NNP2

FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA
NATIONAL
NUTRITION
PROGRAM
2016–2020
JULY 2016
DECLARATION OF NNP IMPLEMENTING SECTORS
We the undersigned, representing the Government of the Federal Democratic Republic

of Ethiopia, National Nutrition Coordinating 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.
Dr. Kebede Worku Dr. Tilaye Gete

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

State Minister of Agriculture and State Minister of Livestock and
Natural Resources Fisheries
Dr. Mebrahtu Meles Ato Jemesdeng Choltot

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

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

State Minister of Labor and State Minister of Women and
Social Affairs Children Affairs
Ato Mitiku Kassa W/ro Firehiwot Ayalew Ato Addisu Arega

Commissioner, State Minister of State Minister of
National Disaster Risk Management Government Communication Affairs Youth and Sport
Coordination Commission
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 I and Focus of NNP II........................................................... 15

2.1 Lessons and Achievements from NNP I................................................................................................. 16
2.2 NNP I Implementation Challenges......................................................................................................... 20
2.3 Rationale for Developing NNP II............................................................................................................ 21
2.4 NNP II Focus and Approach................................................................................................................... 21
CHAPTER 3: Strategic Objectives and Initiatives.......................................................................... 23

The Goals of NNP II..................................................................................................................................... 23
Strategic Objectives of NNP II...................................................................................................................... 23
Strategic Objective 1.................................................................................................................................24
Result 1.1: Nutritional Status of Adolescents Improved............................................................................... 25
Result 1.2: Nutritional Status of Women of Reproductive Age Improved.................................................... 26
Strategic Objective 2................................................................................................................................. 27
Result 2.1: Improved Nutritional Status of Infants and Young Children 0-23 Months................................. 28
Result 2.2: Improved Nutritional Status of Children 24-59 Months............................................................. 30
Result 2.3: Improved Nutritional Status of Children Ages 5-10................................................................... 32
Result 3.1: Improved Nutrition Service Delivery for Communicable and Non-
Communicable Diseases............................................................................................................................. 33
Result 3.2: Healthy Lifestyles and Nutrition Promoted................................................................................. 36
Result 4.1: Strengthened Implementation of Nutrition-Sensitive Interventions
in the MOANR and Ministry of Livestock and Fishery.................................................................................. 39
in the Education Sector................................................................................................................................ 44
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.............. 57
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............................................................................................................... 63
4.4. Gender Dimensions of Nutrition............................................................................................................ 66
4.5. Nutrition Communication....................................................................................................................... 67
CHAPTER 5: Sustainable Nutrition Financing................................................................................ 70

CHAPTER 6: Monitoring, Evaluation and Research...................................................................... 72
6.1 Monitoring and Evaluation..................................................................................................................... 72
6.2 Operational Research............................................................................................................................ 74
Annex ........................................................................................................................................................ 77
Nutrition-specific and nutrition-sensitive
strategies/programs/guidelines in Ethiopia.................................................................................................. 77
Accountability and Results Matrix for NNP Implementation......................................................................... 78
Terms of Reference: NNCB......................................................................................................................... 83
Terms of Reference: NNTC.......................................................................................................................... 86
References .............................................................................................................................................. 89
GOVERNMENT OF ETHIOPIA NATIONAL NUTRITION PROGRAM, 2016-2020 5

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
DRMCC: Disaster Risk Management Coordination Commission
ECCD: Early Childhood Care and Development
EDHS: Ethiopian Demographic and Health Survey
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 Management 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 and Young Child Nutrition
MAM: Moderate Acute Malnutrition
MDG: Millennium Development Goals
MOANR: Ministry of Agriculture and Natural Resources
MOE: Ministry of Education
MOI: Ministry of Industry

MOFEC: Ministry of Finance and Economic Cooperation
MOFED: Ministry of Finance and Economic Development
MOH: Ministry of Health
MOLFR: Ministry of Livestock and Fisheries
MOLSA: Ministry of Labor and Social Affairs
MOT: Ministry of Trade
MOWCA: Ministry of Women and Children Affairs
MOWIE: Ministry of Water, Irrigation and Electricity
NACS: Nutrition Assessment, Counseling and Support
NCD: Non-Communicable Disease
NFFSC: National Food Fortification Steering Committee
NNCB: National Nutrition Coordinating 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
NSAS: Nutrition-Sensitive Agriculture Strategy
ORS: Oral Rehydration Salt
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 Coordinating 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: Trends in nutritional status of children under 5 in Ethiopia, 2000–2014 13
Figure 2: Trends in nutritional status of adolescents and women of reproductive age
2000–2005 in Ethiopia 13
Figure 3: Building blocks of effective nutrition governance 60
Figure 4: National nutrition technical committees 62
Figure 5: Dimensions of nutrition capacity building 62
Figure 6: NNP budget gap 71
Figure 7: Strong program implementation system 73
LIST OF TABLES

Table 1: Number of indicators in each SDG that are highly relevant for nutrition 11
Table 2: Nutrition workforce requirements at various levels 64
Table 3: NNP estimated intervention budget, 2016–2020 71
Table 4: Operational research priorities (2016-2020) 75

1
INTRODUCTION
1.1 BACKGROUND
1.1.1 COUNTRY PROFILE

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.
The Government has been implementing a comprehensive economic reform program over
the last two decades. The reform program 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 assess-
ment, 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.
Ethiopia has developed the second stage of its 5-year development plan, called the Growth
and Transformation Plan II (GTP II), covering the period 2015/16 to 2019/20. The overarching
objective of the plan’s second phase is the realization of Ethiopia’s vision of becoming a lower
middle-income country by 2025. GTP II thus aims to achieve high economic growth within a
stable macroeconomic environment while at the same time pursuing aggressive measures
towards rapid industrialization and structural transformation (MOFED, 2015).

1.1.2 MALNUTRITION
Malnutrition in all its forms is a global burden that affects almost every country in the world,
leading to serious public health risks and incurring high economic costs. Improvements in
nutrition will contribute significantly to reducing poverty and to achieving health, education,
and employment goals (Global Nutrition Report, IFPRI, 2014). Nutrition stimulates economic
growth, which improves the mental health and physical productivity of the labor force. Elim-
inating undernutrition in Ethiopia would prevent losses of 8–11% per year from the gross
national product (IFPRI, 2014, UNGNA, 2015). Globally, hunger and undernutrition reduce
gross domestic product by US$1.4–2.1 trillion a year (Compact, IFPRI 2016). The World
Bank estimates that undernourished children are at risk of losing more than 10% of their
lifetime earning potential, thus affecting national productivity, and recently, a panel of expert
economists at a Copenhagen Consensus Conference concluded that fighting malnutrition
should be the top priority for policymakers and philanthropists (Copenhagen Consensus,
2012). The benefits of better nutrition to health, schooling, and productivity would be tre-
mendous. Improving the national nutrition status is therefore a priority area that needs urgent
policy attention to accelerate socioeconomic progress and development.
In 2013 the Government of Ethiopia together with the African Union Commission published
“The Cost of Hunger in Ethiopia 2013,” a report that quantifies the social and economic impact
of undernutrition (EPHI-AU, 2009). Data in the report included calculations of the costs of child
undernutrition in the health and education sectors. The effects of child undernutrition on hu-
man capacity and workforce productivity were also quantified. Based on the report’s findings,
the total annual cost of undernutrition in Ethiopia was estimated at ETB 55.5 billion, equivalent
to 16.5% of GDP in 2009 (EPHI-AU). According to the study, Ethiopia could reduce losses
by ETB 148 billion by 2025 if underweight rates were reduced to 5% and stunting to 10% in
children under 5. Reducing child undernutrition rates to half the current levels by 2025 could
reduce losses by ETB 70.9 billion, the study suggests.
1.1.3 NUTRITION: MDGS TO SDGS

In 2000, world leaders adopted the Millennium Declaration and agreed on a set of eight Millen-
nium Development Goals (MDGs), which were not fully achieved by most countries. Lessons
learnt from the MDG framework specific to nutrition include the realization that the focus on
undernutrition was too narrow, and that synergies between nutrition and other sectors were
underexploited (UN SCN, 2015).
The Sustainable Development Goals or SDGs, officially known as Transforming Our World:
The 2030 Agenda for Sustainable Development, are an intergovernmental set of aspiration
goals with 169 targets. Spearheaded by the United Nations, the goals are contained in para-
graph 54 of United Nations Resolution A/RES/70/1 of September 25, 2015.
Sustainable development is a driver of malnutrition reduction; improved nutrition will propel

sustainable development. Evidence indicates that the forces that prevent healthy growth and
development in such a profound way—hunger, disease, poverty, disempowerment and un-
healthy environments—are powerful and multisectoral. Therefore, these need to be counter-
acted by equally powerful multisectoral and multi-stakeholder forces combining actions that
are nutrition-specific, nutrition-sensitive, and environmentally enabling at all levels (Global
Nutrition Report, 2015; IFPRI, 2015). Hence, nutrition is placed at the heart of the SDGs—
indeed, nutrition is vital for achieving 12 out of 17 SDGs (Table 1). The remaining 5 SDGs
support improvements in nutrition.

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)

1.1.4 GLOBAL AND REGIONAL MALNUTRITION TRENDS
An estimated 805 million people worldwide are chronically undernourished (FAO, 2014). One
hundred fifty-nine million children under 5 are stunted and 41 million children under 5 are over-
weight and obese. In addition, at least 50 million are severely or moderately wasted (WHO/
UNICEF/The World Bank, 2015). Furthermore, there are about 2 billion children and adults
who are deficient in vitamins or minerals, which can lead to anemia, blindness, cognitive im-
pairment, and greater susceptibility to many diseases that can result in higher mortality (UN
SCN, 2015). 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 (See Box A; WHO, 2014).
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.
1.1.5 NUTRITION TRENDS IN ETHIOPIA

The last four national level Demographic and Health Surveys (EDHS) show a decreasing
trend in the proportion of children who are stunted and underweight. The prevalence of stunt-
ing decreased by 31% (from 58% to 40%) between 2000 and 2014 (Figure 1). The decline
in the proportion of stunted Ethiopian children shows an improvement in chronic malnutrition
over the past 15 years. The proportion of underweight children declined even more substan-
tially, by 39% over the same period. Conversely, the prevalence of wasting has remained fairly
static over the last 15 years. Anemia prevalence among under-five children remains high at
44%, even though it declined by 19% over the last 6 years (EDHS, 2011).
Regarding infant feeding practices, just over half (52%) of children under 6 months were
exclusively breastfed, and, of even greater concern, only 4.3% of children aged older than
6 months consumed the recommended 4 food groups daily. Only 13% of children under 2
consumed iron rich foods (EDHS, 2011). While there have been recent improvements in the
production of iodized salt, still only 23% of households are consuming quality iodized salt in
accordance with the levels specified in the regulations. The 2011 EDHS also revealed that the
level of chronic undernutrition among women (15–49 years old) in Ethiopia is relatively high,
with 27% having a body mass index (BMI) of less than 18.5 kg/m2 (Figure 2), with no signifi-

Figure 1: Trends in nutritional status of children under 5 in Ethiopia, 2000–2014
Adolescents (15-19 yrs) Women (15-49 yrs)
Figure 2: Trends in nutritional status of adolescents and women of reproductive age

2000–2011 in Ethiopia

cant progress over the last decade. Similarly, the prevalence of anemia among women in the
reproductive age group (15–49) was found to be 17% (EDHS 2011).
Ethiopia is not different from other low income countries with respect to the nutritional status
of adolescents. The EDHS 2011 revealed that the proportion of non-pregnant adolescents
aged 15–19 years with chronic malnutrition (BMI <18.5) was 36% (Figure 2). It is well recog-
nized that the size and body composition of the mother at the start of pregnancy is one of the
strongest influences on fetal growth (Kramer, 1987). According to the 2011 EDHS, the median
age for a first marriage is around 16.5. Twelve percent of adolescent girls (aged 15–19) are
either already mothers or pregnant with their first child. Prevalence of anemia in adolescents
aged 15–19 years was 13%. The Ethiopian mini-DHS (EMDHS) conducted in 2014 states
that the fertility rate among adolescents aged 15–19 in Ethiopia is 65 births per 1,000 women.
Although this shows clear improvement from 2011 (79 births per 1,000 women), efforts should
be continued to promote preconception care, family planning, delayed age at first pregnancy,
prolonging of inter-pregnancy interval and psychosocial care.
1.2 GLOBAL NUTRITION MOVEMENTS AND DECLARATIONS

Scaling up Nutrition, or SUN, is a unique movement founded on the principle that all people
have a right to food and good nutrition. It unites people, governments, civil society, the United
Nations, donors, businesses and researchers in a collective effort to improve nutrition. SUN
was launched in 2010 with the adoption of the SUN Framework and Road Map, and has grown
rapidly. In December 2015 the country-driven SUN Movement comprised 57 SUN countries. It
continues to expand, building on the progress achieved. Key facts about SUN are depicted in
Box B (see page 15). Ethiopia joined the SUN movement in April 2012.
SUN stakeholders work together within each country to pursue the following four strategic
objectives:
1. Create an enabling political environment, with strong in-country leadership and a shared
space (multi-stakeholder platforms) where stakeholders align their activities and take joint
responsibility for scaling up nutrition.
2. Establish best practices for scaling up proven interventions, including the adoption of
effective laws and policies.
3. Align actions around high quality, well-costed country plans, with an agreed results frame-
work and mutual accountability.
4. Increase resources directed towards coherent, aligned approaches.
Many nutrition declarations have been made globally, however. Among the most notable that
relate to Ethiopia are the following:
■■ The July 2003 Maputo Declaration, which accepted the Comprehensive Africa Agricul-
ture Development Program as the framework for addressing Africa’s agricultural devel-
opment, and food and nutrition security challenges in a coordinated fashion.
■■ The Global Nutrition for Growth Compact, made at the 2013 Nutrition for Growth
summit in London.

■■ The African Union’s Malabo Declaration on Accelerated Agricultural Growth and
Transformation for Shared Prosperity and Improved Livelihoods under the framework
of the Comprehensive Africa Agriculture Development Program. This was a response to the
United Nations Secretary General’s Zero Hunger Challenge (2012), which followed on the
success of hunger eradication programs in other parts of the world and the importance of
multi-sector actions to achieve this objective.
■■ The Rome Declaration on Nutrition, on achieving food and nutrition security as well as
commitment to achieving the Millennium Development Goals, made at the Second Inter-
national 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.
Box B: Key facts about the SUN movement
■■ 57 Countries and 2 Indian States – Maharashtra and Uttar Pradesh – 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 57 country-led movements to unleash the potential of

millions of healthier, smarter and stronger children.

