NUTRITION BUDGET TRACKING TRENDS FROM 2013 TO 2017 A REPORT FOR THE SUN FUND ZAMBIA. Concern Worldwide

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1 NUTRITION BUDGET TRACKING TRENDS FROM 2013 TO 2017 A REPORT FOR THE SUN FUND ZAMBIA Concern Worldwide March

2 ACKNOWLEDGEMENTS The report authors would like to acknowledge the contribution of Marjolein Mwanwenge who led the data gathering, analysis and review process. It is important to thank the team who analysed, weighted and reviewed the data: Sosten Banda from the National Food and Nutrition Commission (NFNC), Mwandwe Chileshe from the CSO SUN Alliance, Oliver Wakelin from CARE and the SUN Fund Management Unit and Rhoda Mofya Mukuka from Indaba Agricultural Research Institute (IAPRI). Photo Credit (front page): Agnita Munyama a Community Health Volunteer from Shanaube Village giving nutrition counselling in Shichanzu ward, Mumbwa. Photo Gareth Bentley,

3 KEY MESSAGES 1. Malnutrition is a serious issue in Zambia where 40% of children under 5 are not reaching their full potential due to poor nutrition in the first 1,000 days of life. Investing in nutrition has the potential to contribute $123 million to Zambia s GDP. 2. The Government of Zambia has made a number of policy and financial commitments to tackle malnutrition, including spending 300 ZMW per annum per child under 5 on nutrition, but is yet to allocate and disburse enough funds to meet this ambition. 3. Civil society in Zambia have been monitoring allocations to nutrition in the domestic budget since 2013 and have used this evidence and trends to advocate for more government action and commitment to nutrition. 4. The Government of Zambia, through its relevant ministries, has the potential to make a significant change to the lives of Zambian children if it immediately scales up resources, strengthens policies and programmes that target the most vulnerable people to make them more nutrition sensitive and improves the quality and availability of data for civil society and other nutrition actors in Zambia. INTRODUCTION AND BACKGROUND Nutrients are important ingredients for organs; they fuel bodily processes including the development of a strong immune system and healthy brain function. Without adequate nutrition in the first thousand days of life, from conception to a child s second birthday, the growth of some vital organs can be seriously impaired leaving them vulnerable to illness, compromised cognitive ability and at worst, death. Today, without the internal protection that nutrients bring, malnutrition has devastating impacts on a child s life by irreversibly limiting their physical development and reducing their IQ, sometimes by up to 10% 1. On average, children suffering from chronic forms of malnutrition are 20% less able to read and more likely to suffer from health problems. Furthermore, on average these children will experience a 22% loss of yearly income in adulthood 2. Progress in reducing hunger and malnutrition in Zambia is uneven and slow despite the government of Zambia committing to protect children from the ill health and cognitive impairment caused by malnutrition. The opportunity to unlock and progress the potential of Zambian children is a fundamental challenge for the government. Through increased investment in nutrition interventions the government can sustainably improve the nutritional status of their most vulnerable citizens: pregnant and breastfeeding woman, adolescents and children under five years old. While the government is working to implement coherent policies and improve coordination across ministries and the nutrition sectors, there is a desperate shortfall in nutrition funding and as a result the implementation of the government s ambitions faces significant delay. 1 S Horton (1999) Opportunities for investments in low income Asia, Asian Development Review, 17, p Grantham McGregor, S., Cheung, Y., Cueto, et al. (2007). Developmental potential in the first 5 years for children in developing countries. The Lancet, 369(9555), pp

