Project Scoping Document

PROJECT OVERVIEW
Title
ACF project code
ACF project reference
Donor
Donor project code
Sectors
Hub of operation
Project location
Project dates
Budget

Total
Donor
ACF

BACKGROUND
ACF global strategy
ACF Pakistan strategy

Other strategies
Problem statement

UN Maternal and Child Nutrition Stunting Reduction Programme

D3J
UNICEF Stunting
UNICEF
PCA 16-4
PAK 16-34
Nutrition
Ghotki & Khairpur
Province: Sindh;
Districts: Ghotki & Khairpur;
UCs:All 118 UCs of both the districts (42 UCs in Ghotki and 76 in Khairpur)
July14, 2016 Dec 31, 2017
PKR 481,860,333
Cash: PKR 233,890,458
Supplies: PKR 235,414,204
PKR 12,555,670
Aim 1: Mitigate the consequences of hunger
Goal 1: Sustainability
Tackle the root causes of under-nutrition through improving nutrition practices, knowledge,
motivation and access to resources.
Goal 3: Treatment
Ensure that the most vulnerable acutely under-nourished individuals receive access to lifesaving treatment
UNICEF Country Programme/Humanitarian Response Plan
NNS 2011 results showed that in Pakistan 43.7% of children were stunted. The wasting rate
was 15.1% and about 31.5% of the children were underweight. In children iron deficiency
anemia was 43.8%, Vitamin a deficiency was 54%, Zinc deficiency was 39.2% and VitaminD deficiency was 40%. Early initiation of breastfeeding is 40.5%; exclusive breastfeeding less
than 6 months is 12.9%; continued breastfeeding at 2 years of age is at 77.3% and percentage
of children age 623 months who received foods from four or more food groups during the
previous day is 3%
While these results were more severe when it comes to provincial level, In Sindh 48% of

Needs assessment

children under five years are stunted and 4% of these are severely stunted (MICS, 2014). As
per PDHS 2012-13, stunting is higher in male children at 48% than in female children (42%).
Early initiation of breastfeeding is 20.7%; exclusive breastfeeding less than 6 months is
28.9%; continued breastfeeding at 2 years of age is at 48.9% and percentage of children age
623 months who received foods from four or more food groups during the previous day is
14.2%. All these indicators show a dismal state of nutrition in Sindh. NNS 2011 reveals that
72.5% of under five children are anemic and this proportion has increased from 2001 to 2011.
In Ghotki, stunting (HAZ<-2SD) in children under five years of age is 55.2% and wasting is
at 17.2%1. Overall 75,813 children are stunted, out of which 39,423 are males and 36,390 are
females2, while in district Khairpur, stunting (HAZ<-2SD) in children under five years of age
is 53.3% and wasting is at 18%. Overall 122,241 children are stunted, out of which 58,676 are
males and 63,565 are females, clearly linking it with poor nutrition in the first 1,000 days of a
childs life that can lead to stunted growth, which is irreversible and poses threat to physical
and mental development; it can also result in lower level of educational attainment and
economic gains3.
Stunting is a form of malnutrition in which children are shorter than normal for their age and is largely
irreversible after the age of two. If they survive, they grow up physically and intellectually
weaker than their better-fed peers. Pakistan has third most stunted children in the world
(WaterAid, 2016). 9.9 million Pakistani children under the age of five are stunted (Caught
Short, 2016).
Little impact on stunting is seen rather data shows that it has worsened from 2001 to 2011 (NNS
2011). There are patchy interventions but not concerted effort in the context of stunting
prevention because of low political will, sustainability4, lack of expertise, Inter-agency
collaboration and community issues5. Besides, determinants like weak community
mobilization, indicators of IYCF like early initiation of breast feeding (which is low
currently), and myths associated with use of colostrum and poor compliance to continued
breast feeding up till two years of age with minimal meal diversity are highlighted barriers to
better child nutrition outcome6.

1Geographical and socioeconomic inequalities in women and childrens nutritional status in Pakistan in 2011: an analysis of
data from a nationally representative survey: Mariachiara Di Cesare, Zaid Bhatti, Sajid B Soofi , Lea Fortunato, Majid Ezzati,
Zulfiqar A Bhutta, Pakistan Nutrition Lancet GH 2015.
2http://www.pdma.pk/dn/PopulationinSindh/tabid/67/Default.aspx and ibid
3 Ephraim W. Chirwa HN: Determinants of Child Nutrition in Malawi. South African Journal of economics 2008, 76(4):628640
4 Morn JL: External Evaluation: Emergency Nutrition Programme in Sindh Province, Pakistan. In.; 2012.
5 Balagamwala M: Agriculture and Nutrition in Pakistan Pathways and Disconnects. 2013:14

Nutrition in Pakistan has remained off the policy agenda because of large disconnects between
key sectors, a lack of integrated cross-sectoral programs, and a missing constituency for
nutrition within the political and bureaucratic elites, civil society groups, and the electorate in
general7. Pakistan lacks a national nutrition policy; however, at positive end, Pakistan
Integrated Nutrition Strategy8 is now in its preliminary stages of adoption catering to children,
pregnant and lactating women with the aim of prevention and treatment of malnutrition
among under five children and improving nutritional status of PLW. In 2002, protection of
breastfeeding and child nutrition ordinance was passed but was not implemented. PC-1 going
to be implemented in 9 districts of Sindh only in the context of SAM treatment; however,
Ghotki and Khairpur are not included in these districts.

Particular interest

OBJECTIVES
Global Objective
Specific Objective
Gender

This programme will address the problem of stunting by implementing four strategies mainly
for children aged 0-23 months; PLW; adolescent girls and pre-pregnant women.
IYCF activities, multi micronutrients, provision of iron folic acid to pregnant women, SAM
treatment and integrated Behavior Change Communication (BCC) will focus on first 1,000
days windows of opportunity and hence stunting forms the focus of this call.
First of its kind stunting programme;
Supports under-nutrition in Sindh in non-PC1 districts;
Re-establishes our presence in Sindh and helps ACF to enter into two new districts;
Will provide us with a base to further expand our operations and better position
ourselves for upcoming opportunities
Relationship with UN and linkages with USAID

Enhanced Nutrition and WASH Practices contribute to a reduction in stunting by 2017 in

three target districts of Sindh
To improve the health and nutrition status of vulnerable children & PLWs through improved
behaviour towards IYCF practices in Ghotki and Khairpur Districts of Sindh province
ACF International has developed a holistic gender policy, supported with SIDA funding,
and its roll out was completed in Pakistan during 2014. This policy ensures that the gender
lens is applied throughout designing and implementing project activities, based on a prior
analysis of the situation. Sex and Age disaggregated data will be collected in all programs