2
LESSONS FROM NNP I AND FOCUS
OF NNP II
2.1 LESSONS AND ACHIEVEMENTS FROM NNP I
Maternal, infant and child undernutrition are still national problems with important conse-
quences for survival and for incidence of acute and chronic diseases, healthy development,
and economic productivity, at both individual and societal levels. Over the past decade, since
the National Nutrition Strategy was developed, the government, implementers 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 landscapes and government commitment could be improved.
The first National Nutrition Program (NNP I, 2008–2015) focused on integration and coordi-
nation of nutrition-specific interventions that addressed the immediate causes of suboptimal
growth and development and the potential effects of nutrition-sensitive interventions that ad-
dress the underlying determinants of malnutrition. The program also aimed to create an en-
abling environment through which nutrition interventions were governed and supported by ev-
idence-enhanced decision making. The passages below recount the main achievements and
implementation challenges, and discuss focus areas for NNP II, the program’s second phase.
Encouragingly, malnutrition has been decreasing over the last two decades. Focusing on food
security and scaling up nutrition programs have a made tremendous contribution to reducing
undernutrition. However, millions of Ethiopians still suffer from chronic and acute malnutrition.
The country ranks at the top both in sub Saharan Africa and the world for malnutrition (Global
Nutrition Report, 2015). Although the progress and achievements made so far are commend-
able, addressing the deep-rooted causes of malnutrition and ending hunger in Ethiopia call for
high impact integrated and coordinated interventions.

The Government of Ethiopia demonstrated policy commitment to nutrition by developing a
stand-alone National Nutrition Strategy (NNS) along with the 7-year NNP (2008–2013 and
2013–2015). Nutrition indicators were incorporated into the nation’s 5-year Growth and Trans-
formation Plan. Moreover, the government successfully established an implementation plat-
form, the National Nutrition Coordinating Body (NNCB) and the National Nutrition Technical
Committee (NNTC). Through these structures nutrition interventions were integrated, coordi-
nated and mainstreamed into the various national development sectors. Sector based strat-
egies and programs created a good opportunity to mainstream nutrition and develop legal
frameworks to enforce key nutrition interventions such as the Nutrition-Sensitive Agriculture
Strategy, National Food Security Strategy, National Health Sector Transformation Plan, Na-
tional Food Fortification, and the National School Health and Nutrition Strategy.
However, multisectoral coordination and integration were not effective in bringing about sought
changes to this long-lasting public health problem. This was mainly because of inadequate
commitment and lack of strong, suitable governance structures.
2.1.1 PROGRAM IMPLEMENTATION
Nutrition-Specific Interventions
Maternal undernutrition contributes to neonatal death, stunting, wasting and micronutrient de-
ficiencies. Progress has been made; many interventions are being implemented at scale,
and evidence for the effectiveness of nutrition interventions and strategies for their delivery
has grown over the past decade. The fourth phase of the Federal Ministry of Health’s Health
Sector Development Plan (HSDP IV) has integrated nutrition into the Health Extension Pro-
gram (HEP) to improve the nutritional status of mothers and children through scaled-up, nutri-
tion-specific interventions: maternal, infant and young child nutrition promotions, micronutrient
interventions, and community management of acute malnutrition (CMAM). These interventions
are being carried out at health posts, in communities, at other health facilities and through
health development armies. More than 10 million children are receiving Vitamin A supplemen-
tation and are dewormed twice a year.
Thanks to these efforts, the prevalence of maternal anemia has declined from 27% in 2005 to
17.1% in 2016 (CSA, 2011). Furthermore, more than 14,000 health facilities (about 95% of
which are health posts) have the capacity to provide CMAM services. A national assessment
has indicated that the impact of such interventions has resulted in reduced undernutrition
among children. This in turn has contributed to an over 50% reduction in childhood deaths in
Ethiopia.
The approach to nutrition screening, provision of Vitamin A supplementation and deworming

will transition from campaign based activities (Community Health Day) and become enfolded
into routine HEP activities, first in the four agrarian regions (Oromiya, Amhara, SNNPR, and
Tigray) and then nationally. In the developing regional states of Afar, Benishangul-Gumuz,
Gambella and Somali, the Enhanced Outreach Strategy (provision of Vitamin A, screening
of children 6-59 months and deworming of children 24-59 months) is being transitioned into
Community Health Day activities. Moreover, several guidelines are being revised to standardize
the provision of nutrition-specific services at all levels.
The Community Based Nutrition program (CBN), one of the key components of the NNP, has
made nutrition a priority agenda item for families and communities and is influencing sus-
tainable behavioral changes in child care practices and health-seeking behaviors. The CBN

program also brought commendable changes in growth monitoring and promotion for all chil-
dren under 2 years of age together with counseling for caregivers. The program uses regular
community dialogue to engage community members to assess the overall nutritional status
of children in their community, to understand the barriers and potential supports for improved
nutrition, and to develop consensus on plans of action to make a difference.
Nutrition-Sensitive Interventions
Acceleration of progress in nutrition will require nutrition-sensitive programming—effective,
large-scale programs that address key underlying determinants of nutrition and enhance the
coverage and effectiveness of nutrition-specific interventions (Ruel and Alderman, 2013).
Evidence indicates that the forces that prevent healthy growth and development in such a
profound way—hunger, disease, poverty, disempowerment, unhealthy environments—are
powerful and multisectoral. Therefore, these need to be counteracted by equally powerful,
multisectoral, multi-stakeholder forces that combine nutrition-specific, nutrition-sensitive and
environment enabling actions at all levels across sectors (Global Nutrition Report, 2015;
IFPRI, 2015; Black et al., 2008)
Mainstreaming Nutrition into Agriculture: In addition to developing a document in 2015

on nutrition-sensitive agriculture, the Ministry of Agriculture and Natural Resources has taken
the initiative to mainstream nutrition into its overall sectoral plans and has established nutri-
tion implementing structures. The government has also been implementing the Productive
Safety Net Program (PSNP) since 2005. The PSNP began as a food “safety net” that would
provide food or cash for food insecure households during the “hungry” seasons of the year in
exchange for public works through the Ministry of Agriculture. Although it began as a house-
hold food security program it has, for all practical purposes, evolved into a broader package of
social protection, now comprising four components: social protection, livelihoods, disaster risk
management, and nutrition and climate resilience/green economy.
During its fourth stage (PSNP IV) the program was made more nutrition-sensitive through the
incorporation of additional nutrition provisions, “soft conditionality” exemptions from physical
labor for pregnant and lactating women with a child under 1 and for mothers with a severely
malnourished child under 5. These mothers are provided with “temporary transition to direct
support” (i.e., cash or food). Instead of participating in public works, they engage in com-
munity based nutrition activities, such as social and behavioral change communication and
growth monitoring and promotion sessions. A process of “co-responsibility” helps ensure their
participation in these activities. PSNP IV promotes links to social services and activities such
as daycare; women’s empowerment activities; and activities related to water, sanitation and
hygiene (WASH). The PSNP IV monitoring framework includes indicators of participation in
nutrition promotion activities at community level. The framework allows for the regular collec-
tion and reporting of information on household food security, dietary diversity and child feeding
practices.
The Agricultural Growth Program (AGP), implemented in 96 woredas in the four agrarian na-
tional regional states since 2011, is a multi-donor financed program designed to raise produc-
tivity and increase market access for key crop and livestock products in targeted woredas, car-
ried out with increased participation of women and youth. The approach of AGP is value-chain
oriented, decentralized, participatory, integrated, and focuses on key rural and agricultural
development constraints.
School Feeding Program: The Ministry of Education (MOE) designed the Ethiopian National
School Feeding Program (NSFP) to (1) improve schoolchildren’s health and nutrition status, (2)

increase access to education (including enrollment, attendance, retention and completion), (3)
reduce gender and social inequalities by targeting the most vulnerable groups, and (4) increase
smallholder farmers’ access to the school feeding market, thereby increasing their incomes.
Now in the 2016–2020 phase, the NSFP aims to address the needs of the most vulnerable
population groups and areas, specifically targeting primary school children (Grades 0 through
8), in 50 prioritized zones across 6 regions and covering 3 million children. By year 5 (2020),
the NSFP will cover more than 50% of primary students enrolled in Afar and Somali regions
and 15% of students nationally. The 5-year NSFP funding requirements are estimated at be-
tween ETB 4.08bn and ETB 5.1bn.
Food Fortification: Food fortification will be one of the major focal areas for alleviating the na-
tion’s nutrition problem. Coverage of universal salt iodization has reached over 85%, although
iodine levels are still limited because iodization facilities are inefficient. Until recently, food for-
tification was not given much attention, despite its being one of 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 micronutrient (vitamin and mineral) deficiencies.
This process has already begun, while the standards for fortification are being developed.
2.1.2 MULTISECTORAL RESPONSE AND COORDINATION

During NNP I, the government revitalized the National Nutrition Coordinating Body (NNCB)
and its technical committee, and established a Regional Nutrition Coordinating Body (RNCB)
in almost all regions. Woreda-level coordination bodies have been formed in most of the agrar-
ian regions. NNP-implementing sectors, working with development partners, strengthened
their capacity to create a common understanding of nutritional issues and of how to manage a
multisectoral nutrition program and further strengthen the coordination platforms.
2.1.3 NEW INITIATIVES

The Government of Ethiopia has continued its commitment to nutrition by developing the
second phase of the National Nutrition Program (NNP II, 2016–2020). A component of NNP
II is a high level commitment called The Seqota Declaration, which will be managed under
NNP II and implemented by the sectors. The Seqota Declaration aims to transform the lives of
Ethiopian children through integrated community development in agriculture, health, nutrition,
education, water, sanitation and hygiene, as well as social protection. The goal is to end child
undernutrition by 2030 (See Box C).
Innovation is central to achieving the goals of the Seqota Declaration and promoting nutrition
security in some of the most food insecure areas of the country. This transformation agenda
has child development at its center and nutrition within its core. Hence, it focuses on the de-
velopment of human capital, with a particular focus on future generations.

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
2.2 NNP I IMPLEMENTATION CHALLENGES

The challenges faced in the implementation • Some implementing sectors did
of NNP I, which need to be addressed in the not sensitize their strategic plan
second National Nutrition Program, are as with nutrition initiatives or allocate
follows: a budget.
✓✓ Adolescent nutrition and lifestyle related ✓✓ The existing structure is not strong
malnutrition initiatives, including com- enough to coordinate NNP implementa-
municable and non-communicable dis- tion with clearly defined responsibilities
eases, were not implemented or moni- and accountabilities for achievements
tored under NNP I. and failures at levels above that of im-
plementing line ministries.
✓✓ Although multisectoral nutrition coordi-
nation and integration had been advo- ✓✓ Food fortification (oil and flour) was not
cated on every forum and seemed to implemented because of delays in the
have improved over the last 5 years, development of mandatory fortification
most line ministries have lagged in standards and directives.
mainstreaming nutrition into their sec-
toral strategic plans. This was especially ✓✓ Mechanisms for triangulated nutrition
true of efforts to cascade nutrition down information that capture data from all
to the implementation level: relevant sectors are not available.
• Line ministries lack an effective

organizational structure (director-
ates, departments, case teams,
desks, focal persons) to effectively
mainstream nutrition into their core
mandated activities.

2.3 RATIONALE FOR DEVELOPING NNP II
The NNP II was developed:
✓✓ To strategically address the aforemen- ✓✓ To strengthen those strategic objectives

tioned challenges in the implementation that were not well addressed in the first
of NNP I and to maximize and sustain NNP, such as nutrition interventions
the achievements and changes brought among adolescents and individuals with
so far through integrated and compre- communicable and non-communicable/
hensive nutrition service delivery. lifestyle related diseases.
✓✓ To brand the “1,000 Days” initiative (see ✓✓ To strengthen multisectoral nutrition

Section 2.4) through intensive social coordination and capacity building and
and behavioral change communication implementation of nutrition-sensitive in-
and community mobilization. terventions across sectors.
2.4 NNP II FOCUS AND APPROACH

2.4.1 LIFECYCLE APPROACH
The government’s efforts to address malnutrition will be strengthened through the lifecycle
approach, with particular emphasis on the crucial period of pregnancy and the first 2 years of
life—the 1,000 days from conception to a child’s second birthday, during which good nutrition
and healthy growth deliver lasting benefits throughout life. The first 1,000 days is the period
when the need for nutritional and health care is elevated and when pregnant women and
young children in Ethiopia in particular are most vulnerable to inadequate care, inadequate
access to health services and sub-optimal feeding practices.
The next phase of the National Nutrition Program will thus focus on specific age groups and
will call for greater national priority for integrating nutrition-specific and nutrition-sensitive pro-
grams; for enhanced inter-sectoral coordination; and for community, private, national and in-
ternational collaboration to end malnutrition by 2030 (See Box C). Moreover, the program’s
design has taken into account the major indicators and contributing factors in the Sustainable
Development Goals and in the country’s Health Sector Transformation Plan.
2.4.2 MULTISECTORAL COORDINATION AND NUTRITION GOVERNANCE

The adoption of the National Nutrition Strategy in 2008 and the implementation of the National
Nutrition Program (2008–2015) were highly commendable. The significant steps taken by the
Ethiopian government to fight the scourge of malnutrition are duly acknowledged. However,
the National Nutrition Coordinating Body—developed to institutionalize integration of nutrition
into the various sectors to accelerate the reduction of malnutrition—has been ineffective. This
is partly because the National Nutrition Technical Committee was hampered by lack of clarity,
the absence of an implementation guideline, lack of dedicated implementation personnel
at sector level, and lack of established reporting mechanisms using clear and measurable
indicators. The committee was therefore not in a position to accelerate and engage the NNCB
in implementing, monitoring and evaluating the progress of the program.
Several reviews have shown that a successful multisectoral coordination mechanism for
nutrition requires a legitimate institutional arrangement with an authority mandated by country-
level policy/decision-makers. To execute its mandate of coordinating the sectors and fulfilling

the aims of NNP II and the Seqota Declaration, the NNCB needs a revised institutional
arrangement, along with the necessary authority, resources and accountability. It should
be placed in a government institution above the implementing sectors and empowered to
influence all relevant sectors. It is therefore proposed that NNCB be placed under the office
of the deputy prime minister and invested with increased and appropriate executive power
and accountability. Existing coordination mechanisms should be strengthened through strong
reporting and feedback mechanisms, and concrete action plans must be developed.
Nutrition coordinating bodies and technical committees were established in most regions and
in some woredas, and activities to build their capacity were undertaken. However, only a few
of these bodies are functional. NNP II will address these issues by putting in place a clear
structure of accountability along with reporting mechanisms to ensure that these entities are
functional and accountable to the regional president. This structure would avoid sectoral bias
in exercising the authority vested in the NNCB. Sectoral members will be held accountable,
both institutionally and collectively, for the achievement of the nutrition goals and targets set
by the government.
In addition to strategically classifying interventions and services, the smooth implementation

of nutrition-sensitive programming will require the establishment of suitable governance struc-
tures in ministries and agencies. These structures should include new nutrition institutions/
counsels, directorates, 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 nutri-
tion into already existing sector programs, the cascading of structures to ease implementation,
and the creation of sustainable financing and budget allocation might all be viewed as poten-
tial ways of measuring the commitment and level of implementation of the National Nutrition
Program within specific sectors.
Integrated, multisectoral coordination at all levels must be strengthened along with commu-
nity-level action. There must also be clear guidance and better alignment of programs and
resources among partners, and programmatic decisions must be based on and supported by
research and capable knowledge management. Mechanisms for monitoring and evaluation
must be in place, and triangulated nutrition information that captures data from all relevant
sectors must be adequately integrated.