4 Although Zambia is making some progress in reducing malnutrition, it remains a serious public health concern. The government faces a significant challenge as national rates and scales of malnutrition in 2013 and 2014 were worrying: 40% of children under 5 years of age are stunted 6% of children under 5 years of age are wasted 53% of children under 5 years of age and 30% of women of child-bearing age are anaemic 11% of children are born with a low birth weight The Zambian government has made a variety of international commitments to tackle malnutrition including signing up to the United Nations goal of zero hunger and malnutrition by In 2013, at the Nutrition for Growth (N4G) Summit in London, the Zambian government made three important policy commitments which can be tracked through budget monitoring. The planned impact of the combined commitments was to reduce chronic malnutrition (stunting) by 50% within ten years (2023). Increase government expenditure on nutrition to reach the estimated additional US$30 per >5 child required. Progressively match additional cooperating partners resources through new and existing nutrition budget lines. Increase financial contributions by at least 20% annually for the next 10 years. 4

5 NUTRITION BUDGET TRACKING IN ZAMBIA HISTORY AND METHODOLOGY. Since 2013, the Zambia Civil Society Scaling Up Nutrition Alliance (CSO SUN) has been leading nutrition budget tracking and analysis in Zambia. They have produced annual reports, made presentations to the Committee of Estimates at the time of budget finalisation and used the data from budget analysis to advocate for an increase in resources and allocations. In 2015 (for the 2016 budget) Concern Worldwide provided additional support to the CSO SUN for both the budget tracking and for the production of a report3 intended for advocacy ahead of the Rio N4G Summit. However, the Rio event failed to attract heads of state and government ministers and as a result, the report was used primarily for domestic advocacy. Following this report, it was agreed that a more intensive exercise was needed to standardise the data which had been collected since 2013 and agree on standard weightings for the different budget lines. Concern Worldwide led this process to: Review the Yellow Books4 from 2013 using specific search terms as set out in Annex 2. The data was then summarised and used to populate the data table. Review the summarised data with a group of experts from Concern, the National Food and Nutrition Commission (NFNC), the CSO SUN Alliance, the SUN Fund Management Unit and the Indaba Agricultural Research Institute (IAPRI). This group decided on the lines to be included and the weightings and an overview of these discussions is included as Annex 2. Weighting Guidelines (SUN, 2015) 100%: All resources (finance, assets and human) in the identified budget allocation are devoted towards a clearly mentioned nutrition objective or outcome. The identified budget allocation describes a well-defined sectorial intervention with high-impact evidence (2013 Lancet Series) 75%: The identified budget allocation clearly mentions a nutrition objective and/or outcome and/or action as part of an integrated program or department mandate. The identified budget allocation describes a well-defined intervention that addresses an immediate determinant of foetal and child nutrition (e.g. nutrient intake) and/or specifically targets children, women of reproductive age and households that are at highest risk of malnutrition 50%: The identified budget allocation describes a well-defined sector-wide program or department that clearly addresses an underlying determinant of foetal and child nutrition and specifically targets children, women of reproductive age and households that are at highest risk of malnutrition 25%: The identified budget allocation describes a sector wide program or department that clearly addresses underlying determinants of foetal and child nutrition and development. The program or department works at the environment or population level by addressing characteristics that are related to the effectiveness of a nutrition outcome (e.g. maternal or parental education, access to health services, safe and hygienic environment, etc.). 3 Nutrition Matters. Opportunities to Scale up Nutrition in Zambia 4 A Yellow Book is the annual government publication that contains details of government budget allocations for the coming year broken down by Ministry and budget line. 5

6 Weightings were based on the potential contribution of the budget investment to improved nutrition. The weighting methodology was developed by the SUN secretariat, whereby weighing factors of 25, 50, 75 or 100 are given to each budget line. The Guidance Notes are available online5 and are summarised in the box on the previous page. Personal emoluments were not included in the nutrition budget tracking because the information provided in the yellow book lacks the detail (where positions are located, level of payment etc.) required to analyse clearly how much is spent on nutritionists. There are also a number of other positions that do nutrition related work, for example, health facility staff who do a large part of the Infant and Young Child Feeding (IYCF). However, in this exercise it was not possible to provide a weighting for this. Initial data was added from the 2017 yellow book and this was used by CSO SUN for the first round of budget analysis and presentation to the committee of estimates. Once the more comprehensive yellow book was available further data was added. The final tables and analysis was reviewed and validated by the same group of experts prior to summarising in this report. The full data set (Annex 1) is presented as a summary table and the yellow book extractions for each year available from NFNC and SUN Fund/CARE on request. A narrative outlining the decisions around allocations is included as Annex Step-Approach-Version-2.pdf 6

