Seqota Declaration Roadmap For Expansion and Scaleup Phases - Print

Federal Democratic Republic of Ethiopia
Seqota
Declaration
Roadmap for Expansion and Scaleup Phases
2021 – 2030
September 2021
Federal Democratic Republic of Ethiopia
Seqota
Declaration
Roadmap for Expansion and Scaleup Phases
2021 – 2030
September 2021
Contents
Abbreviations and Acronyms........................................................................................... i
Foreword............................................................................................................................ iii
Acknowledgements........................................................................................................... iv
Executive Summary........................................................................................................... v
1. Background.....................................................................................................................1
2. The SD Expansion and Scale-up Phases Roadmap................................................... 4
3. Geographic Location..................................................................................................... 5
4. Seqota Declaration Vision, Mission, and Goals.......................................................... 6
5. Strategic Investment Pillars for Expansion and Scaleup Phases.............................. 7
6. Strategic Objectives......................................................................................................11
7. Governance and Coordination for the SD Expansion and Scale-up Phases............ 42
8. The SD Expansion and Scale-up Phases Estimated Investment Cost..................... 45
References......................................................................................................................... 56
Annexes.............................................................................................................................. 59
Annex 1: The SD Expansion and Scale-up Phases Impact Pathway............................ 59
Annex 2: The SD Innovations........................................................................................... 60
Abbreviations and Acronyms
AARR Average Annual Rate of Reduction
AITEC Agricultural Innovation and Technology Center
ANC Antenatal Care
BCC Behavior Change Communication
CMAM Community-based Management of Acute Malnutrition
CWP Costed Woreda-Based Planning
ECD Early Childhood Development
EDHS Ethiopian Demographic and Health Survey
ESMI Ethiopia School Meal Initiative
ETB Ethiopian Birr (local currency)
FF Food Fortification
FNA/C Food and Nutrition Agency /Council
FNCO Food and Nutrition Coordination Office
FPDU Federal Program Delivery Unit
FS Food Supplementation
FSN Food and Nutrition Strategy
FTC Farmer Training Center
GoE Government of Ethiopia
GMP Growth Monitoring & Promotion
HEWs Health Extension Workers
HEP Health Extension Program
HGSFP Home Grown School Feeding Programs
HH Household
ICT Information Communication Technology
IEC Information Education Communication
IFAS Iron Folic Acid Supplementation
IFS Iron Folate Supplementation
IGA Income-Generating Activity
IYCF Infant And Young Child Feeding
IMNCI Integrated Management of Neonatal and Childhood Illnesses
ITN Insecticide-Treated Nets
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 i
Abbreviations and Acronyms
M&E Monitoring And Evaluation

MNP Micronutrient Powder
MOLSA Ministry of Labor and Social Affairs
MT Metric Tons
MUAC Mid Upper Arm Circumference
NDAs Nutrition Development Agents
NGO Non-Governmental Organization
NUF Water purification technology
NSA Nutrition Sensitive Agriculture
OFSP Orange-Fleshed Sweet Potato
ORS Oral Rehydration Salts
PDU Program Delivery Unit
PFSA Poverty And Food Security Alleviation
PHC Primary Health Care
PLW Pregnant And Lactating Women
PNC Postnatal Care
PSNP Productive Safety Net Program
PTA Parent-Teacher Association
QPM Quality Protein Maize
RPDU Regional Program Delivery Unit
SBCC Social And Behavior Change Communication
SC Stabilization Center
SD Seqota Declaration
SHN School Health Nutrition
SSN Social Safety Net
TA Technical Assistance
UNISE Unified Nutrition Information System for Ethiopia
VAS Vitamin A Supplementation
WASH Water, Sanitation, and Hygiene
WASHCO WASH Committee
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 ii
Foreword
Attaining food and nutrition security is a constitutional and human right of Ethiopians. As part of
its national development agenda, the Government of Ethiopia has been implementing different
strategies and programs to ensure food and nutrition security. Seqota Declaration is one of
these programs where the Government of Ethiopia has made an innovative commitment to end
stunting among children under two years by 2030. The Government has launched the Expansion
Phase of the Seqota Declaration which builds on the lesson learned during the Innovation Phase
and accelerates the implementation of the Food and Nutrition strategy through its
evidence-based innovations. During Innovation Phase, Costed Woreda Based Plan was
implemented as one of the six innovations, which informed the Innovation Phase Investment
Plan.
To facilitate the investment decision for the Expansion and Scale-Up phases this Costed
Roadmap has been developed to indicate the investment required for the coming 10 years. This
Roadmap is a result of the work done by the Government in collaboration with the Seqota
Declaration implementing sectors that estimated the investment cost needed for each of the
sectors to implement nutrition-specific, nutrition-sensitive, and infrastructure interventions. The
Roadmap will serve as a guide for making investment decisions from the Government,
development partners, private sectors, donors, and the community. Moreover, the government
will also utilize this roadmap to make a resource mobilization from domestic and external
sources.
The Seqota Declaration Expansion phase will cover 240 woredas as of July 2021 and aims to
reach about 700 by the end of this phase. In this regard, adequate investment is needed to make
a meaningful impact. Finally, I would like to express my gratitude to all who contributed to
making the Innovation Phase a success and call upon all the Seqota Declaration stakeholders to
contribute their part to meet the investment needs of the Expansion and Scale-up phases and
attain the ending stunting goal.
Dr. Dereje Duguma

State Minister,
Ministry of Health
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 iii
Acknowledgments
The development of this roadmap was initiated by the Seqota Declaration Federal Program
Delivery Unit as part of the preparations for the Expansion Phase. Nutrition International through
its TAN Project has then agreed to provide Technical Assistance and deployed Result for
Development (R4D) to conduct evidence synthesis and develop a costed Roadmap based on
the evidence generated. In this regard, we would like to acknowledge Nutrition International,
formerly called the Micronutrient Initiative, under the Technical Assistance for Nutrition (TAN)
program funded with UK aid from the Government of the UK for providing the finance required
to identify and deploy R4D to work on this Roadmap as a Technical Assistance for Federal
Program Delivery Unit. The NI TAN team has also made extensive contributions in reviewing the
draft document and we are grateful for that too.
We would like to acknowledge the R4D team for their commitment and dedication in mobilizing
the Seqota Declaration stakeholders during the evidence synthesis and development of the
costed Roadmap. We appreciate their effort in finalizing this document irrespective of the
COVID-19 challenges and security situation. Special thanks go to the technical team of SD
implementing sectors who tirelessly worked in identifying the interventions and completing the
costs tabs.
We are also grateful to PDU staff at the Federal and Regional levels for their leadership and
contributions during the evidence synthesis and Roadmap development. We also extend our
appreciation and thankfulness to the Steering Committee members who provided high-level
leadership and guidance. We look forward to all stakeholders making use of this Roadmap to
drive your financial contributions to make the Expansion and Scale-up Phases a success.
Dr. Meseret Zelalem

Director
Maternal and Child Health and Nutrition Directorate
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 iv
Executive Summary
Advancing Ethiopia’s efforts to reduce stunting is critical to accelerate socio-economic
progress and development, and improve the health and educational attainment of current
and future generations. As shown in the previous four Ethiopian Demographic and Health
Surveys (2000 - 2016) there was a substantial reduction in stunting prevalence in children under
five years from 52% to 38%. Despite this impressive progress in reducing stunting rates over the
past decade, the burden of stunting in Ethiopia is high.
In July 2015, the Government of Ethiopia (GOE) launched the Seqota Declaration (SD), a
high-level commitment to end stunting in children under two years by 2030. The declaration
builds on and contributes to the National Nutrition Program II and the Food and Nutrition
Strategy and implements a three-phased multisectoral approach to end stunting.
The SD Innovation Phase was implemented between 2016 and 2020 in selected 40 woredas
in the Takeze basin (27 Amhara and 13 Tigray). The Innovation Phase included six innovations
(Program Delivery Unit - PDU, Data Revolution, Community Labs, Costed Woreda-based
Planning (CWBP), Agricultural Innovation and Technology Centers (AITEC), and The First 1000
Days Plus Public Movement), and various strategic multisectoral nutrition smart and
infrastructure initiatives.
The SD Innovation Phase generated successful program experiences on how to better

cultivate and coordinate political and sectoral commitment, delivery and technical capacity,
collaborative engagement between key actors, and improved performance management
practice at all levels, and provided good examples on effective way to mainstream crosscutting
issues such as gender and social behavioral change and communication (SBCC) efforts across
several sectors. The Innovation Phase also generated promising experiences on the introduction
of high-impact nutrition smart interventions to improve household-level behaviors and practices
on production and consumption of diverse, and nutrient-rich foods.ⁱ Learning and experiences
from the Innovation Phase are synthesized and used to inform the SD Expansion and Scaleup
Phases.ii
Building on lessons from the Innovation Phase and informed with global programmatic
experiences, the SD Expansion Phase (2021-2025) and the Scale-up Phase (2026-2030) will
be implemented across all regions in 700 woredas and 350 woredas respectively. The SD
Expansion and Scaleup Phases will serve as a showcase to provide specific strategic, technical,
and operational guidance on successful implementation of the national Food and Nutrition
Policy and Strategy to achieve rapid and large-scale stunting reduction in children under two.
ⁱ Some of these key nutrition smart interventions are: complementary feeding demonstration, nutrition corners in farmers training centers,
homestead gardening, small scale irrigation, biofortification of staple crops, improved animal husbandry (poultry, goat milk diary, fishery), school
meal initiative, water purification technology, small scale drinking water supply scheme, rural road construction to improve market access in hard
to reach areas.
ii
See Annex 2 of this roadmap for an overview of these six innovations. See also Evidence Synthesis Brief for a more detailed examination of these
innovations, including achievements and limitations during the Innovation Phase, and considerations for the Expansion and Scaleup Phases.
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 v
The SD Expansion and Scaleup phases aim to reduce the stunting rate in under two children
to 14% by end of 2025 and to zero by end of 2030 from the current 28% and will implement
high impact multisectoral nutrition-specific, nutrition-sensitive, and infrastructure interventions
at high coverage, intensity, and compliance using the existing multisectoral government
structures to achieve the following eight strategic objectives that are carefully identified to
address the basic, underlying and immediate causes of stunting in the Ethiopia context.ⁱ
Strategic Objective 1: Improve access to diverse, adequate, nutrient-rich, and

safe food all year round
Strategic Objective 2: Improve maternal, child, and adolescent feeding and

health care practices
Strategic Objective 3: Improve universal access to safe and clean water, and
sanitation and hygiene services, and adoption of improved practices
Strategic Objective 4: Enhance schools’ role for improved nutrition practice

and creation of nutrition change agents for the nation
Strategic Objective 5: Increase the resilience of households and communities

through social protection (social safety nets)
Strategic Objective 6: Enhance women empowerment, gender equity, and

child protection
Strategic Objective 7: Enhance market accessibility and affordability of foods
Strategic Objective 8: Foster an enabling environment for strong governance

and coordination of multi-sectoral stunting reduction efforts
An estimated USD 4.58 billion is needed to implement the SD Expansion and Scale-up Phases.
From this, USD 2.66 billion is needed for the SD Expansion Phase (2021 - 2025) and USD 1.92
billion is needed for the Scale-up Phase (2026-2030). Federal and regional governments are
primarily responsible for the financing of the Expansion and Scale-up Phases, while resources
will also be mobilized from development partners, financial institutes, and donors to
complement the government commitment.
The federal PDU, in collaboration with the SD implementing sectors, will facilitate proper
governance of the SD at the federal level, and support and work closely with the regional PDUs
and Food and Nutrition Coordination Offices (FNCOs) to facilitate vertical coordination between
federal and regional actors. Regional PDUs and FNCOs, are responsible for the governance of
the SD at the regional level, and support and work closely with the woreda coordinators based
at the woreda administration offices to facilitate vertical coordination between region and
woredas, and proper governance of the SD at the woreda level. Once established, the Food and
Nutrition Council/Agency will take over the responsibility of the SD governance.
ⁱ See Annex 1 of this roadmap for the updated SD Theory of Change (TOC)
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 vi
1. Background
In July 2015, the Government of Ethiopia (GoE) exemplified its commitment to nutrition by
issuing the Seqota Declaration (SD) to eliminate child undernutrition and end stunting in
Ethiopia by 2030. The 15-year Seqota Declaration Implementation Plan focuses on delivering
high-impact nutrition-specific, nutrition-sensitive, and infrastructure interventions across
multiple sectors.ⁱ Recognizing that ending child malnutrition requires coordinated efforts from all
stakeholders, the declaration’s implementation plan emphasizes improving adolescent, infant,
and maternal nutrition; increasing access to nutrient-rich food all year round; improving access
to water and hygienic services; building resilient social protection systems; supporting the
economic empowerment of women; and improving access to education, especially for girls. The
SD focuses on stunting because it is considered to be the best overall indicator of children’s
well-being and social inequities globally.
The SD builds on and contributes to the National Nutrition Program (2016-2020) and the
Food and Nutrition Strategy (2021-2030) and implements a multisectoral plan with
nutrition-specific, nutrition-smart, and infrastructure interventions over fifteen years (2016 -
2030).
The SD is being implemented in three phases. The Innovation Phase was implemented from
2016 to 2020 to pilot innovative programs in 40 woredas along the Tekeze river basin in Amhara
(27 woredas) and Tigray (13 woredas). Amhara and Tigray were targeted for the Innovation
Phase because the stunting burden in both regions was consistently above the national average
in children under five (in 2016, the national average was 38%, compared to 46% in Amhara and
39% in Tigray) (EDHS 2016). The Expansion Phase will be implemented between 2021 and 2025
and seeks to expand these innovative pilot programs to 700 woredas. The Scale-up Phase will
take place from 2026 through 2030 and will scale these innovations to additional 350 woredas.
The SD Innovation Phase (2016 to 2020) included six innovations to catalyze the delivery of
SD strategic initiatives to reduce stunting.ii The Innovation Phase used existing multisectoral
structures to implement these innovations based on the “learning by doing” principle.
The six innovations listed below are explained in Annex 2:
1. Program Delivery Unit (PDU),
2. Data Revolution,
3. Community Labs,
4. Costed Woreda-based Planning (CWBP),
5. Agricultural Innovation and Technology Centers (AITEC), and
6. The First 1000 Days Plus Public Movement.
i
The sectors and ministries involved are: Agriculture (MoA), Education (MoE), Health (MoH), Labor and Social Affairs (MoLSA), Road and Transport
(MoT), Women and Children’s Affairs (MOWCYA), Water, Irrigation, and Energy (MoWIE), and Finance (MoF).
ii See Annex 2 of this report for an overview of these six innovations. See also Evidence Synthesis Brief for a more detailed examination of these
innovations, including achievements and limitations during the Innovation Phase, and considerations for the Expansion Phase.
Seqota Declaration: Roadmap for Expansion and Scaleup Phases 2021 – 2030 1
More effort is needed to break the intergenerational effect of stunting in Ethiopia. According
to the Ethiopia Demographic and Health Surveys, stunting in Ethiopia has steadily declined over
the past twenty years (from 52% in 2000 to 37% in 2019 in children under five, and from 40% to
28% in children under two, with high regional variation). The GoE has designed and implemented
several pro-poor policies and strategies across different sectors in the last twenty years
focused on multisectoral poverty reduction, food security, increased agricultural production,
decentralized health systems, health extension programs, accelerated midlevel health care
worker training, girls’ and parental education, maternal nutrition, economic improvement, and
water , sanitation, and hygiene (WASH) practices. Impacts from the implementation of these
policies and strategies collectively contributed to the stunting reduction achieved in Ethiopia
over the last twenty years.¹ Despite this progress, the gains are insufficient to achieve the
country’s stunting reduction targets in either the short term (the NNP II target of reducing
stunting in children under five to 26% by 2020) or long term (World Health Assembly target of
40% reduction in number of stunted children by 2025, and SD target of zero stunting by 2030 in
children under two). Further, the rate of reduction is lower for children under two than for
children under five (an annual average rate of reduction of 1.8% compared to 2.25%,
respectively). This difference indicates the country is far from breaking the intergenerational
consequences of early stunting, as stunting at early life leads to stunted adulthood/mother that
has an association to stunting of the next generation.
Advancing Ethiopia’s efforts to reduce stunting is critical to accelerate socio-economic

