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Harmonising Strategies

  |   SUN in Practice, Advocacy and Communication for Nutrition

Uganda has developed a harmonised Nutrition Advocacy and Communication strategy.

Maureen Bakunzi, Assistant Commissioner for Policy Implementation and Coordination, Office of the Prime Minister and SUN Government Focal Point describes how the strategy has evolved…

The Government of Uganda recognizes the need to ensure that its population is well nourished.

The Constitution of the Republic of Uganda, 1995, sets out the National Objectives and Directive Principles of State Policy and number XXII of these relates to food security and nutrition and provides that:

The State shall

(a) Take appropriate steps to encourage people to grow and store adequate food
(b) Establish national food reserves
(c) Encourage and promote proper nutrition through mass education and other appropriate means in order to build a healthy State

Uganda was among the very first countries to commit and join the SUN Movement in March 2011. The Government acted on its commitments to the Movement by developing the Uganda Nutrition Action Plan (UNAP) which is the
framework for scaling up nutrition as well as the common results framework. The UNAP was launched by
the President in November 2011. The implementation of the UNAP, taking a multi-sectoral approach, is coordinated by the Office of the Prime Minister.

There has been considerable progress since implementation of the UNAP. Major achievements include the formation of District Nutrition Coordination Committees, oriented to the UNAP, that are developing action plans in 31 districts 3. A further 81 districts are planned for in 2014. In addition, the first National Nutrition Forum took place in December 2013 hosted by the Prime Minister where all stakeholders came together to re-affirm their commitment to the multi sectoral approach to scaling up nutrition in Uganda.

Activities to mobilize society, advocate and communicate about nutrition

A variety of activities are underway to highlight the issue of nutrition in Uganda and to stimulate action:

  • Radio campaigns in northern Uganda have taken place including radio spots/talk shows focused on promotion of nutrition best practices. This was supported by the United Nations Children’s Fund (UNICEF)
  • Journalists have been trained on how to objectively cover nutrition priorities supported by the United States Agency for International Development (USAID) together with Food and Nutrition Technical Assistance (FANTA) and UNICEF
  • A community behaviour change communication video initiative is underway. Village health teams use videos to create dialogue on nutrition at community level supported by USAID and the Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) project.
  • Counselling aides have been produced covering aspects such as how to have a healthy baby and family. These are used by village health teams supported by the World Health Organisation (WHO) and the Ministry
    of Health
  • Counselling tools for community-based nutrition through the Uganda Programme for Human and Holistic Development (UPHOLD) and USAID have been created
  • The Cost of Hunger report was published in June 2013 to provide material for nutrition advocacy

Developing the National Advocacy and Communication Strategy for the UNAP

The Office of the Prime Minister, through its Uganda Nutrition Action Plan (UNAP) Secretariat is leading the development and finalization of the National Nutrition Advocacy and Communication (NAC) strategy. The UNAP Secretariat brings together the relevant line ministries and sectors, United Nations (UN) agencies, development partners, civil society, the private sector and academia in the implementation of the UNAP and all these stakeholders have been involved in the development of the NAC strategy through a NAC Taskforce. The Uganda SUN Movement Civil Society group (UCCO-SUN) has been particularly active in the development of the NAC strategy, and will continue to contribute through activities at national and decentralized levels. The UCCO-SUN has a funded advocacy project aimed at high-level policy makers and decision-makers.

The NAC strategy is currently being finalized and is expected to be launched during the month of August 2014. It consists of three distinct components, advocacy, social change and mobilization, and behaviour change communication. To start the process, the advocacy component was finalized in 2013, and has already been used to guide advocacy towards high level decision-makers and donors. The advocacy component identifies different target audiences, and strategies and actions to deliver key messages on nutrition and nutrition
governance. The other two components have been finalized recently and now the three sub-strategies are being merged into one harmonized strategy.

The NAC strategy is organized under a set of overarching priorities and includes communication activities to enable the three components to build upon one another. The strategy is largely built upon the UNAP.

The Cost of Hunger 4 in Uganda

The Cost of Hunger study in Uganda set out to estimate the additional cases of morbidity, mortality, school repetitions, school dropouts, and reduced physical capacity that can be directly associated to a person’s under-nutrition before the age of five, and the associated costs to the economy. National data sets were examined, including the Uganda National Household Survey 2009/2010, Population and Housing Census 2002, Demographic and Household Survey 2011 and previous data sets with the addition of some primary data.

The study found that 15% of child deaths in Uganda are associated with under-nutrition equivalent to more
than 110,000 deaths between 2004 and 2009. Undernourished children are more likely to experience anaemia, acute diarrhoeal syndrome, acute respiratory infection, and in some cases, fever. For every additional
case of child illness, both the health system and families are faced with additional economic costs. The study also found that stunted children are more likely to repeat grades in school at a cost to the education
system and caretakers. Stunted students are more likely to drop out of school altogether. An estimated 54% of the working population in Uganda or 8 million people are estimated to have been stunted as children and to have lower productive capacity.