6Nutrition causal analysis. ACF Pakistan 2012; Pilot bottleneck analysis ACF CMN 2015-16
7Zaidi S, S. K. Mohmand, Z. Bhutta, Acosta. AM: The Political Economy of Undernutrition in Pakistan. DFID-MQSUN: Islamabad.
2013
8WHO: Pakistan Nutrition Strategy

and a thorough analysis will be carried out to react on possibly changing needs during the
project implementation.
ACF will ensure that all children 6-59 month (6-23M SAM and 2-5 deworming and MM
supplementation) suffering from acute malnutrition, regardless of gender or ability, have
equal access to care. Through the intervention, ACF will promote gender equity through
changed mindset of the community in relation to traditional and cultural practices that
negatively affect female nutrition. Increasing womens ability to respond appropriately to
malnutrition empowers women and supports positive female influence at the household or
community level. For the intervention dedicated female staff will ensure to monitor the
services according to the cultural norms and values. In order to improve equity and
sustainability of nutrition provisions, couple health workers will be selected from the
community to promote active involvement of women and men and children from the
community. This project will contribute significantly to gender equality.
ACF ascertains its commitment to principles of neutrality, equity and impartiality by being
needs based: it chooses areas of intervention solely on the basis of its own assessment of
humanitarian needs, and no distinction is made among the victims on any criteria other than
their vulnerability. ACF is increasingly measuring its activities against the do no harm/do
less harm principle, which means avoiding or minimizing negative effect that may be
produced by humanitarian programs.
ACF will involve Govt., community and other NGOs working in the nutrition integrated
activities through close coordination meetings and sharing of ways through which
maximum sustainability output in shorter run and outcome in longer run could be achieved.
Moreover, capacity building will be imparted on SAM protocol; Micronutrients
supplements protocol; and IYCF protocol linking it with sustainability.
ACF will focus on involving both genders and all age groups of communities to increase the
effectiveness and impact of the project in the targeted area. The proposed activities are
designed to build the capacity and raise the level of confidence of all community members,
including female beneficiaries, as well as to increase empowerment for female decision
making. This will support female community members in becoming self-sufficient in
addressing their specific needs and problems. In order to achieve this, ACF will form and
train Mother to Mother support groups and Father to father support groups comprising of
representatives of both genders and all casts/sects. Hygiene and nutrition awareness raising
and sensitization sessions will be conducted with males and females of all age groups in the
target communities, while Nutrition activities will target children and Pregnant and
Lactating Women through CMAM and IYCF interventions.
Age

ACF attends the gender working groups in Pakistan hosted by UN-Women.

Children 06-23 months;

Persons with disabilities

Sustainability

Children 24-60 months;

Pregnant and lactating women (PLW);
Pre-pregnant married child bearing age (CBAs);
Adolescent girls (10-19 years)
N/A
This project has been developed considering the need for sustainability of the project
outcomes. It focuses extensively on working closely with the local authorities to provide
maximum outreach to implement the planned PC1 for nutrition sensitive programming with
high coverage (>80%)
Meanwhile, in terms of the community-led sustainability, this project aims to build
communities knowledge on malnutrition prevention and treatment. This includes mother-tomother groups as well as IYCF awareness rising.
ACF will strengthen the existing Nutrition Support Program under PC-1, through Provision
of Capacity building of DoH staff and as well as National program network force (LHSs &
LHWs), outreach and mobilization activities in non-LHW covered areas and will overcome
the malnutrition and IYCF education plays a vital role towards resilience by addressing
major problem like early initiation of Breasting, Complementary Feeding, continuous
breastfeeding up to 2 years. Moreover, on the job coaching of the existing health system
will be the aim of the proposed action. Various coordination of work, Joint supportive
supervision visits with DoH and Nutrition Cell will build the system more resilient to cope
with the future emergencies. This will enable the communities to prevent from illnesses and
improve child survival through key family practices and ultimately contributes to healthier,
safer and more resilient communities.

BENEFICIARIES
Target
Level
location
Name
#
Criteria
Method
selection

for

Activities
specific
to
this location
Level
Name
#
Criteria

District
Ghotki & Khairpur
2
Non-PC 1 Districts with high stunting rates
Primary & secondary data on stunting i.e. NNS.
Mapping of the District health facilities including DHQs, THQs, RHCs, BHFs and
satellite/communal sites where BHFs are not present or remote area.
All
Union Council (UC)
All
42 UCs in Ghotki and 76 UCs in Khairpur
HFs in all UCs in both Districts except PPHI administrative HFs

Method for
selection
Activities
specific
to
this location
Level
Name
#
Criteria
Method for
selection
Activities
specific
to
this location

Target
group&
project
beneficiaries

Type

Children 6-23 months, PLWs, Pre pregnant married CBAs, Children 24-60 months
Mapping of all HFs according to the project document
All
Village
TBC
All villages in target UCs of both Districts
All HFs under District health system

Village profiling.
Carpet screening of children under 5, CBAs and PLWs
Establishment of IYCF corners at targeted HFs and counselling of PLWs
Awareness of community and PLWs on CMAM, Stunting and IYCF
Mother to mother support groups in community.

Children 06-23 months;

Children 24-60 months;
Pregnant and lactating women (PLW);
Pre-pregnant married child bearing age (CBAs);
Adolescent girls (10-19 years)
District Khairpur
Total pop: 1,647,448 (60% program coverage)
Children 06-23 months: 88,962 (6%)
PLW: 118,616 (8%)
Pre pregnant married CBAs: 53,170 (16.3% of 22%)
Adolescent girls: 48,677 (6.7% of 49%)
Children 24 to 60 months: 103,789 (12%)
Districts Ghotki:
Total pop: 981,015(60% program coverage)
Children 06-23 months 52,975 (6%)
PLW: 70,633 (8%)
Pre pregnant married CBAs: 31,661 (16.3% of 22%)
Adolescent girls: 28,986 (6.7% of 49%)
Children 24 to 60 months: 61,804 (12%)

Criteria
Method for
selection
Specific
activities
RESULT 1

Description
proposal

from

SAM children and MAM CBAs and PLWs

Screening of the children, pre pregnant married CBAs and PLWs
All

Support for appropriate infant and young child feeding (IYCF) is accessed by
vulnerable children (girls and boys), pregnant women and breastfeeding mothers,
especially protecting and supporting exclusive breastfeeding by dissuading and
monitoring the donation of breast milk substitutes and providing safe breastfeeding
areas for nursing mothers, promoting timely and appropriate complimentary feeding
including minimal acceptable diet [diversity and meal frequency] and cooking
demonstration
Output 1.1: Contribution to prevention of chronic malnutrition/stunting through protecting
and supporting infant and young child practices appropriately feeding (IYCF) among
pregnant women and breastfeeding mothers (PLW)
Output 1.2: Continuous inbuilt Monitoring of the activities

Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY1.1
Description
from
proposal

Output 1.3: Provincial coordination meeting with MOH and District coordination meetings
and workshops with sector leads (WASH; Health and Agriculture) for integration for
maximum
PLWs, adolescent girls and pre pregnant married
Lactating mothers, pregnant women
Pre pregnant women, adolescent girls
Establishment of breastfeeding corners and safe areas in those corners
ACF will establish IYCF corners in each union council of both districts with support and
close coordination of District health office. ACF will ensure that at least one IYCF corner is
established in each RHC/THQ. ACF will also establish one IYCF corner in its District
offices to ensure the privacy, dignity and continue breast feeding practices for their own
staff.IYCF corners will be staffed by skilled female personnel who will provide practical
support for breastfeeding and complementary feeding.
All mothers of children under the age of 24 months enrolled in programs will receive a oneto-one assessment in the centres breastfeeding corner and advice on IYCF. Mothers who
had stopped breastfeeding due to illness or nutrition induced reduction in breast milk
production will receive further support to initiate re-lactation.

