2017 Annual Report July 2016–June 2017 JAPAN TRUST FUND Second Phase of Scaling Up Nutrition Investments Contents 1. Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 3. Background & Context. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 4. Objectives, Activities, & Results. . . . . . . . . . . . . . . . . . . . . . . . . 9 5. Program Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 6. Summary of Progress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 7. Annexes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 3 Acronyms BCC Behavior Change Communication CG Consultative Group CMU Country Management Unit DFID Department for International Development DHS Demographic and Health Survey FNC Food and Nutrition Council HNP GP Health, Nutrition and Population Global Practice IBRD International Bank for Reconstruction and Development IDA International Development Association IEY Investing in Early Years IFNA Initiative for Food and Nutrition Security in Africa IMF International Monetary Fund IYCN infant and young child nutrition JICA Japan International Cooperation Agency LGA Local Government Areas MFHNP Multisectoral Food Health Nutrition Project MINSA Ministry of Health in Peru MNFAP Multisectoral Nutrition Framework and Action Plan NMSP National Multisectoral Strategic Plan PE Process Evaluation RBP Retinol Binding Protein RFP request for proposal SAFANSI South Asia Food and Nutrition Security Initiative SDGs Sustainable Development Goals SHGs self-help groups SIEF Strategic Impact Evaluation Fund SUN Scaling Up Nutrition TICAD Tokyo International Conference on African Development TTL Task Team Leader UNICEF United Nations Children’s Fund USAID U.S. Agency for International Development WASH Water, Sanitation and Hygiene WBG World Bank Group 4 2016-2017 Annual Report Overview The Second Phase of Scaling Up Nutrition Investments Annual Report presents the continuation of the sec- ond phase of a three-phased program between the Government of Japan and the World Bank to support the scaling up of nutrition investments. Despite a decline in global poverty to the unprecedented rate of below 10 percent, childhood undernutrition continues to affect approximately 155 million children globally, with the highest burden in low- and middle-income countries. Over the past decade, the World Bank has been a major contributor to the dialogue on scaling up actions to prevent stunting, particularly in the first 1,000 days of a child’s life. This effort has been spearheaded by World Bank President Jim Yong Kim and other global leaders, with several high-level events during the World Bank Annual and Spring Meetings. After waning support for the nutrition agenda in the early to mid-2000s, the Bank began to significantly shift its support. Key reports— Repositioning Nutrition as Central to Development (World Bank 2006) and Scaling Up Nutrition: What Will It Cost? (World Bank 2010)—brought attention to the issue, not just within the World Bank but also among key part- ners and governments, with the latter providing the first-ever estimates of global nutrition costs. The Scaling Up Nutrition (SUN) movement (launched in 2010 at the World Bank with the Government of Japan, Canada, USAID, and the Bill & Melinda Gates Foundation) further rallied partners around the cause. Recently the World Bank’s commitment to investing in the early years (early life nutrition, early learning and stimulation, and nurturing care and protection from stress to support these agendas) has grown exponentially in scope, scale, and coverage. Investments in reducing stunting as well as early childhood stimulation and learning are now center stage of the World Bank’s corporate agenda—not just in the health sector but across several sectors, including education, water and sanitation, social protection, and agriculture. In addition to addressing undernutrition, the World Bank is also focusing efforts on the dual burden of malnu- trition, including the rising problem of overweight and obesity in developing countries. Beyond International Development Association (IDA) and International Bank for Reconstruction and Development (IBRD) resources, new resources are becoming available to support this agenda at both global and national levels—from partners such as the Bill & Melinda Gates Foundation, the Japan Trust Fund for Scaling Up Nutrition Investments, the Dangote Foundation, Tata Trusts, the Power of Nutrition, and the Global Financing Facility in support of Every Woman Every Child. These and many other partners, including civil society organizations, are rallying around to catalyze and reinforce the achievement of results in support of the Sustainable Development Goals (SDGs). In 2009, to expand the implementation of proven nutrition interventions in high-malnutrition-burden countries, the Government of Japan committed US$2 million to the first phase of the Japan Trust Fund for Scaling Up Nutrition Investments. The first phase supported the development and conceptualization of the Scaling Up Nutrition (SUN) movement, supported analytical work on nutrition to generate awareness and demand for nutrition services, built nutrition planning and implementation capacity, catalyzed in-country nutrition policy dialogue, and laid the groundwork for new IDA investments in several high-malnutrition-bur- den countries. In addition to setting up the global SUN movement, the first phase focused on several cross-cut- ting themes across 33 countries, including catalyzing activities, employing the innovative use of media, sup- porting nutrition and early child development, building capacity, fostering South-South knowledge exchange, leveraging additional project funding, and working across sectors. The second phase focuses on consolidating activities with a financial commitment of US$20 million over a four-year period. Building on Phase I, this phase seeks to achieve three key objectives: (1) to consolidate and expand the catalytic activities begun under Phase I to support the scale-up of nutrition-specific and nutri- tion-sensitive interventions in high-burden undernutrition countries; (2) to generate operational knowledge about how to effectively implement nutrition-sensitive interventions in non-nutrition sectors (a multisec- toral approach to nutrition) such as agriculture, social protection, water and sanitation, and education; and (3) to support the work of the SUN movement through a specific focus on the SUN countries, including the Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 5 continued provision of support for the SUN leadership and governance structure (e.g., support to the mid-term evaluation process of the SUN movement), for participation of SUN country focal points in the SUN Global gathering, and for dissemination of lessons learned. Activities will focus on high-burden IDA and IBRD countries. Africa and South Asia continue to be the regions of greatest need for undernutrition. In Sub-Saharan Africa, the proportion of children under five who suffer from undernutrition remains stagnant or is rising in some countries, and South Asia remains the region where the greatest numbers of children are affected. Simultaneously, a rise in the prevalence of overweight and obesity in children and adults in low- and middle-income countries requires further analysis of interventions to reduce overweight and obesity and their influence on noncommunicable diseases. High-malnutrition-bur- den countries in regions other than Africa and South Asia are also eligible for support through the Trust Fund, albeit a large proportion of the available resources are allocated to Africa and South Asia. Activities eligible for funding include primarily technical assistance, policy dialogue, project preparation for nutrition components, pilot testing of innovative approaches, dissemination of best practices and results, and support for the SUN movement—including for the SUN Secretariat, travel, and other support for SUN country focal points. To date, 27 activities across 20 countries have been approved and most have begun implementation with a total commitment thus far of US$4,386,003. Fourteen additional proposals have been received and are cur- rently under review. If approved, these projects could add approximately US$3.5 million in commitments. The funded activities fall strategically within the World Bank’s portfolio of achieving high-level results in influenc- ing and strengthening nutrition programming including institutional arrangements, capacity building for gov- ernments, domestic and official development assistance resource mobilization for nutrition, and multisectoral approaches. Specifically, the multisectoral approaches include Investing in the Early Years (IEY) and activities to strengthen the SUN movement across countries and globally. Twelve of the 27 projects are part of the first wave of IEY countries, and 16 are SUN countries (some fall in both categories). These activities also lend com- plementarity to the Japan International Cooperation Agency (JICA)’s Initiative for Food and Nutrition Security in Africa (IFNA). Four countries with approved Japan Trust Fund support are also IFNA focus countries. A revised Administrative Agreement has been signed (in September 2017) between the Government of Japan and the World Bank that will significantly facilitate uptake of this Trust Fund and allow for even stronger syn- ergies with other Japan–World Bank Group (WBG) supported initiatives, including Universal Health Coverage and IFNA. 6 2016-2017 Annual Report Background & Context The Japan Trust Fund for Scaling Up Nutrition Investments is in the second phase of a three-phase program agreed to between the Government of Japan and the World Bank in late 2009. This section briefly discusses the key points related to this investment. Optimum nutrition in the early years is fundamental to building human capital and driving economic growth. Evidence indicates that tracking height-for-age (an indicator of long-term nutrition status) in a child’s first two years is the best predictor of human capital in low- and middle-income