Académique Documents
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PROJECT OVERVIEW
Title
ACF project code
ACF project reference
Donor
Donor project code
Sectors
Hub of operation
Project location
Project dates
Budget
Total
Donor
ACF
BACKGROUND
ACF global strategy
ACF Pakistan strategy
Other strategies
Problem statement
Needs assessment
children under five years are stunted and 4% of these are severely stunted (MICS, 2014). As
per PDHS 2012-13, stunting is higher in male children at 48% than in female children (42%).
Early initiation of breastfeeding is 20.7%; exclusive breastfeeding less than 6 months is
28.9%; continued breastfeeding at 2 years of age is at 48.9% and percentage of children age
623 months who received foods from four or more food groups during the previous day is
14.2%. All these indicators show a dismal state of nutrition in Sindh. NNS 2011 reveals that
72.5% of under five children are anemic and this proportion has increased from 2001 to 2011.
In Ghotki, stunting (HAZ<-2SD) in children under five years of age is 55.2% and wasting is
at 17.2%1. Overall 75,813 children are stunted, out of which 39,423 are males and 36,390 are
females2, while in district Khairpur, stunting (HAZ<-2SD) in children under five years of age
is 53.3% and wasting is at 18%. Overall 122,241 children are stunted, out of which 58,676 are
males and 63,565 are females, clearly linking it with poor nutrition in the first 1,000 days of a
childs life that can lead to stunted growth, which is irreversible and poses threat to physical
and mental development; it can also result in lower level of educational attainment and
economic gains3.
Stunting is a form of malnutrition in which children are shorter than normal for their age and is largely
irreversible after the age of two. If they survive, they grow up physically and intellectually
weaker than their better-fed peers. Pakistan has third most stunted children in the world
(WaterAid, 2016). 9.9 million Pakistani children under the age of five are stunted (Caught
Short, 2016).
Little impact on stunting is seen rather data shows that it has worsened from 2001 to 2011 (NNS
2011). There are patchy interventions but not concerted effort in the context of stunting
prevention because of low political will, sustainability4, lack of expertise, Inter-agency
collaboration and community issues5. Besides, determinants like weak community
mobilization, indicators of IYCF like early initiation of breast feeding (which is low
currently), and myths associated with use of colostrum and poor compliance to continued
breast feeding up till two years of age with minimal meal diversity are highlighted barriers to
better child nutrition outcome6.
1Geographical and socioeconomic inequalities in women and childrens nutritional status in Pakistan in 2011: an analysis of
data from a nationally representative survey: Mariachiara Di Cesare, Zaid Bhatti, Sajid B Soofi , Lea Fortunato, Majid Ezzati,
Zulfiqar A Bhutta, Pakistan Nutrition Lancet GH 2015.
2http://www.pdma.pk/dn/PopulationinSindh/tabid/67/Default.aspx and ibid
3 Ephraim W. Chirwa HN: Determinants of Child Nutrition in Malawi. South African Journal of economics 2008, 76(4):628640
4 Morn JL: External Evaluation: Emergency Nutrition Programme in Sindh Province, Pakistan. In.; 2012.
5 Balagamwala M: Agriculture and Nutrition in Pakistan Pathways and Disconnects. 2013:14
Nutrition in Pakistan has remained off the policy agenda because of large disconnects between
key sectors, a lack of integrated cross-sectoral programs, and a missing constituency for
nutrition within the political and bureaucratic elites, civil society groups, and the electorate in
general7. Pakistan lacks a national nutrition policy; however, at positive end, Pakistan
Integrated Nutrition Strategy8 is now in its preliminary stages of adoption catering to children,
pregnant and lactating women with the aim of prevention and treatment of malnutrition
among under five children and improving nutritional status of PLW. In 2002, protection of
breastfeeding and child nutrition ordinance was passed but was not implemented. PC-1 going
to be implemented in 9 districts of Sindh only in the context of SAM treatment; however,
Ghotki and Khairpur are not included in these districts.
Particular interest
OBJECTIVES
Global Objective
Specific Objective
Gender
This programme will address the problem of stunting by implementing four strategies mainly
for children aged 0-23 months; PLW; adolescent girls and pre-pregnant women.
IYCF activities, multi micronutrients, provision of iron folic acid to pregnant women, SAM
treatment and integrated Behavior Change Communication (BCC) will focus on first 1,000
days windows of opportunity and hence stunting forms the focus of this call.