Methodology

Bi weekly follow up will be ensured of each mother, if mothers have difficulty to come to
IYCF corner on regular basis then these mothers will be engaged with relevant LHW/CHW
for follow up and ensure their participation on MTMSG sessions in its area
Mapping through program teams in collaboration with District health authorities

Relevant ACF policies

Sustainability

Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.2
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability

Strengthening health system and nutrition guidelines

The IYCF promotion will help build knowledge of the target PLWs which has a
multiplicative effect of further support to their communities.
It also enhance the knowledge of LHWs and LHSs in IYCF and best practice for early
breast feeding and complementary feeding.
42 IYCF corners established in Ghotki and 76 in Khairpur
PLWs and caretakers of children Under
Child bearing age women 15-49 women
PLWs and caregivers of children <2
PLWs and caregivers of children <5
Adolescent girls and pre pregnant married
PLWs and caretakers of children <2
PLWs and caregivers of children <5
Adolescent girls, pre pregnant married, elder female siblings, grandmother, mother in laws
List of each HFs where IYCF corners established, PRs for equipment, furniture + Material,
NoC, MoUs
Breastfeeding best practices in the community
HealthCare Providers; Lady Health Workers and midwives trained on IYCF and
maternal nutrition
ACF will train around 60% of LHWs/LHSs and 236 CHWs in both districts, a two days
IYCF package including MUAC base screening and referral mechanism training will be
provided to all these participants, Training material will be developed and shared with
UNICEF and PNC for approval and validation, after validation nomination and selection
process will be initiated with support from national program District authorities and district
health office. For finalization of names, close coordination will be maintained with other
key partners working in the area to avoid duplication and maximize the cost effectiveness.
Identification and selection of health worker in communities by Community Mobilizer.
Nomination letter signed by DHO/DNC for LHSs & LHWs. PM will submit PR for the
training to logistic department to ensure timely availability of all required materials and
support. When nomination completed agenda and venue of the training will be shared with
concern department for further dissemination. Health department will ensure the availability
of nominated LHSs & LHWs. CHW will be informed by ACF CMs and ensure their
viability in the trainings. Detail training report will be generated by CBDPM and share with
PM and Nutrition Coordinator
Health system support, ACF IYCF guidelines
Enhance knowledge of the District health staff will help detect the active case findings and
will provide the counselling to PLWs and caregivers on breast feeding and complementary
feeding and IYCF best practices
Project health staff trained on IYCF will support health system to increase the knowledge of
District health force through integrated on job case identification and counselling.

Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.3
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice

71 Project staff and 1636 LHWs, LHSs, CHWs trained on IYCF and maternal nutrition
Health workers in District health system
Adults of different age group
Project staff and staff working in District health department
Project staff and staff working in District health department
Community of the targeted Districts
Nomination letter + list of participants + Pre & Post-test + TA/DA sheet + Final training
report
Through strengthening the capacity of existing health system, it will ensure the
sustainability of nutrition program in long run
Pregnant Lactating Women and caregivers attending Infant Young Child Feeding
counselling session
ACF in efforts to improve malnutrition prevention will implement its IYCF approach to
awareness rising. ACF will conduct sessions with primary caregivers (particularly women)
to improve their knowledge and thereby their practices of safe health, nutrition and hygiene
including hand washing, safe feeding practices, information on balanced diets and basic
health indicators. The specific content of sessions will depend on the context. These groups
will be facilitated by community mobilizers, couple health worker with LHWs engaged
where possible. They will primarily be targeted at women given their role as primary
caregivers. However, men will also be able to attend and engaged through father to father
support groups.
IYCF promoter will conduct sessions with primary caregivers (particularly women) to
improve their knowledge and thereby their practices of safe health, nutrition and hygiene
including hand washing, safe feeding practices, information on balanced diets and basic
health indicators. The specific content of sessions will depend on the context. These groups
will be facilitated by community mobilizers, couple health worker with LHWs engaged
where possible. They will primarily be targeted at women given their role as primary
caregivers. However, men will also be able to attend and engaged through father to father
support groups.
ACF IYCF & CMAM guidelines
These counselling sessions will increase the knowledge of the target groups on young child
feeding and will change their behaviour towards breastfeeding to adopt the best practices.
9642 PLWs and caregivers trained in IYCF
PLWs and caregivers
Child bearing age 15-49 years
PLWs and caregivers
PLWs and caregivers of children <5
Caregivers and community
Attendance sheets + session reports + Plans + pictures
Behaviour change activity of the community to adopt the best practices through effective

activity and if so how?

ACTIVITY 1.4
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.5
Description
from
proposal
Methodology

Relevant ACF policies

counselling sessions and one to one support.

Cooking demonstration sessions for preparation of healthy diet and feeding practices
to adolescents; pre-pregnant and pregnant women through LHWs and Couple
healthworkers (CHWs)
ACF will train LHWs and CHWs in the area of healthy food preparation; after training
these LHWs and CHWs will conduct cooking demonstration in their areas on quarterly
basis with local females (specifically with MTMSG members) in their houses. ACF will
provide a lump sum charges to these LHWs and CHWs for food purchase. The activities
will be monitored by ACF staff on regular basis.
ACF will train LHWs and CHWs in the area of healthy food preparation; after training
these LHWs and CHWs will conduct cooking demonstration in their areas on quarterly
basis with local females (specifically with MTMSG members) in their houses. ACF will
provide a lump sum charges to these LHWs and CHWs for food purchase. The activities
will be monitored by ACF staff on regular basis.
ACF CMAM & IYCF guidelines
District health staffs capacity enhanced in cooking practices and healthy diet. Mothers in
the community will be aware about nutritious food and its contents and how to prepare
health food for their children.
1200 LHWs, LHSs, CHWs trained in cooking healthy food
LHWs, LHSs and CHWs and mothers
Different age groups of adults female
LHWs, LHSs, CHWs
Mothers with LHWs, LHSs, CHWs
Caregivers and community
Attendance sheet + pictures + reports + mothers feedback and case studies
Healthy food preparation and change in their eating habits for improved nutritional status of
children and PLWs.
Children screened and referred for vaccination, ARI, Diarrhoea
During door to door MUAC screening and regular activities in field, ACF community
mobilizers, LHWs and CHWs, will identified the children with ARI and diarrhoea sign and
symptoms, and refer them to nearest health facility for treatment.
LHWs, CHWs and CMs will conduct door to door screening and will identified children
with sign symptoms of ARI, Diarrhoea and those who missed their immunization or never
been immunized to refer them to nearest health facilities. All the identified children will be
followed up by LHWS & CHWs and ensured their visits to HF. The health facility staff will
keep proper record of all referrals. Every week this record will be cross checked to identify
the defaulter children. PLWs will also be targeted to ensure their ANC visits and TT
vaccination.
Health system strengthening and support

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.6
Description
from
proposal

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?

District health force trained in active case finding and referral mechanism for common
illnesses in the children
49678 children vaccinated, 26826, 26534 children referred for ARI and diarrhoea treatment
respectively.
Children <5
Children <5
Children <5
Children <5
Mothers and families
Referrals slips + screening data + meeting reports and cross verification
To strengthen referral mechanism
Awareness on appropriate IYCF practices and policy at district level
ACF will organize and celebrate Global Breastfeeding Week and Mother Child Health Week
in close collaboration of DOH. Local community will be involved through LHWs and
CHWs. During the week the following activities will be carried out
o Sessions on awareness of IYCF Practices at nutrition treatment centre and at
community level
o Role played in each UC on good IYCF practices
o Mother to mother support meeting for sharing of good IYCF practices
o Theatre on awareness of Breast Feeding & IYCF practices by MTMSG
o Display of banner and posture in health facility and community
o Seminar and walk on IYCF
In support with District health authorities the different sub activities will be conducted in
both Districts. ACF support department will help program team to conduct this activity.
Invitation for participation will be shared with all stakeholders like DHO, DNC, CNVs,
INGOs/NGOs working on health in the district. The following activities will be conducted
in the field level. A detail report of the events with pictures will be shared with UNICEF and
head office.
Health system strengthening
Promotion of public events on IYCF and motivation of the District health staff and
community to celebrate the health events to increase awareness.
Global breastfeeding seminar conducted
All community
All ages of the adults
Community
District health staff, project staff
Community
Invitation letter + attendance sheet + pictures + reports + if available news cuts

