J.10 STATEMENT OF OBJECTIVES.docx

Solicitation: 72011520R00002 Healthy Mother, Healthy Baby Activity Annex J.10

STATEMENT OF OBJECTIVES

C.1. PURPOSE

The purpose of the Healthy Mother, Healthy Baby Activity is to improve the nutritional status and prevent morbidity and mortality of mothers and children under two as well as improve the quality and availability of lifesaving, evidence-based health interventions for women and children in the Feed the Future Zone of Influence (FTF ZOI) in Khatlon province.

This SOO allows the Contractor to propose and price a solution that achieves the outlined objectives and contributes to measurable improvements in health and nutrition of mothers and children under two, policy changes, supporting the evidence-based practices in maternal and child health (MCH), health system strengthening and improvement of the behavior and practices supporting MCH and Nutrition.

C.2 SCOPE

USAID requires services that will make sustainable improvements in the ability of the Government of Tajikistan (GOT) health system to deliver quality Maternal and Child Health and Nutrition services by building the technical capacity, leadership, management, policy reform potential of Tajikistan Ministry of Health and Social Protection of Population (MOHSPP) and other health institutions and communities. The end result will be improved quality of health and nutrition services for mothers and children under two in FTF ZOI. improved MCH and nutrition practices among beneficiaries especially practices during the first “1000 days” window and good water/hygiene/sanitation behaviors, and a strengthened health system coordinating Scaling up Nutrition Movement, leading the Food Fortification activities, and other MCH and Nutrition related multi-sectoral activities.

Changes in the Government of Tajikistan policies and programs, uncertainty surrounding emergent health priorities, and fine-tuning of USAID development interests mean that the contractor must be able to rapidly incorporate changes in the United States Government (USG) and GOT health programming priorities and policies. In addition, state of the art technical interventions and innovations will evolve during the life of contract performance and the contractor must continuously seek ways to incorporate feasible, innovative, and evidence-based approaches in support of this program’s purpose and objectives.

C.3 PERIOD AND PLACE OF PERFORMANCE

The expected period of performance for the Healthy Mother, Healthy Baby Activity is five years 2020-2025. This will be implemented primarily in Feed the Future Zone of Influence – in 12 western district of Khatlon province: Balkhi, Dusti, Jaihun, Jomi, Khuroson, Kushoniyon, Levakant, Nosiri Khisrav, Qubodiyon, Shahritus, Vakhsh, Yovon), but not limited to this area. National efforts such as support of the Health System Strengthening activities, support of Scaling-up Nutrition movement will be implemented on a national level, country-wide. The activity should have a country office in Dushanbe, with possibility of additional field office in Bohtar city (capital of Khatlon province). The specific management and staffing structure will depend upon proposed activities. However, Dushanbe office will be needed to ensure effective coordination with the USAID Tajikistan Country Office.

C.4 BACKGROUND

In Central Asia, Tajikistan has the highest rates of maternal and child mortality (maternal mortality 32 per 100,000 live births (2015 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group), child mortality (33 per 1,000 live births (Tajikistan DHS 2017)), and chronic malnutrition (18 percent of children under five stunted nationwide (Tajikistan DHS 2017)). High poverty rates directly inhibit households’ abilities to access safe, healthy, and nutritious food as well as clean water and improved sanitation facilities. Food security and nutrition is further compromised as reduced remittances decrease household income available for the purchase of diverse and nutritious foods. The level of remittances decreased drastically from 50 percent of GDP in 2013 to an estimated 36 percent of GDP in 2019 in Tajikistan due to a financial crisis. Such a large decrease in income has a deleterious effect on health-seeking behaviors since out-of-pocket expenditures for health are the norm in Tajikistan.

Poor diets of pregnant women, poor infant and child feeding practices, high unmet need for family planning and birth spacing, low quality of health services, poor hygiene and sanitation, low level of knowledge about healthy nutrition, cultural norms that counter nutrition advice, and low access to nutrient-rich foods also contribute to the high rates of undernutrition and poor health outcomes. As such, maternal, newborn and child health (MNCH) and nutrition is likely to suffer unless these issues are solved.

USAID implements the Feed the Future (FTF) Initiative in 12 districts in Khatlon province, residents of which experience the most inequitable wealth distribution in the country, with almost two-thirds of the population living within the two lowest wealth quintiles.