First of its kind stunting programme;
Supports under-nutrition in Sindh in non-PC1 districts;
Re-establishes our presence in Sindh and helps ACF to enter into two new districts;
Will provide us with a base to further expand our operations and better position
ourselves for upcoming opportunities
Relationship with UN and linkages with USAID
6Nutrition causal analysis. ACF Pakistan 2012; Pilot bottleneck analysis ACF CMN 2015-16
7Zaidi S, S. K. Mohmand, Z. Bhutta, Acosta. AM: The Political Economy of Undernutrition in Pakistan. DFID-MQSUN: Islamabad.
2013
8WHO: Pakistan Nutrition Strategy
and a thorough analysis will be carried out to react on possibly changing needs during the
project implementation.
ACF will ensure that all children 6-59 month (6-23M SAM and 2-5 deworming and MM
supplementation) suffering from acute malnutrition, regardless of gender or ability, have
equal access to care. Through the intervention, ACF will promote gender equity through
changed mindset of the community in relation to traditional and cultural practices that
negatively affect female nutrition. Increasing womens ability to respond appropriately to
malnutrition empowers women and supports positive female influence at the household or
community level. For the intervention dedicated female staff will ensure to monitor the
services according to the cultural norms and values. In order to improve equity and
sustainability of nutrition provisions, couple health workers will be selected from the
community to promote active involvement of women and men and children from the
community. This project will contribute significantly to gender equality.
ACF ascertains its commitment to principles of neutrality, equity and impartiality by being
needs based: it chooses areas of intervention solely on the basis of its own assessment of
humanitarian needs, and no distinction is made among the victims on any criteria other than
their vulnerability. ACF is increasingly measuring its activities against the do no harm/do
less harm principle, which means avoiding or minimizing negative effect that may be
produced by humanitarian programs.
ACF will involve Govt., community and other NGOs working in the nutrition integrated
activities through close coordination meetings and sharing of ways through which
maximum sustainability output in shorter run and outcome in longer run could be achieved.
Moreover, capacity building will be imparted on SAM protocol; Micronutrients
supplements protocol; and IYCF protocol linking it with sustainability.
ACF will focus on involving both genders and all age groups of communities to increase the
effectiveness and impact of the project in the targeted area. The proposed activities are
designed to build the capacity and raise the level of confidence of all community members,
including female beneficiaries, as well as to increase empowerment for female decision
making. This will support female community members in becoming self-sufficient in
addressing their specific needs and problems. In order to achieve this, ACF will form and
train Mother to Mother support groups and Father to father support groups comprising of
representatives of both genders and all casts/sects. Hygiene and nutrition awareness raising
and sensitization sessions will be conducted with males and females of all age groups in the
target communities, while Nutrition activities will target children and Pregnant and
Lactating Women through CMAM and IYCF interventions.
Age
BENEFICIARIES
Target
Level
location
Name
#
Criteria
Method
selection
for
Activities
specific
to
this location
Level
Name
#
Criteria
District
Ghotki & Khairpur
2
Non-PC 1 Districts with high stunting rates
Primary & secondary data on stunting i.e. NNS.
Mapping of the District health facilities including DHQs, THQs, RHCs, BHFs and
satellite/communal sites where BHFs are not present or remote area.
All
Union Council (UC)
All
42 UCs in Ghotki and 76 UCs in Khairpur
HFs in all UCs in both Districts except PPHI administrative HFs
Method for
selection
Activities
specific
to
this location
Level
Name
#
Criteria
Method for
selection
Activities
specific
to
this location
Target
group&
project
beneficiaries
Type
Children 6-23 months, PLWs, Pre pregnant married CBAs, Children 24-60 months
Mapping of all HFs according to the project document
All
Village
TBC
All villages in target UCs of both Districts
All HFs under District health system
Village profiling.
Carpet screening of children under 5, CBAs and PLWs
Establishment of IYCF corners at targeted HFs and counselling of PLWs
Awareness of community and PLWs on CMAM, Stunting and IYCF
Mother to mother support groups in community.
Criteria
Method for
selection
Specific
activities
RESULT 1
Description
proposal
from
Support for appropriate infant and young child feeding (IYCF) is accessed by
vulnerable children (girls and boys), pregnant women and breastfeeding mothers,
especially protecting and supporting exclusive breastfeeding by dissuading and
monitoring the donation of breast milk substitutes and providing safe breastfeeding
areas for nursing mothers, promoting timely and appropriate complimentary feeding
including minimal acceptable diet [diversity and meal frequency] and cooking
demonstration
Output 1.1: Contribution to prevention of chronic malnutrition/stunting through protecting
and supporting infant and young child practices appropriately feeding (IYCF) among
pregnant women and breastfeeding mothers (PLW)
Output 1.2: Continuous inbuilt Monitoring of the activities
Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY1.1
Description
from
proposal
Output 1.3: Provincial coordination meeting with MOH and District coordination meetings
and workshops with sector leads (WASH; Health and Agriculture) for integration for
maximum
PLWs, adolescent girls and pre pregnant married
Lactating mothers, pregnant women
Pre pregnant women, adolescent girls
Establishment of breastfeeding corners and safe areas in those corners
ACF will establish IYCF corners in each union council of both districts with support and
close coordination of District health office. ACF will ensure that at least one IYCF corner is
established in each RHC/THQ. ACF will also establish one IYCF corner in its District
offices to ensure the privacy, dignity and continue breast feeding practices for their own
staff.IYCF corners will be staffed by skilled female personnel who will provide practical
support for breastfeeding and complementary feeding.