3
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 order to end hunger by 2030. The program was
developed in step with the government’s efforts to realize the Seqota Declaration through the
integrated and coordinated implementation of high impact nutrition interventions to reduce
malnutrition among children, women of reproductive age, adolescents and the general
population. The main interventions under NNP II include optimal breastfeeding, optimal
complementary feeding, mitigation and prevention of micronutrient deficiencies, WASH,
deworming, food fortification and management of acute malnutrition.
STRATEGIC OBJECTIVES OF NNP II

The Government of Ethiopia devised programs and initiatives with set targets that directly and
indirectly contribute to the reduction of malnutrition and to ending hunger. These programs
include increasing agricultural productivity, promoting girls’ education, immunization, integrat-
ed management of neonatal and childhood illnesses (IMNCI), water, sanitation and hygiene
(WASH), family planning, prevention of mother-to-child transmission of HIV (PMTCT), skilled
delivery, delaying of first pregnancy, food fortification, and management of micronutrient defi-
ciencies 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 the immediate causes of malnutrition. The overall goal of this program
implementation manual is to facilitate and ignite the accelerated reduction of malnutrition
in order to achieve zero hunger by 2030 and meet Sustainable Development Goal targets.
Below, the core targets, initiatives and expected results of the program are listed beneath

each strategic objective. The performance indicators and targets for each strategic objective
also appear in the accountability and results matrix at the end of the document (Annex).
STRATEGIC OBJECTIVE
improve the nutritional status of women
1
(15–49 years) and adolescent girls (10–19 years)
Globally, maternal undernutrition contributes to 800,000 neonatal deaths, and child

undernutrition is estimated to underlie nearly 3.1 million child deaths annually (Zulfiqar, 2013).
Maternal malnutrition, encompassing both undernutrition and overweight, are global problems
with important consequences for survival, incidence of acute and chronic diseases, healthy
development and economic productivity. Adolescent nutrition is important to the health of girls
and is relevant to maternal nutrition. Especially, pregnancies in adolescence have a higher
risk of complications and higher mortality for mothers, infants and children, as well as poorer
overall birth outcomes than pregnancies in older women.
Prevalence of low BMI (<18.5 kg/m2) in adult women has decreased in Africa and Asia since
1980, but remains higher than 10% in these two large developing regions. Anemia (hemoglo-
bin <110 g/L), which might be attributable to low consumption and/or absorption of iron in the
diet or to blood loss, such as from intestinal worms, is highly prevalent during pregnancy and
has a significant impact on birth outcomes.
Under Strategic Objective 1, the NNP’s interventions address the nutritional problems of
adolescent girls and women of reproductive age, including pregnant and lactating women.
2020 TARGETS
■■ Reduce the prevalence of anemia in adolescent girls from 30% to 15%.
■■ Reduce the prevalence of anemia among women of reproductive age (15-49 years) from
19.3% to 12%.
■■ Reduce the prevalence of anemia among pregnant women from 22% to 14%.
■■ Reduce the proportion of women of reproductive age with BMI <18.5% from 27% to 16%.
■■ Reduce the proportion of newborns with low birth weight (less than 2.5kg at birth) from
11% to 5%.

RESULT 1.1: NUTRITIONAL STATUS OF ADOLESCENTS IMPROVED
INITIATIVES
1. Provide nutritional assessments and ✓✓ Promote the use of iodized salt

counseling services for adolescents at and strengthen enforcement of
all contacts with health care providers. universal salt iodization (USI) reg-
ulations.
✓✓ Conduct nutritional assessments
and counseling services in health ✓✓ Promote and support girls’ educa-
facilities when an adolescent comes tion.
for any kind of health service.
✓✓ Ensure that key influential groups
✓✓ Integrate adolescent nutrition ser- and individuals are aware of the
vices into youth centers and related importance of adolescent nutrition
community based programs. and the consequences of malnutri-
tion during adolescence.
✓✓ Conduct regular monitoring of the
nutritional status of school-age chil- ✓✓ Provide life skills trainings (such as
dren/adolescent girls. assertiveness, negotiation skills,
and decision-making, leadership
2. Ensure adolescents’ access to micronu- and bargaining skills) for girls and
trient services. boys to prevent early pregnancy.
✓✓ Provide school based biannual de- ✓✓ Promote personal hygiene, envi-

worming. ronmental sanitation and infection
prevention measures.
✓✓ Provide biannual deworming for
out-of-school adolescents. 4. Ensure access to reproductive health
information and services for boys and
✓✓ Provide iron folic acid supple- girls to:
mentation for adolescent girls at
schools and health facilities. ✓✓ Delay first pregnancy until age 19.
3. Conduct social and behavioral change ✓✓ Promote the use of adolescent

communication to prevent harmful tra- friendly reproductive health ser-
ditional practices related to nutrition. vices.
✓✓ Promote delaying early marriage ✓✓ Integrate nutrition assessment and

until age 18 and delay of first preg- counseling into youth friendly re-
nancy until age 19. productive health services.
✓✓ Promote dietary diversity. 5. Address the needs of adolescent girls in

special situations (HIV/AIDS, emergen-
✓✓ Prevent food taboos, which con- cy, obesity and eating disturbances).
tribute to intergenerational malnu-
trition.
✓✓ Promote diversified and nutritious

foods for adolescents.

RESULT 1.2: NUTRITIONAL STATUS OF WOMEN OF
REPRODUCTIVE AGE IMPROVED
INITIATIVES ✓✓ Provide deworming during the sec-

ond trimester of pregnancy.
I: Improve Nutrition of Pregnant and
Lactating Women 2. Conduct social and behavioral change
communication on maternal nutrition.
1. Provide comprehensive and routine nu-
tritional assessments and counseling ✓✓ Promote maternal nutrition, includ-
services. ing adequate intake of diversified
foods, daytime rest and additional
✓✓ Conduct nutritional assessments meals during antenatal and postna-
and provide counseling services for tal periods.
pregnant women during antenatal
care (ANC) visits and at any other ✓✓ Identify and support champions to
health contact points. serve as role models to support the
nutrition of women and children.
✓✓ Conduct nutritional assessments
and provide counseling services for ✓✓ Promote shifts in social norms on
lactating women during postnatal food taboos through religious lead-
visits and at any other health con- ers and influential community mem-
tact points. bers to realize adequate nutrition for
pregnant and lactating women.
✓✓ Promote engagement of husbands,
grandparents and other household ✓✓ Promote the use of iodized salt and
members who play key roles in pro- fortified foods.
viding continuous care for pregnant
and lactating women. ✓✓ Promote personal hygiene, environ-
mental sanitation and infection-pre-
✓✓ Provide malnourished pregnant and vention measures.
lactating women (PLW) with target-
ed supplementary food. 3. Strengthen mobile health and nutrition
teams to improve access to nutrition
✓✓ Provide PLW with blanket supple- services in pastoralist areas.
mentary food support in special cir-
cumstances. 4. Ensure free distribution and utilization of
insecticide-treated nets (ITNs) by PLW
✓✓ Identify and treat severe and mod- in all malaria-endemic woredas.
erate acute malnutrition (SAM and
MAM) in PLW. 5. Create access to time and labor saving
technologies.
✓✓ Identify and treat infections such as
malaria and intestinal parasitosis. 6. Ensure access to reproductive health
services.
✓✓ Provide PLW with routine iron and
folic acid supplementation. ✓✓ Ensure access to postnatal and
family planning services.

✓✓ Ensure male involvement in repro- II: Improve the nutritional status of
ductive health services. non-pregnant and non-lactating women
7. Support women’s empowerment. ✓✓ Promote the use of iodized salt.
✓✓ Strengthen women’s economic con- ✓✓ Promote adequate intake of diversi-

trol. fied food.
✓✓ Strengthen women’s ability to have ✓✓ Ensure access to reproductive

equitable decision-making power to health services.
improve their own nutritional status
and that of their households. ✓✓ Ensure the economic empowerment
of women.
STRATEGIC OBJECTIVE 2
improve the nutritional status of children
from birth up to 10 years
Maternal and child malnutrition, encompassing both undernutrition and overnutrition, are
global problems with important consequences for survival, incidence of acute and chronic
diseases, healthy development and the economic productivity of individuals and societies.
Ethiopia is one of the top-ranked countries in terms of malnutrition in sub-Saharan Africa.
Progress has been made with many interventions implemented at scale over the last de-
cade. Strategic Objective 2 emphasizes the first 1,000 days after a child’s birth, which is a
critical period in human life.
2020 TARGETS
■■ Reduce stunting prevalence among under-five children from 40% to 26%.
■■ Reduce the prevalence of underweight among under-five children from 25% to 13%.
■■ Reduce the prevalence of wasting among under-five children from 9% to 4.9%.
■■ Reduce the prevalence of low birth weight (less than 2.5kg at birth) from 11% to 5%.
■■ Reduce the prevalence of anemia in under-five children from 39% to 24%.
■■ Increase the proportion of children 6-23 months with minimum dietary diversity score from
5% to 40%.

RESULT 2.1: NUTRITIONAL STATUS OF INFANTS AND YOUNG
CHILDREN 0–23 MONTHS IMPROVED
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
tial community members on optimal involvement of fathers and influen-
breastfeeding practices. tial 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
ages 6–23 months, emphasizing: ✓✓ Revise existing recipes for comple-

mentary foods, considering agrari- ✓✓ Provide zinc with oral rehydration
an, urban and pastoral contexts. salt (ORS) for diarrhea treatment.
✓✓ 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 therapeutic food (RUTF) and ready-
monitoring and quality control of to-use supplementary food (RUSF).
salt iodization at production sites
(including imported edible salt). ✓✓ Ensure malnourished children are

exempted from treatment service ✓✓ Promote construction and use of
charges. household and community latrines.
✓✓ Ensure that caretakers are able to 10. Link food-insecure households with
get food at stabilization centers. children under 2 to social protection ser-
vices and nutrition-sensitive livelihood
✓✓ Ensure nutritional screening ser- and economic opportunities.
vices for children who visit health
posts and health centers for inte- 11. Integrate Early Childhood Care and
grated management of neonatal and Development stimulation with existing
childhood illnesses (IMNCI). community and facility based child nu-
trition programs.
9. Ensure universal access to WASH and
utilization of WASH practices. ✓✓ Promote appropriate adult-child in-
teraction.
✓✓ Ensure access to clean and safe
water. ✓✓ Ensure the development and uti-
lization of locally relevant early
✓✓ Promote the use of household water childhood development materials.
treatment practices.
✓✓ Integrate ECCD into nutrition
✓✓ Promote safe and hygienic prepara- capacity building efforts (blended
tion and handling of food. integrated nutrition learning module).
✓✓ Promote hand washing with soap. ✓✓ Ensure inclusion of ECCD related

topics in nutrition-blended training
✓✓ Promote safe and clean household materials.
environments (in relation to poul-
try, small ruminants and household
waste management).
RESULT 2.2: NUTRITIONAL STATUS OF CHILDREN

24–59 MONTHS IMPROVED
INITIATIVES
1. Promote appropriate feeding and dietary 2. Prevent and control micronutrient defi-
practices. ciencies.
✓✓ Ensure that households with chil- ✓✓ Identify and treat anemia.

dren under 5 and PLW are linked to
initiatives that promote home/kitch- ✓✓ Provide Vitamin A supplementation
en gardens and small-scale food for children 6-59 months of age
production that support a diverse biannually.
range of nutrient-enhancing foods.
✓✓ Deworm children 2-5 years old
biannually.

✓✓ Promote the use of iodized salt at ✓✓ Promote hand washing with soap.
household level.
✓✓ Promote safe and clean household
✓✓ Provide zinc with ORS for diarrhea environments (in relation to poul-
treatment. try, small ruminants and household
waste management).
3. Detect and manage acute malnutrition
and common childhood infections early. ✓✓ Promote construction and use of
household and community latrines.
✓✓ Train health workers and health
extension workers on identification 5. Integrate Early Childhood Care and
and treatment of acute malnutrition. Development stimulation with existing
community and facility based child nu-
✓✓ Conduct routine screening of chil- trition programs.
dren for malnutrition.
✓✓ Promote appropriate adult-child in-
✓✓ Manage severe and moderate teraction.
acute malnutrition.
✓✓ Ensure the development and uti-
✓✓ Encourage local food processing lization of locally relevant early
factories to participate in fulfilling childhood development materials.
production requirements for RUTF
and RUSF. ✓✓ Integrate ECCD into nutrition ca-
pacity building efforts (blended in-
✓✓ Ensure availability of appropriate tegrated nutrition learning module).
supplies and commodities (supple-
ments, anthropometric equipment, ✓✓ Ensure inclusion of ECCD related
therapeutic food, supplementary topics in nutrition-blended training
food and routine drugs) in a sus- materials.
tainable manner in all health facil-
ities. 6. Improve nutritional services for young
children in special circumstances.
✓✓ Strengthen monitoring, evaluation
and reporting of nutrition services ✓✓ Emergency situations
through harmonized data collection
tools. ✓✓ Refugee camps
4. Ensure universal access to WASH and ✓✓ Orphanages

utilization of WASH practices.
✓✓ Daycare centers
✓✓ Ensure access to clean and safe
water. ✓✓ Chronic infections, etc.
✓✓ Promote the use of household wa-

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

ration and handling of food.

RESULT 2.3: NUTRITIONAL STATUS OF CHILDREN AGES 5–10
IMPROVED
INITIATIVES
1. Promote good nutrition behavior and ✓✓ Provide school based deworming

improved nutritional status of children services.
5–10 years old.
✓✓ Promote the use of iodized salt at
✓✓ Conduct school based health and household level.
nutrition social and behavior change
communication for young children. ✓✓ Promote exercise for preventing
childhood obesity.
✓✓ 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 healthy lifestyle and in the prevention and manage-
ment of chronic communicable and non-communicable diseases. Malnutrition is a critical yet
underestimated factor in susceptibility to infection, including HIV/AIDS, tuberculosis and ma-
laria. Infection saps the individual of energy, which reduces productivity at the community level
and perpetuates an alarming spiral of infection, disease and poverty. Hence, it is essential to
address the nutritional requirements of individuals with infections.
In addition, because of changes in dietary and lifestyle patterns, non-communicable diseases

like obesity, diabetes mellitus, 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 an additional burden on already overtaxed
national health budgets. Undernutrition in utero and early childhood may predispose individu-
als to greater susceptibility to some chronic diseases (Alemu et al., 2014; Gebreyohannes et
al., 2014; Tefalem et al., 2013).
Timely interventions will help prevent these diseases or reduce their severity and consequenc-
es. The health sector, the Ministry of Youth and Sport, and other concerned governmental
bodies are responsible for implementing nutrition-sensitive interventions for those dealing with
communicable, non-communicable and lifestyle related diseases.
RESULT 3.1: NUTRITION SERVICE DELIVERY FOR

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

counseling and support (NACS) into advocacy materials available to
comprehensive HIV/AIDS care and health service providers (in line with
support training materials. the National Health Communication
Strategy).

