Nnp-Ii 2016-2020

FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
NATIONAL
NUTRITION
PROGRAM
2016–2020
We the undersigned, representing the Government of the Federal Democratic Republic
of Ethiopia, National Nutrition Coordination Body, fully recognize each ministry’s
mandate and pledge our commitment to support the achievement of the targets laid out
in this National Nutrition Program document and the Seqota Declaration implementation
manual. We will strive towards equitable and sustainable multisectoral actions to
realize optimal nutritional status for all Ethiopians and to end hunger by 2030. We,
as a government, recognize that the high malnutrition rate in Ethiopia is completely
unacceptable. Hence, we shall work through enhanced strategic partnerships to
prioritize the elimination of malnutrition from Ethiopia as one of the primary strategies
for achieving the second Growth and Transformation Plan.
H.E. Dr. Kebede Worku H.E. Dr. Tilaye Gete

State Minister of Health State Minister of Education
H.E. Ato Wondrad Mandefro H.E. Dr. G/Egiziabher G/Yohannes

State Minister of Agriculture and State Minister of Livestock and
Natural Resources Fishery Resource Development
H.E. Dr. Mebrahtu Meles H.E. Ato Jemesdeng Choltot

State Minister of Industry State Minister of Water,
Irrigation and Electricity
H.E. Ato Asad Ziad H.E. Ato Alemayehu Gujo

State Minister of Trade State Minister of Finance
and Economic Cooperation
H.E. Ato Remedan Ashenafi H.E. W/ro Bizunesh Meseret

State Minister of Labor and State Minister of Women and
Social Affairs Children Affairs
H.E. Ato Mitiku Kassa H.E. W/ro Firehiwot Ayalew H.E. Ato Addisu Arega
Commissioner, State Minister of State Minister of Youth
National Disaster Risk Management Government Communication Affairs and Sport
Coordination Commission
H.E. Ato Demeke Mekonnen

Deputy Prime Minister
GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020 3

TABLE OF CONTENTS
Acronyms....................................................................................................................................................... 6
Figures and Tables......................................................................................................................................... 8
CHAPTER 1: Introduction....................................................................................................................... 9
1.1 Background.............................................................................................................................................. 9
1.2 Global Nutrition Movements and Declarations....................................................................................... 14
2. CHAPTER 2: Lessons from NNP and Focus on NNP II............................................................ 17

2.1 Lessons and Achievements from NNP I................................................................................................. 17
2.2 NNP I Implementation Challenges......................................................................................................... 20
2.3 Rationale for Developing NNP II............................................................................................................ 21
2.4 NNP II Focus and Approach................................................................................................................... 22
CHAPTER 3: Strategic Objectives and Initiatives.......................................................................... 24

The Goals of NNP II..................................................................................................................................... 24
Strategic Objectives of NNP II...................................................................................................................... 24
Strategic Objective 1.................................................................................................................................25
Result 1.1: Nutritional Status of Adolescents Improved............................................................................... 26
Result 1.2: Nutritional Status of Women of Reproductive Age Improved.................................................... 27
Strategic Objective 2................................................................................................................................. 28
Result 2.1: Improved Nutritional Status of Infants and Young Children 0-23 Months................................. 29
Result 2.2: Improved Nutritional Status of Children 24-59 Months............................................................. 31
Result 2.3: Improved Nutritional Status of Children Ages 6-10................................................................... 33
Result 3.1: Improved Nutrition Service Delivery for Communicable and Non-
Communicable Diseases............................................................................................................................. 34
Result 3.2: Healthy Lifestyles and Nutrition Promoted................................................................................. 37
Result 4.1: Strengthened Implementation of Nutrition-Sensitive Interventions
in the MOANR and Ministry of Livestock and Fishery Resource Development........................................... 40
in the Education Sector................................................................................................................................ 45
in the Water, Irrigation and Electricity sector................................................................................................ 46
in the Industry Sector................................................................................................................................... 47
4 GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020

in the Trade Sector....................................................................................................................................... 48
Result 4.6: Strengthened Social Protection Services for Improved Nutrition.............................................. 49
Result 4.7: Strengthened Nutrition-Sensitive Interventions in
Disaster Risk Management.......................................................................................................................... 50
Result 4.8: Ensured Quality and Safety of Nutrition Services and Supplies............................................... 51
Result 4.9: Improved Nutrition Supply Management.................................................................................. 52
Result 4.10: Improved Nutrition Communication........................................................................................ 52
Result 4.11: Improved Gender-Sensitive Nutrition Implementation............................................................ 53
Strategic Objective 5................................................................................................................................. 54
Result 5.1: Improved Community Level Nutrition Implementation Capacity................................................ 55
Result 5.2: Improved Nutrition Workforce Capacity..................................................................................... 56
Result 5.3: Improved NNP Institutional Implementation Capacity and Multisectoral Coordination.............. 56
Result 5.4: System Capacity Strengthened for Improved NNP Implementation.......................................... 57
Result 5.5: Improved Capacity to Conduct Nutrition Monitoring, Evaluation and Research........................ 58
Result 5.6: Improved Regulatory Capacity ................................................................................................. 58
Result 5.7: Improved Capacity of Media...................................................................................................... 58
CHAPTER 4: Nutrition Implementation and Governance............................................................ 59

Objectives ................................................................................................................................................... 59
Nutrition Governance................................................................................................................................... 59
4.1 Political Commitment and Policy Framework......................................................................................... 60
4.2. Multisectoral Nutrition Coordination...................................................................................................... 60
4.3. Capacity Building for Nutrition............................................................................................................... 66
4.4. Gender Dimensions of Nutrition............................................................................................................ 69
4.5. Nutrition Communication....................................................................................................................... 70
CHAPTER 5: Sustainable Nutrition Financing................................................................................ 73

CHAPTER 6: Monitoring, Evaluation and Research...................................................................... 75
6.1 Monitoring and Evaluation..................................................................................................................... 75
6.2 Operational Research............................................................................................................................ 77
ANNEX: Accountability and Results Matrix for NNP Implementation...................................... 80

ACRONYMS
AEW: Agriculture Extension Worker
AGP: Agriculture Growth Program
AMIYCN: Adolescent, Maternal, Infant and Young Child Nutrition
ANC: Antenatal Care
BMI: Body Mass Index
CAADP: Comprehensive Africa Agriculture Development Program
CBN: Community Based Nutrition
CHD: Community Health Day
CMAM: Community Management of Acute Malnutrition
CSA: Central Statistics Authority
DRMFSS: Disaster Risk Management Food Security Sector
ECCD: Early Childhood Care and Development
EDHS: Ethiopian Demographic Health Survey (National)
EIAR: Ethiopian Institute of Agricultural Research
EOS: Enhanced Outreach Strategy
EPHI: Ethiopian Public Health Institute
FAO: Food and Agricultural Organization
FMOH: Federal Ministry of Health
FTC: Farmers Training Center
GDP: Gross Domestic Product
GM: Growth Monitoring
GNP: Gross National Product
GTP: Growth and Transformation Plan
HAB: Household Asset Building
HDA: Health Development Army
HEP: Health Extension Program
HEW: Health Extension Worker
HH: Household
HMIS: Health Monitoring Information System
HP: Health Post
HSDP: Health Sector Development Program
HSTP: Health Sector Transformation Plan
HW: Health Workers
IEC: Information Education Communication
IFAD: International Fund for Agricultural Development
IFPRI: International Food Policy Research Institute
IGA: Income Generating Activities
IMNCI: Integrated Management of Neonatal and Childhood Illnesses
IRT: Integrated Refresher Training
ISS: Integrated Supportive Supervision
ITN: Insecticide Treated Net
IYCN: Infant Young Child nutrition
MAM: Moderate Acute Malnutrition
MDG: Millennium Development Goals
MOANR: Ministry of Agriculture and Natural Resources
MOT: Ministry of Trade
MOI: Ministry of Industry

MOE: Ministry of Education
MOFED: Ministry of Finance and Economic Development
MOFEC: Ministry of Finance and Economic Cooperation
MOWIE: Ministry of Water, Irrigation and Electricity
MOH: Ministry of Health
MOLFR: Ministry of Livestock and Fishery Resource Development
MOLSA: Ministry of Labor and Social Affairs
MOWCA: Ministry of Women and Children Affairs
NACS: Nutrition Assessment, Counseling and Support
NCD: Non-Communicable Disease
NFFSC: National Food Fortification Steering Committee
NNCB: National Nutrition Coordination Body
NNP: National Nutrition Program
NNPMSC: National Nutrition Program Management Steering Committee
NNS: National Nutrition Strategy
NNTC: National Nutrition Technical Committee
NSFP: National School Feeding Program
NSS: Nutrition-Sensitive Agriculture Strategy
ORS: Oral Rehydration Sachets
PFSA: Pharmaceuticals Fund and Supply Agency
PHCU: Primary Health Care Unit
PLW: Pregnant and Lactating Women
PMTCT: Prevention of Mother-To-Child Transmission
PPP: Purchasing Power Parity
PSNP: Productive Safety Net Program
REACH: Renewed Efforts Against Childhood Hunger
RNCB: Regional Nutrition Coordination Body
RUSF: Ready-to-Use Supplementary Food
RUTF: Ready-to Use-Therapeutic Food
SAM: Severe Acute Malnutrition
SDG: Sustainable Development Goal
SHN: School Health and Nutrition
SBCC: Social and Behavioral Change Communication
SUN: Scaling Up Nutrition
TB: Tuberculosis
TVET: Technical and Vocational Education and Training
UNGNA: United Nations Global Nutrition Agenda
UNICEF: United Nations Children's Fund
USI: Universal Salt Iodization
WASH: Water, Sanitation and Hygiene
WFP: World Food Program
WHO: World Health Organization

FIGURES AND TABLES
LIST OF FIGURES
Figure 1: Role of nutrition in achieving the Sustainable Development Goals 10
Figure 2: Trends in nutritional status of children under 5 in Ethiopia, 2000–2014 13
Figure 3: Trends in nutritional status of adolescents and women of reproductive age
2000–2005 in Ethiopia 14
Figure 4: Building blocks of effective nutrition governance 60
Figure 5: Multisectoral nutrition coordination: National Coordination Body 63
Figure 6: Multisectoral nutrition coordination: National Nutrition Technical Committee 63
Figure 7: Nutrition coordination, reporting line and feedback mechanisms 64
Figure 8: Nutrition implementation levels and necessary institutional arrangements 65
Figure 9: National nutrition technical committees 65
Figure 10: Dimensions of nutrition capacity building 66
Figure 11: NNP budget gap 74
Figure 12: Strong program Implementation system 76
LIST OF TABLES

Table 1: Number of indicators in each SDG that are highly relevant for nutrition 12
Table 2: Nutrition-specific and nutrition-sensitive strategies/programs/guidelines

in Ethiopia 61
Table 3: Nutrition workforce requirements at various levels 68
Table 4: NNP estimated intervention budget, 2016–2020 74
Table 5: Operational research priorities (2016-2020) 78

INTRODUCTION
1.1 BACKGROUND
1.1.1 COUNTRY PROFILE
1
Ethiopia, located in the Horn of Africa, lies
between 3o and 15o North and 33o and 48o
East. The total area of the country is around
1.1 million square kilometers. As of 2007,
Ethiopia’s population has been growing at
a rate of 2.6% per annum (CSA, 2007). At
this rate, the total population will number
104 million by 2020. This rapid population
growth exacerbates critical gaps in basic
health services, and in food and nutrition
security (MOH, 2008). The majority of the
population (84%) lives in rural areas, and
subsistence agriculture is the mainstay of
their livelihood and economic productivity.
CHAPTER The Government has been implementing a
comprehensive economic reform program
over the last two decades. The reform pro-
gram has resulted in remarkable economic
performance; macroeconomic stability was
attained. A real gross domestic product
(GDP) growth rate of 11% per annum has
been achieved since 2003. According to
the Ethiopia poverty assessment, Ethiopian
households have experienced a remarkable
reduction in poverty. In 2010, 56% of the
population was living on less than US$1.25
per day (known as purchasing power parity
or PPP). That figure was expected to further
decrease to 22.2% by 2015 (EPA, 2012;
MOFED, 2013). Yet due to high population
growth, the absolute number of people living
below the poverty line has decreased more
slowly than expected over the last 10 years.
While 38.7% of Ethiopians lived in extreme
poverty in 2004–2005, five years later this
figure had dropped to 29.6%, as measured
by the national poverty line of less than $0.6
per day.

Nutrition vital for achieving goals Achieving goals support
Figure 1: Role of nutrition in achieving SDGs
Ethiopia has developed the second stage health, education, and employment goals
of its 5-year development plan, called the (Global Nutrition Report, IFPRI, 2014). Nu-
Growth and Transformation Plan II (GTP II), trition stimulates economic growth, which
covering the period 2015/16 to 2019/20. The improves the mental health and physical
overarching objective of the plan’s second productivity of the labor force. Eliminating
phase is the realization of Ethiopia’s vision undernutrition in Ethiopia would prevent
of becoming a lower middle-income country losses of 8–11% per year from the gross
by 2025. GTP II thus aims to achieve high national product (IFPRI, 2014, UNGNA,
economic growth within a stable macroeco- 2015). Globally, hunger and undernutri-
nomic environment while at the same time tion reduce gross domestic product by
pursuing aggressive measures towards US$1.4–2.1 trillion a year (Compact, IFPRI
rapid industrialization and structural trans- 2016). The World Bank estimates that un-
formation (MOFED, 2015). dernourished children are at risk of losing
more than 10% of their lifetime earning po-
1.1.2 MALNUTRITION tential, thus affecting national productivity,
Malnutrition in all its forms is a global bur- and recently, a panel of expert economists
den that affects almost every country in at a Copenhagen Consensus Conference
the world, leading to serious public health concluded that fighting malnutrition should
risks and incurring high economic costs. Im- be the top priority for policymakers and
provements in nutrition will contribute signifi- philanthropists (Copenhagen Consensus,
cantly to reducing poverty and to achieving 2012). The benefits of better nutrition to

health, schooling, and productivity would Sustainable development is a driver of mal-
be tremendous. Improving the national nu- nutrition reduction; improved nutrition will
trition status is therefore a priority area that propel sustainable development. Evidence
needs urgent policy attention to accelerate indicates that the forces that prevent healthy
socioeconomic progress and development. growth and development in such a profound
way—hunger, disease, poverty, disempow-
In 2013 the Government of Ethiopia to- erment and unhealthy environments—are
gether with the African Union Commission powerful and multisectoral. Therefore, these
published “The Cost of Hunger in Ethiopia need to be counteracted by equally powerful
2013,” a report that quantifies the social and multisectoral and multi-stakeholder forces
economic impact of undernutrition (EPHI- combining actions that are nutrition-specific,
AU, 2009). Data in the report included cal- nutrition-sensitive, and environmentally en-
culations of the costs of child undernutrition abling at all levels (Global Nutrition Report,
in the health and education sectors. The 2015; IFPRI, 2015). Hence, as indicated
effects of child undernutrition on human ca- by Figure 1, nutrition is placed at the heart
pacity and workforce productivity were also of the SDGs—indeed, nutrition is vital for
quantified. Based on the report’s findings, achieving 12 out of 17 SDGs (Table 1). The
the total annual cost of undernutrition in remaining 5 SDGs support improvements in
Ethiopia was estimated at ETB 55.5 billion, nutrition.
equivalent to 16.5% of GDP in 2009 (EPHI-
AU). According to the study, Ethiopia could
1.1.4 GLOBAL AND REGIONAL
reduce losses by ETB 148 billion by 2025 if
underweight rates were reduced to 5% and MALNUTRITION TRENDS
stunting to 10% in children under 5. Reduc- An estimated 805 million people world-
ing child undernutrition rates to half the cur- wide are chronically undernourished (FAO,
rent levels by 2025 could reduce losses by 2014), One hundred fifty-nine million chil-
ETB 70.9 billion, the study suggests. dren under 5 are stunted and 41 million
children under 5 are overweight and obese.
In addition, at least 50 million are severely
1.1.3 NUTRITION: MDGS or moderately wasted (WHO/UNICEF/The
TO SDGS World Bank, 2015). Furthermore, there are
In 2000, world leaders adopted the Millenni- about 2 billion children and adults who are
um Declaration and agreed on a set of eight deficient in vitamins or minerals, which can
Millennium Development Goals (MDGs), lead to anemia, blindness, cognitive impair-
which were not fully achieved by most coun- ment, greater susceptibility to many diseas-
tries. Lessons learnt from the MDG frame- es that can result in higher mortality (UN
work specific to nutrition include the realiza- SCN, 2015). Overweight prevalence has
tion that the focus on undernutrition was too gone up slightly between 1990 and 2014,
narrow, and that synergies between nutri- from 4.8% to 6.1%. There are 41 million
tion and other sectors were underexploited overweight children in the world, about 10
(UN SCN, 2015). million more than there were 2 decades ago
(See Box A; WHO, 2014).
The Sustainable Development Goals or
SDGs, officially known as Transforming
Our World: The 2030 Agenda for Sustain- 1.1.5 NUTRITION TRENDS
able Development, are an intergovernmen- IN ETHIOPIA
tal set of aspiration goals with 169 targets. The last four national level Demographic and
Spearheaded by the United Nations, the Health Surveys (EDHS) show a decreasing
goals are contained in paragraph 54 of trend in the proportion of children who are
United Nations Resolution A/RES/70/1 of stunted and underweight. The prevalence
September 25, 2015. of stunting decreased by 31% (from 58%

Table 1: Number of indicators in each SDG that are highly relevant for nutrition
0 5 10 15 20 25 30
Goal 5: Gender equality 12 2
Goal 3: Healthy lives 12 14
Goal 2: Hunger and nutrition 7 7
Goal 1: Poverty 7 5
Goal 11: Cities 3 12
Goal 10: Reduce inequality 3 8
Goal 6: WASH 3 8
Goal 4: Education 3 8
Goal 16: Peace and justice 2 21
Goal 8: Growth and employment 2 15
Goal 17: Global partnerships 1 24
Goal 12: Sustainable consumption & production 1 12
Goal 15: Terrestrial ecosystems 16
Goal 14: Oceans 10
Goal 13: Climate change 6
Goal 9: Infrastructure 12
Goal 7: Energy access 6
Number of indicators highly relevant to nutrition (56 indicators)

Number of indicators not highly relevant to nutrition (186 indicators)

Box A: Trends in the global nutritional status of children
■■ The global trend in stunting prevalence and numbers of children affected is de-
creasing, but not fast enough to have reached the MDG target. Stunting rates are
dropping, but 159 million children around the world are still affected. Between 1990
and 2014, stunting prevalence declined from 39.6% to 23.8% (-96 million).
■■ In 2014, the global wasting rate was 7.5%, still threatening the lives of 50 million
children across the globe. Approximately 1 out of every 13 children in the world
was wasted in 2014, with a global prevalence of 2.4% in 2014.
■■ Overweight prevalence has gone up slightly between 1990 and 2014, from 4.8% to
6.1%. There are 41 million overweight children in the world; about 10 million more
than there were 2 decades ago.
to 40%) between 2000 and 2014 (Figure exclusively breastfed, and, of even greater
2). The decline in the proportion of stunted concern, only 4.3% of children aged older
Ethiopian children shows an improvement in than 6 months consumed the recommend-
chronic malnutrition over the past 15 years. ed 4 food groups daily. Only 13% of children
The proportion of underweight children de- under 2 consumed iron rich foods (EDHS,
clined even more substantially, by 39% over 2011). While there have been recent im-
the same period. Conversely, the preva- provements in the production of iodized salt,
lence of wasting has remained fairly static still only 23% of households are consuming
over the last 15 years. Anemia prevalence quality iodized salt in accordance with the
among under-five children remains high at levels specified in the regulations. The 2011
44%, even though it declined by 19% over EDHS also revealed that the level of chron-
the last 6 years (EDHS, 2011). ic malnutrition among women (15–49 years
old) in Ethiopia is relatively high, with 27%
Regarding infant feeding practices, just over having a body mass index (BMI) of less
half (52%) of children under 6 months were than 18.5 kg/m2 (Figure 3), with no signifi-
Figure 2: Trends in nutritional status of children under 5 in Ethiopia, 2000–2014

Figure 3: Trends in nutritional status of adolescents and women of reproductive age
2000–2005 in Ethiopia
cant progress over the last decade. Similar- of inter-pregnancy interval and psychoso-
ly, the prevalence of anemia among women cial care.
in the reproductive age group (15–49) was
found to be 17% (EDHS 2011). 1.2 GLOBAL NUTRITION MOVE-
Ethiopia is not different from other low in- MENTS AND DECLARATIONS
come countries with respect to the nutrition- Scaling up Nutrition, or SUN, is a unique
al status of adolescents. The EDHS 2011 movement founded on the principle that all
revealed that the proportion of non-preg- people have a right to food and good nu-
nant adolescents aged 14–19 years with trition. It unites people, governments, civil
chronic malnutrition (BMI <18.5) was 36% society, the United Nations, donors, busi-
(Figure 3). It is well recognized that the size nesses and researchers in a collective effort
and body composition of the mother at the to improve nutrition. SUN was launched in
start of pregnancy is one of the strongest in- 2010 with the adoption of the SUN Frame-
fluences on fetal growth (Kramer, 1987). Ac- work and Road Map, and has grown rapidly.
cording to the 2011 EDHS, the median age In December 2015 the country-driven SUN
for a first marriage is around 16.5. Twelve Movement comprised 55 SUN countries. It
percent of adolescent girls (aged 15–19) continues to expand, building on the prog-
are either already mothers or pregnant with ress achieved. Key facts about SUN are
their first child. Prevalence of anemia in ad- depicted in Box B. Ethiopia joined the SUN
olescents aged 15–19 years was 13%. The movement in April 2012.
Ethiopian mini-DHS (EMDHS) conducted in
2014 states that the fertility rate among ado- SUN stakeholders work together within
lescents aged 15–19 in Ethiopia is 65 births each country to pursue the following four
per 1,000 women. Although this shows clear strategic objectives:
improvement from 2011 (79 births per 1,000
women), efforts should be continued to pro- 1. Create an enabling political environ-
mote preconception care, family planning, ment, with strong in-country leadership
delayed age at first pregnancy, prolonging and a shared space (multi-stakehold-

er platforms) where stakeholders align food and nutrition security challenges
their activities and take joint responsibil- in a coordinated fashion.
ity for scaling up nutrition.
■■ The Global Nutrition for Growth
2. Establish best practices for scaling Compact, made at the 2013 Nutrition
up proven interventions, including the for Growth summit in London.
adoption of effective laws and policies.
■■ The African Union’s Malabo Declaration
3. Align actions around high quality, on Accelerated Agricultural Growth
well-costed country plans, with an and Transformation for Shared Pros-
agreed results framework and mutual perity and Improved Livelihoods un-
accountability. der the framework of the Comprehensive
Africa Agriculture Development Program.
4. Increase resources directed towards This was a response to the United Na-
coherent, aligned approaches. tions Secretary General’s Zero Hunger
Challenge (2012), which followed on the
Many nutrition declarations have been made success of hunger eradication programs
globally, however. Among the most notable in other parts of the world and the impor-
that relate to Ethiopia are the following: tance of multi-sector actions to achieve
this objective.
■■ The July 2003 Maputo Declaration,
which accepted the Comprehensive
Africa Agriculture Development Pro- ■■ The Rome Declaration on Nutrition,
gram as the framework for addressing on achieving food and nutrition security
Africa’s agricultural development, and as well as commitment to achieving the
Box B: Key facts about the SUN movement
■■ 55 Countries and the State of Maharashtra have committed to scaling up nutrition and
working collectively, as a movement.
■■ SUN Country Networks are focused on the critical 1,000 day window of opportunity to
improve nutrition.
■■ SUN Countries work to achieve the six World Health Assembly Goals by 2025.
■■ There are 2,000+ organizations committed to supporting national plans.
■■ SUN is 1 global movement across 55 country-led movements to unleash the potential of

millions of healthier, smarter and stronger children.