All mothers of children under the age of 24 months enrolled in programs will receive a oneto-one assessment in the centres breastfeeding corner and advice on IYCF. Mothers who
had stopped breastfeeding due to illness or nutrition induced reduction in breast milk
production will receive further support to initiate re-lactation.
Methodology
Bi weekly follow up will be ensured of each mother, if mothers have difficulty to come to
IYCF corner on regular basis then these mothers will be engaged with relevant LHW/CHW
for follow up and ensure their participation on MTMSG sessions in its area
Mapping through program teams in collaboration with District health authorities
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.2
Description
proposal
from
Methodology
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.3
Description
proposal
from
Methodology
71 Project staff and 1636 LHWs, LHSs, CHWs trained on IYCF and maternal nutrition
Health workers in District health system
Adults of different age group
Project staff and staff working in District health department
Project staff and staff working in District health department
Community of the targeted Districts
Nomination letter + list of participants + Pre & Post-test + TA/DA sheet + Final training
report
Through strengthening the capacity of existing health system, it will ensure the
sustainability of nutrition program in long run
Pregnant Lactating Women and caregivers attending Infant Young Child Feeding
counselling session
ACF in efforts to improve malnutrition prevention will implement its IYCF approach to
awareness rising. ACF will conduct sessions with primary caregivers (particularly women)
to improve their knowledge and thereby their practices of safe health, nutrition and hygiene
including hand washing, safe feeding practices, information on balanced diets and basic
health indicators. The specific content of sessions will depend on the context. These groups
will be facilitated by community mobilizers, couple health worker with LHWs engaged
where possible. They will primarily be targeted at women given their role as primary
caregivers. However, men will also be able to attend and engaged through father to father
support groups.
IYCF promoter will conduct sessions with primary caregivers (particularly women) to
improve their knowledge and thereby their practices of safe health, nutrition and hygiene
including hand washing, safe feeding practices, information on balanced diets and basic
health indicators. The specific content of sessions will depend on the context. These groups
will be facilitated by community mobilizers, couple health worker with LHWs engaged
where possible. They will primarily be targeted at women given their role as primary
caregivers. However, men will also be able to attend and engaged through father to father
support groups.
ACF IYCF & CMAM guidelines
These counselling sessions will increase the knowledge of the target groups on young child
feeding and will change their behaviour towards breastfeeding to adopt the best practices.
9642 PLWs and caregivers trained in IYCF
PLWs and caregivers
Child bearing age 15-49 years
PLWs and caregivers
PLWs and caregivers of children <5
Caregivers and community
Attendance sheets + session reports + Plans + pictures
Behaviour change activity of the community to adopt the best practices through effective
from
Methodology
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.6
Description
from
proposal
Methodology
District health force trained in active case finding and referral mechanism for common
illnesses in the children
49678 children vaccinated, 26826, 26534 children referred for ARI and diarrhoea treatment
respectively.
Children <5
Children <5
Children <5
Children <5
Mothers and families
Referrals slips + screening data + meeting reports and cross verification
To strengthen referral mechanism
Awareness on appropriate IYCF practices and policy at district level
ACF will organize and celebrate Global Breastfeeding Week and Mother Child Health Week
in close collaboration of DOH. Local community will be involved through LHWs and
CHWs. During the week the following activities will be carried out
o Sessions on awareness of IYCF Practices at nutrition treatment centre and at
community level
o Role played in each UC on good IYCF practices
o Mother to mother support meeting for sharing of good IYCF practices
o Theatre on awareness of Breast Feeding & IYCF practices by MTMSG
o Display of banner and posture in health facility and community
o Seminar and walk on IYCF
In support with District health authorities the different sub activities will be conducted in
both Districts. ACF support department will help program team to conduct this activity.
Invitation for participation will be shared with all stakeholders like DHO, DNC, CNVs,
INGOs/NGOs working on health in the district. The following activities will be conducted
in the field level. A detail report of the events with pictures will be shared with UNICEF and
head office.
Health system strengthening
Promotion of public events on IYCF and motivation of the District health staff and
community to celebrate the health events to increase awareness.
