QUESTIONNAIRE ON BUDGET TRANSPARENCY AND CHILD MALNUTRITION

Transcription

1 Budget Transparency for Children s Rights (BT4CR) QUESTIONNAIRE ON BUDGET TRANSPARENCY AND CHILD MALNUTRITION FINAL VERSION This final version was informed by consultations with the BT4CR researchers and Save the Children staff present at a BT4CR workshop in Pretoria May 2012, and with Elena Mondo at the International Budget Partnership. At the pen: Anna Schnell, Erica Coetzee and Judith Streak Accountability & Transparency for Human Rights Foundation COUNTRY: KENYA

2 Name of researcher: Mathenge Munene Organisation: - Children Development and Environment (CED) consulting Address: Tel: Website: Reference group: Name Title Organisation Edward Ouma Executive Director Children s Legal Action Network (CLAN) Mercy Mugane Program Officer Children s Legal Action Network (CLAN) Gladys Mugambi Raphael Owako Dr Stewart Kabaka. Grace Musyoka 1. Wanja Gitonga 2. Assumpta Ndumi 3. Ibrahim Alubala Everyone Campaign Steering Committee Division of Nutrition- Ministry of Public Health and Sanitation. Paediatric Health and protection- Ministry of Public Health and Sanitation Head- Ministry of Public Health and Sanitation unit. Accountant, Department of Family Health, Ministry of Public Health and Sanitation Save the Children International

3 CONTENTS GLOSSARY OF TERMS USED IN THE QUESTIONNAIRE SECTION 1: INTRODUCTION SECTION 2: PRELIMINARY RESEARCH ON INTERVENTIONS & SUB-NATIONAL UNITS SECTION 3: RUNNING REFERENCE LIST OF SOURCES GENERAL COMMENTS FROM PEER REVIEWERS & AT4HR SECTION 4: QUESTIONS ABOUT POLICY & PLANNING FOR CHILD NUTRITION INTERVENTIONS A. POLICY AND STRATEGIC COORDINATION IN CHILD NUTRITION INTERVENTIONS B. PLANNED (BUDGETED) EXPENDITURES FOR CHILD NUTRITION INTERVENTIONS SECTION 5: QUESTIONS ABOUT THE IMPLENTATION OF CHILD NUTRITION INTERVENTIONS C. ACTUAL EXPENDITURES ON CHILD NUTRITION INTERVENTIONS D. BUDGET PERFORMANCE IN RELATION TO CHILD NUTRITION INTERVENTIONS SECTION 6: QUESTIONS ABOUT PARTICIPATION IN BUDGETING FOR CHILD NUTRITION E. PUBLIC AND CHILDREN S PARTICIPATION IN BUDGETING DECISIONS

4 GLOSSARY OF TERMS USED IN THE QUESTIONNAIRE To answer the questions in this questionnaire it is important to know the definitions of the terms used. This is why the glossary below is the first to be presented in this questionnaire. Actual expenditures: These are the amounts actually spent by a government department or by the government as a whole on a specific programme over a given period, usually over a budget year. Approved expenditure: These are the amounts reflected in the budget enacted by the legislature in a given country, including any revised estimates and other amendments approved by the legislature during the budget year. Budget allocations: See Planned expenditures. Budget documents: In the questionnaire the term budget documents refers to all the formal planning, communication and reporting mechanisms used by a government to present and disseminate information about its budgets and budgeting. It may include print publications, unpublished documents as well as online sources. Typically the most common types of budget documents produced by a government to this end would include a pre-budget statement, the executive s budget proposal, a popular version of the budget or citizens budget, the enacted budget, in-year budget reports, a mid-term budget review, year-end reports and audit reports. Sector specific planning and reporting documents may also present budget information, such as strategic plans and annual reports. Budget information: All information produced, published and disseminated by a government regarding its budgets and budgeting, including the budget implementation process. This means that information from different sectors and departments regarding the roll-out of programmes and services should also be seen as part of budget information. Budget planning: The first phase of the budget process in most countries, usually led by the Ministry of Finance. Budget planning generally includes macro-economic modelling and analysis, revenue projections and the formulation of detailed spending proposals. 1