✓✓ 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 nation-
✓✓ Prioritize children under five, preg- al Health Management Information
nant and lactating women in cases System.
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.
✓✓ Counsel and support HIV-positive
mothers on infant feeding as per ✓✓ Establish linkages between facility
the national recommendations and and community based nutrition in-
strategies for elimination of mother- terventions for PLHIV and livelihood
to-child transmission (EMTCT). support and food assistance inter-
ventions.
✓✓ Link HIV-infected patients who have
graduated from NACS services to ✓✓ Strengthen community based nu-
economic strengthening activities trition care and support activities

for PLHIV through health extension patients or refer them for treatment
workers, agriculture extension work- when the support is available.
ers and health development armies.
✓✓ Link TB patients with nutrition-sen-
B. Nutrition and Tuberculosis sitive interventions and livelihoods
interventions to access nutritious
1. Strengthen the capacity of health facil- foods where and when available,
ities and health professionals working particularly MDR-TB and HIV co-in-
in TB clinics to deliver quality NACS for fected patients.
patients with TB.
✓✓ Link TB patients that graduated
✓✓ Integrate NACS into TB treatment from NACS services to econom-
and care programs. ic strengthening activities (income
generating activities, back-to-work
✓✓ Harmonize TB detection and man- initiatives, etc.).
agement guidelines and/or training
materials with the National Nutrition ✓✓ Strengthen community TB preven-
Program. tion, care and support activities
through health extension workers
✓✓ Equip TB clinics/centers with anthro- and health development armies.
pometric equipment and counseling
materials. ✓✓ Develop and distribute harmonized
social and behavioral change com-
✓✓ Train health workers working in munication materials on nutrition
TB clinics/multi-drug resistant-TB and TB through community based
(MDR-TB) centers on NACS. service providers (health extension
workers and health development
✓✓ Incorporate NACS training into inte- armies).
grated refresher training for HEWs
with focus on TB cases (creating 3. Strengthen integration between TB and
awareness, follow up, linkage to the HIV programs and nutrition.
health facility).
4. Review existing evidence on TB and
2. Ensure nutritional assessment, counsel- nutrition to bridge knowledge gaps and
ing and support for patients with active identify operational research areas to
and drug resistant TB. fully integrate nutrition into TB treatment
and control programs.
✓✓ Conduct routine nutritional assess-
ments for TB patients to determine C. Nutrition and Other Infections
their nutritional status and provide Even though malnutrition is highly associ-
them with nutrition support when es- ated with chronic infectious diseases, other
sential and available. common infections like measles, diarrheal
diseases, malaria, soil transmitted helmin-
✓✓ Provide nutritional education and thiasis and pneumonia are also known to
counseling on the importance and adversely affect the nutritional status of
impact of good nutrition, symptom patients. Therefore, every effort should be
management and improved dietary made to:
intake during and after TB treatment.
1. Ensure that nutritional assessment and
✓✓ Provide nutritional assistance to TB counseling are done while these infec-

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

dietary behaviors and physical activities. promote increased consumption of
fruits and vegetables, reduced con-
✓✓ Develop standardized health and sumption of soda beverages, satu-
nutrition messages on healthy di- rated fats and trans-fatty acids.
etary behaviors.
✓✓ Promote healthy nutrition through
✓✓ Disseminate national nutrition, di- media (TV, radio, newspapers, post-
etetics and healthy life guidelines to ers, social media, websites, etc.).
promote healthy dietary lifestyles.
✓✓ Conduct school based health pro-
✓✓ Produce and disseminate IEC and motion to encourage healthy diet
behavior change communication and avoid childhood obesity among
(BCC) materials on healthy diet and schoolchildren.
physical activity.

✓✓ Train HEWs (both urban and rural) 3. Create/advocate for external environ-
on diet, physical activity and NCDs. ments that enhance physical activity in
schools, at workplaces and in commu-
✓✓ Implement the International Code of nities.
Marketing of Breastmilk Substitutes
and subsequent WHO resolutions. ✓✓ Conduct advocacy workshops for
relevant decision-makers on the im-
✓✓ Promote continuation of breastfeed- portance of physical activity in pre-
ing to age 2 and beyond. venting non-communicable diseas-
es.
✓✓ Develop regional based food guide
pyramids for different cultural set- ✓✓ Collaborate with sector line minis-
tings. tries and other concerned bodies.
2. Provide nutrition assessment and coun- ✓✓ Ensure that schools have safe and
seling services (NACS) at the communi- accessible facilities for active recre-
ty and health facility level. ation, play and sports.
✓✓ Support facilities to integrate NACS ✓✓ Encourage schools to provide stu-

into pediatric services for children dents with daily physical education
under five and into adult outpatient and to equip themselves with appro-
services to identify overweight and priate facilities and equipment.
obesity.
4. Promote the establishment of physical
✓✓ Support facilities to integrate activity and nutrition clubs in urban and
nutrition assessment into different rural settings.
non-communicable disease clinics
(diabetics, hypertension, cancer, ✓✓ Establish physical activity clubs
etc.) within communities, schools and
workplaces in collaboration with
✓✓ Provide disease-specific dietary sector line ministries.
counseling.
✓✓ Collaborate with sector line minis-
✓✓ Provide periodic nutritional screen- tries to establish physical activity
ing and counseling of students for committees in all workplaces.
early identification of obesity and
overweight at school. ✓✓ Establish nutrition clubs within com-
munities, schools and workplaces.
✓✓ Provide periodic nutritional screen-
ing and counseling to women at 5. Promote engagement with professional
youth friendly reproductive health organizations to generate evidence for
clinics for early identification of obe- policy guidance and standard setting.
sity and overweight.
✓✓ Strengthen surveillance of non-
✓✓ Support community level facilities communicable disease risk factors.
to provide nutritional screening and
counseling for early identification of ✓✓ Promote health systems research
obesity and overweight. or epidemiological studies on major

non-communicable disease risk fac- ✓✓ Impose taxation on imported foods
tors, including physical inactivity and and drinks.
unhealthy diet.
✓✓ Develop the necessary regulations
✓✓ Ensure that national surveys on NCD to provide incentives for the pro-
risk factors address dietary intake, duction and formulation of healthy
household expenditure, blood lipids, foods.
hypertension, and blood glucose ✓✓ Develop regulations to ensure that
in collaboration with the Ethiopian NCD prevention is an explicit priority
Public Health Institute. in all stages of food systems, includ-
ing product development, formula-
6. Strengthen the diagnostic and clinical tion, promotion and distribution.
management capabilities of the coun-
try’s health system to prevent and treat ✓✓ Enforce regulations to minimize the
chronic non-communicable/lifestyle re- impact of marketing on dietary pat-
lated diseases. terns and prevent the exploitation of
children, young people, and families
✓✓ Equip health facilities with essential via advertisements of unhealthy di-
supplies, diagnostic equipment and ets and beverages.
other treatment inputs.
✓✓ Organize and conduct sustainable

in-service training programs on clini-
cal diagnosis, treatment, counseling
and comprehensive care of patients
with non-communicable diseases.
✓✓ Establish and foster networking

and collaboration across higher ed-
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.
✓✓ Formulate and enforce legislation

that promotes the local production
and consumption of fruits and veg-
etables.
✓✓ Enforce labeling of composition (in-

gredients) of commercially produced
or imported foods and drinks.

strengthen the implementation of nutrition-sensitive
interventions across sectors
Nutrition sensitivity describes the degree to which an indirect intervention positively affects
nutrition outcomes. Indirect or longer-route interventions include actions within sectors
such as agriculture, social protection, and water and sanitation. Acceleration of progress in
nutrition will require effective, large-scale, multisectoral programs that address key underlying
determinants of nutrition and enhance the 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.
2020 TARGETS
■■ Increase mean number of days of consumption of meat from 1.2 days to 3 days per week.
■■ Increase national food consumption score from 26% to 40%.
■■ Increase proportion of households consuming diversified food by 40%.
RESULT 4.1: IMPLEMENTATION OF NUTRITION-SENSITIVE

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

INITIATIVES ✓✓ Promote local production of comple-
mentary foods.
I: Strengthen the implementation of nutrition-
sensitive interventions in the Ministry 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 asset transfers or asset
✓✓ Ensure access to fruit and vegetable building interventions properly target
seeds and other agricultural inputs. women and vulnerable households.
✓✓ Support the establishment of com- ✓✓ Ensure that vulnerable households

munity fruit and vegetable nursery with a malnourished child are ad-
sites and demonstration sites at equately targeted in transfer and
farmer training centers. safety net initiatives.
✓✓ Promote homestead and school ✓✓ Improve the nutritional value of the

gardening. food basket with the addition of puls-
es or the equivalent cash value.
✓✓ Promote and support urban agricul-
ture. ✓✓ Enhance the implementation of
nutrition-sensitive public works.
✓✓ Promote and support community
level production of fruits and vege- ✓✓ Introduce soft conditionality related
tables. to attendance at behavior change
communication events or uptake of
✓✓ Promote production and consump- other services in order to increase
tion of bio-fortified pulses and veg- health-seeking behavior.
etables (orange-fleshed sweet pota-
to, iron rich beans, etc.) 3. Promote technologies for post-harvest
food processing, handling, preservation
✓✓ Distribute bio-fortified seeds from and preparation to help ensure that food
research entities and other higher is both nutritious and diverse.
institutions.
✓✓ Identify and scale up best practices
✓✓ Improve post-harvest handling and in the processing, preservation and
storage. preparation of fruits, vegetables
and other crops.
✓✓ Improve post-harvest food process-
ing and ensure safety. ✓✓ Improve food handling, storage
and transportation of fruits, vegeta-
✓✓ Improve market linkages for fruit bles and other crops.
and vegetable produce.
4. Enhance agricultural research and
✓✓ Promote production and consump- adoption of technology for increased
tion of nutrient-dense pulses. household access to safe, nutritious
food.

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

✓✓ Conduct research to identify suit- forests and conservation of forests
able agroforestry technologies and harboring wild foods.
appropriate tree species for specific
areas of Ethiopia. ✓✓ Promote provision and distribution
of tree seedlings that will contribute
✓✓ Promote safeguarding and conser- to positive nutritional outcomes.
vation of forest areas where wild
foods are extracted for consumption. 12. Develop laws and policies to codify fair,
legal access to forests by local people
✓✓ Establish a database for tracking for the sustainable harvesting of wild
forest plants that are directly used foods.
as food sources to understand and
improve the contribution of the forest ✓✓ Develop a policy framework, law
to improved nutritional outcomes. and legislation to prevent land-use
challenges to subsistence or com-
✓✓ Integrate nutrition objectives and mercial farming.
interventions into the management
plan of forests and agroforests to ✓✓ Develop laws and policies to pre-
the extent possible. vent forest clearing and deforesta-
tion without a full analysis, includ-
10. Improve the awareness of key stake- ing an analysis of which wild foods
holders about the importance of forests might be lost, along with the nutri-
and of environmental conservation to tional implications of such loss.
improved nutritional outcomes.
II: Strengthen the implementation of nutri-
✓✓ Promote wild foods, particularly veg- tion-sensitive interventions in the Ministry of
etables and fruits, in national and Livestock and Fisheries
local media, in schools, and among
health extension workers to under- 1. Update relevant policies/strategies/
line their nutritional value, to high- guidelines and program implementation
light cultural diversity and to foster manuals with nutrition indicators to en-
appreciation of the traditional foods sure that they contribute to nutrition and
of various cultures and their rele- ensure its implementation.
vance to health.
✓✓ Develop a nutrition-sensitive strat-
✓✓ Incorporate food security, nutrition egy and implementation manual
and agriculture modules in forestry and disseminate to all levels.
training and education curricula to
broaden the understanding of forest- ✓✓ Strengthen advocacy and sensiti-
ers and sensitize them to the poten- zation on nutrition-sensitive fishery
tial role of forests in contributing to and livestock at all levels.
the wellbeing of local communities.
2. Increase year-round availability, access
11. Integrate nutrition related goals, initia- to and consumption of animal-sourced
tives and activities into the forestry ex- foods.
tension program for sustainable nutri-
tional benefits. ✓✓ Increase production and household
consumption of meat, milk and eggs.
✓✓ Develop guidelines and provide
training on using the forestry ex-
tension program to promote agro-

✓✓ Promote rearing of improved breeds food processing, handling, preservation
of dairy cattle, small ruminants and and preparation to help ensure that food
poultry. is both nutritious and diverse.
✓✓ Support the establishment of milk ✓✓ Identify and scale up best practices

collection centers and improved milk in the processing, preservation and
processing technologies at house- preparation of dairy products and
hold level. fish.
✓✓ Promote confined/caged poultry ✓✓ Improve food handling, storage and

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

to attendance at BCC events or up-
take of other services, in order to in-
crease health-seeking behavior.
4. Promote technologies for post-harvest

✓✓ 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.

INTERVENTIONS IN THE EDUCATION SECTOR STRENGTHENED
The education sector is responsible for improving access to quality pre-primary and primary
education in order to make sure that all children, youth and adults acquire the competencies,
skills and values that enable them to participate fully in the development of Ethiopia. Efforts
will also be made to sustain equitable access to quality secondary and tertiary education
services as the basis of and bridge to the demand of the economy for middle and higher level
human resources. The sector will also contribute to the improvement of health and nutrition
and to the reduction of undernutrition in schoolchildren through the provision of school health
and nutrition interventions and through a school feeding program. Moreover, the sector is
expected to improve workforce capacity in the nutrition sector by educating people to join the
sector and thereby contribute to implementation of the overall NNP.
2020 TARGETS
students and other school commu-
■■ Increase the proportion of primary nity members) at each level (region,
schools with a homegrown school feed- zone, woreda and kebele).
ing program from 0 to 25%.
✓✓ Support and promote gender re-
■■ Increase the proportion of schools that sponsive school feeding in different
provide biannual deworming to 60%. modalities.
✓✓ In collaboration with the agriculture

INITIATIVES sector, encourage schools to pro-
mote and transfer sustainable, rep-
licable school gardening models at
1. Promote and scale up school feeding
community level and link them with
programs.
school feeding and WASH pro-
grams.
✓✓ Develop a school feeding imple-
mentation strategy.
✓✓ With community participation, pro-
vide school menus based on locally
✓✓ Develop a training manual and build
produced food.
the capacity of education personnel
(experts, leaders, teachers, PTAs,

2. Promote school health and nutrition all levels but with a focus on prima-
(SHN) interventions through collabora- ry education.
tion with other sectors.
3. Improve the capacity of the nutrition
✓✓ Establish SHN implementation workforce.
structures at various levels.
✓✓ Incorporate gender-responsive nu-
✓✓ Establish and strengthen school trition curricula into primary and sec-
health and nutrition clubs. ondary schools, colleges, technical
and vocational education and train-
✓✓ Celebrate Nutrition Day in educa- ing (TVET) institutes, universities
tion institutions. and non-formal education services
(such as functional adult literacy
✓✓ Improve gender-sensitive water, programs).
hygiene and sanitation facilities in
schools. ✓✓ Encourage and support institutions
of higher education to produce more
✓✓ Promote appropriate nutritional nutrition professionals.
practices (e.g., use of iodized salt)
through different media. ✓✓ Train members of the school health
and nutrition organizational struc-
✓✓ Implement nutrition services (de- ture at different levels.
worming, targeted micronutrient
supplementation). ✓✓ Develop harmonized nutrition spe-
cialty programs in universities (e.g.,
✓✓ Promote girls’ education. applied nutrition, clinical nutrition, di-
etetics, public health nutrition, etc.)
✓✓ Strengthen nutrition related com-
munity based services provided by ✓✓ Strengthen university nutrition lab-
higher institutions. oratories to perform operational re-
search.
✓✓ Build the capacity of school
mini-media to conduct social and ✓✓ Engage higher education in mega-
behavioral change communication research projects on nutrition.
related to nutrition interventions
and to engage in the promotion of ✓✓ Support nutrition students for their
optimal nutrition practices. commitment to community service.
✓✓ Assess school curricula and en- ✓✓ Establish and strengthen academic

sure the mainstreaming of nutrition centers of excellence for nutrition.
concepts and skills into curricula at

RESULT 4.3: IMPLEMENTATION OF
NUTRITION-SENSITIVE INTERVENTIONS IN THE WATER,
IRRIGATION AND ELECTRICITY SECTOR STRENGTHENED
The water, irrigation and electricity sector is responsible for increasing access to potable water
and creating a healthy environment. The sector will reduce the burden of disease, save time
spent fetching water and allow mothers more time to care for their children. In addition, the
Ministry of Water, Irrigation and Electricity (MOWIE) added the promotion and expansion of
medium and large irrigation schemes, which may help in increasing productivity and diversify-
ing foods produced throughout the year.
INITIATIVES
1. Increase access to safe and clean wa- ✓✓ Reduce the proportion of the pop-
ter. ulation at risk of problems related
to fluoride, especially children and
✓✓ Increase access to safe water. women (in Rift Valley):
✓✓ Provide water supply for sewerage 1. Provide alternative low fluoride

facilities. water sources.
✓✓ Increase irrigated farmland through 2. Apply proven fluoride removal

the Irrigation Development Program. technologies.
✓✓ Develop water extension-system 3. Strengthen integrated fluorosis

supporting programs at kebele lev- mitigation activities through nutri-
el that deal with community drinking tional interventions at all levels.
water and self-supply.
2. Increase access to renewable energy.
✓✓ Prepare and implement a sustain-
able rural/urban drinking water qual- ✓✓ Increase access to and availability
ity monitoring system (water safety of stoves using renewable energy
plan). technology and solar energy sav-
ing technologies.
✓✓ Strengthen the coordination of wa-
ter, sanitation and hygiene activities 3. Increase access to small- and large-scale
through one WASH program. irrigation schemes.