Global breastfeeding seminar conducted
All community
All ages of the adults
Community
District health staff, project staff
Community
Invitation letter + attendance sheet + pictures + reports + if available news cuts
from
Methodology
from
women.
Process Monitoring:
A regular process and output monitoring will be carried out throughout the project life as
per performance indicator guide, all the project interventions will be monitored and verified
at field level. Program beneficiaries verification will be regularly carried out through HHS
verification surveys to improve quality and ensure effectiveness. The fields findings will be
shared regularly through debrief session with program teams and management for timely
action. The monitoring activities broadly cover the following components;
Accountability Mechanism:
To mainstream accountability mechanism within project, all the project staff members will
be oriented on FCM (Feedback and complaint mechanism), developed based on HAP
standard. The project staff will further orient target communities and beneficiaries on FCM.
This will provide opportunity to beneficiaries and communities to raise their voice and
provide feedback/Complaints against the assistance provided by the organization. All these
Different checklists shall be used based on project components like; OTP Site supervision
checklist, IYCF Supervision checklist, Stabilization Centre checklist and BSI- Beneficiaries
satisfaction interviews, further these checklists will be translated to database for analysis
and quarterly reports will be generated.
Monitoring Tools
Database.xlsx
BS-Assesment.docx
IYCF Supervision
OTP Site
checklist for validation.docx
Checklist.docx
SC Supervision
checklist.docx
Note: ACF has to get project baseline from UNICEF for developing the soft component
(material) of the project.
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.9
Description
from
proposal
Methodology
6 Supervision, mentoring and on job trainings conducted by PQA to support program teams
All program team
Various age adults
Taluka IYCF supervisors and other program teams
Taluka IYCF supervisors
Program teams and community
Monitoring reports, check list, IEC material, pictures and reports
Program quality and accountability practices for smooth implementation of activities
Joint supervision visits by DNF, EDO and DC NP
Joint monitoring visits will be carried out quarterly on different aspects of the implementing
project. ACF project staff, district health departments, District nutrition officer and DC NP
will be key stakeholders to be engaged in joint monitoring. It will be a learning exercise to
know the project progress in terms of community mobilization, program linkage, referrals,
and challenges at district level. A debrief session for each joint visit will be carried out to
discuss key findings, good practices and challenges, followed by a comprehensive joint
action plan.
Program team will ensure that all stakeholders will be present in joint monitoring visits in
Methodology
each quarter. Work plan for these visits will be shared with all partners and an invitation
letter will also be sent before these visits to partners to remind them about this activity.
Partners will be asked to share their findings and a joint report after feedback and review
from each partner will be generated to see the project progress.
Program quality and accountability
Ownership of the program to District health authorities
12 joint supervision visits conducted in both Districts
District Health staff
All age group of adults
DNF, EDO and DC NP
Program team
Community
Joint monitoring visits reports + pictures
To increase awareness and provide sense of ownership to District health authorities
Qtr. joint progress review meetings with WASH, Health + GOVT district level
In order to achieve the output 1.3 of result 1, ACF will conduct the following activities:
Inception workshop of the project
An inception workshop will be carried out at start of the project in both districts, in which
key stakeholders (DC, DHO, DC NP, DNF, ASP) and other health and WASH partners will
be invited and briefed about the stunting project.
Joint progress review meetings with WASH, Health + GOVT district level
To share project progress, a joint exercise will be carried out quarterly, during the project
life. In which all the relevant stakeholders will be invited. ACF and nutrition support
program focal persons will share their progress, learning, issues / challenges faced and its
remedial measures taken during the course of the project. This exercise will also provide the
reflection of our work and related challenges that will also provide the solution for future
improvement in program and systems/functions.
These meetings will be conducted in coordination with District government. Program team
will ensure the timely invitation to all department and government officials about the venue
and time of the meeting. The interval of these meetings will be quarterly basis. All stake
holders will be asked t prepare their presentations on progress and will be shared in the
meetings, the issues, problems will be discussed and progress of the project will be analysed
in the meeting and solutions with action points will be provided during the meeting. The
report of the meeting will be shared with country office and UNICEF.
Program quality and accountability
Government officials increased knowledge about current context and project activities for
further integration of the project activities in District health plans.
12 Joint meeting conducted in both Districts
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.11
Description
from
proposal
All staff
All ages of adults
Program teams and government officials
Program and District health authorities
Community
Attendance sheet + review meetings reports + pictures
Government ownership in the project intervention
Project Review Meeting at base level
A quarterly project review exercise will be carried out in field office, to review the progress
against the targets within the agreed timeframe as per the project implementation plans and
in comparison to the project burn rate. For any under achievements, a joint action plan will
be devised and monitored to overcome the implementation gap.