countries. Undernutrition impedes economic and human development and is the underlying cause of up to 45 percent of deaths in children. Undernourished children have higher mortality, lower cognitive and school performance, and 10 to 17 percent lower income potential as adults. Improved nutrition can therefore be a driver of economic growth. Improving nutrition is consistently seen as one of the best value-for-money development investments, with a high return on investments—from between US$4 and US$35 for every dollar spent. Collectively acknowledging the inadequate focus on nutrition, the global community acted to bring mul- tiple stakeholders together around the SUN movement. The cross-sectoral nature of nutrition, its multiple stakeholders, and the lack of a single institutional home at the global level for nutrition has resulted in little attention paid to nutrition as a development issue in the past. Global and country-level financing for nutri- tion remains inadequate, and human resources and capacities for implementing, monitoring, and evaluating large-scale nutrition programs are scarce in many countries. To address these gaps, the international nutrition community developed the widely endorsed nutrition initiative known as the Scaling Up Nutrition (SUN) movement in 2010. The World Bank and Government of Japan partnership has made valuable contributions to the SUN move- ment and to efforts to address malnutrition. The SUN Framework, a consensus document laying out the prin- ciples of country-led nutrition programs at scale using a multisectoral approach, was developed with funding from the Japan Trust Fund; SUN was launched at the World Bank during a high-level side-event at the April 2010 World Bank/IMF Spring Meetings that was co-hosted by the Government of Japan.1 The Japan Trust Fund for Scaling Up Nutrition Investments complements the World Bank’s efforts to scale up nutrition. These efforts include developing the evidence base for operationalizing multisectoral approaches to delivering nutrition-sen- sitive actions through sectors such as social protection, agriculture, and education, as well as delivering focused nutrition-specific interventions to benefit pregnant and lactating women and children in the first two years of life. Collectively, the World Bank’s resources for scaling up nutrition and the resources from the Japan Trust Fund for Scaling Up Nutrition Investments will expand the scale-up and implementation of proven nutrition interventions in high-burden countries supported by IDA. The three-phased program to scale up nutrition investments provides the framework for a sustained part- nership to address malnutrition. With the overall objectives of expanding nutrition interventions in countries where there is demand, generating demand in countries where it is lacking, building operational capacities, and leveraging IDA and other resources for nutrition investments in high- undernutrition-burden countries, a three-phased program was agreed upon between the World Bank and the Government of Japan in late 2009. Phase I (US$2 million) was financed by the Government of Japan in late 2009. Under Phase I (Initiation), the Japan Trust Fund financed catalytic country-level activities to lay the foundation for the development of new country nutrition plans, lending projects and IDA investments in select countries. In Phase II and III (Consoli- dation and Institutionalization), the Trust Fund will consolidate and expand the work of Phase I, supporting countries with costed scale-up and implementation plans as well as other relevant analytics that support and 1 See http://siteresources.worldbank.org/NUTRITION/Resources/NutritionSpringMeetingSummary.pdf Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 7 improve the quality of IDA investments. Going forward, the Trust Fund will focus on institutionalizing the achievements of the early phases by enhancing the quality of IDA investments in nutrition, further strength- ening in-country capacity to implement nutrition programs, knowledge sharing and developing information systems to monitor and evaluate the impact of nutrition investments. Resources are targeted to high-malnutrition-burden countries. Africa and South Asia continue to be the regions of greatest need. Sub-Saharan Africa has the greatest proportion of children under five who suffer from undernutrition, while South Asia continues to have the highest absolute numbers of affected children. Several countries in Latin America (e.g., Guatemala, Peru, Haiti), East Asia and Pacific (e.g., Lao People’s Democratic Republic, Cambodia, Indonesia, Papua New Guinea, Philippines, Timor Leste), the Middle East and North Africa (e.g., Yemen, Djibouti), and Eastern Europe & Central Asia (e.g., Tajikistan) also have high rates of stunt- ing, wasting, and/or micronutrient deficiencies. Therefore high-burden countries in regions other than Africa and South Asia are also considered for support through the Trust Fund resources. It is against this background and within this context that the Japan Trust Fund for Scaling Up Nutrition Invest- ments is situated. The following pages provide a brief description of the objectives, activities, and expected results of this phase, and the program management arrangements that have been established, followed by a summary of progress that includes the key opportunities and challenges and an overview of each child activity and its status. 8 2016-2017 Annual Report Objectives, Activities, & Results Objectives The objectives of the Japan Trust Fund for Scaling Up Nutrition Investments is to build on Phase I and move the program toward Phase III. The three key objectives of this Trust Fund are to: 1. Consolidate and expand the catalytic activities commenced under Phase I of the Scaling Up of Nutrition Investments with the aim of scaling up nutrition interventions in high-burden undernutrition countries 2. Generate operational knowledge about how to effectively implement nutrition-sensitive interventions in nonnutrition sectors (a multisectoral approach to nutrition)—such as, inter alia, agriculture, social protec- tion, and water and sanitation—in order to sustain improvements in nutrition status at scale 3. Support the work of the Scaling Up Nutrition (SUN) movement through a specific focus on the SUN coun- tries, including strengthened leadership in the SUN governance structure and dissemination of lessons learned for effective multisectoral approaches to nutrition Activities Activities undertaken will closely be aligned with, and contribute to, the development objectives of the Trust Fund. Activities in this phase will cover more countries, continue or expand investments in capacity development, and support the planning for the SUN movement’s governance structure as it moves to its sec- ond phase. For details of the activities supported under the Trust Fund, please refer to Annex 1. Key Results A set of measurable indicators tracks progress toward the objectives. The following outcome indicators mea- sure the progress of the activities toward the achievement of results: 1. Scale-up plans developed or strengthened in additional SUN or other high-burden countries 2. IDA project preparation underway in additional SUN or other high-burden countries 3. Knowledge-sharing and capacity development efforts supported in four to six SUN or other high-burden countries 4. Innovation pilots implemented in at least three SUN or other high-burden countries 5. Knowledge dissemination strategy developed 6. Project profiles for the Trust Fund–funded work disseminated via various websites 7. Results of Trust Fund activities shared through at least two additional channels/platforms (e.g., the WBG external website) Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 9 8. SUN global movement supported (for example, SUN country focal points attend the SUN annual global gathering, annual event documented) For the complete results framework, please see Annex 3. Focus Countries There is continued focus on South Asia and Africa as regions of highest need, and on high-malnutri- tion-burden countries (both undernutrition and overweight/obesity). Phase II resources are targeted toward the same high-burden IDA countries identified in Phase I with some adjustments and modifications. Given the South Asia Food and Nutrition Security Initiative (SAFANSI) established in 2010 and spearheaded by the United Kingdom Department for International Development (DfID), fewer resources may be needed for South Asia. A special effort will be made to complement rather than duplicate activities between SAFANSI and Phase II of the Japan Trust Fund. At the same time, the need in East Asia is large, as it is in Latin America and the Caribbean where the burden of overweight is being superimposed on the stunting burden in some countries. Coordination and Collaboration Coordination with all stakeholders continues to be important. The nutrition scale-up activities continue to be closely coordinated with all donor partners at the country level, including JICA as part of the SUN implementa- tion support, and at the global level. 