Key Challenges



Theory of Change Pathway and Narrative forIntegrating WASH and Nutrition ProgrammingIn CambodiaDRAFTCambodia February 2016Table of Contents TOC \o "1-3" \h \z \u Key Challenges PAGEREF _Toc317341056 \h 3Vision and Long-term Changes PAGEREF _Toc317341057 \h 4Analysis of Stakeholder Roles PAGEREF _Toc317341058 \h 4Realistic Changes by 2023 PAGEREF _Toc317341059 \h 6Key areas of change PAGEREF _Toc317341060 \h 6Ways of Working PAGEREF _Toc317341061 \h 8Key Assumptions PAGEREF _Toc317341062 \h 8Moving Forward PAGEREF _Toc317341063 \h 10WHAT WE NEED TO DO FOR EFFECTIVE LEARNING & ACCOUNTABILITY PAGEREF _Toc317341064 \h 10HOW WE ARE GOING TO MOVE THIS FORWARD PAGEREF _Toc317341065 \h 11Key ChallengesJoint programming in WASH and nutrition in Cambodia will be undertaken in a complex environment with numerous challenges and underlying factors that will need to be taken into consideration when planning actions.Table 1: Key contextual challenges in CambodiaTECHNOLOGYPHYSICAL ENVIRONMENT & CLIMATE ISSUESSOCIO-ECONOMIC & CULTURAL ISSUESGOV’T POLICIES & LEGISLATIONPOWER DYNAMICS & BUSINESSPhysical: Affordable and appropriate technologies; WASH hardwareInformation systems: reporting systems and geographic mappingPsychological:Mass and social media affecting norms attitudes and behavioursScientific: testing of water and nutritional indicators, mobile technologiesDrought/flood: decrease of nutritious food and hygiene issuesPollution and home environmentUrbanisation: migrations/slum and affects on rural communitiesSeasonalityDam constructionDisparity of wealth in geographic/ethnic areasMigrationGap between knowledge and practiceAvailability and access to servicesAid DependencyLack of community cohesionGender inequalitySocial and cultural behavioural normsGood WASH and Nutrition policies but no enforcement. No integrated strategy on WASH/NutritionLimited coordination and information sharingInformation analysis and sharing Filtering down to the subnational levelAttaching funds to plansPoorest are the most vulnerableLeveraging decision makers with budget allocation powerMediaEmerging MarketsPublic Private PartnershipsCompeting priorities – profit & public healthPeer & family pressureVision and Long-term ChangesThe overall vision for integrated WASH and nutrition programming and the key success factors that would ensure that this vision could become a reality were identified.Vision: All pregnant and lactating women and children under 2 in Cambodia live in a safe and hygienic environment, are healthy, well nourished and cared for so that the children grow to their full potential.Long-term changes:Pregnant and lactating women and caregivers adopt optimal WASH and nutrition behaviours and practices for themselves and the young children in their munity leaders, religions leaders and others act as role models. They empower women in the community, facilitate and demonstrate healthy practices that contribute to healthier pregnancy and healthier young children.Health and WASH service providers at all levels provide quality services for pregnant and lactating women, young children and their caregivers and support them to sustain hygienic and healthy mune and district have clear mandates o nutrition and WASH to ensure that communities have access to sustainable WASH and nutrition services. They advocate to higher government for funds and capacity ernment administrative bodies at all levels effectively priortise budget and resources for WASH and Nutrition. They are able to leverage further funds to support new ways of working.Private investors and business increase their corporate social responsibility and/or invest in efficient and affordable initiatives and/or innovation which benefit pregnancy and lactating women and young children.Line ministries provide clear policies, strategies, funded action plans and guidelines to support WASH and nutrition programming. They have joint performance monitoring frameworks on WASH and nutrition.Analysis of Stakeholder RolesAn analysis the roles and potential contributions to these long term changes of the UN agencies, Government, and NGO community maps out the stakeholder opportunities for influencing change.The UN has a role to play to support government institutions and development/support of systems. The changes needed within the UN community in Cambodia are, better integration of WASH and nutrition, analysis, planning, common M&E framework and bottleneck analysis through:Emphasis is to support government institutions with shift towards less service delivery and more upstream support. When Working a service delivery area focus on capacity building, doing programming to scale and strengthening systemsNew C4D, need to apply communication efforts not just at the community level but also the bigger picture.More engagement with the private sectorInnovative engagementsKnowledge management – document for building the evidence base and NGO currently engages and supports in national technical working groups, provincial networks, health centre management committees and commune development planning. The opportunities for influencing change in WASH/nutrition are:Provide a collective voice in advocacy via appropriate bodies such as SUN, CSA; build joining messaging from the NGO groupExtend