Millennium Development Goals, made
at the Second International Conference
on Nutrition in November 2014.
■■ Ethiopia’s 2015 Seqota Declaration,

which reaffirmed the government’s
commitment to improving nutrition
through a high level agenda to end child
undernutrition by 2030.

LESSONS FROM NNP AND
FOCUS ON NNP II
2.1 LESSONS AND
ACHIEVEMENTS FROM NNP I
Maternal, infant and child undernutrition are
2
still national problems with important con-
sequences for survival and for incidence of
acute and chronic diseases, healthy devel-
opment, and economic productivity, at both
individual and societal levels. Over the past
decade, since the national nutrition strate-
gy was developed, the government, imple-
menters and nutrition development partners
have strived to create appropriate channels,
capacity and resources through which the
intergenerational cycle of malnutrition could
be halted and through which policy land-
scapes and government commitment could
be improved.
CHAPTER The first National Nutrition Program (NNP
I, 2008-2015) focused on integration and
coordination of nutrition-specific interven-
tions that addressed the immediate causes
of suboptimal growth and development and
the potential effects of nutrition-sensitive
interventions that address the underlying
determinants of malnutrition. The program
also aimed to create an enabling environ-
ment through which nutrition interventions
were governed and supported by evidence-
enhanced decision making. The passages
below recount the main achievements and
implementation challenges, and discuss
focus areas for NNP II, the program’s sec-
ond phase.
Encouragingly, malnutrition has been de-

creasing over the last two decades. Focus-
ing on food security and scaling up nutrition
programs have a made tremendous contri-
bution to reducing undernutrition. However,
millions of Ethiopians still suffer from chron-
ic and acute malnutrition. The country ranks

at the top both in sub Saharan Africa and the past decade. The fourth phase of the
the world for malnutrition (Global Nutrition Federal Ministry of Health’s Health Sector
Report, 2015) Although the progress and Development Plan (HSDP IV) has integrat-
achievements made so far are commend- ed nutrition into the Health Extension Pro-
able, addressing the deep-rooted causes of gram (HEP) to improve the nutritional status
malnutrition and ending hunger in Ethiopia of mothers and children through scaled-up,
call for high impact integrated and coordi- nutrition-specific interventions: maternal,
nated interventions. infant and young child nutrition promotions,
micronutrient interventions, and community
The Government of Ethiopia demonstrated management of acute malnutrition (CMAM).
policy commitment to nutrition by develop- These interventions are being carried out
ing a standalone National Nutrition Strategy at health posts, in communities, at other
(NNS) along with the 7-year NNP (2008- health facilities and through health develop-
2013 and 2013-2015). Nutrition indicators ment armies. More than 10 million children
were incorporated into the nation’s 5-year are receiving Vitamin A supplementation
Growth and Transformation Plan. Moreover, and are dewormed twice a year.
the government successfully established
an implementation platform, the National Thanks to these efforts, the prevalence
Nutrition Coordination Body (NNCB) and of maternal anemia has declined from
the National Nutrition Technical Committee 27% in 2005 to 17.1% in 2016 (CSA,
(NNTC). Through these structures nutrition 2011). Furthermore, more than 14,000
interventions were integrated, coordinated health facilities (about 95% of which are
and mainstreamed into the various national health posts) have the capacity to provide
development sectors. Sector based strate- CMAM services. A national assessment
gies and programs created a good oppor- has indicated that the impact of such
tunity to mainstream nutrition and develop interventions has resulted in reduced
legal frameworks to enforce key nutrition in- undernutrition among children. This in turn
terventions such as the Nutrition-Sensitive has contributed to an over 50% reduction in
Agriculture Strategy, National Food Securi- childhood deaths in Ethiopia.
ty Strategy, National Health Sector Trans-
formation Plan, National Food Fortification, The approach to nutrition screening,
and the National School Health and Nutri- provision of Vitamin A supplementation and
tion Strategy. deworming will transition from campaign
based activities (Community Health Day)
However multisectoral coordination and and become enfolded into routine HEP
integration were not effective in bringing activities, first in the four agrarian regions
about sought changes to this long-lasting (Oromiya, Amhara, SNNPR, and Tigray) and
public health problem. This was mainly be- then nationally. In the developing regional
cause of inadequate commitment and lack states of Benishangul-Gumuz and Somali,
of strong, suitable governance structures. the Enhanced Outreach Strategy (provision
of Vitamin A, screening of children 6-59
2.1.1 PROGRAM IMPLEMENTATION months and deworming of children 24-59
months) is being transitioned into Community
Nutrition-Specific Interventions Health Day activities. Moreover, several
Maternal undernutrition contributes to neo- guidelines are being revised to standardize
natal death, stunting, wasting and micro- the provision of nutrition-specific services at
nutrient deficiencies. Progress has been all levels.
made; many interventions are being im-
plemented at scale and evidence for the The Community Based Nutrition program
effectiveness of nutrition interventions and (CBN), one of the key components of the
strategies for their delivery has grown over NNP, has made nutrition a priority agenda

item for families and communities and is in- household food security program it has, for
fluencing sustainable behavioral changes all practical purposes, evolved into a broad-
in child care practices and health-seeking er package of social protection, now com-
behaviors. The CBN program also brought prising four components: social protection,
commendable changes in growth moni- livelihoods, disaster risk management, nu-
toring and promotion for all children under trition and climate resilience/green econo-
2 years of age together with counseling my.
for caregivers. The program uses regular
community dialogue to engage community During its fourth stage (PSNP IV) the pro-
members to assess the overall nutritional gram was made more nutrition-sensitive
status of children in their community, to un- through the incorporation of additional nutri-
derstand the barriers and potential supports tion provisions, “soft conditionality” exemp-
for improved nutrition, and to develop con- tions from physical labor for pregnant and
sensus on plans of action to make a differ- lactating women with a child under 1 and
ence. for mothers with a severely malnourished
child under 5. These mothers are provided
Nutrition-Sensitive Interventions with “temporary transition to direct support”
Acceleration of progress in nutrition will re- (i.e., cash or food). Instead of participating
quire nutrition-sensitive programming—ef- in public works they engage in communi-
fective, large-scale programs that address ty based nutrition activities, such as social
key underlying determinants of nutrition and and behavioral change communication and
enhance the coverage and effectiveness growth monitoring and promotion sessions.
of nutrition-specific interventions (Ruel and A process of “co-responsibility” helps en-
Alderman, 2013). Evidence indicates that sure their participation in these activities.
the forces that prevent healthy growth and PSNP IV promotes links to social services
development in such a profound way—hun- and activities such as daycare; women’s
ger, disease, poverty, disempowerment, empowerment activities; and activities
unhealthy environments—are powerful and related to water, sanitation and hygiene
multisectoral. Therefore, these need to be (WASH). The PSNP IV monitoring frame-
counteracted by equally powerful, multisec- work includes indicators of participation in
toral, multi-stakeholder forces that combine nutrition promotion activities at community
nutrition-specific, nutrition-sensitive and level. The framework allows for the regular
environment enabling actions at all levels collection and reporting of information on
across sectors (Global Nutrition Report, household food security, dietary diversity
2015;IFPRI, 2015; Black et al., 2008) and child feeding practices.
Mainstreaming Nutrition into Agricul- The Agricultural Growth Program (AGP), im-
ture: In addition to developing a document plemented in 96 woredas in the four agrar-
in 2015 on nutrition-sensitive agriculture, the ian national regional states since 2011, is a
Ministry of Agriculture and Natural Resourc- multi-donor financed program designed to
es has taken the initiative to mainstream nu- raise productivity and increase market ac-
trition into its overall sectoral plans and has cess for key crop and livestock products
established nutrition implementing struc- in targeted woredas, carried out with in-
tures. The government has also been im- creased participation of women and youth.
plementing the Productive Safety Net Pro- The approach of AGP is value-chain orient-
gram (PSNP) since 2005. The PSNP began ed, decentralized, participatory, integrated,
as a food “safety net” that would provide and focuses on key rural and agricultural
food or cash for food insecure households development constraints.
during the “hungry” seasons of the year in
exchange for public works through the Min- School Feeding Program: The Ministry of
istry of Agriculture. Although it began as a Education (MOE) designed the Ethiopian

National School Feeding Program (NSFP) development partners, strengthened their
to (1) improve schoolchildren’s health and capacity to create a common understanding
nutrition status, (2) increase access to edu- of nutritional issues and of how to manage
cation (including enrolment, attendance, re- a multisectoral nutrition program and further
tention and completion), (3) reduce gender strengthen the coordination platforms.
and social inequalities by targeting the most
vulnerable groups, and (4) increase small- 2.1.3 NEW INITIATIVES
holder farmers’ access to the school feeding The Government of Ethiopia has continued
market, thereby increasing their incomes. its commitment to nutrition by developing
the second phase of the National Nutrition
Now in the 2016-2020 phase, the NSFP Program (NNP II, 2016-2020). A component
aims to address the needs of the most vul- of NNP II is a high level commitment called
nerable population groups and areas, spe- The Seqota Declaration, which will be man-
cifically targeting primary school children aged under NNP II and implemented by
(Grades 0 through 8), in 50 prioritized zones the sectors. The Seqota Declaration aims
across 6 regions and covering 3 million chil- to transform the lives of Ethiopian children
dren. By year 5 (2020), the NSFP will cover through integrated community development
more than 50% of primary students enrolled in agriculture, health, nutrition, education,
in Afar and Somali regions and 15% of stu- water, sanitation and hygiene, as well as
dents nationally. The 5-year NSFP funding social protection. The goal is to end child
requirements are estimated at between undernutrition by 2030 (See Box C).
ETB 4.08bn and ETB 5.1bn.
Innovation is central to achieving the goals
Food Fortification: Food fortification will of the Seqota Declaration and promoting
be one of the major focal areas for alleviat- nutrition security in some of the most food
ing the nation’s nutrition problem. Coverage insecure areas of the country. This transfor-
of universal salt iodization has reached over mation agenda has child development at its
85%, although iodine levels are still limited center and nutrition within its core. Hence, it
because iodization facilities are inefficient. focuses on the development of human cap-
Until recently, food fortification was not giv- ital, with a particular focus on future gener-
en much attention, despite its being one of ations.
the most sustainable ways of dealing with
micronutrient interventions. The Nutrition
Program points to the fortification of oil and
flour as one of the means for addressing 2.2 NNP I IMPLEMENTATION
micronutrient (vitamin and mineral) defi- CHALLENGES
ciencies. This process has already begun,
while the standards for fortification are be- The challenges faced in the implementation
ing developed. of NNP I, which need to be addressed in the
second National Nutrition Program, are as
follows:
2.1.2 MULTISECTORAL RESPONSE
AND COORDINATION ✓✓ Adolescent nutrition and lifestyle related
During NNP I, the government revitalized malnutrition initiatives, including com-
the National Nutrition Coordination Body municable and non-communicable dis-
(NNCB) and its technical committee, and eases, were not implemented or moni-
established a Regional Nutrition Coordi- tored under NNP I.
nation Body (RNCB) in almost all regions.
Woreda-level coordination bodies have ✓✓ Although multisectoral nutrition coordi-
been formed in most of the agrarian regions. nation and integration had been advo-
NNP-implementing sectors, working with cated on every forum and seemed to

Box C: The Seqota Declaration: A GoE commitment to
end child undernutrition in Ethiopia by 2030
The momentum for nutrition improvement in Ethiopia is strong. The challenge is to lock in the
current high level of commitment to reducing malnutrition in all its forms and convert this com-
mitment into accelerated decline. Thus the Sequota Declaration, named for the town in which
it was launched, was initiated in 2015.
The key goals of the Sequota Declaration include, among others, the following:
■■ Zero stunting in children under 2 years old

■■ 100% access to adequate food all year round
■■ Transformed smallholder productivity and income
■■ Zero post-harvest food loss through reduced post-harvest loss
■■ Innovation around the promotion of sustainable food systems (climate smart)
■■ Water, sanitation and hygiene
■■ Education
■■ Social protection
have improved over the last 5 years, implemented because of delays in the
most line ministries have lagged in development of mandatory fortification
mainstreaming nutrition into their sec- standards and directives.
toral strategic plans. This was especially
true of efforts to cascade nutrition down ✓✓ Mechanisms for triangulated nutrition
to the implementation level: information that capture data from all
relevant sectors are not available.
• Line ministries lack an effective
organizational structure (director-
ates, departments, case teams, 2.3 RATIONALE FOR
desks, focal persons) to effectively DEVELOPING NNP II
mainstream nutrition into their core
mandated activities. The NNP II was developed:
• Some implementing sectors did ✓✓ To strategically address the aforemen-

not sensitize their strategic plan tioned challenges in the implementation
with nutrition initiatives or allocate of NNP I and to maximize and sustain
a budget. the achievements and changes brought
so far through integrated and compre-
hensive nutrition service delivery.
✓✓ The existing structure is not strong
enough to coordinate NNP implementa- ✓✓ To brand the “1,000 Days” initiative (see
tion with clearly defined responsibilities Section 2.4) through intensive social
and accountabilities for achievements and behavioral change communication
and failures at levels above that of im- and community mobilization.
plementing line ministries.
✓✓ To strengthen those strategic objec-
✓✓ Food fortification (oil and flour) was not tives that were not well addressed in the

first NNP, such as nutrition interventions were highly commendable. The significant
among adolescents and individuals with steps taken by the Ethiopian government
communicable and non-communicable/ to fight the scourge of malnutrition are
lifestyle related diseases. duly acknowledged. However, the National
Nutrition Coordination Body—developed to
✓✓ To strengthen multisectoral nutrition institutionalize integration of nutrition into the
coordination and capacity building and various sectors to accelerate the reduction
implementation of nutrition-sensitive in- of malnutrition—has been ineffective. This
terventions across sectors. is partly because the National Nutrition
Technical Committee was hampered by lack
of clarity, the absence of an implementation
2.4 NNP II FOCUS AND guideline, lack of dedicated implementation
APPROACH personnel at sector level, and lack of
established reporting mechanisms using
2.4.1 LIFECYCLE APPROACH clear and measurable indicators. The
The government’s efforts to address malnu- committee was therefore not in a position
trition will be strengthened through the life- to accelerate and engage the NNCB in
cycle approach, with particular emphasis on implementing, monitoring and evaluating
the crucial period of pregnancy and the first the progress of the program.
2 years of life—the 1,000 days from con-
ception to a child’s second birthday, during
which good nutrition and healthy growth de- Several reviews have shown that a successful
liver lasting benefits throughout life. The first multisectoral coordination mechanism for
1,000 days is the period when the need for nutrition requires a legitimate institutional
nutritional and health care is elevated and arrangement with an authority mandated
when pregnant women and young children by country-level policy/decision-makers.
in Ethiopia in particular are most vulnera- To execute its mandate of coordinating the
ble to inadequate care, inadequate access sectors and fulfilling the aims of NNP II and
to health services and sub-optimal feeding the Seqota Declaration, the NNCB needs
practices. a revised institutional arrangement, along
with the necessary authority, resources
The next phase of the National Nutrition and accountability. It should be placed
Program will thus focus on specific age in a government institution above the
groups and will call for greater national pri- implementing sectors and empowered to
ority for integrating nutrition-specific and influence all relevant sectors. It is therefore
nutrition-sensitive programs; for enhanced proposed that NNCB be placed under the
inter-sectoral coordination; and for commu- office of the deputy prime minister and
nity, private, national and international col- invested with increased and appropriate
laboration to end malnutrition by 2030 (See executive power and accountability.
Box C). Moreover, the program’s design Existing coordination mechanisms should
has taken into account the major indicators be strengthened through strong reporting
and contributing factors in the Sustainable and feedback mechanisms, and concrete
Development Goals and in the country’s action plans must be developed.
Health Sector Transformation Plan.
Nutrition coordinating bodies and technical
2.4.2 MULTISECTORAL COORDINATION committees were established in most re-
AND NUTRITION GOVERNANCE gions and in some woredas, and activities to
The adoption of the National Nutrition build their capacity were undertaken. How-
Strategy in 2008 and the implementation ever, only a few of these bodies are func-
of the seven-year two-phase (2008-2013, tional. NNP II will address these issues by
2013-2015) National Nutrition Program

putting in place a clear structure of account- Integrated, multisectoral coordination at
ability along with reporting mechanisms to all levels must be strengthened along with
ensure that these entities are functional and community-level action. There must also
accountable to the regional president. This be clear guidance and better alignment of
structure would avoid sectoral bias in ex- programs and resources among partners,
ercising the authority vested in the NNCB. and programmatic decisions must be based
Sectoral members will be held accountable, on and supported by research and capable
both institutionally and collectively, for the knowledge management. Mechanisms for
achievement of the nutrition goals and tar- monitoring and evaluation must be in place,
gets set by the government. and triangulated nutrition information that
captures data from all relevant sectors must
In addition to strategically classifying in- be adequately integrated.
terventions and services, the smooth im-
plementation of nutrition-sensitive pro-
gramming will require the establishment of
suitable governance structures in ministries
and agencies. These structures should in-
clude new nutrition institutions/counsels, di-
rectorates, case teams, units and dedicated
focal personnel based on the demand and
intensity of the interventions.
Moreover, at sectoral level, the development

of strategic documents for mainstreaming
nutrition into already existing sector pro-
grams, the cascading of structures to ease
implementation, and the creation of sustain-
able financing and budget allocation might
all be viewed as potential ways of mea-
suring the commitment and level of imple-
mentation of the National Nutrition Program
within specific sectors.