10 2016-2017 Annual Report Program Management This section outlines the arrangements set up to ensure robust management of the Japan Trust Fund for Scal- ing Up Nutrition Investments program. Administration and Management Appropriate program management arrangements have been established in year 1 and rigorously adhered to in year 2 of the program. The Trust Fund is managed by the Nutrition Global Solutions Group within the Health, Nutrition and Population Global Practice (HNP GP). The Global Lead for Nutrition in the HNP GP serves as the Trust Fund Program Manager and is responsible for the oversight of the program and the day- to-day management of the Trust Fund. The Program Manager is supported by a team comprising a Senior Nutrition Specialist and an Operations Officer. The Program Manager ensures that requests for proposals are sent out to World Bank staff working on nutrition, the proposals are reviewed as per Japan Trust Fund criteria, and all activities are carried out and completed in accordance with WBG policies and procedures. Appropriate grant solicitation, review, and approval processes have been set up. Calls for proposals are solic- ited from across the World Bank. A three-member screening committee of internal World Bank technical experts has been established with the flexibility of co-opting additional member/s if necessary, but at least three persons collectively review, liaise with the task-teams to sharpen and refine proposals, and move the process along. The screening committee assesses the draft proposals based on the fit of the proposal with the objectives of the Japan Trust Fund, adherence to eligibility criteria approved by the HNP GP leadership, implementation within the Trust Fund’s timeline and link to WBG operations, and makes a collective decision to approve, reject, or send the proposal back to the team for revisions. To ensure that all proposals are well aligned to sector and country priorities, prior to submission to the screening committee proposals are required to be vetted by the respective Practice Manager and World Bank Country Director. Once approved, a child Trust Fund is set up under the main Trust Fund and funding is transferred to that account. Supervision and Monitoring Implementation, monitoring, and reporting are as per standard WBG supervision and management pro- cesses. The implementation of the Trust Fund components and activities are the responsibility of the World Bank task team leaders (TTLs) who manage individual grants to support global, regional, and/or specific coun- try work. All activities follow standard WBG global/regional/country supervision and management processes. Each TTL provides an annual progress update, and the Program Manager submits an annual progress report to the donor. All World Bank TTLs are advised to liaise closely with JICA in the respective countries, and most TTLs have adhered to this request. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 11 Summary of Progress This section provides an overview of the progress achieved in FY 17 (that is, July 1, 2016, through June 30, 2017), a year after the Trust Fund became effective. In this second year, 19 projects were approved for a total of 27 active projects. Their progress is detailed in Annex 1. In addition, 14 activities have been approved in principle. However, these remain to be funded because the revised Administrative Agreement has just recently been signed. With the signing of the revised agreement, these can now be immediately funded and initiated. In order to most effectively utilize the Trust Fund for Scaling Up Nutrition Investments, as part of the revised Administrative Agreement, the World Bank has requested a two-year extension of the Trust Fund’s final clos- ing date. Grants to Madagascar, Senegal, Nicaragua, and the Democratic Republic of Congo have all been completed; one in Nepal will close at the end of September 2017. Overview of Progress To date, 27 activities across 20 countries have been approved and most have begun implementation. The call for proposals from across the World Bank was made in December 2015 and continues to be open. Thirty-one proposals from task teams were received during the last fiscal year and, after a rigorous technical review against the established criteria, 19 of these proposals were approved, bringing the total commitment for 27 activities to US$4,386,003. Fourteen additional proposals have been received and are currently under review. If approved, these projects could add approximately US$3.5 million in commitments. Table 1 provides highlights of the grants approved thus far, including country, activity name, and funding allocations. Activities are strategic in nature, well aligned with the priorities of the Trust Fund, and support the planned results. Although some activities have been recently initiated, many could report progress, as described in the section below. The following points demonstrate that all activities are expected to contribute to results achieve- ment, and will contribute to the results reporting in the coming year. • All activities funded (and under processing) are in countries/regions with the highest burden of malnu- trition or address critical global issues such as obesity, Aflatoxins, and stunting. • Given the multisectoral nature of nutrition problems and the multisectoral focus of the SUN framework, most activities have an overarching focus on multisectoral/intersectoral work, such as Investment in the Early Years, agriculture and nutrition, and rural livelihoods and nutrition. • Of the 27 active projects, 12 are part of the first wave of Investing in the Early Years agenda, 16 are SUN countries, and 4 are part of JICA’s Initiative for Food and Nutrition Security in Africa. • Activities are strategic in nature and are aimed at influencing or supporting high-level results, such as influencing and strengthening nutrition programming including institutional arrangements, building capacity of governments, raising resources for nutrition, or filling knowledge gaps. There is notable leveraging of other activities and resources. For example, adding components to ongoing studies, impact evaluations, surveys, and mainstreaming into World Bank–supported projects enables building on ongo- ing work while adding value and complementing and leveraging resources from other sources. • The focus on expanding and strengthening SUN activities is strong. For example, 16 of the 27 active proj- ects are in SUN countries, and those that are not currently SUN members are being encouraged to join the SUN movement. 12 2016-2017 Annual Report Key achievements include: • The contribution of the Japan Trust Fund to the participation of country colleagues in the wider SUN movement: For example, the Japan Trust Fund–supported analytics for Rwanda have contributed to the development of two new IDA-supported projects—one in Social Protection, and another in Health, Nutri- tion and Population. • Early work done in Côte d’Ivoire was presented at the Consultative Group (CG) meetings in Paris in May 2016, where, for the first time, nutrition was included explicitly on the agenda and in speeches. At the CG, Côte d’Ivoire Prime Minister Daniel Kablan Duncan announced a dedicated nutrition round table to be organized in Abidjan in September 2016 for raising resources for the costed strategic plan for nutrition. For more details, please see the Côte d’Ivoire activity overview in Annex 1. During the past year several new activities have been initiated. In the initial year of the program, the first few months were devoted to establishing robust processes for the administration of the program, thus leaving a period of only seven months to request proposals, screen and fund the proposals following due processes, and initiate activity. In year 2, the stage was set for the initiation of many more activities and the commitment of much larger funds, especially as the work on stunting reduction is scaled up. Nineteen new proposals were reviewed and approved, bringing the total to 27 by the end of June 2017. Fourteen additional proposals were pending approval while the Administrative Agreement was being reviewed and revised to apply the World Bank’s new cost recovery provisions and to include the cost of World Bank staff time. This has been a major hurdle in fast-tracking the use of Trust Fund resources. The work plan for the coming year includes even more active engagement with the Africa and South Asia Regional Management Teams, as well as with the Global Solution teams in areas of relevance to nutrition—for example, Early Childhood Development, Agriculture, and Social Protection—to program the funds. Opportunities and Challenges Several opportunities to scale up Trust Funded activities exist and new ones have opened. Over the past two years, nutrition has emerged as an even greater priority than earlier at all levels within the World Bank, starting at the highest levels. There is strong commitment to addressing undernutrition across the globe. With strong leadership from the President of the World Bank, a new Bank-wide initiative on Investing in the Early Years (IEY) has been spearheaded. This initiative includes a strong focus on early nutrition, early learning/stimula- tion, and in using social protection mechanisms to scale up investments in nutrition and early learning. As a result of the high-level commitments, country demand for scaling up nutrition has increased signifi- cantly. In addition, several donors/partners are expressing strong support for this agenda. Among others, JICA launched IFNA at the Tokyo International Conference on African Development (TICAD) in Nairobi in August 2016. Just before TICAD, the SUN Workshop on Public Financing for Nutrition was held in Nairobi. The increased attention to nutrition means that the Japan Trust Fund can be even more strategic than was originally planned. At the Annual Meetings of the World Bank in October 2016, a high-level event led by WBG President Jim Yong Kim included the President of Côte d’Ivoire and seven Ministers of Finance from high-burden countries making commitments to investments in human capital. The SUN meeting in Nairobi was used as a preparatory event for this landmark event. The teams have since continued to work with countries to build a high-qual- ity IDA pipeline for nutrition. The World Bank Spring Meetings featured a high-level Spotlight on Nutrition: Unlocking Human Potential and Economic Growth event co-hosted by the World Bank and DfID, with leaders from Nigeria and Guatemala’s Finance Ministries, Tata Trusts, donor agencies (including Japan), and civil soci- ety speaking to the importance of investing in nutrition. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 13 The Japan Trust Fund for Scaling Up Nutrition Investments is now strategically placed to be catalytic both in encouraging these investments and in supporting the quality of these investments during their implementation. It is also important to address some challenges that have constrained the use of the Trust Fund. One key issue to highlight from last year’s Annual Report was that budget for staff time and travel was severely restricted under the original Administration Agreement. This has meant that World Bank task teams could not fully finance supervision of the grants. Thus some country teams preferred to access funds that allow for their full participation in the management of the activities. After discussions between the World Bank and the Government of Japan, the Administration Agreement has now been revised to apply the World Bank’s new cost recovery provisions and remove the cap on staff time. The revised Administration Agreement was signed in September 2017, so pending activities can now be approved and will begin implementation as soon as possible. However, given the delay in approving some activities, the World Bank is requesting a two-year extension to the end disbursement date for this phase to allow projects time to achieve progress toward objectives. 14 2016-2017 Annual Report Table 1: Japan Trust Fund for Scaling Up Nutrition Investments: Summary of Projects APPROVED COUNTRY OR IFNA IEY SUN PROPOSAL TITLE TRUST FUND REGION AMOUNT Laying the groundwork for more effective multisectoral action for the reduction $140,000 Africa Regional N N N of undernutrition in Africa Bangladesh N N Y Investigating nutrition-sensitive WASH in Bangladesh 254,000 Benin N N Y Preparing for the next phase of SUN in Benin 162,750 Central America/ The potential of food and nutrition policies and programs in Central America to $199,800 N N N Nicaragua prevent overweight and obesity among children and reproductive-age women Côte d'Ivoire N Y Y Institutional strengthening for nutrition programming and financing $197,200 Democratic Republic Improving the design and targeting in the understanding of the links between $199,500 N N Y of Congo WASH and stunting Egypt N Y N Toward an investment case on nutrition in Egypt $200,000 Effective interventions to prevent overweight and obesity and other diet-related $240,000 Global N N N risk factors for noncommunicable diseases Technical assistance facility to support World Bank client countries and staff in $143,300 Global N N N the design and implementation of fiscal policies to improve diets Supporting Investing in the Early Years for growth and prosperity in SUN $212,000 Global N N N countries Promoting better nutrition by strengthening links between cash transfers and $108,000 Global N N N parenting interventions India N Y N Process evaluation of the Jeevika Multisectoral Convergence Pilot in Bihar, India $187,700 Improving the oversight for and the quality of a multisectoral nutrition program $195,000 Indonesia N Y Y to reduce stunting rates in Indonesia Lao People’s Addressing demand-side constraints to improve nutrition outcomes in Lao PDR $190,000 N Y Y Democratic Republic Uncovering pathways of impact: Innovative measurement in the context of a $60,828.10 Madagascar Y Y Y large-scale nutrition impact evaluation Malawi Y Y Y Impact assessment of the Malawi Community Based Nutrition Project $102,250 Nepal N N Y Operational strategy for addressing malnutrition in Nepal $119,600 Nicaragua: Capacity building and cross-learning for nutrition-sensitive $25,000 Nicaragua N N N agriculture Advocacy and project preparation: Accelerating nutrition results in the Nigeria $269,500 Nigeria Y Y Y project Support for Peru's nutrition strategy to reduce high anemia and stunting in $179,500 Peru N N Y children under 36 months Rwanda N Y Y Scaling up nutrition in Rwanda: What will it take and how much will it cost? $148,300 Senegal Y Y Y Nutrition Investment Case: Senegal $120,200 Senegal Leveraging and preparing nutrition investments 182,500 Improving data management and use for early childhood health, nutrition, and $57,325 Seychelles N N N development in Seychelles Tajikistan N N Y Micronutrient status survey $199,500 Tanzania N Y Y Investigating nutrition-sensitive WASH in Tanzania $197,250 West & East Sahel / Nutrition, water, and climatic variability in the Sahel $95,000 N Y Y Niger Total Approved: 27 4 12 16 US$4,386,003.10 Note: IEY = Investment in the Early Years; IFNA = Initiative for Food and Nutrition Security in Africa; N = no; SUN = Scaling Up Nutrition; Y = yes. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 15 Annex 1: Overview of Approved Grants under TF072449 AFRICA REGIONAL: Laying the groundwork for more effective multisectoral action for the 1  reduction of undernutrition in Africa Implementation dates: 01/26/2017 to 03/31/2018 Grant amount: US$140,000 Project status: Ongoing This regional study will lay the groundwork for more effective multisectoral action on reducing stunting in countries in the Africa region by operationalizing the UNICEF conceptual framework. The long-run objective of this analytic work is to contribute toward enhancing the potential of success of sector-specific nutrition-sen- sitive and nutrition-specific initiatives. The team is currently undertaking a survey of impacts of nutrition-sen- sitive interventions. The aim is to contribute to a more solid basis of evidence for nutrition-sensitive interven- tions in sector-specific programs to provide a platform for expanding coverage in the population of stunted children and for strengthening the impacts of nutrition-specific interventions. Substantial progress has been made since the grant was approved. A meeting was held with the members of the advisory team to get feedback on how key variables from the Demographic and Health Survey (DHS) surveys were mapped to the four drivers of undernutrition in the UNICEF conceptual framework. Drafts of the country briefs have been prepared for the first-wave countries in Sub-Saharan Africa; these were shared with the World Bank’s Human Development Director and feedback was solicited (and received) from country teams. A presentation with the main results has been shared with the World Bank’s Africa Region Chief Economist’s Office for feedback. An additional component was added to the analysis regarding the impact of rainfall-re- lated shocks during the growing season in rural areas of Sub-Saharan African countries on the incidence of child diarrhea and child height-for-age Z-score measures. 2 BANGLADESH: Investigating nutrition-sensitive WASH in Bangladesh  Implementation dates: 12/01/2016 to 05/31/2018 Grant amount: US$254,000 Project status: Ongoing The objectives of this research are (a) to generate new evidence on the links between Water, Sanitation and Hygiene (WASH) interventions and vectors of fecal contamination and (b) to strengthen the evidence between WASH and health and nutritional outcomes in urban environments. BENIN: Preparing for the next phase of SUN in Benin 3  Implementation dates: 06/30/2016 to 12/24/2018 Grant amount: US$162,750 Project status: Ongoing The objective of this grant is to support the government in identifying best and replicable practices that can be applied to a range of pressing policy concerns including gender mainstreaming, multisectoral coordination, and resilience building. 16 2016-2017 Annual Report CENTRAL AMERICA/NICARAGUA: The potential of food and nutrition policies and 4  programs in Central America to prevent overweight and obesity among children and reproductive-age women Implementation dates: 11/03/2016 to 03/01/2019 Grant amount: US$199,800 Project status: Ongoing The main objective of the grant is to assess the impact of current economic policies on obesity in Costa Rica, Guatemala, El Salvador, Nicaragua, Panama, and Honduras. This objective includes the following components: (a) to assess the potential impact of fiscal policies on the consumption of sugar-sweetened beverages and/or food products that are high in calories and nutrient poor, and on health outcomes in Central American coun- tries; (b) to assess the impact of food trade agreements and food marketing policies on nutrition; and (c) to propose national or subregional policies to address the main drivers of obesity, namely the availability of food with low nutritional value, publicity about these foods, and the low price of these products. Progress made toward objective (a): The assessment of the potential impact of fiscal policies on the consump- tion of sugar-sweetened beverages and/or high-calorie and nutrient-poor food products, and on the health outcomes in Central American countries, is under way. One additional country has been added to the study: Dominican Republic. Progress made toward objective (b): Advances have taken place to assess the impact of food trade agreements and food marketing policies on nutrition, and preliminary studies with the identification of the trade policies are in place. Background studies have been commissioned; these will provide information regarding the impact of trade agreements and marketing policies on nutrition as well as their effect on consumer behavior and the incidence in obesity within the targeted countries. 5 CÔTE D’IVOIRE: Institutional strengthening for nutrition programming and financing Implementation dates: 01/24/2016 to 01/31/2018 Grant amount: US$197,200 Project status: Ongoing The objective of this grant is to support the government in its efforts to increase the efficiency and effectiveness of multisectoral service delivery and nutrition financing in Côte d’Ivoire. Among the outcomes expected from this program are (a) strategic diagnostics for improved nutrition outcomes and (b) advice to the Ministry of Health and the Prime Minister's Office on issues related to the design and implementation of nutrition policy in Côte d'Ivoire. 6 DEMOCRATIC REPUBLIC OF CONGO: Improving the design and targeting in the understanding of the links between WASH and stunting Implementation dates: 08/22/2016 to 06/30/2017 Grant amount: US$199,500 Project status: Closed The objective of this grant was to collect empirical evidence on the relative importance of WASH and related factors in stunting outcomes in the Democratic Republic of Congo in order to improve the design and prioriti- zation of future interventions in both the human development and social development sectors. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 17 7 EGYPT: Toward an investment case on nutrition in Egypt Implementation dates: 12/01/2016 to 06/30/2018 Grant amount: US$200,000 Project status: Ongoing The development objective of this grant is to document progress, remaining challenges, and opportunities and costs to inform a new nutrition strategy beyond 2017, and to guide and justify nutrition investments over the next five years by the World Bank and partners in Egypt. Great progress has been made in the development of the investment case, and the process is very much government driven. Some draft chapters have been pro- duced. UNICEF is a close collaborating partner. Implementation is on track, although commencing the invest- ment case took longer than expected, largely because of the time it took to gather partner support. GLOBAL: Effective interventions to prevent overweight and obesity and other diet-related risk 8  factors for noncommunicable diseases Implementation dates: 03/01/2016 to 11/30/2017 Grant amount: US$240,000 Project status: Ongoing The objectives of this grant are (a): to provide an overview of the overweight and obesity epidemic around the world; (b) to take stock of interventions that work to prevent overweight and obesity as well as other interven- tions aimed at improving diets (e.g., to decrease the intake of sodium, sugar, and trans fat); (c) to examine the challenges involved in implementing these policies/interventions; and (d) to assess what are the most suitable World Bank instruments to support countries in the prevention of overweight and obesity. Much progress has been made in achieving the grant objectives. The team has already taken stock of what is known about the underlying causes of the obesity epidemic and the interventions that work for its prevention. Similarly, the work of several case studies has already provided some initial insights on the challenges of designing and implementing these policies and what factors have favored them. Finally, the team has a better understand- ing of the obesity prevention interventions that have already been supported by the Bank and it is working to understand how the World Bank can better support these efforts. All the activities supported by the grant have already been initiated and some are very advanced: (a) most of the literature reviews have been completed; (b) all nine country case studies have been initiated; (c) the data analysis to understand the profile of the epidemic globally is advanced and the data analysis to understand the epidemic in the selected nine countries is about to start; and (d) the database of all World Bank activities that have supported interventions for the prevention of obesity is well advanced. GLOBAL: Technical assistance facility to support World Bank client countries and staff in the 9  design and implementation of fiscal policies to improve diets Implementation dates: 01/30/2017 to 03/31/2018 Grant amount: US$143,300 Project status: Ongoing The grant objectives are to develop a technical assistance facility at the World Bank to increase institutional capacity to respond to and support client countries in developing fiscal policies concerning sugar-sweetened beverages and calorie-dense foods with low nutritional value to reduce consumption and promote public health. The activities financed through this grant aim at understanding what is needed to implement fiscal policies to improve diets; these are policies that are multisectoral in nature since they require the participation of ministries of finance and health as well as ministries in other sectors such as agriculture and trade. The grant 18 2016-2017 Annual Report activities also aim at sharing lessons across countries on the implementation and scale-up of these policies. This grant will finance, among other things, a meeting of experts to discuss a conceptual framework for the design and implementation of taxes to improve diets. Many of the activities in preparation for this meeting have already started. There is already a consultant preparing the background paper for the meeting. In addition, the team has already prepared a list of possible participants and has discussed the meeting with some of them. In addition, the team has met with different World Bank staff from the Health, Nutrition and Population Global Practice as well as from the Macroeconomic and Fiscal Management Global Practice regarding the objectives and logistic of the meeting as well as the objective of the overall grant. 10 GLOBAL: Supporting Investing in the Early Years for growth and prosperity in SUN countries Implementation dates: 08/16/2016 to 03/08/2019 Grant amount: US$212,000 Project status: Ongoing The objective of this grant is to support the expansion of the scale, scope, and coverage of key nutrition inter- ventions in Scaling Up Nutrition (SUN) countries with high stunting burden as part of the Investing in the Early Years (IEY) initiative. The grant will further this agenda by disseminating information about IEY, provid- ing technical assistance for World Bank client countries, and contributing to the development and scale-up of World Bank operations. There are two components under this grant. For component 1, the grant has financed a session on the IEY initiative during the SUN nutrition financing workshop. For component 2, the grant is financing two sets of technical assistance activities related to the IEY initiative: cost data collection and effi- ciency analysis for Tanzania and the development of the monitoring and evaluation framework for the national multisectoral plan in Côte d’Ivoire. The key outcomes achieved from April 2016 through March 2017 include a session on the IEY initiative during the SUN workshop on nutrition financing in Nairobi, Kenya. During the workshop, the World Bank held a plenary presentation on the initiative and a working session with delega- tions from eight African IEY countries. The grant has also financed a South-South exchange led by the SUN secretariat between Côte d’Ivoire and Senegal. The objective of the exchange was to share Senegal's experiences in implementing a multisectoral community nutrition program with a multisectoral team from Côte d’Ivoire, including representatives from the National Nutrition Council and its Permanent Technical Secretariat, and representatives from the Ministries of Health, Finance, Planning, and Interior. This exchange is informing the preparation of the new World Bank operation in Côte d’Ivoire, because lessons from Senegal are being used to design a community nutrition program that will be financed through the operation. 11 GLOBAL: Promoting better nutrition by strengthening links between cash transfers and parenting interventions Implementation dates: 04/17/2017 to 05/31/2018 Grant amount: US$108,000 Project status: Ongoing The project objective is to identify scalable, low-cost models that use cash transfer programs to provide nutri- tion-focused parenting interventions, drawing particularly on behavioral insights and models. The grant was approved in April 2017 and implementation has begun. Short case studies of Social Protection & Jobs contribu- tions to the Early Years were drafted for five countries (Mexico, Bangladesh, Madagascar, Senegal, and Indo- nesia). These were presented in a panel for the World Bank’s Human Development Week 2017 and will be the basis for the larger knowledge product financed by this grant. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 19 12 INDIA: Process evaluation of the Jeevika Multisectoral Convergence Pilot in Bihar, India Implementation dates: 03/02/2016 to 12/31/2018 Grant amount: US$187,700 Project status: Ongoing The objective of the process evaluation (which complements an ongoing impact evaluation) is to generate evidence to fill operational and knowledge gaps, particularly about how and to what extent institutional structures such as self-help groups (SHGs) contribute to improving (a) the convergence of health, nutrition, food security, and sanitation interventions on vulnerable households; and (b) maternal, infant, and young child feeding, caring, and Water, Sanitation and Hygiene (WASH) practices. The overall progress toward achieving grant objectives, as assessed by the World Bank team, is satisfactory. This grant supports a process evaluation to complement the ongoing impact evaluation of a Multisectoral Convergence (MC) pilot that uses the women’s SHG platform to improve nutrition outcomes. The process evaluation aims to generate information to assess the processes through the full chain of the pilot implementation in order to inform the pathways to impact and the role that the SHG institutional structures can play in (a) improving nutrition, food security, health, and WASH behaviors; and (b) assessing processes, quality, and the timeliness of inputs to promote behavior change as well as to enable better access for members of SHGs to existing public services to improve food security and nutrition. The pathways to impact have been fully mapped, with details of inputs, input providers, and the conditions for expected outcomes. This has ensured that the full range of stakeholders and all critical factors influencing the expected outcomes are covered. Appropriate tools were designed and tested to ensure that all relevant information along the spectrum of the impact pathways is obtained and all processes, capacities, and quality are assessed. The quality of the process evaluation has been ensured by engaging a credible and well-re- spected research agency—the International Food Policy Research Institute—that has expertise and experience in conducting several process evaluations; furthermore, the data collection team was appropriately trained and supervised by the research agency, and the World Bank team exercised the needed oversight over the develop- ment and pre-testing of tools and data collection in the field. 