected expenditures EFY 2011 Commitments
Source: IP data from routine FMOH tool
Federal Democratic Republic of Ethiopia Ministry of Health
Example analysis (3): regional spend p.c. vs burdenSignificant regional variation in per capita budget allocations which did not appear to correlate with stunting burden
Per capita funding by region (USD, EFY 2009-2011, USD)
Increasing prevalence of stunting
4,55
0,99
0,190,69
0,41
1,07 1,24
2,70
0,230,38
0
1
2
3
4
5
6
7
8
9
Oro
mia
Dir
e D
awa
Ad
dis
Ab
aba
0.62
Har
ari
Gam
bel
la
Som
ali
SNN
PR
Tigr
ay
Afa
r
Ben
. Gu
mu
z
Am
har
a
Actual expenditureEFY 2009 (per capita)
Expected expenditureEFY 2010 (per capita)
Budget commitmentsEFY 2011 (per capita) Extremely high per-
capita spending in Gambella driven by emergency response for South Sudan refugees
No clear link between higher stunting burden and higher per capita funding
Regional breakdowns have substantial data challenges and are particularly vulnerable to distortions from incomplete responses –these tentative findings are for illustration onlySource: IP data from supplemental tool; does not include any funding from regional bureaus/partners
Federal Democratic Republic of Ethiopia Ministry of Health
Lessons learned and areas for NIPN collaboration
Federal Democratic Republic of Ethiopia Ministry of Health
Lessons Learnt
1. Recent efforts in multisectoral resource tracking using different approaches have provided a useful foundation for a future routine process
2. Integrating nutrition resource tracking within routine health-sector exercises can help avoid duplication of efforts and reporting burden on partners
3. Despite good response rates, there is room for improvement. In initial rounds more sensitisation, support and follow up is needed with multi-sectoral partners who may be new to the exercise
4. Large nutrition-sensitive programs such as PSNP IV and ONE WASH had to be excluded from round 1 analysis due to complexity of reporting, which points to the need for a different resource tracking approach (using existing reports, working with secretariats) for multi-stakeholder programs
5. Aligning the exercises with national plans (costed where available) and using other types of available data (programmatic, burden etc) can yield richer analyses and strategic use for policy makers
Federal Democratic Republic of Ethiopia Ministry of Health
Further areas for NIPN collaborationHow can the analyses inform stronger decision making for nutrition?
1. Partnering on analyses to combine financial data with other types of available data including population data, programmatic indicators, burden estimates and cost data, for insights on efficiencies and equity
2. The data may be tailored to and help answer questions such as:
• What is the volume of funding available for nutrition and what are the trends?
• What strategic objectives in the national strategy are well funded? Where are the gaps?
• What are the types of interventions that funding is directed towards?
• Which geographies (Regions, Districts) is it distributed across?
Federal Democratic Republic of Ethiopia Ministry of Health
Thank you!
Federal Democratic Republic of Ethiopia Ministry of Health
Annexes
Federal Democratic Republic of Ethiopia Ministry of Health
Improved nutrition programme implementation including reallocation to underfunded areas o areas / areas in most need, value for money (comparison with outputs), identifyingduplication t duplication to improve coordination
Regional bureaus (health, nutrition, finance) can coordinate their programmatic and financial planning in a simil planning (as stated above) for nutrition, according to regional priorities
1. Nutrition team at FMoANR compares budgeted plans with resource need and develops an investment c investment case to present to donors, including analysis of regional allocations according to need N 2. Nutrition team at FMoH requests for additional support out of pooled funding from MoFEC
3. Nutrition team at FMoH convenes donors for data driven joint planning and support
MOH steering sectors through NNTC/NNCB to help encourage action within sectors: is there enough fund in funding for nutrition in each sector? Are sectors collaborating to optimize funding allocations and part ner partnerships? What more could be done?
Tracking aid for nutrition globally helps assess donor allocations to countries most in need
Nutrition resource mapping data can inform decision-making at various levels
Data can be used and tailored to the needs of decision-makers at various levels; with increased levels of disaggregation needed for woreda level planning and lesser moving up the pyramid:
Global
Federal level cross sectoral
planning & coordination
Federal level sectoral planning &
coordination
Regional level sectoral planning & coordination
Woreda level sectoral planning & coordination
Federal Democratic Republic of Ethiopia Ministry of Health
Round 1 experience informed the routinization process to ensure sustainability
Data collection & follow up
(donors & IPs)
Data analysis
EFY 2010 [Round 1] EFY 2011 [longer-term]
Development of nutrition-
sensitive tool led by resource
mobilization directorate, aligned with
health resource mapping
Donors and IPsreport nutrition-
sensitive investments
using the Excel tool and send responses to
FMOH byJune 15th
Feb - Mar Mar- Apr May 29th June-Oct TBD Nov onwards
Workshop to launch data collection
phase
Hea
lth
sec
tor
reso
urc
e m
ap
pin
g c
ap
turi
ng
la
rgel
y n
utr
itio
n-s
pec
ific
pa
rtn
ers
Convene stakeholders
to present preliminary
findings, implications and solicit inputs for
longer term routinization
Analyze lessons learned and
review feedback; plan for next round
of data collection and analysis (see
next slide)
Nutrition Case Team leads analysis and outputs that inform key
questions & decision making
for planning purposes; R4D to
support
Partners provided
feedback on tool and data use
case:• UNICEF• FAO• IFPRI• Save the
Children
Tool development
Stakeholder consultations & pilot testing
Launch workshop for development
partners
Review & planning for routinization
Nov