Manual For Country-Level Nutrition Advocacy Using PROFILES .

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FANTA IIIFOOD AND NUTRITIONT E C H N I C A L A S S I S TA N C EManual for Country-Level Nutrition AdvocacyUsing PROFILES and Nutrition Costing11 stingPROFILESWorkshopFood and Nutrition Technical Assistance III Project (FANTA)1825 Connecticut Avenue, NW Washington, DC 20009T: 202-884-8000 www.fantaproject.orgNutritionAdvocacyWorkshopand MaterialsDevelopment

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGThis guide is made possible by the generous support of the American people through the support of the Office ofMaternal and Child Health and Nutrition, Bureau for Global Health, U.S. Agency for International Development(USAID, under terms of Cooperative Agreement No. AID-OAA-A-12-00005, through the Food and NutritionTechnical Assistance III Project (FANTA), managed by FHI 360.The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the UnitedStates Government.April 2018Recommended CitationSethuraman, Kavita; Kovach, Tara; Oot, Lesley; Sommerfelt, A. Elisabeth; and Ross, Jay. 2018. Manual for CountryLevel Nutrition Advocacy Using PROFILES and Nutrition Costing. Washington, DC: FHI 360/Food and NutritionTechnical Assistance III Project (FANTA).Contact InformationFood and Nutrition Technical Assistance III Project (FANTA)FHI 3601825 Connecticut Avenue, NWWashington, DC 20009-5721T 202-884-8000F rg

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGContentsIntroduction . 1STEP 1: Form a Multisectoral Core Working Group and Conduct a Stakeholder Meetingon Nutrition AdvocacyPlanning . 7Session Plans . 12STEP 2: Conduct a PROFILES Workshop to Generate Estimates for Nutrition AdvocacyPlanning . 21Facilitator’s Guidance . 27Session Plans . 96STEP 3: Develop Cost Estimates for Nutrition Service Delivery, Present PreliminaryResults, and Develop a ReportPlanning . 139Guidance on Undertaking Costing as an In-Country Nutrition AdvocacyPlanning Process . 143STEP 4: Conduct a Workshop on Nutrition Advocacy Planning and Finalize a NationalNutrition Advocacy Plan and MaterialsPlanning. 161Session Plans . 167Templates, Handouts, and ScoreboardsAll Templates, Handouts, and Scoreboards . 198i

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGIntroductionWhat is the purpose of the manual?The Food and Nutrition Technical Assistance IIIProject (FANTA), funded by the U.S. Agency forInternational Development and managed by FHI360, has created this manual for facilitation at thecountry level of a comprehensive and consultativenutrition advocacy planning process usingPROFILES and nutrition costing. Using acollaborative approach, FANTA has facilitatednutrition advocacy in several developing countries.The nutrition advocacy planning process used byFANTA as outlined in this manual was developed,expanded, and field-tested over several years tobe as effective and comprehensive as possible.This nutrition advocacy planning process is basedon completing three key elements at various timepoints in the process.What is nutrition advocacy?Nutrition advocacy is a platform to createmovement toward greater political and socialcommitment for nutrition in a country. It is aplanned, systematic, and deliberate processthat is defined and shaped by the specificcountry context.During the past decade, the global nutritioncommunity has been converging on a commonagenda to improve nutrition, built onpreviously separate efforts related tomicronutrient deficiencies, breastfeedingpromotion, complementary feeding, andothers. Efforts such as the World Bank’sstrategy on “Repositioning Nutrition As Centralto Development” in 2006, along withthe establishment of the U.N. SecretaryGeneral’s High-Level Task Force on Food andNutrition Security, the Copenhagen Consensus(which concluded that nutrition interventionswere among the most cost-effective indevelopment), and the Lancet series onmaternal and child nutrition (which provided anew evidence base for action on nutrition)—allin 2008—helped drive the formation of thesemovements. Specifically, initiatives such as theScaling Up Nutrition Movement (SUN), REACH(Renewed Efforts Against Child Hunger), andthe 1,000 Days Campaign have aspired tosupport country-owned, country-led strategiesfor addressing undernutrition.What is included in the manual?The manual includes tools in each step such as: Planning and facilitation notes Session plans for workshop and meetingfacilitators PowerPoint presentations Templates and handouts for workshop andmeeting participants Timeline and staff needs PROFILES Spreadsheet WorkbookWho should use this manual?This manual is designed to be used by practitionerswho work with government and nongovernmentinstitutions who are invited to undertake anutrition advocacy planning process in a givencountry. A key element of the process is to buildconsensus among stakeholders in country for ashared vision for nutrition. Practitioners whowould like to facilitate the nutrition advocacyplanning process using this approach in a specificcountry should follow the steps in this manual. Theskills and expertise required to conduct each stepin this manual vary and are identified at thebeginning of each step.FANTA’s nutrition advocacy planning processcomplements these and other nutritionadvocacy initiatives and can help streamlineexisting efforts in country by working with SUNnetworks and other program efforts toimprove nutrition. This planning process is1

