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Draft Design and Monitoring Framework Project Number: 38117 September 2006 INO: Nutrition Improvement through Community Empowerment A design and monitoring framework is an active document, progressively updated and revised as necessary, particularly following any changes in project design and implementation. In accordance with ADB’s public communications policy (2005), it is disclosed before appraisal of the project or program. This draft framework may change during processing of the project or program, and the revised version will be disclosed as an appendix to the report and recommendation of the President. DESIGN AND MONITORING FRAMEWORK Design Performance Data Sources/ Reporting Assumptions Summary Targets/Indicators Mechanisms and Risks Impact Improved nutrition status • Prevalence of underweight • National Social and Assumptions of children under-five children under 5 years Economic Survey • Government policies and years of age and pregnant reduced from 28% in 2005 to (SUSENAS), Nutrition budget support the reduction and lactating women. less than 20% by 2012a Component 2011 of malnutrition among at-risk populations • Prevalence of wasting among • Food and Nutrition children under 5 years Surveillance System • Government budgets are reduced from 15.5% in 2005 allocate to cost-effective to below 10% in 2012 interventions • Prevalence of anemia among Risk pregnant women reduced • Local government does not from 40% in 2005 to 30% in maintain levels of expenditure 2012 for nutrition • Prevalence of anemia among children under 5 reduced from 48% in 2005 to less than 35% in 2012 • Prevalence of infants born less than 2500grams reduced from 10% in 2005 below 5% in 2012 Outcome Improved utilization and • Number of children 0 to 5 • Health & Development Assumptions quality of nutrition years attending posyandu Research Institute 2007 • Women utilize improved programs and services for during last month increases National Nutrition Survey nutrition services and adopt at-risk women and from 48.5% (2005) to 75% in (to provide baseline data) better child feeding and child children in 6 project 2012 care practices provinces. • Demographic and Health • Number of children under 6 Survey • Local governments utilize months exclusively breastfed resources to strengthen increased from average of • SUSENAS, Nutrition nutrition planning and service 10% in 2005 to 40% in 2012 Component 2011 capacities • Number of women receiving • Project Completion Report • Government approves iron-supplements and at least nutrition policies and 6 ante-natal consultations at • Baseline, Midterm and protocols puskesmas or with village Final Surveys mid-wife increased at least 50% from baseline. Outputs Output 1 • At least 6 revised draft • Biannual project reviews Assumption Strengthened capacity for nutrition policies, protocols • Revised policies and action development of nutrition and/or guidelines prepared by • Reports from surveillance plans are supported by policies, programs and relevant authority in MOH by system of nutrition unit local governments. surveillance year 3 of project implementation. Risk • Number of provincial, district • Surveillance data is not hospital and puskesmas staff analyzed and no action trained in priority areas such taken implementation of guidelines 2 Design Performance Data Sources/ Reporting Assumptions Summary Targets/Indicators Mechanisms and Risks and nutrition surveillance increased by 30% over baseline by 2009 (midterm) and 50% by 2012.a • All project districts have food and nutrition plans by year 4 Output 2 • Number of puskesmas and • Project monitoring and Assumption Improved quality of, and with trained nutrition evaluation reports along • Local government access to, integrated personnel, at least 50% with village monitoring expenditures for nutrition nutrition services for at- women, and related reports. efficiently allocated risk groups in project equipment increased by 50% areas from baseline. • Project Monitoring System Risk • Local governments cannot • 90% of health services at the • Village capability profile maintain trained nutrition province and district with (PODES) staff and allocate budget to designated nutrition-related community-based workers in-patient care facilities and • SUSENAS equipment by 2012. • By 2012, at least 90% of posyandus are providing services at least once per month with coverage of 80% of all under-fives in the catchment area (current national figure for monthly posyandu operations is estimated to be 48%). Output 3 • Improved