Draft Design and Monitoring Framework
         
        Project Number: 38117 
        September 2006 
         
         
         
        INO: Nutrition Improvement through Community 
        Empowerment 
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
         
        A design and monitoring framework is an active document, progressively updated and revised as 
         
        necessary, particularly following any changes in project design and implementation. In accordance with 
         
        ADB’s public communications policy (2005), it is disclosed before appraisal of the project or program. 
        This draft framework may change during processing of the project or program, and the revised version 
        will be disclosed as an appendix to the report and recommendation of the President. 
         
                        
                                                     DESIGN AND MONITORING FRAMEWORK 
               Design                                  Performance                 Data Sources/ Reporting                 Assumptions  
               Summary                              Targets/Indicators                    Mechanisms                         and Risks  
               Impact                                                                                              
               Improved nutrition status      • Prevalence of underweight        •  National Social and           Assumptions  
               of children under-five           children under 5 years              Economic Survey               • Government policies and 
               years of age and pregnant        reduced from 28% in 2005 to         (SUSENAS), Nutrition             budget support the reduction 
               and lactating women.             less than 20% by 2012a              Component 2011                   of malnutrition among at-risk 
                                                                                                                     populations 
                                              •  Prevalence of wasting among      • Food and Nutrition             
                                                children  under  5 years            Surveillance System           • Government budgets are 
                                                reduced from 15.5% in 2005                                           allocate to cost-effective 
                                                to below 10% in 2012                                                 interventions 
                                                                                                                   
                                              •  Prevalence of anemia among                                       Risk 
                                                pregnant women reduced                                            • Local government does not 
                                                from 40% in 2005 to 30% in                                           maintain levels of expenditure 
                                                2012                                                                 for nutrition 
                                               
                                              •  Prevalence of anemia among 
                                                children under 5 reduced 
                                                from 48% in 2005 to less than 
                                                35% in 2012 
                                               
                                              •  Prevalence of infants born 
                                                less than 2500grams reduced 
                                                from 10% in 2005 below 5% 
                                                in 2012 
                                               
                                               
               Outcome                                                                                             
               Improved utilization and       •  Number of children 0 to 5        •  Health & Development         Assumptions 
               quality of nutrition             years attending posyandu            Research Institute 2007       • Women utilize improved 
               programs and services for        during last month increases         National Nutrition Survey       nutrition services and adopt 
               at-risk women and                from 48.5% (2005) to 75% in         (to provide baseline data)      better child feeding and child 
               children in 6 project            2012                                                                care practices 
               provinces.                                                         •  Demographic and Health        
                                              •  Number of children under 6         Survey                        • Local governments utilize 
                                                months exclusively breastfed                                        resources to strengthen 
                                                increased from average of        • SUSENAS, Nutrition               nutrition planning and service 
                                                10% in 2005 to 40% in 2012          Component 2011                  capacities 
                                                                                                                   
                                              •  Number of women receiving        • Project Completion Report     • Government approves 
                                                iron-supplements and at least                                       nutrition policies and 
                                                6 ante-natal consultations at     • Baseline, Midterm and           protocols 
                                                puskesmas or with village           Final Surveys                  
                                                mid-wife increased at least        
                                                50% from baseline. 
                                               
               Outputs                                                                                             
                                                                                                                   
               Output 1                       •  At least 6 revised draft         • Biannual  project reviews     Assumption 
               Strengthened capacity for        nutrition policies, protocols                                     •    Revised policies and action 
               development of nutrition         and/or guidelines prepared by     • Reports from surveillance          plans are supported by 
               policies, programs and           relevant authority in MOH by        system of nutrition unit           local governments. 
               surveillance                     year 3 of project                                                  
                                                implementation.                                                   Risk 
                                              •  Number of provincial, district                                   •    Surveillance data is not 
                                                hospital and puskesmas staff                                           analyzed and no action 
                                                trained in priority areas such                                         taken 
                                                implementation of guidelines                                       
                    
                   2   
                    
                Design                                   Performance                  Data Sources/ Reporting                   Assumptions 
                Summary                               Targets/Indicators                     Mechanisms                           and Risks 
                                                   and nutrition surveillance                                           
                                                   increased by 30% over                                                
                                                   baseline by 2009 (midterm)                                           
                                                   and 50% by 2012.a                                                    
                                                                                                                        
                                               •  All project districts have food                                       
                                                  and nutrition plans by year 4                                                          
                                                                                                     
                                                                  
                Output 2                       • Number of puskesmas and             •  Project monitoring and         Assumption  
                Improved quality of, and          with trained nutrition               evaluation reports along        • Local government 
                access to, integrated             personnel, at least 50%              with village monitoring             expenditures for nutrition 
                nutrition services for at-        women, and related                   reports.                            efficiently allocated 
                risk groups in project            equipment increased by 50%                                            
                areas                             from baseline.                     • Project Monitoring System       Risk 
                                                                                                                       •   Local governments cannot 
                                               •  90% of health services at the      •  Village capability profile         maintain trained nutrition 
                                                  province and district with           (PODES)                             staff and allocate budget  to 
                                                  designated nutrition-related                                             community-based workers 
                                                  in-patient care facilities and     • SUSENAS                          
                                                  equipment by 2012.                                                    
                                                
