Implementation Plan (2016 – 2030)

Summary Programme Approach Document

March 2016

1
 Background

As a follow-up to the launch of the ‘Seqota’ Declaration to end child

undernutrition by 2030, the Minister of Health, Dr. Kesetebirhan Admasu
inaugurated a Taskforce to translate the high level political commitment into an
implementation plan. The 90-page implementation plan lays out a conceptual
framework to inform multisectoral coordination of interventions that address the critical
gaps and barriers which currently exist and limit the progress made in addressing child
undernutrition in Ethiopia. Each implementing sector has outlined priority interventions
along with estimated costs. The plan also describes the multisectoral coordination and
performance management arrangements along with a multi-year implementation
roadmap. It leverages on pre-existing policies, strategies and programmes in place to
maximize lessons learned and apply best practices at scale in a targeted approach. It
is hoped that through the effective roll-out of this implementation plan, Ethiopia will
experience a paradigm shift towards the elimination of child undernutrition by 2030. A
preliminary costing exercise for the proposed interventions estimates that
$211,548,247 million is required to fund Phase 1 implementation from 2016 – 2018.

In preparation for the High Level Strategic Discussion of the ‘Seqota’ Declaration
Implementation Plan, this Summary Programme Approach Document has been
developed to provide contextual information and overview of the Implementation Plan.

Context

The Government of Ethiopia has been implementing a comprehensive economic

reform programme for the last two decades. The reform programme has resulted
in remarkable economic performance; macroeconomic stability was attained. A real
gross domestic product (GDP) growth rate of 11 percent per annum has been
achieved since 2003. According to the Ethiopia poverty assessment, Ethiopian
households have experienced a remarkable reduction in poverty rate from 56 percent
of the population living below $1.25 purchasing power parity (PPP) a day in 2010 to
the current estimate of 29 percent;1 this figure is expected to be much lower at the end
of 2015 (about 22 percent as set in GTP I).2 Yet due to the population growth, the
absolute number of people living below the poverty line has remained static.

Ethiopia has developed a five-year development plan entitled ‘The Growth and
Transformation Plan’ (GTP II), for the period 2015/16 to 2019/20. The overarching
objective of the Second Growth and Transformation Plan is the realization of Ethiopia’s
vision of becoming a lower middle income country by 2025. Thus, GTP II aims to
achieve high economic growth within a stable macroeconomic environment while at
the same time pursuing aggressive measures towards rapid industrialisation and
structural transformation.3

1
Rio+20, 2012
2
HSTP, FMOH 2015
3
MOFED, 2015

2
 Ethiopia’s current demographic profile and projection brings hope that by the
middle of the century, the country could benefit from a demographic dividend.4
As a result of Ethiopia’s commitment to reducing infant and child mortality, improving
reproductive health and family planning, and the subsequent fertility decline, and
coupled with improvements in social determinants of health, Ethiopians have begun
to live longer as evidenced by the increase in estimated average life expectancy at
birth to 64 years from 45 years in 1990. The country is on the right path to a population
age structure that may enable a demographic dividend. In figure 1 below, Ethiopia’s
actual population structure as at 2010 is compared with a projection for 2030.

Figure 1: Demographic Dividend in Ethiopia

In 2013, the Government of Ethiopia published a Cost of Hunger Report, which

quantifies the social and economic impact of undernutrition. The costs of child
undernutrition in the health and education sectors were calculated and the effects of
child undernutrition on human capacity and productivity in the workforce were
quantified. The total annual cost was estimated at ETB 55.5 billion, which was
equivalent to 16.5 percent of GDP in 2009.5 On the other hand, the study estimates
that Ethiopia can reduce losses by ETB 148 billion by 2025 if it reduces underweight
rates to 5 percent and stunting to 10 percent in children under five years; alternatively,
a reduction of the child undernutrition rates to half of the current levels by the year
2025 can reduce losses by ETB 70.9 billion.