5 Budget proposals: Plans drawn up, for example, by a government or by the government as a whole, outlining which programmes and activities it plans to undertake in the upcoming budget year (or over the medium-term) and the costs associated with those programmes and activities. Budget transparency: For the purposes of this questionnaire, budget transparency is defined as a situation in which a member of the public or civil society is able to access information about a given government intervention or programme either via the internet, at a public library or resource centre, or by requesting such information from a government office, in person, by phone or via . In the latter instance, transparency is seen to be adequate if the information is provided within two weeks of the request being made. See also publically available. Budget year: A budget year (sometimes called a fiscal year) is the period for which budget planning is done. When the questionnaire refers to the budget year without further qualification, this is the year for which the executive s most recent budget proposal is being drafted. Caregivers: All those involved in the care and supervision of children, including parents, grandparents, siblings, other children and family or household members, as well as child-minders, babysitters, crèche staff, early childhood development practitioners, teachers, teachers aides, nurses and those working in shelters, orphanages and places of safety. See also Primary caregivers. Cash transfer: A government intervention that takes the form of providing money to individuals or households, usually targeted to those most in need or to those with limited or no income-earning capacity. Cash transfer programmes are typically directed to people with disabilities, veterans, the aged, vulnerable children, the unemployed and impoverished. In different contexts, such programmes may also be referred to as income support, social grants, social security, social benefits or in the case of the aged, state pensions. Child: A child is defined as a person between the ages of birth and seventeen years, up to the day before the eighteenth birthday. This is the same definition as in the United Nation s Convention on the Rights of the Child and the African Union s African Charter on the Rights and Welfare of the Child. 2

6 Children: For the purpose of this questionnaire the word children is used to encompass different children and different groups of children. We do recognise, however, that children are not a homogenous group. Child malnutrition: Child malnutrition includes three distinct conditions known as stunting, wasting and micronutrient deficiency. Stunting is also referred to as chronic malnutrition and can come about in two ways. Firstly stunting can result from a poor diet extending over a number of years, so that the child takes in too few calories or too little nutritious food or both. Secondly, an infection can prevent the absorption of nutrients in the child s body. When a child is stunted, he/she is too short for his/her age. Wasting results from a severe and often sudden lack of food or disease. When a child is wasting, his weight is too low for his height. Micronutrient deficiency exists when a child lacks vital vitamins and minerals in his/her diet. This is linked to long-term lack of nutritious food, or having an infection such as worms. Nearly all child deaths linked to micronutrient deficiency are due to a lack of vitamin A, zinc or iron. Child nutrition: The term child nutrition is used to refer broadly to the nutritional status of children. It represents a range of conditions which differ in the extent to which children are receiving and absorbing the nutrients they need to grow and develop. Child nutrition interventions: This is used in the questionnaire as a short-hand term to refer to all the various kinds of government programmes, projects or other undertakings aimed at reducing child malnutrition or otherwise improving the nutritional status of children in a country. Child rights obligations: The legal obligations on the state to use available resources in order to protect, fulfil and deliver the rights of children living in that country. Such obligations may derive from international or regional human rights treaties and laws, such as declarations and conventions of the African Union and United Nations, recommendations from UN and AU committees overseeing the implementation of specific international or regional human rights treaties, recommendations from the Universal Peer Review of states by the UN Human Rights Council, the Abuja Declaration, and so forth. These examples are referred to as international and regional documents or sources of child rights obligations. However, a government s obligations to children also derive from national laws and policies that give content and 3

7 substance to the delivery of child rights. The in-country documents and sources may include laws and constitutions, policies, strategies, codes of conduct, norms and standards, regulations, formal guidelines and plans of action. Consult with the public: As accepted methods of government consultation tend to vary from country to country, the exact form the consultations take will have to be assessed by the researcher. In most instances, it would be assumed that a government has consulted with citizens if it has undertaken such activities as hosting public meetings, engaging with different stakeholders, inviting submissions from the public, or public feedback on its own proposals, holding focus group discussions with affected groups, conducting public opinion polls, and so forth. Coordinated planning, budgeting and service delivery: Concrete actions taken by government departments to work together to improve child nutrition through joint planning, budgeting and service delivery concerning an intervention that relates to more than one sector or department. Cost an intervention: In short to cost an intervention entails mapping the content of a programme or law for example. Then analysing the content and building a costing model that takes different scenarios into account. The scenarios are based on the current situation and different roll-out scenarios. The roll-out scenario s costs are estimated and outlined. The information is used in planning and budgeting for the intervention. Current budget documents: In this questionnaire, this refers to all the budget documents and strategic plans produced and disseminated by the government pertaining to the budget year for which the government s most recent budget proposal is being drafted. This includes older documents that were produced before the budget year, but are still being used with reference to the budget year. Researchers are encouraged to exercise their discretion in identifying publically available government documents that are most apt for answering the questions. 4