RESULT 4.4: IMPLEMENTATION OF NUTRITION -SENSITIVE INTER-
VENTIONS IN THE INDUSTRY SECTOR STRENGTHENED
The Ministry of Industry (MOI) is responsible for providing all around support to the food man-
ufacturing industries and for accelerating technology transfers to contribute to the reduction
of micronutrient deficiencies in Ethiopia. This is done through the fortification of wheat, salt,
edible oil and other food vehicles, either domestic or imported.
INITIATIVES
✓✓ Select appropriate food fortification
1. Strengthen the Ministry of Industry’s technologies.
capacity to support the production and
distribution of fortified foods. ✓✓ Develop social mobilization and
marketing strategies for food fortifi-
✓✓ Train implementing staff on the na- cation.
tional food fortification program.
✓✓ Assist in availing the industry of in-
✓✓ Establish and equip quality control puts (equipment, raw materials and
laboratories at the Food, Bever- premix).
age and Pharmaceutical Industrial
Development Institute. ✓✓ Establish linkages with universities
and vocational training centers for
✓✓ Establish organizational structures research and skills transfer.
for implementation and coordina-
tion of the national food fortification ✓✓ Ensure quality and safety of locally
program. produced food items.
✓✓ Establish a dedicated food fortifica- 3. Conduct awareness creation events for

tion directorate at the MOI’s Food, the private sector on nutrition related
Beverage and Pharmaceutical requirements and standards for locally
Industry Development Institute. manufactured food items.
✓✓ Strengthen the National Food For- ✓✓ Provide training on food fortification

tification Steering Committee and for food industries, including quality
establish the necessary sub-work- control/quality assurance.
ing groups.
✓✓ Provide training for selected labora-
2. Build industry capacity to meet interna- tories on standardized testing meth-
tional standards for quality and safe for- odologies (private and public institu-
tified foods (edible oils, flour, salt, etc.). tion)
✓✓ Conduct industry mapping to identify ✓✓ Strengthen the capacity of public

and support small- and large-scale and private food control laborato-
wheat flour and edible oil manufac- ries.
turers to produce fortified food prod-
ucts. ✓✓ Formulate strategies and action
plans that assist food manufacturers
to produce safe and nutritious food.

INTERVENTIONS IN THE TRADE SECTOR STRENGTHENED
The Ministry of Trade’s responsibilities pertaining to nutrition includes regulating and enforcing
compliance of locally produced and imported food items. The ministry issues a certificate of
conformity at the country’s ports of entry to ensure the quality and safety of food products.
INITIATIVES
1. Strengthen the capacity of the Ministry ✓✓ Conduct regular inspection and

of Trade to regulate imported food items. monitoring of food processing facto-
ries.
✓✓ Capacitate the Ministry of Trade’s
staff along with regional, zonal and ✓✓ Strengthen the collaboration be-
woreda trade bureaus on the in- tween MOI and regulatory sectors to
spection of imported food items and support and facilitate the importation
the regulations concerning them. of products for food fortification.
✓✓ Develop a guiding manual for the ✓✓ Develop a marketing strategy for

inspection and regulation of food fortified foods.
items.
3. Conduct awareness creation events for
✓✓ Capacitate the Trade Practice and the private sector on nutrition related re-
Consumer Protection Authorities quirements and standards for imported
to promote the use of safe fortified food items.
foods.
4. Conduct awareness creation events for
2. Ensure the quality and safety of import- the public/consumers on the benefits of
ed food items as per the national stan- fortified food.
dard.
5. Support importation of fortified food (ed-
✓✓ Conduct regular market surveillance ible oil, salt, etc.).
to ensure the quality and safety of
fortified products. 6. Ensure access to and a supply chain for
food and food items.

RESULT 4.6: SOCIAL PROTECTION SERVICES FOR IMPROVED
NUTRITION STRENGTHENED
The Ministry of Labor and Social Affairs (MOLSA) was established to realize the vision of
ensuring that citizens have access to productive employment, a stable and decent work
environment and secured social welfare, all of which help to ensure nutritional status. MOLSA
strives to maintain employee health and safety in the workplace, promote efficient and equitable
employment services and provide rehabilitation and capacity building services to vulnerable
and affected members of society. Under Result 4.6 of the National Nutrition Program, MOLSA
will carry out the following initiatives.
INITIATIVES the nutritional status of women and

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

women are eligible for conditional practices through women’s self-help
support – exemption from involve- groups.
ment in physical labor (cash for
work). 3. Increase access to basic nutrition ser-
vices for all vulnerable groups.
✓✓ Ensure that PSNP beneficiaries
with children under 2 also ✓✓ Employ fee-waiver schemes for the
receive messaging pertaining to management of acute malnutrition.
adolescent, maternal, infant and
young child nutrition (AMIYCN) and ✓✓ Expand basic preventative and cu-
engage both males and females rative nutrition services to pastoral-
in complementary food cooking ist and other vulnerable areas.
demonstrations for skills transfer at
household level. ✓✓ Improve nutritional services for the
poor, the elderly and persons with
✓✓ Integrate nutrition practices with so- disabilities.
cial safety net programs to improve

RESULT 4.7: NUTRITION-SENSITIVE INTERVENTIONS IN DISASTER
RISK MANAGEMENT COORDINATION COMMISSION
STRENGTHENED
The National Disaster Risk Management Coordination Commission provides a framework

for coping with the impact of hazards and related disasters and contributes to reducing
malnutrition related risks caused by disaster. The food security directorate within Disaster
Risk Management is responsible for supporting food insecure households in chronically food
insecure woredas in a way that prevents asset depletion at household level. The directorate
also facilitates access to credit for farm and off-farm activities that contribute to maximizing
productivity, and thus creates opportunities to build assets.
INITIATIVES
based on assessments.
1. Strengthen and scale early warning sys-
tems for food and nutrition information ✓✓ Ensure provision of adequate and
from the community level up to the na- appropriate information during
tional 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
a timely fashion a comprehensive ✓✓ Ensure the capacity for mapping
package of nutrition services and affected areas.
food items for emergencies and re-
covery periods. ✓✓ Develop evidence based emer-
gency preparedness and response
✓✓ Ensure early detection and manage- plans.
ment of acute malnutrition (severe
and moderate). ✓✓ Strengthen the capacity for coordi-
nating an emergency nutrition re-
✓✓ Integrate the management of infant sponse.
and young child feeding in emergen-
cy response interventions. 4. Improve knowledge and practice of nu-
trition-sensitive disaster risk manage-
✓✓ Undertake Vitamin A supplementa- ment among farmers, using behavior
tion and measles vaccination. change communication.
✓✓ Establish and strengthen supple- ✓✓ Improve household level knowledge

mentary and therapeutic feeding and practice about dietary diversity.

✓✓ Establish behavior change commu- ✓✓ Use social and behavioral change
nication strategies relevant for nutri- communication strategies to impart
tion-sensitive disaster risk manage- information about resilience to nutri-
ment. tion related shocks in all farmer and
agricultural extension worker train-
✓✓ Use local media to address food ing manuals.
taboos and cultural constraints.
RESULT 4.8: QUALITY AND SAFETY OF NUTRITION SERVICES

AND SUPPLIES ENSURED
The Food, Medicine and Healthcare Administration and Control Authority (FMHACA) is man-
dated to promote and protect public health by ensuring the safety and quality of health related
products and services through registration, licensing and inspection of health professionals.
In the implementation of the National Nutrition Program, FMHACA may have a significant role
in setting standards and legislation and in developing guidelines/manuals. The authority also
provides certificates of competency for manufacturers, importers and exporters, and ensures
the quality and safety of food products.
INITIATIVES
✓✓ Fortified foods, food fortificants/pre-
1. Develop/revise directives, standards, mix.
legislation and manuals to control the
quality and safety of food products. 5. Register and issue market authorization
for nutritious food products.
2. Issue a certificate of competence for
manufacturers, importers, exporters, 6. Ensure that the quality and safety of the
distributors and quality control laborato- public water supply is up to standard.
ries.
7. Ensure that the quality and safety of
3. Enforce and regulate the activities of food products used in school feeding
manufactures, importers and distribu- programs is up to standard.
tors of products and supplies.
8. Conduct regular capacity needs assess-
4. Ensure the quality and safety of the fol- ments and build the capacity of experts
lowing by conducting laboratory analy- in inspection and regulatory activities.
sis:
9. Strengthen and equip regulatory labo-
✓✓ Infant formula, special nutritional ratories at federal, branch and regional
products and food supplements. levels.
✓✓ Complementary foods, therapeutic

and supplementary foods and spe-
cial food products for vulnerable
groups.

RESULT 4.9: NUTRITION SUPPLY MANAGEMENT IMPROVED
The Pharmaceuticals Fund and Supply Agency (PFSA) enables public health institutions to
supply quality assured, essential nutrition products at affordable prices in a sustainable man-
ner. It plays a complementary role in efforts to expand and strengthen health services by en-
suring an enhanced and sustainable supply of nutrition products.
INITIATIVES
tributing and using nutrition supplies
1. Ensure timely access to nutrition sup- through an integrated logistics manage-
plies. ment information system.
✓✓ Conduct timely forecasting and pro- ✓✓ Put in place a coordinated informa-

curement by involving all stakehold- tion sharing mechanism showing
ers. stock on hand, quantities distribut-
ed, and stock on pipeline (in transit).
✓✓ Conduct proper warehousing and
distribution. ✓✓ The FMOH will develop a distribu-
tion plan on a quarterly basis (or at
✓✓ Conduct periodic follow-up and minimum every 6 months) and share
monitoring of consumption of sup- it with all stakeholders.
plies in order to take appropriate
and timely action. ✓✓ All stakeholders should follow up on
the stock status of nutrition supplies
2. Build the capacity of regional, zonal and at all levels.
woreda health offices and health facili-
ties in the management of nutrition sup- ✓✓ Nutrition commodity security issues
plies. should be an agenda item in nutri-
tion technical working group meet-
3. Coordinate partners in procuring, dis- ings.
RESULT 4.10: NUTRITION COMMUNICATION IMPROVED

Nutrition communication is recognized as a primary form of intervention in national food and
nutrition programs. It is an integral component of nutrition intervention approaches, such as
food production, food assistance, food formulation and fortification, supplementary feeding,
promotion of breastfeeding, nutrition related health services and provision of a potable water
supply. The ultimate goal of nutrition communication is to produce nutritionally literate deci-
sion makers who are motivated, knowledgeable, skilled and willing to choose proper nutrition
alternatives.
Nutrition communication is a two-way process, where participants can freely exchange knowl-
edge, values and practices on nutrition, food, and related areas. It ensures the active in-
volvement of those who could and should take part in decision-making, and in motivating and
providing users with easy access to nutrition related information, resources, and services. The
Government Communication Affairs is responsible for coordinating and supporting all nutrition
communication activities.

INITIATIVES
6. Allocate airtime to promote healthy
1. Develop advocacy programs on nutri- diets, lifestyles and optimal nutrition.
tion related policies, strategies, legisla-
tions and guidelines. 7. Engage stakeholders through dialogue
to promote policy awareness and
2. Utilize available media outlets to pro- strong implementation and in order to
mote optimal nutrition behavior. influence nutrition actions.
3. Engage private and public media to 8. Develop a nutrition communication

take nutrition as a priority social re- strategy.
sponsibility agenda item.
9. Conduct media monitoring for cover-
4. Provide media coverage for multisec- age, quality and impact.
toral nutrition related best practices.
10. Create public awareness on healthy
5. Own the nutrition agenda and cooper- dietary practices, healthy lifestyles,
ate with nutrition implementing sectors and lifestyle related non-communicable
in nutrition advocacy. diseases.
RESULT 4.11: GENDER-SENSITIVE NUTRITION

IMPLEMENTATION IMPROVED
Ethiopia is bringing into being remarkable achievements, especially with respect to gender
parity in primary school education and in the number of governmental seats held by women,
including in Parliament. More educated mothers have the skills to compete for high skilled,
well paid jobs and will therefore be in a better position to feed, care for and educate their
children. To promote the empowerment of women, nutrition interventions implemented across
sectors should be gender sensitive.
Gender and nutrition are inextricable parts of the vicious cycle of poverty. Gender inequality
can be a cause as well as an effect of hunger and malnutrition. Gender equality and women’s
empowerment is an essential part of human development. Along with unequal, gender based
resource distribution at the household level, a number of harmful traditional practices, such as
food taboos for women and girls (especially pregnant and lactating women), early marriage,
and violence against women, have contributed to the poor nutritional status of the majority of
infants, young children and women in Ethiopia.
In order to address this multifaceted problem, the government has put in place several efforts.
Nutrition interventions have principally tended to address factors that directly contribute to nu-
trient intake and health, missing other underlying and basic factors, such as the decision-mak-
ing capacity of women in households, access to education, and economic resources, to name
a few. The Ministry of Women and Children has been mandated to ensure and strengthen
gender-sensitive nutrition interventions across sectors.

INITIATIVES
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 skills transfer.
implementation.
3. Mainstream gender equality within all

nutrition training programs.
4. Give due attention to gender sensitive

monitoring and evaluation; use sex dis-
aggregated indicators.
improve multisectoral coordination and capacity to implement
the national nutrition program
In order to realize food and nutrition security at national and household levels and to accelerate
the reduction of malnutrition, the Government of Ethiopia opted for an approach that would see
nutrition integrated into various sectors through a well strengthened and integrated multisectoral
approach. Several reviews have shown that in order for a multisectoral coordination mechanism
to succeed, it should have a strong institutional arrangement within the NNP implementing
sectors. To execute its mandate of coordinating the sectors and fulfilling the aims of NNP II
and the Seqota Declaration, the National Nutrition Coordinating Body (NNCB) needs to be
well strengthened and functional up to the kebele levels, along with the necessary resources
and accountability. Sectoral members would therefore be held accountable, both institutionally
and collectively, for the achievement of the nutrition goals and targets set by the National
Nutrition Program.
2020 TARGETS
■■ Eighty percent of the health development army will be trained in the preparation of diverse
complementary food and follow up support through home visits.
■■ All NNP implementing sectors will establish an appropriate structure that can carry out
nutrition activities within that sector.