posyandu facilities • Project Monitoring System Assumption Enhanced community in 80% of block grant eligible Women utilize improved capability for, and villages. • Biannual ADB project posyandu services implementation of, reviews improved nutrition and Risk hygiene interventions. • PODES • Lack of transparency of village management of • SUSENAS block grant funds Output 4 • Percentage of fortified salt • Monitoring reports of Food Assumptions Expanded food and wheat at retail level and Drug Administration. • Low-cost fortified fortification programs and meeting mandated complementary food nutrition communication fortification standards • Project monitoring and available in the market increased from 60% in 2003 evaluation reports. to 90% in 2012. Risk • Baseline and follow-up • Availability and affordability • Micronutrient supplements surveys of project of micronutrient (sprinkles) available on a implementation. supplements at the district commercial basis in at least level 30% of project provinces. • National breastfeeding studies show improved rate of exclusive breastfeeding at 6 months from <10% in 2005 to 40% in 2012. 3 Output 5 • At least 700 trained • Project monitoring and Capacity building for community facilitators, at evaluation reports. nutrition policy and least 50% women, in place by programs institutionalized Year 2 with an additional and M&E established in 300+ in place by end of year project areas 3 with 90% having received at least one refresher course by 2012. • Project implementation units developed detailed implementation and monitoring strategies Activities with Milestones Inputs Output 1: Institutional Development for Nutrition Policy, Programs and Surveillance 1.1. Improved Nutrition Institutional Capacity Asian Development Fund (ADF) 1.1.1. Review and develop policies and guidelines in the following areas: food safety, loan: $ 50million nutrition emergencies, iron supplementation, malnutrition prevention and mitigation, breastfeeding promotion, HIV/AIDS in nutrition services for mothers and children ( Government counterpart funds: 1.1.2.Review, update and prepare action plans of dietary guidelines (year 2) $19.1 million 1.1.3.Review protocol for the treatment of severe malnutrition and its application and revise nutrition counseling methods for each service level ( International consultants: 78 1.1.4.Provide refresher training for all levels on treatment protocols, counseling and person-months monitoring and evaluation. 1.1.5.Provide training for professional organizations of nutritionists, midwifes and nurses. Domestic consultants: 212 1.1.7.Prepare strategies and training for nutrition program planning, financing, and monitoring person-months at the local level. 1.1.8.Advocacy and preparations for necessary government regulations/decrees (years 1 & Civil works: $0.1 million to establish a National Institute of Nutrition (Institute Gizi Nasional) (years 3-6) 1.1.9 30 refresher training for provincial and district food inspectors and food sanitation Training, Fellowships and officers on food safety issues. Workshops: $7.6 million 1.2.1. training of trainers on nutrition emergency response, promotion of breast feeding and child care feeding and caring practices, nutrition counseling, hygiene improvement and Equipment: $2.7 million referral 1.2.2.Provide training on nutrition counseling and community-based monitoring to staff of the System Development and nutrition academies, nurses, nutritionists, midwifes and selected members of community – Studies: $6.6 million based organizations (PKK, health committees), child feeding practices and child care, counseling Nutrition advocacy and 1.2.4.Training of school teachers on nutrition communication: $5.5 million 1.2.5.Training for CBOs on community-based growth monitoring and hygiene 1.2. Nutrition Surveillance System 1.2.1.Assessment of current nutrition surveillance system and reporting mechanisms 1.2.2.Prepare guidelines and provide training for evidence-based nutrition, planning and budgeting 1.2.3.Procurement of IT equipment and software 1.2.4.Training of trainers on nutrition data analysis and reporting 1.2.5.Develop integration protocols between departments of health, agriculture and district logistic (DOLOG) especially at the district level. Output 2: Integrated Nutrition Services 2.1. Strengthening Local Nutrition Services (hospitals and puskesmas) 2.1.1.Upgrade nutrition facilities in provincial and district hospitals and puskesmas. 2.1.2.Provide nutrition-related equipment for hospitals and puskesmas
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