Is this a best practice

activity and if so how?
ACTIVITY 1.7
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.8
Description
proposal

from

Awareness raising on celebration of health events

Couple health workers, LHWS and LHSs trained on IYCF Key Practices and taking
MUAC for SAM children
ACF community Mobilizers will identify and select active persons in the community. These
active persons may be couple (husband & wife, brother & Sister or Father & daughter etc).
These couple will be selected from LHWs non-covered areas. After selection all these
couple will trained on proper MUAC taking and referral mechanism.
In non-covered LHWs areas ACF will mobilize volunteers and its community mobilizers to
identify couple i.e. husband & wife, brother & sister, father & daughter. These couple will
be trained in active case findings through screening of the children in the community and
referred them to the ACF supported treatment sites for further confirmation and treatment.
CMAM guidelines
Increased awareness in the community at house hold level for active case finding and
referral mechanism
1636 LHWs, LHSs and CHWs couple trained on IYCF key practices and SAM case
finding.
Couple of LHWs, LHSs and CHWs
All ages of Health workers
Couple LHWs, LHSs and CHWs
Couple LHWs, LHSs and CHWs
Community
Nomination letter + attendance sheets + training reports + screening data registers + pictures
+referral slips
Enhance knowledge of health force in early detection of SAM cases
Taluka IYCF supervisor with expertise for supervision of IYCF and Stunting
activities at all targeted union councils
ACF Program Quality and Accountability (PQA) unit will look-after project related
Monitoring, Evaluation, Accountability and Learning activities, aiming to support program
implementation team to ensure quality services to the target communities.
The unit will support in designing the M&E system for the project based on the IYCF
guidelines, followed by integration of the system within the nutrition program through
comprehensive training/orientation and on-job coaching to the designated staff. Several
checklists will be developed based on project components like OTP sites monitoring, IYCF
session monitoring, MTMSG and FTFSG monitoring and plans, Stabilization centres
monitoring, Beneficiaries satisfaction surveys etc., further these checklists will be translated
to database for analysis and quarterly reports will be generated.
Checklist of distribution of MMS to the targeted group (with follow up mechanism)
Checklist of distribution of iron folic acid to make sure the longitudinal care of pregnant

women.
Process Monitoring:
A regular process and output monitoring will be carried out throughout the project life as
per performance indicator guide, all the project interventions will be monitored and verified
at field level. Program beneficiaries verification will be regularly carried out through HHS
verification surveys to improve quality and ensure effectiveness. The fields findings will be
shared regularly through debrief session with program teams and management for timely
action. The monitoring activities broadly cover the following components;

All eligible PLWs/Children are receiving supplementation as per protocols.

All pregnant women receive iron and folic acid as per protocols
HH level IYCF caring practices, (early initiation of breast feeding, Exclusive breast
feeding and Age appropriate complementary feeding and continuation of breast
feeding till 2 years)
Monitoring of IYCF, WASH & Nutrition sessions and also verification of
participants
HH level hygiene knowledge (personal, Domestic and environmental hygiene)
Monitoring of MTMSGs and FTFSGs sessions and meetings
Monitoring of cooking demonstrations on regular basis.
All children under 24 months are screened & Severe Acute malnourished children
are enrolled as per protocols
Monitor through check list of all referred children are enrolled.
Regular monitoring visits to IYCF, OTP sites, nutrition stabilization centre and
outreach activities.
Beneficiaries satisfaction interviews (BSI) from caretakers of SAM children
(Defaulter, non-responders).
To check the anthropometry equipments availability as well as quality.
To monitor the stock storage & availability of RUTF, essential medicines.
Randomly checking of selected beneficiaries (Cured, defaulter).
All eligible PLWs/Children are receiving supplementation as per protocols.
LHWs and CHWs conducting quality cooking demonstrations.

Accountability Mechanism:
To mainstream accountability mechanism within project, all the project staff members will
be oriented on FCM (Feedback and complaint mechanism), developed based on HAP
standard. The project staff will further orient target communities and beneficiaries on FCM.
This will provide opportunity to beneficiaries and communities to raise their voice and
provide feedback/Complaints against the assistance provided by the organization. All these

feedback and complaints will be managed in a database; complaints will be resolved in

consultation with relevant program staff and management and end up with proper feedback
to the complainant.
Methodology

Different checklists shall be used based on project components like; OTP Site supervision
checklist, IYCF Supervision checklist, Stabilization Centre checklist and BSI- Beneficiaries
satisfaction interviews, further these checklists will be translated to database for analysis
and quarterly reports will be generated.

Monitoring Tools
Database.xlsx

Relevant ACF policies

BS-Assesment.docx

IYCF Supervision
OTP Site
checklist for validation.docx
Checklist.docx

SC Supervision
checklist.docx

ACF FCM guidelines shall be used to implement FCM mechanism

FCM Guidelines.docx

Note: ACF has to get project baseline from UNICEF for developing the soft component
(material) of the project.
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.9
Description
from
proposal

Methodology

6 Supervision, mentoring and on job trainings conducted by PQA to support program teams
All program team
Various age adults
Taluka IYCF supervisors and other program teams
Taluka IYCF supervisors
Program teams and community
Monitoring reports, check list, IEC material, pictures and reports
Program quality and accountability practices for smooth implementation of activities
Joint supervision visits by DNF, EDO and DC NP
Joint monitoring visits will be carried out quarterly on different aspects of the implementing
project. ACF project staff, district health departments, District nutrition officer and DC NP
will be key stakeholders to be engaged in joint monitoring. It will be a learning exercise to
know the project progress in terms of community mobilization, program linkage, referrals,
and challenges at district level. A debrief session for each joint visit will be carried out to
discuss key findings, good practices and challenges, followed by a comprehensive joint
action plan.
Program team will ensure that all stakeholders will be present in joint monitoring visits in

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.10
Description
from
proposal

Methodology

Relevant ACF policies

Sustainability
Expected output

each quarter. Work plan for these visits will be shared with all partners and an invitation
letter will also be sent before these visits to partners to remind them about this activity.
Partners will be asked to share their findings and a joint report after feedback and review
from each partner will be generated to see the project progress.
Program quality and accountability
Ownership of the program to District health authorities
12 joint supervision visits conducted in both Districts
District Health staff
All age group of adults
DNF, EDO and DC NP
Program team
Community
Joint monitoring visits reports + pictures
To increase awareness and provide sense of ownership to District health authorities
Qtr. joint progress review meetings with WASH, Health + GOVT district level
In order to achieve the output 1.3 of result 1, ACF will conduct the following activities:
Inception workshop of the project
An inception workshop will be carried out at start of the project in both districts, in which
key stakeholders (DC, DHO, DC NP, DNF, ASP) and other health and WASH partners will
be invited and briefed about the stunting project.
Joint progress review meetings with WASH, Health + GOVT district level
To share project progress, a joint exercise will be carried out quarterly, during the project
life. In which all the relevant stakeholders will be invited. ACF and nutrition support
program focal persons will share their progress, learning, issues / challenges faced and its
remedial measures taken during the course of the project. This exercise will also provide the
reflection of our work and related challenges that will also provide the solution for future
improvement in program and systems/functions.
These meetings will be conducted in coordination with District government. Program team
will ensure the timely invitation to all department and government officials about the venue
and time of the meeting. The interval of these meetings will be quarterly basis. All stake
holders will be asked t prepare their presentations on progress and will be shared in the
meetings, the issues, problems will be discussed and progress of the project will be analysed
in the meeting and solutions with action points will be provided during the meeting. The
report of the meeting will be shared with country office and UNICEF.
Program quality and accountability
Government officials increased knowledge about current context and project activities for
further integration of the project activities in District health plans.
12 Joint meeting conducted in both Districts

Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.11
Description
from
proposal

All staff
All ages of adults
Program teams and government officials
Program and District health authorities
Community
Attendance sheet + review meetings reports + pictures
Government ownership in the project intervention
Project Review Meeting at base level
A quarterly project review exercise will be carried out in field office, to review the progress
against the targets within the agreed timeframe as per the project implementation plans and
in comparison to the project burn rate. For any under achievements, a joint action plan will
be devised and monitored to overcome the implementation gap.
To sharing project learning's, good practices and experiences, a joint lesson learnt exercise
will be carried out yearly, during the project life. This will be a joint learning sharing event,
in which all the relevant stakeholders will be invited. ACF and nutrition support program
focal persons will share their learning, issues / challenges faced and its remedial measures
taken during the course of the project. This exercise will also provide the reflection of our
work and related challenges that will also provide the solution for future improvement in
program and systems/functions.