The Government of Ethiopia recognizes that addressing undernutrition is

essential to achieving sustainable development. The prevalence of undernutrition
remains a serious challenge in Ethiopia. It is reported that almost half (45 percent) of
child deaths are associated with undernutrition,6 the causes of which are multifaceted.
The immediate causes include inadequate dietary intake and disease, whilst
underlying causes include household food insecurity, poor caring practices, lack of
access to basic services, including lack of access to safe water supply, health services
(including knowledge and training of health workers); and unhealthy living

4
The demographic dividend is a boost to economic growth that occurs when there is a “bulge” in the number of working age
people. During this period, the productive population is large compared to the dependent population of children and old
people and, inversely, the dependency ration (the number of people dependent age for every 100 of working age) is low.
5
AU Commission a.o., The Cost of Hunger in Ethiopia. Implications for the Growth and Transformation of Ethiopia. The Social and
Economic Impact of Child Undernutrition in Ethiopia - Summary Report, 2013, pp. 1-21.
6 R Black et al. Lancet 2013, Maternal and Child Nutrition 1: Maternal and child undernutrition and overweight in

low-income and middle-income countries

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 environment, such as open defaecation.7 In turn, these causes are influenced by
‘economic, political and social conditions, national and global contexts, capacity,
resources, environmental conditions and governance’.8

The challenging nature of the malnutrition situation in Ethiopia means that it

cannot be addressed using traditional methods. Over the past two decades, many
interventions ‘at scale’ have been attempted including the National Nutrition
Programme (NNP) but with varying results. As a result, millions of children remain
malnourished and it is clear that new approaches are urgently needed. 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.

‘Seqota’ Declaration

The ‘Seqota’ Declaration is a special commitment which will be managed under

the National Nutrition Programme II i.e. NNP II and implemented by NNP
implementing sectors including Ministry of Agriculture and Natural Resources
(MOANR), Ministry of Livestock and Fishery Resource Development (MOLF), Ministry
of Health (MOH), Ministry of Water, Irrigation and Electricity (MOWIE), Ministry of
Education (MOE), and Ministry of Labour and Social Affairs (MOLSA). This was
officially launched by the Deputy Prime Minister, His Excellency, Demeke Mekonnen
and presented by the Minister of Health, Dr. Kesetebirhan Admasu in July 2015 at the
periphery of the International ‘Financing for Development Conference’ convened in
Addis Ababa (13th – 16th July, 2015).

The key goals of this Declaration include, amongst others, to achieve the
following by 2030: (1) Zero stunting in children less than 2 years; (2) 100 percent
access to adequate food all year round; (3) Transformed smallholder productivity and

7
ESAR, UNICEF Regional Advocacy Strategy for Eastern and Southern Africa 2014–2017, Priority 2 Reducing Stunting, p. 3 and
Headey (Ethiopia Strategy Support Program), An Analysis of Trends and Determinants of Child Undernutrition in Ethiopia,
2000‐2011, 2014, p. 7.
8
UNCT, Policy Brief: Scaling Up the United Nations’ Involvement in Nutrition in Ethiopia, p. 1 with a reference to ‘The Lancet,
2008, 2013’.

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income; (4) Zero post-harvest food loss through reduced post-harvest loss; (5)
Innovation around promotion of sustainable food systems (climate smart); (6) Continue
to improve the accessibility and coverage of adequate and safe drinking water supply,
100 percent open defaecation free kebeles by 2030 and irrigation for supporting
agriculture as well as access to water source; (7) Increase efforts to educate women
and girls, especially rural girls, to help prevent the intergenerational transmission of
poverty, and implement the school health and nutrition strategy initiatives: school
feeding, deworming and nutrition education; and (8) Focus on poverty reduction and
resilience building through predictable cash transfer to the most vulnerable group, and
in addition, targeted support to school feeding programmes, pregnant and lactating
women as well as children under 2 years..