multisectoral bodies (such as SUN, CSA) to provincial levelContinuing good practice in health, support provincial department of rural development (PDRDs) to learn from learn from good practice Ensure good practice is consistent from one province to another through, amongst other, documentation and sharingWork with national committee for decentralisation (NCDD) and CCC to ensure NGOs all understand their role in commune/district/provincial development planning and actively participate.Individual NGOs take action to participate, share information, and support a quality process (and advocate for WASH & nutrition).Collaborate, plan, monitor together betterCo-locate WASH and nutrition projects, share information at all ernment currently works with national level policy, strategy and coordination through technical working groups. There is a newly established sub-working group on WASH and nutrition but no strategy for integrated WASH and nutrition. At the sub-national level the government works through Line departments, subnational administrations, local administration and CBOS. The opportunities for the government in influencing change in WASH/nutrition are:Developing a Joint Statement/Strategy on WASH and Nutrition IntegrationShift so that donors and other stakeholders fund and implement programme within the umbrella of Government plansReinforce/widely disseminate policy and strategiesJoint performance monitoring framework and work plansAppoint one body to lead (such as CARD with strengthening the WASH and nutrition SWG)Strengthen and reactive working groups at the subnational levelLink commune level groups (CIP and CDP) (CCWC and HCMC)Realistic Changes by 2023Realistic changes, or goals, that stakeholders together can achieve because of our work by 2023 Sector stakeholders can demonstrate how and where resources have been invested in WASH and nutrition, what worked, what the remaining gaps are, and describe the roles of all actors in the past and future. This enabled more PLW and U2s to benefit from effective interventions to improve healthy practices and receive quality services.More effective and appropriate technological solutions are being implemented at scale Most of the communes and social service providers are investing in key interventions and this improves WASH and Nutrition practices by PLW, young children and caregivers.More community leaders who are facilitating WASH and nutrition behaviors and practices fully participate and receive recognition from higher government.Pregnant and lactating women (households) fully understand and are able to adopt good hygiene and nutrition practices using safe water, positively affects child health and growth.Key areas of changeInitially the UN and NGOs have some in-house preparatory work to enable them to move forward adequately with integrated WASH and nutrition programming. This work will enable them to work effectively with government at different levels so that government systems policies and structures are in place and ready to support and facilitate integrated programming through implementation channels. The complementary platforms will work effectively to achieve positive results for women and young children. More work needs to be done on detailing how implementation will work in practice but preliminarily implementation channels have been identified as:Community ChannelCCWC/communeCBO/private sectorReligious leadersVHSGHealth System ChannelPublic PrivateHospital/primary careCommunication ChannelMediaInter personal communicationRoad showsProvincial government bodiesBuy in342900-342900Ways of WorkingUndernutrition is determined not only by nutrient intake, but equally by nutrient loss. A vicious cycle exists between diarrhoea and undernutrition: children with diarrhoea eat less and are less able to absorb the nutrients from their food; malnourished children are more susceptible to diarrhoea when exposed to faecal material from their environment. Inadequate access to clean water and unsafe sanitation?and hygiene practices increase the risk of severe infectious diseases that can contribute to undernutrition. There is strong evidence that improved water and sanitation conditions are associated with a decrease in stunting.For long-term changes to occur the government of Cambodia has the ultimate responsibility and authority; therefore the UN and NGO community needs to support the government to enable sustainable change. The stakeholders committed to integrating nutrition and WASH programming have chosen to collectively assist the government to develop systems and structures that will enable the implementation of programming that will make a difference for the nutritional outcomes of young children.The main points of intersection for WASH and nutrition programming within the Cambodia context is currently thought joint analysis, coordination, planning at national and sub-national level, implementation and monitoring. In addition there needs to be an enabling environment of policy and strategies and effective advocacy as needed. Key AssumptionsA summary of the key assumptions that have been made, and how they can be tested throughout the lifetime of the programme, are below.AssumptionsTestsThere will be political will to push WASH and nutrition at top of