Coinciding with significant investments over 5 years by USAID and multiple development partners, child mortality decreased from 43 to 33 percent nationwide, child stunting across the FTF Zone of Influence (ZOI) decreased from 25 percent to 18 percent between 2012 and 2017 (Tajikistan DHS 2017) and the percentage of women achieving minimum dietary diversity increased to 69.5 percent (Tajikistan DHS 2017). However anemia rates for women of reproductive age and children are still extremely high, 54 and 51 percent respectively (Tajikistan DHS 2017).

Optimal health and nutrition are fundamental to a country’s journey to self reliance, and to also achieve USAID’s wider mission to end extreme poverty and promote resilient, democratic societies while advancing US national security and prosperity. While USAID investments have helped improve maternal and child health, maternal and child mortality ratios are still high. These rates are sensitive indicators of the effectiveness of the entire health system reflecting the low quality of the health services. In addition, 38 percent of women report (Tajikistan DHS 2017) that the cost of medical treatment is a barrier to accessing health care services.

In Tajikistan, malnutrition; water, sanitation and hygiene (WASH); food insecurity; and poverty are closely intertwined. Patterns of food consumption are determined not only by income level but also by availability, access, culture, and household utilization of food. Accordingly, improving food security and nutritional status will require an integrated approach that addresses not only availability and access but also improved household level maternal nutrition and infant and young child feeding and hygiene behaviors, social norms around allowable foods for pregnant women and young children, and gender equality.

There is strong momentum towards achieving the Sustainable Development Goals (SDGs), and several National Strategies such as the National Health Sector Strategy and National/Mid-Term Development Strategy have been developed to support the sectoral results embedded within them. Tajikistan has made strong commitments to improving maternal and child health and nutrition by becoming a Scaling Up Nutrition (SUN) Movement Country, committing to end malnutrition, in all its forms. This engagement with the SUN Movement has led to some multisectoral engagement around nutrition at the national level, but this will need to be built upon and rolled out nationally to achieve sustained, nation-wide improvements in nutrition.

Tajikistan has demonstrated commitment to and capacity in both maternal and child health and nutrition, but both need to be strengthened in order to help the country on their journey to self-reliance. This will involve continuing to build the capacity of the health sector workforce as well as strong community engagement systems that can sustain improvements seen as a result of the project. It is critical that this activity support the government to plan, finance, and implement solutions to address its own development challenges.

Related USAID Activities

USAID’s FTF Tajikistan Health and Nutrition Activity (THNA) works to improve the quality of healthcare services; increase access to diverse, nutrient-rich foods throughout the year; increase the practice of healthy behaviors; and institutionalize advances made in Tajikistan’s health sector. THNA is scheduled to end in September 2020. This new activity will intentionally build upon THNA successes and incorporate lessons learned.

USAID supports the World Food Program’s Targeted Supplementary Feeding Program to support treatment of moderate acute malnourished children in primary healthcare clinics.

With USAID support, UNICEF’s Improvement of Universal Salt Iodization project aims to sustainably eliminate Iodine Deficiency Disorders through the expansion of ongoing universal salt iodization (USI) efforts by the Tajik government and industry. USAID Fortification efforts in the region led up to Tajikistan’s Food Fortification Legislation for wheat flour, salt, juice and dairy products, which was adopted in July 2019.

C.5 PERFORMANCE OBJECTIVES, GOALS AND OUTCOMES

5.1 Overall Goal and Objectives:

Goal: To improve the nutritional status and prevent morbidity and mortality of mothers and children under two as well as improve the quality and availability of lifesaving, evidence-based health interventions for women and children in the FTF ZOI, Khatlon province.

The overall performance objectives to reach this goal include:

· Scaling up and institutionalizing quality health and nutrition services to mothers, newborns, and children

· Support the Scaling Up Nutrition Movement and national strategies

· Social and behavior change to improve nutrition, and maternal and child health

The Contractor is required to address these USG’s performance objectives with cost-effective and innovative solutions.

5.1.1 Objective 1: Support the Ministry of Health and Social Protection of Population in scaling-up and institutionalizing quality health and nutrition services to mothers, newborns and children.

Organization and governance of the health system still shaped by Soviet legacy. The private sector remains small, is concentrated in urban areas, and is limited to certain sets of services. Governance is still essentially top down and decentralization is limited although the responsibility for service provision is mostly local. The physical health infrastructure is in poor shape except in a few areas supported by donors and basic necessities such as water, sanitation and heating are lacking in many facilities including hospitals and maternities.

