Workshop of French-speaking countries in Western Africa on costing, tracking expenditure and participatory evaluation of the impacts of interventions aimed at improving nutrition

Report by Patrizia Fracassi, SUN Movement Secretariat.

Participating countries: Senegal, Benin, Togo, Burundi, Madagascar, Democratic Republic of Congo, Niger, Mali, Burkina Faso, Cote d’Ivoire. Delegation members: SUN focal points, representatives of relevant ministries (including health, finance, budget and agriculture), representatives of civil society and United Nations agencies.

Cotonou, Benin, 29-31 October, Workshop opened by His Excellency the Minister of Development in Benin, Marcel De Souza, underlining that improving nutrition must be at the heart of progress in each country.

Welcoming addresses by the Chairman of the Food and Nutrition Council in Benin, Professor Roch Mongbo, Anna Vincent, UNICEF representative and Patrizia Fracassi, SUN Movement Secretariat representative, highlighting the multidisciplinary character of nutrition and the collective responsibility of the various sectors (governmental sectors, civil society, academia, private sector and development actors).

Professor Roch Mongbo, Dr. Anne Vincent, E. Marcel De Souza, Patrizia Fracassi

Day 1 – Costing:

Presentation and discussions on the costing of nutrition programmes using two approaches (Marc Nene, Consultant for the World Bank).

Experience of Mali on costing specific nutrition initiatives (Patrick Eozenou, World Bank) and costing the multi-sector action plan (Jakub Kakietek ICF, Amadou Fofana, REACH and Modibo Diarra, SUN Focal Point)

Experience of Benin with the OneHealth tool to cost nutrition initiatives within the framework of a sectoral healthcare plan (Raymond Amoussou, Health Ministry)

Main points:

• Costing is an integral part of the strategic planning cycle.
• Costing takes time and requires input from all actors.
• The tools are based on the ingredients-based approach or the unit cost approach. Compromises must always be made between exhaustiveness and detail.

Mali delegation: Dembele Diakaridia

Day 2 – Monitoring Nutrition Investments

Presentation of methods for analysing and monitoring investments which can be used by the nutrition sector (Clara Picanyol, OPM) and discussion on a three-pronged approach – identification, categorisation and weighting – to monitor specific nutrition-related initiatives, from the national budgets (Patrizia Fracassi, SUN Secretariat). Tutorials on monitoring investments from national budgets.

Three-pronged approach:

• Stage 1: Identifying relevant programmes or departments using keyword search
• Stage 2: Assess whether the programmes and departments identified come under the category of investments that are “nutrition-specific” or “contribute to nutrition”. It is important to do this in consultation with the stakeholders
  • Nutrition-specific budget allocations are those that are attached to a department, a nutrition programme or a budget line for nutrition.
  • To be identified as “contributing to nutrition”, a programme must take into account the underlying causes of malnutrition and be particularly beneficial to the most vulnerable segments of the population, i.e. women and children.
• Stage 3: Weighting a percentage of the budget allocated to nutrition.
  • 100% of the overall amount will be allocated to programmes, departments and budget lines categorised as “nutrition-specific”
  • A percentage of the overall amount (e.g. 25%) will be allocated to programmes categorised as “contributing” (nutrition-related).

Main points:

The national budget is the government’s main economic policy document and indicates how the government intends to use public resources (budget allocations) to reach its strategic objectives.

• The approach proposed may provide a useful starting point for tracking. Stakeholders may agree on a list of keywords, the classification and weighting of programmes, departments and budget lines identified using the keyword search (Stage 1).
• The national budget is often not sufficiently detailed. For programmes with no “nutrition-specific” objective, it is essential to identify and engage with the responsible agency to decide if the programme “contributes to nutrition”.
• All keywords searched and the percentage of the budget allocated to programmes or departments must be listed in the Excel spreadsheet. The Excel spreadsheet also includes a column which identifies funding sources.
• The main point of the exercise to is analyse historical trends using the same parameters (e.g. the same keyword and the same classification) across all years (e.g. 2013, 2012, 2011). It will not be used to compare countries.
• The exercise requires two to three weeks maximum and will cover keyword search and consultation with stakeholders. A reporting form will be drawn up to ensure transparency and feasibility.
• Over the next six months, the SUN Movement Secretariat will help interested countries to conduct this exercise, with the assistance of technical partners. Data validated by stakeholders will be included in the 2015 Sun Movement report and the 2015 Global Nutrition Report.

Presentation of the National Health Accounts for monitoring nutrition spending (Marie-Jeanne Offosse, Consultant for the World Bank). Experience of Benin in relation to the National Health Accounts (Léandre Hounhoui)

Main points:

• The 2011 System of Health Accounts (SCS) is used to monitor all health spending in a given country over a defined period of time.
• Spending is analysed from various angles: funding sources; funding agents, service providers, beneficiaries, illness and state of health including in terms of nutritional deficiencies.
• The 2011 SCS is used to estimate total spending on nutrition in healthcare and other sectors, the main aim being to improve the state of health.
• Countries using the 2011 SCS for the first time take 6-12 months to conduct this exercise. These periods should be reduced to three months in the coming years. As they are based on current spending, there is generally no data for one to two years, which depends on the data available from government and other sources.
• The methodology of mapping nutrition funding used in Malawi in 2013 has the advantage of tracking financial transactions for nutrition initiatives conducted outside the healthcare sector. It should be noted that other ministries (e.g. the Minister for Agriculture) still have to finalise the classification because it was not based on a consultation process.

DRC (Congo) delegation: Eric Alan Atgabo with the national budget

Day 3 – Participatory Monitoring

Anne Floquet (Lead researcher, LADYD; Head of Department, CEBEDES) presented the experience of Benin on Participatory Local Impact Monitoring in the primary education sector. The aim of SILP is to survey communities to assess whether the resources allocated to education are used effectively.  The participatory monitoring approach was presented at school level to ensure that information was fed back to various State services.

Muhamed Bizimana of Care International presented the Community Card Score (CCP), giving a brief overview of this before launching workshop sessions to help participants familiarise themselves with the CCP and mobilise their support.

Main points:

• The principles of the CCP are based on participation, acceptability and shared responsibility.
• Four common principles with different participatory monitoring methods were presented.

  – Participation: designing the process with the beneficiaries/persons concerned by an initiative.

– Negotiation: agreeing on what will be monitored/assessed and the type of data to be collected.

– Learning: Integrating lessons learned to improve initiatives – cyclical challenges.

– Flexibility: aligning to the context and conditions of the environment

• The results achieved by the CCP include increased service availability and improved access to and use of services. It has been successful in involving citizens, improving relations and encouraging dialogue between service users and providers. The challenges include the fact that it is anchored in the national performance management and accountability system.

Presented by Anne Floquet: the SILP can help to reduce distance

Presented by Anne Floquet: the risk of a lack of community participation

Day 4

Summary of previous three days and presentation of country roadmaps and the support scheme.