                                               •  By 2012, at least 90% of 
                                                  posyandus are providing 
                                                  services at least once per 
                                                  month with coverage of 80% 
                                                  of all under-fives in the 
                                                  catchment area (current 
                                                  national figure for monthly 
                                                  posyandu operations is 
                                                  estimated to be 48%). 
                                                
                Output 3                       •  Improved posyandu facilities       • Project Monitoring System      Assumption 
                Enhanced community                in 80% of block grant eligible                                       Women utilize improved 
                capability for, and               villages.                          • Biannual ADB project           posyandu services 
                implementation of,                                                     reviews                          
                improved nutrition and                                                                                 Risk 
                hygiene interventions.                                               • PODES                           •   Lack of transparency of 
                                                                                                                           village management of 
                                                                                     • SUSENAS                             block grant funds 
                                                                                                                        
                Output 4                       •  Percentage of fortified salt       •  Monitoring reports of Food     Assumptions  
                Expanded food                     and wheat at retail level            and Drug Administration.        • Low-cost fortified 
                fortification programs and        meeting mandated                                                         complementary food 
                nutrition communication           fortification standards            •  Project monitoring and             available in the market 
                                                  increased from 60% in 2003           evaluation reports.              
                                                  to 90% in 2012.                                                      Risk 
                                                                                     •  Baseline and follow-up         • Availability and affordability 
                                               • Micronutrient supplements             surveys of project                  of micronutrient 
                                                  (sprinkles) available on a           implementation.                     supplements at the district 
                                                  commercial basis in at least                                             level 
                                                  30% of project provinces.                                             
                                                                                      
                                               • National breastfeeding               
                                                  studies show improved rate          
                                                  of exclusive breastfeeding at       
                                                  6 months from <10% in 2005          
                                                  to 40% in 2012.                     
                                                                                      
                                                                                      
                                                                                                                                                    3
                     
                     
                Output 5                        •  At least 700 trained              •  Project monitoring and 
                Capacity building for             community facilitators, at            evaluation reports. 
                nutrition policy and              least 50% women, in place by        
                programs institutionalized        Year 2 with an additional           
                and M&E established in            300+ in place by end of year        
                project areas                     3 with 90% having received          
                                                  at least one refresher course       
                                                  by 2012.                            
                                                                                      
                                                •  Project implementation units       
                                                  developed detailed                  
                                                  implementation  and                 
                                                  monitoring  strategies              
                                                                                      
                                                                                      
                                                                                      
                                                                                      
                                                                                      
                Activities with Milestones                                                                             Inputs 
                Output 1: Institutional Development for Nutrition Policy, Programs and Surveillance                     
                1.1. Improved Nutrition Institutional Capacity                                                         Asian Development Fund (ADF) 
                1.1.1. Review and develop policies and guidelines in the following areas: food safety,  loan: $ 50million 
                nutrition emergencies, iron supplementation, malnutrition prevention and mitigation,   
                breastfeeding promotion, HIV/AIDS in nutrition services for mothers and children (                     Government counterpart funds: 
                1.1.2.Review, update and prepare action plans of dietary guidelines (year 2)                           $19.1 million 
                1.1.3.Review protocol for the treatment of severe malnutrition and its application and revise   
                nutrition counseling methods for each service level (                                                  International consultants: 78 
                1.1.4.Provide refresher training for all levels on treatment protocols, counseling and  person-months 
                monitoring and evaluation.                                                                              
                1.1.5.Provide training for professional organizations of nutritionists, midwifes and nurses.           Domestic consultants: 212 
                1.1.7.Prepare strategies and training for nutrition program planning, financing, and monitoring        person-months 
                at the local level.                                                                                     
                1.1.8.Advocacy and preparations for necessary government regulations/decrees (years 1 &  Civil works: $0.1 million 
                to establish a National Institute of Nutrition (Institute Gizi Nasional) (years 3-6)                    
                1.1.9 30 refresher training for provincial and district food inspectors and food sanitation  Training, Fellowships and 
                officers on food safety issues.                                                                        Workshops: $7.6 million 
                1.2.1. training of trainers on nutrition emergency response, promotion of breast feeding and   
                child care feeding and caring practices, nutrition counseling, hygiene improvement and  Equipment: $2.7 million 
                referral                                                                                                
                1.2.2.Provide training on nutrition counseling and community-based monitoring to staff of the  System Development and 
                nutrition academies, nurses, nutritionists, midwifes and selected members of community –               Studies: $6.6 million 
                based organizations (PKK, health committees), child feeding practices and child care,   
                counseling                                                                                             Nutrition advocacy and 
                1.2.4.Training of school teachers on nutrition                                                         communication: $5.5 million 
                1.2.5.Training for CBOs on community-based growth monitoring and hygiene 
                 
                1.2. Nutrition Surveillance System                                                                      
                1.2.1.Assessment of current nutrition surveillance system and reporting mechanisms 
                1.2.2.Prepare guidelines and provide training for evidence-based nutrition, planning and 
                budgeting 
                1.2.3.Procurement of IT equipment and software 
                1.2.4.Training of trainers on nutrition data analysis and reporting 
                1.2.5.Develop integration protocols between departments of health, agriculture and district 
                logistic (DOLOG) especially at the district level. 
                 
                Output 2: Integrated Nutrition Services 
                2.1. Strengthening Local Nutrition Services (hospitals and puskesmas) 
                2.1.1.Upgrade nutrition facilities in provincial and district hospitals and puskesmas. 
                2.1.2.Provide nutrition-related equipment for hospitals and puskesmas