progress and development, and improve the health and educational attainment of current
and future generations. According to the Cost of Hunger in Africa Report (2013), because of
factors associated with undernutrition, Ethiopia loses 17% of GDP each year, which slows down
the country’s ambition to achieve inclusive growth and become a lower-middle-income country
by 2025. If Ethiopia achieves the WHA target of a 40% reduction in the number of stunted under
five children by 2025, the cumulative increase in income for the non-stunted workforce would
be USD 16 billion from 2035 to 2060 (assuming the workforce is not stunted from the year they
enter the labor force to the end).² This is partially driven by the significant health and education
impact stunting wreaks across generations. Stunting begins in the prenatal environment leading
to low birth weight and continues with growth faltering in the first two years, after which it is
generally irreversible.³ Consequences of early stunting extend to the next generation; maternal
stunting before 24 months of age is associated with a lower birth weight in the next
generation.4,5 The vicious cycle of undernutrition and disease means that stunted children are
more likely to become sick due to their immunodeficiency status and sick children are more
likely to become stunted due to poor nutrient consumption and absorption.⁶ Stunting also
carries an elevated risk of death. A moderately stunted child carries twice the risk of dying
compared to a non-stunted child, while the mortality risk is more than four-fold among severely
stunted children.⁷ Stunting leads to lost growth potential associated with school achievement
and reduced earnings.⁸
The implementation of the SD six innovations during the Innovation Phase generated
adequate insights and lessons that will guide the GoE on how to advance the stunting
reduction efforts through strengthened governance and coordination of the multisectoral
nutrition efforts at all levels and increased delivery capacity and commitment of the SD
implementing sectors for the implementation of high impact interventions. See the Evidence
Synthesis Report for more details about the specific lessons learned from these innovations
(defined in Annex 2 of this report).
Building on lessons from the Innovation Phase, the SD Expansion, and Scale-up Phases will
serve as a showcase to provide specific strategic, technical, and operational guidance on
successful implementation of the national Food and Nutrition Policy and Strategy to achieve
rapid and large-scale stunting reduction in children under two. It will continue cultivating the
political will and commitment created during the Innovation Phase at both the national and
sub-national levels through strong advocacy efforts to expand the support and resource base
to achieve an enhanced stunting reduction in Ethiopia over the next ten years. When it is
replicated at scale, the best practices from the SD Innovation Phase can effectively drive
accountability, multisectoral coordination and collaboration, adequate and sustainable
financing, and improved planning for multisectoral nutrition response towards rapid stunting
reduction in Ethiopia.
The SD Expansion and Scale-up Phases will provide a package of high-impact

nutrition-specific, nutrition-sensitive, and infrastructure interventions to be implemented
with high coverage, compliance, and intensity to ensure individual sectors meaningfully
contribute to ending stunting in children under two by 2030.
2. The SD Expansion and
Scale-up Phases Roadmap
This document serves as a Roadmap for the SD Expansion and Scale-up Phases, drawing on
evidence and lessons from the SD Innovation Phase, activity plans from the GoE’s
nutrition-relevant sectors, and programmatic evidence of successful nutrition interventions to
identify the activities to expand.ⁱ It leverages existing sectoral expertise, structures, and
resources, and seeks to identify and fill their capacity gaps to ensure sectors fully own and
manage the planning, implementation, monitoring, and evaluation of their high-impact nutrition
interventions.
The Roadmap defines the main approaches, interventions, and milestones needed to
translate the rationale for the SD Expansion and Scale-up Phases into specific sectoral
actions to drive rapid stunting reduction in children under two between 2021 and 2030 in
Ethiopia. It will also serve as a strategic communication tool to 1) onboard critical stakeholders
on the scale-up efforts and facilitate their continued commitment, 2) conduct resource tracking
and mobilization from all stakeholders, and 3) provide the accountability needed to achieve the
SD goal.
The Roadmap was developed under the leadership of the SD Federal Program Delivery Unit
(F-PDU) in the Federal Ministry of Health (MoH), and with technical assistance support
provided by Results for Development (R4D). With the F-PDU, eight SD implementing sector
ministries namely the Ministry of Health (MoH), Ministry of Agriculture (MoA), Ministry of Water,
Irrigation and Energy (MoWIE), Ministry of Labor and Social Affairs (MoLSA), Ministry of
Education (MoE), Ministry of Women, Children and Youth Affairs (MWCYA), Ministry of Road and
Transport (MoT), and Ministry of Finance (MoF) will be responsible for the implementation of
the SD Expansion and Scale-up phases. These sectors played a lead role collectively and
individually in the process of the SD Roadmap development. Different co-creation workshops
were organized with focal persons from these sector ministries and the F-PDU team to
adequately and jointly brainstorm and set intervention ideas, and outline the approaches and
content of the Roadmap based on the recommendations from evidence synthesis of the SD
Innovation Phase, and global and Ethiopia programmatic experience review. An advisory team
formed by the F-PDU was also engaged and consulted to bring in perspectives from diverse
experts and leaders in multisectoral nutrition and seek guidance and advice about the key
aspects of developing and costing the Roadmap.
i
Please see “Synthesized Learnings from the Seqota Declaration Innovation Phase and Evidence on High-Impact Nutrition Interventions:
Considerations for the Expansion Phase Roadmap Development,” for a full assessment of the SD Innovation Phase and resulting
recommendations.
3. Geographic Location
The SD will be implemented nationally, in all 1050 woredas by 2030. It covers 700 woredas in
the Expansion Phase including the 40 woredas from Innovation Phase, and an additional 350
woredas in the Scale up-Phase.
The level of SD geographic expansion was decided through an inter-ministerial meeting that
provided leadership for SD implementing sectors. The decision was made based on a
combination of factors, including a sectors’ ambition to accelerate stunting reduction, the
opportunity for continued large-scale government-led programs that contribute to the SD goal,
and the potential contribution of the country’s ten-year inclusive economic development plan to
nutrition outcomes. A critical mass of woredas generally considered to have a high stunting
burden (e.g., all Productive Safety Net Program (PSNP) woredas) will be reached during the
Expansion Phase.
Figure 1: Coverage of the Seqota Declaration
Scaleup Phase - 2026-2030
350 Woredas
Expansion Phase - 2021-2025

700 Woredas
1st Round Expansion - 2021-2022
240 Woredas
2nd Round Expansion - 2023-2025
460 Woredas
Innovation Phase: 2016-2020

40 Woredas
(27 Amhara & 13 Tigray)
4. Seqota Declaration
Vision, Mission, and Goals
The SD Expansion and Scale-up Phase Roadmap is guided by the below vision, mission, and
goals.
Vision
We aspire to see Ethiopia’s children free from undernutrition.
Mission
We will work to end stunting in Ethiopia for children under two years through effective
coordination and collaboration of efforts across sectors, communities, and our
development partners, focusing on high impact nutrition-specific and nutrition smart
interventions and social behavior change communication (SBCC) with special
consideration for cross-cutting issues, such as gender mainstreaming, environment,
and integrated community development approaches.
Goal
To end stunting in children under two by 2030.
Intermediary Goals
• To reduce stunting in children under two to 14% by 2025 from the current 28%.
• To achieve ≥ 3% AARR of stunting in children under two between 2021 and 2030
Assumptions
Informed with the programmatic experiences in the SD Innovation Phase and global and national
evidence review, the goal and high-impact interventions for the SD Expansion and Scale-up
Phases are proposed based on the following key assumptions:
• Stunting continues as the main outcome of the SD Expansion and Scale-up Phases with 28%
stunting prevalence in under two children (mini-EDHS 2019) as a baseline.
• The GoE sustains its commitment to acting at scale both in financing and implementing
high-impact interventions in the expanded geographies to end stunting in children under two
by 2030.
• A threshold of minimum 70% implementation coverage for high-impact interventions to

achieve the required annual average stunting reduction rate of ≥3% to end stunting in children
under two by 2030.
5. Strategic Investment Pillars
for Expansion and Scaleup Phases
The SD Expansion and Scale-up Phases are informed by the findings from successful
programs in Ethiopia and across the globe on child stunting reduction. These findings
suggest high-impact interventions across agriculture, health, WASH, education, social
protection, women empowerment and child protection, and infrastructure sectors and overall
multisectoral nutrition governance are critical to addressing the proximate, intermediary, and
underlying determinants of stunting.ⁱ
Successful implementation of high-impact interventions at scale is more likely to be

achieved when they are categorized and implemented according to the level of investments
and accountability mechanisms they require. Evidence from global programmatic experience
suggests that at least 70% implementation coverage of high-impact interventions is required to
achieve the desired high stunting reduction (≥3% AARR). Based on this evidence base and their
current coverage status and complexity of the associated barriers for low coverage, availability
of existing platforms, and their potential contribution to creating an enabling environment for
enhanced delivery and impact of cross-sectoral interventions, the high-impact interventions
proposed for SD Expansion and Scale-up Phases are categorized into the following four
strategic investment pillars
LIFTING
The “lifting” investment pillar aims to raise the coverage and/or compliance of
high-impact direct nutrition interventions across different sectors where current
coverage is considered to be low, and which need innovative or highly intensive
implementation to meet the minimum 70% coverage requirement. The SD PDUs and
FNCOs will demonstrate direct responsibility and accountability to improve coverage and
compliance of these interventions through strong resource mobilization, and facilitation
of their implementation at scale, in close collaboration with the implementing sectors.
Some of the innovations tested during the Innovation Phase—such as the “Community
Labs” and “the first 1000 Days Plus Public Movement for social and behavior
change”—can be excellent drivers of interventions in this category.
i
For a full examination of the global evidence, please refer to the “Synthesized Learnings from the Seqota Declaration Innovation Phase and
Evidence on High-Impact Nutrition Interventions: Considerations for the Expansion Phase Roadmap Development”.
BACKSTOPPING
The “backstopping” investment pillar aims to ensure timely and quality delivery of
high-impact nutrition interventions that would be routinely planned, implemented,
monitored, and evaluated by the associated implementing sectors. The SD PDUs and
FNCOs will support sectors through technical assistance to ensure interventions are
being planned and financed directly by the relevant sectors. Although sectors will be
responsible for financing these interventions, the SD PDUs and FNCOs can assist in
resource mapping and mobilization strategies. Lastly, the SD coordination office could
provide sector-specific technical assistance (TA) related to the design and delivery of
specific interventions based on the sectoral TA needs.
LEVERAGING
The “leveraging” investment pillar aims to enhance the nutrition sensitivity of routine or
cross-cutting sectoral interventions that have been identified as high-impact
interventions in reducing stunting. The SD PDUs and FNCOs will provide light-touch
support to respective sectors through developing and sharing technical guidance on
mainstreaming nutrition across these interventions. High coverage of interventions in
this category is critical to enhancing their contribution to reducing stunting, and FPDU
and FNCOs will regularly analyze and track their coverage and advocate with relevant
sectors to improve and maintain the interventions coverage above the 70% requirement.
Since these interventions are already routine and have well-established financing
mechanisms, the SD will only be responsible for any additional funding for the
sensitization support.
ENABLING
The “enabling” investment pillar aims to support and adapt the multisectoral nutrition
response governance innovations tested during the Expansion and Scale-up Phases. The
SD will expand and institutionalize the innovations across different administrative
structures to facilitate an enabling ecosystem for the delivery of nutrition-smart
interventions. These innovations include the Program Delivery Unit/Food and Nutrition
Coordination Office, the Nutrition Human Resource, Data Revolution, the Costed
Woreda-based Planning, and the Community Lab. The SD PDUs and FNCOs will be
responsible for financing, planning, implementing, monitoring, and evaluating the
ongoing governance interventions in close collaboration with relevant sectors.
Figure 2: SD Expansion and Scale-up Phases Intervention Priorities by Investment Pillars
Lifting sectoral high Backstopping routine Leveraging routine

impact direct nutrition high impact direct high-impact non-direct
interventions considered nutrition interventions nutrition interventions
to be low coverage across sectors across sectors
- Improved diary, poultry, - Strengthen farmer training - Large scale irrigation farm
and fish production and centers - Transform smallholder
consumption - Food safety practice productivity and income
- Improved production and - Post-harvest loss (agricultural inputs,
consumption of - Staple crop diversification extension services)
Agriculture nutrient-rich horticulture - Agriculture workers - Natural resource
- Biofortification of staple training on management
crops (maize, potato, nutrition-sensitive
bean) agriculture
- Local food processing (e.g.
dried meat powder and
egg powder)
- Optimum breast feeding - Early identification and - Family planning

- Minimum acceptable diet, treatment of acute - Child immunization
diet diversity, and animal malnutrition - Antenatal care, Post-natal
source consumption by - Child Growth Monitoring care, and skilled delivery
infants and young children Promotion - Integrated management of
Health and pregnant and - Vitamin A Supplementation childhood illnesses
lactating women (PLW) - Deworming - Malaria prevention and
- Multiple micronutrient - Health workers training on treatment
supplementation for nutrition-related services - Strengthening Health
pregnant women Extension Program
- Improved latrine and basic - Household and - Universal access to clean,

hand washing facility for community-based WASH adequate and safe water
households promotion through large scale water
- Universal access to clean, supply scheme
adequate and safe water
WASH through small scale water
supply scheme
- Girls’ education - Training of teachers on - General school-based

- Expansion of model nutrition sensitive nutrition, WASH, and
home-grown school education reproductive health
feeding program (Ethiopia - School curriculum revision promotion and services
school meal initiative to adequately incorporate
Education model) nutrition
- Student participation in
school and family nutrition
promotion activities,
especially adolescents
girls
Lifting sectoral high Backstopping routine Leveraging routine
impact direct nutrition high impact direct high-impact non-direct
interventions considered nutrition interventions nutrition interventions
to be low coverage across sectors across sectors
- Pulse transfer to PLW - Train social safety net - General Productive Safety
- Medical fee waiver to all staff and social workers Net Program
malnourished children on nutrition sensitive - Medical fee waiver to
- Conditional cash / food social protection indigents
Social transfers to community
Protection nutrition champions
- Supportive social - Women’s social - Labor, time, and

environment for proper empowerment and gender energy-saving technology
child, PLW, and adolescent equity for domestic work
girls care and feeding - Child day care / Early - Women economic
Women, - Male involvement in child Childhood Development empowerment
Children & nutrition and care expansion
Youth Affairs
- Perishable food supply - Financing facility to actors - General rural road

chain standard and in perishable food value development and
directives development chain especially women networking
- Construction of road to producers
Nutrition very hard to reach areas - Food market linkages and
smart value affordability
chain and
infrastructure
- Fostering Political Commitment and Leadership
- Multisectoral Coordination and governance

Enabling - FNCOs, PDUs, Woreda Coordinators
Ecosystem
- Human Resource for Nutrition
- Career structure and recruitment of sectoral nutrition experts
- Costed Woreda-based Planning

- Nutrition resource tracking and budget gap analysis; resource mobilization at all levels;
efficiency improvement and allocative decision
- Data Revolution
- Data use culture (data demand for decision making, analysis, and visualization)
- Performance management and adaptation
o Web based data system (UNISE and YAZMI (a smartphone-based tool that operates
through satellite connection))
o Key performance indicator (KPI) manual tracking and rating (Scorecard)
o Collaborative review and learning
- Baseline and Evaluation including annual outcome monitoring
- Coordination of cross cutting innovations

- Community labs (community participation and ownership; local resource mobilization)
- The 1000 days public movement mainstreaming
- Expansion of model nutrition-smart infrastructures / technologies and innovations across
different sectors and genders
6. Strategic Objectives
The evidence reviewing Ethiopia’s programmatic experience and impact analysis, and the
Exemplars in Global nutrition work indicate that the implementation of high-impact interventions
at scale, with increased intensity and coverage (70% coverage), in addition to innovative
governance and accountability mechanisms (such as Program Delivery Units (PDUs) and Food
and Nutrition Coordination Offices) – will result in a significant reduction in stunting (≥3% AARR).
Based on the programmatic experiences of accelerated reduction in child stunting in Ethiopia,

the food and nutrition strategy, and lessons learned across different countries, the following
eight strategic objectives should be implemented at scale in the SD intervention areas during
the SD Expansion Phase (2021-2025) and Scale-up Phase (2026-2030).