Financing of the health sector is the lowest in WHO’s European region (7.2% of GDP in 2017). The government contributes to 2.1% of GDP and the public health budget has remained stagnant despite an objective of 4.5% mentioned in the 2010-2020 National health strategy. The share of Public Financing amounts to 29.1% of all health expenditures and out-of-pocket (OOP) expenditures paid by the population amount to 63.6%, which is disproportionately high. Payments are made to providers formally, or often informally as well as for the purchasing of medicines, X Rays, or laboratory services.

Many patients belonging to the lowest income quintiles are low or non-users of services because they cannot afford the care they require. Charges may even have to be paid by the patients to access preventative care.

While the current USAID MCH and nutrition activity has brought about quality improvements in health facilities in the ZOI, more work is necessary to continue to improve the quality of care provided by health workers. Utilization of maternal and child health services is reasonably high, particularly for antenatal care and facility deliveries, but as the quality of care increases, demand for and use of health services is likely to also increase.

Performance Standards: To achieve this objective, the contractor must attain the following results:

IR 1.1 Increased availability and access to high quality MCH and nutrition services and commodities IR 1.2 Increased professional and institutional capacity IR 1.3 Improved systems to plan, manage, and evaluate MCH and nutrition programs

Illustrative activities may include these but not limited to:

· Build capacity of health providers to deliver high impact, evidence based services at a sustained level of quality and respectful care.

· Create incentives for health workers to deliver quality care and test the effectiveness of performance-based financing.

· Cooperate with the Ministry of Health and Social Protection of Population as well as local Universities to update the pre-service education and skills development of family nurses and midwives and institutionalize improvements in pre-service training on MCH and nutrition.

· Support the Ministry of Health and Social Protection of Population to design, approve and implement the terms of reference for family nurses and midwives.

· Support the Ministry of Health and Social Protection of Population in introduction of continuous medical education (CME) for family nurses and midwives with a focus on provincial and district-level training.

· Identify and implement appropriate responses to the financial barriers to seeking care, including reducing out-of-pocket costs for MCH services for the poor (at subnational and local levels).

· Create stronger linkages between levels of health services, from community to primary health center to hospital to district to national level.

· Engage communities in quality improvement initiatives at primary health centers and hospitals.

· Increase capacity to analyze and use data for decision making at all levels of the health system.

· Institutionalize baby-friendly hospital initiative to ensure that all infants begin breastfeeding within the first hour of birth.

5.1.2 Objective 2: Support the Scaling up Nutrition Movement and Republic of Tajikistan’s national strategies. (i.e. New Health Strategy, 1000-day Communication Strategy, Nutrition and Physical Activity Strategy, Food Fortification Action Plan, SUN Common Results Framework-SUN Multisectoral Action Plan, plus others in development).

The Government of Tajikistan has demonstrated their commitment to maternal and child health and nutrition through the number of high quality national strategies and policies they have enacted. Their capacity to fully implement these strategies and policies still requires strengthening. This activity should support the Government of Tajikistan to roll out nutrition and MCH-related strategies within the ZOI.

As members of the SUN Movement, the Republic of Tajikistan has publicly committed to implementing multi-sectoral solutions to nutrition problems across the country. While there has been national level engagement multi-sectorally, this could be strengthened and expanded to include greater district and local engagement toward multi-sectoral efforts to address nutrition during the first 1000 days.

Under this Objective, in collaboration with the new USAID Education Activity the activity should engage with the Ministry of Health and Social Protection of Population and the Ministry of Education to support the design and introduction of the educational package on health and nutrition for secondary schools. This way, adolescents will enter adulthood and parenthood with the necessary skills and knowledge to provide themselves and their future children with good nutrition.

The Contractor should support the efforts to enact and enforce the Food Fortification Law. This may include working with the Government to develop the Food Fortification Action Plan as well as strengthening the Government’s capacity to enforce the law.

Performance Standards: To achieve this objective, the contractor must attain the following results:

IR 2.1 Increased political will and resources for MCH and nutrition programs.

IR 2.2 Increased stakeholder engagement around national MCH and nutrition goals to include stronger linkages between all levels of health services.

IR 2.3 Strengthened coordinated multi-sectoral programming and planning among MCH and nutrition stakeholders.

Illustrative activities may include these but not limited to:

· Support Ministry of Health and Social Protection of Population in improving the quality, comprehension, and appeal of their mass media campaigns related to MCH and nutrition (e.g. TV spots, printed materials).

