Alliance for Child Nutrition - APS No: M/OAA/GRO/EGAS – 09-232

CONCEPT PAPER

For:

NUTRITION-RELATED

PUBLIC-PRIVATE PARTNERSHIP APPLICATIONS

Submitted to:

USAID

APS No: M/OAA/GRO/EGAS – 09-232

September 2009

Submitted by:

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Alliance for Child Nutrition - APS No: M/OAA/GRO/EGAS – 09-232

Delia Haustein

Executive Director

Marilu Chiang

Director of Human Development

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Alliance for Child Nutrition - APS No: M/OAA/GRO/EGAS – 09-232

Address: PRISMA

Carlos Gonzales 251

San Miguel, Lima

Peru

Telephone: 511 616 5500

Partner organizations

ADRA

CARE

Caritas

Radio Programas del Peru (RPP)

Cia Minera MILPO

Barbastro and Sillustani

Banco de Crédito del Perú (BCP)

Regional and Local Governments in intervention regions

List of Acronyms

CCM / Chronic Child Malnutrition
CENAN/INS / National Food and NutritionCenter at the National Institute of Health
CIAS / Inter-Ministerial Commission on Social Affairs, it groups all social sectors and heads CRECER
CMI / Child Malnutrition Initiative or Iniciativa contra la desnutrición crónica infantil is an aliance of Title II Cooperating Sponsors in Peru (ADRA, CARE, Caritas and PRISMA), USAID, United Nations organizations (WHO/PAHO, UNICEF, FAO, WFP, UNFPA) and the Mesa de Concertación de Lucha contra la Pobreza
CRECER / Government strategy for promoting national, sub-national, and local multi-sector coordination for more efficient ways of attaining the goal of reducing child malnutrition by 9% by the year 2011
CSR / Corporate Social Responsibility
ENDES/DHF / Encuesta nacional de salud, National health Surrey
FFP / Food for Peace
IAC / Instancia de Articulación and Coordination, local level group responsible for local implementation of CRECER
Juntos / Contitional cash transfer program
National Accord / Acuerdo Nacional is a dialogue "space" among all political forces in Perú (private business, labor organizations, public sector, political parties, etc) that signend a national agreement in 2002.
NGOs / Non Governmental Organizations
PCM / Prime Minister’s Office
PCNP / Partnership for Child Nutrition in Peru
Planes articulados / Plans based on the results of the TDI
TDI / Decisiones informadas technology, a tool for population diagnosis of nutritional status determinants at district level, developed by CENAN/INS with USAID technical and financial support

Table of contents

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Alliance for Child Nutrition - APS No: M/OAA/GRO/EGAS – 09-232

Presentation

Discussion of objectives

Strategies

Amount of effort

Target population

Time frame

Expected Results

Complement USAID specific strategic results

Type of support requested from USAID

SUPPORTING INFORMATION

  1. Proposed total estimated cost: 2010
  2. Cost breakdown (one year sample):
  3. Proposed amount of participation (one year sample):
  4. Proposed prospective partners committed at present:
  5. Proposed activity duration: 5 years from 2010 to 2015
  6. Brief description of applicant’s prior work and experience

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Alliance for Child Nutrition - APS No: M/OAA/GRO/EGAS – 09-232

Project Title: A Partnership for Child Nutrition in Peru (PCNP)

In terms of a country’s prospective development, chronic malnutrition, measured by a child’s height by his/ her age, means future generationswill never achieve their full genetic potential and members of that willexperience cognitive and psycho-motor setbacks that translate into low educational achievement and reduced workforce readiness and job performance.

Malnutrition affects 27.5% of children under 5 years in Peru. Despitesustained and significant economic growth over the past7 years, increased per capita GDP has not been reflectedin a similar decline in the prevalence of Chronic Child Malnutrition (CCM) over the same period.[1]

The situation is particularly critical in rural areas, where CCM rates are44.3% among children under five years,as stated in the 2008 Demographic and Family Health Survey (ENDES).

Since 2006, the Child Malnutrition Initiative (CMI), originally a partnership of Title II cooperating sponsor institutions in Peru,and later integrating the United Nations agencies, USAID, and the Roundtable in the Fight against Poverty, hassupported national and sub-nationalauthorities inprioritizingchild nutrition in the public policy agenda. Two of the most important results attained were havingPresident Garcia agreeto make reducing child malnutrition a government priority and to establishing the goal of reducing CCM by 9% (from 25% to 16%) in five years; however, the figure fell only 2.6% from 2007 and 2009, a trend that puts Peru at risk of not reaching the goal.