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGmeant to be the initial phase of a broader nutrition advocacy process, followed byimplementation of advocacy activities in country.What is FANTA’s nutrition advocacy planning process, and what are the keyelements?FANTA’s nutrition advocacy planning process engages national stakeholders by using aparticipatory and consensus-building approach toward a shared national vision for nutrition. Itcan support a given country at any stage along the way to providing nutrition services andreducing malnutrition.A central focus of this process is to promote accountability for nutrition and strengthennutrition governance. For example, it can serve to support the development of a nutritionpolicy, increase investment of resources to strengthen and expand implementation of nutritionservices, and promote greater coordination between government and nongovernmentalorganizations that play a role in providing nutrition services across a country.By examining the context of the nutrition situation and tailoring advocacy needs to thatsituation, advocacy can be more effective in igniting change and making strides toward thedesired outcome.The three key elements of FANTA’s nutrition advocacyplanning process are:1. Nutrition Advocacy Plan and Material Development2. PROFILES3. Nutrition CostingEach element builds on and mutually reinforces the others.For each of these elements, the guiding principles are that:1. A consensus-building and participatory approach is usedat the country level to promote a shared vision for achievingnutrition objectives and to use the most credible data andinformation available as identified by in-countrystakeholders, which lends credibility to the process andresults.2. The process considers the country context, and materialsare tailored accordingly.3. All the steps are completed to ensure a systematic andimpactful process.2The VIPP MethodThe visualization inparticipatory programs(VIPP) method is referred tothroughout the manual. Itwas chosen as a facilitationmethod to promote aconsensus-based andparticipatory approach andto ensure that “everyone’svoice is heard” throughoutthe process.VIPP materials needed andinformation on how to usethe method are included ineach session plan. Otherparticipatory methods canalso be used.