■■ National research capacity will be strengthened in the areas of food and nutrition.
■■ The National Nutrition and Food Policy will be developed and disseminated.
■■ Regional nutrition coordinating bodies and technical committees will be established and/or
strengthened in all regions.
■■ Zonal and woreda nutrition coordinating bodies and technical committees will be estab-
lished and strengthened in all zones and woredas.
■■ All woredas will establish and strengthen kebele level nutrition coordination platforms.
■■ The reporting and accountability mechanism between national, regional, zonal and wore-
da coordinating bodies will be strengthened.
RESULT 5.1: COMMUNITY LEVEL NUTRITION

IMPLEMENTATION CAPACITY IMPROVED
INITIATIVES
through male involvement and com-
1. Improve the capacity of primary health munity awareness activities.
care units (PHCU) and health develop-
ment armies (HDA) to implement the ✓✓ Link local media with community or-
NNP. ganizations, such as women’s asso-
ciations, faith based organizations,
✓✓ Provide nutrition trainings with prac- community WASH and community
tical sessions on complementary schools, for wider uptake of optimal
feeding for health extension work- nutrition practices.
ers who are directly supporting the
HDA. 2. Strengthen the community level linkage
between HEWs, teachers, agriculture-
✓✓ Ensure delivery of quality integrated extension workers, WASH committees
refresher trainings to HEWs based and health and agriculture development
on identified gaps. armies.
✓✓ Harmonize and make available so- ✓✓ Equip community level centers

cial and behavioral change commu- (health posts, farmer training cen-
nication materials on optimal infant, ters and schools) with basic nutrition
young child, child, adolescent and materials (IEC, demonstration mate-
maternal feeding practices for use rials, etc.).
by HEWs and the health develop-
ment army. ✓✓ Establish/strengthen and capacitate
a community level, multisectoral
✓✓ Strengthen HEWs nutrition monitor- nutrition program coordination plat-
ing support to the HDAs. form.
✓✓ Strengthen PHCU linkages. ✓✓ Ensure regular reporting and feed-

back mechanisms for multisectoral
✓✓ Mainstream gender issues in all nu- nutrition implementation.
trition related trainings, for instance

RESULT 5.2: NUTRITION WORKFORCE CAPACITY IMPROVED
INITIATIVES
1. Integrate nutrition into higher institu- ✓✓ Provide in-service training using the
tions, regional colleges and TVETs blended, integrated nutrition learn-
to provide nutrition-specific and nutri- ing module for health workers.
tion-sensitive pre-service training for
students of health, agriculture, water 4. Strengthen the capacity of women
engineering, food science and technol- based structures and associations at all
ogy, and education. levels to promote optimal adolescent,
maternal, infant and young child nutri-
2. Support training institutions with curricu- tion (AMIYCN) and caring practices.
lum development and revision, provision
of educational materials and technical ✓✓ Provide training on optimal AMIYCN
assistance to build needed critical skills and caring practices for members of
(e.g., clinical nutrition, public health nu- the Ministry of Women and Children
trition and dietetics). Affairs and for the staff of gender di-
rectorates from all NNP implement-
3. Provide competency based in-service ing sectors at federal level.
trainings to health workers, health ex-
tension workers, agriculture extension ✓✓ Provide training for members of re-
workers, teachers and staff working in gional, zonal and woreda Women
other NNP sectors. and Children Affairs offices on opti-
mal AMIYCN and caring practices.
✓✓ Conduct a national quantification/
audit on the needs and gaps in the ✓✓ Provide training on optimal AMIYCN
nutrition workforce. feeding practices for members of
women based structures and asso-
✓✓ Prepare a blended, multisectoral nu- ciations at all levels.
trition learning module for in-service
nutrition training.

RESULT 5.3: NNP INSTITUTIONAL IMPLEMENTATION CAPACITY
AND MULTISECTORAL COORDINATION IMPROVED
INITIATIVES
1. Strengthen multisectoral nutrition coor- 2. Establish an appropriate structure for

dination at all levels. nutrition with dedicated staff at all lev-
els that can carry out nutrition activities
✓✓ Strengthen the National Nutrition based on the various roles and respon-
Coordinating Body. sibilities of NNP implementing sectors.
✓✓ Establish and/or strengthen the Re- 3. Improve the capacity of all NNP imple-
gional Nutrition Coordinating Body menting sectors.
in all regions.
✓✓ Strengthen the capacity of the nutri-
✓✓ Strengthen the national and region- tion coordination body and nutrition
al nutrition technical committees technical committees at all levels.
(NNTC and RNTC).
✓✓ Provide pre-service nutrition training
✓✓ Establish and strengthen zonal, for health, water engineering, agri-
woreda level nutrition coordination culture, education, and food tech-
platforms and ensure that kebele nology graduates.
level nutrition coordination is inte-
grated into the existing kebele com- ✓✓ Provide comprehensive in-service
mittee. nutrition training for staff of NNP im-
plementing sectors.
✓✓ Ensure regular reporting and feed-
back mechanisms for multisectoral 4. Ensure the involvement of women’s
nutrition implementation and coordi- entities in NNP implementation and
nation at all levels. coordination at different levels.
RESULT 5.4: SYSTEM CAPACITY STRENGTHENED FOR IMPROVED

NNP IMPLEMENTATION
INITIATIVES
guidelines.
1. Formulate nutrition workforce standards
based on the level of competency 4. Establish and strengthen an appropri-
required for different roles. ate structure for nutrition with dedicated
staff in all sectors at different levels.
2. Create nutrition posts and nutrition
career paths. 5. Strengthen institutions providing nutri-
tion and food science trainings (short-,
3. Prepare and enact relevant nutrition medium- and long-term trainings).
policies, strategies, directives and

RESULT 5.5: CAPACITY TO CONDUCT NUTRITION MONITORING,
EVALUATION AND RESEARCH IMPROVED
INITIATIVES
1. Strengthen national research capacity 5. Strengthen the capacity of NNP imple-

in the areas of food and nutrition. menting sectors in nutrition monitoring
and evaluation.
2. Strengthen the capacity of clinical nutri-
tion and food analysis laboratories. 6. Strengthen the capacity of sectors, train-
ing and research institutions to under-
3. Provide training on nutrition monitoring take operational research on nutrition.
and evaluation for staff across sectors.
7. Establish annual national nutrition
4. Establish an appropriate platform to or- forums to disseminate research findings
ganize and utilize nutrition related infor- and documentation on best practices.
mation across sectors.
RESULT 5.6: REGULATORY CAPACITY IMPROVED
INITIATIVES
1. Strengthen the regulatory system ✓✓ Establish and equip quality control

throughout the country. laboratories at national and regional
levels.
✓✓ Provide training for technical food
inspectors on quality and safety of ✓✓ Capacitate regional regulatory bod-
nutrition supplies. ies and strengthen coordination
among them.
RESULT 5.7: CAPACITY OF MEDIA IMPROVED
INITIATIVES
1. Build the capacity of national and re- ✓✓ Equip media with nutrition related
gional media personnel. SBCC materials to promote positive
nutrition practices.
✓✓ Provide nutrition training for me-
dia personnel, including local and 2. Protect the public from media based
school mini-medias. commercial pressures (advertisements)
that are against optimal nutrition prac-
✓✓ Update and harmonize age appro- tices.
priate SBCC materials to ensure
effective use of all available mass 3. Provide media based opportunities for
media channels. open dialog between the general public
and nutrition professionals.

4
NUTRITION IMPLEMENTATION
AND GOVERNANCE
Nutrition has a multidimensional and multisectoral nature in terms of both effect and out-
comes. Thus, in order to accelerate progress on NNP implementation, strong 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 priority agen-
da item in all NNP implementing sectors and beyond.
3. Strengthen multisectoral nutrition coordination for a harmonized, multisectoral response

and for efficient resource mobilization and utilization.
4. Define feasible, locally accepted Communication for Development activities to bring about
the behavioral changes required for improved nutrition.
5. Continue providing leadership to regions on cascading and executing the NNP

implementation plan.
NUTRITION GOVERNANCE
Currently, there is no generally accepted framework or set of terminology for conceptualizing
nutrition governance. Nonetheless, five key building blocks of effective nutrition governance
are apparent in the literature. These are political commitment, consensus building and coordi-
nation, financing, service delivery capacity, and transparency and accountability. This chapter

Transparency Poli4cal Consensus
& Commitment Building &
Accountability Coordina4on
Service
Delivery Financing
Capacity
Figure 3: Building blocks of effective nutrition governance
will describe all of these components in the Ethiopian context with the exception of financing,
which is dealt with in Chapter 5.
4.1 POLITICAL COMMITMENT AND POLICY FRAMEWORK

The Government of Ethiopia demonstrated its political commitment to nutrition by developing
the National Nutrition Strategy and National Nutrition Program in 2008, along with various oth-
er policies, strategies and programs. The government also incorporated nutrition, with particu-
lar attention to the reduction of stunting, into its 5-year Growth and Transformation Plan. Most
of the main policies, strategies and programs developed to mainstream nutrition into NNP
implementing sectors are summarized in “Nutrition-specific and nutrition-sensitive strategies/
programs/guidelines in Ethiopia,” the first table in this document’s annex.
4.2 MULTISECTORAL NUTRITION COORDINATION

The National Nutrition Program is a long-term national program that requires the involvement
of all responsible sectors and partners. Timely and effective implementation requires an effi-
cient operational framework as well as appropriate leadership and implementation capacity.
The NNP will continue to use existing government structures to ensure sustainability and
long-term achievement of objectives. The following sub-sections describe the institutional ar-
rangements required to improve multisectoral coordination, along with human and institutional
capacity building strategies to guide implementation.

4.2.1 MULTISECTORAL COORDINATION AND LINKAGES
FOR NUTRITION
This component of the program is designed to strengthen coordination and linkages across
all sectors that deal with the underlying and basic causes of malnutrition. The purpose is to
enhance the nutritional impact of programmatic activity in these sectors. To improve existing
multisectoral coordination and strengthen linkages based on lessons learned over the last 7
years of NNP implementation, this revised NNP has included the role of responsible sectors
as shown in Strategic Objective 4 as well as in the Accountability and Results Matrix located
at the end of this document. Ethiopia has well defined policies, strategies and implementation
guidelines in those sectors with the potential to affect better nutrition. These will be the basis
for nutrition related cross-sectoral linkages.
To ensure viable linkages and harmonization among sectors, the Federal Ministry of Health
houses and manages the organizational and management structure of the National Nutrition
Program. The National Nutrition Coordinating Body and the National Nutrition Technical Com-
mittee were established in 2008 and 2009, respectively, to ensure effective coordination and
linkages. The current program, NNP II, outlines human resource capacity building activities,
with emphasis on all relevant sectors. These adjustments will ensure that implementation
of the NNP is harmonized across all sectors and levels, particularly at regional, woreda and
community levels.
4.2.2 INSTITUTIONAL ARRANGEMENTS FOR MULTISECTORAL

NUTRITION COORDINATION AND LINKAGES
The National Nutrition Coordinating Body will remain the main mechanism for leadership,
policy decisions and coordination of the National Nutrition Program. The NNCB consists of
13 government sectors and a range of nutrition development partners, including civil society
organizations, academia, and the private sector.
Over the last 3 years, almost all regions established a Regional Nutrition Coordinating Body
(RNCB) and a Regional Nutrition Technical Committee (RNTC). In a few regions, sub-regional
level coordination platforms at zonal and woreda level were also established. The current
program implementation phase, 2016–2020, will focus on further cascading multisectoral
coordination frameworks and program implementation arrangements down to remaining
zones, woredas and kebeles using the decentralized government structure.
The terms of reference for NNCB and NNTC, along with information on membership, frequen-
cy of meetings and the roles and responsibilities of NNP implementing sectors, will be detailed
in a multisectoral nutrition coordination implementation guideline.
In order to enhance accountability and maximize ownership, NNCB and NNTC need to regu-
larly meet and discuss the progress of NNP implementation. Moreover, all NNP implementing
sectors will regularly report on the progress of nutrition-sensitive and specific interventions
and on the coordination and implementation of NNP to the NNCB chair. All RNCBs will regu-
larly report on progress and performance of regional NNP implementation to the NNCB.
Similarly, all regional NNP implementing sector bureaus will regularly report on progress and
performance to the RNCB and to their respective federal NNP implementing sectors. Woreda
nutrition coordinating body chairs will report to zonal nutrition coordinating body chairs and
these in turn will report to their respective regional nutrition coordinating body chairs.

National Nutrition
Coordinating Body
(NNCB)
National Nutrition
Technical Committee
(NNTC)
National Nutrition National Food National Nutrition

Program Management Fortification Steering Monitoring, Evaluation &
Steering Committee Committee Research Steering
Committee
Figure 4: National nutrition technical committees
System
Organiza/onal
Workforce/Human
Resource
Individual
and
Community
Figure 5: Dimensions of nutrition capacity building

The director of the Maternal and Child Health - Nutrition directorate will serve as secretary for
the NNCB and as chair for the National Nutrition Technical Committee. All nutrition technical
committees should regularly report on their plans and performance to the appropriate
chairperson in the nutrition coordination body.
National Nutrition Steering Committees

The National Nutrition Coordinating Body created several steering committees to promote ef-
ficient and effective implementation and coordination of the National Nutrition Program. These
committees include the National Nutrition Program Management Steering Committee, led by
the Ministry of Health; the National Food Fortification Steering Committee, led by the Ministry
of Industry; and the National Nutrition Monitoring, Evaluation and Research Steering Com-
mittee, led by the Ethiopian Public Health Institute. The overall objective of the steering com-
mittees is to support coordination among program implementers and partners for successful
implementation of the National Nutrition Program.
The terms of reference, membership, frequency of meetings and roles and responsibilities of
each of the steering committees will be detailed in a multisectoral nutrition coordination and
implementation guideline.
4.3 CAPACITY BUILDING FOR NUTRITION

For effective implementation of sustained nutritional impact, capacity building for nutrition
should address four dimensions. These are system capacity, organizational capacity,
workforce/human resource capacity and individual and community capacity (Figure 5).
4.3.1 SYSTEM CAPACITY BUILDING FOR NUTRITION

Although nutrition is being coordinated and implemented by various implementing sectors
in the country, there is no career structure for the nutrition workforce. Nevertheless, meeting
NNP objectives calls for the various ministries to devote special attention to the cultivation of
a career path for the nutrition workforce.
System capacity for nutrition includes the following:
✓✓ Strengthening supply chain man-

✓✓ Strengthening leadership and gov- agement for nutrition.
ernance in nutrition programming.
✓✓ Improving the nutrition information
✓✓ Creating career paths and posts for system.
the nutrition workforce.
✓✓ Strengthening management capaci-

ty in the nutrition workforce.
✓✓ Improving capacity to mobilize and

manage resources.