CRECER is the new governmentstrategy for promoting national, sub-national, and local multi-sector coordination, through which it is attempting to findmore efficient ways of attaining the goal.It comprises three components: 1) building human capacity and respectingfundamental rights, 2)promoting opportunities and economic capacities, and 3) establishing a social safety under the direction of the Inter-Ministerial Commission on Social Affairs (CIAS).

The purpose of CRECER is to protect human and social capital of at risk groups and to contribute to linking families and producers to the market so as to reduce poverty and to promote sustainable employment.[2]

The development of this strategy was one of the principal recommendations CMI made to Garcia’s incomingadministration, and supporting the effective implementation of CRECER has been a major priority for CMI members over the last two years. ADRA, CARE, CARITAS,andPRISMA, PCNP members with experience developing and implementing validated intervention models with important results in reducing CCM, have been working with pilot CRECER settingsthanks to USAID financial and technical support. These pilot projects have focused on supporting local and sub-national CRECER planning and implementation and now need to be scaled up in order to stimulate and to encourage action by more sub-national and local governments to increase effectiveness of their nutrition programs. Private sector experience and participation and long term commitment to the regions and a recognizedbusinessinterest in this proposed concept paperwill be important complements to attaining social cohesion and inclusion of the most marginalized groups in the country - the rural poor and native populations.

CMI, as it has done every year since 2006, drafted and published its report, “Balance and Recommendations”in July 2009 in which it evaluatedthe current administration’s performance, now in its third year, and proposed recommendations that have been generally welcomed by government and civil society as an appropriate route to take for achieving the CCM reduction goal.

Private businesses have also recently become convinced of the need to reduce CCM to maintain Peru’s economic growthand so have been supporting evidence-based projectsto overcome malnutrition as partof their corporate social responsibility programs and are helping the state in its roleof providing quality social services to the population, which, in turn, is contributing to reducing inequality and to promoting social inclusion.

Proposed intervention purposeis to help the government implementCRECER locally and sub-nationally, by uniting all levels of government and promoting civil society and private enterprise participation and collaboration in a combined effort to reduce CCM.

From PCNP’s analysis of the problem, specific objectives should be:

  • To position CCM in the public agenda
  • To build capacities to connect and to manage CCM programs and initiatives
  • To develop intervention models for families with children under 3 years
  • To empower the general populationtocarefor small children and provide them proper nutrition

Discussion of objectives

1. Authorities, local opinion leaders, and general population take action to keep the fight against CCM in the public agenda.[3]

Sustaining CCM reduction depends on maintaining the topic on the public agenda. To achieve the goal of 9% CCM reduction by 2011, it is necessary to develop innovative communication strategies that promote social change in order to prioritize the fight against CCMinthe media, authorities, leaders, and the general population.

This Public-Private-Partnership will:

  1. coordinate with the National Accord, political parties, and social movements to position CCM as a priority issue for candidateplatforms for the next sub-national(2010) and national (2011) elections
  2. facilitate effective local and sub-national social program and CRECER strategy coordinating mechanisms, roles, functions, and responsibility,thereby helping to establish connections amonggovernment units
  3. support formulation and implementation of local communication policiesand plans on maternal and child nutrition inPeru
  4. inform political leaders, opinion leaders, and the general public about CCM causes and consequences to promote adoption of agreements for actions tackling infant malnutrition
  5. promote new public private partnershipsfor reducing CCM.

2. Sub-national and local governmentshavebuilttheir capacities to be able to link and to manage CCM reducing programs efficiently. [4]

Intervention will provide technical assistance and training to the CIAS Technical Secretariat, Prime Minister’s Office (PCM), National Food and NutritionCenter (INS/CENAN), sectors, and local and sub-national governments to help themcoordinateCCM reduction plans, programs, and projects within the performance based budgeting program. PPP will also develop a management toolkit for effective CRECER implementation (sub-nationalcoordinated plans, coordination body guidelines, sub-nationaloversight and monitoring mechanisms [CRECER helpdesk], monitoring and evaluation systems, andinformed decisions technology). It will support development of public and private investment projects in child nutrition as well as promotion of local and sub-nationalgroupings of municipalities[5]oriented at optimizing resources.