Strategic Objective 3: Improve universal access to safe and clean water, and
sanitation and hygiene services, and adoption of improved practices
Strategic Objective 4: Enhance schools’ role for improved nutrition practice

and creation of nutrition change agents for the nation

Strategic Objective 6: Enhance women empowerment, gender equity, and

child protection

and coordination of multi-sectoral stunting reduction efforts
A successful agricultural production system contributes to household food and nutrition security
by increasing availability, affordability, and consumption of diverse, nutrient rich, and safe food
throughout the year. Increased household food and nutrition security in turn contributes to
increased household income and, eventually, poverty reduction.
According to the Comprehensive Food Security and Vulnerability Analysis by WFP, in Ethiopia,
nearly 21% of households are food insecure.10 This analysis also shows poor nutrition security
in Ethiopia, with over half of Ethiopians consuming four or fewer food groups out of the
recommended seven in a week;ⁱ on average, households consume meats and fruits less than
one day a week, and per capita milk consumption is seventeen kilograms per year, which is
much lower than the consumption in other countries (e.g. Tanzania, Uganda and Kenya) with
smaller cattle populations.10 The ability of households to produce, purchase, and access diverse
foods is generally limited among Ethiopian households due to poor productivity, food market
system and affordability, and low nutrition literacy.11
Innovation Phase Experiences
Key interventions that increase production and consumption of diverse foods by

households with a primary focus of improving the nutritional status of infant and young
children (IYC) and pregnant and lactating women (PLW) were implemented in the SD
Innovation Phase. Priority was given to the food types that are less accessible to
households because of low production practices and/or unaffordable market prices for a
majority of households, such as eggs, milk, fish, fruits and vegetables, and nutrient-rich
biofortified crops.
The Innovation Phase particularly tried to address access barriers to improved animal
breeds and their feeds, and crop seeds through close collaboration with private farms and
youth group enterprises, and successfully mobilized resources from the agriculture sector
and non-governmental organizations (NGOs) for free distribution to PLW. These efforts
were further supported by establishing nutrition corners in Farmer Training Centers (FTCs)
to improve the overall awareness of and practices for diverse food preparation and
consumption by households, with a focus on PLW and their children. Small scale irrigation,
innovative homestead gardening (e.g. key hole gardening), and climate-smart technologies
to promote land treatment and reduce post harvest loss were also introduced as
mechanisms to increase agricultural productivity.
If implemented at scale, these interventions will help to overcome the unacceptably very
low diet diversity score by household, and eventually contribute to accelerated reduction of
stunting in Ethiopia.
i
The food groups used in the analysis for household diet diversity score are: (1) starch (2) pulses, (3) vegetables, (4) fruits, (5) meat, (6) diary, (7)
oil and fat, (8) sugar.
Based on learnings from the SD Innovation Phase and global experience, the SD Expansion and
Scale-up Phases will facilitate the implementation of high impact nutrition-sensitive
agriculture sector interventions at scale to enhance the household capacity to produce and
consume more diverse, nutrient rich, and safe food to end stunting in children under two. It
will particularly seek to achieve the following results:
Result 1.1 Improved production of diverse nutrient rich food all year round
Result 1.1.1 Improved production and consumption of poultry and poultry

products
Egg play an important role in child nutrition by providing nutrients important to childhood growth
and development. According to the recent poultry production review by FAO, in Ethiopia, the
poultry sector is dominated in rural areas by family poultry production of indigenous breeds that
scavenge around homestead areas, while intensive poultry farming businesses of exotic breeds
is expanding in urban and semi-urban areas.12 This review shows about 56% of Ethiopian
households have poultry holdings with flock sizes ranging between one and nine chickens.
Critical challenges to poultry production in Ethiopia are access to improved breeds, feeds, and
veterinary services, and poor knowledge of improved poultry production practices.12 Egg and
poultry meat consumption per capita in Ethiopia is much below the African average. Only 17% of
Ethiopian children consumed eggs in the previous 24 hours (Morris, Beesabathuni, & Headey
2018a).
During the Innovation Phase, poultry production was one of the successful interventions
implemented through the agriculture sector. Partnership was created between the
agriculture sector and the private poultry farms to grow and supply one-day-old chicken
and feeds to PLW. Adequate orientation was also provided to PLW on proper poultry
farming. PLW were prioritized to ensure the immediate contribution of the intervention to
stunting through increased egg consumption by PLW and their children.
The SD Expansion and Scale-up Phases will continue targeting households with pregnant and
lactating women (PLW) to lift the current low consumption of eggs, particularly for PLW and
their children aged 6 to 23 months by ensuring surplus production that satisfies both the
consumption and additional income need of the PLW through family poultry production.
The following priority activities will be implemented at scale:
• Organize youth in improved chicken breed and poultry feed-producing enterprises and link
them to household poultry farms
• Facilitate free distribution of one-day-old chicken and feed to PLWs by agriculture sectors
and NGOs
• Establish and strengthen poultry production training and demonstration sites (within
existing FTCs) to ensure adoption of improved poultry production by households at scale
• Improve access to poultry veterinary services and feeds to households
Train PLWs and family members on improved poultry production practices and egg
consumption.
Result 1.1.2 Improved production and consumption of dairy products
Milk and milk products are excellent sources of protein, vitamins, and minerals important to child
growth and development. In Ethiopia, dairy production in rural households is widely practiced
both for consumption and income generation, but the average annual milk consumption per
capita in Ethiopia is much lower than the consumption in other African countries. This suggests
poor milk productivity leads to milk shortages.11 Cattle are the main source of milk in Ethiopia
(78%), while camel (19%) and goat (3%) also serve as sources of milk mainly in pastoral and
agro-pastoral areas.13 Dairy production is constrained by productivity challenges because of low
milk production by local cattle, and poor access to improved veterinary services, artificial
insemination, improved cattle breeds, and foraging. Poor hygienic milk production practice is
another challenge.14
During the Innovation Phase, goats milk consumption by IYC and PLW was promoted
through free goat distribution to households with PLW, and in some communities where
goat milk was not familiar, through social and behavior change communication involving
religious leaders. The key learning from the promotion of dairy products by PLW and IYC
from the Innovation Phase was the need for free distribution of goat and feeds, veterinary
support, and the involvement of religious leaders to promote consumption of goat milk.
To address the critical challenge related to low animal source food consumption in Ethiopia, the
SD Expansion and Scale-up Phases will seek to lift the current low access to and consumption
of milk and milk products by PLW and IYC, and will undertake the following priority
interventions:
• Provide goat to poor households with PLW in areas goat milk is consumed
• Supply feeds for goat milk and milk product production to households with PLW
• Improve access to goat veterinary services and feeds to households
• Establish and strengthen dairy production training and demonstration sites (within existing
FTCs)
• Train PLs and family members on improved and hygienic dairy production practices and
dairy consumption by PLW and IYC
• Establish community level animal feed concentrate processing centers in selected woredas
• Finance artificial insemination (AI) services to increase population of improved breed cattle
/ cows in SD kebeles
Result 1.1.3. Improved production and consumption of fish and fish
products
Fish plays an important role in food security and is an excellent source of rich nutrients. Ethiopia
has the potential to annually produce an estimated 51,000 metric tons (MT) of fish, with an
estimated current annual fish production of 29,000 MT, mainly from the six big lakes (75%) and
25% from other small lakes and rivers. Fish consumption is generally very low (less than 0.5kg
annually per capita compared to 9kg for Africa), and accounts for 1% of animal protein intake,
compared to 19% for Africa. This limits the fish contribution to food and nutrition security in
Ethiopia.15 Poor fish supply and challenges in the value chain, low demand for consumption, and
poor technical and material support to the sector are major constraints to fish production and
consumption in Ethiopia.16
Among the fish farming-related experiences worth considering for the Expansion and
Scale-up Phases of the SD was the behavior change towards fish and fish consumption with
the involvement of religious leaders, and the support provided to youth associations who
engaged in fish farming from the Tekeze River to improve market linkages and post-harvest
lose through road construction and accessibility of refrigerated trucks. Improved
involvement of the communities near the Tekeze River in fish farming improved access and
consumption of fish by the wider communities in some Innovation Phase woredas.
The SD Expansion and Scale-up Phases will seek to lift demand for fish consumption through
strong behavior change communication (BCC) including assessing demand barriers, and work
closely with the agriculture office, job creation commission, and trade and industry office to
expand fish production and markets, including cold chain systems in selected SD woredas
by linking it to the ongoing youth job creation effort. The SD will undertake a feasibility
assessment and support expansion of pond construction (household level pond for selected
PLW and communal woreda level ponds for youth enterprise), road construction, and cold chain
supply for expanded fish production in selected SD woredas.
Result 1.1.4. Improved production and consumption of nutrient rich fruits

and vegetables
Fruits and vegetables play an important role in human nutrition and health due to their high
vitamin and mineral content. In Ethiopia, cultivation and consumption of vegetables and fruits
are extremely suboptimal. About 42% and 76% of households didn’t engage in production of any
common vegetables and fruits respectively.17 Ethiopia meets only 36% of the
WHO-recommended volume of average fruit and vegetable consumption (146 kg per year per
capita, or at least two servings of fruits and three servings of vegetables per day).10 A household
in Ethiopia should spend 11% of their income on average to meet this WHO recommendation,
and this is 2.5 times more for poor households, indicating an association between low
consumption and market price driven by low production of fruits and vegetables.18
The involvement of private sector and the community seed producers in the production of
fruit and vegetable seedlings, and the associated promotion to improve backyard gardening
practices by households with PLW through free seed / seedling distribution and intensive
awareness creation efforts were the great success from the Innovation Phase that can be
easily replicated at scale. In communities where water is critically scarce, keyhole
gardening using household water waste (less labor and water intensive and does not
require costly fertilizers or pesticides), and small-scale river dam construction were
introduced and used, to widely expand production of fruits and vegetables. A small scale
and cost-effective greenhouse model was also designed and introduced to early adopter
households to promote protected vegetable production. Involving religious leaders and
community open days were found to be key approaches to easily promote adoption of new
nutrient rich vegetables (e.g. pumpkin).
To address this, the SD Expansion and Scale-up Phases will enhance the production and
consumption of fruits and vegetables by PLW and their children through the following priority
activities:
• Support households (priority to households with PLW) by constructing small scale river dam
and other community water harvesting structures (e.g. hand-dug well, small scale river
dam), and distributing water pumps for irrigation of fruits and vegetables production during
dry season
• Provide improved seedling of fruits and vegetable seeds to households with PLW
• Facilitate adoption of fruit and vegetable cultivation in areas with no or less production by
establishing fruit seedling multiplication centers
• Promote underutilized nutrient rich fruits and vegetables through BCC
• Promote keyhole gardening
• Promote protected agriculture greenhouses
• Promote expanded practices of homestead gardening during rainy season
• General public awareness on fruits and vegetables consumption
• Promote agro-ecology-based food recipes
• Increase market share and availability of nutrient dense vegetables and fruits by
constructing vegetable and fruits market sheds
Result 1.1.5. Improved production and consumption of diversified staple

crops, including bio-fortified crops (e.g., quality protein-rich maize (QPM),
orange-fleshed sweet potato (OFSP), iron and zinc rich bean (IZRB))
Diversification of crop production without harming the farming efficiency contributes to stunting
reduction. In Ethiopia, the average caloric consumption in the general population has generally
improved, but the high percentage of calories derived from cereal staples (71%) indicates very
poor diet diversity.10 Although maize provides essential nutrients, it lacks adequate amino acids
important to child growth and development. In areas where maize accounts for over 50% of daily
caloric requirement, protein malnutrition may exist widely.19
Orange-fleshed sweet potato (OFSP) and Quality Protein Maize (QPM) were successfully
promoted in the Innovation Phase through strong awareness creation effort of its value add
to improve household nutrition security. Early adopters of both the OFSP and QPM were
supplied with seed. In collaboration with agriculture research institutes, iron and zinc-rich
bean (IZRB) were successfully experimented and ready for expansion, which will be the
major intervention to prevent zinc and iron deficiency anemia in the general population in
Ethiopia if implemented at scale.
To address this, the SD Expansion and Scale-up Phases seek to lift the diversity of crop
production and consumption in SD woredas by working closely with the agriculture sector on
the following priority initiatives:
• Improve farmer awareness of the benefit of crop diversification for nutrition security
• Facilitate increased demand for QPM, OFSP, and IRZB, and work with agriculture research
institutes and universities to multiply and distribute QPM seeds to poor households
• Identify potential priority crops (such as pulses) that can diversify the existing staple
cereals across different agroecology, and work with agricultural research institutes and
universities to multiply and supply poor households with improved seed
• Install small scale irrigation to promote diverse and year-round crop production, including
pulses
Result 1.2. Improved food safety practices
According to WHO definition, aflatoxins are poisonous substances produced by certain kinds of
fungi (molds) that are naturally widespread; they can contaminate food crops and pose a
serious health threat to humans and livestock. Evidence demonstrates existing high public
health risks of aflatoxin in Ethiopia due to increased contamination of staple cereals and animal
husbandry with mycotoxins.20
To address this, the SD Expansion and Scale-up Phases will provide technical assistance (TA)
support to the Ministry of Agriculture at the federal, regional, and woreda levels to design and
implement food safety improvement strategies and will organize awareness creation training for
households on good food safety practices.
Result 1.3. Improved food safety and post-harvest management practices

across the food system
Post-harvest food loss is a major concern that affects food security in Ethiopia.
During the Innovation Phase, post-harvest technologies such as airtight bags/hermetic

bags and metal silos were successfully introduced and promoted to reduce post-harvest
loss through strong demand creation and distribution to early adopters. Training was also
provided to farmers to improve their post-harvest management and food safety practices.
To address this, the SD Expansion and Scale-up Phases will provide TA support to the Ministry
of Agriculture at the federal, regional, and woreda levels to design and implement a
post-harvest loss and food safety improvement strategy across the food value chain from
production to consumption, and to enhance awareness of the key actors across the food value
chain. Post-harvest technologies such as airtight bags/hermetic bags and metal silos will be
distributed to farmers in SD Expansion and Scale-up Phase kebeles with adequate training to
improve household post-harvest management practices.
Result 1.4. Enhanced capacity of agriculture sector staff and farmers /

pastoralist training centers on nutrition-sensitive agriculture
Building capacity of agriculture sector staff is essential to improve quality planning,

implementation, and monitoring of nutrition-sensitive agriculture interventions.
During the Innovation Phase, farmer training centers were strengthened and supported to
establish nutrition corners. The nutrition corner consists of a display room for nutrient rich
seeds; a cooking demonstration corner; and a food preservation demonstration corner
(dried vegetables, bottling technologies). Capacity building trainings were provided to the
Agriculture Extension Workers on proper delivery of the nutrition-sensitive agriculture
interventions and on use of nutrition corners for demonstration that promotes production,
food safety, cooking, and consumption of diverse food.
To address this, the SD Expansion and Scale-up Phases will provide TA support to the Ministry
of Agriculture to assess and fill the capacity building needs of the agriculture sector staff,
including agriculture extension workers, woreda supervisors, and food and nutrition focal
persons at the regional and federal levels on nutrition-sensitive agriculture. The SD will use
coaching and mentoring support through the deployment of TA providers on different
nutrition-sensitive agriculture technical areas including on how to use Community Labs for
improved nutrition-sensitive agriculture practices, and organize targeted face-to-face training
for agriculture sector staff at all levels. Construction of model nutrition corners within the
existing FTCs will also be promoted and supported with key equipment and supplies.
Result 1.5. Improved consumption of diversified and nutrient rich foods
During the Expansion and Scale-up Phases, the SD will provide TA support to the agriculture
sector to develop and use standard SBCC messages, mainstream guidelines and materials
(both electronic and print) to strengthen the overall nutrition sensitive practices, and enhance
education and promotion of consumption of diverse and nutrient rich foods. Efforts will also be
made to improve access to locally-processed nutrient rich foods through organizing and training
youth and women enterprises on value addition of selected foods and supporting them with
small scale processing/technologies that support local food processing and value adding
practices.
In close collaboration with the Ministry of Trade and Industry, the SD will promote and support
private sector and farmer cooperative associations to produce and market dried meat powder
and egg powder to overcome low access to and consumption of meat and egg by young
children and PLW. This will include a feasibility study, investor incentives including a market
guarantee (procure and distribute for free or highly subsidize the end product), and technical
assistance support. Dried meat powder and egg powder consumption will also be intensively
promoted as part of the HEWs complementary feeding preparation and cooking demonstration
activities.
Result 1.6. Strengthened advocacy for improved nutrition sensitivity of

routine agriculture interventions
The partnership between the federal and regional governments for the construction of
medium-scale irrigation schemes to promote year-round production and consumption of
diverse crops was one of the best learnings for the Expansion and Scale-up Phases of SD.
However, the delay in project implementation should be addressed during the Expansion
Phase with timely resource mobilization.
In addition to the above high impact, direct agriculture sector nutrition interventions that require
intensive resource and technical assistance support to lift their current low coverage, the SD
Expansion and Scale-up Phases will strategically engage with the Ministry of Agriculture
structures at the federal, regional, and woreda levels to leverage the routine agriculture
interventions which have already been implemented at scale and identified as high impact to
reduce child stunting. The SD will ensure critical macro and micro-level barriers related to
these interventions are identified and addressed through a well-designed issue
identification/tracking mechanism and advocacy plan to gain additional depth and coverage for
these interventions. Some of the provisional SD interventions will include:
• Advocate for enhanced large scale agricultural irrigation schemes for dry season crop
production with consideration of pulses to diversify the target crops for the scheme
• Advocate for increased subsidies and access to financial facilities for smallholders to
purchase and use accessible and affordable agricultural supply inputs (pesticide, fertilizer,
insecticide) and technology (tractor and harvesting machines), especially for women
farmers
• Advocate for financial and market access to energy and time saving agricultural
technologies by women to enhance women engagement in agricultural production
• Advocate for universal access to veterinary services for small breeding as well as livestock,
cattle
• Advocate for enhanced climate-smart agriculture techniques and resources and natural
resource management (e.g. soil management, pest management, grazing plans)
Table 1: Target for SD Strategic Objective 1 Outcome – Improve access to diverse, adequate, nutrient-rich, and safe food year-round
Target*
Indicator Baseline
2023 2025 2028 2030
Proportion of rural HHs with PLW reported owning Not 40% 50% 65% 70%
chickens for egg consumption at least by PLW or Available
children 6-24 months
Proportion of rural HHs with PLW reported owning Not 60% 70% 70% 70%
cow or camel or goat for milk and milk product Available
consumption at least by PLW or children 6-24
months
Proportion of HHs with PLWs reported having Not 20% 30% 50% 70%
access to fish and fish products either from market Available
or own fish production pond
Proportion of HHs reported having access to fruits Not 70% 80% 80% 80%
for consumption at least by PLW or children 6-24 Available
months from backyard/home gardening or from
market
Proportion of HHs reported having access to Not 70% 80% 80% 80%
vegetables for consumption at least by PLW or Available
children 6-24 months from backyard/home
gardening or from market
Proportion of HHs reported have access to nutrient Not 30% 40% 50% 70%
rich bi0forified food (e.g. OFSP, QPM, IZRB) Available
Proportion of HHs practicing food safety practices Not 70% 70% 70% 70%
in the last 24 hours Available
Proportion of HHs using post-harvest technologies Not 70% 70% 70% 70%
for food storage Available
Percentage of HH dietary diversity score improved Not 70% 70% 70% 70%
Available
Proportion of kebeles having functional and well- Not 70% 70% 70% 70%
equipped farmers / pastoralist training center Available
*Means of verification is by conducting mid- and end-line evaluations both for the Expansion and Scale-up Phases. Our
evidence synthesis suggested the need to achieve >=70% targets across nutrition specific, nutrition sensitive and
infrastructure interventions to meaningfully contribute for the country’s goal to end stunting by 2030.
This strategic objective focuses on identifying and addressing critical behavior and
service-related barriers to improved child and maternal feeding practices and health conditions
as a path to achieve child stunting reduction.
Several smart nutrition interventions to improve coverage of breast and complementary