To sharing project learning's, good practices and experiences, a joint lesson learnt exercise
will be carried out yearly, during the project life. This will be a joint learning sharing event,
in which all the relevant stakeholders will be invited. ACF and nutrition support program
focal persons will share their learning, issues / challenges faced and its remedial measures
taken during the course of the project. This exercise will also provide the reflection of our
work and related challenges that will also provide the solution for future improvement in
program and systems/functions.
Methodology
All relevant department will be invited to attend this meeting at base level and will be asked
to present the current progress of the project activities and any challenges, issues will be
highlighted and solutions will be provided in line with the guidelines and policies of ACF to
improve the program progress if any. The joint review meeting with WASH and government
will be followed after this internal exercise.
Program quality and accountability
Internal or in house capacity building exercise before organizing meetings with other
stakeholders.
6 meetings conducted in two districts
All staff
All ages
Program teams
Program teams
Community and District authorities
Attendance sheets + reports + pictures
Yes, to improve project activities by lesson learnt
ACTIVITY 1.12
Description
proposal
Methodology
from
Health baby competition and Performances based award ceremonies at District level
N/A
ACF program team in support from logs and other departments and in coordination with
District government will conduct a performance based competition amongst health workers
and based upon the best case studies by these health workers and their involvement in these
case studies and changing behaviour of the community, PLWs and caregivers to improve the
health and nutritional status of their children <5. A committee will be formed to judge and
finalize the results of healthy baby competition. Award ceremony will be conducted and all
relevant stakeholders will be invited in the competition.
Health system strengthening and behaviour change
Sense of ownership of the health workers and community
8 events conducted in both Districts
Health workers, PLWs, children <5
Staff and children <5
Health workers and children <5
Health workers and children <5
PLWs and caregivers and community
Attendance sheets + pictures + community feedback/ reports
Behaviour changes for best practices about health and nutritional status of children <5
Participate in provincial coordination meetings on monthly basis
N/A
PMs from relevant Districts will participate in monthly coordination meeting conducted by
UNICEF and PNC.
Coordination
Established linkage with government authorities and improved coordination
18 meetings attended by program team
Program staff
All ages
PNC, UNICEF and Program team
Program
Community
Meeting minutes
Better coordination practices
RESULT 2
Description
from
proposal
Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY 2.1
Description
proposal
from
Methodology
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.2
Description
from
proposal
Methodology
from
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
are not available; these areas will be covered by 236 CHWs. The referral system will start
from the standard community mobilization strategy by early detection of cases (Door to
door screening) and referral to the relevant health facility or satellite site. The LHWs and
CHW will conduct regular follow-ups in the community along with defaulter tracing and by
collecting information from health facilities and communities on a daily basis.
Carpet screening and community mobilization will be done through community volunteers
and project staff at OTP established sites and in the community. The screened children from
community will be referred to the treatment sites for further treatment.
CMAM guidelines
Through couple health workers community will be directly involved in the program,
increase their knowledge about the malnutrition, its under lying causes and how and where
the malnutrition can be treated.
141937 children screened
Both male and female children
6-23 months
6-23 months
Children < 2
PLWs
Screening data register + referral slips + pictures + reports + NIS
NA
Severely acute malnourished children 6-23 months of age referred and admitted to
OTP program
LHWs and CHWs will refer all the children with compromised health to OTP site and
admitted in OTP program. Treatment will follow the revised 2014 National Guidelines for
Acute Malnutrition. Supplies for the treatment of Acute Malnutrition, including Ready-toUse Therapeutic Food (RUTF) and the appropriate medication will be provided by
UNICEF.
LHWs and CHWs after screening the children will Screened children will be referred to
OTP sites for further treatment
CMAM guidelines
Through capacity enhancement, the MoH staff will be able to detect and refer children for
further treatment in outpatient program.
23420
Both male & female children
Children 6-23 months
Children 6-23 months
Children < 2 years
PLWs, CHWs and LWHs
Admission register + referral slips + Ration cards + pictures + case studies + NIS +
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.5
Description
proposal
Methodology
from
SQUEAC findings
N/A
SAM children with medical complications identified and referred for treatment to SC
LHWs and ACF team will assess the health status of all children according to the CMAM
protocols. Those children who have medical complication will be refer to Stabilization
Centres for further treatment. A referral slip will be properly filled out before referring the
child and OTP nurse will contact SC Focal person before referring the child and keep close
contact with SC focal person about the health condition of children. After discharge from
SC all children will be refer back to OTP site for continuation of further treatment.