Table 2: Nutrition workforce requirements at various levels
Level/organization Required profession Description Remark
Nutritionist, public health
Knowledge and skill of
Federal ministries and nutritionists, food
nutrition science and Health and
regional level sector technologists, other
disease, nutrition other sectors
bureaus professionals with adequate
advocacy, management,
nutrition training
Basic nutritional sciences,

Woreda level sector Basic knowledge on
others professionals with
offices food and nutrition
adequate nutrition training
Knowledge and skill of

Hospitals Nutritionists and dieticians nutrition science and
disease
Health centres, health Health professionals
Nutritionists
posts with training on nutrition
Health and
Nutritionists, teachers trained Teachers with adequate
Schools education
on nutrition counselling nutrition knowledge
sectors
Teachers, health and

Development army trained on agriculture professionals
Community
nutrition counselling with adequate nutrition
knowledge
Basic knowledge, skills

Universities, health and Nutritionists, food Based on the
and practice in
agriculture colleges, technologists, dieticians and type of the
nutritional sciences and
TVETs public health nutritionists training
research
4.3.2 ORGANIZATIONAL CAPACITY FOR NUTRITION
Coordination capacity
To fulfill the mandate to coordinate and implement National Nutrition Program, sector minis-
tries will establish and capacitate appropriate implementing bodies in their structures.
Supply and logistics capacity

Supply and logistics are key inputs for effective implementation of nutrition-sensitive and
nutrition-specific interventions. Sector ministries will conduct needs assessments and develop
supply and logistics plans. Each ministry will review the plan and take measures to improve
and put the plan into effect. Supplies and logistics needed to deliver the National Nutrition
Program include but are not limited to:
✓✓ Supplements and therapeutic prod- ✓✓ Agricultural inputs

ucts
✓✓ Food processing materials and in-
✓✓ Training manuals puts
✓✓ Print and electronic materials for so- ✓✓ Food safety and quality control labo-
cial and behavioral change commu- ratory materials
nication
✓✓ Supplies for hygiene and sanitation,
water purifiers, etc.

Nutrition information system capacity development
Developing the capacity of nutrition data collection, analysis, interpretation and utilization in-
volves strengthening organizations that conduct nutrition program monitoring, evaluation and
research related activities. A multisectoral nutrition information platform will be established at
national level to monitor the implementation of NNP across sectors. Moreover, all NNP imple-
menting sectors will ensure that nutrition related information is regularly monitored, used and
shared.
4.3.3 NUTRITION WORKFORCE CAPACITY BUILDING

All NNP implementing sectors should have an adequate number and mix of competent nutri-
tion cadres or technical persons placed at all levels of service delivery and management. The
major strategies for availing human resources are pre-service and in-service trainings.
During NNP implementation, the capacity of the nutrition workforce will be enhanced as fol-
lows:
assistance to build critical skills that
✓✓ At national level, NNP implementing are not yet adequately available.
sectors will build a workforce that
will be responsible for coordinating ✓✓ Competency based in-service train-
nutrition within their respective sec- ings will be provided. These will en-
tor. Specific ministries, based on the able workers to plan, implement and
scope of work, will determine the monitor multisectoral nutrition inter-
number of staff members needed. ventions.
✓✓ Sectors will work with the Ministry ✓✓ Health facilities at various levels will
of Education and with regional gov- be staffed with appropriate nutrition
ernments to integrate nutrition into professionals.
universities and regional colleges/
TVET institutes to provide nutrition ✓✓ Job aids, training materials and
pre-service trainings. community teaching materials will
be prepared in local languages.
✓✓ Training institutions will be support-
ed with curriculum development and ✓✓ Media professionals will be provided
revision, with provision of educa- with continuous nutrition training.
tional materials and with technical
4.3.4 CAPACITY DEVELOPMENT OF INDIVIDUALS AND

COMMUNITIES IN NUTRITION
Nutrition programs aim to achieve optimal nutrition knowledge, behavior and practices among
target communities and individuals. In order to achieve this objective, developing the nutrition
capacity of communities is of paramount importance. The ways in which communities respond
to challenges affecting their nutritional status will be improved, and the ability of communities
to participate in and manage community resources to achieve better nutritional outcomes will
be enhanced.

Capacity building at the individual and community level will focus on the following:
✓✓ Community level development tative nutrition messages and prac-

groups (health and agricultural de- tices and to facilitate nutrition-sen-
velopment armies, etc.) will be the sitive community development
key entry points for community level interventions.
nutrition work. They will receive on-
going support from health and agri- ✓✓ Improving community access to labor
cultural extension workers. and resource saving technologies.
✓✓ Existing community/social struc- ✓✓ Community level centers of excel-

tures, such as “idir,” women’s and lence for wider experience sharing
youth associations, and faith based will be established.
organizations, will serve as addition-
al channels for delivering communi- ✓✓ Community level structures and
ty and individual nutrition capacity centers, such as farmers training
development activities. centers, schools and health posts
will be equipped with nutrition learn-
✓✓ Community structures will be providing materials.
ed with nutrition information and will
be motivated to deliver key preven-
4.4 GENDER DIMENSIONS OF NUTRITION

Gender and nutrition are inextricable parts of the vicious cycle of poverty. Gender and under-
nutrition are highly correlated and interconnected with livelihood security at household and
community levels throughout the entire lifecycle. Gender inequality can be a cause as well
as an effect of hunger and malnutrition. While chronic food insecurity takes a severe toll on
the health of all household members, research shows that women and girls suffer most. A
mother’s ability to make decisions within the household and in her community is an important
factor not only for her own nutritional outcomes but also for those of her children. At the family/
household level, the heavy workload resulting from the many household responsibilities that
women shoulder usually leaves women with little or no time to properly care for their children
and themselves. Along with unequal, gender based resource distribution at the household
level, a number of harmful traditional practices, such as food taboos for women and girls (es-
pecially pregnant and lactating women), early marriage, and violence against women have
contributed to the poor nutritional status of the majority of infants, young children and women
in Ethiopia.
Gender is considered a cross-cutting issue and has remained a crucial concern that has
prompted the setting of clear objectives for gender mainstreaming at all levels of the various
sectoral programs. Most nutrition programs target women and children but neglect the ado-
lescent stage, an important period of development. The key role that men play in achieving
nutrition security has also been overlooked. Nutrition interventions have principally tended to
address factors that directly contribute to nutrient intake and health, missing other underlying,
basic factors, such as the decision-making capacity of women in households and access to
education and economic resources, to name a few.

The National Nutrition Program has affirmed the reciprocal relationship between gender and
nutrition and articulated a way to mainstream gender into various components of the program.
Some of the major recommended strategies are as follows:
✓✓ Incorporate a gender analysis as ✓✓ Give due attention to gender sensi-

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

The National Nutrition Coordination Board
will implement the following objectives and KEY ACTIVITIES
key activities for nutrition communication.
✓✓ Conduct advocacy and public dia-
4.5.1 POLICY ADVOCACY AND logues for nutrition related policy,
PUBLIC DIALOGUE strategies, programs and legislation,
including the International Code of
OBJECTIVES Marketing of Breastmilk Substitutes
and extension of maternity leave to
6 months.
1. Implementation of nutrition related poli-
cy and legislation enforced.
✓✓ Engage the media to promote nutri-
tion policy and practice among the
2. Multisectoral nutrition coordinating bod-
public and among policymakers.
ies and technical communities are en-
gaged in policy dialogues and dissem-
✓✓ Identify and engage nutrition cham-
ination.
pions for nutrition related policy mes-
sage delivery and implementation.
3. NNP implementers understand nutrition
related policy and legislation.
✓✓ Engage stakeholders for policy
awareness, implementation and in-
4. Ensure that nutrition is an agenda item
fluence through dialogues.
for the media.

✓✓ Promote utilization of nutrition evi- dardized and culturally acceptable.
dence for policy input and dialogue. 5. Community participation and engage-
ment in the promotion and uptake of op-
✓✓ Promote healthy feeding and life- timal nutrition and child caring practices
styles. increased.
✓✓ Identify appropriate channels and KEY ACTIVITIES

influential actors to reach, inform,
influence, capacitate and motivate ✓✓ Promote social and behavioral
decision makers. change communication across the
country and strengthen community
✓✓ Engage policymakers to enforce pol- participation for improved nutrition.
icies around prevention of non-com-
municable and lifestyle related dis- ✓✓ Generate evidence to identify bar-
eases. riers, facilitators and behavioral de-
terminants, social norms and tradi-
✓✓ Sensitize and involve the private tions for optimal nutrition practices.
sector in implementing NNP objec-
tives. ✓✓ Map and harmonize existing nutri-
tion communication multimedia ma-
✓✓ Develop a nutrition communication terials to support both media and
strategy. interpersonal communication in var-
ious languages.
✓✓ Develop a nutrition communication
toolkit to help policy implementation ✓✓ Identify appropriate channels and
and public dialogue. influential actors to reach, inform,
influence, capacitate and motivate
✓✓ Conduct media monitoring to gauge the public.
the quality and impact of nutrition
coverage. ✓✓ Create public awareness on healthy
dietary practices, healthy lifestyle,
4.5.2 SOCIAL AND BEHAVIORAL and lifestyle related non-communi-
CHANGE COMMUNICATION cable diseases.
OBJECTIVES ✓✓ Build the capacity of community

level implementers (HEWs, AEWs,
1. Capacity of nutrition actors strength- DAs, farmer groups, women’s and
ened at community and institutional youth forums, teachers and stu-
levels on social and behavioral change dents) to promote positive behavior
communication. 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 promoted through tra- nutrition practices.
ditional and innovative behavior change
methods and channels. ✓✓ Develop innovative nutrition com-
munication and social mobilization
4. Nutrition messages and materials stan- guidelines.

✓✓ Engage the media to promote good
nutrition practices among the public
and to foster dialogue on nutrition
among experts and the public.
✓✓ Identify and engage nutrition cham-

pions and influential actors for dis-
semination of nutrition messages
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.

5
SUSTAINABLE NUTRITION
FINANCING
The Government of Ethiopia is committed to accelerating the implementation of a multisec-
toral, harmonized National Nutrition Program to make a strong impact on nutrition and on the
overall wellbeing of the nation. This NNP is designed to address both long-term and short-term
nutrition goals in Ethiopia. The strategic plan outlines a package of proven, cost-effective nu-
trition interventions that will break the cycle of malnutrition and ensure child survival.
So far, inadequate budget allocation, resource shortages, weak financial mobilization and low
utilization have been the main challenges to implementing the National Nutrition Program.
Implementation challenges therefore should be addressed in order to scale up and accelerate
implementation of nutrition strategies already in place.
Costing for the NNP was conducted using one health tool for the nutrition-specific interven-
tions to be implemented by health sectors, and using activity based costing approaches for nu-
trition-sensitive interventions to be implemented by nutrition-sensitive implementing sectors.
The total budget required for implementing the NNP over the next 5 years is estimated to be
1.1billion USD. Out of this budget the Government of Ethiopia’s contribution is 515,690,757.00
(45%), the donor contribution is 198,116,469.00 (17%) and the budget gap is 430,280,689.00
(38%).
Nearly 88.6% of the total budget is planned for nutrition-specific interventions while 11.4%
will be used for nutrition-sensitive interventions (Table 3). In the last 3 years, the FDRE/ MOH
have consolidated new partnerships to raise more funds for NNP implementation. Hence, suc-
cessful implementation of the NNP requires timely mobilization of resources and minimizing of
uncertainties in the planning of nutrition interventions.

Table 3: 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 6: NNP budget gap

6
MONITORING, EVALUATION AND
RESEARCH
6.1 MONITORING AND EVALUATION
The National Nutrition Program is built on the assumption that there will be a strong nation-
al partnership among nutrition development partners, multilateral and bilateral donors, ac-
ademia, 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.
The NNP accountability and results framework was developed to enable effective manage-
ment and optimal mobilization, allocation, use of resources, and the making of timely de-
cisions to resolve constraints or problems of implementation (see Annex). 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 using multi-sectoral score cards as per the multisector monitor-
ing and evaluation guideline, and terms of reference will be developed for each sector. The
program implementation, monitoring and evaluation components of the plan are designed to
support each other (Figure 7). The Ethiopian Public Health Institute and the Ethiopian 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.

Figure 7: Strong program implementation system
To strengthen the monitoring and evaluation component of the NNP, implementing sectors will
do the following:
✓✓ 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 an appropriate platform to ✓✓ Conduct midterm and end-line eval-

organize and utilize multisectoral uation, impact assessments and
nutrition related information. surveys.

✓✓ Develop central food and nutrition ✓✓ Conduct systematic review and pub-
information platform/databases for lication of existing nutrition data for
research and surveys. programming and decision making.
Dissemination of M&E Results

To inform decisions across the implementation system as well as the public at large, NNP im-
plementing sectors will disseminate information through the following mechanisms:
✓✓ Monitoring reports, which will be ✓✓ Evaluation and research findings,

disseminated quarterly, biannually which will be disseminated through
and annually. publications, reports, workshop
proceedings and policy briefs.
6.2 OPERATIONAL RESEARCH

Operational research is designed to test alternative intervention modalities and to answer key
operational questions as they arise during NNP implementation. The Ethiopian Public Health
Institute, as the lead nutrition research institute in the country, leads operational research as
part of its mandate. In the course of implementing the previous NNP (2008–2015), EPHI held
a workshop with NNP stakeholders and partners to specify and prioritize studies.
Building on lessons learned, the focal areas of operational research will be as follows:
ports and data. A method of col-

✓✓ Strengthen the capacity of EPHI lecting, compiling and storing op-
to coordinate, carry out and su- erational research (data, reports)
pervise operational research and needs to be set up and housed
to sub-contract to other organiza- within EPHI as the country’s pre-
tions/institutions. mier nutrition research institute.
This will serve to avoid duplication
✓✓ Carry out a mapping exercise of of research efforts and facilitate the
all nutrition related operational re- identification of key outstanding op-
search to avoid duplication. erational research areas.
✓✓ Identify priority research areas ✓✓ Ensure that nutritional impact is

based on the revised NNP follow- measured in all social protection
ing consultation with all nutrition and development programs.
stakeholders. EPHI will facilitate
the decision as to whether a given ✓✓ Support university based research-
research topic will be handled in- ers with grants to undertake nutri-
house or outsourced. tion research of national priority
through the engagement of gradu-
✓✓ All organizations carrying out operate students.
ational research should liaise with
EPHI during the entire process,
including sharing topics and meth-
ods, requesting ethical clearance,
sharing results and providing re-

Table 4: 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 4 continued on next page

Table 4: 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 4 continued from previous page

ANNEX
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

ACCOUNTABILITY AND RESULTS MATRIX FOR
NNP IMPLEMENTATION
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 that have established appropriate
Output NA 1 4 4 4 4 Annual National Admin report
structures for nutrition with dedicated staff
National nutrition and food policy developed Output NA 0 1 1 1 1 Annual National Admin report
Proportion of NNP implementing regional bureaus
with appropriate structures and dedicated nutrition Output NA 11 33 56 79 100 Annual Regional Admin report
staff
Proportion of woredas reporting multisectoral
Output NA 15 36 58 79 100 Annual Regional Admin report
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 woreda 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