8 Department: For the purposes of this study, department is used to refer to an administrative unit of government responsible for the execution of programmes or services in a given sector. In some countries, such units may be referred to as ministries or agencies. At different levels of government, departments may also be known as (or divided into) agencies, branches, district offices, and so forth. Development aid: Development aid is used as an umbrella term in this questionnaire to refer to all foreign funds, including grants and loans, received by a developing country from another country s government, a donor organisation or international financial institution for the purposes of welfare and socio-economic development. It may take the form of official development assistance or technical assistance and includes both bilateral and multi-lateral aid. Intervention: For the purposes of this questionnaire, the term intervention denotes any project, programme, good or service undertaken by a government sector, department or agency to meet a given objective, for example to improve child nutrition. Typically the interventions under the spotlight in this study are not once-off events (for example a conference on child malnutrition) but rather on-going initiatives running for at least one budget year, if not longer. Income support: See Cash transfer. Indicators: See Performance indicators. Law: See Policy. Mechanisms to gather the public s perspectives: The government is accountable to the public and is responsive to public participation when it provides feedback to the public on issues raised. Mechanisms to gather the public s perspectives are therefore needed. These mechanisms can take many shapes and forms. This questionnaire agrees with the following statement found in the Open Budget Survey 2012 of the International Budget Partnership (slightly modified): The government should systematically collect, maintain, monitor, and evaluate information gained from public involvement activities. The government should also maintain contact information for individuals and groups that want to be involved in specific budget issues, and it should use multiple communication mechanisms to ensure that those that want to 5

9 be involved are notified of opportunities to engage in and decisions regarding these issues. The government should explain to those who participated in its public engagement mechanisms, and to the broader public, how this engagement has informed budget plans and execution. It should also gather feedback on the public s perception of how successful these processes and their outcomes have been. This type of engagement is particularly important for those members of the public who put effort into participating. There may be certain legitimate situations in which the government may choose to withhold the identity of a person providing inputs on the budget, for instance, if the safety of the person is of concern (e.g., such situations may arise over corruption complaints). Non-financial data: The budget should not only present the amount of money being spent on an intervention but also other information needed to analyse it. In terms of this questionnaire non-financial data could be the number of vulnerable children, number of beneficiaries, number of meals, number of social security grants, number of health workers, etc. Outputs: Goods or services delivered as the result of a government intervention being implemented. For example, the outputs of an education programme could be teachers trained, schools built or students educated. Performance indicators: Measures defined and used in government programmes to plan and monitor the implementation of services and programmes. Indicators may be used to measure progress towards meeting certain targets (see outputs and service delivery targets in this glossary). For example, if a performance indicator for a child nutrition programme is to measure the number of children reached through a school-feeding scheme, the associated service delivery target might be to reach 10,000 children. Planned expenditures: These are the projected spending figures that make up a department s (or the entire government s) budget for the upcoming fiscal year, and for two to three subsequent years if that country uses a medium-term economic framework. In this questionnaire, the term planned expenditures is seen to be synonymous with budgeted expenditures, allocated expenditures and allocations. 6

10 Policy: Guiding national, regional and international documents, including laws, this set out the principles, goals, rules and parameters of a government s approach to a certain sector, function, problem or issue. Policies are generally expected to have a longer lifespan than strategic plans and budgets, and may include norms and standards that have to be met through such strategic plans and budgets. Primary caregiver: The person or persons responsible for the largest share of the care and supervision given to a child, frequently the mother, grandmother and/or other female family member(s). Publically available: For the purposes of this study, information is regarded as publically available if a member of the public or civil society is able to access it via the internet, at a public library or resource centre, or by requesting such information from a government office, in person, by phone or via . In the latter instance, information is seen as publically available if it is provided within two weeks of the request being made. Only documents that are publically available should be used as source material for this study. See also budget transparency. Public participation: For the purpose of this questionnaire the term public participation is used to describe what takes place when people engage with the government in relation to public budget planning and spending. The public s engagement could for example be intended to lead to better service delivery of an intervention in a community. Scale: For the purpose of this study the term scale refers to the number of children. Sector: A term used to differentiate between broad areas of societal activity and government intervention. Traditionally the social sectors are seen to include education, health, welfare, housing and so on. The economic sectors are seen to include agriculture, trade and industry, forestry and so forth. Service delivery targets: The planned outputs to be achieved by a given government intervention over a defined period. For example, the service delivery targets of a child nutrition programme could be to increase uptake of Vitamin A supplementations by 20 per cent over three years, or to ensure that 50,000 children are provided with meals through a school-feeding scheme. For the purposes of this questionnaire, service delivery targets are understood as the immediate (annual) or medium-term aims of an intervention. Service delivery targets may have 7