13 INDONESIA: Improving the oversight for and the quality of a multisectoral nutrition program to reduce stunting rates in Indonesia Implementation dates: 04/15/2017 to 01/31/2019 Grant amount: US$195,000 Project status: Ongoing This grant supports the implementation of Multisectoral Nutrition Framework and Action Plan (MNFAP), which is one of the pillars of the World Bank’s multisectoral engagement for nutrition in Indonesia over the next five years. The grant also leverages ongoing World Bank lending operations that prioritize nutrition outcomes (such as the reduction of stunting) and complements other funding sources. The grant is still at an early stage of implementation. It has been used to support the policy dialogue on operationalizing a convergence approach that connects and integrates all nutrition-specific and nutrition-sensitive programs and to build the necessary enabling environment for a coordinated and multisectoral response. Additionally, the grant has been used to support follow-up of the Peru study tour visits that help build common awareness and vision for applying new promising approaches for enhancing impact at scale. Such approaches focus on (a) using results-based budgeting to leverage large-scale intergovernmental fiscal transfers; (b) changing behavior, including securing a commitment from the highest level to raise awareness at the local and household levels; (c) building the capacity of local governments and establishing mechanisms to engage them better; and (d) reforming social and behavioral change communi- cation toward a more integrated approach that focuses on interpersonal communication and the use of informa- tion and communication technologies. The grant has contributed to the formulation of a Road Map for Nutrition Improvement Acceleration Program through technical inputs and knowledge sharing of global good practices on the convergence approach, particularly in aligning the demand-side, supply-side, and financing incentives to leverage nutrition results. The grant has also supported an initial engagement with Alive & Thrive on social and behavioral change communication, which is one of the key components of the Road Map. 20 2016-2017 Annual Report 14 LAO PEOPLE’S DEMOCRATIC REPUBLIC: Addressing demand-side constraints to improve nutrition outcomes in Lao PDR Implementation dates: 08/18/2016 to 01/31/2018 Grant amount: US$187,700 Project status: Ongoing The primary objective of this grant is to identify practical approaches to addressing demand-side constraints to improving nutrition outcomes in the Lao PDR. The secondary objective is to facilitate knowledge transfer so the government can learn from international experience. 15 MADAGASCAR: Uncovering pathways of impact: Innovative measurement in the context of a large-scale nutrition impact evaluation Implementation dates: 03/20/2016 to 04/30/2017 Grant amount: US$60,828.10 Project status: Closed The objective of this grant was to collect specialized data on biomarkers and child development in the context of a large-scale impact evaluation of a nutrition and child development intervention during the first 1,000 days in Madagascar. These resources contributed to the data collection efforts for the endline survey of the Chronic Malnutrition and Early Stimulation pilot in Madagascar. The objectives of the grant were fully achieved. A 5-arm randomized control trial pilot, initially funded by the World Bank’s Strategic Impact Evaluation Fund (SIEF), was designed to enhance the existing platform of the community-based program in Madagascar. The status-quo program (a community growth promotion program) was compared with four treatment variants that offer enhanced intensity and have differing costs: (a) intensified nutrition counseling through home visits; (b) intensified nutrition counseling combined with lipid-based supplementation to children 6–18 months of age, (c) intensified nutrition counseling combined with lipid supplementation to pregnant/lactating mothers and children 6–18 months of age, and (d) intensified nutrition counseling in addition to home visits for early stimulation for children. A baseline survey was administered in June–August 2014, with the different inter- ventions started in September 2014. A midline survey was administered after one year in 2015 and an endline survey was planned two years after baseline, in 2016. The funding aimed to add in-depth nutrition biomarkers and direct child assessments to a subsample of communities and children to the endline household survey. 16 MALAWI: Impact the assessment of the Malawi Community Based Nutrition Project Implementation dates: 02/20/2017 to 07/30/2018 Grant amount: US$102,250 Project status: Ongoing The development objective of this grant is to assess impact of the World Bank–supported integrated communi- ty-based nutrition program in Malawi. Malawi is one of the 22 first-wave Investing in the Early Years coun- tries. Since 2012 the country has been implementing a World Bank–supported integrated community-based nutrition program with the primary goal of reducing childhood stunting. The program combines interventions and activities aiming at enhancing (a) infant and young child nutrition (IYCN) practices; (b) home-based care and care seeking for common infectious diseases; (c) hygiene and the utilization of safe water and sanitation; (d) the prevention of parasitic infections; (e) iron intake by women and children; (f) dietary intake by women before, during, and after pregnancy; (g) household care of pregnant women and the utilization of antenatal services; (h) increased spacing of pregnancies for mothers postpartum; and (i) adequate weight gain in children under two and pregnant women. The progress toward the achievement of the grant objectives is on track. One Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 21 technical mission was carried out in April 2017, which provided inputs to a concept note development that is now being reviewed. The findings of this study will further inform the government and increase its inter- est in allocating additional domestic financing for nutrition; it will also encourage the World Bank and other donors to scale up financing to implement the project at scale. In addition, the findings of this study will inform government and donors about a necessary course correction of the current program and about which of the program elements are likely to have contributed to the program’s success. The outcomes of the planned impact assessment study will be disseminated through multiple channels including in-country seminars, international symposiums, and journal articles. 17 NEPAL: Operational strategy for addressing malnutrition in Nepal Implementation dates: 03/01/2016 to 10/31/20 Grant amount: US$119,600 Project status: Ongoing The grant’s development objective is to help the Government of Nepal enhance its national nutrition response. The intended research will review the political economy, institutional structures, and implementation arrange- ments currently in place in Nepal to address malnutrition. It will also identify constraints and make recommen- dations related to the delivery of nutrition projects in the country. The project has produced a report, Study of Operational Strategies to Reduce Malnutrition in Nepal, based on a qualitative analysis of the various nutrition and food security projects in Nepal. The findings relate to the political economy, the current implementation, and the institutional structures of the projects, leading to an identification of bottlenecks of implementation. The study provides recommendations for future nutrition projects/programs under different thematic areas includ- ing technical approaches, targeting mechanisms, financial management, institutional structure, collaborations, and monitoring and evaluation. The grant was intended to finance a qualitative study that included activities such as in-depth interviews, focus group discussions, and dissemination of findings in an evidence synthesis workshop. The grant also financed the hiring of a short-term consultant to help in the research. 18 NICARAGUA: Capacity building and cross-learning for nutrition-sensitive agriculture Implementation dates: 10/30/2016 to 06/23/2017 Grant amount: US$25,000 Project status: Closed This grant was intended to improve knowledge about nutrition-sensitive agriculture among public sector insti- tutions and local organizations on the Caribbean Coast of Nicaragua. 19 NIGERIA: Advocacy and project preparation: Accelerating nutrition results in the Nigeria project Implementation dates: 03/20/2017 to 07/20/2019 Grant amount: US$269,500 Project status: Ongoing The development objective of this grant is to build commitment for domestic and foreign investments to accelerate nutrition results in Nigeria and to increase the quality of preparation of a new IDA-financed project. The World Bank, in collaboration with the Bill & Melinda Gates Foundation, conducted in 2014 an analysis that generated the Costed Plan for Scaling Up Nutrition: Nigeria (World Bank 2014). The report identifies a set of high-priority interventions based on global evidence and Nigerian implementation experience, and estimates 22 2016-2017 Annual Report the benefits that would accrue from this investment. It also presents various scale-up scenarios. That analy- sis has generated interest—among certain stakeholders in Nigeria and within World Bank management—in exploring the possibility of developing a US$350 million IDA investment to address Nigeria’s malnutrition challenges. This project would likely prioritize a set of nutrition-specific interventions because the coverage of these interventions remains very low. At the same time, Nigeria is one of the 22 first-wave countries for the Investing in the Early Years initiative. A preliminary analysis of the portfolio has been carried out, but more thorough engagement with the key sectors will be required to enhance the nutrition sensitivity of the overall World Bank portfolio in the country. There is considerable donor interest for nutrition in Nigeria and the World Bank is developing a multi-donor trust fund to enhance the quality of the implementation of the US$350 mil- lion project as well as to catalyze nutrition-sensitive investments in key sectors such as agriculture, social pro- tection, education, and water/sanitation. Although the pace of activity is low, it is proceeding at a satisfactory pace given that the grant was activated recently and a number of grant-financed activities are underway. The pace of grant implementation is in line with the pace of the preparation of the project it is meant to support. 