TERMS OF REFERENCE: NATIONAL NUTRITION
COORDINATING BODY
1. BACKGROUND
Nutrition has a multidimensional and multisectoral nature both in terms of effect and
outcomes. The Government of Ethiopia has demonstrated its policy commitment to
nutrition by developing a stand-alone National Nutrition Strategy (NNS) and National
Nutrition Program (NNP) in 2008, along with relevant guidelines, and incorporated nutrition
- especially stunting - into its 5-year Growth and Transformation Plan (GTP). Sectoral
strategies and programs create a good opportunity to mainstream nutrition into responsible
sectors and put legislation or legal frameworks in place to enforce some key nutrition
interventions.
Among these, the most notable ones are the GTP, the National Food Security Strategy, the
National Health Sector Policy and its Health Sector Transformation Plan, and the National
School Health and Nutrition strategy and its transformation plan. Thus, it is the responsibility
of the line ministries or sectors to effectively mainstream the National Nutrition Strategy and
National Nutrition Program into sectoral policy and programs and implement the nutrition
interventions/programs that they are mandated to implement.
The Federal Ministry of Health, as indicated in the NNS, will house and manage the organi-
zational and management structure of the NNP. However, in order to have viable linkages
and harmonization with the relevant sectors, the NNP implementation and coordination
framework has multisectoral implementation and coordination arrangements at the policy
and implementation level in all the decentralized administration and service delivery levels of
the country. Thus, the NNP proposes a five-tired (federal, regional, zonal, woreda and kebele
level) coordination mechanism that is in line with the decentralized administration structure
of the government and requires considerable support of partners, the private sector and
academia.
A National Nutrition Coordinating Body (NNCB) and National Nutrition Technical Committee
(NNTC) were established at the federal level to ensure effective coordination and linkages at
the national level. There is a similar arrangement at the regional level with some adaptation
based on the current situation of the regions. As the existing zonal, woreda and kebele level
administration arrangement is multisectoral in nature, nutrition will be addressed with the
leadership of zonal, woreda and kebele administrative offices.
2. NATIONAL MULTISECTORAL NUTRITION COORDINATION
2.1 THE NATIONAL NUTRITION COORDINATING BODY

The National Nutrition Coordinating Body (NNCB) is the highest governing body that is re-
sponsible for leadership, policy decisions and coordination of the National Nutrition Program
among government sectors, nutrition development partners, academia and the private sec-
tor. To strengthen accountability and maximize ownership of the multisectoral coordination

mechanism, members of the NNCB need to regularly meet and discuss the progress of NNP
implementation. Moreover, all NNP implementing sectors will regularly report on the prog-
ress of nutrition-sensitive and nutrition-specific interventions and on the coordination and
implementation of the NNP to the NNCB chair. All Regional Nutrition Coordinating Bodies will
regularly report on progress and performance of regional NNP implementation to the NNCB.
2.2 NNCB COMPOSITION

The National Nutrition Coordinating Body is composed of high level officials from the NNP
implementing sectors, representatives from donors, United Nations agencies, civil society
organizations, the private sector and academia.
They are:
Management Coordination Commission
✓✓ State Minister of Health – Chair ✓✓ State Minister of the Government Com-

munication Affairs Office
✓✓ State Ministry of Agriculture and Natu-
ral Resource – Co-chair ✓✓ Director General of the Ethiopian Public
Health Institute
✓✓ State Ministry of Education – Co-chair
✓✓ Director General of the Food, Medicine
✓✓ FMOH, Maternal and Child Health Di- and Health Care Administration and
rectorate Director – Secretary Control Authority
✓✓ State Ministry of Livestock and Fisher- ✓✓ Director General of the Ethiopian Insti-
ies tute of Agriculture Research (EIAR)
✓✓ State Ministry of Water, Irrigation and ✓✓ Dean, School of Postgraduate Studies,

Electricity Jimma University – representing aca-
demia
✓✓ State Ministry of Finance and
Economic Cooperation ✓✓ Save the Children Country Director –
representing CSO, the Ethiopian Civil
✓✓ State Ministry of Women and Children’s Society Coalition for Scaling up Nutri-
Affairs tion (ECSC-SUN)
✓✓ State Ministry of Labor and Social ✓✓ Manager of the Chamber of Commerce

Affairs – representing the private sector
✓✓ State Ministry of Trade ✓✓ USAID Mission Director and DFID

Head of Office – representing nutrition
✓✓ State Ministry of Industry donors
✓✓ State Minister of Youth and Sport ✓✓ UNICEF Country Representative --

representing UN agencies
✓✓ Commissioner of the Disaster Risk

3. ROLES AND RESPONSIBILITIES OF NNCB
✓✓ Serve as an advisory body to the gov- ✓✓ Develop a strategy for mainstreaming

ernment on national nutrition issues. the National Nutrition Strategy and
Program into government policies,
✓✓ Provide vision and general leadership strategies and national plans; and into
to nutrition in the country and at inter- relevant sectoral plans and programs.
national forums/agendas.
✓✓ Mobilize resources and track resource
✓✓ Act as an advocate on national nutrition utilization to support the National Nutri-
matters and build partnership among tion Program.
different stakeholders.
✓✓ Facilitate and support the development
✓✓ Lead and facilitate the coordination of of the implementation capacities of the
multisectoral stakeholders, including sectors.
relevant government sectors, donors
and nutrition development partners, ✓✓ Update the National Nutrition Program
academia and the private sector at na- based on Ethiopia’s changing needs.
tional level for effective implementation
of the National Nutrition Strategy and ✓✓ Review performance of the National
Program. Nutrition Program and give feedback.
✓✓ Regularly review the effectiveness of ✓✓ Review and approve the annual nation-
multisectoral coordination for nutrition al multisectoral nutrition plan.
and update accordingly.
✓✓ Prepare biannual and annual reports.
✓✓ Facilitate policy and guideline devel-
opment that is relevant for NNP imple- ✓✓ The members of the NNCB shall ex-
mentation. pect to meet on biannual basis.
Note: Based on the above outlined responsibilities and membership list, the NNCB is expect-
ed to expand or modify its ToR and develop detailed working procedures as per demand.

TERMS OF REFERENCE: NATIONAL NUTRITION
TECHNICAL COMMITTEE
1. BACKGROUND
Nutrition has a multidimensional and multisectoral nature both in terms of effect and
outcomes. The Government of Ethiopia has demonstrated its policy commitment to
nutrition by developing a stand-alone National Nutrition Strategy (NNS) and National
Nutrition Program (NNP) in 2008, along with relevant guidelines, and incorporated nutrition
- especially stunting - into its 5-year Growth and Transformation Plan (GTP). Sectoral
strategies and programs create a good opportunity to mainstream nutrition into responsible
sectors and put legislation or legal frameworks in place to enforce some key nutrition
interventions.
Among these, the most notable ones are the GTP, the National Food Security Strategy, the
National Health Sector Policy and its Health Sector Transformation Plan, and the National
School Health and Nutrition strategy and its transformation plan. Thus, it is the responsibility
of the line ministries or sectors to effectively mainstream the National Nutrition Strategy and
National Nutrition Program into sectoral policy and programs and implement the nutrition
interventions/programs that they are mandated to implement.
The Federal Ministry of Health, as indicated in the NNS, will house and manage the organi-
zational and management structure of the NNP. However, in order to have viable linkages
and harmonization with the relevant sectors, the NNP implementation and coordination
framework has multisectoral implementation and coordination arrangements at the policy
and implementation level in all the decentralized administration and service delivery levels of
the country. Thus, the NNP proposes a five-tired (federal, regional, zonal, woreda and kebele
level) coordination mechanism that is in line with the decentralized administration structure
of the government and requires considerable support of partners, the private sector and
academia.
A National Nutrition Coordinating Body (NNCB) and National Nutrition Technical Committee
(NNTC) were established at the federal level to ensure effective coordination and linkages at
the national level. There is a similar arrangement at the regional level with some adaptation
based on the current situation of the regions. As the existing zonal, woreda and kebele level
administration arrangement is multisectoral in nature, nutrition will be addressed with the
leadership of zonal, woreda and kebele administrative offices.
2. NATIONAL MULTISECTORAL NUTRITION COORDINATION
2.1 THE NATIONAL NUTRITION COORDINATING BODY

The National Nutrition Coordinating Body NNCB) is the highest governing body that is re-
sponsible for leadership, policy decisions and coordination of the National Nutrition Program
among government sectors, nutrition development partners, academia and the private sector.
The composition of the NNCB includes state ministers of NNP implementing sectors, rep-

resentatives from donors, UN agencies, the Ethiopian Civil Society Coalition for Scaling up
Nutrition, the private sector and academia.
2.2 NATIONAL NUTRITION TECHNICAL COMMITTEE

In addition to the NNCB, which mainly deals with policy issues, there is a National Nutrition
Technical Committee (NNTC) that operates under the auspices of the NNCB. Its responsibil-
ity is provision of technical advice focusing on the multisectoral integration of nutrition pro-
grams and responses in the country.
2.3 COMPOSITION OF THE NATIONAL NUTRITION TECHNICAL

COMMITTEE
The composition of this technical committee includes directors of relevant directorates within
ministries that are members of the NNCB and directors of directorates in other pertinent
authorities/agencies. It also includes representatives from donors, nutrition development
partners, the private sector and academia. The technical committee is accountable to the
NNCB. Any other nutrition technical working group or steering committee will be accountable
to the NNTC. The main responsibility of the committee is handling the overall technical work
related to federal level NNP coordination.
The NNTC consists of the following:

✓✓ Director, Disaster Risk Management
✓✓ Director, Ministry of Health – Maternal Coordination Commission
and Child Health Directorate – Chair
✓✓ Director, Government Communication
✓✓ Director, Ministry of Agriculture and Affairs Office
Natural Resources – Co-chair
✓✓ Director, Ethiopian Public Health
✓✓ Director, Ministry of Education – Co- Institute
chair
✓✓ Director, Food, Medicine and Health
✓✓ Director, Ministry of Livestock and Care Administration and Control
Fisheries Authority
✓✓ Director, Ministry of Water, Irrigation ✓✓ Director, Ethiopian Institute of

and Electricity Agriculture Research
✓✓ Director, Ministry of Finance and ✓✓ Head Department of Nutrition and

Economic Cooperation Dietetics, Institute of Health, Jimma
University – representing academia
✓✓ Director, Ministry of Women and
Children’s Affairs ✓✓ Head of Nutrition Sector, Save the
Children – representing CSO (ECSC-
✓✓ Director, Ministry of Labor and Social SUN)
Affairs
✓✓ Manager, Chamber of Commerce –
✓✓ Director, Ministry of Trade representing the private sector
✓✓ Director, Ministry of Industry ✓✓ Nutrition Advisor from USAID and

Nutrition Advisor from DFID –
✓✓ Director, Minister of Youth and Sport representing donors

✓✓ Head of Nutrition Section, UNICEF – Coordinator, Maternal and Child Health
representing UN agencies Directorate, FMOH – Secretary
✓✓ National Nutrition Case Team
3. ROLES AND RESPONSIBILITIES OF THE NNTC
✓✓ Provide technical advisory support to the tive implementation of NNP II.

NNCB.
✓✓ Monitor, evaluate and regularly review
✓✓ Facilitate inter and multisectoral coordi- the effectiveness of multisectoral coor-
nation of nutrition. dination for nutrition, and update NNCB
accordingly.
✓✓ Facilitate the implementation of the Na-
tional Nutrition Strategy and Program. ✓✓ Facilitate resource mobilization and track
resource utilization to support NNP II
✓✓ Facilitate the coordination of multisectoral implementation.
stakeholders, including relevant govern-
ment sectors, partners, academia and ✓✓ Strengthen the three multisectoral nu-
the private sector at national level for trition coordination steering committees
effective implementation of the National (National Nutrition Program Manage-
Nutrition Program. ment, National Food fortification, Nation-
al Nutrition Research, Monitoring and
✓✓ Coordinate, supervise, monitor and Evaluation Steering Committee) or any
evaluate the implementation of NNP in other existing nutrition technical working
the different sectors, with development groups to address specific issues on nu-
partners, and NGOs. trition and establish nutrition sub-groups
as need arises.
✓✓ Develop Ethiopian Food and Nutrition Pol-
icy relevant for NNP implementation. ✓✓ Report to NNCB on progress and bottle-
necks in the regular NNTC meetings and
✓✓ Develop and finalize a multisectoral report on progress on nutrition priorities,
nutrition coordination and implementation emerging concerns and recommenda-
guideline and detailed plan of action to tions suggested for high level decisions/
put the NNP II into practice. actions.
✓✓ Support development of nutrition-sen- ✓✓ Prepare quarterly, biannual and annual

sitive strategies for mainstreaming the multisectoral nutrition coordination plan
National Nutrition Strategy and Program and report to be submitted to the NNCB.
into government policies, strategies, and
national plans; and into relevant sectoral ✓✓ Identify resource gaps and mobilize fund-
plan and programs. ing for nutrition.
✓✓ Identify intra and inter country experienc- ✓✓ Prepare quarterly, biannual and annual
es, lessons and best practices for effec- reports.
Note: Based on the above outlined responsibilities and membership list, the NNTC is expected to
expand or modify its ToR and develop detailed working procedures as per demand.

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NATIONAL NUTRITION PROGRAM
2016–2020
FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

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FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

We the undersigned, representing the Government of the Federal Democratic Republic

Dr. Kebede Worku Dr. Tilaye Gete

Ato Wondrad Mandefro Dr. G/Egiziabher G/Yohannes

Dr. Mebrahtu Meles Ato Jemesdeng Choltot

Ato Asad Ziad Ato Alemayehu Gujo

Ato Remedan Ashenafi W/ro Bizunesh Meseret

Ato Mitiku Kassa W/ro Firehiwot Ayalew Ato Addisu Arega

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

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

2. CHAPTER 2: Lessons from NNP I and Focus of NNP II........................................................... 15

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

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

2.4 NNP II Focus and Approach................................................................................................................... 21

CHAPTER 3: Strategic Objectives and Initiatives.......................................................................... 23

Strategic Objectives of NNP II...................................................................................................................... 23

Strategic Objective 1.................................................................................................................................24

Result 1.1: Nutritional Status of Adolescents Improved............................................................................... 25

Result 1.2: Nutritional Status of Women of Reproductive Age Improved.................................................... 26

Strategic Objective 2................................................................................................................................. 27

Result 2.2: Improved Nutritional Status of Children 24-59 Months............................................................. 30

Result 2.3: Improved Nutritional Status of Children Ages 5-10................................................................... 32

Strategic Objective 3.................................................................................................................................33

Result 3.2: Healthy Lifestyles and Nutrition Promoted................................................................................. 36

Strategic Objective 4.................................................................................................................................39

Result 4.1: Strengthened Implementation of Nutrition-Sensitive Interventions

in the MOANR and Ministry of Livestock and Fishery.................................................................................. 39

Result 4.2: Strengthened Implementation of Nutrition-Sensitive Interventions

in the Education Sector................................................................................................................................ 44

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............................................................................................................... 63

4.4. Gender Dimensions of Nutrition............................................................................................................ 66

4.5. Nutrition Communication....................................................................................................................... 67

CHAPTER 5: Sustainable Nutrition Financing................................................................................ 70

6.2 Operational Research............................................................................................................................ 74

Accountability and Results Matrix for NNP Implementation......................................................................... 78

Terms of Reference: NNCB......................................................................................................................... 83

Terms of Reference: NNTC.......................................................................................................................... 86