11 different names in different documents or countries; they may for example be referred to as planned outputs, performance targets, service delivery milestones and the like. Progress in meeting service delivery targets are often measured with the help of performance indicators (see Performance indicators in this glossary). Sources of revenue: All the means through which a country, or sub-national section of a country, collects income for public spending, investment and debt repayment. Sources of revenue could include direct and indirect taxes, levies, interest on investments, income from extractive industries, loans, grants and other forms of development aid, Spending plans: See Planned expenditures. Sub-national level: A level or sphere of government other than the national level. In many countries, certain powers and duties of government are devolved to lower levels, for example provinces, states, regions, districts or municipalities. Sub-national units: A sub-national unit is a single province, district, municipality or similar entity that is under the executive authority of a given sub-national government. Vulnerable children and most vulnerable children: The term vulnerable children refers to children who due to difficult circumstances in which they live are at high risk of suffering, or suffer, from malnutrition. The target audience of child nutrition interventions are most often selected from among these vulnerable children (who form a subgroup to the whole child population). From a child rights perspective, all children have a right to adequate nutrition, and hence governments should identify and target all vulnerable children in their child malnutrition interventions. However, in reality, resources are limited. It is acknowledged in the Convention on the Rights of the Child that a sub-set of vulnerable children may therefore be targeted, with progressive upward adjustment in eligibility over time as more resources become available. In this questionnaire the term used for this sub-set of vulnerable children is most vulnerable children. For the purpose of this study most vulnerable children refers to the subset of children among the vulnerable children that suffers most from malnutrition. 8

12 These children are important to identify as they need to be given special priority by government when designing, budgeting for and implementing interventions to promote child nutrition. Year-end reports: Budget reports, including actual expenditure figures, submitted at the end of the budget year, reporting on the implementation of approved programmes. 9

13 SECTION 1: INTRODUCTION 1.1 Broad aims of the Budget Transparency for Child Rights initiative Budget Transparency for Child Rights (BT4CR) was established to work towards more effective monitoring of children s rights. The core idea is that we need greater access to more and better budget information about what governments around the world are doing to realise the rights of children. Over the next few years, the BT4CR aims to: Investigate and report on the extent and nature of transparency in public spending on interventions and services aimed at children; Develop tools to track budget transparency for children through budget planning to service delivery, at national and sub-national levels; Provide opportunities for child rights advocates in various countries to build a budget transparency angle into their campaigns; and to Encourage dialogue on possible norms for transparency in public budgeting in relation to children, so that we are better able to meaningfully monitor the implementation of children s rights. 1.2 Specific objectives of this questionnaire The questionnaire contained in this document is a pilot research instrument. It intends to shed light on how transparent government budgeting is when it comes to one critical responsibility we have towards children: ensuring that they have enough nutrition to survive into adulthood. The specific objectives of the questionnaire are to: Take a detailed look into transparency around public spending on child malnutrition in five African countries, namely Kenya, South Africa, Uganda, Zambia and Zimbabwe. In these five countries, assess and record how much and what kind of budget information is publically available pertaining to government interventions aimed at combating child malnutrition. Collate and compare the findings to formulate recommendations and inform further advocacy and research. 10

14 1.3 Definition of budget transparency Transparency can be and has been defined in many different ways by civil society actors, academics and governments themselves. It is generally agreed that transparency is a key element in democratic practice, and helps to ensure and enhance participation and accountability. In an ideal case, transparency requires more than the mere existence of information, and includes considerations about the quality and usefulness of that information. However, it would be a huge undertaking to assess not only whether budget information exists in relation to a government s child nutrition interventions, but furthermore to evaluate how comprehensive and useful that information is. Given the constraints of this pilot study, this questionnaire applies a narrow definition of budget transparency. Budget information is regarded as transparent if it is publically available in the sense that: The information can be accessed online, or The information can be found in a hard copy budget document in a public library or similar public resource centre, or The information can be requested (and is duly provided) from a government office, or The information is provided freely (or at a very low cost) within 2 weeks of a request for such information having been made via letter, or telephone. 1.4 The focus on child malnutrition It is not possible within the bounds of this pilot study to investigate all government budgeting affecting children s rights. To mark out a manageable research terrain, this questionnaire has a specific focus on the child s right to health, and within that, on efforts to prevent and reduce child malnutrition. (For more information on the definition of child malnutrition, see the Glossary of Terms at the beginning of the document). The selection of this focus is informed by strategic and practical considerations. The nutritional status of children plays a critical role in their wellbeing and survival. Malnourished children are more vulnerable to disease: it is one of the key factors affecting the life expectancy of children, especially young children. The Millennium Development Goal number 4 (MDG4) is to reduce the mortality rate of children under 5 by a third by 11