20 PERU: Support for Peru’s nutrition strategy to reduce high anemia and stunting in children under 36 months Implementation dates: 12/30/2016 to 04/30/2018 Grant amount: US$179,500 Project status: Ongoing The grant’s development objective is to (a) increase knowledge about the determinants and prevalence of ane- mia in targeted areas; and (b) improve the quality of nutrition services in targeted areas by adapting or devel- oping strategies tailored to each territory (urban, rural, indigenous). The activities financed through this grant are expected to complement the ones developed by the current Juntos Results for Nutrition project, as well as to provide valuable information on an eventual new engagement with the Government of Peru on the subject. Several studies would be commissioned, including assessing which elements of service delivery should be modified to improve nutrition outcomes in the targeted areas (focusing on Control de Crecimiento y Desarrollo, or CRED, and the acceptance of micronutrients), and exploring the factors that could explain the persistent high levels of anemia in the Amazon region. In addition, the grant has also contributed to disseminating the experi- ence of Peru, which halved stunting rates in less than a decade. Lessons learned are of great relevance for other middle-income countries facing similar challenges. Activities included: (a) The production of a short video, co-financed by the grant, that updated testimonies from a previous video produced 10 years ago with small children and their families in communities where the strategy to tackle malnutrition was about to be launched. (b) A country-level workshop to disseminate part of the findings and to share lessons from the implementation of the above-mentioned project that was organized in Lima on June 5, 2017. (c) As part of the process of sharing lessons from Peru, a field visit by high-level multisectoral delegations from Indonesia, Cameroon, and Mad- agascar took place from April 24–28, 2017. This was co-financed by the Investing in the Early Years initiative and organized by the Ministry of Finance. As part of the activities supported through this grant, the team is supporting the Ministry of Health in Peru (MINSA) in the elaboration of a national campaign against anemia. The different components of the campaign are currently under development and will be ready to be shared by mid-September 2017. Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 23 21 RWANDA: Scaling up nutrition in Rwanda: What will it take and how much will it cost? Implementation dates: 04/14/2017 to 08/31/2019 Grant amount: US$148,300 Project status: Ongoing The development objective of this grant is to support the Government of Rwanda in identifying and costing alternative packages of cost-effective nutrition interventions for national scale-up. The analysis of trends and determinants of stunting has been completed and is serving as an input into the design of a social protection operation and a new health/nutrition investment project. During high-level discussions between the president of the World Bank and the president of the Republic of Rwanda, a decision was taken to spearhead a major new initiative to dramatically reduce stunting and progress toward elimination. The Ministry of Economy and Finance has now agreed to dedicate US$25 million toward the financing of a new IDA Rwanda Stunting Pre- vention and Reduction Project. 22 SENEGAL: Nutrition Investment Case: Senegal Implementation dates: 01/01/2016 to 06/30/2017 Grant amount: US$120,200 Project status: Closed The objective of this grant was to (a) generate new understanding of successful policy development processes by documenting lessons learned from over 10 years of SUN-styled nutrition policy development and imple- mentation; and (b) support the government in its vast and comprehensive multisectoral policy development process with studies and technical assistance that culminated in the delivery of a nutrition investment case. 23 SENEGAL: Leveraging and preparing nutrition investments Implementation dates: 05/30/2017 to 12/31/2018 Grant amount: US$182,500 Project status: Ongoing This grant will contribute to the following: (a) wide and effective dissemination (including a high-level Round Table event) of the Multisectoral Nutrition Strategic Plan, the series of seven thematic studies plus the Indepen- dent Evaluation Group evaluation report of a decade-long IDA support to nutrition, and the Nutrition Invest- ment Case to raise the visibility of and resources for nutrition in a multisectoral context; (b) follow-on advisory services regarding the development of a financing plan, a communication plan, and a monitoring and evalua- tion framework for nutrition in a context of multisectoral planning, implementation, and monitoring; and (c) preparation of the upcoming Investing in the Early Years and Global Finance Facility operations that entered the pipeline as a result of the analytical works and technical assistance finance under the first grant to Senegal. In pursuing this agenda in support of Scaling Up Nutrition in Senegal, the team will coordinate with other development partners by complementing the support of government and leveraging resources for technical assistance, capacity building, and investments. 24 SEYCHELLES: Improving data management and use for early childhood health, nutrition, and development in Seychelles Implementation dates: 06/19/2016 to 12/31/2017 Grant amount: $57,325 Project status: Ongoing 24 2016-2017 Annual Report The development objective of this grant is to establish structures and procedures for collection, management, and use of data related to early childhood health, nutrition, and development. A Child Health & Nutrition Indi- cator Collection manual was developed. 25 TAJIKISTAN: Micronutrient status survey Implementation dates: 10/10/2016 to 10/31/2017 Grant amount: US$199,500 Project status: Ongoing This grant will help co-finance the 2016 Micronutrient Survey in Tajikistan with UNICEF. The survey will help analyze the status of micronutrient deficiency in Tajikistan. Based on the findings of the survey, recommenda- tions will be distilled regarding priority actions to improve nutrition status of mothers and children. 26 TANZANIA: Investigating nutrition-sensitive WASH in Tanzania Implementation dates: 10/15/2016 to 5/31/2018 Grant amount: US$197,250 Project status: Ongoing The objectives of this research are to (a) generate new evidence of the relationship between WASH and health and nutritional outcomes and (b) inform WASH policy and programming about how to be more health and nutrition sensitive. 27 WEST AND EAST SAHEL REGION/NIGER: Nutrition, water, and climatic variability in the Sahel Implementation dates: 08/31/2016 to 04/30/2018 Grant amount: US$95,000 Project status: Ongoing The objective of this grant is to improve the design and prioritization of future interventions in both the human development and social development sectors by providing robust empirical evidence of the magnitude, inter- action, and relative importance of water and sanitation access, rainfall and climate shocks, and related factors to stunting outcomes in the Sahel. The research undertaken is responding to the objectives of grant but has also ventured beyond to integrate and connect issues such as the role of groundwater storage and productiv- ity—a role that is particularly notable in the event of climatic shocks (particularly droughts). In going beyond the objectives of the grant, the research will contribute to the expansion of the understanding of the spatial dimension of malnutrition and inform policy makers about geographical areas where certain types of water interventions may contribute to better nutritional outcomes. Following a period of important data preparation and organization during the early stages of the year, initially focused on Niger and Mali as a starting point and extended to the rest of Africa with all available Demographic and Health Survey (DHS) data sets by May 31, the analysis is close to completion. The analysis has also been extended to include groundwater data, providing a newer take on the food security/water/agriculture nexus and the areas of high malnutrition where irrigation potential appears to be underused and that could be priority areas for this type of intervention in through an integrated nutrition approach.   Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 25 Annex 2: Activities to be Funded under the Japan Trust Fund for Scaling Up Nutrition Investments The activities (which may be described as “components” of activities) to be financed by the Trust Fund and for which the World Bank has implementation responsibility consist of the following types of undertakings and products: I. Expanded Catalytic Activities A. Technical Assistance 1. Carrying out diagnostics, analysis, and synthesis of current country nutrition situations, encompassing inter alia mapping of nutrition projects and programs, national nutrition policies 2. Developing national nutrition scale-up plans (costed) in an additional four to six high-burden countries 3. Developing integrated nutrition communication advocacy plans 4. Delivering training and capacity development, including: • Health worker capacity assessments • Development of health worker nutrition training materials (e.g., video) for all levels (community through national) • Knowledge sharing through at least one South-South knowledge exchange event such as a regional conference 5. Providing technical coordination and quality assurance for Trust Fund–supported activities B. Policy Dialogue and Project Preparation for Nutrition Components and Projects 1. Formulating reports about preparation for policy dialogue, including, inter alia, on costing analyses of scaling up nutrition programs/interventions, options for institutional and financial flows for efficient delivery of nutrition services, and planning for domestic and other resource mobilization 2. Preparing projects proposed for World Bank financing in four to six additional high-burden countries II. Generation of New Knowledge Pilot Testing of Innovate Approaches and Best Practices for both Nutrition-Specific and A.  