7 ANALYSIS OF DATA From the summary in table 1 and figure 1, overall it is clear that nutrition budgets have not increased and remain static, if not in decline. As an overall percentage of budget expenditure, expenditure on nutrition has dropped and there is certainly not the incremental year on year increases that are needed to effectively tackle undernutrition or that reflect the commitments from the N4G compact. The peak in funding in 2015 is most likely linked to increases in the Ministry of Chiefs and Traditional Affairs (an activity called Food and Nutrition in Chiefdoms ) and the Ministry of Gender (an activity called Nutrition Campaigns ) which in that year had specific budget lines related to nutrition Figure 1 - Annual Nutrition Allocations % of National budget MCTA MLGH MGEC MOE MFL MoA MCDSW MoH % on nutrition As can be seen from Figure 2 and Figure 3 below, allocation of nutrition funds per child has fallen since 2015 and now stands at 11 kwacha - or $1 - per child per year which is far short of the government s $30 per child under 5 target. As can be seen in Figure 3, the allocation of nutrition funds per child has fallen more dramatically in USD terms due to the kwacha devaluation against the dollar. Figure 2 - Nutrition allocation per child in kwacha Nutrition allocation per child (Kwacha) Figure 3 - Nutrition allocation per child in US$ Nutrition allocation per child (US$)

8 Table 1 and figure 4 show the nutrition spend per key line Ministry for 2017 which reflects the priority areas as identified in the National Food and Nutrition Strategic Plan ( ) and the Most Critical 1 st 1000 Days Programme. These are investments in Health (nutrition-specific and nutrition-sensitive) under Ministry of Health (MoH), food security and welfare (nutrition-sensitive) under Ministry of Community Development and Social Welfare (MCDSW), increasing local availability of diverse nutritious foods (nutrition-sensitive) under Ministries of Agriculture (MoA) and Fisheries and Livestock (MFL) and finally improving access to clean water and sanitation (nutrition-sensitive) under the Ministry of Local Government and Housing (MLGH). It shows that the bulk of the investments remain in nutrition-sensitive activities under the MoH with important contributions from WASH under the MLGH and the Food Security Pack under MCDSW. It is important to note that this analysis does not include emoluments due to the challenges with accuracy and data outlined in the methodology. The Minister of Health announced the employment of 500 additional nutritionists under the Ministry in 2017 which should be noted here as an important investment in nutrition for this budget year. Table 1: Nutrition spending by Line Ministry based on Yellow Book Analysis Total nutrition allocation (x1000 ZMK) MoH 8,410 10,373 11,061 15,736 13,261 MCDSW 6,250 11,774 12,507 5,060 9,842 MoA 1,487 9,441 7,944 4,283 3,496 MFL MOE MGEC MLGH 325 1,420 4,940 4,771 4,773 MCTA Total 17,100 33,386 37,373 29,959 31,446 National budget 32,212,160 42,682,034 46,666,561 53,135,825 64,510,302 % on nutrition Nutrition allocation per child (Kwacha) Nutrition allocation per child (US$) The overall investment in the Social Cash Transfer (SCT) under MCDSW has increased from 75 million kwacha in 2013 to 500 million kwacha in However, it has not been included in this analysis because, while it contributes to improved household food security, the evidence base is not yet available to show the positive impacts of the SCT on nutrition. Likewise, Ministry of General Education expenditures have not been captured as the only available figures were for school feeding (around 35 million kwacha for 2016 and 2017) with figures for School Health and Nutrition (SHN) interventions not available at the time of writing. While school feeding is important and contributes to attendance and health of adolescents, it will have a greater impact on the next generation as it does not target children in the first 1,000 days window. Previously, SHN did represent a substantial investment, standing at over 35 million kwacha in 2016 but with the transformation to output based budgeting in 2017 the SHN cannot be tracked. 8