15 2015. Addressing child malnutrition has been identified by Save the Children and others as a critical strategy for achieving MDG4. We would expect to see government interventions aimed at advancing child nutrition and combating child malnutrition in the budgets of any country committed to reducing child mortality. In addition, government budgeting to advance child nutrition is likely to display some other features which should assist this study: It is anticipated that interventions for child nutrition can relatively easily be identified within budgets as distinct programs or projects thereby enhancing the scope for meaningful research and comparisons across countries. Interventions for child nutrition may well involve more than one government department or sector. This could help to shed light on intragovernmental co-ordination an important factor affecting government delivery for children more broadly. Interventions to improve child nutrition stand a good chance of involving more than one level of government. This should allow the study to gain more nuanced insights into variations in budget transparency at different levels. 1.5 Identification of relevant government sectors In many countries, government interventions to combat child malnutrition involve more than one government sector. Therefore this questionnaire cannot be customised for or limited to a single sector. In each of the pilot countries, researchers will have a preliminary task of scanning the various sectors in their context and identifying interventions that have as a direct or indirect aim to enhance the nutritional status of children. It is anticipated that in the majority of countries, relevant interventions are most likely to be found in the sectors of health, social development or welfare, agriculture and education. However, interventions affecting child nutrition may also be uncovered in other sectors such as trade and industry, community development, water and sanitation, public works and in some instances, located within dedicated ministries or departments of child affairs or child welfare. SECTION 2 of this document provides background information and guidelines for conducting this preliminary exercise. 12

16 1.6 Levels and units of government This questionnaire asks of researchers to look into budget transparency at both the national level and at relevant sub-national levels in their countries. The dual emphasis is important because: The implementation of interventions aimed at children often happens at sub-national levels and it should be possible to track public funds to where they are spent. The extent and nature of budget information about interventions at sub-national levels may vary considerably from that which is available at national level. There may be noteworthy variations in budget transparency between different sub-national units, for example different provinces or districts, in the same country. It is, however, beyond the scope of this study to investigate the budget transparency of government s child nutrition interventions at all subnational levels and within every sub-national unit in a country. It will be necessary for researchers to identify three sub-national units (for example, three provinces, districts or municipalities) to consider more closely as part of their enquiry. These units should be selected with a view to including areas that are likely to have better and worse capacity for budget reporting and varying track-records in government transparency. SECTION 2 of this document provides guidance for researchers to identify the most relevant sub-national units to focus on in their study. 1.7 Spotlight on government budgets The questionnaire on budget transparency and child malnutrition focuses exclusively on public resources in the five pilot countries; therefore the spotlight falls on all funds that flow through government budgets, whether at the national or sub-national levels. Development aid (including donor funds and loans from international financial institutions) may play a significant role in financing government interventions aimed at combating child malnutrition. Such funds will only form part of the study to the extent that they form part of the country s public budget. Offbudget funding of child nutrition interventions are explicitly excluded from this research. 13

17 1.8 The structure of the questionnaire The questionnaire is divided into six parts: SECTION 1 is the introduction to the document. SECTION 2 provides a framework for preliminary research into government budgeting for child nutrition. It guides the selection of five interventions to focus on in the rest of the questionnaire, as well as the three sub-national units that will be investigated. SECTION 3 is a running bibliography of sources pertaining to the research. It includes tables for recording documents and other sources consulted in the process of completing the questionnaire, as well as the details of interviews and other investigative communications. SECTION 4 consists of questions relating to the government s policy and planning for child nutrition interventions, including budget planning. SECTION 5 presents questions about the implementation of child nutrition interventions, including actual expenditures and service delivery. SECTION 6 sets out questions pertaining to public participation in budget decision-making about interventions to advance child nutrition. 1.9 Research deadlines and submission dates The overall deadline for the completion of this questionnaire is 17 August A number of interim deadlines have been set to ensure steady progress and opportunities for feedback during the research process: SECTION 2 is to be completed and submitted by 2 July SECTIONS 4 and 5 are to be completed and submitted by 27 July SECTIONS 6 and 3 are to be completed and submitted by 17 August All sections should be submitted to Anna Schnell by at the following address: anna@melander-schnell-consultants.se). Following the submission of the completed questionnaires, researchers will be asked to respond to questions of clarification and comments from peer reviewers. Questions related to this questionnaire should also be communicated with Anna. 14

18 1.10 The findings from this research The findings from this questionnaire on budget transparency and child malnutrition will be used to inform budget advocacy and child rights campaigns in each of the five pilot countries. In addition, the collective findings across the five pilot countries will be analysed and summarised to produce a cross-country research report. Relevant findings and insights will be highlighted and if appropriate, included as a special focus theme in or alongside the forthcoming Open Budget Index (OBI) 2012 report, which is due to be published and disseminated by the IBP in Organisations involved in the study This pilot questionnaire on budget transparency and child malnutrition was developed by the Accountability and Transparency for Human Rights (ATHR) Foundation, in consultation with domain experts. The ATHR is a new organisation created to undertake this pilot study. It seeks to advance children s rights by promoting transparency, accountability and participation. The pilot study is supported by the International Budget Partnership (IBP) and aims to complement the IBP s work on budget transparency in countries around the world, particularly through its Open Budget Initiative (see IBP staff played a key role in informing the conceptualisation and design of the project and research methodology. This pilot study is being carried out in collaboration with the Child Rights Governance Initiative (CRGI) of Save the Children. The pilot study aims to inform the CRGI breakthrough on Investment in Children and complement Save the Children s EveryOne campaign, which is active in 50 countries and focuses particularly on countries with high child death rates (see Save the Children supported the BT4CR workshop held in Pretoria in May 2012 and is part of the reference group that contributes to the methodology development of BT4CR. Save the Children intends to use results of the BT4CR to among other target the African Union. The following organisations are research partners in this pilot study: In Kenya, the Children s Legal Action Network (CLAN). In South Africa, the Public Service Accountability Monitor (PSAM). 15