feeding were implemented during the innovation phase, including: Vitamin A
supplementation (VAS), deworming, growth monitoring promotion (GMP),
community-based management of acute malnutrition (CMAM), and iron folic acid
supplementation (IFAS) for PLW and children under five. Awareness creation and behavior
change at individual and community levels were facilitated through design and
implementation of the 1000 days plus public movement for social and behavioral change,
cooking demonstration sessions, community conversations and promotion of maternal,
infant and young children nutrition (MIYCN) using religious leaders. SBCC technical
assistance, need-based nutrition-related trainings for health extension workers (HEWs) and
leadership at various levels (woreda and primary health care units), and GMP supply
distribution to health facilities were delivered in collaboration with health sector and
development partners to strengthen capacities for proper implementation of these nutrition
interventions.
Building on the global, national, and Innovation Phase experiences, the SD Expansion and
Scale-up Phases will particularly seek to achieve the following critical results:
Result 2.1 Improved feeding practices of infant and young children,

pregnant and lactating mothers, and adolescent girls
Though there is a slight improvement in key IYCF metrics such as early initiation and exclusive
breast feeding and minimum meal frequency, the condition remains very poor and requires
improvement to achieve zero stunting in children under two by 2030. According to the recent
systemic review on the state of child nutrition in Ethiopia early initiation of breastfeeding,
exclusive breastfeeding are 65% and 60% respectively 21 (an improvement from 51% early
initiation of breast feeding and 52% exclusive breast feeding in EDHS 2011). This analysis also
show the timely initiation of complementary feeding is 62%, but only 10% of children aged 6 to
24 months met the minimum acceptable diet (composite indicator of minimum dietary diversity
and minimum meal frequency) with dietary diversity and meal frequency of 20% and 56%
respectively.21 Maternal undernutrition—which is one of the immediate factors for low birth
weight—is 21% in Ethiopia.22 Maternal nutrition education and counseling can make significant
improvements to early child feeding practices and stunting reduction.23
Adolescence (ages 10 to 19) is a crucial life stage for growing vibrant and healthy young people
while laying down lifelong eating habits. Adolescents are also the parents of the future; their
nutritional status shapes the health of the next generation. As potential future mothers who will
be in charge of nutrition decisions within their future households, the health and nutrition of
adolescent girls is particularly important to interrupt the generational cycle of malnutrition.
The SD recognizes the immediate and increased efforts to lift the unacceptably poor IYCF
practice and maternal and adolescent girls’ undernutrition in Ethiopia to accelerate child
stunting reduction over the coming ten years. The SD Expansion and Scale-up Phases will
particularly undertake the following interventions:
• The SD will build on the 1000 Days Plus Public Movement lessons and frameworks from
the SD Innovation Phase to aggressively promote behaviors and practices that support
optimum IYCF and maternal and adolescent girl feeding practices at community and
household levels in both rural and urban locations. (See Annex 2 for a brief description of
this Movement.) This includes championing and using mass media and public figures,
facility-based and school-based interventions, and using community level participatory
approaches (such as community conversation) for the promotion of optimum child,
maternal, and adolescent girl feeding practices.
• The SD will use the Health Extension Program (HEP) platform to implement community
level optimum breastfeeding and complementary food preparation and cooking
demonstrations; and nutrition counseling for all PLW during ANC and PNC contacts in SD
woredas. This will include standardizing and using counseling and demonstration job aids,
and procuring and distributing demonstration kits and food items.
• Promote dried meat powder and egg powder consumption as part of the HEWs
complementary feeding preparation and cooking demonstration, once their market
availability is ensured
• Strengthen ongoing efforts to establish and strengthen breastfeeding corners in health
facilities
• Mobilize religious leaders to teach their followers on the exemption of PLW and children
under five from religious fasting.
Result 2.2. Enhanced essential nutrition services in children under five,

pregnant women, and adolescent girls
Evidence shows that being wasted is predictive of stunting, as it negatively affects linear growth
and therefore undermines child growth and development.24 This indicates the need for more
attention on the improvement of wasting prevention and treatment to reduce child stunting. A
recent study in Gonder hospital indicated that 30% of newborns were stunted at birth; stunting
has a strong association with low birth weight and chronic maternal malnutrition.25 Infants and
children have higher vitamin A requirements to support rapid growth and to help them combat
infections.26 The Ethiopia Micronutrient Survey 2016 report shows, in Ethiopia VAD (serum
retinol 0.7 µmol/l or lower) in children 6-59 months is 14%,27 which shows significant
improvement from the WHO estimation in 2009 (46%).28 Consistent associations exist between
deworming and reduced stunting and deworming and reduced anemia.29 WHO recommends
deworming of children aged one to fourteen and pregnant women as one preventive measure of
soil transmit helminths.
According to the mini EDHS 2019, about 7.5% of children under age 5 years are wasted in
Ethiopia, and Vitamin A supplementation coverage for children 6 to 59 months is 47%. 30
To address this, the SD Expansion and Scale-up Phases will undertake the following priority
activities:
• Provide backstopping support to the existing routine nutrition services through training,
resource mobilization, and behavior change and communication in order to enhance
intensity, quality, and coverage of existing VAS, GMP, , deworming of preschool children
and pregnant women, early detection and treatment of child wasting, and maternal
undernutrition.
• Assist the health sector to undertake a barrier assessment and design and implement
improved service delivery models to help achieve and maintain high coverage of the acute
and mild malnutrition treatment, VAS, deworming, and GMP services.
• Pilot the functional feasibility of providing multiple micronutrient supplementation (MMS)
to pregnant women in selected SD woredas and facilitate expansion across wider areas
as one mechanism to prevent low birth weight and stunting at birth
Result 2.3. Strengthened capacity of primary health care and health

extension program for nutrition services
The SD will support the health sector to undertake periodic capacity building needs and gaps of
the primary health care (PHC) and HEP on nutrition, and assist on updating existing training
materials and organizing capacity building trainings for HEWs and nutrition focal persons.
Result 2.4. Strengthened advocacy and support for improved coverage of

routine high impact large scale health sector interventions
In addition to the above direct nutrition interventions, the SD will make strong advocacy efforts
to leverage ongoing health-specific services which are high impact interventions to enhance
their coverage and contribution to the child stunting reduction. These interventions include:
family planning; child immunization; integrated management of childhood illness with a focus on
childhood diarrhea, pneumonia, and malaria; maternal health care services; malaria prevention
and control; and primary health care access and quality. The SD Expansion and Scale-up Phases
will specifically undertake the following advocacy activities:
• Periodically analyze coverage of contraceptives, all basic child immunization, diarrheal

diseases treated with oral rehydration salts (ORS) and zinc, health seeking behavior, ANC,
PNC, and skilled delivery, and strongly advocate for increased effort and accountability
by federal ministry of health and regional health bureaus to achieve the 70% coverage
threshold to reduce child stunting.
• Periodically assess nutrition sensitivity of maternal counseling during basic child and
maternal health care service contacts, and assist in updating, printing, and distributing
counseling guides if need be.
Table 2: Targets for SD Strategic Objective 2 Outcome - Improve maternal, child and adolescent feeding and health care practices
Target*
Indicator Baseline
2023 2025 2028 2030
Percentage of children born in the last 24 months 62% 70% 75% 80% 85%
who were breastfed within 1 hour of birth
Percentage of children 0-5 months exclusively 60% 70% 70% 70% 70%
breastfed in the last 24 hours
Proportion of children 6-23 months who receive a 10% 40%% 55%% 70% 70%
minimum acceptable diet (MAD), apart from breast
milk in the last 24 hours
Proportion of children 6-23 months who consume 20% 50% 70% 75% 80%
a minimum diet diversity (MDD) in the last 24 hours
Proportion of PLW who consume MDD in the last Not 50% 70% 75% 80%
24 hours Available
Proportion children 6-59 months who received 47% 80% 80% 80% 80%
age-appropriate VAS dose in the last 6 months
Proportion of children 12-59 months who were Not 80% 80% 80% 80%
dewormed in the last 6 months, as reported by available
their mothers or guardian
Proportion of children 0-23 months whose weight Not 70% 70% 70% 70%
was monitored by health workers in the last one available
month
*Means of verification is by conducting mid and end-line evaluations both for the Expansion and Scale-up Phases. Our
Strategic Objective 3: Universal access to safe and clean water, and sanitation
and hygiene services and adopting of improved practices
Evidence shows a strong association between access to improved water, sanitation, and
handwashing with reduced child stunting in Ethiopia.31,8 In Ethiopia, access to improved water
drinking sources (without indicating the adequacy and safety) has improved (70%) but access
to improved latrine facilities is very low (25%).32
During the SD Innovation Phase, the establishment of WASHCO (community WASH

committees), construction of water supply schemes, maintenance of non-functional water
schemes, provision of training to WASHCO, and provision of alternative energy sources
were the lessons learned and worth expanding during the Expansion and Scale-up Phases.
Moreover, the two technologies from the ‘Bank of Water Technologies and
Solutions’—namely the surface water and turbid shallow groundwater treatment by
NUFiltration technology and the solar powered pumping and distribution System by
Innovation Africa—are technologies that need to be implemented during the Expansion and
Scale-up Phases.
The SD Expansion and Scale-up Phases will seek to achieve the following results:
Result 3.1. Increased access to improved drinking water sources by

households
The SD will mobilize resources to procure and supply water purification technology (NUF) for
villages without access to clean drinking water. It will also leverage the ongoing government
plan to achieve universal access to clean drinking water sources to rural and urban households
through assessing and identifying communities with low coverage (<70%) of access and
mobilizing additional resources to create sustainable access to safe drinking water to
households by constructing new small to large scale water schemes, and by making them more
gender-friendly.
Result 3.2. Increased household access to improved latrine and

handwashing facilities
The SD will lift the extremely low access to improved latrine facilities through strong community
mobilization to construct improved, gender-friendly latrines or upgrade existing traditional
latrines at household and communal levels. It will also build on the Community Lab practice from
the SD Innovation Phase to engage communities on designing cost-effective and improved
odorless pit latrines and water-saving handwashing models for rural households, and on how to
finance the scale-up of the model.
Result 3.3. Improved Water, Sanitation, and Hygiene (WASH) practices at
households
The SD will provide TA support to the WASH implementing sectors to develop key SBCC
messages on WASH, integrate the messages into the 1000 Days Public Movement framework,
and assist implementation at scale across all SD woredas. Intensive WASH promotion will also
be implemented using community forums, schools, and public TV/radio mass media platforms.
WASH committees (WASHCO) will also be established and/or trained in selected kebeles to
improve water infrastructure management and promote good WASH practices in SD kebeles.
Table 3: Target for the SD Strategic Objective 3 Outcome - Universal access to safe and clean water, and sanitation and hygiene
services and adoption of improved practices
Target*
Indicator Baseline
2023 2025 2028 2030
Universal access to clean, adequate and safe Not 80% 90% 95% 100%
drinking water by HHs (achieve daily per capita available
water supply in urban areas based on category of
towns –
Level 1: 100 l/c/d;
Level 2: 80 l/c/d;
Level 3: 60 l/c/d;
Level 4: 50 l/c/d;
Level 5: 40 l/c/d; and in rural areas = 25 liter/c/day
within 1 km)
HH access to improved latrine with hand washing 25% 50% 70% 80% 90%
facility
Basic WASH knowledge and practice by HH Not 70% 80% 85% 90%
available
Strategic Objective 4: Enhance schools’ role for improved nutrition practice and
creation of nutrition change agents for the nation
The education sector has strong potential to reduce stunting in several ways. First, the school
can play an important role in providing a supportive environment to promote nutrition education
and practices that support nutrition outcomes, such as hygiene and sanitation practices among
children and adolescents. Students that participate in nutrition activities can influence nutrition
awareness, demand for diet diversity, and hygiene and sanitation practices of their family and
siblings. They can also gain lifelong knowledge and skills they can pass on to their own families
and shape the nutrition practice of future generations. Second, school meals can improve the
nutrition status of children and adolescents from poor families and play a crucial role in
supporting the education of at-risk groups, such as girls. Girls’ education is one of the high
impact nutrition interventions, as maternal education level is one of the strong determinants of
stunting. If linked with local food supply markets, school meals can help to influence the diverse
food production habit of local smallholders, and this, in turn, changes the dietary diversity habit
of the local community. School meals can also serve as a social safety net that helps reduce
household spending on food and frees up income to fulfill the nutrition need of vulnerable family
members (young children, PLWs). Third, school gardens can help students and expand
experience and knowledge to home gardens if they are linked as community demonstration
sites [33].
During the Innovation Phase, the establishment of functional health and nutrition clubs,
WASH and school health nutrition (SHN)-related training to students, the construction of
school latrines, the construction of water supply systems in schools, upgrading of the shed
(das) schools to class, promotion of home grown school feeding programs (HGSFP),
promotion of school gardening and using it to contribute for the HGSFP and to promote
production and consumption of nutrient rich food such as pumpkin were successfully
implemented to enhance schools’ role on improving good nutrition practices both within
school and in the wider community.
The super school of 5 (SSo5) that include weekly lessons, daily filling out of diaries, daily
hand and face washing at the classroom level, and establishing hand and face washing
stations helped to easily and continuously engage students to improve their hygiene
behavior and practices, and encourage their families to do so as well.
In support of this, the SD Expansion and Scale-up Phases will seek to achieve the following
results:
Result 4.1. Enhanced girls’ education
As one of the cost-effective and high-impact interventions that lead to a longstanding reduction
of stunting, the SD Expansion, and Scale-up Phases will implement the following key
interventions at scale to address critical barriers to universal access to girls’ education and their
retention in school.
• Provide technical support to the education sector at federal and regional levels to analyze
the status of girls’ education (enrollment, drop out) across all school levels, and organize
annual forums to jointly discuss and set action plans to identify and address critical
barriers to girls’ education.
• Advocate for sustainable supply of free sanitary and other educational materials for
schoolgirls in areas where girls’ school enrollment is low and dropout rates are high.
• Organize girls’ school enrollment and retention promotion in the wider community using
community champions for girls’ education
• Construct gender-segregated latrine and handwashing facilities, and drinking water for
schools to create a conducive environment for girls in school
• Improve/upgrade all shade class building on the “Dases to classes” innovation phase
initiative to improve access to girl’s education
Result 4.2. Increased number of schools with homegrown school feeding

programs
The SD will strengthen the ongoing homegrown school feeding (HGSF) platform through the
following activities:
• Backup resource mobilization to increase the coverage and ensure the sustainability of
school feeding across food-insecure areas to enhance its contribution to the stunting
reduction.
• Provide TA to develop safety guidelines for HGSF platforms and improve the current HGSF
recipe to better promote diverse crop production by local smallholder farmers and diverse
food habits by students and the local community.
• Building on the Innovation Phase Community Lab Experience, facilitate collaborative

engagement with and effort by the local community and government sectors to jointly set
solutions or actions to overcome barriers to engaging smallholder farmers and schools in
the production and supply of diverse crops to HGSF.
• Support schools through mobilizing resource and technical assistance in designing and
constructing water harvesting structures, and in supplying fruit and vegetable seeds and
seedlings to engage students in school gardening and supply to HGSF, including the
construction of model Ethiopia School Meal Initiative (ESMI) in selected schools.
• Support schools to develop and implement strategic approaches to use school gardens
as demonstration sites for home gardens in areas where fruit and vegetable production is
generally less practiced and/or nutrient-rich vegetables and fruits are not consumed, and
to use school animal husbandry (poultry, cow, goat) as a demonstration model for
households on improved household level poultry and dairy farms.
Result 4.3. Improved student participation in school and family nutrition
promotion activities
The SD will provide mini media material to schools and train school nutrition club leaders and
facilitators on mini media message development and dissemination and overall proper nutrition
promotion to establish and strengthen nutrition clubs for nutrition education and demonstration
sessions for the wider school community. Schools will be supported to develop strategic
approaches and plan to encourage adolescent students to influence the nutrition awareness
and practice of their families, particularly on nutrition for IYC and PLWs.
Result 4.4. Leveraged ongoing nutrition service and promotion efforts in