9 Figure 4 - Nutrition allocation per key ministry for 2017 MLGH, 4,773, 15% MCTA, 50, 0% MGEC, 16, 0% MOE, -, 0% MFL, 7, 0% MoA, 3,496, 11% MoH, 13,261, 42% MCDSW, 9,842, 32% MoH MCDSW MoA MFL MOE MGEC MLGH MCTA No ministry has increased allocations to nutrition and several have actually reduced their nutrition budgets. Amongst these is the Ministry of Gender which has very few budget lines that currently qualify as nutrition-sensitive, despite the key role that women s empowerment has been shown to have in improving household nutrition security. The Ministry of Agriculture and Ministry of Fisheries and Livestock appear to have decreased their expenditure on the promotion and development of agriculture which can be deemed nutrition-sensitive, as it includes agriculture that makes available affordable foods that supply essential macro and micro-nutrients. As shown in Figure 5 below, funding to the National Food and Nutrition Commission (NFNC) has fallen substantially since 2015 as an overall percentage of the Ministry of Health budget (illustrated by the blue line on Figure 5). In real terms it has not increased since 2014 despite the strengthened and central role the NFNC plays in efficient and successful coordination across key sectors and ministries, agreed by government as a critical function in the response to malnutrition. Figure 5 - Allocation to NFNC Annual NFNC budget (x1000 ZMW) % age of MOH budget 9

10 Cooperating partners continue to invest in nutrition in Zambia, either directly through funds like the SUN Fund or through support to maternal and child health. At least $25 million will be spent in 2017 by donors on projects that contribute to the reduction of malnutrition in Zambia, up from $17.1 million in While Figure 6 does not capture historical spend accurately, it does reflect a sustained commitment by international donors to nutrition in Zambia which is not currently matched by progressive increases in GRZ budgets. 300,000 Figure 6 - Donor funding X1000 ZMK 250, , , ,000 50,000 - Management of malnutrition PHC RMNCAH & Nutritional Services Prevention of mother to child transmission Scaling Up Nutrition Social Cash Transfers Strenghtening womens livelihood Nutrition surveillance, control and technical support CONCLUSION AND RECOMMENDATIONS While many investments are being made across Zambia to tackle undernutrition, the government budget allocation, outside of human resources, remains stagnant and in some cases, decline. In the meantime, the National budget overall has doubled since Eliminating undernutrition in children can increase productivity for an entire country and boost GDP by as much as 12%; given the

11 critical role that good nutrition will play in the future economic development of Zambia, the opportunity for continued and meaningful investment should not be missed, in particular when evidence is in place for many interventions which are known to have a high impact. The Nutrition Matters report published last year 7 also noted that an annual public investment of $47.8 million would reduce stunting, save lives, free up people from disability and chronic ill health and contribute $123 million to the GDP of Zambia. Current planned investment for 2017 stands at only $3.1 million, with a further $25 million from cooperating partners which is far short of this target. Investments in nutrition must be scaled up and disbursed to tackle undernutrition in Zambia. To do this, the authors of the report recommend the Government to: MAKING DATA AVAILABLE FOR ACCOUNTABLITY AND TRANSPARENCY Support better budget tracking and make data available to monitor disbursements and expenditures. Undertake a comprehensive review of public and donor expenditure on nutrition and establish an open system and database for consistent, well managed and regular tracking of nutrition financing. Use a common results framework to hold all actors working on nutrition to account for achievements. Revisit and reaffirm the N4G targets and ensure the data is readily available to measure and track them accurately. Establish and make available data to measure impact indicators at the national level (for example stunting, anaemia, obesity) in addition to publicly reporting on global commitments. Fund a new food consumption and micro nutrient survey as the most recent comprehensive food consumption survey (covering the whole year) was conducted in Nutrition Matters, Opportunities to Scale up Nutrition in Zambia. Zambia CSO Sun Alliance