19 In Uganda, the Uganda Debt Network (UDN). In Zambia, the University of Zambia in collaboration with Zambia Civic Education Association (ZCEA). In Zimbabwe, the National Association of Non-Governmental Organisations (NANGO). 16

20 SECTION 2: PRELIMINARY RESEARCH ON INTERVENTIONS & SUB-NATIONAL UNITS The aim of this section is to provide a framework for selecting the interventions you will focus on in the rest of the questionnaire, as well as the sub-national units most relevant for your research. The section is structured as follows: Sub-section 2.1 offers background information and examples of the typical kinds of interventions you might expect to find in a developing country to advance child nutrition. Read only. Sub-section 2.2 gives criteria to inform the selection of interventions for the research you undertake in your country. Read only. Sub-section 2.3 contains 8 tables to be completed by the researcher. These tables guide you through the process of listing, scoring and selecting the five most relevant interventions in your context. Researcher to complete TABLES 1A to 1E, as well as TABLES 2, 3 and 4 by ticking boxes and entering text as instructed. Sub-section 2.4 gives criteria to inform the selection of the sub-national units you will focus on in your research. Read only. Sub-section 2.5 contains 2 tables to be completed by the researcher. These tables guide you through the process of analysing and selecting three appropriate sub-national units for your research. Researcher to complete TABLES 5 and 6 by ticking boxes and entering text as instructed. Please note: If you are in doubt regarding a definition of a term in this questionnaire, consult the glossary at the beginning of this document or contact Anna Schnell at ATHR (see section 1.9). 2.1 Government interventions to combat malnutrition Child malnutrition is caused, in direct terms, by inadequate diet and by infection. These primary causes of malnutrition are influenced by food access and availability, health care, water and sanitation, the nutritional and hygiene knowledge of caregivers, as well as other determinants of health and hygiene in the child s environment. 17

21 Every country will have a different collection of strategies for combating child malnutrition. In addition, various government functions, for example the provision of sanitation services, can have a significant indirect impact on children s nutritional status, without having the overt purpose of combating child malnutrition. For the purposes of this study, the term interventions is used as a blanket term to refer to all government programmes, projects and/or other initiatives that aim to improve, either directly or indirectly, the nutritional status of children. One of the first tasks you, as the country researcher, will have to undertake is to identify relevant government interventions in your own context that you will focus on when completing the questionnaire. The interventions you select will depend on what is actually being done by your country s government in relation to child nutrition. However, it is important to think broadly when considering which interventions to focus on in. To this end, some examples are given below of a range of different interventions that governments may be using to reduce child malnutrition and promote child nutrition. Please note that these are simply examples to inform your own research and thinking, and that the interventions in your own country may be different from, or not appear on, the list. Examples of interventions that could advance child nutrition Income support/cash transfers (including conditional and unconditional grants and transfers) targeted at children and/or vulnerable adults, for example the elderly. Food transfers (targeted at poor families, households or/and communities). Providing support to small scale farmers, which may include subsidies for key inputs and/or raising productivity by improving knowledge. Micro Nutrient Supplementation and Food fortification. (Universal salt iodization) Treatment of Children with Malnutrition Promotion of Home Gardens for Diet diversification to improve the micro-nutrient intake at household level Providing meals to children at schools (often referred to as school-feeding). 18

22 School feeding program - Enhancing the nutritional intake of children attending early childhood development (ECD) facilities, for example by providing subsidies to centres that provide ECD programmes. The promotion of exclusive breast-feeding up to 6 months. The promotion of breast-feeding plus complementary feeding post 6 months. Vitamin A and Zinc supplementation for children (from 6 months of age). Improving the nutrient intake of breastfeeding mothers. Special care for children exposed to and infected with HIV. Growth monitoring of very young children. Food supplements for mothers at high risk of malnutrition and their children. What is the difference between this and the improving nutrient intake Programmes providing social support for pregnant and lactating mothers. Providing insecticide-treated bed-nets in areas of high risk for malaria (as infection has a detrimental effect on children s nutritional intake). Strategies to prevent infectious diseases amongst children. (Immunization, knowledge on immunization (e.g malaria control, control of diarrheal diseases, simple hand-washing etc) De-worming of children aged 12 to 69 months. link this to ECD Interventions that improve access to clean water for children at risk of malnutrition and their families. Interventions that improve access to adequate sanitation facilities. Educating caregivers of children on basic hygiene practices to prevent infection. 19