The ‘Seqota’ Declaration Implementation Plan leverages pre-existing policies,

strategies and programmes in place to maximize lessons learned and to apply
best practices at scale in a targeted approach. It is hoped that through the effective
roll-out of this implementation plan, Ethiopia will experience a paradigm shift towards
the elimination of child undernutrition by 2030. Informed by a conceptual framework
built around three pathways of change (see below), the ‘Seqota’ Declaration
Implementation Plan will focus on delivering high impact nutrition specific and nutrition
smart interventions across multiple sectors including health, agriculture, water,
education and social protection. All of these interventions will be driven by social
behaviour change communication (SBCC) strategies with special consideration for
crosscutting issues such as gender mainstreaming, multisectoral coordination and
integrated community development approaches for nutrition.

Overall conceptual framework for the ‘Seqota’ Declaration

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Three factors underpin this new innovative approach to addressing
undernutrition: (1) Utilizing ‘Community Labs’ to find solutions to complex
problems and testing them within communities that are most affected by the
challenges of undernutrition; (2) A Programme Delivery Unit to drive execution and
routines necessary for effective delivery; and (3) A robust data management system
to support performance management.

Community Labs represent an independent entity created to find solutions to

complex problems and test them using existing resources and systems so they
can be taken to scale if proven impactful. The Government of Ethiopia will establish
a Community Lab in the Tekeze River Basin during Phase 1 – Innovative Phase i.e.
Learning by Doing (2016 – 2018) to design and pilot solutions that can help to improve
nutrition outcomes in the region and serve as a template for replication of successful
interventions during the expansion and scale-up phases. The Community Lab Team
will apply three fundamental ways of impacting child undernutrition in Ethiopia: (1)
Implementing a multisectoral response - which will address the challenges
encountered in coordination during the implementation of NNP I; (2) Ensuring greater
stake of the community in designing solutions – which is informed by the principles
of community participation in development interventions; and (3) Committing to
evaluating the solutions and learning to evidence – which will inform the scale-up
of successful solutions across Ethiopia. A baseline assessment will be conducted as
soon as the Implementation Plan is launched to establish sector by sector targets
against timelines.

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 The Life Cycle Approach

Pregnant and Lactating

Women

Adolescent Girls (10 - 19 years) Children 0 - 23 months

School Children Children 24 - 59 months

 Agriculture and Natural Resources sector response to nutrition

Agriculture has been the dominant sector of Ethiopia’s economy, representing

nearly 42 percent of GDP, 77 percent of employment and 84 percent of exports.9
As an agrarian country, the majority of the agriculture sector consists of smallholder
farmers who make their living from less than two hectares of land. Ethiopia is endowed
with abundant natural resources and some of the most diverse ecological zones in the
world. Ethiopia’s ~ 74.3 million hectares of arable land are spread out over 18 major
and 49 sub agro-ecological zones at altitudes ranging from 148 to 4,620 meters above
sea level.

The ’Seqota’ Declaration Implementation Plan has adopted Sustainable

Development Goal (SDG) 2, which is “to end hunger, achieve food security and
improved nutrition, and promote sustainable agriculture” as a means of
enhancing development in Ethiopia. This will be achieved by integrating and
implementing climate- and nutrition-smart agriculture interventions.

Building on the existing food security programme of the Ministry of Agriculture

and Natural Resources and the Agriculture Growth Programme II, the ‘Seqota’
Declaration Implementation Plan will pilot the establishment of 20 hectares
modernized demonstration farms called Agricultural Innovation and
Technology Centers (AITCs) in the Tekeze Region. This agricultural innovation
system is defined as “a system of individuals, organisations and enterprises focused
on bringing new products, processes and forms of organisation into social and
economic use to achieve food and nutrition security, economic development and
sustainable natural resource management”. AITCs represent agricultural innovation
systems founded on gender-equality, inclusivity, sustainability and good governance
and their adoption is part of a holistic approach for regional and national response.
This is based on a model developed by Engineers Without Borders, Israel and
currently being piloted in Tigray Region.