ACF nutrition team will screened the children and referred those children to SC who have
SAM with medical complication
CMAM Guidelines and standard treatment protocols
Through capacity enhancement, the MoH staff will be able to detect and refer children for
further treatment in inpatient program.
4684 SAM children with medical complication treated
Both male & female children < 5
Children < 5
Children < 5
Male and female children < 5
Lactating mothers & caregivers
Referral slips + Admission and discharge slips + NIS
Children referred for treatment from OTP sites and direct from community to improve their
nutrition & health status
OTP programme achieves SPHERE standards (percentages) for cured, Death and
Default rates
ACF will ensure the achievements of all SPHERE standards for OTP program in the area.
ACF nutrition team will screen and referred the children for further treatment according to
the SPHERE standard and according to the national CMAM guidelines. The team will
ensure to maintain the SPHERE standards in all components of CMAM including OTP,
referral to SC and discharge/cured standards.
CMAM guidelines and treatment protocols
The awareness of the community will be enhanced to how to refer their children for
treatment of SAM and follow up in the HFs.
Cured rate >75%
Death Rate <10%
Default Rate <15%
Male & female children < 5
Children < 5
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.6
Description
from
proposal
Methodology
Target group
Direct Beneficiaries
from
Indirect Beneficiaries
ACTIVITY 3.1
Description
proposal
from
Methodology
from
Methodology
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.3
Description
from
proposal
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.4
Description
proposal
from
141937 children and 84831 pregnant women received multiple micronutrient sachets
Male female children and pregnant women
Children < 2 and pregnant women
Children < 2 and pregnant women
Children < 2 and pregnant women
Community & health care staff
Screening register + NIS + monthly reports
The children & pregnant women will be identified on early case detection and sent for
treatment
PLWs receive iron, folic acid and MM supplementation as per standard protocols
Pregnant will be benefited through iron, folic acid and MM supplementation as per standard
protocols in two districts, 90 MM tablets and 90 iron folic acid tablets will be provided to
each PW for 3 months. The couple health workers and lady health worker will be involved
in micronutrients supplementation to PLWs in the targeted areas of both districts. While in
health facility the Nutrition assistant and IYCF counsel will also provide these supplements
to PLWs who is arrived to the center. Supplementation will be recorded on screening
registers for further follow up.
The ACF nutrition team will screen and identify the PLWs who need iron, folic acid and
MM supplementation and will be provided with certain number of sachets for the treatment
of anaemia.
CMAM guidelines and treatment protocols
Support health system in identifying the PLWs and their treatment to correct their nutrition
status
94625 Pregnant women & 94625 lactating women received iron, folic acid and MM
supplementation
Female
Child bearing age
Child bearing age
PLWs
Children & families
Screening register + NIS + monthly reports + SQUEAC
N/A
Children 2 to 5 years of age dewormed every 6 months as per standard protocols by
COWs; NA and IYCF counsellors
2 to 5 years children will be dewormed every 6 months as per standard protocol by
community outreach worker, Nutrition assistant and IYCF counsellors in two districts. Any
children who is referred or arrived to the health facility for treatment will be first investigate
regarding deworming and then will be dewormed and also during screening in the
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.5
Description
from
proposal
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
RESULT 4
Description
from
proposal
Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY 4.1
Description
proposal
from
Methodology
Description
proposal
from
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 4.3
Description
proposal
Methodology
from
ACF IYCF supervisors and counsellors will organize sessions for MtMSGs and FtFSGs on
best practices on breastfeeding and complementary feeding along with awareness sessions
on communicable and common ailments in both districts.
IYCF best practices
Enhanced awareness among mothers and fathers about breastfeeding and complementary
feeding along with awareness on communicable disease and common ailments.
1888 CHWs (MtMSGs+FtFSGs) trained on IYCF and common illnesses
Male & female
All ages of adults
CHWs
CHWs mothers and fathers
Children
Meetings reports + session reports + pictures + monitoring reports
Best practices of IYCF
Monitoring of CHWs orientation sessions by IYCF supervisors and ACF community
mobilizers randomly, and involvement of IYCF promoters in sessions on monthly basis
Monitoring of CHWs orientation sessions by IYCF supervisors and ACF community
mobilizers randomly, and involvement of IYCF promoters in sessions on monthly basis
ACF IYCF supervisors will ensure that the community sessions are conducted as per
schedule in the targeted UCs. These randomly monitoring visits will be done by the
supervisors during each training scheduled for the target beneficiaries.
MEAL
Maintained sense of responsibility in CHWs about the children & PLWs suffering from
malnutrition
50% sessions conducted successfully
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
CROSS
CUTTING
CONSIDERATIONS
Access considerations
Staff training
MEAL
Objective/ Results
Performance Indicators
Method of
Verification
Time/
Frequency of
data collection
Sampling
or full
Focal
person
Outcome 1: Improved enabling environment in provincial government to address stunting in Sindh province and in particular the
3 target districts by 2017.