23 Interventions to address child malnutrition have been found to work differently in different contexts (World Bank 2010). Therefore it is vital that the design and combination of interventions in a country is soundly informed by the particular nature of the child malnutrition problem in that country. The institutional capacity to deliver interventions is also an important consideration. There is no one size fits all approach that a government can adopt wholesale from another country. As a general trend, an appropriate package of government interventions to reduce child malnutrition and promote child nutrition (should) usually displays the following characteristics: Interventions involving different parts of government: Given the broad range of factors affecting child nutrition, action is typically required across multiple sectors, including health, welfare/social development, education, agriculture, trade and industry, water and sanitation, community development and public works. Focus on prevention and cure: More than one strategy is required to deal with the causes and effects of child malnutrition. Governments typically need to implement both preventive and curative interventions. Interventions targeting poverty relief or vulnerable households more broadly: At least some interventions that could have substantial impact on child nutrition may not be defined in nutritional terms or targeted directly to children. For example, in some countries, social transfers (in cash or in kind) are distributed to poor households, families or communities. The exact extent to which such interventions specifically benefit children s nutritional status is not easy to determine. However, research suggests that they do have an impact and that resources transferred to women are more likely to be spent on child nutrition than those transferred to men. Prioritisation of very young children: Very young children (those under 2 years of age) are the most vulnerable to malnutrition. The negative effects of malnutrition are also amplified when it occurs at a young age and more likely to lead to permanent damage. Interventions to support mothers (ante and post natal): The health of very young children is intertwined with the health of their mothers. Thus a key element in promoting child nutrition is providing basic health care and social support to pregnant women and new mothers who, due to poverty and other factors, are at risk of having malnourished children. 20

24 To learn more about existing research on government interventions that aim to combat malnutrition (including assessments of what seems to work and what doesn t), please see the reference list at the end of this section and consult with health experts in your country. However, keep in mind that you are not expected to be an expert on child nutrition in order to undertake this research. Nor does this questionnaire ask you to evaluate the adequacy or effectiveness of your government s interventions in relation to child malnutrition. The core question is rather whether resource decision-making and public spending on these interventions (however adequate they may be) are transparent or not. 2.2 Criteria for selecting interventions to focus on in this questionnaire In order to complete the rest of this questionnaire, it is necessary to select a maximum of five government interventions that combat malnutrition or otherwise advance child nutrition in your country. If there are exactly five or less than five interventions of this nature in your country, there is no need to make a selection and you should focus on all the interventions that do exist. However, if there are more than five government interventions for child nutrition to take into consideration in your country, you will have to select those that are most relevant and appropriate for this study. It is impossible to prescribe a checklist for the selection of these interventions in your context. The criteria listed below are included here as a set of guidelines to steer your research and thinking. They contain normative phrases like most critical, best geared and so forth. It will be necessary for you to consult with a reference group of health experts and child health experts in your country to interpret these criteria, and on that basis, apply your own judgment in choosing the interventions to focus on. The following criteria should be considered in making your decision. Importance: Select those government interventions that appear, in the light of the current child malnutrition, policy and institutional context the most critical or central to combating child malnutrition in your country. As is explained below, to identify the most important interventions you will need to speak to experts in the area of child health, poverty and rights. Targeting: Select those government interventions that are best geared to reach children who are the most vulnerable to malnutrition in your country (henceforth called vulnerable children). 21

25 Child rights obligations: Select those government interventions that can most clearly be linked back to the government s legal obligations to realise children s rights in your country. Traceability: Select those government interventions that can most readily be identified as distinct programs or lines of expenditure in your country s budget documents. Decentralisation: Select those government interventions that are implemented (and even better, budgeted for) at levels of government lower than the national level in your country. 2.3 Selecting interventions relevant to child nutrition in your country This sub-section contains eight tables to be completed by the researcher: TABLES 1A to 1E provide space for you to capture your consideration of the child nutrition interventions in your country in relation to each of the five criteria presented in Section 2.2. There is a separate table for each of the criteria. TABLE 2 is a summary table of your findings from TABLES 1A to 1E. It should allow you to compare the overall scores you have allocated to the various interventions across all five criteria. TABLE 3 provides space to list your selected interventions and capture some basic information about each one. TABLE 4 invites the researcher to record the child rights and legal/policy framework relating to each selected intervention. 22