12 INCREASING INVESTMENTS IN NUTRITON Continue to fund the whole of government approach which is already employed under programmes like the Most Critical 1000 Days Programme and recognizes that the responsibility for tackling undernutrition rests across different sectors and Ministries. Provide high level instructions for ministries to make sufficient use of nutrition budget lines already created and create additional budget lines for nutrition-sensitive work in the relevant ministries. Increase the budgetary expenditure on nutrition-sensitive interventions in line with the NFNC s recommendation of ZMW 40 million per year and nutrition-specific interventions to meet the WHO target of 300ZMW/child under 5 per year. Scale up high impact nutrition interventions (as outlined in the 2013 Lancet series) and those with emerging evidence of effectiveness in Zambia to reach 80% of the target population by Address human resource constraints by filling the 24% of vacant nutrition positions in key line ministries and generating more, particularly at the level of service delivery. Ensure School Health and Nutrition - which focuses on education, knowledge and behaviours within the curriculum - is fully funded and that the figures are available to facilitate tracking. Leverage the substantial investment in the Social Cash Transfer to increase impact on nutrition by targeting pregnant and lactating women and integrating nutrition messages into the programme. Increase funding to the NFNC to ensure ministries and sectors coordinate efforts to have the greatest impact on malnutrition. This funding must be sufficient enough to fund coordination, monitoring and evaluation, creating and sharing of information, resource mobilization, communications and advocacy. 12

13 ANNEX 1 NUTRITION BUDGET ANALYSIS WEIGHTED AMOUNTS 1.1 Ministry of community development and social welfare National Expenditure Budget lines Weight factor Ministry of Community Development and Social Welfare Program 5040: Social welfare support Social cash transfers Program 5023: Food security Agricultural support 25 6,250,000 11,773,750 12,457,250 5,000,000 9,775,000 Program 6019 Community Development Distribution of Food Security Pack Input/Training beneficiaries in Nutrition - Eastern Province 50-50,200 60,240 66,525 SUBTOTAL 6,250,000 11,773,750 12,507,450 5,060,240 9,841,525 HEAD TOTAL MINISTRY OF COMMUNITY DEVELOPMENT AND SOCIAL WELFARE BUDGET 1,492,037,026 1,890,332,561 2,028,157, ,556, ,953,373 13

14 1.2 Ministry of Health National Expenditure Budget lines Weight factor Ministry of Health Program 5005: grants to institutions National Food and Nutrition Commission 100 6,052,450 8,173,499 8,233,904 8,233,904 8,233,904 Program 5104: Nutrition/5070 Child Health Management of malnutrition , , , ,089 - Infant and Young Child Feeding , , , , ,195 Growth monitoring and promotion , , , , ,012 Micronutrient program , , , , ,488 Program 5030: Policy and planning Health service strenghtening 25 85, , ,070 2,500,000 - Program 5132 Surveillance control and research Nutrition surveillance, control and technical support , ,468 - Water and Sanitation ,454 Hygiene promotion control 25-1,799 6,115 53,037 - Prrogram medical supplies Procuments of nutritional support commodities ,500,000 2,500,000 Program 5071: reproductive health Focused antenatal care & safe motherhood , ,016 90,284 79,698 79,698 14

15 National Expenditure Budget lines Weight factor Adolescent health 25 82,105 65,684 79,538 73,144 80,644 Family Planning services , , , , ,250 Prevention of mother to child transmission 25 72,511 62,261 27,906 48,957 - Program 5070: Child health Integrated management of childhood illnesses , , , , ,389 Printing of Under Five Cards , , , , ,000 SUBTOTAL 8,410,254 10,372,556 11,060,563 15,736,343 13,261,033 HEAD TOTAL MiINISTRY OF HEALTH BUDGET 2,053,383,288 2,646,390,466 2,758,080,222 4,436,592,856 5,732,842,152 15