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?

All relevant department will be invited to attend this meeting at base level and will be asked
to present the current progress of the project activities and any challenges, issues will be
highlighted and solutions will be provided in line with the guidelines and policies of ACF to
improve the program progress if any. The joint review meeting with WASH and government
will be followed after this internal exercise.
Program quality and accountability
Internal or in house capacity building exercise before organizing meetings with other
stakeholders.
6 meetings conducted in two districts
All staff
All ages
Program teams
Program teams
Community and District authorities
Attendance sheets + reports + pictures
Yes, to improve project activities by lesson learnt

ACTIVITY 1.12
Description
proposal
Methodology

from

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 1.13
Description
from
proposal
Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?

Health baby competition and Performances based award ceremonies at District level
N/A
ACF program team in support from logs and other departments and in coordination with
District government will conduct a performance based competition amongst health workers
and based upon the best case studies by these health workers and their involvement in these
case studies and changing behaviour of the community, PLWs and caregivers to improve the
health and nutritional status of their children <5. A committee will be formed to judge and
finalize the results of healthy baby competition. Award ceremony will be conducted and all
relevant stakeholders will be invited in the competition.
Health system strengthening and behaviour change
Sense of ownership of the health workers and community
8 events conducted in both Districts
Health workers, PLWs, children <5
Staff and children <5
Health workers and children <5
Health workers and children <5
PLWs and caregivers and community
Attendance sheets + pictures + community feedback/ reports
Behaviour changes for best practices about health and nutritional status of children <5
Participate in provincial coordination meetings on monthly basis
N/A
PMs from relevant Districts will participate in monthly coordination meeting conducted by
UNICEF and PNC.
Coordination
Established linkage with government authorities and improved coordination
18 meetings attended by program team
Program staff
All ages
PNC, UNICEF and Program team
Program
Community
Meeting minutes
Better coordination practices

RESULT 2
Description
from
proposal
Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY 2.1
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability

Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.2
Description
from
proposal

Children 6 to 23 months have access to appropriate feeding services, and provision of

essential supplies especially therapeutic foods for the management of severe acute
malnutrition (SAM)
Output 2.1: Severely acute malnourished children 6-23 months of age are early identified
and treated in therapeutic program
Children < 2
Children < 2
Mothers and caregivers
Outpatient therapeutic sites (fix 15 in RHC, 5 THQs, 2 DHQs and 96 community
static/Satellite sites) in intervention area
ACF will establish 22 static sites in 15 RHCs, 5 THQs, and 2 DHQs in both districts.
Selection of sites will be mutually discussed with both the DHOs in the districts. Satellite
sites will be selected based on the availability of space in the community, communal, easy
accessible for both staff and community, Space available to run the minimum standards of
CMAM program and to establish and run IYCF corner.
Program team will coordinate with District health authorities and share a mapping plan for
the assessment of the HFs including RHC, THQs and DHQs. The mapping plan for the
satellite/communal sites will also be prepared and shared with stakeholders. The mapping
will be conducted with support from District health department. The identified sites will be
discussed with them and finalized to establish OTP sites.
CMAM guidelines and HSS
Health system strengthening through capacity building and integrated approach with
District health services for primary health care.
Established 22 static sites and communal sites
NA
NA
District Health System
District Health System
Children <5 and PLWs
NOC + MOUs + List of sites + pictures
N/A
6-23 months of children screened for SAM
1400 LHWs/LHSs and 236 Couple Health Worker (CHW) will cover up geographical areas
(UCs in both districts) to address nutritional needs. This includes 42 UCs in Ghotki and 76
UCs in Khairpur Districts in Sindh. Identification and referral of acutely malnourished
children aged 6-23 months will be done through static and satellite sites (depending on
ground reality), a special focus will be kept on those geographical locations where LHWs

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.3
Description
proposal

from

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should

are not available; these areas will be covered by 236 CHWs. The referral system will start
from the standard community mobilization strategy by early detection of cases (Door to
door screening) and referral to the relevant health facility or satellite site. The LHWs and
CHW will conduct regular follow-ups in the community along with defaulter tracing and by
collecting information from health facilities and communities on a daily basis.
Carpet screening and community mobilization will be done through community volunteers
and project staff at OTP established sites and in the community. The screened children from
community will be referred to the treatment sites for further treatment.
CMAM guidelines
Through couple health workers community will be directly involved in the program,
increase their knowledge about the malnutrition, its under lying causes and how and where
the malnutrition can be treated.
141937 children screened
Both male and female children
6-23 months
6-23 months
Children < 2
PLWs
Screening data register + referral slips + pictures + reports + NIS
NA
Severely acute malnourished children 6-23 months of age referred and admitted to
OTP program
LHWs and CHWs will refer all the children with compromised health to OTP site and
admitted in OTP program. Treatment will follow the revised 2014 National Guidelines for
Acute Malnutrition. Supplies for the treatment of Acute Malnutrition, including Ready-toUse Therapeutic Food (RUTF) and the appropriate medication will be provided by
UNICEF.
LHWs and CHWs after screening the children will Screened children will be referred to
OTP sites for further treatment
CMAM guidelines
Through capacity enhancement, the MoH staff will be able to detect and refer children for
further treatment in outpatient program.
23420
Both male & female children
Children 6-23 months
Children 6-23 months
Children < 2 years
PLWs, CHWs and LWHs
Admission register + referral slips + Ration cards + pictures + case studies + NIS +

be retained for the audit?

Is this a best practice
activity and if so how?
ACTIVITY 2.4
Description
from
proposal

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.5
Description
proposal
Methodology

from

Relevant ACF policies

Sustainability
Expected output
Gender
Age

SQUEAC findings
N/A
SAM children with medical complications identified and referred for treatment to SC
LHWs and ACF team will assess the health status of all children according to the CMAM
protocols. Those children who have medical complication will be refer to Stabilization
Centres for further treatment. A referral slip will be properly filled out before referring the
child and OTP nurse will contact SC Focal person before referring the child and keep close
contact with SC focal person about the health condition of children. After discharge from
SC all children will be refer back to OTP site for continuation of further treatment.
ACF nutrition team will screened the children and referred those children to SC who have
SAM with medical complication
CMAM Guidelines and standard treatment protocols
Through capacity enhancement, the MoH staff will be able to detect and refer children for
further treatment in inpatient program.
4684 SAM children with medical complication treated
Both male & female children < 5
Children < 5
Children < 5
Male and female children < 5
Lactating mothers & caregivers
Referral slips + Admission and discharge slips + NIS
Children referred for treatment from OTP sites and direct from community to improve their
nutrition & health status
OTP programme achieves SPHERE standards (percentages) for cured, Death and
Default rates
ACF will ensure the achievements of all SPHERE standards for OTP program in the area.
ACF nutrition team will screen and referred the children for further treatment according to
the SPHERE standard and according to the national CMAM guidelines. The team will
ensure to maintain the SPHERE standards in all components of CMAM including OTP,
referral to SC and discharge/cured standards.
CMAM guidelines and treatment protocols
The awareness of the community will be enhanced to how to refer their children for
treatment of SAM and follow up in the HFs.
Cured rate >75%
Death Rate <10%
Default Rate <15%
Male & female children < 5
Children < 5

Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 2.6
Description
from
proposal
Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
RESULT 3
Description
proposal