These government-owned AITCs will implement integrated interventions and

solutions linked to improved agricultural production, economic empowerment,
conservation of soil and water resources, adaptive management of natural
resources at farm levels, post-harvest processing and improved nutrition and
education. Operated as centralized training and education centres for farmers,
agronomists, development agents, and agriculture students from near-by universities
and technical colleges, the AITCs will serve as central mechanisms for implementation
of additional agriculture and nutrition interventions (e.g. modern irrigation systems,
crop variety and diversification, agri-technical methods, and post-harvest processing)
under the authority of the Ministry of Agriculture and Natural Resources and its various
agencies. Ultimately, these AITCs will facilitate smallholder farmers’ transformation by
resolving root causes of poor agricultural production and promoting market orientation
capabilities. Each 20 hectare modernized, demonstration AITC will support the
establishment of 3 – 5 smaller satellite demonstration AITCs in the region which will
also serve as training sites for local smallholder farmers. The preliminary cost of
agriculture and natural resources sector led interventions in support of the ‘Seqota’
Declaration Implementation Plan is estimated at $3,282,135 million.

9
Agriculture Transformation Agency (ATA) website as of 13th February, 2016

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 Water, Irrigation and Electricity sector response to nutrition

Ethiopia has a generous endowment of water, but this water is distributed

unevenly in space and time. Ethiopia has 12 river basins with an annual runoff
volume of 122 billion cubic metres and groundwater potential of 2.6 billion cubic metres
with an insignificant amount currently being utilized as evidenced by a water
availability of 1,743 cubic metres per person per year. The complex interaction
between the climate, biophysical and socio-economic characteristics of Ethiopia is
associated with a high level of spatial and temporal variability in river flow, turbid
surface waters, and tremendous potential for hydropower in the highlands and
irrigation in the lowlands. Ethiopia is also extremely vulnerable to drought and other
natural disasters such as floods, heavy rains, frost and heat waves.

The Government of Ethiopia developed a 15-year Water Sector Development

Programme (WSDP) to run from 2002 – 2016 with the following five major
components:10 (1) Water Supply and Sewerage Programme; (2) Irrigation and
Drainage Programme; (3) Hydropower Development Programme; (4) General Water
Resources Programme; and (5) Institutions/Capacity Building Programme. Building on
the set targets and momentum generated from this programme, the ‘Seqota’
Declaration Implementation Plan will adopt a strategic approach for managing water
resources in a way that contributes to improving the health and wellbeing of Ethiopians
by increasing water supply and sanitation access and the adoption of good hygiene
practices whilst increasing access to water supply for agricultural purposes.

Three River Basin Authorities (RBAs) have been established in strategic river
basins in Ethiopia. However, in most cases, they lack adequate financial, human and
technical resources to fulfil their mandate. Current water technologies in the Tekeze
River Basin are not sufficient and new technologies must be adopted or scaled-up.

10
National Water Development Report for Ethiopia December 2004

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 As part of the ‘Seqota’ Declaration Implementation Plan, a critical intervention
proposed for priority implementation is the establishment of the Tekeze River
Basin Authority to address the institutional vacuum for water resources planning
and management. The experience of fast-growing economies in South Asia and China
indicates that investments in water infrastructure need to be inscribed in an institutional
framework that ensures that water resources are developed in a coordinated and
sustainable manner, maximising economic returns to water across sectors while
protecting local livelihoods and ecosystems.11 The operational mandate of the Tekeze
River Basin Authority will be derived from Proclamation No. 534/2007 River Basin
Councils and Authorities Proclamation.

International Water Management Institute (IWMI) scientists have developed an

analytical tool to evaluate the need for water storage and its likely effectiveness
under existing and possible future climate conditions. This has been applied in
the Volta Basin and the Ethiopian part of the Blue Nile Basin. The tool considers
reliability, resilience, and vulnerability, and the economic, social and environmental
aspects of water storage options for different areas. Following the establishment of the
Tekeze River Basin Authority, priority consideration will focus on the establishment of
a “Bank of Water Technologies and Solutions” which will include various technologies
that have been successfully implemented in Ethiopia as well as new technologies
available from other countries, especially Israel. These new technologies will be
assessed and analyzed for technical issues, feasibility tests, social and environmental
impacts before recommendations can be made for their use. Ultimately, the Tekeze
River Basin Authority will be responsible for deciding on custom-made solutions for
each woreda.