STRATEGIC OBJECTIVES
AND INITIATIVES
THE GOALS OF NNP II
The goal of the National Nutrition Program
is to provide a framework for coordinated
implementation of nutrition interventions in
3
order to end hunger by 2030. The program
was developed in step with the govern-
ment’s efforts to realize the Seqota Decla-
ration through the integrated and coordinat-
ed implementation of high impact nutrition
interventions to reduce malnutrition among
children, women of reproductive age, ado-
lescents and the general population. The
main interventions under NNP II include op-
timal breastfeeding, optimal complementary
feeding, mitigation and prevention of micro-
nutrient deficiencies, WASH, deworming,
food fortification and management of acute
malnutrition.
CHAPTER STRATEGIC OBJECTIVES OF

NNP II
The Government of Ethiopia devised pro-
grams and initiatives with set targets that di-
rectly and indirectly contribute to the reduc-
tion of malnutrition and to ending hunger.
These programs include increasing agricul-
tural productivity, promoting girls’ education,
immunization, integrated management of
neonatal and childhood illnesses (IMNCI),
water, sanitation and hygiene (WASH), fam-
ily planning, prevention of mother-to-child
transmission of HIV (PMTCT), skilled deliv-
ery, delaying of first pregnancy, food forti-
fication, and management of micronutrient
deficiencies and acute malnutrition, among
others.
The interventions that fall under the

National Nutrition Program are grouped
into two major categories: nutrition-specific
and nutrition-sensitive. This grouping is

based on the impact of the intervention on and expected results of the program are
the immediate causes of malnutrition. The listed beneath each strategic objective.
overall goal of this program implementation The performance indicators and targets for
manual is to facilitate and ignite the each strategic objective also appear in the
accelerated reduction of malnutrition in accountability and results matrix at the end
order to achieve zero hunger by 2030 of the document (Annex I).
and meet Sustainable Development Goal
targets. Below, the core targets, initiatives
STRATEGIC OBJECTIVE
improve the nutritional status of women
1
(15–49 years) and adolescent girls (10–19 years)
Globally, maternal undernutrition contrib- Under Strategic Objective 1, the NNP’s in-
utes to 800, 000 neonatal deaths, and child terventions address the nutritional problems
undernutrition is estimated to underlie near- of adolescent girls and women of reproduc-
ly 3.1 million child deaths annually (Zulfiqar, tive age, including pregnant and lactating
2013). Maternal malnutrition, encompass- women.
ing both undernutrition and overweight,
are global problems with important con- 2020 TARGETS
sequences for survival, incidence of acute
and chronic diseases, healthy development ■■ Reduce the prevalence of anemia in ad-
and economic productivity. Adolescent nu- olescent girls from 30% to 15%.
trition is important to the health of girls and
is relevant to maternal nutrition. Especially, ■■ Reduce the prevalence of anemia
pregnancies in adolescence have a higher among women of reproductive age (15-
risk of complications and higher mortality 49 years) from 19.3% to 12%.
for mothers, infants and children, as well as
poorer overall birth outcomes than pregnan- ■■ Reduce the prevalence of anemia
cies in older women. among pregnant women from 22% to
14%.
Prevalence of low BMI (<18.5 kg/m2) in
adult women has decreased in Africa and ■■ Reduce the proportion of women of re-
Asia since 1980, but remains higher than productive age with BMI <18.5% from
10% in these two large developing regions. 27% to 16%.
Anemia (hemoglobin< 110 g/L), which might
be attributable to low consumption and/ ■■ Reduce the proportion of newborns with
or absorption of iron in the diet or to blood low birth weight (less than 2.5kg at birth)
loss, such as from intestinal worms, is high- from 11% to 5%.
ly prevalent during pregnancy and has a
significant impact on birth outcomes.

RESULT 1.1: NUTRITIONAL STATUS OF ADOLESCENTS IMPROVED
INITIATIVES
✓✓ Promote the use of iodized salt
1. Provide nutritional assessments and and strengthen enforcement of
counseling services for adolescents at universal salt iodization (USI) reg-
all contacts with health care providers. ulations.
✓✓ Conduct nutritional assessments ✓✓ Promote and support girls’ educa-

and counseling services in health tion.
facilities when an adolescent comes
for any kind of health service. ✓✓ Ensure that key influential groups
and individuals are aware of the
✓✓ Integrate adolescent nutrition ser- importance of adolescent nutrition
vices into youth centers and related and the consequences of malnutri-
community based programs. tion during adolescence.
✓✓ Conduct regular monitoring of the ✓✓ Provide life skills trainings (such as

nutritional status of school-age chil- assertiveness, negotiation skills,
dren/adolescent girls. and decision-making, leadership
and bargaining skills) for girls and
2. Ensure adolescents’ access to micronu- boys to prevent early pregnancy.
trient services.
✓✓ Promote personal hygiene, envi-
✓✓ Provide school based biannual de- ronmental sanitation and infection
worming. prevention measures.
✓✓ Provide biannual deworming for 4. Ensure access to reproductive health

out-of-school adolescents. information and services for boys and
girls to:
✓✓ Provide iron folic acid supple-
mentation for adolescent girls at ✓✓ Delay first pregnancy until age 19.
schools and health facilities.
✓✓ Promote the use of adolescent
3. Conduct social and behavioral change friendly reproductive health ser-
communication to prevent harmful tra- vices.
ditional practices related to nutrition.
✓✓ Integrate nutrition assessment and
✓✓ Promote delaying early marriage counseling into youth friendly re-
until age 18 and delay first preg- productive health services.
nancy until age 19.
5. Address the needs of adolescent girls in
✓✓ Promote dietary diversity. special situations (HIV/AIDS, emergen-
cy, obesity and eating disturbances).
✓✓ Prevent food taboos, which con-
tribute to intergenerational malnu-
trition.
✓✓ Promote diversified and nutritious

foods for adolescents.

RESULT 1.2: NUTRITIONAL STATUS OF WOMEN OF
REPRODUCTIVE AGE IMPROVED
✓✓ Provide deworming during the sec-
INITIATIVES ond trimester of pregnancy.
I: Improve Nutrition of Pregnant and 2. Conduct social and behavioral change

Lactating Women communication on maternal nutrition.
1. Provide comprehensive and routine nu- ✓✓ Promote maternal nutrition, includ-

tritional assessments and counseling ing adequate intake of diversified
services. foods, daytime rest and additional
meals during antenatal and postna-
✓✓ Conduct nutritional assessments tal periods.
and provide counseling services for
pregnant women during antenatal ✓✓ Identify and support champions to
care (ANC) visits and at any other serve as role models to support the
health contact points. nutrition of women and children.
✓✓ Conduct nutritional assessments ✓✓ Promote shifts in social norms on

and provide counseling services for food taboos through religious lead-
lactating women during postnatal ers and influential community mem-
visits and at any other health con- bers to realize adequate nutrition for
tact points. pregnant and lactating women.
✓✓ Promote engagement of husbands, ✓✓ Promote the use of iodized salt and

grandparents and other household fortified foods.
members who play key roles in pro-
viding continuous care for pregnant ✓✓ Promote personal hygiene, environ-
and lactating women. mental sanitation and infection-pre-
vention measures.
✓✓ Provide malnourished pregnant and
lactating women (PLW) with target- 3. Strengthen mobile health and nutrition
ed supplementary food. teams to improve access to nutrition
services in pastoralist areas.
✓✓ Provide PLW with blanket supple-
mentary food support in special cir- 4. Ensure free distribution and utilization of
cumstances. insecticide-treated nets (ITNs) by PLW
in all malaria-endemic woredas.
✓✓ Identify and treat severe and mod-
erate acute malnutrition (SAM and 5. Create access to time and labor saving
MAM) in PLW. technologies.
✓✓ Identify and treat infections such as 6. Ensure access to reproductive health

malaria and intestinal parasitosis. services.
✓✓ Provide PLW with routine iron and ✓✓ Ensure access to postnatal and
folic acid supplementation. family planning services.
✓✓ Ensure male involvement in repro-

ductive health services.

II: Improve the nutritional status of
7. Support women’s empowerment. non-pregnant and non-lactating women
✓✓ Strengthen women’s economic con- ✓✓ Promote the use of iodized salt.

trol.
✓✓ Promote adequate intake of diversi-
✓✓ Strengthen women’s ability to have fied food.
equitable decision-making power to
improve their own nutritional status ✓✓ Ensure access to reproductive
and that of their households. health services.
✓✓ Ensure the economic empowerment

of women.
STRATEGIC OBJECTIVE 2
improve the nutritional status of women
from childbirth up to 10 years
Maternal and child malnutrition, encom-

passing both undernutrition and overnu- ■■ Reduce the prevalence of underweight
trition, are global problems with important among under-five children from 25% to
consequences for survival, incidence of 13%.
acute and chronic diseases, healthy devel-
opment and the economic productivity of ■■ Reduce the prevalence of wasting
individuals and societies. Ethiopia is one of among under-five children from 9% to
the top-ranked countries in terms of mal- 4.9%.
nutrition in sub-Saharan Africa. Progress
has been made with many interventions ■■ Reduce the prevalence of low birth
implemented at scale over the last decade. weight (less than 2.5kg at birth) from
Strategic Objective 2 emphasizes the first 11% to 5%.
1,000 days after a child’s birth, which is a
critical period in human life. ■■ Reduce the prevalence of anemia in un-
der-five children from 39% to 24%.
2020 TARGETS
■■ Increase the proportion of children 6-23
■■ Reduce stunting prevalence among un- months with minimum dietary diversity
der-five children from 40% to 26%. score from 5% to 40%.

RESULT 2.1: IMPROVED NUTRITIONAL STATUS OF INFANTS AND
YOUNG CHILDREN 0-23 MONTHS
INITIATIVES
✓✓ Timely initiation of age-appropriate
1. Promote, support and protect optimal complementary foods at 6 months
breastfeeding practices for infants 0–6 of age.
months at community and facility level
through individual and group counsel- ✓✓ Continued breastfeeding until age 2
ing. and beyond.
✓✓ Counsel pregnant women, partners, ✓✓ Active and responsive feeding for

family members and other influen- children 6-23 months old with the in-
tial community members on optimal volvement of fathers and influential
breastfeeding practices. family members.
✓✓ Promote initiation of breastfeeding ✓✓ Feeding during illness and recovery.

within 1 hour of birth, use of colos-
trum and avoidance of pre-lacteal 3. Develop and enforce minimum stan-
feeds. dards on nutritional services for young
children in special situations.
✓✓ Promote and support exclusive
breastfeeding for the first 6 months. ✓✓ Refugee camps
✓✓ Establish a baby friendly health fa- ✓✓ Orphanages

cility initiative in all public and pri-
vate health facilities. ✓✓ Daycare centers
✓✓ Enforce the International Code of ✓✓ PSNP public work sites, etc.

Marketing for Breastmilk Substi-
tutes. 4. Support local production of enriched
complementary food.
✓✓ Promote enactment of maternity
leave according to International La- ✓✓ Assess and identify recommended
bour Organization Convention #183. complementary feeding options for
different communities (i.e., agrari-
✓✓ Promote designated breastfeeding an, pastoral, urban).
rooms in major service providing in-
stitutions. ✓✓ Promote local production of com-
plementary foods meeting accept-
✓✓ Support breastfeeding working able standards and using a variety
mothers to exclusively breastfeed of mechanisms.
until the child is 6 months old.
✓✓ Harmonize tested procedures for
local production of complementary
2. Build the capacity of service providers foods.
on complementary feeding for children
aged 6-23 months, emphasizing: ✓✓ Revise existing recipes for comple-

mentary foods, considering agrari- sachets (ORS) for diarrhea treat-
an, urban and pastoral contexts. ment.
✓✓ Promote and demonstrate the ✓✓ Promote the use of fortified foods

preparation and utilization of diver- (edible oil and flour).
sified complementary foods.
✓✓ Promote the use of micronutrient
5. Promote key actions for diversification powders in areas where iron defi-
and utilization of complementary foods ciency is greater than 20% among
at household level. children under five.
✓✓ Harmonize and standardize com- 8. Detect and manage acute malnutrition

plementary feeding practices, social and common childhood illnesses early.
mobilization, and behavioral change
communication materials to help en- ✓✓ Train HEWs on identification, treat-
sure dietary diversity through the use ment and timely referral of acutely
of various varieties of food sources. malnourished (SAM/MAM) children.
✓✓ Train health workers and health ex- ✓✓ Ensure HEWs conduct routine
tension workers on preparation of screening and referral of children
enriched complementary foods for with complicated acute malnutrition.
cascading down to development
armies and households. ✓✓ Ensure timely availability of appropri-
ate nutrition products and commod-
✓✓ Build the capacity of regional, zonal ities—anthropometric equipment,
and woreda health offices and pri- therapeutic food, supplementary
mary health care units on interven- food and essential drugs—as per
tions to promote child growth. the acute malnutrition management
guideline in all health facilities.
6. Conduct monthly growth monitoring and
promotion for children under 2. ✓✓ Ensure the establishment of stabi-
lization centers at health facilities
7. Prevent and control micronutrient defi- (health centers and hospitals).
ciencies.
✓✓ Ensure the establishment of outpa-
✓✓ Identify and treat anemia. tient treatment services at health
posts and health centers.
✓✓ Provide Vitamin A supplementation
for children 6–59 months of age bi- ✓✓ Promote active case finding and
annually. management for malnutrition and
childhood illness in the community.
✓✓ Promote the proper use of iodized
salt at household level. ✓✓ Encourage local food processing fac-
tories to participate in fulfilling produc-
✓✓ Improve the production of quality, tion requirements for ready-to-use
iodized salt by enforcing the moni- therapeutic food (RUTF) and ready-
toring and quality control of salt io- to-use supplementary food (RUSF).
dization at production sites (includ-
ing imported edible salt). ✓✓ Ensure malnourished children are
exempted from treatment service
✓✓ Provide zinc with oral rehydration charges.

✓✓ Ensure that caretakers are able to ✓✓ Promote construction and use of
get food at stabilization centers. household and community latrines.
✓✓ Ensure nutritional screening ser- 10. Link food-insecure households with

vices for children who visit health children under 2 to social protection ser-
posts and health centers for inte- vices and nutrition-sensitive livelihood
grated management of neonatal and and economic opportunities.
childhood illnesses (IMNCI).
11. Integrate Early Childhood Care and
9. Ensure universal access to WASH and Development stimulation with existing
utilization of WASH practices. community and facility based child nu-
trition programs.
✓✓ Ensure access to clean and safe
water. ✓✓ Promote appropriate adult-child in-
teraction.
✓✓ Promote the use of household water
treatment practices. ✓✓ Ensure the development and uti-
lization of locally relevant early
✓✓ Promote safe and hygienic prepara- childhood development materials.
tion and handling of food.
✓✓ Integrate ECCD into nutrition
✓✓ Promote hand washing with soap. capacity building efforts (blended
integrated nutrition learning module).
✓✓ Promote safe and clean household
environments (in relation to poul- ✓✓ Ensure inclusion of ECCD related
try, small ruminants and household topics in nutrition-blended training
waste management). materials.
RESULT 2.2: IMPROVED NUTRITIONAL STATUS OF

CHILDREN 24-59 MONTHS
INITIATIVES ✓✓ Provide Vitamin A supplementation

for children 6-59 months of age
1. Promote appropriate feeding and dietary biannually.
practices.
✓✓ Deworm children 2-5 years old
✓✓ Ensure that households with biannually.
children under 5 and PLW are
linked to initiatives that promote ✓✓ Promote the use of iodized salt at
home/kitchen gardens and small- household level.
scale food production that support
a diverse range of nutrient- ✓✓ Provide zinc with ORS for diarrhea
enhancing foods. treatment.
2. Prevent and control micronutrient defi- 3. Detect and manage acute malnutri-
ciencies. tion and common childhood infec-
tions early.
✓✓ Identify and treat anemia.

✓✓ Train health workers and health 5. Integrate Early Childhood Care and
extension workers on identification Development stimulation with existing
and treatment of acute malnutrition. community and facility based child nu-
trition programs.
✓✓ Conduct routine screening of chil-
dren for malnutrition. ✓✓ Promote appropriate adult-child in-
teraction.
✓✓ Manage severe and moderate
acute malnutrition. ✓✓ Ensure the development and uti-
lization of locally relevant early
✓✓ Encourage local food processing childhood development materials.
factories to participate in fulfilling
production requirements for RUTF ✓✓ Integrate ECCD into nutrition ca-
and RUSF. pacity building efforts (blended in-
tegrated nutrition learning module).
✓✓ Ensure availability of appropriate
supplies and commodities (supple- ✓✓ Ensure inclusion of ECCD related
ments, anthropometric equipment, topics in nutrition-blended training
therapeutic food, supplementary materials.
food and routine drugs) in a sus-
tainable manner in all health facil- 6. Improve nutritional services for young
ities. children in special circumstances.
✓✓ Strengthen monitoring, evaluation ✓✓ Emergency situations

and reporting of nutrition services
through harmonized data collection ✓✓ Refugee camps
tools.
✓✓ Orphanages
4. Ensure universal access to WASH and
utilization of WASH practices. ✓✓ Daycare centers
✓✓ Ensure access to clean and safe ✓✓ Chronic infections, etc.

water.
✓✓ Promote the use of household wa-

ter treatment practices.
✓✓ Promote safe and hygienic prepa-

ration and handling of food.
✓✓ Promote hand washing with soap.
✓✓ Promote safe and clean household

environments (in relation to poul-
try, small ruminants and household
waste management).
✓✓ Promote construction and use of

household and community latrines.

RESULT 2.3: IMPROVED NUTRITIONAL STATUS OF
CHILDREN AGES 6-10
INITIATIVES ✓✓ Provide school based deworming

services.
1. Promote good nutrition behavior and
improved nutritional status of children ✓✓ Promote the use of iodized salt at
6-10 years old. household level.
✓✓ Conduct school based health and ✓✓ Promote exercise for preventing

nutrition social and behavior change childhood obesity.
communication for young children.
✓✓ Train teachers and Parent-Teacher

Association members in core child
nutrition areas and raise awareness
on child nutrition and health services
in the community.
✓✓ Promote and demonstrate food di-

versification through school gardens
and nutrition clubs.
✓✓ Promote healthy school environ-

ments through school health and
nutrition programs.
✓✓ Initiate a homegrown school feeding

program for school-aged children.
✓✓ Promote access to safe, potable

water, and sanitation and hygiene in
schools and at home.
✓✓ Promote proper disposal of human,

animal and environmental waste.

improve the delivery of nutrition services for communicable and
non-communicable/lifestyle related diseases
Nutrition is an important component of a an additional burden on already overtaxed

healthy lifestyle and in the prevention and national health budgets. Undernutrition in
management of chronic communicable and utero and early childhood may predispose
non-communicable diseases. Malnutrition individuals to greater susceptibility to some
is a critical yet underestimated factor in chronic diseases (Alemu et al., 2014;
susceptibility to infection, including HIV/ Gebreyohannes et al., 2014; Tefalem et al.,
AIDS, tuberculosis and malaria. Infection 2013).
saps the individual of energy, which reduces
productivity at the community level and Timely interventions will help prevent
perpetuates an alarming spiral of infection, these diseases or reduce their severity
disease and poverty. Hence, it is essential and consequences. The health sector,
to address the nutritional requirements of the Ministry of Youth and Sport, and other
individuals with infections. concerned governmental bodies are
responsible for implementing nutrition-
In addition, because of changes in dietary sensitive interventions for those dealing
and lifestyle patterns, non-communicable with communicable, non-communicable
diseases like obesity, diabetes mellitus, and lifestyle related diseases.
cardiovascular disease, hypertension,
stroke and some types of cancer are
becoming increasingly significant causes
of disability and premature death in both
developing and developed countries, placing
RESULT 3.1: IMPROVED NUTRITION SERVICE DELIVERY FOR

COMMUNICABLE AND NON-COMMUNICABLE DISEASES
INITIATIVES TARGETING
COMMUNICABLE DISEASES ✓✓ Integrate nutritional assessment,
counseling and support (NACS) into
A. Nutrition and HIV/AIDS comprehensive HIV/AIDS care and
support training materials.
1. Strengthen the capacity of facilities and
health professionals to deliver quality ✓✓ Harmonize the HIV/AIDS care and
standard nutrition services to people liv- treatment guidelines and/or training
ing with HIV (PLHIV). materials with the National Nutri-
tion Program and National Nutrition
Strategy.