schools
As a critical intervention to ensure sustained stunting reduction, the SD Expansion and Scale-up
Phases will leverage the education sector’s ongoing efforts to improve student’s nutrition
literacy and access to basic nutrition services:
• Provide training for teachers, education experts, PTA members on nutrition and hygiene,
and sanitation
• Provide TA to the national and regional education sectors on the incorporation of nutrition
topics into the primary and secondary school curriculum
• Provide TA to assess and set actions to strengthen school-based nutrition services, such
as intermittent IFAS, deworming, nutrition screening, and reproductive health services
Table 4: Target for SD Strategic Objective 4 Outcome - Enhance schools’ role for improved nutrition practice and creation of nutrition
change agents for the nation
Target*
Indicator Baseline
2023 2025 2028 2030
Primary education completion rate 68% 75% 80% 90% 95%
for female students (Grade 8)
Schools with clean and safe water Primary School 50% 70% 90% 100% 100%
available 5-7 days per week both Secondary School
for drinking and washing 46%
Schools with improved gender- PS - 29% for improved 70% 90% 100% 100%
sensitive latrine SS -31% for improved
Percentage of adolescent girls Not Available 50% 80% 90% 90%
reported having access to
affordable/free menstrual hygiene
material
Proportion of primary schools Not Available 55% 65% 80% 90%
having school gardening/animal
husbandry as a demonstration site
to the surrounding community
Proportion of primary schools with Not Available 30% 50% 50% 50%
school feeding programs in SD
woredas
evidence synthesis suggested the need to achieve >=70% targets across nutrition-specific, nutrition-sensitive and
infrastructure interventions to meaningfully contribute to the country’s goal to end stunting by 2030.
Social safety net programs play a crucial role to improve food access to poor households
year-round in countries like Ethiopia where household food insecurity is high. There is a strong
association between household food insecurity and stunting in Ethiopia.34 The GoE has launched
the fifth Productive Safety Net Program (PSNP) to reach about nine million people each year
between 2021-2025.
During the Innovation Phase, PLWs and malnourished children in food insecure woredas
benefited from soft conditional PSNP Temporary Direct Support (cash and food) through
strong advocacy. The film was also produced and disseminated using local TV stations to
generate public awareness on the social impact of stunting.
The SD Expansion and Scale-up Phases will seek to achieve the following results:
Result 5.1. Increased coverage of children and PLW that benefit from social
safety net programs
The SD will advocate for planning, resource allocation, and implementation of the social safety
nets package that was poorly implemented under previous PSNPs, such as adding pulses in
conditional cash and food transfer packages to PLW, and fee waivers to all malnourished
children and PSNP households for medical services. Federal and regional level advocacy forums
will be organized with PSNP implementing sectors, NGOs, and funders to facilitate collective
effort and decision to implement these high-impact social safety net package.
The SD will strengthen the ongoing nutrition-sensitive social safety net program by training
Ministry of Labor and Social Affairs (MOLSA) staff on nutrition-sensitive social safety net
programs, and providing TA to MOLSA federal and regional structures to annually analyze the
nutrition sensitivity of the social protection programs, and organize an annual forum to review
and enhance this nutrition sensitivity.
Table 5: Target for SD Strategic Objective 5 Outcome – Increase the resilience of households and communities through social
protection (social safety nets)
Target*
Indicator Baseline
2023 2025 2028 2030
Proportion of PLWs that received conditional Not available 100% 100% 100% 100%
cash and food (including pulse) transfer
Proportion of PSNP HHs enrolled for the fee Not available 100% 100% 100% 100%
waiver for medical services
Proportion of children with acute malnutrition in Not available 100% 100% 100% 100%
PSNP kebele that benefited from fee waiver for
medical services
Strategic Objective 6: Enhance women empowerment, gender equity, and child
protection
Gender inequality is highly associated with child malnutrition and child mortality. Women’s
socio-economic empowerment in terms of access to education, information, media, and
income-generating activities is strongly associated with lower rates of childhood stunting and
wasting, and women’s decision-making power is positively associated with better health status
for children.35 Men’s dietary knowledge strongly contributes to maternal and childhood dietary
diversity.36 Labor and time-saving technologies play an important role in promoting gender
equality and women’s empowerment, which would help women engage in income-generating
activities and agricultural production and improve their nutritional status and that of their
children.
During the Innovation Phase, different advocacy workshops and direct training for women
and youth were organized to address gender-based violence and inequalities and to
strongly promote access to and control over resources for women. Female-headed
households were also supported to have business skills and the financial facility to engage
in income-generating activities (IGAs). Mobile daycare centers were also established in
selected kebeles to allow mothers to engage in PSNP and other tasks outside the home.
The SD Expansion and Scale-up Phases will seek to achieve the following results through
implementing priority activities that facilitate gender equality and female empowerment:
Result 6.1. Improved female decision-making power, and access to and

control over resources
Ethiopia has filled about 71% of the gender disparities in the economic, education, health, and
political environment in 2020 (UN gender gap report). The SD will support the Ministry of
Women, Children, and Youth Affairs (MWCYA) to keep this momentum by enhancing women
empowerment through undertaking the following priority activities:
• Organize regular community-based forums on women access to and control over

resources, decision-making, couple communication, and husbands’ support to achieve
female empowerment
• Facilitate collaborative engagement between MWCYA, MoLSA, and micro and small
enterprise agencies to leverage the ongoing efforts to improve microfinance access to
poor rural women to engage in income-generating activities (IGAs)
• Facilitate collaboration between Job Creation Agency, MOWIE, and MWYCA to leverage
the ongoing efforts to expand the design and marketing of labor-saving technologies for
household work
Result 6.2. Improved social environment for appropriate child and maternal
feeding and caring practices
• Facilitate collaborative engagement between MWCYA and health and city / regional
administration sectors to establish child daycare and early childhood development
centers in SD kebeles
• Support synthesis of evidence available on food taboos and general harmful traditional
practices that affect the psychosocial and health wellbeing, and feeding practices of
children, women, and adolescent girls across different sociocultural contexts, and develop
and disseminate BCC messages through local mass media and community discussion
platforms. Community leaders (including religious leaders, female leaders, role models,
etc.) will be involved with this BCC messaging.
• Develop and disseminate BCC messages through local mass media and community
discussion platforms on food taboos; harmful traditional practices including gender-based
violence; child protection; women empowerment; fathers’ involvement in childcare and
feeding; and husband support for women empowerment
Table 6: Target for SD Strategic Objective 6 Outcome – Enhance women empowerment, gender equity, and child protection
Target*
Indicator Baseline
2023 2025 2028 2030
Proportion of early marriage and genital Not <5% <5% <5% <5%
mutilation in SD woredas available
Proportion of fathers engaging in child Not 70% 75% 80% 85%
feeding and caring role available
Proportion of women having access to Not 70% 75% 80% 85%
and control over resources available
Proportion of HHs having labor saving Not 50% 60% 65% 70%
technology for domestic works available
Proportion of SD kebeles having child Not 5% 20% 60% 70%
day care / ECD centers available
Market accessibility and food prices are important determinants of nutrition security. Food
inflation in Ethiopia is 23% in January 2021 (Trading economics 2021). This indicates that a high
financial burden exists for the poor and those dependent on market purchases for food
consumption. The market for agricultural outputs is also characterized by insufficient transport
networks and infrastructure in Ethiopia. Though the rural infrastructure is generally improving,
still 71% of people in Ethiopia live over 2 km from a marketplace.37
Poor access to all-weather roads and the high challenge of topography created barriers to
taking fish and other agriculture products to market in SD Innovation Phase woredas. The
SD supported the construction of roads to improve market linkages for fish and other
agricultural food products in selected hard-to-reach woredas.
The SD Expansion and Scale-up Phases will work closely with the Ministry of Trade and Industry
and Ministry of Road and Transport to achieve the following result:
Result 7.1. Improved food market value chain system and infrastructure
• Regularly assess the rural road infrastructure, and the overall food market value chain
barriers including their implication for food market accessibility in SD woredas.
• Facilitate the development of solutions to address the critical barriers identified through
the assessment to enhance food market accessibility and stable food market price.
• Advocate for improved market value chain infrastructure for perishable foods and food
products, and overall food market accessibility, and stable food market price
• Provide TA to Ethiopia Food and Drug Authority and Ministry of Trade and Industry for
development of standardization, regulation, and improved cold chain infrastructure for
transportation and storage of perishable foods
• Facilitate financing facility for medium- to large-scale groups or individual actors across
the perishable food value chain
• Construct roads to very hard-to-reach rural kebeles to improve market access and linkage
Table 7: Target for SD Strategic Objective 7 Outcome – Enhance market accessibility and affordability of foods
Target*
Indicator Baseline
2023 2025 2028 2030
Proportion of SD kebeles with all-weather road Not 70% 75% 80% 100%
available
Proportion of SD woredas with measures in Not 70% 75% 80% 100%
place to improve market value chains for available
perishable food
and coordination of multisectoral stunting reduction efforts
Strong nutrition governance is associated with reduced stunting, wasting, and underweight
prevalence.38 The GoE demonstrates strong political will and commitment to create an enabling
environment to mobilize and sustain multisectoral nutrition actions to reduce undernutrition.
This commitment is currently driven by the National Food and Nutrition Policy (2018), the
Seqota Declaration (2015-2030), and the Food and Nutrition Strategy (2021-2030), and the
establishment of the Food and Nutrition Council / Agency. Nutrition is also embedded in various
sectoral strategies and the national economic development plan. Despite these positive
developments, inefficiencies in multisector coordination, human resources, sustainable
financing, and monitoring and evaluation for nutrition limit the success and impact of
multisectoral nutrition governance in Ethiopia (IDS 2020).
During the Innovation Phase, the SD successfully demonstrated the following key
innovations promising to streamline the multisectoral nutrition governance and coordination
issues in Ethiopia. (See Annex 2 for a brief description of all six Innovation Phase
innovations.)
1. Established a two-tiered PDU (federal and regional) to address limited horizontal

ministerial-level inter-sectoral nutrition coordination mechanisms in support of the SD
delivery with core functions across strategic management, monitoring and improving
performance, managing the politics of policies, communicating results, and improving
accountability.
2. “Data revolution” in nutrition as one of the SD innovations was implemented using

web-based and manual KPI system to improve data availability essential to design and
implement effective, evidence-based policies and programs, mobilize resources and
monitor progress.
3. A Costed Woreda-based Plan (Costed-One-Plan) as a bottom-up planning process

and output that consolidates a list of nutrition-sensitive and nutrition-specific
activities across SD implementing sectors and development partners at the woreda
level, including the resources needed was one of the six innovations that was
implemented at scale across all the SD Innovation Phase woredas.
4. A Community Lab approach was implemented during the SD Innovation Phase as a

collaborative mechanism that brings together woreda and kebele-level stakeholders
to jointly identify, prioritize and address complex and multidimensional
nutrition-related problems in a community.
5. A 1000 days plus public movement framework was designed and used as an
innovative tool to drive cross-cutting SBCC activities at all levels
The SD will seek to ensure the following multisectoral nutrition governance aspects are
achieved to facilitate an enabling ecosystem for multisectoral nutrition interventions in
coordination, financing, and monitoring and evaluation.
Result 8.1. Increased political commitment and leadership for stunting
reduction
During the SD Innovation Phase, the PDU successfully onboarded political leaders to the nutrition
agenda and increased their support. The PDU facilitated various advocacy meetings with senior
political leaders, including the deputy prime minister, regional presidents in Amhara and Tigray, and
the minister and state ministers of SD implementing sectors. As a result, the federal government
allocated an earmarked budget for SD Innovation Phase implementation. Sector ministers and state
ministers visited the SD implementation sites. Increased demand for regular status updates on SD
implementation from the deputy prime minister, regional presidents, and sector ministers and state
ministers. These helped nutrition become a priority agenda at the regional administration level.
The political commitment created at the federal and regional levels in Amhara and Tigray during
the SD Innovation Phase to implement and support key nutrition actions to end stunting will be
cultivated and expanded in the SD Expansion and Scale-up Phases. An evidence-informed
advocacy strategy will be used to motivate critical government leaders to support enhanced
accountability, responsiveness, and commitment to finance, deliver, and measure SD progress
and impact. Existing nutrition leadership networks, nutrition professional associations, and
nutrition researchers will be strengthened to enable them to play a key role in catalyzing the effort
to create a shared vision among government administrative and donor leaders to end stunting
among children under two by 2030 in Ethiopia. Training will also be provided to nutrition leaders
across different sectors and levels to improve their leadership and communication skills to plan
and effectively communicate nutrition actions to decision-makers in their sphere of influence.
Result 8.2. Strengthened multisectoral coordination at all levels
Intersectoral and vertical coordination between the different administrative levels plays an
important role in expanding and scaling up the proper planning, implementation, and delivery of
nutrition activities.
During the SD Innovation Phase, the federal and regional PDUs facilitated easy and effective
interaction between the SD implementing sectors and development partners and ensured regular
joint planning for better alignment. It provided an excellent platform to effectively manage and build
technical capacity on multisectoral nutrition intervention delivery, planning, review, monitoring,
evaluation, and reporting process of the SD Innovation Phase activities and budget. It demonstrated
responsibility for the SD performance and ensured shared accountability across implementing
sectors through a scorecard-based joint sectoral performance review and rating, and regularly
tracking and sharing implementation outputs with implementing sectors. The PDU also improved the
delivery capacity and multisectoral coordination at the district level by deploying a coordinator in
each SD woreda.
The PDU played a key resource mobilization role for the SD Innovation Phase by cultivating interest
and commitment from regional government and development partners.
The PDU provided technical assistance mechanisms to key implementing sectors on sector-specific
nutrition-smart interventions through its high profile and experienced technical advisors.
The SD Expansion and Scale-up Phases will implement the following activities to strengthen
multisectoral coordination at all levels:
• Strengthen the newly established FNCOs across all regions by enhancing their capability
to play a lead role to coordinate and manage the SD Expansion and Scale-up Phase
activities. This support will be provided through coaching and targeted face-to-face
training support, allocation of adequate budget to cover costs of coordination and office
management, adequately staffing the coordination office, and developing a clearer
operational definition and standard operational procedure for key functions of the
coordination office.
• Continuity of the current federal PDU will be a great opportunity that would largely benefit
the effort to strengthen the newly established coordination offices across different
regions, and it would lead to the capacity building, codification, and institutionalization of
the standard operational procedure for key functions of the new coordination offices. The
scope, structure, and role of the current federal PDU will be redefined and aligned with
the increased need during the Expansion Phase due to the expanded geography of the
SD and the newly established coordination offices. Communication and the operational
relationship between the federal PDU and the newly established FNCOs will also be
clearly defined to facilitate easy and constructive engagement. Similarly, the regional PDU
in Amhara and Tigray will be strengthened through the deployment of additional staff, and
logistical and financial support to enable them to play a coordination role in the two regions.
• A clear transition strategy for the current federal PDU will be developed to transition its
role or to make it operate under the new government-financed Food and Nutrition
Agency/Council with an optimized structure and role to align with the mandate and
priorities of the new agency/council. For the same reason, there will also be a clear
transition plan for the regional PDU in Amhara and Tigray to transition its financing source
and management fully to the government.
• Deployment and capacity building of the woreda food and nutrition coordinators will be
strongly facilitated in the SD Expansion and Scale-up Phase to enable them to play a lead
role in the coordination, planning, monitoring, and reporting of multisectoral nutrition
response activities at the woreda and kebele levels, and to catalyze the vertical
coordination between woreda and regions.
Result 8.3. Strengthened human resource capacity for nutrition at all levels
The SD will leverage the ongoing advocacy effort for career structure development and deploy
nutrition experts for nutrition-sensitive implementing sectors at all levels (federal, region, zone,
and woreda level) to overcome the current barrier of the insufficient workforce for proper and
timely planning, implementation, and monitoring of sectoral nutrition interventions.
Result 8.4. Expanded and strengthened costed woreda-based planning.
The SD designed and implemented costed woreda-based plans (CWP) in all Innovation Phase
woredas to ensure sector priorities and implementation timelines for nutrition activities are
aligned, and increase sector accountability to plan, finance, and implement nutrition activities.
It generally helped to improve cross-sectoral coordination and complementarities between
programs, reduce effort duplication across sectors, and build the ability to better plan
activities by using the CWPs to identify required activities and resources. The CWP was used
also to influence development partners to plan their activities and resources by woreda. The
effort was further supported with woreda-based nutrition resource tracking to estimate
resources available both at the federal and regional levels for the SD Innovation Phase against
the CWP for each woreda and the costed overall SD investment plan for the Innovation Phase.
The costed woreda-based planning (CWP) from the SD Innovation Phase will continue serving
as a tool to successfully cultivate cross-sectoral coordination and alignment for nutrition
activities and to increase awareness and accountability among implementing sectors on
nutrition activities and the resources required to implement them.
In the SD Expansion and Scale-up Phases, the following activities will be implemented across all
SD woredas:
• Standard Operating Procedures (SOPs) on CWP will be developed to guide the CWP
process, tools, stakeholders’ roles, and how to use the CWP to coordinate efforts,
timelines, and activities across implementing sectors. Training will be organized for
nutrition staff and woreda coordinators on the SOPs.
• The implementation of the CWP will be supported with expanded annual resource
mapping initiated during the SD Innovation Phase to regularly map and analyze available
nutrition resources and use the information for adequate resource mobilization efforts. This
resource mapping process will also be aligned to the annual government budget schedule
for better efficiency to facilitate adequate budget allocation by the government at all levels.
• In collaboration with the Ministry of Finance, implementing sector capacity will be