· Support Ministry of Health and Social Protection of Population and Ministry of Education in design and introduction of the educational package on health and nutrition for secondary schools.

· Identify ways domestic resources (i.e. CSO and private sector) can be mobilized for nutrition and MCH efforts and work to increase government allocations for nutrition and MCH (at national and local levels).

· Support development and implementation of the Food Fortification Action Plan.

· Facilitate multi-sectoral engagement for nutrition at the district and community level, with efforts to engage the private sector, civil society, and other actors to collaborate in improving nutrition in the first 1000 days.

5.1.3 Objective 3: Implement social and behavior change (SBC) activities to improve nutrition and maternal and child health practices.

Past behavior change activities have shown some success at improving maternal, infant, and young child feeding practices, but further work is needed to change social norms and institutionalize the behavior change in a way that sustains MCH and nutrition practices and outcomes, even for new mothers and babies. While the broad range of MCH and nutrition behaviors should be included within the scope of activities, the Contractor should identify a limited number of priority behaviors and small, doable actions to focus on that will realistically be able to change in significant, meaningful, and sustainable ways over the course of the project. These can and should include hygiene behaviors.

Priority behaviors and small, doable actions should be justified based on available data and evidence, with an appropriate behavior change theory proposed that will guide interventions around the behavior. The theories guiding the approaches to different behaviors or small, doable actions may be the same or different, as appropriate.

High quality SBC works to break down barriers and increase motivators to enable an individual or community to practice the desired behaviors. It is vital to engage people on an emotional level so that they feel compelled to try or practice the behavior. While communications activities are an important aspect of SBC, non-communications activities should also be considered where appropriate.

Community engagement is an important aspect of SBC. When communities feel ownership over their health, they are more likely to take action to improve it. When communities are engaged with health services and trust the service providers, they are more likely to utilize those services. Pressure from communities can also motivate health service providers to improve the quality of care. Strengthening community structures is also an important aspect of fostering self-reliance.

Performance Standards: To achieve this objective, the contractor must attain the following results:

IR 3.1 Improved social and behavior change strategies and approaches for MCH, nutrition-specific, and nutrition-sensitive activities IR 3.2 Increased innovations and creative approaches to change social norms around selected high-impact MCH and nutrition behaviors.

IR 3.3 Strengthened or newly created links between community-level approaches and primary health facilities.

Illustrative activities may include these but not limited to:

· Strengthen SBC interventions based on formative research on consumer and household preferences, needs and barriers to changing behaviors

· Create positive social norms that reinforce desired behaviors working at national, regional, and local levels.

· Strengthen community involvement, financing, and multiple product choices to promote improved practices.

· Continue to work on a community level through health providers, village authorities, volunteer networks, and civil society to improve MCH and nutrition practices for pregnant and lactating women, children under 2 years of age, and adolescent girls, with a focus on increasing optimal practices related to seeking care when danger signs emerge during pregnancy and child illnesses, birth spacing, preventing malnutrition and introducing good breastfeeding/weaning practices, as well as drinking water and sanitation.

· Use creative, community-level approaches, such as storytelling, community video, etc.to engage communities and change social norms around selected MCH and nutrition behaviors.

· Implement peer support groups to help break down barriers to adopting improved nutrition and MCH practices.

· Engage with men and mothers-in-law to gain their support for improved MCH and nutrition behaviors.

· Create and/or strengthen links between community-level approaches and primary health centers.

· Work with families and communities to foster joint decision-making and budgeting within families to improve the status and agency of young women.

C.6 PROGRAMMATIC APPROACHES

Gender All interventions must be designed using a gender lens and aiming for a gender-transformative approach at all levels. Gender inequality persists throughout Tajikistan society and contributes to poor nutrition and MCH behaviors and outcomes. According to the 2017 DHS, only 46% of women participate in decision-making about their own health care and 38% participate in decision-making about major household purchases. Gender-based violence is common, with 31% of ever-married women reporting having experienced physical, sexual, or emotional violence by their current or most recent husband (2017 DHS).

The Contractor is expected to demonstrate compliance with USAID’s GEFE Policy, ADS 205, and shall explicitly state how their proposal will address gender inequalities and work towards improving the nutrition and health status of women, children, and other vulnerable populations. The Contractor is expected to carry out a detailed Gender Analysis and submit a Gender Integration Plan for fulfilling the goals and objectives of this activity. In the performance management plan, data will be disaggregated by sex, and custom indicators will be used where appropriate.