Training programs will build on lessons learned in proven experiences through exchange visits, systematization, and design of anincentive system for good government in child nutrition.

3. Interventions related to the fight against CCM in national and sub-national policies are implemented in communities and families with children under 3 years.

PCNPwill promote activities atdifferent levels of government for individuals and households through access to quality universal services (health, education, and identity), adoption of adequate health and feeding attitudes and practices, and implementation of the “healthy and productive homes strategy”.

PCNP technical team will validate, tailor, and institutionalize intervention models adapted to local contexts and based onpromoting universal servicesand improved health service quality. We will implementmicronutrient deficiency prevention interventions and thehealthy family– healthy communitystrategy plusbuild organization and community leader capacities to direct CCM reductionand social surveillance.

After systematizingobjectives, the technical team will gradually and methodically scale up model intervention strategiesso they will become part of government provided social policy and services.

4. PCNPsupportsindividualdevelopment and empowerment forparticipating in social surveillance of actions to tackle child malnutrition.

We propose to strengthen local, sub-national, and national citizenparticipation in setting and monitoring priority interventions to tackle malnutrition, in defining budgets, and in implementingCCM reduction initiatives. Such participation and oversight is a key element for the CRECER strategy and its sustainability.

PCNP will strengthen community organizations, promote community nutrition and health surveillance systems,and ensure prioritization of nutrition problems in local and sub-nationaldevelopment plans, participatory budgets, and accountability processes. By promoting and regulating citizen surveillance of CRECER, PCNPwill enable greater and more effective coordination amongcivil society, the private sector, NGO’s, and public institutions in this priority area of public policy.

Strategies

Based on our experience tocontribute successfully to reducing CCM in Peru over recent decades, PCNP will apply the following strategies:

Territorial development:helping local government conduct territorial development processes, based on their leadership and capacity to reach consensus and to use resources efficiently.

Rights based approach:reducing vulnerability of excluded populations living in poverty, ensuring compliance with state obligations to guaranteeingthe right to a life of dignity and to protecting capacities.

Social participation:achieving active involvement of social and community stakeholders and strengthening legitimate community participation bodies.

Monitoring and Evaluation

  • Evaluation:baseline, midterm evaluation, and final evaluation.
  • Systematization, sharing,and transfer of intervention model in coordination with the private sector.

Amount of effort

The intervention area will coverthree political regions of Peru with high CCM and anemia prevalence and the capacity to act on intervention implementation, which can later be scaledup,orwhere private businesses are interested in supporting it.

This proposal includes local, sub-national, and national actions as well as work with different key sectors, including PCM personnel working under the CIAS Secretariat.

Target population:

The focus of the direct intervention will be three regions, Ancash, Pasco and Huancavelica, 4 provinces within these regions and 8 districts. The number of communities to intervene directly is approximately eighty, with a total number of families of around four thousand.

Other stakeholders that will benefit from this intervention are as follows

  • National, sub-national, and local authorities and public workers linked to CRECER.
  • Social program operators: PRONAA, Vaso de Leche, Agrorural, etc
  • Political and community leaders, heads of social organizations, andcivil society representatives.
  • Families with children younger than 3 years and pregnant mothers.
  • Mass communication media

Time frame: 5 years (2010-2015)

Expected Results

  • CCM is positioned in the public agenda
  • Local and sub-national authorities are connected to and efficiently managing child nutrition programs and initiatives
  • Models are being implemented in communities and families with children < 3 years.
  • General population is empowered tocare forsmall children and provide them proper nutrition

Complement USAID specific strategic results

The PL 480 Title II program, implemented through the four cooperating sponsors (CARE, ADRA, PRISMA, and Caritas)that also form this child nutrition PPP, can boast of outstanding accomplishments, i.e. significantly lowering the percentage of children under three with chronic malnutrition, improving food security, and reducing poverty in mountain and jungle communities. USAID/Peru Title II funding recently ended after over 50 years of work in Peru. Nevertheless, USAID/Peru continues to address health, nutrition, and population issues through current programs as well as by ongoing support of the Peruvian government in its efforts to combat chronic malnutrition, through investing in its people.

This proposal lines up withUSG Foreign Assistance strategic objective “Investing in People”and USAID/Peru Health Office objective “Improved Health of Peruvians at High Risk”. Specific goal is to decrease malnutrition in Peruvian children younger than five years by protecting their human capacities and by building human capacity among all stakeholders involved in the process of improving child nutrition in Peru.