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGThe four steps in FANTA’s nutrition advocacy planning process are:Step 1: Convene a multisectoral core working group and then conduct a stakeholder meetingon nutrition advocacy using PROFILES and nutrition costing.Step 2: Conduct a PROFILES workshop, present preliminary results, and develop reports.Step 3 (optional): Develop cost estimates for nutrition service delivery, present preliminaryresults, and develop a report.Step 4: Conduct a national nutrition advocacy planning workshop and finalize a nationalnutrition advocacy plan and materials.The order in which Steps 2, 3, and 4 are completed can vary depending on the country context.Although Steps 2 and 3 generate estimates, the estimates by themselves have little value if theyare not used and embedded within a broader nutrition advocacy planning process. Therefore,Step 4 is essential to complete. In fact, for a nutrition advocacy tool like PROFILES, the keylesson learned from past implementation was that the estimates alone have limited use andimpact in moving the nutrition agenda forward without a strategic nutrition advocacy plan andrelated materials. Step 3 on nutrition costing is optional as the nutrition advocacy process maybe completed with or without nutrition costing. In the templates included in this manual,instructions related to nutrition costing are italicized and in brackets so that they can easily betaken out if not being done in a specific country. The process outlined within each step,however, should not vary in order to ensure that each step results in the intended outcome.What is nutrition advocacy plan and material development?A nutrition advocacy plan is developed to identify key audiences to be targeted by nutritionadvocacy and determine a specific call to action for each. This is a critical step in the process asthe plan lays out how to conduct nutrition advocacy in a systematic and coordinated way withall partners in country. In addition, the plan identifies monitoring and evaluation (M&E)indicators to track progress in achieving nutrition advocacy outcomes. Nutrition advocacymaterials that support implementation of the nutrition advocacy plan are then developed,building upon and using results from the estimates generated from PROFILES and nutritioncosting.What is PROFILES?PROFILES is a spreadsheet-based nutrition advocacy tool used to calculate consequences ifmalnutrition does not improve or change over a defined time period and the benefits ofimproved nutrition over the same time period, including lives saved, disabilities averted, humancapital gains, and economic productivity gains. PROFILES also includes a section whereestimates are calculated for two risk factors of stunting. PROFILES estimates are based onreduction in the prevalence of several nutrition problems, such as iron deficiency anemia; lowbirth weight; vitamin A deficiency; iodine deficiency; suboptimal breastfeeding practices; andchildhood stunting, underweight, and wasting. The stunting risk factor estimates are based on a3

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGreduction in a suboptimal complementary feeding practice (inadequate dietary diversity) and areduction in teenage pregnancy. To calculate estimates, PROFILES requires current countryspecific information (e.g., nutrition, demographic, and employment data) that is identified andagreed upon in collaboration with stakeholders in country.What is nutrition costing?Nutrition costing estimates the costs of implementing a comprehensive set of nutritionprograms or interventions in a country or prioritized geographic area over a specific timeperiod. Nutrition costing is developed in country, considering the country-specific context, andis the result of a collaborative and participatory process during which multisectoralstakeholders define the assumptions on which nutrition costing is based—for instance,selecting necessary interventions and activities and defining a management structure forservice provision—which in turn allows for the identification of the required inputs for eachactivity and estimation of the program cost for a specified time period.What is the difference between PROFILES and nutrition costing?The estimates generated using PROFILES or nutrition costing answer different questions.PROFILES answers the question: What are the consequences if nutrition does not improve overa given time period or conversely, what are the benefits if nutrition improves over the sametime period? The PROFILES estimates are presented in terms of health and developmentoutcomes, such as lives saved or economic productivity gains. PROFILES gives you estimatesthat support the argument for why investing in nutrition is important and helps raise nationalawareness that malnutrition is a problem in a given country. However, it does not tell you howmuch it will cost a country to provide nutrition services to improve the nutrition situation.In contrast, nutrition costing, like health costing, answers the question: How much will it cost toimplement nutrition programs or interventions in a given country or prioritized geographic areaover a specified time period? Costing in general is a useful approach for forecasting andplanning the budget allocation required for specific services, but it is also useful for advocacy toincrease the funding allocated to nutrition. As such, nutrition cost estimates complementPROFILES estimates. In fact, relative to PROFILES estimates, cost estimates are more tangible inthat they provide policymakers with an estimate for how much they need to invest in nutritioneach year in local currency amounts. Like PROFILES estimates, nutrition cost estimates can alsobe projected to a population level over multiple years.4