✓✓ Equip facilities with nutrition assess- ✓✓ Counsel and support HIV-positive
ment and counseling materials. mothers on infant feeding as per
the national recommendations and
✓✓ Make nutrition communication and strategies for eliminationof mother-
advocacy materials available to to-child transmission (EMTCT).
health service providers (in line with
the National Health Communication ✓✓ Link HIV-infected patients who have
Strategy). graduated from NACS services to
economic strengthening activities
✓✓ Train health workers on NACS (income-generating activities, back-
based on acute malnutrition man- to-work initiatives, etc.).
agement guidelines.
3. Ensure sustainability of NACS services.
✓✓ Incorporate NACS training in in-
tegrated refresher training (IRT) ✓✓ Encourage local food processing
for HEWs on HIV/AIDS (creating factories to participate in fulfilling
awareness, follow up and linkage to production requirements for RUTF
the health facility). and RUSF.
2. Integrate nutritional assessment coun- ✓✓ Study/consider the possibility of oth-

seling and support into HIV treatment, er cost-effective food commodities
care and support services. for the management of acute malnu-
trition in PLHIV.
✓✓ Support facilities to integrate nutri-
tion counseling and clinical nutrition ✓✓ Ensure sustainable availability of ap-
services into existing HIV services. propriate supplies and commodities
(supplements, anthropometric equip-
✓✓ Standardize clinical nutrition and HIV ment, therapeutic food, supplemen-
services as per national guidelines. tary food) in all health facilities.
✓✓ Provide NACS for all PLHIV. ✓✓ Incorporate monitoring and evalua-

tion of NACS services in the national
✓✓ Prioritize children under five, preg- Health Monitoring Information Sys-
nant and lactating women in cases tem.
of supply shortage.
4. Coordinate facility based therapeutic
✓✓ Ensure that nutritional assessment, and community based preventive food
care and support for women living and nutrition interventions for PLHIV.
with HIV is an integral part of ante-
natal, postnatal and prevention of ✓✓ Coordinate and integrate food assis-
mother-to-child transmission of HIV tance and HIV programs at all levels.
(PMTCT) services.
✓✓ Strengthen nutrition education, in-
✓✓ Health facilities should design a cluding knowledge of water purifica-
strategy to identify eligible mothers tion, food hygiene, preparation and
and provide necessary support. handling, and other complementary
interventions.
✓✓ Promote appropriate feeding op-
tions for infants born to HIV-infected ✓✓ Employ strategies for client
mothers. graduation through linkages to other
services.

✓✓ Establish linkages between facility ✓✓ Provide nutritional education and
and community based nutrition in- counseling on the importance and
terventions for PLHIV and livelihood impact of good nutrition, symptom
support and food assistance inter- management and improved dietary
ventions. intake during and after TB treatment.
✓✓ Strengthen community based nu- ✓✓ Provide nutritional assistance to TB

trition care and support activities patients or refer them for treatment
for PLHIV through health extension when the support is available.
workers, agriculture extension work-
ers and health development armies. ✓✓ Link TB patients with nutrition-sen-
sitive interventions and livelihoods
B. Nutrition and Tuberculosis interventions to access nutritious
foods where and when available,
1. Strengthen the capacity of health facil- particularly MDR-TB and HIV co-in-
ities and health professionals working fected patients.
in TB clinics to deliver quality NACS for
patients with TB. ✓✓ Link TB patients that graduated
from NACS services to econom-
✓✓ Integrate NACS into TB treatment ic strengthening activities (income
and care programs. generating activities, back-to-work
initiatives, etc.).
✓✓ Harmonize TB detection and man-
agement guidelines and/or training ✓✓ Strengthen community TB preven-
materials with the National Nutrition tion, care and support activities
Program. through health extension workers
and health development armies.
✓✓ Equip TB clinics/centers with anthro-
pometric equipment and counseling ✓✓ Develop and distribute harmonized
materials. social and behavioral change com-
munication materials on nutrition
✓✓ Train health workers working in and TB through community based
TB clinics/multi-drug resistant-TB service providers (health extension
(MDR-TB) centers on NACS. workers and health development
armies).
✓✓ Incorporate NACS training into inte-
grated refresher training for HEWs 3. Strengthen integration between TB and
with focus on TB cases (creating HIV programs and nutrition.
awareness, follow up, linkage to the
health facility). 4. Review existing evidence on TB and
nutrition to bridge knowledge gaps and
2. Ensure nutritional assessment, counsel- identify operational research areas to
ing and support for patients with active fully integrate nutrition into TB treatment
and drug resistant TB. and control programs.
✓✓ Conduct routine nutritional assess- C. Nutrition and Other Infections

ments for TB patients to determine Even though malnutrition is highly associ-
their nutritional status and provide ated with chronic infectious diseases, other
them with nutrition support when es- common infections like measles, diarrhe-
sential and available. al diseases, malaria, soil transmitted hel-

minthiasis and pneumonia are also known
to adversely affect the nutritional status of ✓✓ Organize and implement in-service
patients. Therefore, every effort should be training programs on leadership and
made to: program management focusing on
chronic non-communicable disease
1. Ensure that nutritional assessment and prevention and control.
counseling are done while these infec-
tions are being treated in children under ✓✓ Promote physical activity to be inte-
five. grated into NNP implementing sec-
tors.
2. Provide RUTF/TSF/RUSF support for
children under five facing acute malnu- ✓✓ Advocate for reviewing existing pol-
trition. icies in relevant NNP implementing
sectors to ensure that they are con-
3. Strengthen community based nutrition sistent with best practices in popula-
education through the Health Extension tion-wide approaches to increasing
Program and through other community physical activity.
based interventions.
✓✓ Incorporate competency based nu-
4. Provide counseling on proper feeding trition into the existing curricula of
recommendations to prevent malnutri- health professionals.
tion during and after attacks of infection.
✓✓ Develop national nutrition, dietet-
INITIATIVES TARGETING ics and healthy life guidelines for
CHRONIC NON-COMMUNICABLE/ prevention and management of
non-communicable diseases and
LIFESTYLE RELATED DISEASES risk factors.
1. Strengthen national response through
policy, governance and leadership.
RESULT 3.2: HEALTHY LIFESTYLES AND NUTRITION PROMOTED
INITIATIVES ✓✓ Produce and disseminate IEC and

behavior change communication
1. Promote public awareness on healthy (BCC) materials on healthy diet and
dietary behaviors and physical activities. physical activity.
✓✓ Develop standardized health and ✓✓ Disseminate IEC/BCC materials to

nutrition messages on healthy di- promote increased consumption of
etary behaviors. fruits and vegetables, reduced con-
sumption of soda beverages, satu-
✓✓ Disseminate national nutrition, di- rated fats and trans-fatty acids.
etetics and healthy life guidelines to
promote healthy dietary lifestyles. ✓✓ Promote healthy nutrition through
media (TV, radio, newspapers, post-
ers, social media, websites, etc.).

✓✓ Conduct school based health pro- counseling for early identification of
motion to encourage healthy diet obesity and overweight.
and avoid childhood obesity among
schoolchildren. 3. Create/advocate for external environ-
ments that enhance physical activity in
✓✓ Train HEWs (both urban and rural) schools, at workplaces and in commu-
on diet, physical activity and NCDs. nities.
✓✓ Implement the International Code of ✓✓ Conduct advocacy workshops for

Marketing of Breastmilk Substitutes relevant decision makers on the im-
and subsequent WHO resolutions. portance of physical activity in pre-
venting non-communicable diseas-
✓✓ Promote continuation of breastfeed- es.
ing to age 2 and beyond.
✓✓ Collaborate with sector line minis-
✓✓ Develop regional based food guide tries and other concerned bodies.
pyramids for different cultural set-
tings. ✓✓ Ensure that schools have safe and
accessible facilities for active recre-
2. Provide nutrition assessment and coun- ation, play and sports.
seling services (NACS) at the communi-
ty and health facility level. ✓✓ Encourage schools to provide stu-
dents with daily physical education
✓✓ Support facilities to integrate NACS and to equip themselves with appro-
into pediatric services for children priate facilities and equipment.
under five and into adult outpatient
services to identify overweight and 4. Promote the establishment of physical
obesity. activity and nutrition clubs in urban and
rural settings.
✓✓ Support facilities to integrate
nutrition assessment into different ✓✓ Establish physical activity clubs
non-communicable disease clinics within communities, schools and
(diabetics, hypertension, cancer, workplaces in collaboration with
etc.) sector line ministries.
✓✓ Provide disease-specific dietary ✓✓ Collaborate with sector line minis-

counseling. tries to establish physical activity
committees in all workplaces.
✓✓ Provide periodic nutritional screen-
ing and counseling of students for ✓✓ Establish nutrition clubs within com-
early identification of obesity and munities, schools and workplaces.
overweight at school.
5. Promote engagement with professional
✓✓ Provide periodic nutritional screen- organizations to generate evidence for
ing and counseling to women at policy guidance and standard setting.
youth friendly reproductive health
clinics for early identification of obe- ✓✓ Strengthen surveillance of non-
sity and overweight. communicable disease risk factors.
✓✓ Support community level facilities ✓✓ Promote health systems research

to provide nutritional screening and or epidemiological studies on major

non-communicable disease risk fac- ✓✓ Formulate and enforce legislation
tors, including physical inactivity and that promotes the local production
unhealthy diet. and consumption of fruits and veg-
etables.
✓✓ Ensure that national surveys on NCD
risk factors address dietary intake, ✓✓ Enforce labeling of composition (in-
household expenditure, blood lipids, gredients) of commercially produced
hypertension, and blood glucose or imported foods and drinks.
in collaboration with the Ethiopian
Public Health Institute. ✓✓ Impose taxation on imported foods
and drinks.
6. Strengthen the diagnostic and clinical
management capabilities of the coun- ✓✓ Develop the necessary regulations
try’s health system to prevent and treat to provide incentives for the pro-
chronic non-communicable/lifestyle reduction and formulation of healthy
lated diseases. foods.
✓✓ Equip health facilities with essential ✓✓ Develop regulations to ensure that

supplies, diagnostic equipment and NCD prevention is an explicit priority
other treatment inputs. in all stages of food systems, includ-
ing product development, formula-
✓✓ Organize and conduct sustainable tion, promotion and distribution.
in-service training programs on clini-
cal diagnosis, treatment, counseling ✓✓ Enforce regulations to minimize the
and comprehensive care of patients impact of marketing on dietary pat-
with non-communicable diseases. terns and prevent the exploitation of
children, young people, and families
✓✓ Establish and foster networking via advertisements of unhealthy di-
and collaboration across higher ed- ets and beverages.
ucation institutions to harmonize
the training curriculum on chronic
non-communicable diseases.
7. Formulate and enforce legislation and

regulations that address unhealthy life-
style and diet.
✓✓ Produce and distribute regulatory

guidelines on food products to en-
sure production and marketing of
healthy foods.

strengthen the implementation of nutrition-sensitive
interventions across sectors
Nutrition sensitivity describes the degree 2020 TARGETS

to which an indirect intervention positively
affects nutrition outcomes. Indirect or ■■ Increase mean number of days of con-
longer-route interventions include actions sumption of meat from 1.2 days to 3
within sectors such as agriculture, days per week.
social protection, water and sanitation.
Acceleration of progress in nutrition will ■■ Increase national food consumption
require effective, large-scale, multisectoral score from 26% to 40%.
programs that address key underlying ■■ Increase proportion of households con-
determinants of nutrition and enhance the suming diversified food by 40%.
coverage and effectiveness of nutrition-
specific interventions (Ruel and Alderman,
2013). In other words, nutrition-sensitive
programs can help scale up nutrition-specific
interventions and foster a stimulating
environment for ending hunger.
RESULT 4.1: STRENGTHENED IMPLEMENTATION OF NUTRITION-

SENSITIVE INTERVENTIONS IN THE MOANR AND MINISTRY OF
LIVESTOCK AND FISHERY RESOURCE DEVELOPMENT
Ethiopia’s economy, which mainly depends sensitive initiatives represent either new
on agriculture, and its ecological system are activities or a refocusing of existing activities
fragile and vulnerable to climate change. to achieve nutritional outcomes. All of
The agricultural sectors have already these programs have their own targets and
put in place programs and initiatives that contribute to reducing undernutrition; each
directly and indirectly contribute to the needs to be scaled up with more emphasis
reduction of undernutrition. These include on increasing the quality of food produced
the Food Security Program, the Agricultural and on mainstreaming nutrition.
Growth Program, Disaster Prevention and
Preparedness, the Livestock Master Plan, The following initiatives are to ensure that
Agricultural Research Systems and the the agriculture related ministries operate
Agriculture Nutrition Sensitive Strategic in a manner that is nutrition-sensitive
Plan. The agriculture related ministries will and aligned with the Agricultural Sector
continue to scale up these programs and Strategic Objectives of Ethiopia’s Growth
initiatives with a nutrition lens. The nutrition- and Transformation Plan (GTP II).

INITIATIVES ✓✓ Promote local production of comple-
mentary foods.
I: Strengthened implementation of nutrition-
Ministry
sensitive interventions in the of 2. Strengthen the capacity of the agricul-
Agriculture and Natural Resources ture and livestock sectors to integrate
nutrition-sensitive interventions into ag-
1. Increase year-round availability, access riculture programs (PSNP, AGP, Master
to and consumption of fruits and vegeta- Plan, etc.)
bles, nutrient-dense cereals and pulses.
✓✓ Ensure access to fruit and vegetable ✓✓ Ensure asset transfers or asset

seeds and other agricultural inputs. building interventions properly target
women and vulnerable households.
✓✓ Ensure vulnerable households with

✓✓ Support the establishment of com- a malnourished child are adequately
munity fruit and vegetable nursery targeted in transfer and safety net
sites and demonstration sites at initiatives.
farmers training centers.
✓✓ Improve the nutritional value of the
✓✓ Promote homestead and school food basket with the addition of puls-
gardening. es or the equivalent cash value.
✓✓ Promote and support urban agricul- ✓✓ Enhance the implementation of

ture. nutrition-sensitive public works.
✓✓ Promote and support community ✓✓ Introduce soft conditionality related

level production of fruits and vege- to attendance at behavior change
tables. communication events or uptake of
other services, in order to increase
✓✓ Promote production and consump- health-seeking behavior.
tion of bio-fortified pulses and veg-
etables (orange-fleshed sweet pota- 3. Promote technologies for post-harvest
to, iron rich beans, etc.) food processing, handling, preservation
and preparation to help ensure that food
✓✓ Distribute bio-fortified seeds from is both nutritious and diverse.
research entities and other higher
institutions. ✓✓ Identify and scale up best practices
in the processing, preservation and
✓✓ Improve post-harvest handling and preparation of fruits, vegetables
storage. and other crops.
✓✓ Improve post-harvest food process- ✓✓ Improve food handling, storage

ing and ensure safety. and transportation of fruits, vegeta-
bles and other crops.
✓✓ Improve market linkages for fruit
and vegetable produce. 4. Enhance agricultural research and
adoption of technology for increased
✓✓ Promote production and consump- household access to safe, nutritious
tion of nutrient-dense pulses. food.

✓✓ Develop nutrition-sensitive agricul-
✓✓ Support the development of bio-for- ture strategy and implementation
tified crops and vegetables and in- manual and disseminate to all lev-
crease access to them by farmers. els.
✓✓ Establish bio-fortification center and ✓✓ Promote and monitor implementa-

capacity at the Ethiopian Institute of tion of PSNP/Nutrition, AGP II/Nutri-
Agricultural Research. tion, and drought resilience sustain-
able livelihood programs.
✓✓ Identify and scale up selected best
practices on preservation, storage
and processing of fruit and vegeta- ✓✓ Develop a food and nutrition policy
bles at farm and household levels. that guides food and nutrition
✓✓ Promote women’s labor and time systems in the country.
saving technologies.
✓✓ Strengthen advocacy and sensitiza-
✓✓ Support research and production of tion on nutrition-sensitive agriculture
micronutrient enhanced fertilizers at all levels.
(e.g., zinc fortified fertilizer).
8. Develop regional and district level ca-
5. Improve natural resources base to im- pacity to facilitate comprehensive in-
prove food availability. tegration of nutrition into planning and
implementing initiatives in the environ-
✓✓ Rehabilitate/improve small-scale ir- ment and forestry sectors.
rigation systems in priority areas for
better nutrition outcomes. ✓✓ Provide awareness-creation training
to federal, regional, district and ke-
6. Improve nutrition-sensitive agriculture bele level civil servants working in
(NSA) knowledge and practice among environment and forestry.
farmers.
✓✓ Map and mobilize resources intend-
✓✓ Improve household level knowledge ed for coordination of nutrition-sen-
and practice about dietary diversity. sitive interventions in forested land-
scapes.
✓✓ Establish nutrition behavior change
communication strategies relevant ✓✓ Establish a nutrition unit/focal per-
for NSA. son at the national and regional lev-
els and if possible at district level as
✓✓ Use local media to address food ta- well.
boos and cultural constraints.
9. Increase forest coverage nationally to
✓✓ Integrate nutrition-sensitive, agricul- 20% by the year 2020.
ture relevant social and behavioral
change communications in all farm- ✓✓ Identify, cluster and register 5 million
er and development army training hectares for potential manmade for-
manuals. est as planned in GTP II.
7. Update relevant agriculture and natu- ✓✓ Conduct research to identify suit-

ral resource sector policies/strategies/ able agroforestry technologies and
guidelines and program implementation appropriate tree species for specific
manuals with nutrition indicators. areas of Ethiopia.

✓✓ Promote safeguarding and conser- of tree seedlings that will contribute
vation of forest areas where wild to positive nutritional outcomes.
foods are extracted for consump-
tion.
12. Develop laws and policies to codify fair
✓✓ Establish database for tracking for- legal access to forests by local peo-
est plants that are directly used as ple for the sustainable harvest of wild
food sources to understand and im- foods.
prove the contribution of the forest
to improved nutritional outcomes. ✓✓ Develop a policy framework, law
and legislation to prevent land-use
✓✓ Integrate nutrition objectives and challenges to subsistence or com-
interventions into the management mercial farming.
plan of forests and agroforests to
the extent possible. ✓✓ Develop laws and policies to pre-
vent forest clearing and deforesta-
10. Improve the awareness of key stake- tion without a full analysis, includ-
holders about the importance of forests ing an analysis of which wild foods
and of environmental conservation to might be lost, along with the nutri-
improved nutritional outcomes. tional implications of such loss.
✓✓ Promote wild foods, particularly veg- II: Strengthened implementation of nutrition-

etables and fruits, in national and sensitive interventions in the Ministry of
local media, in schools, and among Livestock and Fishery Resource Development
health extension workers to under-
line their nutritional value, to high- 1. Update relevant policies/strategies/
light cultural diversity and to foster guidelines and program implementation
appreciation of the traditional foods manuals with nutrition indicators to en-
of various cultures and their rele- sure that they contribute to nutrition and
vance to health. ensure its implementation.
✓✓ Incorporate food security, nutrition ✓✓ Develop a nutrition-sensitive strat-

and agriculture modules in forestry egy and implementation manual
training and education curricula to and disseminate to all levels.
broaden the understanding of forest-
ers and sensitize them to the poten- ✓✓ Strengthen advocacy and sensiti-
tial role of forests in contributing to zation on nutrition-sensitive fishery
the wellbeing of local communities. and livestock at all levels.
11. Integrate nutrition related goals, 2. Increase year-round availability, access

initiatives and activities into the forestry to and consumption of animal-sourced
extension program for sustainable foods.
nutritional benefits.
✓✓ Increase production and household
✓✓ Develop guidelines and provide consumption of meat, milk and eggs.
training on using the forestry ex-
tension program to promote agro- ✓✓ Promote rearing of improved breeds
forests and conservation of forests of dairy cattle, small ruminants and
harboring wild foods. poultry.
✓✓ Promote provision and distribution ✓✓ Support the establishment of milk

collection centers and improved milk 4. Promote technologies for post-harvest
processing technologies at house- food processing, handling, preservation
hold level. and preparation to help ensure that food
is both nutritious and diverse.
✓✓ Promote confined/caged poultry
production systems. ✓✓ Identify and scale up best practices
in the processing, preservation and
✓✓ Increase production and consump- preparation of dairy products and
tion of fish. fish.
✓✓ Promote technologies that increase ✓✓ Improve food handling, storage and

fish production and utilization and transportation of dairy products and
reduce post-harvest loss in fisheries fish.
and aquaculture.
5. Enhance agricultural research and
✓✓ Promote small-scale beekeeping by adoption of technology for increased
women and other vulnerable groups. household access to safe, nutritious
food.
✓✓ Improve farmers’ access to safe fod-
ders. ✓✓ Support the development of im-
proved breeds of dairy cattle, small
✓✓ Support/establish agrobusiness ruminants and poultry, and increase
centers to promote production and farmers’ access to these resources.
consumption of poultry, fish, small
ruminants and cattle. ✓✓ Identify and scale up selected best
practices on preservation, storage
✓✓ Strengthen linkages with local mar- and processing of dairy products,
kets and ensure that smallholder fish and animal products at farm and
farmers and pastoralists have con- household level.
sistent access to inputs and produce
markets and income streams. ✓✓ Promote women’s labor and time
saving technologies.
3. Strengthen the capacity of the livestock
sectors to integrate nutrition-sensi- 6. Improve natural resource base to im-
tive interventions into sector programs prove food availability.
(AGP, Livestock Master Plan, etc.)
✓✓ Rehabilitate/improve small-scale
✓✓ Ensure asset transfers or asset livestock water points in priority
building interventions properly tar- areas for better nutrition outcomes.
geted women and vulnerable house-
holds. 7. Improve nutrition-sensitive livestock and
fishery development knowledge and
✓✓ Introduce soft conditionality related practice among farmers through behav-
to attendance at BCC events or up- ior change communication.
take of other services, in order to in-
crease health-seeking behavior.