supported and held accountable at all levels to ensure nutrition is included as one of the
core budget line items in the sector’s annual budget request, and to properly utilize the
allocated nutrition budget.
• In collaboration with the Ministry of Finance, an annual partnership forum will be

organized to mobilize nutrition resources from bilateral and multilateral donors.
• Community platforms, such as Community Labs, will be used to promote local resource
mobilization to scale up some of the local nutrition solutions.
Result 8.5. Expanded and strengthened data revolution at all levels
The SD Innovation Phase’s “Data Revolution” seeks to drive a culture of data use for
decision-making by establishing a robust data management system to collect, analyze, and use
real-time high-quality multisectoral nutrition information; this will help to accelerate actions and
decisions for stunting reduction.
The SD established key performance indicators (KPIs) and targets for the SD Innovation
Phase for each implementing sector, which helped to standardize performance
measurement and communicate performance expectations with key stakeholders at
federal, regional, woreda, and kebele levels. The SD used scorecards at the regional level
quarterly review meetings and at the federal level bi-annual review meetings, to review and
rate the KPI status and the SD strategic initiatives implementation progress by all
implementing sectors.
In collaboration with UNICEF and the Ethiopian Public Health Institute (EPHI), the SD team
successfully piloted a Unified Nutrition Information System for Ethiopia (UNISE) data
management and sharing system in nine selected SD woredas. UNISE was designed by
UNICEF and FMOH to provide a web-based platform to track, analyze, and use multisectoral
nutrition data at all administrative levels, and integrate it into the DHIS-2 system. Key
nutrition-sensitive and nutrition-specific UNISE indicators for six priority SD implementing
sectors (Health; Agriculture; Women, Youth, and Children Affairs; Labor and Social Affairs;
Water, Irrigation, and Energy; and Education) were defined. The UNISE user guide was
developed and the system was installed into the woreda, zone, region, and federal system
of these six sectors. Adequate training on the use of the system was provided to staff of the
six implementing sectors at all levels to enter input data and track progress. The system has
data visualization features for easy tracking and interpretation of nutrition data. The pilot
phase was successful as key partners and sectors at all levels of government were able to
use the outputs of the data collection.
Yazmi technology (a smartphone-based tool that operates through satellite connection)

was also installed in health facilities in seven SD woredas to help collect and report
real-time multisectoral nutrition data from the community level. The system is connected to
the UNISE system, and training was provided to installers. Once fully functional, it will
replace the current paper-based nutrition data reporting from kebele to woreda.
The SD Expansion and Scale-up Phases will particularly undertake the following priority Data
Revolution activities:
• High priority will be given to strategically address the critically poor data use culture and
data practice observed during the SD Innovation Phase to ensure data are demanded,
analyzed, and used for decision-making at all levels. A comprehensive operational
guideline that guides implementing sectors on what data needs to be collected and
reported, the process and frequency to do so, the level of analysis required at all levels,
and who should use them will be developed, and include a mechanism to ensure quality
data. Relatedly, there will be capacity-building training for implementing sectors at all
levels on data analysis and visualization tools.
The web-based UNISE and Yazmi data systems piloted during the SD Innovation Phase will
be expanded to the SD Expansion and Scale-up Phase woredas to ensure real-time
nutrition data reporting, analysis, and use at all levels to adjust program plans and the
course of program implementation in a timely way. The SD will continue mobilizing
adequate resources for the installation of the UNISE and Yazmi technologies and create
the right capacity building needed to run the system through targeted training and
coaching support to nutrition experts and frontline workers.
Until the UNISE and Yazmi technology fully roll out, the SD will expand the practice of using
KPI-based scorecards to track, review, and improve multisectoral nutrition performances at
all levels.
A fully dedicated monitoring and evaluation expert will be deployed at regional food and
nutrition coordination offices or PDUs to lead the Data Revolution during the SD Expansion
Phase. The capacity of woreda coordinators will also be built through training and coaching
support from regional coordination offices and PDUs to enable them to play a lead role in
coordinating timely data collection, analysis, visualizations, sharing and using data for
decision-making in SD expansion woredas.
Collaborative performance review and adapting: PDUs, coordination offices, and woreda
coordinators will organize a regular review meeting to bring together relevant stakeholders
at federal, regional, and woreda levels to review performance, identify critical operational
challenges, set collective solutions, and adapt implementation.
Baseline and Evaluation: To enhance accountability and measure the progress and impact
of the SD Expansion and Scale-up Phases, a baseline and final evaluation will be
conducted during both phases. Less expensive, technically, and operationally feasible
outcome tracking survey methods will be designed and implemented in collaboration with
regional universities in addition to the baseline and end line evaluations.
Result 8.6. Improved coordination of key cross-cutting nutrition activities
During the SD Innovation Phase, the multisectoral coordination and resource mobilization at
the woreda and community level were facilitated through a Community Lab innovation
(described briefly in Annex 2 of this report, and more detail in the Evidence Synthesis
Report). The two approaches of the Community Lab, namely, the Learning Journey and
Open Day were implemented in some of the SD woredas which helped to bring together
woreda and kebele-level stakeholders to collaboratively engage to identify and prioritize
complex and multidimensional nutrition-related problems in a community and identify, test,
and replicate potential solutions to overcome them. Community Lab processes led to strong
coordination between the different community-level agents across sectors.
The First 1000 Days Plus Public Movement as SBCC and coordination innovation tool was
designed and implemented to build synergy, commitment, and a sense of shared mission
amongst the many organizations and people who in different ways can influence child,
mother, and adolescent nutrition because of their professional roles or positions of
authority. The First 1000 Days Plus Public movement mainstreaming framework was
developed to coordinate the multisectoral SBCC activities at all levels.
The SD Expansion and Scale-up Phases will undertake the following activities to properly
coordinate cross-cutting SBCC activities, facilitate the expansion of cross-sectoral
innovation/model infrastructures, and support collaborative stakeholder engagement for
local-level solutions, resource-mobilization, and coordination efforts for multidimensional
nutrition problems.
In addition to its benefit as a tool to drive identification, prototyping, and designing, and
scaling up community-level solutions or innovations (proposed across different strategic
objectives above), the Community Lab will be used to facilitate and strengthen
multisectoral stakeholder engagement and coordination to collaboratively work on
identifying and addressing critical operational, performance, technical, financial, and
alignment issues of nutrition interventions at woreda and kebele level.
Implement the First 1000 Days Plus Public Movement for SBCC framework to facilitate and
coordinate multisectoral coordination on cross-cutting SBCC activities
Facilitate a learning forum and visits to expand the adoption of model nutrition-sensitive
infrastructure or innovative interventions
Table 8: Target for SD Strategic Objective 8 Outcome – Foster an enabling environment for strong governance and coordination of
multisectoral stunting reduction efforts
Target*
Indicators Baseline
2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Annual budget Not <10% <10% <10% <10% <10% <10% <10% <10% <10% <10%
deficit for the SD available
Expansion and
Scale-up Phases
Proportion of Not 70% 75% 80% 90% 90% 90% 90% 90% 90% 90%
woredas with available
annual score card
rated above 80%
for governance
related KPI
woredas assigned appropriate
with woreda
coordinators
activities in CWP appropriate
implemented by
the end of the
fiscal year
7. Governance and Coordination
for the SD Expansion and Scale-up Phases
The federal PDU, in collaboration with the SD implementing sectors, will facilitate proper
governance of the SD at the federal level in close collaboration with the nutrition unit across SD
implementing sectors until its role is transitioned to the Food and Nutrition Council/Agency. The
federal PDU will support and work closely with the regional PDUs and FNCOs to facilitate vertical
coordination between federal and regional actors. Once established, the Food and Nutrition
Council/Agency will take over the responsibility of SD governance.
Regional PDUs and FNCOs that are responsible for the regional administration offices are
responsible for the governance of the SD at the regional level. They will support and work closely
with the woreda coordinators based at the woreda administration offices to facilitate vertical
coordination between region and woredas, and to facilitate proper governance of the SD at the
woreda level.
A. Coordination and governance
Federal Level: Currently the government is preparing to establish the National Food and
Nutrition Council/Agency. The Proclamation for the establishment of the Agency is currently
submitted for Cabinet of the Ministers office for approval. The Agency will be primarily
responsible for technical and administrative leadership of the regional food and nutrition
coordination offices where the expansion phase will be implemented. The Food and Nutrition
Coordination Council/Agency will be responsible for mobilizing resources, managing the
multisectoral coordination, implementation of the SD Innovation and Expansion Phase
interventions, and management of resources allocated by the federal and regional governments
and other development partners for the operationalization of the Seqota Declaration and
reduction of stunting.
Until the Food and Nutrition Council/Agency is fully functional, F-PDU will continue to
collaborate closely with and support the Nutrition Case Team at FMOH to support the
national-level coordination for the SD Expansion Phase.
The Seqota Declaration Federal and Regional Program Delivery Units (PDUs) will be part of
the technical arm of the Food and Nutrition Council/Agency and provide technical and advisory
support for the implementation of the expansion phase. It will remain responsible for the
finalization of Innovation Phase implementation. Provide technical support to the Seqota
Declaration Expansion Phase for the new council / Agency, and coordinate and provide
leadership to the Expansion Phase woredas in Amhara and Tigray National Regional States.
The High-Level Seqota Declaration Leadership Forum led by H.E. Deputy Prime Minister has
been and will be responsible for providing overall leadership and strategic guidance for both
Innovation and Expansion Phases. The Ministry of Health will provide day-to-day technical
leadership for the Inter-Ministerial Steering Committee. The steering committee will transition
into the Food and Nutrition Council/Agency when the Food and Nutrition Proclamation is
approved. Currently, the members of the Steering Committee are Ministries of Agriculture;
Water, Irrigation and Energy; Education; Women, Youth, and Children; Labour and Social Affairs;
Transport; Finance; Planning Commission; and Commission for Environment, Forestry, and
Climate Change. It is expected that the Steering Committee will meet quarterly.
At the regional level, the Expansion Phase will be coordinated through the FNCOs in the regions
while the regional coordination body led by H.Es the Regional Presidents will provide overall
leadership.
The PDUs in Amhara and Tigray regions and FNCOs in other regions will primarily be responsible
for the following:
Introduce the concept of Deliverology and set performance targets
Establish and lead a multisectoral and multi-disciplinary technical working group
Engage with high-level leaders to ensure ownership of the program, provide leadership and
review the performance targets regularly
Mobilize zonal and woreda leadership using the influence of the Regional President
Work with Zonal and Woreda Administrators to assign dedicated staff or focal persons who
will be accountable and responsible to the Woreda Administrators for coordinating activities
at the zonal and woreda level
Provide guidance for zonal- and woreda-level focal persons
Support woredas to develop multisectoral and multistakeholder CWPs aligned with the
National Food and Nutrition Strategy
Lead the woreda level baseline study and set performance targets for the duration of the
Expansion Phase
Provide technical and financial leadership and mentorship to zonal- and woreda-level
coordinators to make sure that their coordination platforms are fully functional
Work with the development partners to mobilize resources
Facilitate expansion of locally relevant innovations that were tested during the innovation
phase
At the zonal and woreda level, the Zonal and Woreda Administrators will be responsible for
providing leadership while dedicated staff or focal persons will be responsible for the day-to-day
coordination of the multisectoral planning, reporting, and performance management.
B. Financing the SD Expansion and Scale-up Phases
The Expansion Phase woredas are primarily financed by the government. Both federal and
regional governments will contribute their part to the successful implementation of the Expansion
Phase investment plan. Moreover, resources will be mobilized from the development partners,
financial institutes, and donors to complement the government commitment. The community will
also contribute resources that are available locally, including labor and locally available resources,
through the community lab platform.
For the first 200 new woredas, the regional government will lead the entire process and allocate
resources similar to the Innovation Phase for effective implementation and generation of learning,
while the federal government will provide technical and capacity-building support to regions and
city administrations. When the expansion is conducted in additional woredas, the regions will be
able to have the required capacity to provide leadership in resource mobilization and
implementation, while the federal government will provide support for the 1:1 match to ensure that
the regions be able to reach the target woredas in the Expansion Phase to fully implement the SD
intervention package.
8. The SD Expansion and Scale-up
Phases Estimated Investment Cost
The SD Expansion and Scale-Up Phases, as outlined in the Roadmap, were costed by applying
an ingredient-based costing approach, but within a results-based framework, from the
perspective of the different implementing sectors. To provide the detail required for the costing,
the PDU and sectoral teams developed their specific Strategic Objective work plans into result
areas, as well as the activities required to achieve these results. They then indicated their
targeted annual coverage rates for each activity, as well as the details of how the activities
would be implemented (ingredients, frequencies, quantities). The sectoral teams also collated
the relevant prices of ingredients (in 2021 Ethiopian Birr (ETB)), as far as possible, and the
costing team further developed the unit costs as required. This ensured the sectoral
implementation plans were designed within a results-based framework, by the sectoral teams
with their full ownership of, and buy-in to, their results and activities. The detailed sectoral
costed work plans provide detail of their detailed ingredients and prices, and their summarised
estimated costs of implementation are presented below according to the Strategic Objectives
(Figure 3 and Tables 9.a&b) and the Result Areas (Figure 4 and Tables 10.a&b). The costs are
presented in nominal Ethiopian Birr (2021 ETB prices), for GoE’s planning purposes i and were not
inflated for future years.
Figure 3: The estimated annual costs of the SD, per Strategic Objective (2021-2030, ETB billions)
i
In Table 10, the total annual amounts were converted to USD using the National Bank of Ethiopia’s weighted average for 2020 (Jan-Dec): 31.82.
Table 9.a.: The estimated annual costs of the SD, per Strategic Objective (Expansion Phase: 2021-2025, ETB)
EXPANSION PHASE COSTS (ETB)

Strategic Objective Total Expansion
YR1 YR2 YR3 YR4 YR5
Phase costs (ETB)
Improve access to diverse,

Strategic
adequate, nutrient rich and
Objective 1 3,823,219,900 10,857,386,789 8,898,419,303 15,578,774,642 15,352,251,542 54,510,052,176
Improve maternal, child and
Strategic
adolescent feeding and
Objective 2 97,528,304 87,552,604 239,730,844 339,824,987 319,405,787 1,084,042,526
Universal access to safe and
clean water, sanitation and
Strategic
hygiene services, and
Objective 3 1,123,211,520 2,336,817,060 3,284,424,998 3,284,424,998 1,729,924,290 11,758,802,866
adoption of improved
practices
Enhance schools’ role for
Strategic improved nutrition practice
Objective 4 and creation of nutrition 908,216,564 944,017,834 1,665,816,041 1,768,979,430 1,016,714,773 6,303,744,642
Increase the resilience of
Strategic households and communities
15,136,756
Objective 5 through social protection 15,136,756 24,169,216 12,327,195 2,700,000 69,469,922
(social safety nets)
Enhance women
Strategic
empowerment, gender equity
Objective 6 185,017,572 478,904,692 804,883,992 804,327,192 1,054,327,192 3,327,460,639
and child protection
Strategic Enhance market accessibility
Objective 7 and affordability of foods 26,150,000 76,665,936 183,968,895 178,118,895 178,118,895 643,022,623
Fostering an enabling
environment for strong
Strategic
governance and coordination
Objective 8 627,007,659 1,119,864,366 2,318,800,179 1,908,324,552 1,056,200,919 7,013,817,674
of multi-sectoral stunting
reduction efforts
Total SD costs (ETB) 6,805,488,274 15,916,346,037 17,420,213,468 23,875,101,890 20,709,643,397 84,710,413,067
Total SD costs (USD) (Ex.Rate USD:ETB =

$ 213,885,308 $ 500,224,588 $ 547,488,669 $ 750,355,200 $ 650,870,044 $ 2,662,309,012
31.82)
The costs to achieve the SD strategic objectives may increase from around ETB 6.8 billion (USD 214 millioni) in the first year, reaching their
maximum level in the fourth year (2024) at ETB 23.9 billion (USD 750 million), which would equate to around 5.8% of the 2021/22 total GoE
budget.ii Thereafter, the total resource need declines to ETB 20.7 billion (USD 651 million) in the fifth year (2025) of the Expansion Phase, still
representing a significant share of the total GoE budget.
i National Bank of Ethiopia’s weighted average exchange rate for 2020 (Jan-Dec): 31.82. This rate was applied to all future years, although by mid-2021, it had increased to 46ETB = 1USD.
ii
Ethiopian Council of Ministers approved an 18% increase in the total government budget reaching ETB 561.7 billion (USD 12.9 billion) for 2021/22 (June, 2021):
https://www.reuters.com/article/ethiopia-budget-idUSL5N2NN05Y
In the Scale-Up Phase, the annual costs hover around ETB 12 billion (almost USD 400 million), dropping to ETB 12.2 billion (USD 383 million)
by the tenth year. Over the entire period, the largest share of resources (58%) will be needed for Strategic Objective 1, implemented by the
agricultural sector, followed by 12% for the water and sanitation sector. Strategic Objective 2 (health sectoral interventions) will need 10% and
appears to have low costs in the Expansion Phase which then increases in the Scale-Up Phase.
The estimated costs of the Scale-Up Phase (2026-203) are presented in Table 10.b. below.
Table 9.b.: The estimated annual costs of the SD, per Strategic Objective (Scale-Up Phase: 2026-2030, ETB)
SCALE-UP PHASE COSTS (ETB)