The preliminary cost of water, irrigation and electricity sector led interventions in
support of the ‘Seqota’ Declaration Implementation Plan is estimated at $108,323,000
million.

11
Calow and Mason, 2014

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 Education sector response to nutrition

Growth and transformation of the education sector is fundamental for attaining

Ethiopia’s vision of middle-income status by 2025 through inclusive and
sustainable development. Education is strongly linked to reducing infant and child
mortality and morbidity, while promoting safe reproductive behaviours, family health
and planning, and sanitation. In Ethiopia, the government has made significant
progress in expanding access to primary education to work toward Universal Primary
Education. However, gender disparities still exist in the distribution of educational
opportunities and drop-out rates remain high, particularly in pastoralist and remote
areas where drought and localized conflict are common.

With more Ethiopia children attending school than ever before, interventions
aimed at school children are increasingly viewed as vital in improving the health
and nutritional status of the population as a whole. It is estimated there are 33,284
government and non-government schools, 18,850,986 school-age children and some
376,937 teachers in primary and secondary levels of education in the country. 12 To this
end, the Ministry of Education is committed to the promotion of quality health and
nutrition for school-age children (including under-fives) and adolescents (10 – 24 years
old) who constitute 15 percent and 35 percent respectively of the total population, 13
and of whom a major portion suffer from alarming levels of ill-health, nutritional
deficiencies and morbidity, and which has called for the development of a National
School Health and Nutrition Strategy.

The Ministry of Education has incorporated national school health and nutrition
strategy in its sector programme to guide activities that are designed to improve
access to better health and nutrition services for school-age children. In 2015,
the Ministry of Education began full implementation of the One WASH strategy to
improve school health through adequate supply of water and sanitation facilities.
Schools promote quality health and nutrition services for school-age children and
adolescents, who constitute 15 percent and 35 percent of the nation’s total population
respectively.14

The Ministry of Health designed the Ethiopian National School Feeding

Programme (ESFP) to: (1) Improve school children’s health and nutrition status; (2)
Increase access to education; i.e. enrolment, 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. During the first phase (2016 – 2020), the ESFP aims to
address the needs of the most vulnerable population groups and areas, specifically
targeting pre-primary and primary school children i.e. Grades 0 through 8, in 50
prioritized zones across 6 regions covering 3 million children. It prioritizes schools
currently served by the World Food Programme CSB+ programme, at the same time
as rapidly expanding coverage across regions and establishing effective institutional
structures for future growth.

12
MOE-EMIS, 2011
13
CSA 2008
14
ESDP V, 2008

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 The ’Seqota’ Declaration Implementation Plan promotes the scale up of the
Ethiopian School Feeding Programme as a means of contributing to the
alleviation of short-term hunger and helping children concentrate on their
studies, thus enabling them to gain increased cognition and better educational
outcomes. This approach will also address micronutrient deficiencies such as vitamin
A, iodine, and iron among others which directly or indirectly affect cognition and can
result in better school performance. The Ministries of Education, Health and
Agriculture and other relevant ministries and development partners will work closely
with communities and assist and encourage them to ensure a minimum level of local
food production to implement a Home Grown School Feeding (HGSF) programme and
to ensure sustainability and ownership of the programme.

In addition, the ‘Seqota’ Declaration Implementation Plan promotes the

development of safe and adequate water supply as well as proper sanitation and
hygiene promotion as prerequisites for realizing a healthy and hygienic school
environment. The health benefits that could be derived out of safe and adequate
water and in improved sanitation and hygiene are numerous, ranging from a reduction
in acute watery diarrhoea, intestinal worms, trachoma, and increased levels of self-
esteem from a clean toilet/latrine. Concurrently, the ‘Seqota’ Declaration
Implementation Plan calls for scaled up implementation of the School Health
Programme especially as health, including visual health, is inextricably linked to school
achievement, quality of life, employability and economic productivity. The preliminary
cost of education sector led interventions in support of the ‘Seqota’ Declaration
Implementation Plan is estimated at $70,221,303 million.

