Overview:

The Joint Programme “Reducing malnutrition in children in Albania”  aimed to implement multi-sectoral interventions in high risk rural and peri-urban communities, while strengthening the national policy development, through partnerships and systematic capacity building of health sector and food & agriculture experts in issues related to nutrition and household food security.

The JP supports the priorities of the Government of Albania in the areas of health, agriculture, education, social protection and social inclusion. All key results contribute to national priorities reflected in the National Strategy for Development and Integration (NSDI) through three outcomes, mainly, by strengthening  national capacities in order to incorporate nutritional objectives into sectoral policies and programmes; by strengthening national delivery of  nutrition services to the public and through the development, testing and implementation of cross sectoral nutrition interventions in the target areas.

The programme is aligned with Albania’s development objectives, its government’s priorities and  strategies as well as the overall goals of the UN as articulated in the UNDAF. 

Some key results included increased national stakeholder capacity by supporting in-depth research on Nutrition and Food Security including  first time data on causes of anaemia and food security in especially vulnerable regions. This data was used to advocate for increased resources and led to the development of the new Food and Nutrition Action Plan (FNAP2013-2020), which contributed to strengthening  focus on food security and social inclusion in the National Strategy for Agriculture and Rural Development (2014-2020). Capacity building took place at all levels and ultimately led to a more participatory approach from national, regional, district authorities and local governments, which in turn led to the development of community based plans to improve food and nutrition security.

The programme also contributed to the PHC reform and improved quality of Government service delivery through capacity building in the health sector, and contributed to the education sector reform through the development of resource materials such as specific modules on nutrition education for teachers and students in compulsory education.

Outcome 1:

Increased awareness of nutrition as a national development priority at all levels.

Outcome Achievments:

• The Joint Programme contributed to increase awareness of nutrition as national development priority among key sectors at national and local level, which led to the development of the new Food and Nutrition Action Plan as well as community based plans on food and nutrition security.
• An important institutional framework for inter-sectoral collaboration was established through an MOU which was signed by five key line ministries (Health, Agriculture, Education, Social Affairs and Finance) to address malnutrition and food insecurity issues. As a result the Ministry of Health appointed a national coordinator;   Government and UN partners undertook joint field trips to monitoring activities; all formal meetings were convened by line Ministries, with official letters issued and signed by the Ministry of Health and Ministry of Agriculture.
• National and local capacities were strengthened for evidence based decision making.  
• Contributed to the development of the new Food and Nutrition Action Plan (FNAP 2013-2020) which forms the basis of institutional commitment and future collaboration.

Outcome 2:

Coordination and capacities to design, implement and monitor nutrition and food security interventions are enhanced at all levels.

Outcome Achievments:

• The Joint Programme contributed to improving knowledge, skills and participation of national, regional, district authorities and local governments in the design and formulation of community based plans to improve food and nutrition security.
• Participatory sector and cross sector interventions were developed by key stakeholders at regional and local levels, some of which are included in the FNAP.
• Capacity development of 435 primary health care workers to improve coverage and quality of growth monitoring and nutrition counseling. The use of child growth charts was institutionalized by the order of the Minister of Health as was the counseling of mothers by health personnel on nutrition during pregnancy and IYCF (Infant and young child feeding) .
• 15 local government units established coordination structures for nutrition and food security with representatives from health, education, agriculture and social sectors.
• 245 homestead gardens and small-scale animal husbandry models were established for a greater variety and year-round availability of high nutrient produce.
• A well designed communication strategy and action plan were at the center of all behavior change interventions combining the media campaign “New and better ways for IYCF” with counseling through health centers and interpersonal communication activities at community level.
• The Joint Programme contributed to the integration nutrition modules in the school curricula through the development of nutrition modules for teachers and students in Grades 1 – 9 in compulsory education.

Outcome 3:

Public health nutrition repositioned within the primary health care services.

Outcome Achievments:

Addressed capacity gap in public health nutrition (PHN) through capacity development on development of competence based PHN curricula and interactive teaching methods resulting in an improved PHN syllabus in faculty of Nursing, which will contribute to sustainability of the nutrition related capacity development interventions supported by the JP and at same time will help raise the profile of PHN among health care professionals. In addition, PHN module was integrated in the third year curricula of the education program for Medical Doctors.

Best practices:

• Intersectoral collaboration - Five Key Ministries formally committed themselves to take joint action to improve the nutritional status of the Albania population in order to reach the MDGs and to establish a sustainable coordination mechanism at the highest level of decision-making. Each Ministry nominated a focal person to coordinate the activities of the joint programme. This  MOU on Food and Nutrition was recognized as a good practice by the European Observatory on Health Systems and Policies (EOHSP).

• Joint implementation - The programme evaluation found that implementation was undertaken jointly by all relevant stakeholders, and identifies this as the result of a combination of key elements including :  a)  programme  design   where JP activities complement each other to prevent parallel implementation; b) implementation through the establishment of  Technical Working Groups (government institutions and UN agencies) in charge of planning, implementing, and c) monitoring and reporting of specific JP interventions  through regular joint monitoring (central and local levels of government with UN agencies) to ensure accountability towards results and timely changes/improvements in the implementation process.

Lessons learned:

• Cross-sector collaboration works better when there are institutional mechanism for coordination: Nutrition cuts across many sectors and therefore requires a cross-sectorial approach. Cross-sector collaboration involves increased responsibilities and workload for staff, as well as expanded individual capacities and skills to understand issues from a ‘big picture’ perspective. As such it requires setting up an institutionalized coordination mechanism to provide the venue for coordinated planning, resource-base for technical information, and repository for institutional memory, as well as entry point for nutrition advocacy into the national dialogue.
• Engaging national counterparts at all levels of the programme cycle enhances national ownership and sustainability. While working groups are an effective mechanism for programme processes, visibility, national ownership and potential for sustainability is increased exponentially if the working groups are led by national counterparts, with clear TORs, a defined scheduled for completing tasks and for reporting back at the ministerial level on achievements. This also contributes to national capacity development.
• One of the challenges associated with middle income countries is the reduction of official development assistance, which effectively lays the burden and responsibility for programme implementation on the shoulders of the government. In this context, support for the development of national systems, policies and models to address food insecurity and malnutrition is crucial in the context of a middle income country.

More details can be found in the documents below.