Local Systems The Contractor will engage with local systems to facilitate system interactions without assuming responsibility for performing them directly. Local systems can include, but are not limited to, the Republic of Tajikistan, the private sector, civil society organizations, and communities. The Contractor must recognize that the strength of local systems and its prospects for sustainability depends on its ability to operate unaided, and that intervening too heavily robs local actors of opportunities to craft a true local solution. Local people understand their situations far better than external actors. The Contractor will be expected to regularly seek out local perspectives, paying particular attention to the voices of marginalized populations and apply those lessons in a practical way to maximize results. The Contractor will build on the understanding of a system’s contours elicited during the mapping phase, and incorporate discrete interventions that will strengthen local systems and produce sustainable results. The Contractor must partner with local institutions and advisors to the greatest extent possible.

Please consult Local Systems: A Framework for Supporting Sustained Development for additional information

Self-Reliance and Sustainability It is USAID policy that each country must lead its own development journey, but we can help partners by prioritizing programs that foster stability, incentivize reform and innovation, strengthen in-country capacity, and mobilize domestic resources, including private capital. There are two pillars of self-reliance and sustainability, 1) commitment and 2) capacity. Commitment represents “how well a country’s laws, policies, actions, and informal governance mechanisms -- such as cultures and norms -- support progress towards self-reliance.” Capacity addresses “how far the country has come in its journey across the dimensions of political, social, and economic development, including the ability to work across these sectors.”

The Contractor will effectively and accurately assess both the commitment and capacity of counterparts in the Government of Tajikistan to work in relevant political, social, and economic sectors including its overall ability to work across these sectors. The finding of this assessment will be expected to inform the choice of interventions the contractor will implement to promote self-reliance while advancing the project’s goals. This activity will be working mostly to increase the capacity of the Government of Tajikistan for MCH and nutrition, but in some cases will also include some work to increase the commitment toward MCH and nutrition. All proposed interventions should clearly identify how they will foster self-reliance of the Government of Tajikistan or other local actors.

Coordination and Collaboration The Contractor should actively seek out opportunities to collaborate and/or coordinate with development partners working on maternal and child health and/or nutrition throughout the country as well as with those development partners working in the same target districts regardless of their focus. Whenever possible, collaboration should be used to amplify impact and ensure that there is no unnecessary duplication of efforts.

Collaborating, Learning, and Adapting (CLA) This activity must incorporate a collaborating; learning and adapting (CLA) approach that: a) generates, captures, shares, and applies information and knowledge to support and improve development outcomes; b) promotes collaborative learning and exchanges with relevant institutions, stakeholders, and development partners; and c) uses information to improve the cost-effectiveness of interventions over the life of the activity. It must build on lessons learned from previous and current/existing maternal and child health and nutrition activities, including those of other donors.

C.7 PERFORMANCE WORK STATEMENT RESULTS AND INDICATORS

The Performance Work Statement (PWS) must incorporate interventions that:

1) Fully address the problems laid out above;

2) Meet all of the specific objectives and provide a realistic, yet ambitious, plan for hitting the proposed performance targets;

3) Provide a clear strategy for meeting the overarching goal in a manner that will sustain

4) results beyond the life of the activity; and

5) Address gender inequalities which negatively impact nutrition of females and focus on improving the nutritional status of adolescent girls and women of reproductive age.

The PWS must provide a variety of creative and appropriate solutions to address the challenges of maternal and child health and malnutrition as discussed above. The PWS must demonstrate an understanding of USAID/Central Asia/Tajikistan’s priorities and strategy, as described in the Regional Development and Cooperation Strategy (RDCS). The PWS should include specific, achievable targets over the five year implementation period. The Monitoring, Evaluation and Learning Plan must include all relevant standard US Government indicators at least the following indicators to measure program results. The Offeror may propose additional indicators.

Indicators

HL.6-1: Estimated potential beneficiary population for maternal, newborn and child survival program: number of live births.

HL. 6.2-1: Number of women giving birth who received uterotonics in the third stage of labor through USG-supported programs

HL.6.3-63: Number of newborns who received postnatal care within two days of childbirth in USG-supported programs.