Social Protection sector response to nutrition

Ethiopia has made significant progress towards reducing poverty over the last
several years. However, rural areas in particular still suffer from pervasive levels of
deprivation and seasonal hunger. Children are particularly vulnerable. Five underlying
factors are key to understanding the causes of child malnutrition in Ethiopia: (1)
Insufficient food availability; (2) Inadequate provision of a healthy environment (e.g.
poor water, sanitation and hygiene); (3) Maternal wellbeing and quality of caring
practices; (4) Women’s decision-making power and control of resources; and (5)
Political economy factors.

With a reach of approximately 8.3 million people, the PSNP is the largest social
protection programme in Africa (outside of South Africa, where the Child
Support Grant reaches 10 million children).15 The PSNP signifies a critical policy
shift towards longer-term sustainable solutions rather than emergency-based relief, in
line with the new nutrition policy. This is to be achieved through more stable and
predictable cash and/or food-based transfers targeting the chronically poor and food
insecure households.

The ‘Seqota’ Declaration Implementation Plan aims to improve the resilience of

families in the Tekeze River Basin to economic shocks through the expansion
of the Productive Safety Nets Programme whilst improving the nutrition status
of children as well as pregnant and lactating women. PSNP is made more nutrition

15
Taylor, 2012

12
smart by incorporating additional nutrition provisions in PSNP4 that aim to enhance
nutrition outcomes and offer a ‘temporary transition to direct support’ (cash or food)
for pregnant and lactating women (PLW), starting from the time of registration of
pregnancy up to the time when the newborn child reaches 12 months of age. During
this time period a co-responsibility will be exercised to ensure the pregnant mother
and the mother with newborn child participate in community-based nutrition activities
such as social and behavioural change communication and growth monitoring and
promotion and are exempt from physical ‘public works’ during this period. PSNP4 will
also promote other links to social activities and services like day-care and health and
hygiene in general and is putting emphasis on actions to support empowerment of
women in general. In addition, public works will support nutrition smart interventions.

Given the progress achieved by the Government of Ethiopia in terms of social

protection, the appraised design of the PSNP, and the various windows of opportunity
to facilitate multisectoral collaboration through its implementation, the ‘Seqota’
Declaration Implementation Plan strongly recommends its focused expansion in the
Tekeze River Basin in order to document its potential impact in the region and other
regions in the country. Two proposed interventions are the scaling up of PSNP4 to
cover more woredas in the Tekeze River Basin and scaling up of the Tigray Cash
Transfer Programme.

Implementation Approach and Governance Arrangements

The Seqota Declaration has affirmed the reciprocal relationship between gender
and nutrition and articulated a way to mainstream gender into various
components of the programme. Some of the recommended strategies are as
follows: (1) Integrate gender equality interventions into all sectors; go beyond
addressing the symptoms. Interventions will aim to tackle root, immediate and
underlying causes, and will include but are not limited to: promoting girls’ education,
combating harmful traditional practices (especially girls’ food taboos and early
marriage that has strong linkage with malnutrition); putting in place reproductive
services friendly to women and adolescent girls, sensitizing and involving women
development groups, enhancing decision-making at household level, promoting
access to information; ensuring energy and time saving technologies and promoting
the economic empowerment of women. (2) Promote meaningful male involvement
in nutrition interventions. Women and girls may be targeted in view of their special
vulnerabilities, but men and boys should also be reached to help address their
practical needs and strategic interests as well.

Achieving nutrition’s full impact on health and development outcomes requires

a multisectoral approach. Nutrition specific interventions are key to accelerating
progress. Nonetheless, it is also critical that all relevant sectors - like agriculture,
education, women, children, and social welfare – work jointly in order to tackle
undernutrition.16 A truly multisectoral approach will achieve optimal nutrition outcomes
through greater coverage and better targeting, whilst also helping other programmes
achieve more powerful results and demonstrate their own potential for impact.

16
Garrett, J., and M. Natalicchio, ed. 2011. Working Multisectorally in Nutrition: Principles, Practices, and Case Studies.
Washington, DC: International Food Policy Research Institute.