Target group
Direct Beneficiaries

from

Children < 5 with SAM

Children < 5
Mothers & caregivers
SQUEAC findings + NIS
Increased awareness in mothers and caregivers for treatment of their children for SAM
Project staff trained on OTP protocol for treatment of SAM children
ACF Capacity Building will organize and conduct a 3 Days training for project staff. All the
participants will be provided with protocols and guidelines for further supervision and
monitoring purpose.
The capacity building of the volunteers, LHWs and LHSs will enhance the knowledge of
the health workforce in the District for timely identification of the malnourished cases and
will refer to the treatment sites in the future.
Through community volunteers the local community will be directly involved in the
program, increase their knowledge about the malnutrition, its under lying causes and how
and where the malnutrition can be treated
CMAM guidelines
Produce workforce for the district on CMAM
120 project staff trained on OTP protocols for SAM treatment
Male & female staff
Adult of different ages
Project staff
Project staff
Community, mothers & caregivers
Attendance sheet + training report + pictures + NIS
Enhanced capacity of project staff which will contribute to provide support to District health
system
Children and women access to Multi micronutrient supplementation
Output 3.1: Increased national capacity to ensure availability of, and access to, services and
to strengthen systems
Output 3.2: Children 6-23 months of age and women access to micronutrients
supplementation (pre pregnant and pregnant women, and lactating women) to address
anaemia and othermicronutrient deficiencies
Health care providers and children < 2
Health care providers & children < 2

Indirect Beneficiaries
ACTIVITY 3.1
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.2
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability

Community, mothers & caregivers

Health care providers trained on standard protocols for micronutrient
supplementation and on iron folic acid protocol for pregnant women
ACF will train a total of 118 health care providers (HCPs) on standard protocols on
micronutrients supplementation in two districts. One-day training on micronutrients
supplementation will be organized for the HCPs.
ACF nutrition team will do a training need assessment in coordination with Districts health
department and finalize the lists of the potential health care providers to enhance their
capacity on provision of micronutrient supplementation and folic acid according to the
standard protocols. The venue will be selected and one day training will be conducted in
both districts.
Health system strengthening
These trained staff will work as trained medical force for the District health department and
provide support in provision of micronutrient supplementation and folic acid for pregnant
women
118 Health care providers trained on
Male & female HCPs
All ages
Health care providers
Health care providers
Pregnant women
Nomination letter + attendance sheet + training report + pictures + NIS
The trained staff will be a front force to identify and provide supplementation to pregnant
women
Children 6-23 months and pre-pregnant women received multiple micronutrient
supplementation
During door to door screening LHWs and CHWs will provide 60 multi micronutrients
sachets to children 6 to 23 months of age for two months (one sachet per day) and 30 MM
tablets to pre pregnant for one month in the targeted area of intervention, and record on
screening register for further follow up and other doses while second dose will be provided
to all children after a gap of 4 months. The Nutrition assistant and IYCF counsellor will also
distribute the MM supplements in the health facility to the targeted beneficiaries during
treatment and IYCF support.
The nutrition team will be doing the screening and during the exercise the team will identify
the children < 2 and pregnant women who need supplementation to improve their health.
These team members will distribute a certain number of sachets among the children < 2 and
pregnant women and the exercise will be repeated after every 4 month.
Treatment of children < 5 and women according to CMAM protocols
A referral system will be maintained and database will also have developed during the
exercise which will be helpful for District heath system.

Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.3
Description
from
proposal

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.4
Description
proposal

from

141937 children and 84831 pregnant women received multiple micronutrient sachets
Male female children and pregnant women
Children < 2 and pregnant women
Children < 2 and pregnant women
Children < 2 and pregnant women
Community & health care staff
Screening register + NIS + monthly reports
The children & pregnant women will be identified on early case detection and sent for
treatment
PLWs receive iron, folic acid and MM supplementation as per standard protocols
Pregnant will be benefited through iron, folic acid and MM supplementation as per standard
protocols in two districts, 90 MM tablets and 90 iron folic acid tablets will be provided to
each PW for 3 months. The couple health workers and lady health worker will be involved
in micronutrients supplementation to PLWs in the targeted areas of both districts. While in
health facility the Nutrition assistant and IYCF counsel will also provide these supplements
to PLWs who is arrived to the center. Supplementation will be recorded on screening
registers for further follow up.
The ACF nutrition team will screen and identify the PLWs who need iron, folic acid and
MM supplementation and will be provided with certain number of sachets for the treatment
of anaemia.
CMAM guidelines and treatment protocols
Support health system in identifying the PLWs and their treatment to correct their nutrition
status
94625 Pregnant women & 94625 lactating women received iron, folic acid and MM
supplementation
Female
Child bearing age
Child bearing age
PLWs
Children & families
Screening register + NIS + monthly reports + SQUEAC
N/A
Children 2 to 5 years of age dewormed every 6 months as per standard protocols by
COWs; NA and IYCF counsellors
2 to 5 years children will be dewormed every 6 months as per standard protocol by
community outreach worker, Nutrition assistant and IYCF counsellors in two districts. Any
children who is referred or arrived to the health facility for treatment will be first investigate
regarding deworming and then will be dewormed and also during screening in the

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 3.5
Description
from
proposal

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
RESULT 4
Description

from

community by community outreach worker.

ACF COWs, NA and IYCF team will provide the required treatment to children 2-5 years
for deworming
CMAM guidelines
Provide support to District health system
165593 children dewormed
.Male female children
Children from 2-5 years of age
Children from 2-5 years of age
Children < 5
Mothers and caregivers
Screening register + NIS + monthly reports + SQUEAC
N/A
Adolescent girls (10-19 years) received iron; folic acid; iodine and Zinc supplements
Adolescent girls (10- 19 years) will be benefitted through iron, folic acid. The CMWs,
LHWs and community outreach worker will be involved in community level iron, folic
acid, iodine supplementation to adolescent girls and at facility level the NA and IYCF
counselor if any adolescent girl who is arrived to health facility will be benefitted through
MM supplements.
The trained CMWs, LHWs and COWs will identify during screening and will provide iron,
folic acid and zinc supplementation to 10 to 19 years adolescent girls and the visiting girls
at health facility will also receive the MM supplementation
Provision of iron & folic acid and MM supplementation according to national guidelines.
Support to District health system
77630 adolescent girls received iron, folic acid, iodine and zinc supplementation
Girls
Adolescent girls of 10-19 years of age
Adolescent girls of 10-19 years of age
Adolescent girls of 10-19 years of age
Families and communities
Screening register + NIS + monthly reports + SQUEAC
Enhance the awareness amongst adolescent girls on their health & nutrition status
Children and women access behaviour change communication interventions for
promoting positive preventive nutritional knowledge; attitude and practices
particularly focused on IYCF
Output 4.1: Contribute to improved knowledge of nutrition practices of community

proposal

Target group
Direct Beneficiaries
Indirect Beneficiaries
ACTIVITY 4.1
Description
proposal

from

Methodology

Relevant ACF policies

Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 4.2

Description
proposal

from

members in prevention of malnutrition through a behaviour change approach along with

educating target groups (pre pregnant and pregnant women, and lactating women and
caretakers) on appropriate feeding practices to address anaemia and other micronutrient
deficiencies
PLWs
Pre pregnant and pregnant women
Children
At least 4 each of mothers and father support groups in each union council of targeted
talukas/ Tehsils formed for promotion of IYCF practices within the communities
In LHWs non covered areas per union council 2 couple health workers (CHWs) will be
identified and trained, each CHW will form 2 mother to mother and 2 father to father
support groups in their area. MTMSG will be comprised of pregnant, lactating and elderly
women, as well as Community Birth Attendants (CBA). In LHWs covered areas these
MTMSGs will be formed through LHWs.
ACF will identify the LHWs uncovered areas and do the sensitization of the community.
The identified and potential couples of CHWs will be formed in each uncovered UCs and
will be trained on IYCF. Furthermore, these couple team members will identify the potential
mothers and fathers and will form 2 groups of MtMSGs and FtFSGs in each UC for further
awareness messages and sessions in the community on IYCF best practices.
Health system support
These groups will work as front line worker for district health system in identifying and
refer the PLWs for best IYCF practices to improve their children and their own health &
nutrition status.
944 MtMSGs & 944 FtFSGs formed in both Districts
Male & female
All ages of adults
Mothers & Fathers
Males, females and PLWs
Children
List of group members + meeting reports + monthly reports
Increased awareness among mothers and fathers along with other caregivers
Orientation sessions to support groups; (MTMSGs, FTFSGs)on awareness of
recommended breastfeeding practices; commencement of complementary foods at 6
months of age; preparation of complementaryfoods at age-appropriate frequency,
amounts, consistency, hand washing with soap and hygienic preparation of food;
prompt attentionto fever in malaria settings; and measures to manage diarrhoea
Monthly orientation sessions will be held with these groups in which below key practices
can be discussed and shared.
o Early initiation of breast feeding