agenda. If we produce a strong argument with evidence, costing and budget, the MEF will allocate more budgets.Further analysis of budget allocation, process, practices of MEF, national development plansAssessing the quality of argument/costingSufficient human resources are available at sub-national level to implement interventions.Capacity for gap assessment for sub-national and community levelAssessment of the planning for decentralization and deconcentration of MRD and MoH and level of alignment with our interpretation of the roles and responsibilities of these munity level actors are motivated and incentivesReview of real motivation of community leaders/actors and how these match with our proposed interventionsAssessment of existing incentive schemes for village level actors and their efficacy, efficiency and munication messages will lead to behavior changeEnsure regular and rigorous monitoring of the quality of our communication messages and research impacts.Monitoring systems are effective and functioning.Integration yields better results on stuntingDesign and evaluate integrations versus convergence versus business as usual.Private sector is an active participant across the countryPrivate sector solutions prove viable and profitable through FGDS and interviewPiloted models are sustainable and can be scaled up.Analysis of resources needed, political commitment at various levels and cost-effectiveness of various components of the piloted methods.The stakeholders around which the long-term goals are built are completeRevisit the ToC on a regular basis for validation at all levels in relation to all parts of the country (systemic review)Assume that the government increases the budget for WASH and nutritionLook at budget allocationThere is capacity at subnational government bodies levelScreening capacity of sub-national structure and staffPlanning translated into budgetJoint M&E mechanismWe assume that there are clear coordination platforms to coordinate cross-sectoral stakeholdersClear TORClear action-planTimely synchronization of supply and demand is taking place.Define framework with benchmarks; develop operational guidelines with what who when and howFollow on the implementation and feedback/fine-tuning toCommitment, political will and funds agreed and on the priorities o from government and development partnersCoordination with strong timelinesUSE CARD as a mechanism/platform to engage higher level participation and stimulate dialogueConsolidate workplan developed by gov’t and development partners and review progress quarterlyActive participation and support from Commune Council and Health Workers communityUse existing group to provide feedback on the interest to be engaged (select communities)Support case studiesIdentify synergy/success storiesCheck the increase of dynamic groups engagementMoving ForwardWHAT WE NEED TO DO FOR EFFECTIVE LEARNING & ACCOUNTABILITYBenchmarks developedSWG made accountable to benchmarksDefined parameters for how we work togetherDevelopment of monitoring frameworks together Need formal mandate for SWGRegular schedule for reviewing and annual reviewAssigned focal points for reviewing and reporting backFeed in the review into the regular joint planning/review of SWG annual workplanContinue elaboration of ToC and priority actionsAnnual review of ToCConnect the annual ToC review with benchmarks and indicatorsFrom now until 2019 further develop and test the ToCFunds needed for CARD to lead on the development and ownership of the ToCGuidelines/outline for how to operationalize joint WASH & nutrition programming to be developedCommittee of key players to new ways of workingHOW WE ARE GOING TO MOVE THIS FORWARDFurther map out why the WASH and nutrition programming currently on-going in Cambodia isn’t working through methods such as bottleneck analysis. This will provide a stronger platform of evidence to build from.Understand what implementation channels are needed for integrated WASH and nutrition programming so as to map the challenges and develop plans.Need to develop benchmarks/milestones and indicators to measure progress along the pathways sequence.Consider how to bring the private sector into the conversationUse government indicators/platforms (JMI) as an opportunity to bring efforts togetherUNICEF and CARD to work on the draft Theory of Change from the workshop and present to SWG for more consultation (open to other motivated people/org who want to contribute and/or representative of NGO/CSOs)CARD proposes a training of trainers of ToC to adopt and propagate the methodology, even for application to other sectors.In 2019 (when the next national cycle begins and more local evidence and results are available) would be a good time to establish a results framework.Identify individual actions (as agencies/individuals) that will contribute to progressing joint programming with reference to the framework of the ToC.Develop active plan for engagement of more partnersNext meeting of the SWG (February 19) the ToC learning and process will be shared with partnersDocument experiences with integrating WASH and nutrition programming so that Cambodia can ‘show by doing’.Annex 1: Assessment Matrix for Quality ToC ................
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