HL.6.6-1: Number of cases of diarrhea treated in USG-assisted programs

HL.8.1-1: Number of people gaining access to basic drinking water services as a result of USG assistance

HL.8.2-2: Number of people gaining access to a basic sanitation service as a result of USG assistance

HL.9-1: Number of children under five reached by USG-supported nutrition programs

HL.9-2: Number of children under two reached by USG-supported nutrition programs

HL.9-3: Number of pregnant women reached with nutrition interventions through USG-supported programs

HL.9-4: Number of individuals receiving nutrition-related professional training through USG-supported programs

HL.9-5: A national multi-sectoral nutrition plan or policy is in place that includes responding to emergency nutrition needs (Yes=1, No=0)

Prevalence of women of reproductive age consuming a diet of minimum diversity

Prevalence of exclusive breastfeeding of children under six months of age

Prevalence of children 6-23 months receiving a minimum acceptable diet

C.8 OPERATING CONSTRAINTS

Budgetary: The activity will be expected to provide adequate budget, narrative, and results information to meet the planning and reporting demands of the Operating Plan annual budget process.

Legal and Policy Framework: The contractor must operate in line with GOT, USAID/Central Asia, and USG policies, procedures, and priorities. These include, but are not limited to, the GOT National Development Strategy, the National Health Strategy, the USAID/Central Asia RDCS, the USAID Multi-sectoral Nutrition Strategy 2014-2025. The contractor must be familiar with these strategies and formulate approaches and interventions accordingly. The contractor must collaborate closely with the GOT and other national and international health and development stakeholders to implement a sound program, which is contextually and politically appropriate and viable. The program must work under a Memorandum of Understanding between the USAID and MOHSPP.

RESULTS FRAMEWORK

PROBLEM STATEMENT

The remote Khatlon province -- FTF Zone of Influence -- has some of the country’s poorest agricultural and maternal and child health statistics. The region has the highest under-five mortality rate in the country (40 per 1,000 live births), nearly four times as high as in the capital, Dushanbe. Nearly one-fifth of children in the oblast are stunted. Stunting, measured as height for age, is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation. Stunting in early life, particularly the first 1000 days from conception until the age of two, has adverse functional consequences in the child, which include poor cognition and educational performance, low adult wages, lost productivity, and when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life.

THEORY OF CHANGE

IF USAID improves Government of Tajikistan capacity and commitment to deliver quality health care services, increases use of these improved services, and improves access to and consumption of diverse diets, THEN health and nutrition status will improve, particularly for women and children.

Objective 1: IF health providers are skilled at and utilize evidence-based practices at all levels of the health system, IF they have the necessary supplies to carry out these practices, and IF ongoing supervision and quality improvement is institutionalized, THEN they will deliver better quality services and maternal and infant morbidity and mortality will decline.

Objective 2: IF the Government of Tajikistan has the capacity and commitment to implement national strategies, reflecting evidence-based guidelines and standards, at all levels of the health system, THEN the quality of health care provided and health and nutrition outcomes will continue to improve over the long term towards sustainable self-reliance.

Objective 3: IF women, family decision-makers, and community members recognize the danger signs in pregnancy, delivery, and post-delivery and the danger signs of child illnesses and IF communities and families value and prioritize good nutrition during the first “1000 days” window and good water/hygiene/sanitation behaviors, THEN they will practice healthy behaviors and seek health care when needed and maternal and infant morbidity and mortality will decline.

POLICY AND STRATEGY IMPLICATIONS

The Healthy Mother, Healthy Baby activity will align with multiple USAID and Republic of Tajikistan priorities. This activity is fully aligned with USAID’s Journey to Self-Reliance, where all objectives support improving both commitment and capacity of the Government to improve the nation’s health and nutrition. The new activity aligns with USAID Multi-Sectoral Nutrition Strategy 2014-2025, Global Health Bureau priority Preventing Maternal, Newborn, and Child Deaths, and with the Global Food Security Strategy (GFSS). This activity will be principally implemented in the GFSS Feed the Future ZOI in the Khatlon province of Tajikistan with the ability to expand as needed. In addition, this aligns with the Tajikistan Multi-Year Feed the Future Strategy and the Central Asia Regional Development Cooperation Strategy.

More importantly the activity will address the priorities of the Republic of Tajikistan’s National Health Strategy (current and new) and the Scaling Up Nutrition (SUN) Movement Strategic Priorities as well as the Republic of Tajikistan Country Strategic Review of Food Security and Nutrition. This activity should also be in alignment with and address all other Republic of Tajikistan policies and strategies related to MCH and nutrition that are already approved or are approved over the life of the activity, including the pending Food Fortification Law.

image1.png