Exclusive breast feeding

Age appropriate feeding
Provision and promotion of multi-micro nutrients for children 6 to 24
months and PLWs
o Compliance to consumption of iron and folic acid
o Hand washing and other improved hygiene and sanitation practices
o Promotion of use of iodized salt
o Treatment of diarrhoea using zinc and low osmolality ORS.
Furthermore, these groups will trickle down the IYCF key messages to the community,
where IYCF promoters, community mobilizers and CHWs will part of these community
based sessions. A monthly meeting and session will be conducted with these groups through
CHWs, while IYCF supervisor will randomly take part in these meetings
o
o
o

Methodology
Relevant ACF policies
Sustainability
Expected output
Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?
ACTIVITY 4.3
Description
proposal
Methodology

from

Relevant ACF policies

Sustainability
Expected output

ACF IYCF supervisors and counsellors will organize sessions for MtMSGs and FtFSGs on
best practices on breastfeeding and complementary feeding along with awareness sessions
on communicable and common ailments in both districts.
IYCF best practices
Enhanced awareness among mothers and fathers about breastfeeding and complementary
feeding along with awareness on communicable disease and common ailments.
1888 CHWs (MtMSGs+FtFSGs) trained on IYCF and common illnesses
Male & female
All ages of adults
CHWs
CHWs mothers and fathers
Children
Meetings reports + session reports + pictures + monitoring reports
Best practices of IYCF
Monitoring of CHWs orientation sessions by IYCF supervisors and ACF community
mobilizers randomly, and involvement of IYCF promoters in sessions on monthly basis
Monitoring of CHWs orientation sessions by IYCF supervisors and ACF community
mobilizers randomly, and involvement of IYCF promoters in sessions on monthly basis
ACF IYCF supervisors will ensure that the community sessions are conducted as per
schedule in the targeted UCs. These randomly monitoring visits will be done by the
supervisors during each training scheduled for the target beneficiaries.
MEAL
Maintained sense of responsibility in CHWs about the children & PLWs suffering from
malnutrition
50% sessions conducted successfully

Gender
Age
Target group
Direct Beneficiaries
Indirect Beneficiaries
What documents should
be retained for the audit?
Is this a best practice
activity and if so how?

CROSS
CUTTING
CONSIDERATIONS
Access considerations
Staff training

MEAL
Objective/ Results

Male & female

All ages of adults
CHWs
CHWs
PLWs and caregivers
Session reports + pictures + monitoring reports
Develop a good sense of responsibility with accountability

Is there a need to apply for NOC?

Yes
Is there any training that should be considered?
Project staff would be trained as per the training topics and schedule outlined in the
proposal

Performance Indicators

Method of
Verification

This section should be set up and use by the PQA team

Baseline Target Ghotki Target Khairpur Related
activity

Time/
Frequency of
data collection

Sampling
or full

Focal
person

Outcome 1: Improved enabling environment in provincial government to address stunting in Sindh province and in particular the
3 target districts by 2017.
AWP Output 1:
Strengthened
political
commitment
and
national capacity to
legislate, plan and
budget for children
Programme
Output 1: Enabling
environment
created in
communities for
improved Nutrition

1: Project Brief and work plan

endorsed by district government

Notification on
endorsement
available

01

01

2: Inter-sectoral and inert agency

coordination mechanism
established for Nutrition specific
interventions

Meeting minutes
of district
Nutrition
coordination
committee with
defined terms of
reference
Evidence of
programme

01

01

01

01

3: Stunting programme monitoring

framework developed

Meetin
g with
Govt.
for
endorse
ment
Meetin
gs /
Coordin
ation

once

NA

Field
co /
project
manag
er

Ongoing

NA

Field
co /
PM

Monitor

Once

NA

??

Services

monitoring
framework
templates
available for
reporting

4: District Nutrition and WASH

coordination Committee notified

Copy of
notification
available

01

01

5: Joint framework in relation to

common touch points on
convergence developed and
implemented
6: Nutrition Management
Information System/database
developed and operationalized

Joint work plan

on convergence
available

01

01

ing
Templat
es
based
on
project
activitie
s
Meetin
g/
Coordin
ation
with
District
govt.
Work
plan

Ongoing

NA

Field
co /
PM

Once

NA

Field
co /PM

Software
0
01
01
MIS
Once
Monthly
PM
developed
updated database
available
Result 1. Support for appropriate infant and young child feeding (IYCF) is accessed by vulnerable children (girls and boys), pregnant women and breastfeeding mothers, especially protecting and
supporting exclusive breastfeeding by dissuading and monitoring the donation of breast milk substitutes and providing safe breastfeeding areas for nursing mothers, promoting timely and appropriate
complimentary feeding including minimal acceptable diet [diversity and meal frequency] and cooking demonstration.
Program data
0
42
76
AWP Output 3: 1: Number of breastfeeding
Breastf
Once
Full
IYCF
Enhanced
support
for corners and safe areas in those
eeding
Superv
children,
families
and corners.
corners
isor
communities to promote
at sites
knowledge,
behaviour 2: No of HealthCare Providers;
Training
26 Project
45 Project Staff
Trainin As per plan
Sample
IYCF
change,
demand
for Lady Health Workers and
Attendance
0
Staff,
980 LHW/LHS,
g
Superv
services and opportunities midwives trained on IYCF and
Sheets, Training
420
152 CHW
isor /
for participation
maternal nutrition
Reports
LHW/LHS,
PM
Program Output 1.1
84 CHW
Contribution to prevention
of chronic
3:Number of Pregnant Lactating
Program Data,
0
3,599 sessions
6,043 sessions
Session As per plan
Smaple
IYCF
malnutrition/stunting
Women and caregivers attending
Session
s
supervi
through protecting and
Infant Young Child Feeding
Attendance sheets
sor /
supporting infant and young
counselling session
PM
child practices
4: Number of cooking
Program Data,
0
427
773
appropriately.
Session As per plan
Sample
IYCF
demonstration session for
Session
(1 cooking
(1 cooking
feeding (IYCF) among
s
supervi
preparation of healthy diet and
Attendance
demonstration/ demonstration/qu
pregnant women and
sor /
feeding practices to adolescents;
Sheet, quarterly
quarter/LHW
arter/LHW or
breastfeeding mothers PL
PM
pre-pregnant and pregnant women
narrative reports
or /CHW)
/CHW)
through LHWs and Couple health
workers (CHWs)
5: Number of children screened
Program Data,
0
18541
31137
Child
Monthly
Sample
IYCF

AWP
2:Increased

Output

national
capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems
Output 1.2:
Continuous inbuilt
Monitoring of the activities

Vaccination,
10012 ARI,
16518
Diarrhoea
Referrals

Vaccination,
16814 ARI
10,016 Diarrhoea
Referrals

screeni
ng and
referral
s

01 Global
Breast feeding
Seminars

01 Global Breast
feeding Seminars

Semina
r

As per plan

Full

PM

Training
Attendance
Sheet, Training
Reports

84 CHWs

152 CHWs

As per plan

Full

PM

420
LHW/LHS,

980 LHW/LHS,

Trainin
g

8: No of Taluka IYCF supervisor

with expertise for supervision of
IYCF and Stunting activities at all
targeted union councils
9: Number of joint supervision
visits by DNF, EDO and DC NP.
11: Qtr. joint progress review
meetings with WASH, Health +
GOVT district level