✓✓ Improve household level knowledge ✓✓ Integrate NSA-relevant social and
and practice about dietary diversity. behavioral change communications
in all farmer and development army-
✓✓ Establish nutrition behavior change training manuals.
communication strategies relevant
to NSA.
✓✓ Use local media to address food ta-

boos and cultural constraints.
RESULT 4.2: STRENGTHENED IMPLEMENTATION OF NUTRITION-

SENSITIVE INTERVENTIONS IN THE EDUCATION SECTOR
The education sector is responsible for im- ✓✓ Develop a school feeding imple-
proving access to quality pre-primary and mentation strategy.
primary education in order to make sure
that all children, youth and adults acquire ✓✓ Develop a training manual and build
the competencies, skills and values that en- the capacity of education personnel
able them to participate fully in the develop- (experts, leaders, teachers, PTAs,
ment of Ethiopia. Efforts will also be made students and other school commu-
to sustain equitable access to quality sec- nity members) at each level (region,
ondary and tertiary education services as zone, woreda and kebele).
the basis of and bridge to the demand of the ✓✓ Support and promote gender re-
economy for middle and higher level human sponsive school feeding in different
resources. The education sector will also modalities.
contribute to the improvement of health and
nutrition and to the reduction of undernutri- ✓✓ In collaboration with the agriculture
tion in schoolchildren through the provision sector, encourage schools to pro-
of school health and nutrition interventions mote and transfer sustainable, rep-
and through a school feeding program. licable school gardening models at
Moreover, the sector is expected to improve community level and link them with
workforce capacity in the nutrition sector school feeding and WASH pro-
by educating people to join the sector and grams.
thereby contribute to implementation of the
overall National Nutrition Program. ✓✓ With community participation, pro-
vide school menus based on locally
produced food.
2020 TARGETS
■■ Increase the proportion of primary
2. Promote school health and nutrition
schools with a homegrown school feed-
(SHN) interventions through collabora-
ing program from 0 to 25%.
tion with other sectors.
■■ Increase the proportion of schools that
provide biannual deworming to 60%.
✓✓ Establish SHN implementation
structures at various levels.
INITIATIVES
✓✓ Establish and strengthen school
1. Promote and scale up school feeding health and nutrition clubs.
programs.

✓✓ Celebrate Nutrition Day in educa- ✓✓ Incorporate gender responsive nu-
tion institutions. trition curricula into primary and sec-
ondary schools, colleges, technical
✓✓ Improve gender-sensitive water, and vocational education and train-
hygiene and sanitation facilities in ing (TVETs) institutes, universities
schools. and non-formal education services
(such as functional adult literacy
✓✓ Promote appropriate nutritional programs).
practices (e.g., use of iodized salt)
through different media. ✓✓ Encourage and support institutions
of higher education to produce more
✓✓ Implement nutrition services (de- nutrition professionals.
worming, targeted micronutrient
supplementations) ✓✓ Train members of the school health
and nutrition organizational struc-
✓✓ Promote girls’ education. ture at different levels.
✓✓ Strengthen nutrition related com- ✓✓ Develop harmonized nutrition spe-

munity based services provided by cialty programs in universities (e.g.,
higher institutions. applied nutrition, clinical nutrition, di-
etetics, public health nutrition, etc.)
✓✓ Build the capacity of school
mini-media to conduct social and ✓✓ Strengthen university nutrition lab-
behavioral change communication oratories to perform operational re-
related to nutrition interventions search.
and to engage in the promotion of
optimal nutrition practices. ✓✓ Engage higher education in mega
research projects on nutrition.
✓✓ Assess school curricula and en-
sure the mainstreaming of nutrition ✓✓ Support nutrition students for their
concepts and skills into curricula at commitment to community service.
all levels but with a focus in primary
education. ✓✓ Establish and strengthen academic
centers of excellence for nutrition.
3. Improve the capacity of the nutrition
workforce.
RESULT 4.3: STRENGTHENED IMPLEMENTATION OF

NUTRITION-SENSITIVE INTERVENTIONS IN THE WATER,
IRRIGATION AND ELECTRICITY SECTOR
The water, irrigation and electricity sector children. In addition, the Ministry of Water,
is responsible for increasing access to po- Irrigation and Electricity (MOWIE) added
table water and creating a healthy environ- the promotion and expansion of medium
ment. The sector will reduce the burden of and large irrigation schemes, which may
disease, save time spent fetching water and help in increasing productivity and diversi-
allow mothers more time to care for their fying foods produced throughout the year.

INITIATIVES
✓✓ Reduce the proportion of the pop-
1. Increase access to safe and clean wa- ulation at risk of problems related
ter. to fluoride, especially children and
women (in Rift Valley):
✓✓ Increase access to safe water.
1. Provide alternative low fluoride wa-
✓✓ Provide water supply for sewerage ter sources.
facilities.
2. Apply proven fluoride removal
✓✓ Increase irrigated farmland through technologies.
the Irrigation Development Program.
3. Strengthen integrated fluorosis mit-
✓✓ Develop water extension-system igation activities through nutritional
supporting programs at kebele lev- interventions at all levels.
el that work on community drinking
water and self-supply. 2. Increase access to renewable energy.
✓✓ Prepare and implement a sustain- ✓✓ Increase access to and availability

able rural/urban drinking water qual- of stoves using renewable energy
ity monitoring system (water safety technology and solar energy sav-
plan). ing technologies.
✓✓ Strengthen the coordination of wa- 3. Increase access to small- and large-scale

ter, sanitation and hygiene activities irrigation schemes.
through one WASH program.
RESULT 4.4: STRENGTHENED IMPLEMENTATION OF NUTRI-

TION-SENSITIVE INTERVENTIONS IN THE INDUSTRY SECTOR
✓✓ Establish and equip quality control
The Ministry of Industry is responsible for laboratories at the Food, Beverage
providing all around support to the food and Pharmaceutical Industrial De-
manufacturing industries and for accelerat- velopment Institute.
ing technology transfers to contribute to the
reduction of micronutrient deficiencies in ✓✓ Establish organizational structures
Ethiopia. This is done through the fortifica- for implementation and coordina-
tion of wheat, salt, edible oil and other food tion of the national food fortification
vehicles either domestic or imported. program.
INITIATIVES ✓✓ Establish a dedicated food fortifica-

tion directorate at the MOI’s Food
1. Strengthen the Ministry of Industry’s Beverage, and Pharmaceutical
capacity to support the production and Industry Development Institute.
distribution of fortified foods.
✓✓ Strengthen the National Food For-
tification Steering Committee and
✓✓ Train implementing staff on the na- establish the necessary sub-work-
tional food fortification program. ing groups.

2. Build industry capacity to meet interna- ✓✓ Ensure quality and safety of locally
tional standards for quality and safe for- produced food items.
tified foods (edible oils, flour, salt, etc.).
3. Conduct awareness creation events for
✓✓ Conduct industry mapping to identify the private sector on nutrition related
and support small- and large-scale requirements and standards for locally
wheat flour and edible oil manufac- manufactured food items.
turers to produce fortified food prod-
ucts. ✓✓ Training on food fortification for food
industries including quality control/
✓✓ Select appropriate food fortification quality assurance.
technologies.
✓✓ Provide training for selected labora-
✓✓ Develop social mobilization and tories on standardized testing meth-
marketing strategies for food fortifi- odologies (private and public institu-
cation. tion)
✓✓ Assist in availing the industry of in- ✓✓ Strengthen the capacity of public

puts (equipment, raw materials and and private food control laborato-
premix). ries.
✓✓ Establish linkages with universities ✓✓ Formulate strategies and action

and vocational training centers for plans that assist the food manufac-
research and skill transfer. ture to produce safe and nutritious
food.
RESULT 4.5: STRENGTHENED IMPLEMENTATION OF

NUTRITION-SENSITIVE INTERVENTIONS IN THE TRADE SECTOR
The Ministry of Trade’s responsibilities per- ✓✓ Develop a guiding manual for the
taining to nutrition includes regulating and inspection and regulation of food
enforcing compliance of locally produced items.
and imported food items. The ministry is-
sues a certificate of conformity at the coun- ✓✓ Capacitate the Trade Practice and
try’s ports of entry to ensure the quality and Consumer Protection Authorities
safety of food products. to promote the use of safe fortified
foods.
INITIATIVES
2. Ensure the quality and safety of import-
1. Strengthen the capacity of the Ministry ed food items as per the national stan-
of Trade to regulate imported food items. dard.
✓✓ Capacitate the Ministry of Trade ✓✓ Conduct regular market surveillance

staff and regional, zonal and woreda to ensure quality and safety of forti-
trade bureaus on the inspection of fied products.
imported food items and the regula-
tions concerning them. ✓✓ Conduct regular inspection and

monitoring of food processing facto- quirements and standards for imported
ries. food items.
✓✓ Strengthen the collaboration be- 4. Conduct awareness creation events for

tween MOI and regulatory sectors to the public/consumers on the benefits of
support and facilitate importation of fortified food.
products for food fortification.
5. Support importation of fortified food (ed-
✓✓ Develop a marketing strategy for ible oil, salt, etc.).
fortified foods.
6. Ensure access to and a supply chain for
3. Conduct awareness creation events for food and food items access.
the private sector on nutrition related re-
RESULT 4.6: STRENGTHENED SOCIAL PROTECTION SERVICES

FOR IMPROVED NUTRITION
The Ministry of Labor and Social Affairs ✓✓ Ensure that pregnant and lactating
(MOLSA) was established to realize the vi- women are eligible for conditional
sion of ensuring that citizens have access support – exemption from involve-
to productive employment, a stable and de- ment in physical labor (cash for
cent work environment and secured social work).
welfare, all of which help to ensure nutrition-
al status. MOLSA strives to maintain em- ✓✓ Ensure that PSNP beneficiaries with
ployee health and safety in the workplace, children under 2 also receive mes-
promote efficient and equitable employment saging pertaining to adolescent,
services and provide rehabilitation and ca- maternal, infant and young child nu-
pacity building services to vulnerable and trition (AMIYCN) and engage both
affected members of society. Under Result males and females in complementa-
4.6 of the National Nutrition Program, MOL- ry food cooking demonstrations for
SA will carry out the following initiatives. skills transfer at household level.
INITIATIVES ✓✓ Integrate nutrition practices with so-

cial safety net programs to improve
1. Promote the implementation of gen- the nutritional status of women and
der-sensitive social safety net programs children.
and other social protection instruments
in urban settings to protect vulnerable 2. Promote the provision of credits, grants,
groups from food insecurity and under- microfinance services and other in-
nutrition. come generating initiatives to support
increased access to nutritious foods
✓✓ Ensure that vulnerable households among vulnerable groups, with primary
affected by malnutrition and/or nu- focus on unemployed women and fe-
trition emergencies are adequately male headed households.
targeted by safety net initiatives.
✓✓ Improve the access of women’s self-
help groups to grants and credits.

✓✓ Promote nutrition and AMIYCN ✓✓ Expand basic preventative and cu-
practices through women’s self-help rative nutrition services to pastoral-
groups. ist and other vulnerable areas.
3. Increase access to basic nutrition ser- ✓✓ Improve nutritional services for the
vices for all vulnerable groups. poor, the elderly and persons with
disabilities.
✓✓ Employ fee-waiver schemes for the
management of acute malnutrition.
RESULT 4.7: STRENGTHENED NUTRITION-SENSITIVE

INTERVENTIONS IN DISASTER RISK MANAGEMENT
a timely fashion a comprehensive
The National Disaster Risk Management package of nutrition services and
Coordination Commission provides a frame- food items for emergencies and re-
work for coping with the impact of hazards covery periods.
and related disasters and contributes to re-
ducing malnutrition related risks caused by ✓✓ Ensure early detection and manage-
disaster. The food security directorate with- ment of acute malnutrition (severe
in Disaster Risk Management is responsible and moderate).
for supporting food insecure households in
chronically food insecure woredas in a way ✓✓ Integrate the management of infant
that prevents asset depletion at household and young child feeding in emergen-
level. The directorate also facilitates access cy response interventions.
to credit for farm and off-farm activities that
contribute to maximizing productivity, and ✓✓ Undertake Vitamin A supplementa-
thus creates opportunities to build assets. tion and measles vaccination.
✓✓ Establish and strengthen supple-

INITIATIVES mentary and therapeutic feeding
based on assessments.
1. Strengthen and scale up early warning
systems for food and nutrition informa- ✓✓ Ensure provision of adequate and
tion from the community level up to the appropriate information during
national level. emergencies.
✓✓ Support the monitoring and evalu- ✓✓ Ensure access to safe water, sani-
ation system’s capacity to ensure tation and hygiene during emergen-
credible and timely data collection cies.
and analysis.
3. Ensure the capacity for coordinat-
2. Facilitate participatory risk assessments ed emergency preparedness and re-
and preparedness planning within com- sponse.
munities to support nutrition emergency
response and recovery programs. ✓✓ Facilitate the collection of timely,
reliable, quality emergency data.
✓✓ Develop, promote and implement in

✓✓ Ensure the capacity for mapping
affected areas. ✓✓ Establish behavior change commu-
nication strategies relevant for nutri-
✓✓ Develop evidence based emer- tion-sensitive disaster risk manage-
gency preparedness and response ment.
plans.
✓✓ Use local media to address food
✓✓ Strengthen the capacity for coordi- taboos and cultural constraints.
nating an emergency nutrition re-
sponse. ✓✓ Use social and behavioral change
communication strategies to impart
4. Improve knowledge and practice of nu- information about resilience to nutri-
trition-sensitive disaster risk manage- tion related shocks in all farmer and
ment among farmers using behavior agricultural extension worker train-
change communication. ing manuals.
✓✓ Improve household level knowledge

and practice about dietary diversity.
RESULT 4.8: ENSURED QUALITY AND SAFETY OF NUTRITION

SERVICES AND SUPPLIES
The Food, Medicine and Healthcare Ad- 3. Enforce and regulate the activities of
ministration and Control Authority (FMHA- manufactures, importers and distribu-
CA) is mandated to promote and protect tors of products and supplies.
public health by ensuring the safety and
quality of health related products and ser- 4. Ensure the quality and safety of the fol-
vices through registration, licensing and lowing by conducting laboratory analy-
inspection of health professionals. In the sis:
implementation of the National Nutrition
Program, FMHACA may have significant ✓✓ Infant formula, special nutritional
role in setting standards and legislation and products and food supplements.
in developing guidelines/manuals. The au-
thority also provides certificates of compe- ✓✓ Complementary foods, therapeutic
tency for manufacturers, importers and ex- and supplementary foods and spe-
porters, and ensures the quality and safety cial food products for vulnerable
of food products. groups.
INITIATIVES ✓✓ Fortified foods, food fortificants/pre-

mix.
1. Develop/revise directives, standards,
legislation and manuals to control the 5. Register and issue market authorization
quality and safety of food products. for nutritious food products.
2. Issue a certificate of competence for 6. Ensure that the quality and safety of the
manufacturers, importers, exporters, public water supply is up to standard.
distributors and quality control laborato-
ries. 7. Ensure that the quality and safety of

food products used in school feeding 9. Strengthen and equip regulatory labo-
programs is up to standard. ratories at federal, branch and regional
levels.
8. Conduct regular capacity needs assess-
ment and build the capacity of experts in
inspection and regulatory activities.
RESULT 4.9: IMPROVED NUTRITION SUPPLY MANAGEMENT

woreda health offices and health facili-
The Pharmaceuticals Fund and Supply ties in the management of nutrition sup-
Agency (PFSA) enables public health insti- plies.
tutions to supply quality assured, essential
nutrition products at affordable prices in a 3. Coordinate partners in procuring, dis-
sustainable manner. It plays a complemen- tributing and using nutrition supplies
tary role in efforts to expand and strengthen through an integrated logistics manage-
health services by ensuring an enhanced ment information system:
and sustainable supply of nutrition products.
✓✓ Put in place a coordinate, informa-
INITIATIVES tion sharing mechanism showing
stock on hand, quantities distribut-
1. Ensure timely access to nutrition sup- ed, and stock on pipeline (in transit).
plies.
✓✓ The FMOH will develop a distribu-
✓✓ Conduct timely forecasting and pro- tion plan on a quarterly basis (or at
curement by involving all stakehold- minimum every 6 months) and share
ers. it with all stakeholders.
✓✓ Conduct proper warehousing and ✓✓ All stakeholders should follow up on

distribution. the stock status of nutrition supplies
at all levels.
✓✓ Conduct periodic follow-up and
monitoring of consumption of sup- ✓✓ Nutrition commodity security issues
plies in order to take appropriate should be an agenda item in nutri-
and timely action. tion technical working group meet-
ings.
2. Build the capacity of regional, zonal and
RESULT 4.10: IMPROVED NUTRITION COMMUNICATION

Nutrition communication is recognized as a ing, nutrition related health services and
primary form of intervention in national food provision of a potable water supply. The
and nutrition programs. It is an integral com- ultimate goal of nutrition communication
ponent of nutrition intervention approaches, is to produce nutritionally literate decision
such as food production, food assistance, makers who are motivated, knowledgeable,
food formulation and fortification, supple- skilled and willing to choose proper nutrition
mentary feeding, promotion of breastfeed- alternatives.

Nutrition communication is a two-way pro- 4. Provide media coverage for multisec-
cess, where participants can freely ex- toral nutrition related best practices.
change knowledge, values and practices on
nutrition, food, and related areas. It ensures 5. Own the nutrition agenda and cooper-
the active involvement of those who could ate with nutrition implementing sectors
and should take part in decision making, in nutrition advocacy.
and in motivating and providing users with
easy access to nutrition related information, 6. Allocate airtime to promote healthy
resources, and services. The Government diets, lifestyles and optimal nutrition.
Communication Affairs office is responsible
for coordinating and supporting all nutrition 7. Engage stakeholders through dialogue
communication activities. to promote policy awareness, strong
implementation and in order to influ-
INITIATIVES ence nutrition actions.
1. Develop advocacy programs on nutri- 8. Develop a nutrition communication

tion related policies, strategies, legisla- strategy.
tions and guidelines.
9. Conduct media monitoring for cover-
2. Utilize available media outlets to pro- age, quality and impact.
mote optimal nutrition behavior.
10. Create public awareness on healthy
3. Engage private and public media to dietary practices, healthy lifestyles,
take nutrition as a priority social re- and lifestyle related non-communicable
sponsibility agenda item. diseases.
RESULT 4.11: IMPROVED GENDER-SENSITIVE NUTRITION

IMPLEMENTATION
part of human development. Along with un-
Ethiopia is bringing into being remarkable equal, gender based resource distribution
achievements, especially with respect to at the household level, a number of harmful
gender parity in primary school education traditional practices, such as food taboos
and in the number of governmental seats for women and girls (especially pregnant
held by women, including in Parliament. and lactating women), early marriage, and
More educated mothers have the skills to violence against women have contributed to
compete for high skilled, well paid jobs and the poor nutritional status of the majority of
will therefore be in a better position to feed, infants, young children and women in Ethi-
care for and educate their children. To pro- opia.
mote the empowerment of women, nutrition
interventions implemented across sectors In order to address this multifaceted prob-
should be gender sensitive. lem, the government has put in place sev-
eral efforts. Nutrition interventions have
Gender and nutrition are inextricable parts principally tended to address factors that
of the vicious cycle of poverty. Gender indirectly contribute to nutrient intake and
equality can be a cause as well as an effect health, missing other underlying and basic
of hunger and malnutrition. Gender equality factors, such as the decision-making capac-
and women’s empowerment is an essential ity of women in households, access to ed-

ucation, and economic resources, to name
a few. The Ministry of Women and Children 3. Mainstream gender equality within all
has been mandated to ensure and strength- nutrition training programs.
en gender-sensitive nutrition interventions
across sectors. 4. Give due attention to gender sensitive
monitoring and evaluation; use sex dis-
INITIATIVES aggregated indicators.
1. Incorporate a gender analysis as part of 5. Ensure the integration of gender into

the regular nutrition situation analysis, sectoral nutrition implementation pro-
analyzing the needs, priorities and roles grams, strategies and guidelines.
of men and women.
6. Engage and mobilize women’s groups
2. Ensure gender responsive nutrition in nutrition advocacy and skill transfer.
implementation.
improve multisectoral coordination and capacity to implement
the national nutrition program
In order to realize food and nutrition secu- carry out its function. This approach would
rity at national and household levels and avoid sectoral bias in exercising the author-
to accelerate the reduction of malnutrition, ity vested in the NNCB. Sectoral members
the Government of Ethiopia opted for an would be held accountable, both institution-
approach that would see nutrition integrat- ally and collectively, for the achievement of
ed into various sectors through a formally the nutrition goals and targets set by the
institutionalized, multisectoral approach. National Nutrition Program.
Several reviews have shown that in order
for a multisectoral coordination mechanism 2020 TARGETS
to succeed, it should have a legitimate in-
stitutional arrangement with an authority ■■ Eighty percent of the health develop-
mandated by country-level policy/decision ment army will be trained in the prepara-
makers. To execute its mandate of coordi- tion of diverse complementary food and
nating the sectors and fulfilling the aims of follow up support through home visits.
NNP II and the Seqota Declaration, the Na-
tional Nutrition Coordination Body (NNCB) ■■ All NNP implementing sectors will es-
needs a revised institutional arrangement, tablish an appropriate structure (direc-
along with the necessary authority, resourc- torate, case teams, dedicated nutrition
es and accountability. The NNCB should focal persons) that can carry out nutri-
therefore be placed in a government insti- tion activities within that sector.
tution above the level of the sectors and
vested with appropriate executive power ■■ National research capacity will be
and accountability, with clear action plans, strengthened in the areas of food and
concrete targets and sufficient resources to nutrition.