26 Instructions for completing TABLES 1A to 1E: Apply the same process to each of the five tables: 1. Use the left-hand column to list all the government interventions that exist in your country that could be seen to combat child malnutrition or advance child nutrition in some way. This may require some preliminary research and consultations in your country. 2. Be sure to consider at least the following four sectors: health, social development/welfare, agriculture and education. 3. Once you have listed the interventions in the left-hand column, score each intervention in terms of the criterium given in the heading row, using a scale of 1 to Please use the comments box that follows each table to record any concerns you had or important points you want to highlight concerning the scoring of the interventions. You are encouraged to consult with child health experts in your context, as required, in order to score the interventions. 23

27 TABLE 1A: SCORING OF INTERVENTIONS IN TERMS OF IMPORTANCE IN COMBATING CHILD MALNUTRITION Interventions under consideration IMPORTANCE: How critical is this intervention for advancing child nutrition? 1 (Not critical at all) 24 2 (Not very important) 3 (Fairly important) 4 (Very critical) 5 (Extremely critical) For each intervention, write down a score of 1 to 5 in the corresponding cell 1. Maternal Nutrition for pregnant and lactating women 5 2. Promotion of Exclusive Breastfeeding of children up to six months 3. Complimentary Feeding and Food Safety Program for children after six months 4. Nutrition program in Early Childhood Development centres 5. Micronutrient program including Food Fortification and supplementation 6. Emergency nutrition 4 7. Micronutrient Supplementation for prevention and management of common childhood diseases 8. Deworming 4 9. Malaria Control Hygiene and Sanitation including hand washing at home and in Schools promoted through teachers and health workers 11. Production of nutritious foods to ensure food security and prevent malnutrition

28 Comments on Table 1A: Scoring for importance Please use the space below to record any concerns or important issues relating to the scoring of interventions. These comments are not compulsory, and are to be completed at the discretion of the researcher. There is no need to comment if you are satisfied that, in consultation with health experts in your country, you have been able to score an intervention with relative ease and accuracy. Intervention # 1. Maternal Nutrition for pregnant women 2. Promotion of Exclusive Breastfeeding of children up to six months 3. Complimentary Feeding and Food Safety Program for children after six months 4. Feeding program in Early Childhood Development centres Comments concerning the scoring of interventions According to the Ministry of Public Health and Sanitation, this intervention is extremely critical because it targets the unborn child. The pregnant mother must remain healthy so that she does not lose her child at birth. If something goes wrong during pregnancy, the child is likely to be born with deformities. According to the Ministry of Public Health and Sanitation, this intervention is extremely critical because breastfeeding must start at the right time. The child should not be fed on anything else except the mother s milk within the first 30 minutes after birth. This should continue exclusively for six months without introducing other foods According to the Ministry of Public Health and Sanitation, this intervention is extremely critical because other foods (such as porridge, mashed potatoes and bananas) given to children after 6 months exclusive feeding are not as nutritious as the mother s milk. Food safety also ensures that all food given to children is safe and free from toxins that could cause. According to the Ministry of Public Health and Sanitation, this intervention is extremely critical because it targets children in learning centres who may suffer malnutrition because parents may not afford nutritious food due to poverty. Teachers are also trained to identify malnourished children so that they can be provided with adequate nutritious food, Vitamin A supplementation, and safe drinking water. 5. Food Fortification Kenya has adopted the East, Central, and Sothern Health Community (ECSA) recommendation to fortify all foods consumed in almost every household. These include: Maize and Wheat flour (fortified with multiple micronutrients, Vitamin A and B, folate, and Zinc), Sugar (fortified with vitamin A), Salt (fortified with iodine), Oil (fortified with Vitamin A) 25

29 26 QUESTIONNAIRE ON BUDGET TRANSPARENCY & CHILD MALNUTRITION TABLE 1B: SCORING OF INTERVENTIONS IN TERMS OF HOW TARGETED THEY ARE TO VULNERABLE CHILDREN Interventions under consideration TARGETING: How well-targeted is this intervention to reach vulnerable children? 1 (Not targeted to vulnerable children at all) 2 (Not very welltargeted to reach vulnerable children) 3 (Fairly welltargeted to vulnerable children) 4 (Well-targeted to reach vulnerable children ) 5 (Extremely welltargeted to reach vulnerable children) For each intervention, write down a score of 1 to 5 in the corresponding cell 1. Maternal Nutrition for pregnant women 3 2. Promotion of Exclusive Breastfeeding of children up to six months 3. Complimentary Feeding and Food Safety Program for children after six months 4. Feeding program in Early Childhood Development centres 5. Food Fortification 4 6. Emergency nutrition 3 7. Micronutrient Supplementation for prevention and management of common childhood diseases 8. Deworming 3 9. Malaria Control Hygiene and Sanitation including hand washing at home and in Schools promoted through teachers and health workers 11. Production of nutritious foods to ensure food security and prevent malnutrition