16 1.3 Ministry of Agriculture National Expenditure Budget lines Ministry of Agriculture Program 1003: capacity building Weight factor Backstopping Food and Nutition ,678 44,573 54,573 56,575 - Program 1053: Crop production, advisory and technical services (Promotion of) Crop diversification and yield improvement ,601 2,807,563 2,303,550 1,151, ,014 Promotion of Crop Production and Diversification 25 4, , ,583 69,332 - Crop Diversification Demonstration 50 5, , Food and Nutrition , Nutrition and Education ,322 5,257,042 4,310,363 2,167,153 1,409,631 Promotion of Conservation Agriculture 25 6,875-57,425 55,834 51,442 Program 1078: Food conservation, preservation and storage Food storage and processing training 25 17,697 42,500 43,775 35,100 46,280 Development of improved storage structures 25 2,500 12,500 12,500 9,975 7,246 Program 1079: Food processing and utilization Food consumption and nutrition assessment , ,408 84,508 84,550 65,678 Traditional recipe development ,200 90, ,250 80,250 - Development of small scale processing technologies 50 5,000 25,000 50,000 17,800 12,930 16

17 National Expenditure Budget lines Weight factor Support to scaling up Nutrition ,000 74, ,208 Food processing and utilization 50 35, , , ,526 Program 1008: cross cutting issues/ Programme 1013 Advisory Services Food processing and preservation, HIV and gender 50 35,030 55,931 71,750 3,393 7,714 Program 1044: Conservation farming Conservation Agriculture support 25 25,000 65,000 67,500 67,375 - Conduct Conservation Agriculture ,789-83,757 77,177 - Conservation Agriculture ,073 Program 1102: Land Husbandry Conservation Farming ,002 38,201 Program 1151: Research & Development Crop diversification 50 15,365 50,000 75,000 22,800 0 Program 1250: Crop Diversification Crop diversification ,000 Program 1043 Community Outreach Provision of safe water and sanitation 50 1, Program 1013: Advisory services Nutrition & Education , ,149 57,750 22,500 5,447 Program 1176: Technical and economic cooperation 17

18 National Expenditure Budget lines Weight factor Coordination and implementation of CAADP , ,750 30,000 64,162 25,000 SUBTOTAL 1,487,319 9,440,557 7,944,484 4,282,777 3,496,389 HEAD TOTAL MINISTRY OF AGRICULTURE BUDGET 1,458,682,622 3,031,654,385 4,108,454,445 2,382,266,379 5,435,167, Ministry of Fisheries and Livestock Ministry of Fisheries and Livestock Program 1108 Livestock production Promotion of Livestock production 50 13,083-52,563 33,849 6,392 Program 1039 Capture Fisheris Management and Development Aquaculture extension and farmer training 25 34,761 30,375 16, SUBTOTAL 47,844 30,375 68,583 33,849 7,308 HEAD TOTAL MINISTRY OF FISHERRIES BUDGET 708,533, ,686,689 18

19 1.5 Ministry of Education National Expenditure Budget lines Ministry of Education Program 5005: School, health and nutrition Weight factor School Health and Nutrition SUBTOTAL HEAD TOTAL MINISTRY OF EDUCATION BUDGET 5,554,228,758 8,599,147,755 8,599,147, Ministry of Gender Ministry of Gender Program 3150: economic empowerment of women Equipment/technology support to women Training of women's clubs in entrepreneurship development 25 74, Agriculture and Entrepreneurship Training for Women ,250 Program 3191 Promotion of gender equalty Enactment and operationalization of Gender equality act , Progam 5015 Child protection Nutrition campaigns , Program 3155: Promotion of gender balance Mainstream gender equity for food security and

20 Weight National Expenditure Budget lines factor nutrition ,472 SUBTOTAL 74, ,050-16,250 HEAD TOTAL MINISTRY OF GENDER AND EARLY CHILDHOOD BUDGET 235,249,689 35,281,288 42,625,737 33,129,547 20