■■ The National Nutrition and Food Policy ■■ All woredas will establish and strength-
will be developed and disseminated. en kebele level nutrition coordination
platforms.
■■ Regional nutrition coordinating bodies
and technical committees will be estab- ■■ A functional reporting and accountabili-
lished and/or strengthened in all regions. ty structure between national, regional,
zonal and woreda coordinating bodies,
■■ Zonal and woreda nutrition coordinating chaired by the highest respective politi-
bodies and technical committees will cal office, will be established.
be established and strengthened in all
zones and woredas.
RESULT 5.1: IMPROVED COMMUNITY LEVEL NUTRITION

IMPLEMENTATION CAPACITY
through male involvement and com-
INITIATIVES munity awareness activities.
1. Improve the capacity of primary health ✓✓ Link local media with community or-
care units (PHCU) and health develop- ganizations, such as women’s asso-
ment armies (HDA) to implement the ciations, faith based organizations,
NNP. community WASH and community
schools, for wider uptake of optimal
✓✓ Provide nutrition trainings with prac- nutrition practices.
tical sessions on complementary
feeding for health extension work- 2. Strengthen the community level linkage
ers who are directly supporting the between HEWs, teachers, agricultural
HDA. extension workers, WASH committees
and health and agriculture development
✓✓ Ensure delivery of quality integrated armies.
refresher trainings to HEWs based
on identified gaps. ✓✓ Equip community level centers
(health posts, farmer training cen-
✓✓ Harmonize and make available so- ters and schools) with basic nutrition
cial and behavioral change commu- materials (IEC, demonstration mate-
nication materials on optimal infant, rials, etc.).
young child, child, adolescent and
maternal feeding practices for use ✓✓ Establish/strengthen and capacitate
by HEWs and the health develop- a community level, multisectoral
ment army. nutrition program coordination plat-
form.
✓✓ Strengthen HEW nutrition monitor-
ing support to the HDAs. ✓✓ Ensure regular reporting and feed-
back mechanisms for multisectoral
✓✓ Strengthen PHCU linkages. nutrition implementation.
✓✓ Mainstream gender issues in all nu-

trition related trainings, for instance

RESULT 5.2: IMPROVED NUTRITION WORKFORCE CAPACITY
INITIATIVES ✓✓ Provide in-service training using the

blended, integrated nutrition learn-
1. Integrate nutrition into higher institu- ing module for health workers.
tions, regional colleges and TVETs
to provide nutrition-specific and nutri- 4. Strengthen the capacity of women
tion-sensitive pre-service training for based structures and associations at all
students of health, agriculture, water levels to promote optimal adolescent,
engineering, food science and technol- maternal, infant and young child nutri-
ogy, and education. tion (AMIYCN) and caring practices.
2. Support training institutions with curricu- ✓✓ Provide training on optimal AMIYCN

lum development and revision, provision and caring practices for members of
of educational materials and technical the Ministry of Women and Children
assistance to build needed critical skills Affairs and for the staff of gender di-
(e.g., clinical nutrition, public health nu- rectorates from all NNP implement-
trition and dietetics). ing sectors at federal level.
3. Provide competency based in-service ✓✓ Provide training for members of re-

trainings to health workers, health ex- gional, zonal and woreda Women
tension workers, agricultural extension and Children Affairs offices on opti-
workers, teachers and staff working in mal AMIYCN and caring practices.
other NNP sectors.
✓✓ Provide training on optimal AMIYCN
✓✓ Conduct national quantification/au- feeding practices for members of
dit on the needs and gaps in the nu- women based structures and asso-
trition workforce. ciations at all levels.
✓✓ Prepare a blended, multisectoral nu-

trition learning module for in-service
nutrition training.
RESULT 5.3: IMPROVED NNP INSTITUTIONAL IMPLEMENTATION

CAPACITY AND MULTISECTORAL COORDINATION
INITIATIVES ✓✓ Establish and/or strengthen region-

al nutrition coordinating body in all
1. Strengthen multisectoral nutrition coor- regions.
dination at all levels.
✓✓ Strengthen the national and region-
✓✓ Strengthen the national nutrition co- al nutrition technical committees
ordination body. (NNTC and RNTC).

✓✓ Establish and strengthen zonal,
woreda level nutrition coordination ✓✓ Assign focal point for nutrition at
platforms and ensure the kebele lev- zonal and woreda levels.
el nutrition coordination integrated
into the existing kebele committee. ✓✓ Ensure assignment of an adequate
number of dedicated staff in all NNP
✓✓ Ensure regular reporting and feed- implementing sectors at federal,
back mechanisms for multisectoral regional, zonal and woreda levels
nutrition implementation and coordi- based on the recommended struc-
nation at all levels. tures.
2. Establish a nutrition directorate, case 3. Improve the capacity of all NNP imple-
team or focal point at all levels based on menting sectors.
the various roles and responsibilities of
NNP implementing sectors. ✓✓ Strengthen the capacity of the nutri-
tion coordination body and nutrition
✓✓ Establish nutrition directorates at technical committees at all levels.
the Ministries of Health, Education,
Agriculture and Natural Resources, ✓✓ Provide pre-service nutrition training
Livestock and Fishery Resource De- for health, water engineering, agri-
velopment, and Industry. culture, education, and food tech-
nology graduates.
✓✓ Establish nutrition case teams at the
Ministry of Trade, Ministry of Women ✓✓ Provide comprehensive in-service
and Children Affairs, Ministry of Fi- nutrition training for staff of NNP im-
nance and Economic Development, plementing sectors.
Ministry of Labor and Social Affairs
and the Ministry of Water, Irrigation 4. Ensure the involvement of women’s en-
and Electricity. tities in NNP implementation and coordi-
nation at different levels.
✓✓ Establish regional level nutrition
case team in all NNP implementing
bureaus.
RESULT 5.4: SYSTEM CAPACITY STRENGTHENED FOR IMPROVED

NNP IMPLEMENTATION
INITIATIVES
3. Prepare and enact relevant nutrition pol-
1. Formulate nutrition workforce standards icies, strategies, directives and guide-
based on the level of competency re- lines.
quired for different roles.
4. Establish and strengthen nutrition direc-
2. Create nutrition posts and nutrition ca- torates, case teams and focal points.
reer paths.
5. Strengthen institutions providing nutri-
tion and food science trainings (short,
medium and long term trainings).

RESULT 5.5: IMPROVED CAPACITY TO CONDUCT NUTRITION
MONITORING, EVALUATION AND RESEARCH
INITIATIVES
5. Strengthen the capacity of NNP imple-
1. Strengthen national research capacity menting sectors in nutrition monitoring
in the areas of food and nutrition. and evaluation.
2. Strengthen the capacity of clinical nutri- 6. Strengthen the capacity of sectors, train-
tion and food analysis laboratories. ing and research institutions to under-
take operational research on nutrition.
3. Provide training on nutrition monitoring
and evaluation for staff across sectors 7. Establish annual national nutrition
forums to disseminate research findings
4. Establish a unified nutrition information and documentation on best practices.
system to monitor nutrition interventions
across sectors.
RESULT 5.6: IMPROVED REGULATORY CAPACITY
INITIATIVES ✓✓ Establish and equip quality control

laboratories at national and regional
1. Strengthen the regulatory system levels.
throughout the country.
✓✓ Capacitate regional regulatory bod-
✓✓ Provide training for technical food ies and strengthen coordination
inspectors on quality and safety of among them.
nutrition supplies.
RESULT 5.7: IMPROVED CAPACITY OF MEDIA

INITIATIVES
✓✓ Equip media with nutrition related
1. Build the capacity of national and re- SBCC materials to promote positive
gional media personnel. nutrition practices.
✓✓ Provide nutrition training for me- 2. Protect the public from media based
dia personnel, including local and commercial pressures (advertisements)
school mini-medias. that are against optimal nutrition prac-
tices.
✓✓ Update and harmonize age appro-
priate SBCC materials to ensure 3. Provide media based opportunities for
effective use of all available mass open dialog between the general public
media channels. and nutrition professionals.

NUTRITION IMPLEMENTATION
AND GOVERNANCE
Nutrition has a multidimensional and multi-
sectoral nature in terms of both effect and
outcomes. Thus, in order to accelerate
progress on NNP implementation, strong
4
governance and program implementation
arrangements are vital. This issue will be
addressed by pursuing the following set of
objectives and their sub-components.
OBJECTIVES
1. Develop and enforce nutrition related
policies and legislations.
2. Sustain political will and commitment on

nutrition; mainstream nutrition as a pri-
ority agenda item in all NNP implement-
ing sectors and beyond.
CHAPTER
3. Strengthen multisectoral nutrition coor-
dination for a harmonized, multisectoral
response and for efficient resource mo-
bilization and utilization.
4. Define feasible, locally accepted Com-

munication for Development activities to
bring about the behavioral changes re-
quired for improved nutrition.
5. Continue providing leadership to re-

gions on cascading and executing the
NNP implementation plan.
NUTRITION GOVERNANCE
Currently, there is no generally accepted
framework or set of terminology for concep-
tualizing nutrition governance. Nonetheless,
five key building blocks of effective nutrition
governance are apparent in the literature.
These are political commitment, consensus
building and coordination, financing, service
delivery capacity, and transparency and ac-

Transparency Poli4cal Consensus
& Commitment Building &
Accountability Coordina4on
Service
Delivery Financing
Capacity
Figure 4: Building blocks of effective nutrition governance
countability. This chapter will describe all of 4.2. MULTISECTORAL

these components in the Ethiopian context
NUTRITION COORDINATION
with the exception of financing, which is
dealt with in Chapter 5.
The National Nutrition Program is a long-
term national program that requires the
4.1 POLITICAL COMMITMENT involvement of all responsible sectors and
partners. Timely and effective implementa-
AND POLICY FRAMEWORK tion requires an efficient operational frame-
The Government of Ethiopia demonstrat- work as well as appropriate leadership and
ed its political commitment to nutrition by implementation capacity. The NNP will
developing the National Nutrition Strategy continue to use existing government struc-
and National Nutrition Program in 2008, tures to ensure sustainability and long-term
along with various other policies, strategies achievement of objectives. The following
and programs. The government also incor- sub-sections describe the institutional ar-
porated nutrition, with particular attention rangements required to improve multisec-
to the reduction of stunting, into its 5-year toral coordination, along with human and
Growth and Transformation Plan. Most of institutional capacity building strategies to
the main policies, strategies and programs guide implementation.
developed to mainstream nutrition into NNP
implementing sectors are summarized in
Table 2.

Table 2: Nutrition-specific and nutrition-sensitive
strategies/programs/guidelines in Ethiopia
Nutrition-specific guidelines
Document title Organization Date
Micronutrient Deficiencies Prevention and Control Guideline FMOH 2015
Adolescent, Maternal, Infant and Young Child Nutrition Guideline FMOH 2015
Acute Malnutrition Management Guideline FMOH 2015
Multi-sectoral nutrition implementation and coordination guideline FDRE 2016
National Nutrition Strategy FDRE 2008
National Nutrition Program II FDRE 2015
Seqota 15 years strategic plan FDRE 2016
Nutrition-sensitive strategies/programs/guidelines
Document Body Year
Poverty reduction and development
Growth and Transformation Plan II MOFEC 2015
Agriculture and food security
Agriculture Growth Program II MOANR 2015
PSNP IV MOANR 2015
Nutrition Sensitive Agriculture Strategic Plan MOANR 2016
Public health
Health Policy FDRE 2015
Health Sector Transformation Plan FMOH 2015
Reproductive Health Strategy FMOH 2011
National Strategy for Child Survival FMOH 2015
Education
School Health and Nutrition Strategy MOE 2016
National School Feeding Program MOE 2016
Social protection
National Social Protection Policy MOLSA 2015
Nutrition relevant regulations/standards/proclamations
Fortified flour manufacturer, importer, exporter and wholesaler directive FMHACA 2015
Fortified oil manufacturer, importer, exporter and wholesaler directive FMHACA 2015
Fortified oil standard ESA Draft
Fortified flour standard ESA Draft
Infant formula directive FMHACA 2015
Food supplement directive FMHACA 2015
Directives for Advertising FMHACA 2012
Iodized salt controlling directive FMHACA Ratified
Food manufacturing licensing criteria FMHACA Ratified
Ratified
Food export import & wholesalers directive FMHACA
2014
Food retailer licensing criteria FMHACA Ratified

4.2.1. MULTISECTORAL including civil society organizations, aca-
COORDINATION AND LINKAGES demia, and the private sector. Figures 5-9
FOR NUTRITION depict coordination and linkage mecha-
This component of the program is designed nisms for nutrition at the national level.
to strengthen coordination and linkages
across all sectors that deal with the under- Over the last three years, almost all
lying and basic causes of malnutrition. The regions established a Regional Nutrition
purpose is to enhance the nutritional impact Coordinating Body (RNCB) and a Regional
of programmatic activity in these sectors. Nutrition Technical Committee (RNTC). In a
To improve existing multisectoral coordi- few regions, sub-regional level coordination
nation and strengthen linkages based on platforms at zonal and woreda level were
lessons learned over the last seven years also established. The current program
of NNP implementation, this revised NNP implementation phase, 2016-2020, will
has included the role of responsible sectors focus on further cascading multi sectoral
as shown in Strategic Objective 4 as well coordination frameworks and program
as in the Accountability and Results Matrix implementation arrangements down to
located at the end of the document. Ethio- remaining zones, woredas and kebeles
pia has well defined policies, strategies and using the decentralized government
implementation guidelines in those sectors structure.
with the potential to affect better nutrition.
These will be the basis for nutrition related The terms of reference for NNCB and NNTC,
cross-sectoral linkages. along with information on membership, fre-
quency of meetings and the roles and re-
To ensure viable linkages and harmoniza- sponsibilities of NNP implementing sectors
tion among sectors, the Federal Ministry of will be detailed in a multisectoral nutrition
Health houses and manages the organi- coordination implementation guideline.
zational and management structure of the
National Nutrition Program. The National In order to enhance accountability and max-
Nutrition Coordinating Body and the Nation- imize ownership, the NNCB should regularly
al Nutrition Technical Committee were es- report on the progress of NNP implementa-
tablished in 2008 and 2009, respectively, to tion to the Office of the Deputy Prime Min-
ensure effective coordination and linkages. ister. All NNP implementing sectors should
The current program, NNP II, outlines hu- also regularly report on the progress of
man resource capacity building activities, nutrition-sensitive interventions and on the
with emphasis on all relevant sectors. These performance of NNP implementation to the
adjustments will ensure that implementation NNCB chair as well as to the Office of the
of the NNP is harmonized across all sectors Deputy Prime Minister. All RNCBs should
and levels, particularly at regional, woreda regularly report on progress and perfor-
and community levels. mance in regional NNP implementation to
the NNCB and to their respective regional
president’s office. Regional presidents will
4.2.2 INSTITUTIONAL ARRANGE- regularly report to the Office of the Deputy
MENTS FOR MULTISECTORAL Prime Minister.
NUTRITION COORDINATION AND
LINKAGES Similarly, all regional NNP implementing
The National Nutrition Coordinating Body sector bureaus should regularly report on
will remain the main mechanism for lead- progress and performance to the RNCB and
ership, policy decisions and coordination of to their respective federal NNP implement-
the National Nutrition Program. The NNCB ing sectors. Woreda nutrition coordinating
consists of eleven government sectors and body chairs (woreda administrators) should
a range of nutrition development partners, report to zonal nutrition coordinating body

Na#onal Nutri#on Coordina#ng
Body
Co-‐chair, State Minister, MoANR Chair, State Minister, MOH
Secretary, Director, MCHN
Private Sectors
Academia
NDRMCC
FMHACA
MOWCA
MOANR
MOWIE
MOFEC
MOLSA
FONSE
FBPIDI
MOYS
MOH
MOE
MOT
EPHI
EIAR
NDP
MOI
GCA
CSO
Figure 5: Multisectoral nutrition coordination: National Coordination Body
Na#onal Nutri#on Technical

Commi2ee
Co-‐Chair, Director, Nutri#on

Chair, Director, MCHND
Directorate, MOANR
Secretary, Nutri#on Case Team

Private Sectors
Academia
NDRMCC
MOLFRD
FMHACA
MOWCA
MOANR
MOWIE
MOFEC
MOLSA
FONSE
MOYS
MOH
MOE
MOT
EPHI
EIAR
NDP
MOI
GCA
CSO
Figure 6: Multisectoral nutrition coordination: National Nutrition Technical Committee

Office of the Deputy
Prime Minister
Regional
Sector Ministries NNCB
President
Sector Ministries RNCB
Sector Zonal Zonal

ZNCB AdministraJon
Departments
Sector Woreda Woreda

WNCB AdministraJon
Offices
HEWS, AEWs, Teachers, Kebela

Social Workers, Women KNTC AdministraJon
Group Leaders, Water
CommiIee Leaders
Figure 7: Nutrition coordination, reporting line and feedback mechanisms
chairs (zonal administrators) and these in mote efficient and effective implementation
turn to their respective regional nutrition co- and coordination of the National Nutrition
ordinating body chairs as well as to the re- Program. These committees include the
gional president. Zonal and woreda health Nutrition-Specific Interventions Steering
offices will act as secretary. Committee, led by the Ministry of Health;
the National Food Fortification Steering
The director of the Nutrition Directorate will Committee, led by the Ministry of Industry;
serve as secretary for the NNCB and as the National Nutrition Monitoring, Evalua-
chair for the National Nutrition Technical tion and Research Steering Committee, led
Committee. Zonal and woreda level nutri- by the Ethiopian Public Health Institute. The
tion coordinating bodies will be chaired by overall objective of the steering committees
zonal and woreda administrators. All Nutri- is to support coordination among program
tion Technical Committees should regularly implementers and partners for successful
report on their plans and performance to the implementation of the National Nutrition
appropriate chairperson in the Nutrition Co- Program.
ordination Body.
Establishing steering committee under the
National Nutrition Steering Committees NNTC was found to be an ideal way to ef-
The National Nutrition Coordination Body ficient and effectively coordinate NNP pro-
created several steering committees to program implementation. Coordinating both

Implementa)on Ins$tu$onal
Levels Arrangements
Office of the Office with adequate personnel

DPM for coordina)on
NNP Implemen)ng Necessary structure, sufficient

Sectors personnel and budget
Regional Unit and Personnel
Focal Person Dedicated for

Zonal Nutri)on
BSc in food science, nutri)on,

Woreda Postharvest, trained health
professionals
HEWs, AEWs, Teachers, HDAs,

Kebele/ ADAs, Women group, trained
Community on Nutri)on
Figure 8: Nutrition implementation levels and necessary

institutional arrangements
Na#onal Nutri#on
Coordina#on Body
(NNCB)
Na#onal Nutri#on
Technical Commi:ee
(NNTB)
Na#onal Nutri#on
Na#onal Nutri#on Na#onal Nutri#on
Monitoring, Evalua#on &
For#fica#on Steering For#fica#on Steering
Research Steering
Commi:ee Commi:ee
Commi:ee
Figure 9: National nutrition technical committees

System
Organiza/onal
Workforce/Human
Resource
Individual
and
Community
Figure 10: Dimensions of nutrition capacity building
nutrition-specific and nutrition-sensitive in- nutrition should address the following four
terventions was beyond the scope of the dimensions. These are system capacity,
Ministry of Health alone. It requires further organizational capacity, workforce/human
division of tasks among sector ministries resource capacity and individual and
based on their engagement and account- community capacity (Figure 10).
ability for nutrition interventions. Therefore,
it became clear that the Program Man- 4.3.1. SYSTEM CAPACITY
agement Steering Committee needed to BUILDING FOR NUTRITION
comprise both nutrition-specific and nutri- Although nutrition is being coordinated
tion-sensitive committees led by their re- and implemented by various implementing
spective ministries. An additional sectoral sectors in the country, there is no career
steering committee, for resource mobiliza- structure for the nutrition workforce. Nev-
tion and financial monitoring, should also be ertheless, meeting NNP objectives calls for
given due attention. the various ministries to devote special at-
tention to the cultivation of a career path for
The terms of reference, membership, the nutrition workforce. System capacity for
frequency of meetings and the roles and nutrition includes the following:
responsibilities of each of the steering
committees will be detailed in a multisectoral ✓✓ Strengthening leadership and gov-
nutrition coordination and implementation ernance in nutrition programming.
guideline.
✓✓ Creating career paths and posts for
4.3. CAPACITY BUILDING the nutrition workforce.
FOR NUTRITION ✓✓ Strengthening management capaci-
For effective implementation sustained ty in the nutrition workforce.
nutritional impact, capacity building for