Strategic Objective Total Scale-Up
YR6 YR7 YR8 YR9 YR10
Costs (ETB)
Improve access to diverse,
Strategic
adequate, nutrient rich and 5,033,837,220 5,826,721,339 6,299,185,236 6,747,051,339 6,710,227,589 30,617,022,724
Objective 1
Improve maternal, child and
Strategic
adolescent feeding and 2,279,043,965 2,200,354,532 3,034,013,038 3,034,013,038 3,034,013,038 13,581,437,610
Objective 2
Universal access to safe and
clean water, sanitation and 1,321,194,210 1,323,171,660 1,429,924,290 994,837,280 590,242,100 5,659,369,541
Strategic
hygiene services, and
Objective 3
adoption of improved
practices
Enhance schools’ role for
Strategic improved nutrition practice 1,012,283,730 576,529,380 398,380,794 750,927,117 761,137,902 3,499,258,923
Objective 4 and creation of nutrition
Increase the resilience of
Strategic households and communities 15,136,756 21,911,101 10,025,791 2,700,000 2,700,000 52,473,647
Objective 5 through social protection
(social safety nets)
Enhance women
Strategic
empowerment, gender 601,438,242 837,931,442 337,931,442 337,931,442 337,931,442 2,453,164,009
Objective 6
equity and child protection
Strategic Enhance market accessibility
Objective 7 and affordability of foods 113,316,291 101,528,395 107,378,395 101,528,395 101,528,395 525,279,872
Fostering an enabling
environment for strong 1,509,027,414 1,258,302,777 610,131,999 605,648,773 636,958,868 4,620,069,832
Strategic governance and
Objective 8 coordination of multi-
sectoral stunting reduction
efforts
Total SD costs (ETB) 11,885,277,828 12,146,450,626 12,226,970,985 12,574,637,384 12,174,739,335 61,008,076,158
Total SD costs (USD) (Ex.Rate USD:ETB = $ 373,534,742 $ 381,742,973 $ 384,273,596 $ 395,200,179 $ 382,632,041 $ 1,917,383,531
31.82)
The estimated costs to achieve each Result Area for the SD strategic objectives are presented below, Figure 4 and Tables 10.a&b below.
Figure 4: The estimated annual costs of the SD, per Result Area (2021-2030, ETB billions)
The details of each activity required to achieve these result areas are provided in the
sectoral-specific costed work plans, with every activity or sub-activity broken into its
ingredients, annual targets, unit costs, and annual prices. Fluctuations in the annual costs are
due to changing targets and numbers of woredas to be covered, as determined by the sectors
for every intervention. Result Area 1.1 costs increase in the Expansion Phase and then decline in
the Scale-Up Phase. Result Area 2.2 has no estimated costs in the Expansion Phase and then
increases in the Scale-Up Phase. Please refer to the costed sectoral work plans for further
details.
Table 10.a.: Annual SD costs per Result Area (Expansion Phase: 2021-2025, ETB)
EXPANSION PHASE COSTS (ETB)

Strategic Objective and their Result Areas Total Expansion
YR1 YR2 YR3 YR4 YR5
Phase costs (ETB)
Strategic Improve access to diverse, adequate, nutrient rich and
3,823,219,900 10,857,386,789 8,898,419,303 15,578,774,642 15,352,251,542 54,510,052,176
Objective 1 safe food all year round
Improved production of diverse nutrient rich food all
Result 1.1 3,039,103,120 8,158,945,904 6,782,846,832 11,935,565,616 11,933,225,616 41,849,687,090
year round
Result 1.2 Improved food safety practices - - - -
- -
Improved post harvest management practices of
Result 1.3 779,868,800 2,278,348,800 1,569,947,200 3,037,798,400 3,088,846,400 10,754,809,600
households
Enhanced capacity of agriculture sector staff and
Result 1.4 farmers/pastoralist training centers on nutrition 808,975 241,989,600 229,989,600 244,984,400 107,497,400 825,269,975
sensitive agriculture
Improved consumption of diversified and nutrient rich
Result 1.5 474,000 175,137,479 312,670,666 357,461,220 219,717,120 1,065,460,485
foods
Strengthened advocacy for nutrition sensitivity of
Result 1.6 2,965,005 2,965,005 2,965,005 2,965,005 2,965,005 14,825,027
Strategic Improve maternal, child and adolescent feeding and
97,528,304 87,552,604 239,730,844 339,824,987 319,405,787 1,084,042,526
Objective 2 health care practices
Improved feeding practices of infant and young
Result 2.1 75,284,863 55,256,398 202,087,039 146,367,160 146,367,160 625,362,619
children, and pregnant and lactating mothers
Enhanced essential nutrition services in under five
Result 2.2 9,068,836 19,121,601 4,050,000 170,073,621 170,073,621 372,387,680
children and pregnant women
Strengthened capacity of primary health care / health
Result 2.3 10,209,600 10,209,600 30,628,800 20,419,200 - 71,467,200
extension program on nutrition services
Strengthened advocacy and support for improved
Result 2.4 coverage of routine high impact large scale health 2,965,005 2,965,005 2,965,005 2,965,005 2,965,005 14,825,027
sector interventions
Universal access to safe and clean water, sanitation
Strategic
and hygiene services, and adoption of improved 1,123,211,520 2,336,817,060 3,284,424,998 3,284,424,998 1,729,924,290 11,758,802,866
Objective 3
practices
Increased access to improved clean and safe water
Result 3.1 833,087,010 833,087,010 1,569,767,558 1,569,767,558 833,087,010 5,638,796,146
source by households
Increased access to improved latrine and handwashing
Result 3.2 202,297,590 1,416,083,130 1,618,380,720 1,618,380,720 809,190,360 5,664,332,520
facilities by households
Improved awareness on personal hygiene, household,
Result 3.3 87,826,920 87,646,920 96,276,720 96,276,720 87,646,920 455,674,200
and environmental sanitation
Strategic Enhance schools’ role for improved nutrition practice
908,216,564 944,017,834 1,665,816,041 1,768,979,430 1,016,714,773 6,303,744,642
Objective 4 and creation of nutrition change agents for the nation
Result 4.1 Enhanced girl's education 784,974,502 800,350,102 1,339,807,518 1,528,834,527 989,377,111 5,443,343,761
Increased number of schools with home grown school
Result 4.2 16,550,005 25,850,005 16,550,005 16,550,005 16,550,005 92,050,027
feeding programs
Improved student participation in school and family
Result 4.3 76,702,456 76,702,456 219,319,712 153,404,912 10,787,656 536,917,193
nutrition promotion activities
Leveraged ongoing nutrition service and promotion
Result 4.4 29,989,600 41,115,271 90,138,806 70,189,986 - 231,433,662
efforts in schools
Increase the resilience of households and
Strategic
communities through social protection (social safety 15,136,756 15,136,756 24,169,216 12,327,195 2,700,000 69,469,922
Objective 5
nets)
Increased coverage of children and pregnant and
Result 5.1 lactating women that benefit from social safety net 15,136,756 15,136,756 24,169,216 12,327,195 2,700,000 69,469,922
programs
Strategic Enhance women empowerment, gender equity and
185,017,572 478,904,692 804,883,992 804,327,192 1,054,327,192 3,327,460,639
Objective 6 child protection
Improved female decision-making power, and access to
Result 6.1 130,754,676 130,754,676 418,414,676 418,414,676 418,414,676 1,516,753,382
and control over resources
Improved social environment for the appropriate child
Result 6.2 635,912,515 1,810,707,257
and maternal feeding and caring practice 54,262,895 348,150,015 386,469,315 385,912,515
Strategic Enhance market accessibility and affordability of
26,150,000 76,665,936 183,968,895 178,118,895 178,118,895 643,022,623
Objective 7 foods
Improved food market value chain system and
Result 7.1 178,118,895 643,022,623
infrastructure 26,150,000 76,665,936 183,968,895 178,118,895
Fostering an enabling environment for strong
Strategic
governance and coordination of multi-sectoral 627,007,659 1,119,864,366 2,318,800,179 1,908,324,552 1,056,200,919 7,013,817,674
Objective 8
stunting reduction efforts
Increased political commitment and leadership for
Result 8.1 4,572,743 3,137,033 4,865,553 3,802,653 3,137,033 19,515,013
stunting reduction
Strengthened multisectoral nutrition response
Result 8.2 146,286,412 148,432,748 316,966,698 327,618,948 327,618,948 1,266,923,756
coordination at all levels
Strengthened human resource capacity for nutrition at
Result 8.3 1,569,225 65,469,225 213,900,000 213,900,000 213,900,000 708,738,450
all levels
Expanded and strengthened costed woreda-based
Result 8.4 26,757,353 21,403,783 48,146,443 40,628,933 38,380,228 175,316,739
planning
Result 8.5 Expanded and strengthened data revolution at all levels 441,961,293 870,587,785 1,729,060,852 1,311,540,226 467,304,077 4,804,074,233
Improved coordination of key cross cutting nutrition
Result 8.6 5,860,633 10,833,793 5,860,633 10,833,793 5,860,633 39,249,483
activities
Total Seqota Declaration costs (ETB) 6,805,488,274 15,916,346,037 17,420,213,468 23,875,101,890 20,709,643,397 84,710,413,067
Total Seqota Declaration costs (USD) $ 213,885,308 $ 500,224,588 $ 547,488,669 $ 750,355,200 $ 650,870,044 $ 2,662,309,012
Table 10.b.: Annual SD costs per Result Area (Scale-Up Phase: 2026-2030, ETB)
SCALE-UP PHASE COSTS (ETB)

Strategic Objective and their Result Areas Total Scale-Up
Costs (ETB)
Strategic Improve access to diverse, adequate, nutrient rich and
5,033,837,220 5,826,721,339 6,299,185,236 6,747,051,339 6,710,227,589 30,617,022,724
Objective 1 safe food all year round
Improved production of diverse nutrient rich food all
Result 1.1 3,828,371,955 4,519,400,274 4,958,130,570 5,441,730,274 5,441,730,274 24,189,363,347
year round
Result 1.2 Improved food safety practices - - - -
- -
Improved post harvest management practices of
Result 1.3 1,098,963,040 1,063,229,440 1,098,963,040 1,063,229,440 1,098,963,040 5,423,348,000
households
Enhanced capacity of agriculture sector staff and
Result 1.4 farmers/pastoralist training centers on nutrition 23,246,100 114,994,800 114,994,800 114,994,800 64,994,800 433,225,300
sensitive agriculture
Improved consumption of diversified and nutrient rich
Result 1.5 80,291,120 126,131,820 124,131,820 124,131,820 101,574,470 556,261,050
foods
Strengthened advocacy for nutrition sensitivity of
Result 1.6 2,965,005 2,965,005 2,965,005 2,965,005 2,965,005 14,825,027
Strategic Improve maternal, child and adolescent feeding and
2,279,043,965 2,200,354,532 3,034,013,038 3,034,013,038 3,034,013,038 13,581,437,610
Objective 2 health care practices
Improved feeding practices of infant and young
Result 2.1 127,230,381 76,209,660 76,209,660 76,209,660 76,209,660 432,069,021
children, and pregnant and lactating mothers
Enhanced essential nutrition services in under five
Result 2.2 2,123,324,578 2,110,970,266 2,954,838,373 2,954,838,373 2,954,838,373 13,098,809,963
children and pregnant women
Strengthened capacity of primary health care / health
Result 2.3 25,524,000 10,209,600 - 35,733,600
extension program on nutrition services - -
Strengthened advocacy and support for improved
Result 2.4 coverage of routine high impact large scale health 2,965,005 2,965,005 2,965,005 2,965,005 2,965,005 14,825,027
sector interventions
Universal access to safe and clean water, sanitation
Strategic
and hygiene services, and adoption of improved 1,321,194,210 1,323,171,660 1,429,924,290 994,837,280 590,242,100 5,659,369,541
Objective 3
practices
Increased access to improved clean and safe water
Result 3.1 833,087,010 833,087,010 533,087,010 98,000,000 98,000,000 2,395,261,031
source by households
Increased access to improved latrine and handwashing
Result 3.2 404,595,180 404,595,180 809,190,360 809,190,360 404,595,180 2,832,166,260
facilities by households
Improved awareness on personal hygiene, household,
Result 3.3 83,512,020 85,489,470 87,646,920 87,646,920 87,646,920 431,942,250
and environmental sanitation
Strategic Enhance schools’ role for improved nutrition practice
1,012,283,730 576,529,380 398,380,794 750,927,117 761,137,902 3,499,258,923
Objective 4 and creation of nutrition change agents for the nation
Result 4.1 Enhanced girl's education 788,320,311 412,077,403 371,620,003 734,377,111 734,377,111 3,040,771,941
Increased number of schools with home grown school
Result 4.2 16,550,005 16,550,005 16,550,005 16,550,005 16,550,005 82,750,027
feeding programs
Improved student participation in school and family
Result 4.3 137,223,428 102,917,571 - 240,140,999
nutrition promotion activities - -
Leveraged ongoing nutrition service and promotion
Result 4.4 70,189,986 44,984,400 10,210,786 10,210,786 135,595,957
efforts in schools -
Increase the resilience of households and
Strategic
communities through social protection (social safety 15,136,756 21,911,101 10,025,791 2,700,000 2,700,000 52,473,647
Objective 5
nets)
Increased coverage of children and pregnant and
Result 5.1 lactating women that benefit from social safety net 15,136,756 21,911,101 10,025,791 2,700,000 2,700,000 52,473,647
programs
Strategic Enhance women empowerment, gender equity and
601,438,242 837,931,442 337,931,442 337,931,442 337,931,442 2,453,164,009
Objective 6 child protection
Improved female decision-making power, and access to
Result 6.1 217,052,676 217,052,676 217,052,676 217,052,676 217,052,676 1,085,263,382
and control over resources
Improved social environment for the appropriate child
Result 6.2 384,385,565 620,878,765 120,878,765 120,878,765 120,878,765 1,367,900,627
and maternal feeding and caring practice
Strategic Enhance market accessibility and affordability of
113,316,291 101,528,395 107,378,395 101,528,395 101,528,395 525,279,872
Objective 7 foods
Improved food market value chain system and
Result 7.1 113,316,291 101,528,395 107,378,395 101,528,395 101,528,395 525,279,872
infrastructure
Fostering an enabling environment for strong
Strategic
governance and coordination of multi-sectoral 1,509,027,414 1,258,302,777 610,131,999 605,648,773 636,958,868 4,620,069,832
Objective 8
stunting reduction efforts
Increased political commitment and leadership for
Result 8.1 5,011,958 3,137,033 3,137,033 3,626,967 3,137,033 18,050,022
stunting reduction
Strengthened multisectoral nutrition response
Result 8.2 183,471,858 188,813,869 188,813,869 188,813,869 188,813,869 938,727,335
coordination at all levels
Strengthened human resource capacity for nutrition at
Result 8.3 108,900,000 108,900,000 108,900,000 108,900,000 108,900,000 544,500,000
all levels
Expanded and strengthened costed woreda-based
Result 8.4 35,456,662 27,171,328 24,916,292 24,916,292 24,916,292 137,376,864
planning
Result 8.5 Expanded and strengthened data revolution at all levels 1,165,353,144 924,419,915 273,531,013 273,531,013 305,331,042 2,942,166,128
Improved coordination of key cross cutting nutrition
Result 8.6 10,833,793 5,860,633 10,833,793 5,860,633 5,860,633 39,249,483
activities
Total Seqota Declaration costs (ETB) 11,885,277,828 12,146,450,626 12,226,970,985 12,574,637,384 12,174,739,335 61,008,076,158
Total Seqota Declaration costs (USD) $ 373,534,742 $ 381,742,973 $ 384,273,596 $ 395,200,179 $ 382,632,041 $ 1,917,383,531
A summary of the key cost components (line/budget items) for all the SD Strategic Objectives is
provided in Figure 5 with details in Tables 11a&b below. These are useful to inform the annual
sectoral budgeting processes. Salary costs are not fully represented here since the sectors
anticipate that they will cover salaries from their annual budgets, an important contribution from
public funds. Capital investments (for example, in construction and renovations, water and
sanitation infrastructure, and agricultural equipment) will be key cost drivers in the Expansion
Phase. In the Scale-up Phase, these will be decreased. The health sector’s costs (for Strategic
Objective 2) increase in the Scale-up Phase mainly due to medicines and supplements, which
were not anticipated in the Expansion Phase.
Figure 5: The estimated annual costs of the SD, per Cost Component (2021-2030, ETB billions)
The details of the cost components are provided in Table 12a&b below.
Table 11.a&b.: The estimated annual costs of the SD, per Cost Component (2021-2025, 2026-2030, ETB)
EXPANSION PHASE COSTS ETB