21 1.7 Ministry of Government and Local Housing National Expenditure Budget lines Ministry of Government and Local Housing Progamme 5011: Infrastructure development Weight factor Sanitation , , ,643-1,907 Sanitation Infrastructure Development and sensitzation ,771,275 4,771,275 4,771,275 Sanitation Urban 25-1,250, SUBTOTAL 325,000 1,420,474 4,939,918 4,771,275 4,773,182 HEAD TOTAL MINISTRY OF LOCAL GOVERNMENT AND HOUSING BUDGET 749,294, ,124, ,418, ,100,179 Ministry of Chiefs and Traditional Affairs Program 5130 Cross cutting issues in chiefdoms Food and Nutrition in Chiefdoms ,000 50,000 48, Water and sanitation in chiefdoms 50 25,000 25,000 24,350 75,000 50,000 Prevention of Mother to Child Transmission , SUBTOTAL 75,000 75,000 85,550 75,000 50,000 HEAD TOTAL MINISTRY OF CHIEFS AND TRADITIONAL AFFAIRS 93,428,206 42,682,034, ,815, ,498,301 TOTAL NATIONAL BUDGET 32,212,106,297 42,682,034,134 TOTAL NUTRITION SPENDING 16,669,619 33,112,712 36,755,597 29,959,483 31,445,686 21

22 Donor Funding Management of 11,566 malnutrition PHC RMNCAH & 254,025 Nutritional Services Prevention of mother 9,769 to child transmission Scaling Up Nutrition 16,986 73,398 86,644 66,910 Social Cash Transfers 54,627 49,239 30,589 52,000 52,000 Strengthening 32,500 women s livelihood Nutrition 2,900 1,870 surveillance, control and technical support total 426,770 Allocation to NFNC as part of total MOH budget NFNC MoH Budget % of MoH budget ,052 2,053, ,173 2,646, ,234 2,758, ,234 4,436, ,234 5,732,

23 ANNEX 2 NARRATIVE BACKGROUND TO ALLOCATIONS Keywords used in the search are; o Adolescent o Agriculture or Agricultural o Aquaculture o Antenatal o CAADP o Child o Diversification o Family Planning o Fish o Food o Gender o Growth o Health promotion o Hygiene o Infant and Young Child Feeding o Livestock o Malnutrition o Micronutrient o Nutrition o Sanitation o School Health o Social Cash o Under-five o Water o Women The data for the SHN project is only available for 2013 and After which SHN was part of output based budget (OBB). Many activities are budgeted at district or provincial level; therefore, some budget lines are repeated several times. In the FINAL Budget analysis table, only aggregated data are provided (totals of all districts and provinces of activity line under specific programme). The budget lines which were moved from Health, to Community Development and again back to Health, are all represented under Health. The excel file is built in such a way that any change in weighing factors in the original table, will result in changes in the complete document (including the graphs). Although there is evidence that social cash transfers can have an impact on nutrition, evidence is inconclusive, and the programs need to be targeted for improved nutritional status. Therefore, it may be necessary to review the weighing factors and adjust. For now, we have removed social cash transfers from the nutrition budget analysis by putting weighing factor at zero. Donor funding is mentioned separately and not included in the nutrition allocation from government within the budget analysis. For example, the management of malnutrition received a donor grant from 11 million, which is included under donor funding and the figure has not been included in the data analysis. 23

24 There are certain activities which are budgeted for under different programs (such as conservation agriculture). The budget lines were kept for different programmes separate as this may help with the entry of data for coming years. Only activities where the link with nutrition is clear have been included. Certain activities which were previously included have been removed as there was no clarity on whether the budget line was impacting on nutrition, e.g. gender mainstreaming was only included when it was specifically mentioned for food and nutrition security. There is a budget line on the procurement of nutrition commodities of We have produced two graphs for nutrition-specific budget lines; one with the four budget lines which have been included over the past years, and one with the new budget line added. 24