Type of support requested from USAID

  • Requested support from USAID is $1 million per year for five years, starting 2010 and ending 2015 (US$ 5 million total).
  • Assistance for an International Child Nutrition Conference during implementation year 1 isneeded to bring in child nutrition and development experts.

SUPPORTING INFORMATION

  1. Proposed total estimated cost:2010 to 2015 US $ 13´000,000
  1. Cost breakdown (one year sample):

BUDGET PARTNERSHIP FOR CHILD NUTRITION IN PERU
LINE ITEMS / Total US$ / USAID / PARTNERS
FINANCIAL / IN KIND
1. Personnel costs (Staff salaries and benefits) / 773,133 / 590,933 / 55,000 / 127,200
2. Materials and equipment costs / 544,964 / 54,496 / 490,468
3. Operation costs / 79,040 / 15,808 / 63,232
4. Program activity costs / 772,991 / 158,795 / 614,197
5. Travel costs / 11,200 / 11,200
6. Consultancy costs / 247,600 / 173,320 / 74,280
7. Monitoring, evaluation and Audit costs / 63,757 / 63,757
Sub-total / 2,492,685 / 898,314 / 789,742 / 804,629
Agency NICRAs and administrative/management costs / 185,631 / 157,131 / 28,500
TOTAL BUDGET / 2,678,316 / 1,055,445 / 818,242 / 804,629
  1. Proposed amount of participation (one year sample):

Amount US$ / Project Results supported / Type of support
Partners / Financial / In Kind
Regional government Ancash / 400,000 / 2 / x
BARBASTRO and SILLUSTANI / 35,000 / 3 / x
Regonal government Huancavelica / 146,758 / 3 / x
BCP / 10,000 / 1,4 / x
CARE / 50,000 / 1,4 / x
RPP / 740,000 / 1,4 / x
Local Government Ancash / 200,000 / 2,3 / x
Cia Minera MILPO / 250,000 / 2,3 / x
ADRA / 50,000 / x
CARITAS / 50,000 / X
PRISMA / 50,000 / X
TOTAL / 1,981,758
  1. Proposed prospective partners committed at present:
  2. The PCNP associates: ADRA, CARE, Caritas
  3. Radio Programas del Peru (RPP) is a national reaching radio station which, for the last three years has worked a nutrition campaign funded by Alicorp, a leader in food commercialization. RPP will invest an additional in kind contribution
  4. Cia Minera MILPO is a mining company with more than 50 years exploiting minerals in Pasco with an old history of CSR working in health and nutrition with PRISMA in the late 1980s and more recently with Caritas.
  5. Barbastro and Sillustani: two mining exploration projects related to the MINSUR Group in the central area of Huancavelica. Once exploration is completed in two to three years, and depending on its results, participation could increase or end.
  6. Banco de Crédito del Perú (BCP), largest bank in Peru with most important network of agencies and agents. It will lend its TV monitors in agencies and print/distribute material promoting change in child caring practices through their agents in the intervention regions
  7. Regional and Local Governments in intervention regions (Mancomunidad AMUZCEH)
  1. Proposed activity duration: 5 years from 2010 to 2015
  1. Brief description of applicant’sprior work and experience

The four partners PRISMA, CARE, Caritas, ADRA are the Title II agencies, cofounders, with the USAID Mission in Peru, of the Child Malnutrition Initiative, which successfully advocated securing a commitment from the new government in 2006 to reduce chronic malnutrition by 5 percentage points over the next five years, narrowing the gap between rural and urban areas. They have also worked together with the national nutrition center, CENAN, on the "Informed Decisions Technology", and on a pilot initiative to ensure effective local implementation of CRECER in several 4 regions.

PRISMA is a non-governmental Peruvian organization working from 1988 to 2007 in research on the social determinants of chronic child malnutrition and developed intervention models that were sustainable, effective and efficient with the Ministry of Health and local authorities as counterparts.

PRISMA is currently managing projects in food security for native communities in Loreto and Cusco, a health and sanitation project in 66 rural communities in Ayacucho and Huancavelica, a nutrition project with micronutrient supplementation in La Libertad and a project to improve management of health andeducation services in the 14 regions of “Juntos”, including Ancash, Pasco and Huancavelica. PRISMA is coordinator of the Nutrition group at Forosalud (a national civil society group with presence in the three regions).