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The ‘Seqota’ Declaration Implementation Plan will use existing government
structures to ensure sustainability and long-term achievement of objectives. In
order to ensure effective multisectoral programme coordination, common structures
have been established to represent all the categories of stakeholders implementing
and supporting nutrition programmes in Ethiopia. The two nutrition coordination bodies
are nutrition coordination body (NCB) which is designated by higher officials of
respective sectors and representatives of other stakeholders. The other is nutrition
technical coordination (NTC) which is the technical wing of the coordination, to
consistently represent the organization in the coordination activities.

There are two nutrition coordination committees at federal level; the National
Nutrition Coordination Body (NNCB) is the higher level decision making body
and the technical arm is called National Nutrition Technical Committee (NNTC).
The figures below depict the structure for NNCB and NNTC respectively for
coordination at national level. The NNCB provides policy/strategic decisions related to
the NNP, allocate and approve budget for the implementation of NNP with key
indicators and provide guidance. The NNCB consists of eleven government sectors,
Nutrition Development Partners including civil society organizations, academia, and
the private sector. In order to enhance accountability and maximize ownership, the
NNCB should regularly report progress of the Seqota Declaration Implementation Plan
to the Deputy Prime Minister.

The National Nutrition Technical Committee (NNTC) operates under the

auspices of the NNCB. This committee comprises the technical personnel from the
member organizations of the NNCB and their main responsibility is the handling of
overall technical work related to the federal level NNP coordination. (See figure below)

A similar structure for regions is called Regional Nutrition Coordination Body

(RNCB) and Regional Nutrition Technical Committee (RNTC).

14
Multi-sectoral Nutrition Coordination structure, National Nutrition Coordinating Body (NNCB)

National Nutrition
coordinating body

Co-chair-State Minister
Chair-State Minister of Health of Agriculture and
Natural resource
Secratary-Director, Nutrition
directorate FMOH

MOAN MOWC FMHAC ACADA private

MOE MOLF MOT MOFEC FBPIDI MOH MOLSA MOWIE GCA EPHI NPD
R A A MIA sector

Multi-sectoral Nutrition Coordination structure, National Nutrition Technical Committee (NNTC)

The Seqota Declaration Implementation Plan will adopt both top-down and
bottom-up approaches to multisectoral nutrition planning with meaningful
participation of all stakeholders and actors in the realization of goals including
the community. The top-down planning allows for good planning in line with global
and national development targets. It breaks down to generate local level targets to
allow achievement of national and global level goals already set. However, without
due consideration of local reality, it is impossible to achieve any target at all. Therefore,
bottom-up planning allows understanding of the perceived needs and priorities of
communities and woredas. It also allows the uniqueness of one community from the
other, and hence the various potential bottlenecks to achievement of development
goals.

15
The proposed interventions to be implemented by participating sectors under
the three pathways directly respond to the 8 components of the ‘Seqota’
Declaration as depicted below:

Community development interventions with nutrition outcomes can target

stunting by providing nutritious food for mothers and children, and can help to
promote economic inclusion to the lowest income communities in the region by
increasing livelihoods.17 The ‘Seqota’ Declaration Implementation Plan will differ
from other initiatives undertaken in Ethiopia by its approach of combining nutrition
specific and nutrition smart interventions with economic development and
infrastructure projects surgically targeting specific woredas. Although there is
insufficient evidence about the effectiveness of multisectoral community development
approaches on nutrition (combined with other nutrition specific and smart interventions
that this implementation plan proposes), it is important to highlight that there exists
strong evidence related to specific components of these interventions individually. In
addition, we have early lessons from other African countries that can help us to outline
an integrated intervention in Ethiopia.

In the Ethiopian context, the role of women development groups (WDGs) in

addressing nutrition is critical and will inform implementation arrangements of the
‘Seqota’ Declaration Implementation Plan although there will be a need to sensitize
them and develop their capabilities.

17The World Bank. Improving nutrition through multi-sectoral nutrition approaches. Washington, DC:
The World Bank. 2013.