✓✓ Improving capacity to mobilize and ✓✓ Food safety and quality control labo-
manage resources. ratory materials
✓✓ Strengthening supply chain man- ✓✓ Supplies for hygiene and sanitation,
agement for nutrition. water purifiers, etc.
✓✓ Improving the nutrition information Nutrition information system capacity

system. development
Developing the capacity of the nutrition in-
4.3.2. ORGANIZATIONAL CAPACITY formation system involves strengthening
FOR NUTRITION organizations that conduct nutrition pro-
gram monitoring, evaluation and research
Coordination capacity related activities. A multisectoral nutrition
To fulfill its mandate to coordinate and im- information platform should be established
plement national nutrition objectives, the at national level to monitor the implemen-
Federal Ministry of Health will establish a tation of NNP across sectors. Moreover, all
dedicated, well-staffed directorate for nutri- NNP implementing sectors should ensure
tion. Similarly, nutrition directorates will be that nutrition related information is regularly
established in MOANR, MOLFR, MOI and monitored, used and shared and monitored.
MOE. The roles and responsibilities of the
nutrition directorate in each implementing 4.3.3. NUTRITION WORKFORCE
sector will be detailed in a multisectoral CAPACITY BUILDING
nutrition implementation and coordination All NNP implementing sectors should have
guideline. an adequate number and mix of competent
nutrition cadres or technical persons placed
Supply and logistics capacity at all levels of service delivery and man-
Supply and logistics are key inputs for ef- agement. The major strategies for avail-
fective implementation of nutrition-sensitive ing human resources are pre-service and
and nutrition-specific interventions. Sector in-service trainings. During the NNP imple-
ministries will conduct needs assessments mentation period, the capacity of the nutri-
and develop supply and logistics plans. tion workforce will be enhanced as follows:
Each ministry will review the plan and take
measures to improve and put the plan into ✓✓ At national level, sector nutrition di-
effect. Supplies and logistics needed to de- rectorates and/or case teams will
liver the National Nutrition Program include build a workforce that will be respon-
but are not limited to: sible for coordinating nutrition within
their respective sector. Specific min-
✓✓ Supplements and therapeutic prod- istries, based on the scope of work,
ucts will determine the number of staff
members needed.
✓✓ Training manuals
✓✓ Sectors will work with the Ministry
✓✓ Print and electronic materials for so- of Education and with regional gov-
cial and behavioral change commu- ernments to integrate nutrition into
nication universities and regional colleges/
TVET institutes to provide nutrition
✓✓ Agricultural inputs pre-service trainings.
✓✓ Food processing materials and in- ✓✓ Training institutions will be supported

puts with curriculum development
and revision, with provision of

Table 3: Nutrition workforce requirements at various levels
Level/organization Required profession Description

Nutritionists, public health Knowledge and skill of
Federal ministries and nutritionists food nutrition science and
regional level sector technologists, other disease, nutrition
bureaus professionals with adequate advocacy,
nutrition training management
Basic nutritional sciences,
Woreda level sector Basic knowledge on
other professionals with
offices food and nutrition
adequate nutrition trainings
Knowledge and skill of
Hospitals Nutritionists and dieticians nutrition science and
disease
Health professionals
Health canters, health
Nutritionists with training on
posts
nutrition
Teachers with
Nutritionists, teachers trained
Schools adequate nutrition
on nutrition counselling
knowledge
Teachers, health and
agriculture
Development army trained on
Community professionals with
nutrition counselling
adequate nutrition
knowledge
Basic knowledge,
Universities, health and Nutritionists, food
skills and practice in
agriculture colleges, technologists, dieticians and
nutritional sciences
TVTs public health nutritionists
and research
educational materials and with with continuous nutrition training.

technical assistance to build critical
skills that are not yet adequately 4.3.4. CAPACITY DEVELOPMENT
available. OF INDIVIDUALS AND COMMUNI-
TIES IN NUTRITION
✓✓ Competency based in-service train-
ings will be provided. These will en-
Nutrition programs aim to achieve optimal
able workers to plan, implement and
nutrition knowledge, behavior and practices
monitor multisectoral nutrition inter-
among target communities and individuals.
ventions.
In order to achieve this objective, developing
the nutrition capacity of communities is of
✓✓ Health facilities at various levels will
paramount importance. The ways in which
be staffed with appropriate nutrition
communities respond to challenges affect-
professionals.
ing their nutritional status will be improved,
and the ability of communities to participate
✓✓ Job aids, training materials and
in and manage community resources to
community teaching materials will
achieve better nutritional outcomes will be
be prepared in local languages.
enhanced.
✓✓ Media professionals will be provided

Capacity building at the individual and com- insecurity takes a severe toll on the health
munity level will focus on the following: of all household members, research shows
✓✓ Community level development that women and girls suffer most. A mother’s
groups (health and agricultural de- ability to make decisions within the house-
velopment army, etc.) will be the key hold and in her community is an important
entry points for community level nu- factor not only for her own nutritional out-
trition work. They will receive ongo- comes but also for those of her children. At
ing support from health and agricul- the family/household level, the heavy work-
tural extension workers. load resulting from the many household re-
sponsibilities that women shoulder usually
✓✓ Existing community/social struc- leaves women with little or no time to prop-
tures, such as “idir,” women’s and erly care for their children and themselves.
youth associations, and faith based Along with unequal, gender based resource
organizations, will serve as addition- distribution at the household level, a num-
al channels for delivering communi- ber of harmful traditional practices, such as
ty and individual nutrition capacity food taboos for women and girls (especially
development activities. pregnant and lactating women), early mar-
riage, and violence against women have
✓✓ Community structures will be provid- contributed to the poor nutritional status of
ed with nutrition information and be the majority of infants, young children and
motivated to deliver key preventa- women in Ethiopia.
tive nutrition messages and practic-
es and to facilitate nutrition-sensitive Gender is considered a cross-cutting issue
community development interven- and has remained a crucial concern that
tions. has prompted the setting of clear objectives
✓✓ Improve community’s access to la- for gender mainstreaming at all levels of the
bor and resource saving technolo- various sectoral programs. Most nutrition
gies. programs target women and children but
neglect the adolescent stage, an important
✓✓ Community level centers of excel- period of development. The key role that
lence for wider experience sharing men play in achieving nutrition security has
will be established. also been overlooked. Nutrition interven-
tions have principally tended to address
✓✓ Community level structures and factors that directly contribute to nutrient in-
centers, such as farmers training take and health, missing other underlying,
centers, schools and health posts basic factors, such as the decision-making
will be equipped with nutrition learn- capacity of women in households and ac-
ing materials. cess to education and economic resources,
to name a few.
4.4. GENDER DIMENSIONS OF The National Nutrition Program has af-
NUTRITION firmed the reciprocal relationship between
gender and nutrition and articulated a way
Gender and nutrition are inextricable parts to mainstream gender into various compo-
of the vicious cycle of poverty. Gender and nents of the program. Some of the major
undernutrition are highly correlated and recommended strategies are as follows:
interconnected with livelihood security at
household and community levels through- ✓✓ Incorporate a gender analysis as
out the entire lifecycle. Gender inequali- part of the regular nutrition situation
ty can be a cause as well as an effect of analysis, focusing on the needs,
hunger and malnutrition. While chronic food priorities and roles of men and

women. tive monitoring and evaluation. Rel-
evant indicators should be disaggre-
✓✓ Promote meaningful male involve- gated by sex, and data collection
ment in nutrition interventions. and analysis formats should facili-
Women and girls may be targeted in tate gender-sensitive data collection
view of their special vulnerabilities, and analysis.
but men and boys should also be
reached to help address their needs ✓✓ Ensure the integration of gender into
as well. sectoral nutrition implementation
guidelines.
✓✓ All human-capacity building inter- ✓✓ Engage women’s groups in nutrition
ventions planned by NNP will con- advocacy and in engaging citizens
sider mainstreaming gender equal- about the effects of malnutrition on
ity within training programs and will the socioeconomic status of the na-
engage an equal number of male tion (education, health and produc-
and female participants. tivity).
✓✓ Give due attention to gender-sensi-
4.5. NUTRITION COMMUNICATION

The National Nutrition Coordination Board tion, including extension of mater-
will implement the following objectives and nity leave to 6months and the In-
key activities for nutrition communication. ternational Code of Marketing of
Breastmilk Substitutes.
4.5.1 POLICY ADVOCACY AND
PUBLIC DIALOGUE ✓✓ Engage the media to promote nutri-
tion policy and practice among the
public and policymakers.
OBJECTIVES
✓✓ Identify and engage nutrition cham-
1. Implementation of nutrition related poli- pions for nutrition related policy
cy and legislation enforced. message delivery and implementa-
tion.
2. Multisectoral nutrition coordinating bod-
ies and technical communities are en- ✓✓ Engage stakeholders for policy
gaged in policy dialogues and dissem- awareness, implementation and in-
ination. fluence through dialogues.
3. NNP implementers understand nutrition ✓✓ Promote utilization of nutrition evi-

related policy and legislation. dence for policy input and dialogue.
4. Ensure that nutrition is an agenda item
for the media. ✓✓ Promote healthy feeding and life-
styles.
KEY ACTIVITIES
✓✓ Identify appropriate channels and
✓✓ Conduct advocacy and public dia- influential actors to reach, inform,
logues for nutrition related policy, influence, capacitate and motivate
strategies, programs and legisla- decision makers.

change communication across the
✓✓ Engage policymakers to enforce pol- country and strengthen community
icies around prevention of non-com- participation for improved nutrition.
municable and lifestyle related dis-
eases. ✓✓ Generate evidence to identify bar-
riers, facilitators and behavioral de-
✓✓ Sensitize and involve the private terminants, social norms and tradi-
sector in implementing NNP objec- tions for optimal nutrition practices.
tives.
✓✓ Map and harmonize existing nutri-
✓✓ Develop a nutrition communication tion communication multimedia ma-
strategy. terials to support both media and
interpersonal communication in var-
✓✓ Develop a nutrition communication ious languages.
toolkit to help policy implementation
and public dialogue. ✓✓ Identify appropriate channels and
influential actors to reach, inform,
✓✓ Conduct media monitoring to gauge influence, capacitate and motivate
the quality and impact of nutrition the public.
coverage.
✓✓ Create public awareness on healthy
4.5.2 SOCIAL AND BEHAVIORAL dietary practices, healthy lifestyle,
CHANGE COMMUNICATION and lifestyle related non-communi-
cable diseases.
OBJECTIVES
✓✓ Build the capacity of community
level implementers (HEWs, AEWs,
1. Capacity of nutrition actors at commu-
DAs, farmer groups, women’s and
nity and institutional levels on social
youth forums, teachers and stu-
and behavioral change communication
dents) to promote positive behavior
strengthened.
change in the community.
2. Healthy feeding and prevention of life-
✓✓ Build the capacity of the media, in-
style related non-communicable diseas-
cluding school mini-media, to own
es among the general public promoted.
SBCC nutrition interventions and
engage in the promotion of optimal
3. Optimal AMIYCN through traditional
nutrition practices.
and innovative behavior change meth-
ods and channels promoted.
✓✓ Develop innovative nutrition com-
munication and social mobilization
4. Nutrition messages and materials stan-
guidelines.
dardized and culturally acceptable.
✓✓ Engage the media to promote good
5. Community participation and engage-
nutrition practices among the public
ment in the promotion and uptake of op-
and to foster dialogue on nutrition
timal nutrition and child caring practices
among experts and the public.
increased.
✓✓ Identify and engage nutrition cham-
KEY ACTIVITIES pions and influential actors for dis-
semination of nutrition messages
✓✓ Promote social and behavioral and policy-influencing activities.

✓✓ Build the capacities of nutrition
champions and influential actors in
effective interpersonal communica-
tion.
✓✓ Document and share best practices

of AMIYCN activities at all levels, es-
pecially focusing on the model fam-
ily.
✓✓ Monitor and evaluate the impact of

nutrition communication and social
mobilization activities for program
improvement.
✓✓ Conduct media monitoring to gauge

the quality and impact of nutrition
coverage.
✓✓ Develop a nutrition communication

toolkit to support rollout of nutrition
related SBCC interventions.

SUSTAINABLE NUTRITION
FINANCING
The government of Ethiopia is committed to
accelerating the implementation of a multi-
sectoral, harmonized National Nutrition Pro-
gram to make a strong impact on nutrition
and on the overall wellbeing of the nation.
5
This NNP is designed to address both long-
term and short-term nutrition goals in Ethio-
pia. The strategic plan outlines a package of
proven, cost-effective nutrition interventions
that will break the cycle of malnutrition and
ensure child survival.
So far, inadequate budget allocation, re-

source shortages, weak financial mobiliza-
tion and low utilization have been the main
challenges to implementing the National Nu-
trition Program. Implementation challenges
therefore should be addressed in order to
scale up and accelerating implementation of
CHAPTER nutrition strategies already in place.
Costing for the NNP was conducted using

one health tool for the nutrition specific inter-
ventions to be implemented by health sec-
tors and activity based costing approaches
for nutrition sensitive interventions to be im-
plemented by nutrition sensitive implement-
ing sectors. The total budget required for im-
plementing the NNP over the next 5 years is
estimated to be 1.1billion USD. Out of this
budget the Government of Ethiopia’s contri-
bution is 515,690,757.00 (45%), the donor
contribution is 198,116,469.00 (17%) and the
budget gap is 430,280,690.00 (38%).
Nearly 88.6% of the total budget is planned

for nutrition specific interventions while
11.4% will be used for nutrition sensitive in-
terventions (Table 4). In the last 3 years, the
FDRE/ MOH have consolidated new partner-
ships to raise more funds for NNP implemen-
tation. Hence, successful implementation of
the NNP requires timely mobilization of re-
sources and minimizing of uncertainties in
the planning of nutrition interventions.

Table 4: NNP estimated intervention budget, 2016-2020
Summary Budget
to Implement Summary Budget Estimated in USD Total Budget in
Nutrition
USD
Interventions
across Sectors
2016 2017 2018 2019 2020
Budget for nutrition-
specific 123,549,793.25 160,607,069.33 207,070,394.89 244,213,694.81 278,384,505.76 1,013,825,458.04
interventions
Budget for nutrition-
sensitive
23,615,708.17 25,692,611.44 27,724,167.21 25,254,639.08 27,975,331.63 130,262,457.53
interventions
across sectors
Total budget to
implement both
nutrition-specific
147,165,501.42 186,299,680.76 234,794,562.10 269,468,333.89 306,359,837.39 1,144,087,915.57
and nutrition-
sensitive
interventions
Amount in USD
$1,144,087,916.00
$515,690,757.00
$430,280,689.00
$198,116,469.00
Es1mated budget Government contribu1on Donor contribu1on Budget gaps
Figure 11: NNP budget gap

MONITORING, EVALUATION
AND RESEARCH
6.1 MONITORING AND
EVALUATION
6
The National Nutrition Program is built on
the assumption that there will be a strong
national partnership among nutrition de-
velopment partners, multilateral and bilat-
eral donors, academia, the private sector
and NNP implementing sector ministries at
all levels. This NNP document will be the
source document for a harmonized plan of
action with a clear monitoring and evaluation
framework. The accountability and results
matrix at the end of the document outlines
the core results, targets and their indicators
as well as the sectors accountable and the
measuring period for these indicators.
CHAPTER The NNP accountability and results frame-
work was developed to enable effective
management and optimal mobilization, al-
location, use of resources, and the making
of timely decisions to resolve constraints or
problems of implementation (see Annex 1).
Routine service and administrative records
compiled through the sectoral information
systems will provide the information source
for timely monitoring. To enrich the data,
supervisory visits and review meetings will
be conducted terms of reference that will
be developed for each sector. The program
implementation, monitoring and evaluation
components of the plan are designed to
support each other (Figure 14). The Ethio-
pian Public Health Institute and the Ethio-
pian Institute of Agricultural Research will,
in collaboration with nutrition implementing
sectors, undertake periodic assessments,
operational research and surveys to help
identify program strengths, weaknesses
and key challenges.

Program
coordina,on

Informa,on Monitoring,
Interventions system Evalua,on
& Research
Figure 12: Strong program implementation system
To strengthen the monitoring and evaluation be collected at facility and communi-

component of the NNP, implementing sec- ty levels, including nutrition surveys
tors will do the following: and assessments.
✓✓ Integrate the recording and report- ✓✓ Strengthen HMIS to incorporate ap-

ing of sex and age disaggregated propriate nutrition-specific indicators
nutrition data within existing sectoral that can be collected at facility and
information systems. community levels, including nutrition
surveys and assessments.
✓✓ Ensure appropriate integration of
nutrition-sensitive and nutrition-spe- ✓✓ Ensure incorporation of nutrition in-
cific indicators in sector-specific dicators in plans for each sector.
woreda based plans.
✓✓ Build the capacity of nutrition pro-
✓✓ Ensure appropriate use of nutri- gram implementing line ministries,
tion-sensitive and nutrition-specif- agencies and institutes at all levels
ic results in sector-specific woreda to collect and use nutrition data for
based planning. planning and decision making.
✓✓ Strengthen joint operational re- ✓✓ Ensure regular integrated support-

search planning in the areas of food ive supervision (ISS), multisectoral
and nutrition among sectors and in- and sectoral review meetings at all
stitutions. levels.
✓✓ Develop a unified food and nutri- ✓✓ Conduct midterm and end-line eval-
tion information system to capture uation, impact assessments and
appropriate nutrition-sensitive and surveys.
nutrition-specific indicators that can

✓✓ Develop a central food and nutrition
information platform/databases for ✓✓ Carry out a mapping exercise of
research, surveys and programmat- all nutrition related operational re-
ic data that allow triangulation of in- search to avoid duplication.
formation from all sectors.
✓✓ Identify priority research areas
✓✓ Conduct systematic review and pub- based on the revised NNP follow-
lication of existing nutrition data for ing consultation with all nutrition
programming and decision making. stakeholders. EPHI will facilitate
the decision as to whether a given
Dissemination of M&E Results research topic will be handled in-
To inform decisions across the implemen- house or outsourced.
tation system as well as the public at large,
NNP implementing sectors will disseminate ✓✓ All organizations carrying out oper-
information through the following mecha- ational research should liaise with
nisms: EPHI during the entire process,
including sharing topics and meth-
✓✓ Monitoring reports, which will be ods, requesting ethical clearance,
disseminated quarterly, biannually sharing results and providing re-
and annually. ports and data. A method of col-
lecting, compiling and storing op-
✓✓ Evaluation and research findings, erational research (data, reports)
which will be disseminated through needs to be set up and housed
publications, reports, workshop within EPHI as the country’s pre-
proceedings and policy briefs. mier nutrition research institute.
This will serve to avoid duplication
of research efforts and facilitate the
identification of key outstanding op-
6.2 OPERATIONAL RESEARCH erational research areas.
Operational research is designed to test ✓✓ Ensure that nutritional impact is
alternative intervention modalities and to measured in all social protection
answer key operational questions as they and development programs.
arise during NNP implementation. The Ethi-
opian Public Health Institute, as the lead nu- ✓✓ Support university based research-
trition research institute in the country, leads ers with grants to undertake nutri-
operational research as part of its mandate. tion research of national priority
In the course of implementing the previous through the engagement of gradu-
NNP (2008–2015), EPHI held a workshop ate students.
with NNP stakeholders and partners to
specify and prioritize studies.
Building on lessons learned, the focal areas

of operational research will be as follows:
✓✓ Strengthen the capacity of EPHI
to coordinate, carry out and su-
pervise operational research and
to sub-contract to other organiza-
tions/institutions.