Nutrition-Sensitive Interventions/Approaches 1. Consolidating the pilot testing activities carried out under Phase I of the Trust Fund for Scaling Up Nutrition Investments, encompassing, inter alia, testing of (a) alternative approaches for private sector investment in food supplement production; (b) adaptations for more effective delivery of 26 2016-2017 Annual Report community-based growth promotion programs through improved service provision; and (c) the effec- tiveness of social transfers (food or cash) to reduce child undernutrition 2. Developing, testing, and monitoring/evaluating new innovative approaches to achieve improved nutri- tion outcomes at scale  issemination of the Results of the Activities Carried Out under Phase II of the Trust B. D Fund for Scaling Up Nutrition Investments, including, inter alia: 1. Developing materials, reports, blogs, and other communication tools suitable for uploading across the full range of World Bank Group websites and knowledge hubs with the aim of disseminating the results of the activities financed by the Contribution, and creation of a subsite on the SecureNutrition Knowl- edge Platform website to feature the work and results of said activities 2. Hosting seminars/knowledge dissemination events on the World Bank premises as well as at in-country offices and other venues to present the results of the activities financed by the Contribution to World Bank Group staff and stakeholders, jointly with the Japan International Cooperation Agency when possible III. Support of the Work of the SUN Movement Support the Implementation of the SUN Movement in Consultation with the SUN Secre- A.  tariat, SUN Country Focal Points, and the SUN Donor Partner Network, including through activities such as: 1. Providing technical assistance to the SUN Donor Partner Network and/or SUN Secretariat, as needed, for the review of proposals and technical documents, the development of plans for improved/expanded aid architecture, and other related activities 2. Providing technical assistance, capacity building, costing of national nutrition plans, and other related activities in SUN countries that aim to scale up national nutrition plans 3. Disseminating new approaches for effective integration and delivery of multisectoral approaches to nutrition to SUN countries Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 27 Annex 3: Results Framework: Phase II OVERALL ACTIVITIES JAPAN TRUST FUND–SUPPORTED INDICATORS TO MEASURE SUCCESS AND OUTPUTS ACTIVITIES Prepare additional country plans to scale up nutrition Develop scale-up plans in additional countries Scale-up plans developed or strengthened in 4–6 interventions SUN or other high-burden countries Prepare new projects for scaling up nutrition Prepare for policy dialogue and project preparation International Development Association project preparation under way in 4–6 SUN or other high- burden countries Strengthen capacity for nutrition program Support efforts to build capacity to support national Knowledge-sharing and capacity development development, service delivery, program management, nutrition program scale-up plans efforts supported in 4–6 SUN or other high-burden and supervision in SUN countries and other high- countries burden countries Test innovative approaches for effective Support pilot efforts to test innovative approaches Innovation pilots implemented in at least 3 SUN or implementation of nutrition-specific and nutrition- for effective implementation of nutrition-specific and other high-burden countries sensitive interventions and approaches, including nutrition-sensitive approaches through a variety of engagement with the private sector sector delivery channels Disseminate results of the Japan Trust Fund–supported Design and implement knowledge-sharing and Knowledge dissemination strategy developed; activities through a variety of media and knowledge communications strategies to disseminate results of SecureNutrition Knowledge Platform subsite for the dissemination outlets the Japan Trust Fund through the World Bank Group’s Japan Trust Fund established; Results of Trust Fund websites and knowledge platforms, including the activities shared through at least two additional development of a subsite on the SecureNutrition channels/platforms (e.g., the World Bank Group and Knowledge Platform other partner external websites) Support the implementation of the SUN movement to Support the implementation of the SUN global Support for the SUN global movement through such boost global progress in the reduction of malnutrition movement through activities that may include funding illustrative actions as providing travel support to in consultation with the SUN Secretariat, SUN country country participation in SUN meetings/consultations SUN country focal points to attend an annual global focal points, and the SUN Donor Partner Network, and disseminating new approaches for the effective gathering among others integration of multisectoral approaches to nutrition in SUN countries, among other countries 28 2016-2017 Annual Report Annex 4: Criteria for Applications to the Japan Trust Fund for Scaling Up Nutrition Investments A. Criteria for regional and country inclusion: 1. Regions a. Regions where the greatest numbers of children are affected, i.e., Africa and South Asia will be prior- itized. However, countries in other high-burden regions, including both IDA and IBRD countries are eligible. 2. High burden countries that have one or more of the following characteristics: a. Child stunting rates > 30% b. Child wasting rates > 10% c. Childhood overweight rates > 10% or maternal overweight > 40% d. Micronutrient deficiency rates of high public health significance based on WHO classifications Selected countries will be encouraged to join the SUN movement if they are not already SUN members. 3. Both IDA and IBRD countries are eligible. 4. Only in exceptional cases, countries with lower national burden may be included, if the lessons from that country work could serve as a model for other high-burden countries or for global policies. In such cases, demonstrated country/global demand and opportunities for sharing lessons will be essential. 5. Alternatively, exceptions may be made if there are large subnational differences and large numbers of children at the subnational level are affected (the overall number of children affected remains an import- ant criterion) with prevalence rates similar to those listed under #2 above, and if there is strong potential for linking with pipeline operations. B. Activities to be financed: 1. Knowledge creation a. Advisory Services and Analytics on critical issues relevant to the nutritional epidemiology of the country b. Operationally relevant knowledge that can address service delivery challenges and/or bottleneck analyses to support the scale-up of high impact interventions through Health, Nutrition and Popula- tion; Social Protection; Agriculture; early childhood education, and WASH sectors c. Decision and delivery science issues relevant to national and global contexts d. Economic and financing analytics as well as technical and allocative efficiencies at global and country levels Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 29 e. Evaluations, including impact evaluations, project evaluations, process evaluations, and evaluations of training/capacity development—all evaluations should link to scale-up plans and/or World Bank operations f. Capacity assessments and capacity strengthening linked to pipeline/ongoing operations (if not cov- ered by IDA/IBRD sources) g. Global public goods such as regional assessment of nutrition burden, regional strategies, new knowl- edge generation, and so on h. Strategic support to the SUN movement at global and national levels (with specific and defined outputs) 2. Knowledge sharing events/fora/communications a. With SUN member countries, partners, civil society organizations, and so on b. Across sectors: with agriculture, social protection, early childhood development, and WASH c. Nutrition communications and advocacy 3. Technical assistance to client countries a. Based on demonstrated demand from client countries b. Technical assistance for business generation in SUN countries 4. Project preparatory work for new/pipeline operations in high-burden countries a. Policy dialogue b. Preparation of nutrition components/projects c. Pilot activities: innovative approaches for nutrition-specific and nutrition-sensitive interventions; these should be directly linked to ongoing or pipeline operations C. Timeline: Not to exceed 30 months Total costs: Except in exceptional cases that will need to be very tightly justified, TTLs are D.  requested to keep budgets within the range of US$100,000–US$200,000 E. Process: 1. Task team leaders (TTLs) are required to fill in a one-page form 2. The screening committee will screen, shortlist, and approve a concept on a conditional basis, pending a sector and Country Management Unit (CMU) review of the concept note (this step is very important and the only way sector and CMU involvement and buy-in can be obtained). Clearance by the regional Practice Manager and/or Director (for global activities) will be essential. 3. Applications will be accepted on a rolling basis for the first year. Wherever feasible, decisions will be made within 2–3 (working) weeks of submission. 30 2016-2017 Annual Report 4. TTLs are responsible for sector and CMU approval following due processes for Advisory Services and Analytics/operations Japan Trust Fund: Second Phase of Scaling Up Nutrition Investments 31