Total Expansion
SD Costs by cost item
YR1 YR2 YR3 YR4 YR5 Phase costs
(ETB)
1.1 Salaries - program management 69,054,739 132,954,739 342,954,739 342,954,739 342,954,739 1,230,873,696
2.1 Training related per
241,278,711 308,222,845 711,036,330 514,729,022 142,914,013 1,918,180,921
diems/transport/other costs
2.3 Supervision/surveys/data
collection related per 103,707,507 88,938,009 184,324,459 198,564,209 227,388,209 802,922,394
2.4 Meeting/Advocacy related per
335,281,027 383,309,558 1,077,063,190 1,046,880,564 1,032,898,915 3,875,433,253
2.5 Other Transportation costs 4,800,000 3,500,000 2,500,000 2,400,000 4,800,000 18,000,000
3.1 Technical Assistance
29,175,000 80,265,000 92,300,000 81,400,000 70,670,000 353,810,000
Fees/Consultants
3.4 Other external professional
19,092,446 24,894,000 19,194,000 24,394,000 19,194,000 106,768,446
services
4.7 Other medicines - - - 168,773,621 168,773,621 337,547,243
8.2 Renovation/constructions 937,436,806 2,812,514,346 3,400,394,152 3,698,894,152 2,554,189,576 13,403,429,032
9.1 IT - Computers, computer
equipment, Software and 232,268,884 635,360,412 1,235,383,704 850,748,176 76,863,120 3,014,244,296
applications
9.3 Other non-health equipment 10,360,000 10,360,000 20,360,000 20,360,000 10,360,000 71,800,000
9.5. Agricultural equipment 794,568,320 2,466,436,960 1,671,868,640 3,302,371,280 3,178,273,280 11,413,518,480
9.6. Water & Sanitation equipment
1,869,768,882 3,463,132,627 3,403,131,302 5,236,495,046 4,499,814,499 18,472,342,356
(including irrigation for agriculture)
10.1 Printed materials (forms, books,
16,378,008 2,987,656 40,735,308 4,830,312 1,582,656 66,513,940
guidelines, brochure, leaflets...)
10.2 Television/Radio spots and
85,069,280 243,103,520 243,103,520 243,103,520 243,103,520 1,057,483,360
programmes
12.2 Food and care packages - - 140,700,000 140,700,000 140,700,000 422,100,000
12.4. Agricultural inputs/livestock 2,055,702,528 5,251,252,128 4,806,885,648 7,997,503,248 7,995,163,248 28,106,506,800
12.5 Other LSTP costs 1,546,136 9,114,238 28,278,476 - - 38,938,849
Total Costs (ETB) 6,805,488,274 15,916,346,037 17,420,213,468 23,875,101,890 20,709,643,397 84,710,413,067
SCALE-UP PHASE COSTS ETB

SD Costs by cost item Total Scale-Up
Costs (ETB)
1.1 Salaries - program management 182,580,000 182,580,000 182,580,000 182,580,000 182,580,000 912,900,000
2.1 Training related per
475,893,337 329,730,911 109,380,875 69,084,049 103,109,393 1,087,198,565
2.3 Supervision/surveys/data collection
133,821,202 115,133,869 115,133,869 115,133,869 143,957,869 623,180,679
related per diems/transport/other costs
2.4 Meeting/Advocacy related per
622,481,424 615,617,264 608,092,740 596,406,164 600,766,949 3,043,364,541
2.5 Other Transportation costs 5,700,000 2,400,000 2,400,000 2,400,000 4,800,000 17,700,000
3.1 Technical Assistance
90,475,000 51,920,000 50,920,000 44,500,000 45,070,000 282,885,000
Fees/Consultants
3.4 Other external professional services 27,412,446 19,194,000 24,394,000 19,194,000 24,394,000 114,588,446
4.7 Other medicines 2,109,670,266 2,109,670,266 2,953,538,373 2,953,538,373 2,953,538,373 13,079,955,651
8.2 Renovation/constructions 1,303,534,396 1,511,911,288 1,440,506,468 2,582,763,576 2,128,168,396 8,966,884,124
9.1 IT - Computers, computer equipment,
804,608,176 612,290,412 35,337,120 35,337,120 35,337,120 1,522,909,948
Software and applications
9.3 Other non-health equipment 5,360,000 4,110,000 360,000 360,000 360,000 10,550,000
9.5. Agricultural equipment 1,063,229,440 1,157,273,520 1,174,832,880 1,157,273,520 1,136,590,520 5,689,199,880
9.6. Water & Sanitation equipment
1,730,403,829 2,148,109,818 2,246,450,754 1,533,022,808 1,533,022,808 9,191,010,018
(including irrigation for agriculture)
10.1 Printed materials (forms, books,
27,694,002 2,640,371 345,000 345,000 345,000 31,369,373
guidelines, brochure, leaflets...)
10.2 Television/Radio spots and
243,103,520 243,103,520 243,103,520 243,103,520 243,103,520 1,215,517,600
programmes
12.2 Food and care packages - - - - - -
12.4. Agricultural inputs/livestock 3,040,655,136 3,040,765,386 3,039,595,386 3,039,595,386 3,039,595,386 15,200,206,680
12.5 Other LSTP costs 18,655,653 - - - - 18,655,653
Total Costs (ETB) 11,885,277,828 12,146,450,626 12,226,970,985 12,574,637,384 12,174,739,335 61,008,076,158
For each of the sectoral strategic objectives, their detailed result areas and activities were
costed – please refer to the specific costed workplans. As an example, the details of Strategic
Objective 1 (agricultural sector) are presented below, first by Result Areas (Figure 6), and then
by Cost Components (Figure 7). As explained above, there are large agricultural capital
investments (inputs and equipment such as irrigation) anticipated in the Expansion Phase, but
once the need has been met in the targeted woredas, these would not be replaced in those
woredas in the Scale-up Phase. Livestock, in particular, should allow the targeted households to
continue to generate their production of nutrient-rich food, as demonstrated in Figure 8 which
shows the planned activities for chicken supply to households, for the one result area under
Strategic Objective 1.
Figure 6: The estimated annual costs of SD Strategic Objective 1 (Agriculture), per Result Area (2021-2030, ETB millions)
Figure 7: The estimated annual costs of Strategic Objective 1 (Agriculture), per Cost Component (2021-2030, ETB millions)
Each Result Area is split into its activities, and details of its costs and cost components are
available in the costed work plans. An example of Result 1.1.1 per activity is provided in Figure 8
and Table 13 following.
Figure 8: The estimated activity costs of SD Result Area 1.1: Improved production of diverse, nutrient-rich food all year round
(2021-2025, ETB millions) – as an example of the detail in the costed sectoral work plans
Table 12: The estimated annual costs of SD Result Area 1.1, per Activity (2021-2025, ETB millions) – as an example of the detail in
the costed sectoral work plans
These cost estimates will inform sectoral budgeting processes and resource mobilisation.
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Annexes
Annex 1: The SD Expansion and Scale-up Phases Impact Pathway
Then nation's
Reduced morbidity School performance Work capacity/ social-economic
and learning capacity Adult Stature
and mortality Productivity development is achieved
Then stunting in U2
Reduced rates of stunting in children under the age of two children ends
Then immediate
Adequate Dietary Intake Low Disease Burden cause of stunting
will be addressed
SO₁: Access
Production and consumption of nutrient
rich animal source food year round SO₆: Supportive
SO₂:
Optimum breast and complementary feeding
practice
SO₅: High
impact social
SO₃: Improved
access to safe and
=
social
to diverse, Production and consumption of Maternal, Pregnant and lactating women feeding protection clean water, and
environment for If at least 70%
adequate, nutrient rich fruits and vegetables child and practice
interventions sanitation and
the appropriate implementation
nutrient Production and consumption of adolescents U5 & PLW nutrition services (VAS, deworming, hygiene services
child, girls and coverage of high
rich, and biofortified crops girls feeding GMP, MMS, acute malnutrition treatment)
Conditional
maternal
safe food for Affordable and quality agricultural and health cash/food including Universal access to impact
feeding and Access, quality and coverage of other high
all year inputs, infrastructure and services care impact nutrition sensitive interventions (FP, EPI, pulse transfer to drinking water interventions that
caring practice PLWs
round SO₇: Cold chain for perishable food, road practices HEP, IMNCI, Malaria, ANC, PNC, Skilled delivery) address underlying
access, market linkages and food price Universal access to
Medical care wavier improved latrine and
cause of stunting
to malnourished handwashing facility are achieved
children and PLW
+
General HH level WASH
practice
Nutrition Enabling Environment Nutrition Social Condition
SO₈: Fostering and enabling environment for multi-sectoral stunting reduction efforts SO₆: Enhance women empowerment, gender equality and If basic causes of
child protection stunting are well
1. Fostering Political Commitment and Leadership addressed
2. Multisectoral Coordination and governance 1. Women decision making power, and access to control over resources
2. Women income
3. Human Resource for Nutrition
4. Costed Woreda-based Planning and resource mobilization SO₄: Girls Education
5. Date Revolution for evidence informed performance management and improved accountability
6. Coordination of scale up of cross cutting innovations such as the Community Lab and the 1000 days public movement
Annex 2: The SD Innovations
The SD Innovation Phase (2016 to 2020) included six innovations to catalyze the delivery of SD
strategic initiatives to reduce stunting. The Innovation Phase used existing multisectoral
structures to implement these innovations based on the “learning by doing” principle. The six
innovations are:
1. Program Delivery Unit,
2. Data Revolution,
3. Community Labs,
4. Costed Woreda-based Planning (CWP)
5. Agricultural Innovation and Technology Centers (AITEC), and
6. the First 1000 Days Plus Public Movement
This section briefly describes these six innovations. Please see the Evidence Synthesis Review
for complete information, including achievements, limitations, and considerations for the
Expansion Phase.
Innovation 1: Program Delivery Unit (PDU)
The SD adopted the PDU model based on success stories in other countries across Africa, Asia, and
Europe to address common public service delivery challenges in Ethiopia.i The following are some
of the challenges faced in the delivery of public health services in Ethiopia:
1. A general tendency in civil service to focus more on process and procedures than outcomes;
2. A lack of clarity around the practical steps and coordination and accountability mechanisms
needed across sector ministries to turn national policy commitments into tangible outcomes; and
3. The challenge of ensuring quality delivery once responsibility is devolved to local and
sub-national levels.
The SD established a two-tiered PDU (federal and regional) to address limited horizontal
ministerial-level inter-sectoral nutrition coordination mechanisms in support of the SD delivery with
five core functions. These functions are strategic management; coordinating policy; monitoring and
improving performance; managing the politics of policies; and communicating results and
accountability.
i
Federal Program Delivery Unit. Seqota Declaration: Program Delivery Unit Operational Manual. Addis Ababa: Federal Ministry of Health; 2018.
The PDU has a direct line of communication to senior leadership and is located outside of the
Ethiopian government’s line-management hierarchy for optimum effectiveness. At the same
time, there is a clear communication and reporting line between the federal and regional PDUs
for better coordination and technical oversight.i
Innovation 2: Data Revolution
The SD has identified a “data revolution” in nutrition as one of its innovative approaches to improve
data availability essential to design and implement effective, evidence-based policies and
programs, mobilize resources, and monitor progress. Using a web-based platform, the data
revolution innovation aims to bring all nutrition data from different sectors into a single common hub
for joint and routine monitoring by all sectors, to help in data analysis and visualization. The goal is
to develop and implement a culture of data-driven decision-making by establishing a robust,
multisectoral data management system to collect high-quality data to inform decision-making and
intervention targeting and ultimately lead to a reduction in childhood stunting. SD implementing
sectors could access the web-based platform to routinely report and review their progress against
the 50 strategic initiatives of the SD.
Innovation 3: Community Labs
A Community Lab approach is a collaborative mechanism that brings together woreda and
kebele-level stakeholders to jointly identify and prioritize complex and multidimensional
nutrition-related problems in a community, and identify, test, and replicate potential solutions to
overcome them. It is driven by the principle of local solutions for local problems through a
locally-owned and led process. SD Community Labs have woreda and kebele-level structures.
Woreda Community Labs comprise representatives from woreda administration offices, SD
implementing sector offices, development partners, religious leaders, and community-based
organizations. Kebele Community Labs consist of representatives from kebele administrators,
school principals, health extension workers, youth associations, women associations, religious
leaders, cooperatives, farmers, and community members.
Community Labs use two major approaches: (1) Learning Journey is a full-day exercise in which
members of the Woreda Community Lab visit key locations at the kebele and interact with
community members and social service providers to better understand their day-to-day
experiences and challenges. (2) Open Day is a Kebele Community Lab-led one-day event in which
Woreda Community Lab members are invited to visit the kebele to have an open discussion about
progress, successes, and challenges. Through iterative testing, learning, and reflection, the
Community Lab eventually lands on sustainable, innovative solutions that can eventually be
replicated at scale. ii
i
Federal Program Delivery Unit. Seqota Declaration: Program Delivery Unit Operational Manual. Addis Ababa: Federal Ministry of Health; 2018.
Sinamo S. Community Labs: An innovation of Seqota Declaration, Ethiopia's commitment to end stunting. Addis Ababa, Ethiopia: Federal Program
ii
Delivery Unit, FMoH.
Innovation 4: Costed Woreda-based Planning (CWP)
A Costed Woreda-based Plan (Costed-One-Plan) is a bottom-up planning process and output that
consolidates a list of nutrition-sensitive and nutrition-specific activities across SD implementing
sectors and development partners at the woreda level, including the resources needed and the
implementation timeline. It aims to ensure sector priorities and implementation timelines for nutrition
activities are aligned, and increases sector accountability to plan, finance, and implement nutrition
activities across SD woredas.
Innovation 5: Agricultural Innovation and Technology Centers (AITEC)
The AITEC farms serve as pathways for the integrated introduction and demonstration of
innovations and technologies for horticulture, crop farming, and livestock production that improve
the productivity of smallholder farmers for increased production and diverse food.
Innovation 6: The First 1000 Days Plus Public Movement
The Seqota Declaration focuses on the first 1000 days plus of life to promote better nutrition
practices in pregnant women, lactating women, and adolescents. It uses a public movement to
mobilize influential community leaders and individuals and tailored social behavioral change and
communication messages to promote essential nutrition actions and practices to reduce stunting.
These practices include, for example, exclusive breastfeeding, complementary feeding, dietary
diversity, WASH, health-seeking behaviors, male engagement, women empowerment, and
challenging and reducing harmful traditional practices.
Seqota Declaration
Roadmap for Expansion and
Scaleup Phases
2021 – 2030

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Seqota Declaration Roadmap For Expansion and Scaleup Phases - Print

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Federal Democratic Republic of Ethiopia

2. The SD Expansion and Scale-up Phases Roadmap................................................... 4

4. Seqota Declaration Vision, Mission, and Goals.......................................................... 6

5. Strategic Investment Pillars for Expansion and Scaleup Phases.............................. 7

7. Governance and Coordination for the SD Expansion and Scale-up Phases............ 42

8. The SD Expansion and Scale-up Phases Estimated Investment Cost..................... 45

M&E Monitoring And Evaluation

Dr. Dereje Duguma

Dr. Meseret Zelalem

The SD Innovation Phase generated successful program experiences on how to better

Strategic Objective 1: Improve access to diverse, adequate, nutrient-rich, and

Strategic Objective 2: Improve maternal, child, and adolescent feeding and

Strategic Objective 4: Enhance schools’ role for improved nutrition practice

Strategic Objective 5: Increase the resilience of households and communities

Strategic Objective 6: Enhance women empowerment, gender equity, and

Strategic Objective 7: Enhance market accessibility and affordability of foods

Strategic Objective 8: Foster an enabling environment for strong governance

The six innovations listed below are explained in Annex 2:

1. Program Delivery Unit (PDU),

4. Costed Woreda-based Planning (CWBP),

5. Agricultural Innovation and Technology Centers (AITEC), and

6. The First 1000 Days Plus Public Movement.

Advancing Ethiopia’s efforts to reduce stunting is critical to accelerate socio-economic

The SD Expansion and Scale-up Phases will provide a package of high-impact

Figure 1: Coverage of the Seqota Declaration

Scaleup Phase - 2026-2030

Expansion Phase - 2021-2025

Innovation Phase: 2016-2020

We aspire to see Ethiopia’s children free from undernutrition.

To end stunting in children under two by 2030.

• A threshold of minimum 70% implementation coverage for high-impact interventions to

Successful implementation of high-impact interventions at scale is more likely to be

Lifting sectoral high Backstopping routine Leveraging routine

- Optimum breast feeding - Early identification and - Family planning

- Improved latrine and basic - Household and - Universal access to clean,

- Girls’ education - Training of teachers on - General school-based

- Supportive social - Women’s social - Labor, time, and

- Perishable food supply - Financing facility to actors - General rural road

- Fostering Political Commitment and Leadership

- Multisectoral Coordination and governance

- Costed Woreda-based Planning

- Coordination of cross cutting innovations

Based on the programmatic experiences of accelerated reduction in child stunting in Ethiopia,

Strategic Objective 1: Improve access to diverse, adequate, nutrient-rich, and

Strategic Objective 2: Improve maternal, child, and adolescent feeding and

Strategic Objective 4: Enhance schools’ role for improved nutrition practice

Strategic Objective 5: Increase the resilience of households and communities

Strategic Objective 6: Enhance women empowerment, gender equity, and

Strategic Objective 7: Enhance market accessibility and affordability of foods

Strategic Objective 8: Foster an enabling environment for strong governance

Innovation Phase Experiences

Key interventions that increase production and consumption of diverse foods by

Result 1.1.1 Improved production and consumption of poultry and poultry

Innovation Phase Experiences

The following priority activities will be implemented at scale:

Innovation Phase Experiences

Innovation Phase Experiences

Result 1.1.4. Improved production and consumption of nutrient rich fruits