Table 5: Operational research priorities (2016-2020)
Establish a multisectoral national nutrition research database
Conduct systematic reviews and produce policy briefs on
nutrition-specific and nutrition-sensitive interventions
Expand and update existing Ethiopian food composition table
National Document, develop recipes for and promote indigenous and
nutrition underutilized foods for food and nutrition security
research
Develop food guide pyramid and daily recommended allowance
database and
for Ethiopians
documentation
Conduct surveillance of food safety and quality (fortified foods
and selected food items)
Nutritionally characterize/classify released and improved
Ethiopian crop varieties and livestock products (including bio-
fortified products)
Lifestyle and dietary related non-communicable diseases
The role of nutrition in infectious diseases (TB, HIV, malaria and
intestinal parasites)
ICYF (infant and young child feeding) practice for better health
and nutrition outcomes
! Identify cultural and social barriers of child feeding practices
Health and in Ethiopia
nutrition ! Establish a national breastmilk bank (pilot study)
interaction
Develop dietary menus for various entities (hospital patients,
military, schools, refugees, prisons, rehabilitation centers and
athletes)
! Optimize and popularize bean based recipes
Conduct an impact evaluation of health and agriculture sector
linkages to implement nutrition-specific and nutrition-sensitive
activities
Appropriate food processing technology identification,
assessment, adoption and transfer to the community
Study on the linkages between nutrition security, health,
agriculture and climate change
Develop region based complementary food products for under 5
children and for pregnant and lactating mothers
Develop supplementary food from locally grown crops for
Food treatment of children with moderately acute malnutrition
processing Enhance food processing technologies through development of
technology alternative enzymes, starter cultures and other biotechnological
and product products
development ! Evaluation of soybean products (milk and cheese) improved
with locally available herbal materials
! Development and popularization of fruit flavored yogurt
! Optimizing nutritive value of traditional foods and beverages
by using whey
! Optimizing bread making quality of teff, finger millet, cassava
and soybean flours by incorporating with wheat flour
! Processing technique evaluation of three commercially
important fish species in Ethiopia
! Nutritional and sensory evaluation of soybean fortified kocho
Table 5 continued on next page

Table 5: Operational research priorities (2016-2020)
Study food shelf life and food and water safety and quality in
Ethiopia
! Edible oil study (lipid profile and safety of commonly

consumed oils)
Food safety ! Quality and safety of butter: Traditional preservation and
and quality adulterant characterization
! Effect of agro-ecology and varieties of teff on nutritional,
sensory and shelf life stability of injera
! Food safety (heavy metals, pesticides, herbicides, persistent
organic pollutants, microbials, drug residue, including
hormones and radioactive materials)
Operational research on micronutrient interventions (food

fortification)
Multiple micronutrient powder supplementation feasibility study

(including packaging)
National micronutrient survey and end-line survey

Micronutrient
research Stable isotope techniques to determine nutrient body pool size
Study on safety, stability and bio-availability of fortificants

(premixes)
Study on the effect of zinc enriched fertilizer on the micronutrient
status of young children and women of reproductive age
Evaluation of the impact on health and nutrition of school

nutrition in pilot program implementation areas
Program
performance Evaluation of community based nutrition (CBN) programs
and impact
evaluation Systematic reviews and policy briefs
Nutrition research output dissemination
Public education on nutrition and health
Education and Assessment of nutrition issues in primary school syllabi

gender related
research Capacity and needs assessment of women development groups
in nutrition promotion
Behavioral change and communication studies
Table 5 continued from previous page

ANNEX: ACCOUNTABILITY AND
RESULTS MATRIX FOR NNP
IMPMEMENTATION
Impact Objectives: Improve Nutritional Status of Women and Children

Impact Indicators 2011/2014 Target Periodicity Level of Source
(Baseline) Data
2016 2017 2018 2019 2020 Collection
Proportion of under 5 children with height-for-age Z-score
below -2 SD (prevalence of stunting) 40 37.2 34.4 31.6 28.8 26 by 2019/20 National EDHS, 2014
Proportion of under 5 children with weight-for-age Z-score
25 22.6 20.2 17.8 15.4 13 by 2019/20 National EDHS, 2014
below -2 SD (prevalence of underweight)
Proportion of under 5 children with weight-for-height Z-
9 8.2 7.4 6.5 5.7 4.9 by 2019/20 National EDHS, 2014
score below -2 SD (prevalence of wasting)
Proportion of women of reproductive age (15-49 years)
27 24.8 22.6 20.4 18.2 16 by 2019/20 National EDHS, 2014
with BMI <18.5
Proportion of newborns who weighed less than 2.5 kg at
11 9.8 8.6 7.4 6.2 5 by 2019/20 National EDHS, 2014
birth
Prevalence of overweight among women of reproductive
9 8 7.5 7 6.5 6 by 2019/20 National EPHI, 2015
age
Strategic Objective 1: Improve the nutritional status of women (15-‐49 years) and adolescents (10-‐19 years)
Indicators Type Baseline Target Periodicity Level of Data Source
2014/15 Collection
2016 2017 2018 2019 2020
Proportion of adolescent girls aged 10-19 years Annual / RHB, WorHO
Output NA* 10 20 30 40 50 Reports
supplemented with IFA Biannual and HFs
Prevalence of anemia in adolescents aged 10-19 years Outcome 28% 25 22 19 16 13 - Community Survey
Annual / RHB,WorHO
Proportion of adolescents received deworming tablets Output NA 15 30 45 60 75 Reports
Biannual and HFs
Proportion of adolescent girls married below 18 years Outcome 8% 6.8 5.6 4.4 3.2 2 - National Survey
Prevalence of teenage (15-19 years) pregnancy Outcome 12% 10.6 9.2 7.8 6.4 5 - National Survey
Prevalence of anemia among women of reproductive
Outcome 19.30% 15.6 14.8 13.9 13 12 - National Survey
age (15-49 years)
Prevalence of anemia among adolescent girls Outcome 30% 27 24 21 18 15 - National Survey
National/ Survey &
Prevalence of anemia among pregnant women Outcome 22% 20.4 18.8 17.2 15.6 14 HP/HC
HP/HC Report
Proportion of PLW provided acute malnutrition
Output NA 5 16.3 27.5 38.8. 50 HP HC/community Report
treatment or support in targeted woredas
Percentage of women consuming diversified meal (> 5
Output 20.3 23 25 27 29 31 - National Survey
food groups) during pregnancy
Percentage of pregnant women consuming additional
Output 16 19 22 25 27 30 - National Survey
meal during pregnancy
Proportion of pregnant women receiving IFA
Outcome 17% 25 30 34 37 40 - National Survey
supplements for at least 90 days
Proportion of women who received deworming drugs
Output 6% 19 31 44 57 70 - National Survey
during recent pregnancy
Percentage of HH using adequately iodized salt (>15
ppm)
NA = not available

Strategic Objective 2: Improve the nutritional status of infants (0-‐6 months), young children (6-‐24 months), children under 5 years
and school age children (6-‐10 years) with emphasis on the first 2 years of life
2014/15 2016 2017 2018 2019 2020 Collection
Proportion of infants 0-6 months exclusively
breastfed (%)
Percentage of newborns who started breastfeeding
within 1 hour of birth
Number of health facilities implementing 10 steps of Annual / FMHO/EPHI/
Output NA 6 12 18 24 30 Reports
BFHI biannual RHB
Maternity leave proclamation revised to align with Ratified
Output No - - - - Yes - Once
ILO/global recommendations document
Proportion of children age 6-23 months with
Output 9.80% 15.8 21.8 27.8 33.8 40 - National Survey
minimum dietary diversity score
Proportion of children age 6-23 months who received
Output 67.10% 68 69 71 73 75 - National Survey
minimum meal frequency
Proportion of children age 6-23 months who received
minimum acceptable diet
Proportion of school age children 6-14 years with
median urinary iodine > 100 ppb
Proportion of infants 6–8 months of age who receive
solid, semi-solid or soft foods
Proportion of GM participation among children
under 2
Prevalence of anemia in children 6-59 months (sex
Output 39 40.2 36.4 32.6 28.8 24 - National Survey
disaggregated)
Monthly/
Targeted coverage of VAS in children (6-59 months) Output 56.9 64 71 77 83 90 HFs Reports
biannual
Proportion of children 0 to 59 months receiving zinc Monthly/
Output 5 15 25 35 45 50 HFs Report
for acute diarrhea treatment biannual
Proportion of children 24 to 59 months dewormed Output 91 84 94 95 96 97 biannual HFs Report
Proportion of children 0 to 59 months with SAM
Output NA 100 100 100 100 100 biannual HFs Report
treated
Proportion of health facilities providing SAM
Output NA 100 100 100 100 100 biannual HFs Report
(OTP& SC) services
Prevalence of overweight for women of reproductive
Outcome 9 8 7.5 7 6.5 6 - National Survey
age
Strategic Objective 3: Improve nutrition service delivery for communicable and non-communicable lifestyle related diseases affecting all age groups
2014/15 Collection
2016 2017 2018 2019 2020
Number of health facilities providing nutrition counseling for at least
National/ Media messages
two non-communicable diseases/lifestyle related diseases (diabetes, Output NA 4 4 Biannual
regional broadcasted
hypertension, cancer, obesity, CHD/CVD, etc.)
Number of health facilities providing NACS for HIV and TB cases Output 413 87 100 Biannual HFs Report
# of PLHIV received nutrition counseling through NACS Output NA Biannual HFs Report
# of HIV clients who received nutrition assessment Output NA Biannual HFs Report
# of HIV clients who are identified as malnourished Output NA Biannual HFs Report
# of HIV clients who received nutrition counseling Output NA Biannual HFs Report
# of HIV clients who have got nutrition support Output NA Biannual HFs Report
# of TB clients who received nutrition assessment Output NA Biannual HFs Report
# of TB clients who are identified as malnourished Output NA Biannual HFs Report
Number of TB clients who received nutrition counseling Output NA Biannual HFs Report
Number of TB clients who have got nutrition support Output NA Biannual HFs Report
Number of health workers in TB clinics/multi-drug resistance (MDR) Biannual/Annu
Output NA HFs Report
TB trained on NACS al

Strategic Objective 4: Strengthen implementation of nutrition-sensitive
interventions in various sectors
Result 4.1 Strengthened implementation of nutrition-sensitive interventions in agriculture (Ministry of Agriculture and Natural Resources, Ministry
of Livestock and Fishery, Ministry of Environment, Forestry and Climate Change)
2014/15 Collection
2016 2017 2018 2019 2020
Proportion of households consumed fruits and
vegetables
Proportion of households consumed animal
source foods
Proportion of households with homestead
Output NA 20 25 30 35 40 Annual National CSA report
gardening
Number of groups engaged in community
Output NA 20 40 60 80 100 Annual National CSA report
horticulture production
Number of fruit nursery sites
Output 5 8 11 14 17 20 Annually National MOA report
established/supported at national level
Proportion of urban households in zonal capitals
Output NA 5 10 15 20 25 Annually National MOA report
with urban gardening
Proportion of urban areas with mushroom MOI/MOA
Output NA 3 6 9 12 15 Annually National
producing groups report
Proportion of rural/urban households practicing
Output NA 1 2 3 4 5 Annually National MOA report
caged/fenced poultry
Number of poultry multiplication centers (both Multiplication
Input NA 1 2 3 4 5 Annually MOA report
private and gov.) in each region centers
Proportion of woredas with at least one milk
Output NA 1 2 3 4 5 Annually Household MOA report
collection center supported
Proportion of potential lakes withfish producing
Output NA 5 10 20 30 50 Annual Woreda MOA report
groups supported
Fish hatching center established/supported Output 1 2 3 4 5 6 Annual Center MOA report
Number of community ponds established Output 1,500 1600 1700 1800 1900 2000 Woreda MOA report
Number of food processing
Output NA 1 2 3 4 5 Annually
technologies/practices identified and introduced
Number of fruit and vegetable preservation
Input NA 1 2 3 4 5 Annually National MOA report
technologies/practices identified and introduced
Number of fish preservation technologies
identified and introduced
Number of nutritionally improved varieties of
seeds released/adopted and disseminated
% of FTCs with nutrition corner Input NA 10 20 30 40 50 Annually Kebele MOA report
Number of woreda with women group engaged
Output 20 30 40 50 60 70 National National MOA report
in local production of complementary food
Number of women’s groups engaged in
Output NA 600 1200 1800 2400 3000 National National MOA report
agricultural income generating activities
Number of nutritionally improved seed varieties
Input NA 2 1 1 1 6 National Center Centers report
released by agricultural research centers

Result 4.2: Strengthened implementation of nutrition interventions in the education sector
2014/15 Collection
2016 2017 2018 2019 2020
Proportion of schools promoting selected nutrition
Input NA 10 20 40 60 80 Annual REB, WoEO Reports
actions through health and nutrition school clubs
Proportion of schools that have model school
Output NA 10 20 30 40 50 Annual REB, WoEO Reports
gardening
Proportion of primary schools (5-10) conducting
Output NA 60 0.7 0.7 75 80 Biannual Kebele Report
biannual deworming
Proportion of primary schools (10-19) conducting
Output NA 20 25 30 35 40 Biannual
biannual deworming
Proportion of primary schools with school feeding
Output NA 50 60 70 80 90 Annual Woreda Reports
program
Proportion of schools with homestead grown
Output NA 1 5 10 15 20 Annual Woreda Reports
gardening school feeding
Number of students graduated with nutritional University/Col
Output 150 300 450 600 750 900? Annual Reports
sciences disaggregated by level, type and sex lege
Number of health, agriculture and technology
University/Col
institutions that have incorporated nutrition courses Output NA 10 15 20 25 30 Annual Reports
lege
into their curriculum
Gender parity index in primary and secondary
P1 = 0.93 P1=0.94 P1 = 1.0 P1 = 1.0 P1 = 1.0 P1 = 1.0
education(F/M)
(Note: P1: primary 1st ; P2: primary 2nd ; S1: School/Univer
Output P2 = 0.97 P2=0.97 P2 = 1.0 P2 = 1.0 P2 = 1.0 P2 = 1.0 Annual Reports
secondary 1st ; and S2: secondary 2nd) sity/College
S1 = 0.80 S1 =1.0 S1 = 1.0 S1 = 1.0 S1 = 1.0 S1 = 1.0
S2 = 0.46 S2 =0.83 S2 = 1.0 S2 = 1.0 S2 = 1.0 S2 = 1.0
Adult literacy program curriculum included nutrition Output NA Annual National Reports
Proportion of universities with nutrition training
Output NA 20 40 60 80 100 Annual National Reports
programs providing community nutrition services
Result 4.3: Strengthened nutrition-sensitive interventions in the water, irrigation and electricity sector
2014/15 Collection
2016 2017 2018 2019 2020
NWI/DHS
% of HH with clean and safe drinking water supply Output 58 64 70 76 82 90 Annual Community
survey
Proportion of households benefited from small scale
Output NA 1 2 3 4 5 Annual National Report
irrigation (SSI) schemes with multiple use of water
Proportion of schools with water supply Output 33 47 60 73 87 90 Annual School Report
Hectares of farmlands cultivated through irrigation
Output 140 168 196 224 252 280 Annual MoWE Report
(ha X 1000)
Proportion of HH with hand washing facilities Output NA 10 25 39 54 68 Community Survey report
Result 4.4: Strengthened nutrition-sensitive interventions in the industry sector

Baseline Target Level of Data
Indicators Type Periodicity Source
2014/15 2016 2017 2018 2019 2020 Collection
Proportion of flour producing industries fortifying
wheat flour, blended foods
Proportion of oil processing industries fortifying
edible oil with Vitamin A
Number of awareness creation events conducted in
the private sectors related to requirements and Output NA 1 3 5 10 20 Annual Federal level Report
standards of locally manufactured food items
Result 4.6: Strengthened social protection services for improved nutrition

Baseline Target Level of Data
Indicators Type Periodicity Source
2014/15 2016 2017 2018 2019 2020 Collection
Proportion of HHs graduated from PSNP Output Annual National Report
Proportion of women’s self-help groups received
grants and credits
Proportion of women’s self-help groups trained on
key nutrition practices
Number of woredas providing nutritional services
for elderly poor
Number of primary schools in food-insecure
Output 1187 1246 1305 1364 - - Annual Schools Reports
woredas with school feeding program
Proportion of declared nutrition emergencies
Output 100 100 100 100 100 100 Annual Community Reports
responded to within 72 hours

Result 4.8. Ensured quality and safety of nutrition services and supplies (FMHACA)
2014/15 2016 2017 2018 2019 2020 Collection
Proportion of imported food items inspected for Federal and
Output NA 100 100 100 100 100 Annual Report
compliance with food safety and quality standards regional
Number of standards developed for food and food
Output 58 60 62 64 66 68 Annual National Reports
items
Number of regulations developed for food and
5 6 7 8 9 10 Annual National Reports
food items
Number of companies certified for competency on
Output NA 20 85 100 Annual National Reports
food items production and trade
Number of fully tested nutrition products (infant
formula, premix, nutrition supplements, Output NA 15 45 100 Annual National Reports
micronutrients…)
Number of registered food and nutrition products Output NA 100 100 100 Annual National Reports
Percent of public water supply ensured for quality
and safety as per the standard
Number of promotions/ policy dialogue made on
enforcement of regulation on advertisement of NA 1 2 3 4 5 Annual National Reports
unhealthy diet / beverages
Result 4.9. Improved nutrition supply management (PFSA)

2014/15 2016 2017 2019 2020 Collection
Proportion of health facilities with IFA stocked out. Output NA 0 0 0 0 Annual All levels Survey reports
No. of nutrition supply stock status reports shared Output NA 4 4 4 4 Annual National Reports
Strategic objective 5: Improve multisectoral coordination and capacity to ensure implementation of the NNP
2014/15 2016 2017 2018 2019 2020 Collection
Number of sectors established Nutrition Directorate Output NA 1 4 4 4 4 Annual National Admin report
Number of sectors established nutrition case team at
Output NA 1 4 4 4 4 Annual National Admin report
federal
National institute of Nutrition and Food research
Output NA 0 1 1 1 1 Annual National Admin report
established
National Nutrition and Food Policy developed Output NA 0 1 1 1 1 Annual National Admin report
Proportion of NNP implementing regional bureaus
Output NA 11 33 56 79 100 Annual Regional Admin report
with nutrition case team
Proportion of woredas reporting multisectoral
nutrition coordination activity to the higher level
Proportion of woredas with nutrition coordination
platform
Proportion of woredas with kebele level nutrition
coordination platform
Proportion of woredas offices with nutrition
coordinator/ dedicated focal points
Proportion of health development army (HDA)
output NA 10 28 45 63 80 Survey Community Survey
trained in the preparation of complementary food

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NATIONAL NUTRITION PROGRAM
2016–2020
FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

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FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

H.E. Dr. Kebede Worku H.E. Dr. Tilaye Gete

H.E. Ato Wondrad Mandefro H.E. Dr. G/Egiziabher G/Yohannes

H.E. Dr. Mebrahtu Meles H.E. Ato Jemesdeng Choltot

H.E. Ato Asad Ziad H.E. Ato Alemayehu Gujo

H.E. Ato Remedan Ashenafi H.E. W/ro Bizunesh Meseret

H.E. Ato Demeke Mekonnen

GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020 3

Figures and Tables......................................................................................................................................... 8

1.2 Global Nutrition Movements and Declarations....................................................................................... 14

2. CHAPTER 2: Lessons from NNP and Focus on NNP II............................................................ 17

2.2 NNP I Implementation Challenges......................................................................................................... 20

2.3 Rationale for Developing NNP II............................................................................................................ 21

2.4 NNP II Focus and Approach................................................................................................................... 22

CHAPTER 3: Strategic Objectives and Initiatives.......................................................................... 24

Strategic Objectives of NNP II...................................................................................................................... 24

Strategic Objective 1.................................................................................................................................25

Result 1.1: Nutritional Status of Adolescents Improved............................................................................... 26

Result 1.2: Nutritional Status of Women of Reproductive Age Improved.................................................... 27

Strategic Objective 2................................................................................................................................. 28

Result 2.2: Improved Nutritional Status of Children 24-59 Months............................................................. 31

Result 2.3: Improved Nutritional Status of Children Ages 6-10................................................................... 33

Strategic Objective 3.................................................................................................................................34

Result 3.2: Healthy Lifestyles and Nutrition Promoted................................................................................. 37

Strategic Objective 4.................................................................................................................................40

Result 4.1: Strengthened Implementation of Nutrition-Sensitive Interventions

in the MOANR and Ministry of Livestock and Fishery Resource Development........................................... 40

Result 4.2: Strengthened Implementation of Nutrition-Sensitive Interventions

in the Education Sector................................................................................................................................ 45

Result 4.3: Strengthened Implementation of Nutrition-Sensitive Interventions

in the Water, Irrigation and Electricity sector................................................................................................ 46

Result 4.4: Strengthened Implementation of Nutrition-Sensitive Interventions

in the Industry Sector................................................................................................................................... 47

4 GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020

in the Trade Sector....................................................................................................................................... 48

Result 4.6: Strengthened Social Protection Services for Improved Nutrition.............................................. 49

Result 4.7: Strengthened Nutrition-Sensitive Interventions in

Disaster Risk Management.......................................................................................................................... 50

Result 4.9: Improved Nutrition Supply Management.................................................................................. 52

Result 4.10: Improved Nutrition Communication........................................................................................ 52

Result 4.11: Improved Gender-Sensitive Nutrition Implementation............................................................ 53

Strategic Objective 5................................................................................................................................. 54

Result 5.1: Improved Community Level Nutrition Implementation Capacity................................................ 55

Result 5.2: Improved Nutrition Workforce Capacity..................................................................................... 56

Result 5.4: System Capacity Strengthened for Improved NNP Implementation.......................................... 57

Result 5.6: Improved Regulatory Capacity ................................................................................................. 58

Result 5.7: Improved Capacity of Media...................................................................................................... 58

CHAPTER 4: Nutrition Implementation and Governance............................................................ 59

4.1 Political Commitment and Policy Framework......................................................................................... 60

4.2. Multisectoral Nutrition Coordination...................................................................................................... 60

4.3. Capacity Building for Nutrition............................................................................................................... 66

4.4. Gender Dimensions of Nutrition............................................................................................................ 69

4.5. Nutrition Communication....................................................................................................................... 70

CHAPTER 5: Sustainable Nutrition Financing................................................................................ 73

6.2 Operational Research............................................................................................................................ 77

ANNEX: Accountability and Results Matrix for NNP Implementation...................................... 80

GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020 5