AWP Output 1:
Strengthened
political
commitment
and
national capacity to
legislate, plan and
budget for children
Programme
Output 1: Enabling
environment
created in
communities for
improved Nutrition
Notification on
endorsement
available
01
01
Meeting minutes
of district
Nutrition
coordination
committee with
defined terms of
reference
Evidence of
programme
01
01
01
01
Meetin
g with
Govt.
for
endorse
ment
Meetin
gs /
Coordin
ation
once
NA
Field
co /
project
manag
er
Ongoing
NA
Field
co /
PM
Monitor
Once
NA
??
Services
monitoring
framework
templates
available for
reporting
Copy of
notification
available
01
01
01
01
ing
Templat
es
based
on
project
activitie
s
Meetin
g/
Coordin
ation
with
District
govt.
Work
plan
Ongoing
NA
Field
co /
PM
Once
NA
Field
co /PM
Software
0
01
01
MIS
Once
Monthly
PM
developed
updated database
available
Result 1. Support for appropriate infant and young child feeding (IYCF) is accessed by vulnerable children (girls and boys), pregnant women and breastfeeding mothers, especially protecting and
supporting exclusive breastfeeding by dissuading and monitoring the donation of breast milk substitutes and providing safe breastfeeding areas for nursing mothers, promoting timely and appropriate
complimentary feeding including minimal acceptable diet [diversity and meal frequency] and cooking demonstration.
Program data
0
42
76
AWP Output 3: 1: Number of breastfeeding
Breastf
Once
Full
IYCF
Enhanced
support
for corners and safe areas in those
eeding
Superv
children,
families
and corners.
corners
isor
communities to promote
at sites
knowledge,
behaviour 2: No of HealthCare Providers;
Training
26 Project
45 Project Staff
Trainin As per plan
Sample
IYCF
change,
demand
for Lady Health Workers and
Attendance
0
Staff,
980 LHW/LHS,
g
Superv
services and opportunities midwives trained on IYCF and
Sheets, Training
420
152 CHW
isor /
for participation
maternal nutrition
Reports
LHW/LHS,
PM
Program Output 1.1
84 CHW
Contribution to prevention
of chronic
3:Number of Pregnant Lactating
Program Data,
0
3,599 sessions
6,043 sessions
Session As per plan
Smaple
IYCF
malnutrition/stunting
Women and caregivers attending
Session
s
supervi
through protecting and
Infant Young Child Feeding
Attendance sheets
sor /
supporting infant and young
counselling session
PM
child practices
4: Number of cooking
Program Data,
0
427
773
appropriately.
Session As per plan
Sample
IYCF
demonstration session for
Session
(1 cooking
(1 cooking
feeding (IYCF) among
s
supervi
preparation of healthy diet and
Attendance
demonstration/ demonstration/qu
pregnant women and
sor /
feeding practices to adolescents;
Sheet, quarterly
quarter/LHW
arter/LHW or
breastfeeding mothers PL
PM
pre-pregnant and pregnant women
narrative reports
or /CHW)
/CHW)
through LHWs and Couple health
workers (CHWs)
5: Number of children screened
Program Data,
0
18541
31137
Child
Monthly
Sample
IYCF
AWP
2:Increased
Output
national
capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems
Output 1.2:
Continuous inbuilt
Monitoring of the activities
Vaccination,
10012 ARI,
16518
Diarrhoea
Referrals
Vaccination,
16814 ARI
10,016 Diarrhoea
Referrals
screeni
ng and
referral
s
01 Global
Breast feeding
Seminars
01 Global Breast
feeding Seminars
Semina
r
As per plan
Full
PM
Training
Attendance
Sheet, Training
Reports
84 CHWs
152 CHWs
As per plan
Full
PM
420
LHW/LHS,
980 LHW/LHS,
Trainin
g
Supervision visit
reports, Program
Data
02
04
Field
visits
Monthly
Full
IYCF
supervi
sor
Supervision visit
reports
Meeting Minutes,
Monthly
Narrative reports
06
06
Quarterly
Full
PM
06
06
Field
Visits
Review
Meetin
g
Quarterly
Full
Meeting minutes
and narrative
report
03
03
Meetin
g
Quarterly
Full
Narrative reports
04
04
Award
ceremo
nies
As per plan
Full
PM &
Distric
t
authori
ties
and
Key
staff
PM &
Key
staff
PM
Referrals slips
Seminar Reports
supervi
sor /
PM
Meetin
gs
Meeting minutes
0
18
18
Reports
Result 2. Children 6 to 23 months have access to appropriate feeding services, and provision of essential supplies especially therapeutic foods for the management of severe acute malnutrition
(SAM)
AWP Output 2: Increased 1: Number of Outpatient
