Like in many countries around the world, malnutrition and poor childhood growth—or stunting—have plagued families in Uganda for many years, harming children’s health and reducing the ability of children to learn, succeed in school, and earn a good income as adults. To help address this issue, the Government of Uganda is actively striving to achieve the United Nations sustainable development goal of ending all forms of malnutrition within its borders by 2030. Meeting this goal requires not just a commitment from the national government, but also the active involvement of district-level government authorities and many local community stakeholders.

Several districts in Uganda are making strides toward improving maternal and child nutrition and health with capacity-strengthening and support from the U.S. Agency for International Development (USAID), FANTA, and the Wageningen University & Research Centre/ Centre for Development Innovation (CDI) to develop district nutrition action plans in 10 Feed the Future districts across the Southwest and Northern Uganda regions. Of these 10, Dokolo district was the first to get approval for its plan in 2015, offering keys to success for other districts.

Background

Nutrition has been a national priority for the Government of Uganda for the past 10 years, and the Uganda Nutrition Action Plan 2011– 2016 provides a multi-sectoral framework for improving nutrition, especially among children and women of reproductive age. Although several policy documents—the second National Development Plan 2015/16–2019/20, the Local Government Development Planning Guidelines 2014, and the Sector Development Planning Guidelines 2015—mandate that all levels of government must work together on nutrition as a cross-cutting issue, more work needs to be done to ensure that local governments become active partners. This includes encouraging them to incorporate nutrition into their 5-year district development plans, annual work plans, and budgets, as well as develop district nutrition action plans (DNAPs). Integrating nutrition in these key documents allows districts to allocate and mobilize resources for nutrition activities as well as attract and coordinate with partners to achieve common district nutrition goals.

Uganda’s Office of the Prime Minister (OPM) Nutrition Secretariat and the Ministry of Local Government are working with USAID, FANTA, and CDI to strengthen nutrition leadership and governance at both the national and district level in order to integrate nutrition into district activities. This partnership, known as the District Nutrition Coordination Committee (DNCC) Initiative, is a 2-year effort that is focused on 10 Feed the Future districts: Amuru, Dokolo, Kamwenge, Kasese, Kisoro, Lira, Masindi, Ntungamo, Oyam, and Sheema.

Strengthening District Leadership: Multi-Sectoral Planning for Nutrition

Since multi-sectoral planning for nutrition was new to the local governments in the 10 selected districts, FANTA and CDI provided each district with the tools and support they would need for planning and implementation of nutrition activities and for ensuring the sustainability of efforts to address malnutrition. Staff from various government sectors (health, agriculture, gender/ social development, education, finance, water/ environment, and trade/industry) at both the local and national levels participated in a series of workshops, organized by OPM with support from FANTA and facilitated by CDI, to address gaps in the districts’ efforts to reduce malnutrition. The workshops focused on nutrition advocacy training, orientation on the national nutrition planning guidelines, identification of nutrition issues, planning and budgeting for nutrition, and formulating a 5-year DNAP.

After the workshops, participants consulted with their districts’ Technical Planning Committee, other sector teams, and nutrition implementing partners to gather information (such as the current status of malnutrition in their sub-counties, the state of the health facilities in regard to nutrition, and resources available specific to nutrition and health) and determine which nutrition interventions would work in specific sub-counties. These interventions were considered for inclusion in the DNAP.

Technical staff from FANTA and CDI then advised participants on strategies to efficiently develop the DNAP and fast-track approval. These strategies included: keeping the political and technical teams involved at every stage of DNAP development; advocating on the need to plan for nutrition; and ensuring that the DNAP remains a relevant document during the course of its implementation. With technical assistance from FANTA, OPM regularly interacted with the district teams to support the DNAP development process. The experience in Dokolo provides important insights that can help other districts in Uganda (and in other countries) turn nutrition policy into action.

“It took commitment, dedication, team drive, and an enabling environment for us to be able to get our district nutrition action plan approved by the district council.”
– Mwima Rebeca, Assistant Chief Administrative Officer, Dokolo district

Key Steps for Success in Dokolo District

In 2015, Dokolo district was the first to obtain approval for its DNAP, just a month after it was presented to the Technical Planning Committee (TPC). Successful approaches used by the Dokolo DNCC members for DNAP approval included:

• Different sectors working together closely throughout the DNAP development and approval process, even after the workshops had ended.
• Mapping and advocating with district stakeholders and decision-makers, including the district’s TPC, the Dokolo District Executive Committee, and the sectoral committees as well as civil society organizations and implementing partners, to raise awareness of the DNAP and the need to invest in nutrition. The TPC quickly gave the go-ahead for the DNAP to be presented to the standing committees, followed by the highest approval body, the District Council.
• Nominating a small DNAP sub-committee to seek logistical support from Dokolo’s Chief Administrative Officer, including time to meet and discuss the DNAP, transportation to workshops, and support in coordinating with team members.
• Preparing a fine-tuned presentation of the DNAP for the District Council when seeking final approval. Because of previous advocacy efforts, the council was already aware of the DNAP, requiring less time to review the document.
• Timing the presentation of the DNAP to coincide with the quarterly District Council meeting to avoid a 3-month delay.

Throughout the process, the DNCC members continuously demonstrated that they had mastered the skills acquired from the workshops—effective advocacy, stakeholder mapping, and collaborative engagement across sectors.

“We kept talking to him [Dokolo’s Chief Administrative Officer] about the DNAP, and in this case he chairs the TPC—so these updates ensured he kept bringing up our issues in the planning meetings.”
– Dokolo DNCC member

From Policy to Action

After its approval in 2015, the Dokolo district DNAP has become a working document. The district is using it to lobby for resources to undertake nutrition activities and to encourage nutrition stakeholders in the district to align their activities with priorities outlined in the DNAP. Since its approval, Dokolo district has received funding from the USAID-funded Strengthening Decentralisation for Sustainability Project to purchase anthropometric equipment (MUAC tapes and weighing scales) and ready-to-use therapeutic foods for health facilities. In addition, village health team members and health facility workers now meet each month to discuss health issues related to malnutrition. The USAID-funded Community Connector Project has strengthened its support of quarterly DNCC meetings and sub-county nutrition coordination committees. In short, the DNAP has become a strong reference point for nutrition implementation and resource mobilization in Dokolo district.

After Dokolo’s DNAP was approved, five other districts—Kamwenge, Kasese, Lira, Oyam, and Sheema—have also obtained approval for their DNAPs, and more are expected to follow. It is through their efforts that Uganda continues to make progress toward improving the lives of mothers and children throughout the country.

“We grew close as departments and our team spirit was strengthened. All those who went through the DNAP development process now talk to each other and our team work has been strengthened.”
– Dokolo DNCC member