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGPROFILES and nutrition costingare helpful in situationswhere: The prevalence of many formsof malnutrition are high Investment, commitment,governance, andaccountability for nutrition arelow Nutrition services arefragmented and not holisticAdvocacy processes fornutrition need to be: Based on a soundunderstanding of the currentcountry context for nutrition Systematic, planned, anddeliberate Part of a collaborativemultisectoral effort includinggovernment andnongovernment stakeholders Targeted at key audiencesegments that are influentialand can promoteaccountability and goodgovernanceTools such as PROFILES andnutrition costing promote: Insight for action Consensus-building and ashared vision for nutrition(“one voice”) Accountability and goalsetting for investment innutrition across the life cycle,including services along acontinuum of care for theprevention and treatment ofmalnutritionHow long does the nutrition advocacy planning process take, and what are thefollow-up steps?The length of time this nutrition advocacy planning process takes depends on the countrycontext. However, most countries typically take between 1 year and 18 months, depending onwhether nutrition costing is part of the process. Nutrition costing typically takes about 12–18months to complete due to the need to identify and use locally available data to develop costestimates. Once the nutrition advocacy planning process has been completed in a country,support for the implementation of the nutrition advocacy plans may be needed depending onthe country context. The four steps in this manual are the initial planning phase for nutritionadvocacy in a country, and they allow for strategic and coordinated nutrition advocacyoutreach to be completed over several years as a next step. In order to move the nutritionagenda forward in a country, it is essential to implement the nutrition advocacy plans afterthese initial four steps are completed. Also, nutrition advocacy plans and materials may need tobe updated every 2–5 years depending on the country context, while PROFILES and nutritioncosting estimates should be updated every 5 to 10 years (depending on country needs and theavailability of new survey data). Even though new survey data may be released more frequentlythan 5-10 years, often the prevalence estimates for various nutrition conditions change slowly.In addition, population growth in many developing countries is high; for PROFILES estimatesthat are calculated based on population projections, the implication of this is that the estimatesmay not be that different from year to year—so repeating PROFILES in given country moreoften than 5-10 years often adds little value to the broader nutrition advocacy efforts,particularly given that this can be a resource intensive and expensive process. Moreinformation on timing can be found in Steps 2–4.5

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTINGIllustrative Timeline and Key Steps for Nutrition Advocacy Planning Process Using PROFILESand Nutrition CostingWhat final documents are developed as part of the nutrition advocacy process?1. PROFILES final reports2. Nutrition costing final report3. National Nutrition Advocacy Plan and corresponding nutrition advocacy materials (targetedto audiences identified in the Nutrition Advocacy Plan)6

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING: STEP 1Form a Multisectoral Core Working Group and Conduct a Stakeholder Meeting on Nutrition AdvocacySTEP 1Form a Multisectoral Core Working Groupand Conduct a Stakeholder Meeting onNutrition AdvocacyPLANNING7

MANUAL FOR COUNTRY-LEVEL NUTRITION ADVOCACY USING PROFILES AND NUTRITION COSTING: STEP 1Form a Multisectoral Core Working Group and Conduct a Stakeholder Meeting on Nutrition AdvocacySTEP 1. Form a Multisectoral Core Working Group andConduct a Stakeholder Meeting on Nutrition AdvocacyThe first step in conducting nutrition advocacy using PROFILESTemplates and Handoutsand nutrition costing in a specific country is to convene amultisectoral core working group to lead the process, whichFind all of the relatedtypically takes several weeks or months to complete. This istemplates and handoutscritical to establishing a consensus-building and participatoryat the end of the manual.approach to promote a shared vision for achieving nutritionobjectives. The core working group will help to organize andconduct a one-day stakeholder meeting with key stakeholders from the government andnongovernmental or other organizations who may be involved in nutrition advocacy efforts.The stakeholder meeting typically takes place 1 to 2 months after the core working groupmeeting and can be planned to occur immediately before the PROFILES workshop. Thestakeholder meeting provides an opportunity to invite a larger group of stakeholders andexperts to review t

Manual for Country-Level Nutrition Advocacy . Using PROFILES and Nutrition Costing. FANTA III. FOOD AND NUTRITION TECHNICAL A SSISTANCE. Food and Nutrition Technical Assistance III Project (FANTA) 1825 Connecticut Avenue, NW Washington, DC 20009 T: 202-884-8000 1. 3. Nutrition . 1 Costing. Multi-Sectoral

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