Supervision visit
reports, Program
Data

02

04

Field
visits

Monthly

Full

IYCF
supervi
sor

Supervision visit
reports
Meeting Minutes,
Monthly
Narrative reports

06

06

Quarterly

Full

PM

06

06

Field
Visits
Review
Meetin
g

Quarterly

Full

12: Project Review Meeting at

base level

Meeting minutes
and narrative
report

03

03

Meetin
g

Quarterly

Full

13: Health baby competition and

Performances based award
ceremonies at District level

Narrative reports

04

04

Award
ceremo
nies

As per plan

Full

PM &
Distric
t
authori
ties
and
Key
staff
PM &
Key
staff
PM

and referred for vaccination, ARI,

Diarrhoea

Referrals slips

6: Awareness on appropriate IYCF

practices and policy at District
level

Seminar Reports

7: No of Couple health workers,

LHWS and LHSs trained on IYCF
Key Practices and taking MUAC
for SAM children

14: Participate in provincial

coordination meetings on monthly
basis

supervi
sor /
PM

Meetin
gs

Meeting minutes
0
18
18
Reports
Result 2. Children 6 to 23 months have access to appropriate feeding services, and provision of essential supplies especially therapeutic foods for the management of severe acute malnutrition
(SAM)
AWP Output 2: Increased 1: Number of Outpatient
Program Data /
0
03 static RHC, 12 static RHC, 02 Sites
Monthly
Full
IYCF
national capacity to ensure therapeutic sites (fix 15 in
NIS database
02 THQ, 01
THQ, 01 DHQ
supervi
availability of, and access RHC, 5 THQs, 2 DHQs
DHQ and 35
and 61
sor /
to,
services
and
to and 96 community
community/
community/
PM
strengthen systems
satellite Sites
satellite Sites
static/Satellite sites) in
intervention area

Output 2.1
Severely acute
malnourished children 6-23
months of age are early
identified and treated in
therapeutic program

2: Number of 6-23 months of

children screened for SAM

Program Data /
NIS database

52975

88962

3: Number of severely acute

malnourished children 6-23 months
of age referred and admitted to
OTP program

Program Data /
NIS database /
Referral Slips

8741

14679

4: Number of SAM children with

medical complications identified
and referred for treatment to SC

Referral slips

1748

2936

5: OTP programme achieves

SPHERE standards (percentages)
for cured, Death and Default rates

Program Data /
NIS database

Cured rate >75%

Death Rate <10%
Default Rate
<15%

Training
Attendance
Sheet, Training
Reports
Result 3. Children and women access to Multi micronutrient supplementation

Cured rate
>75%
Death Rate
<10%
Default Rate
<15%
43 Project
Staff

6: No of Project staff trained on

OTP protocol for treatment of
SAM children

AWP
2:Increased

Output

77 Project Staff

national
capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems

1: Number of Health care

providers trained on standard
protocols for micronutrient
supplementation and on iron folic
acid protocol for pregnant women

Training
Attendance
Sheet, Training
Reports

42 HCPs

76 HCP

Program Data

AWP
Output
3.1:Increased
national

2: Number of children 6-23 months

and pre-pregnant women received
multiple micronutrient
supplementation

52975
(children)

88962
children

31,661
(Pre-pregnant
women)

53,170 pre
pregnant

Pregnant
35,317
Lactating
35,317
61,804

Pregnant 59,308
Lactating 59,308

capacity
to
ensure
availability of, and access
to,
services
and
to
strengthen systems

3: Number of PLW received iron,

folic acid and MM
supplementation as per standard
protocols

Program Data

Screeni
ng /
Data
review
Screeni
ng /
Data
review
Screeni
ng /
Data
review
Data
analysis

Monthly

Full

NIS
officer

Monthly

Full

NIS
officer

Monthly

Full

NIS
officer

Monthly

Full

NIS
officer

Trainin
g

As per plan

Full

PM

Trainin
g

As per plan

Selected
people

IYCF
supervi
sor /
PM

Monitor
ing

Monthly

Sample

IYCF
Superv
isor

Monitor
ing

Monthly

Sample

IYCF
Superv
isor

Output 3.2
Children 6-23 months of
age and women access to
4: Number of children 2 to 5 years
Program Data
0
1,03,789
Monitor Monthly
Sample
IYCF
micronutrients
of age dewormed every 6 months
ing
Superv
supplementation (pre
as per standard protocols by
isor
pregnant and pregnant
COWs; NA and IYCF councillors
women, and lactating
Program Data
0
28,986
48,644
Monitor Monthly
Sample
IYCF
women) to address anaemia 5: No of adolescent girls (10-19
years)
received
iron;
folic
acid;
Girls
Girls
ing
Superv
and other micronutrient
iodine and Zinc supplements
deficiencies
isor
Result 4. Children and women access behaviour change communication interventions for promoting positive preventive nutritional knowledge; attitude and practices particularly focused on IYCF

AWP

Output

3:

Enhanced
support
for
children,
families
and
communities to promote
knowledge,
behaviour
change,
demand
for
services and opportunities
for participation
Output 4.1
Contribute to improved
knowledge of nutrition
practices of community
members in prevention of
malnutrition through a
behaviour change approach
along with educating target
groups (pre pregnant and
pregnant women, and
lactating women and
caretakers) on appropriate
feeding practices to address
anaemia and other
micronutrient deficiencies

OTHER MEAL
Accountability

Learning

1: At least 4 each of mothers and

father support groups in each union
council of targeted talukas/ Tehsils
formed for promotion of IYCF
practices within the communities.
2: No of Orientation sessions to
support groups; (MTMSGs,
FTFSGs)on awareness of
recommended breastfeeding
practices; commencement of
complementary foods at 6 months
of age; preparation of
complementary
foods at age-appropriate frequency,
amounts, consistency,
hand washing with soap and
hygienic preparation of food;
prompt attention
to fever in malaria settings; and
measures to manage diarrhoea
3: Monitoring of CHWs orientation
sessions by IYCF supervisors and
ACF
community
mobilizers
randomly, and involvement of
IYCF promoters in sessions on
monthly basis

Training and
meetings
Attendance sheet
and reports,

336 MTMSGs,
336 FTFSGs

608 MTMSGs,
608 FTFSGs

Attendance sheets

672 monthly
sessions of
CHW with
each group

1216 monthly
sessions of CHW
with each group

Attendance sheet

50%
of
sessions will
be monitor by
IYCF
supervisor.

Monthly sessions
report

50% sessions
will be
attended and
supervise by
IYCF
promoter and
community
mobilizer

MTMS
G
FTFSG

As per plan

Full

PM

Session
s

As per plan

Full

IYCF
supervi
sor /
PM

50% of sessions
will be monitor
by IYCF
supervisor.
50% sessions will
be attended and
supervise by
IYCF promoter
and community
mobilizer

Any other activities of MEAL should be included here. This should be completed by PQA
What will be in place for this?
ACF accountability mechanism (FCM) Integrated into program
Staff training on FCM to further replicate within communities
Handling complaints
What will be completed for learning? Workshops? Good practices
At the end of project PQA unit will conduct Lessons Learnt workshop in collaboration with
program and support units.

Assessments

Are there assessments beyond the project log frame to be completed?

Evaluation

When Evaluation to be conducted?

N/A
OTP Site supervision checklist,
IYCF Supervision checklist,
Stabilization Centre checklist
BSI- Beneficiaries satisfaction interviews

Output/Process
Monitoring

N/A

2016 UNICEF Stunting PSD

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