The total losses associated with child nutrition in Uganda are US$899 million equivalent to 5.6% of Gross Domestic Product (GDP) per year.

Source: Summary Report: The Cost of Hunger in Uganda. Implications on National Development and Prosperity. June 2013

The NAC strategy prioritizes four pillars that directly contribute to the achievement of the UNAP objectives:

Pillar 1: Importance of healthy growth during the first 1000 days of Life;
Pillar 2: Promotion of nutritious Ugandan diet;
Pillar 3: Promotion of role models (and champions, such as champion communities to gather social proof and empower change); and
Pillar 4: Accountability (collective responsibility for all nationals). It should be noted that all the four pillars have implications for activities at national, sub-national, community and even household level.

The aim is for messages at all levels – for individuals, communities, districts, and at national level – to be coherent and aligned. The strategy also includes measurable success indicators, and will eventually include a limited number of impact indicators. A monitoring and evaluation plan is being developed to accompany the strategy and action plan, and will be implemented following the launch in August 2014.

Actions in the community

Through the Ministry of Health community nutrition programme and support from various development partners’ activities at district, county, sub-county and community levels, behaviour change communication activities are taking place regularly. These include community nutrition demonstrations, counselling, growth monitoring and promotion activities, world breastfeeding week, and health days, for example, which promote healthy behaviours and service delivery. The NAC strategy and action plan will enhance and build on existing activities, and increase the capacity of service providers, especially at community and service-delivery levels, to promote improved healthy nutrition behaviours.

A proposal is being prepared to establish a UNAP knowledge management facility/repository, which would assist various stakeholders, including the NAC Taskforce to systematically record innovations and experiences, and share them throughout the country. In line with the above, materials are currently being reviewed, updated and new tools and materials for nutrition advocacy will be developed. By the end of 2014, the repository will be available and tools and materials ready for sharing.

Challenges

The current major challenges to effective communication and advocacy for scaling up nutrition in Uganda include:

  • Inadequate resources for activities, for developing and reproducing tools and materials
  • Coordination between partners/stakeholders, to prevent duplication and to ensure the best use of resources, pooling of ideas and funds, and the rational division of tasks
  • Lack of knowledge about available resources, tools, materials to permit better harmonization of messages and materials
  • Capacity to plan, create and implement communication and advocacy materials/ events is mixed – some stakeholders have high level skills and capacity while others do not

The first step in addressing these challenges has been the creation of an action-oriented Task Force, led by the UNAP Secretariat and aimed at carrying out specific actions to create the NAC Strategy and action plan. Through various development partners including USAID – SPRING, international experts have been brought in to provide advice and technical support (e.g. MANOFF Group5) for the NAC strategy. Individual projects/ agencies have brought technical support from headquarters and in the form of technical consultants. Additional assistance, in the form of materials, ideas, and experiences from other countries would be most welcome. Exchange visits to observe and learn from other countries would be very beneficial.

Nutrition advocacy and communication in the UNAP

The NAC strategy supports the following UNAP objectives and strategies starting with Objective 5 which is the most relevant:
Objective 5: Create awareness of and maintain national interest in and commitment to improving and supporting nutrition programmes in the country,
Strategy 5.1: Increase awareness of and commitment to addressing nutrition issues in the country, and;
Strategy 5.2: Advocate for increased commitment to
improving nutrition outcomes.
Objective 1: Improve access to and utilization of services related to maternal, infant and young child nutrition,
Strategy 1.2: Address gender and socio-cultural issues that affect maternal, infant and young child nutrition.
Objective 2: Enhance consumption of diverse diets,
Strategy 2.1: Increase access to and use of diverse nutritious foods and use at the household level;
Strategy 2.2: Enhance post-harvest handling, storage, and utilization of nutritious foods, at the household and farm levels;
Strategy 2.3: Promote consumption of nutrientenhanced foods.
Objective 3: Protect households from the impact of shocks and other vulnerabilities that affect their nutritional status,
Strategy 3.1: Develop preparedness plans for shocks;
Strategy 3.2: Promote social protection intervention for improved nutrition.
Objective 4: Strengthen the policy and legal frameworks and the capacity to effectively plan, implement, monitor, and evaluate nutrition programmes,
Strategy 4.1: Strengthen the policy and legal frameworks, for coordinating, planning and monitoring nutrition activities.

Key Lessons

  • Working together for a common result – in this case the NAC strategy – has been a major learning and productive experience for stakeholders committed to scaling up nutrition in Uganda.
  • By bringing together different partners and stakeholders to support government and each other, the competitive advantages of different groups have been maximized.
  • Employing a consultative approach to strategy development has yielded very beneficial results.

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