16
Pilot woredas for Phase 1 Implementation are reflected in the table below:

Amhara Region Tigray Region

Abergele woreda Ofla woreda
East Belessa woreda Saharti Samre woreda
Telemt woreda Tanqua Abergele woreda
Seqota woreda Tselemti woreda

Monitoring and Evaluation

The Seqota Declaration Implementation Plan builds on the existing strong

national partnership among relevant NNP implementing sector ministries and
their respective structures at all levels, nutrition development partners,
multilateral and bilateral donors, academia and private sector. This
Implementation Plan will be the source document for a harmonized plan of action with
a clear monitoring and evaluation framework. The NNP’s accountability and results

17
matrix which outlines the core results, targets and their indicators as well as the sectors
accountable and the measuring period for these indicators will be adapted to reflect
the proposed interventions under the Seqota Declaration.

A Seqota Declaration Implementation Plan accountability and results framework

will be developed to enable effective management and optimum mobilization,
allocation and use of resources, and to make timely decisions to resolve
constraints or problems of implementation. The sources of information for timely
monitoring will be routine service and administrative records compiled through the
sectoral information systems and the Early Warning System. To enrich the data,
supervisory visits and review meetings will be conducted.

The Ethiopian Public Health Institute (EPHI), in collaboration with Amhara and
Tigray Public Health Institutes will undertake a baseline assessment of the
Tekeze River Basin to inform Phase 1 implementation as soon as the
Implementation Plan is approved by the Government of Ethiopia. The EPHI, in
collaboration with implementing sectors will undertake periodic assessments,
operational research and surveys to help identify programme strengths and
weaknesses. Mid-term and end-line evaluations will be conducted by EPHI in
collaboration with implementing sectors and nutrition development partners.

To strengthen the M&E component of the ‘Seqota’ Declaration Implementation

Plan, the Federal Ministry of Health (FMOH), Ethiopian Public Health Institute
(EPHI), Ethiopian Agricultural Research Institute (EARI), and other
implementing sectors will do the following:
1) Integrate the recording and reporting of sex and age disaggregated nutrition
data within existing sectoral information systems.
2) Ensure appropriate integration of nutrition specific and smart indicators in
sector specific woreda based plans.
3) Ensure appropriate use of nutrition specific and smart results in sector specific
woreda based planning.
4) Strengthen joint operational research planning among sectors and institutions.
5) Develop nutrition information platforms to capture appropriate nutrition specific
and smart indicators that can be collected at facility and community levels,
including nutrition surveys and assessments.
6) Strengthen the HMIS to incorporate appropriate nutrition specific indicators that
can be collected at facility and community levels, including nutrition surveys and
assessments.
7) Ensure incorporation of nutrition indicators in each sector planning.
8) Build the capacity of nutrition programme implementing line ministries,
agencies, and institutes at all levels to collect and utilize nutrition data for
planning and decision making.
9) Ensure regular Integrated Supportive Supervision (ISS) and multisectoral &
sectoral review meetings at all levels.
10) Conduct evaluation (Seqota Declaration mid-term and end-line), research and
surveys (micronutrients).
11) Develop a central nutrition information platform/database for research, surveys
and programmatic data that allow triangulation of information from all sectors.
12) Conduct systematic review and publication of the existing nutrition data for
programming and decision-making.

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The Seqota Declaration Implementation Plan shall use various mechanisms to
disseminate information to inform decisions at various levels of the
implementation system and to inform the public at large. The major information
products and dissemination mechanisms are: (1) Monitoring reports, which will be
disseminated quarterly, semi-annually and annually; and (2) Evaluation and research
findings, which will be disseminated through publications, reports, workshop
proceedings and policy briefs.

A Programme Delivery Unit (PDU) established as the implementation ‘vehicle’

of the Community Lab is designed to oversee all of the performance
management activities related to the ‘Seqota’ Declaration Implementation Plan.
The PDU’s performance management functions include responsibility for reporting on
the progress being made by the Seqota Declaration Implementation Plan in Phase 1.
To this extent, they will integrate data across all sectors (using existing data sources,
score cards, etc.) to ensure that the outcomes and impacts of implementation activities
are being tracked.

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