Program Data /
0
03 static RHC, 12 static RHC, 02 Sites
Monthly
Full
IYCF
national capacity to ensure therapeutic sites (fix 15 in
NIS database
02 THQ, 01
THQ, 01 DHQ
supervi
availability of, and access RHC, 5 THQs, 2 DHQs
DHQ and 35
and 61
sor /
to,
services
and
to and 96 community
community/
community/
PM
strengthen systems
satellite Sites
satellite Sites
static/Satellite sites) in
intervention area
Output 2.1
Severely acute
malnourished children 6-23
months of age are early
identified and treated in
therapeutic program
Program Data /
NIS database
52975
88962
Program Data /
NIS database /
Referral Slips
8741
14679
Referral slips
1748
2936
Program Data /
NIS database
Training
Attendance
Sheet, Training
Reports
Result 3. Children and women access to Multi micronutrient supplementation
Cured rate
>75%
Death Rate
<10%
Default Rate
<15%
43 Project
Staff
AWP
2:Increased
Output
77 Project Staff
national
capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems
Training
Attendance
Sheet, Training
Reports
42 HCPs
76 HCP
Program Data
AWP
Output
3.1:Increased
national
52975
(children)
88962
children
31,661
(Pre-pregnant
women)
53,170 pre
pregnant
Pregnant
35,317
Lactating
35,317
61,804
Pregnant 59,308
Lactating 59,308
capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems
Program Data
Screeni
ng /
Data
review
Screeni
ng /
Data
review
Screeni
ng /
Data
review
Data
analysis
Monthly
Full
NIS
officer
Monthly
Full
NIS
officer
Monthly
Full
NIS
officer
Monthly
Full
NIS
officer
Trainin
g
As per plan
Full
PM
Trainin
g
As per plan
Selected
people
IYCF
supervi
sor /
PM
Monitor
ing
Monthly
Sample
IYCF
Superv
isor
Monitor
ing
Monthly
Sample
IYCF
Superv
isor
Output 3.2
Children 6-23 months of
age and women access to
4: Number of children 2 to 5 years
Program Data
0
1,03,789
Monitor Monthly
Sample
IYCF
micronutrients
of age dewormed every 6 months
ing
Superv
supplementation (pre
as per standard protocols by
isor
pregnant and pregnant
COWs; NA and IYCF councillors
women, and lactating
Program Data
0
28,986
48,644
Monitor Monthly
Sample
IYCF
women) to address anaemia 5: No of adolescent girls (10-19
years)
received
iron;
folic
acid;
Girls
Girls
ing
Superv
and other micronutrient
iodine and Zinc supplements
deficiencies
isor
Result 4. Children and women access behaviour change communication interventions for promoting positive preventive nutritional knowledge; attitude and practices particularly focused on IYCF
AWP
Output
3:
Enhanced
support
for
children,
families
and
communities to promote
knowledge,
behaviour
change,
demand
for
services and opportunities
for participation
Output 4.1
Contribute to improved
knowledge of nutrition
practices of community
members in prevention of
malnutrition through a
behaviour change approach
along with educating target
groups (pre pregnant and
pregnant women, and
lactating women and
caretakers) on appropriate
feeding practices to address
anaemia and other
micronutrient deficiencies
OTHER MEAL
Accountability
Learning
Training and
meetings
Attendance sheet
and reports,
336 MTMSGs,
336 FTFSGs
608 MTMSGs,
608 FTFSGs
Attendance sheets
672 monthly
sessions of
CHW with
each group
1216 monthly
sessions of CHW
with each group
Attendance sheet
50%
of
sessions will
be monitor by
IYCF
supervisor.
Monthly sessions
report
50% sessions
will be
attended and
supervise by
IYCF
promoter and
community
mobilizer
MTMS
G
FTFSG
As per plan
Full
PM
Session
s
As per plan
Full
IYCF
supervi
sor /
PM
50% of sessions
will be monitor
by IYCF
supervisor.
50% sessions will
be attended and
supervise by
IYCF promoter
and community
mobilizer
Any other activities of MEAL should be included here. This should be completed by PQA
What will be in place for this?
ACF accountability mechanism (FCM) Integrated into program
Staff training on FCM to further replicate within communities
Handling complaints
What will be completed for learning? Workshops? Good practices
At the end of project PQA unit will conduct Lessons Learnt workshop in collaboration with
program and support units.
Assessments
Evaluation
Output/Process
Monitoring
N/A
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