RFA FFP CSI Karamoja.pdf

Country Specific Information (CSI): Karamoja, Uganda

U.S. Agency for International Development

Office of Food for Peace

Fiscal Year 2017

I. Introduction

II. Country Background

III. Relationship to USAID/Uganda’s CDCS 2.0 and Other U.S. Government Strategies

IV. Guiding Principles

V. Collaborating, Learning, and Adapting

VI. Geographic Targeting and Activity Participants

VII. Activity Priorities: Context, Challenges, and Opportunities

A. Community Level Governance Structures

B. Preventing Chronic Malnutrition

C. Water, Sanitation, and Hygiene (WASH)

D. Sustainable Livelihoods: Agriculture, Livestock, Natural Resource Management, Off-farm Opportunities, and Productive Water

VIII. Sustainability Planning

IX. Development Data

X. Evaluation Criteria

Acronym List

Annex A: Uganda CDF Budget Requirements

I. Introduction

The U.S. Agency for International Development’s (USAID’s) Office of Food for Peace (FFP) intends to award up to two cooperative agreements to improve food and nutrition security and economic well-being in the Karamoja sub-region of Uganda. FFP investments are intended to contribute to the achievement of USAID/Uganda’s Country Development Cooperation Strategy

(CDCS) 2.0, particularly in building a foundation for community and household resilience.

Subject to availability, the anticipated funding for these new multi-year development food security activities is approximately $75 million (total resources for up to two awards) for a five-year period. The activity focus area is the Karamoja sub-region. Applicants may request variable annual funding levels over the life of the activity, but the total amount awarded will not exceed approximately $75 million in total. It is expected that the activity(ies) will be funded with Feed the Future Community Development Funds (CDF); thus, applicants should not include the importation of Title II food commodities in their application. With appropriate justification, applicants may request funding to support the local and/or regional procurement of food commodities, cash transfers and vouchers FFP seeks to address underlying issues surrounding access to and utilization of food.

The Karamoja sub-region, which includes the seven districts of Kaabong, Kotido, Abim, Moroto, Napak, Nakapiripirit, and Amudat, is designated as USAID/Uganda’s secondary Feed the Future Zone of Influence. Applicants may propose which districts they plan to work in and should stay within the confines of the Karamoja sub-region. A successful applicant will define an innovative and holistic approach to building resilience of communities through an integrated food security, nutrition, and economic well-being improvement activity shaped by an in-depth understanding of community and household stresses and shocks in the Karamoja sub-region.

The successful candidate(s) will implement an activity that strengthens and capitalizes upon local systems and leaderships and builds upon existing strengths in communities, local government, and the private sector with a strategic eye towards sustainability. The successful candidate(s) will link with other activities in the target districts that seek to reduce extreme poverty and improve education, improve health status, strengthen family planning and livelihoods, and reduce/mitigate conflict.

II. Country Background

More than one-third of the national population live in chronically poor households, comprised of people living on less than $1.90 a day1, while over 70 percent experience multidimensional poverty2, or live at constant risk of falling back into poverty in the face of shocks and stresses.

This vulnerability is characterized by the inability of households and communities to mitigate and manage risk and adapt to climate and other shocks and stresses.3

The pervasive weakness of systems, particularly those related to education, health, and economic development, as well as issues such as poor health and household-level poverty, makes much of Uganda’s population extremely vulnerable to external shocks and stresses.

While it is beyond the power of any donor to mitigate completely against crises such as conflict, humanitarian emergencies, and climatic variability and change, work can and must be done to improve the resilience and reduce the vulnerability of Ugandans so that they are better equipped to withstand such crises.

Applicants should refer to FANTA’s Food Security Desk Review for Uganda; FEWS NET’s

Karamoja Uganda Enhanced Market Analysis; and ATLAS’ Climate Risk Screening in Karamoja for additional background on the unique food security, health, nutrition, and climate conditions, market viability, and shocks in the Karamoja sub-region. Applicants should also refer to

USAID/Uganda’s CDCS 2.04 for further explanation of Mission priorities.

III. Relationship to USAID/Uganda’s CDCS 2.0 and Other U.S. Government

Strategies

USAID/Uganda’s CDCS 2.0

USAID/Uganda’s new CDCS 2.0’s goal of “Uganda’s systems are accelerating inclusive education, health, and economic development” is vitally important to these FFP activities. The proposed FFP activities will contribute to all three of the CDCS 2.0’s development objectives:

1) Community and household resilience in select areas and target populations increased

2) Demographic drivers affected to contribute to long-term trend shift

3) Key systems more accountable and responsive to Uganda’s development needs

1 The World Bank (2016). The Uganda Poverty Assessment Report 2016 Farms, cities and good fortune : assessing poverty reduction in Uganda from 2006 to 2013 2 Moyer, J.D., et al. (2015). Advancing development in Uganda: evaluating policy choices for 2016-2021 and selected impacts to 2040. Frederick S. Pardee Center for International Futures: Denver, Colorado, USA 3 USAID Leveraging Economic Opportunities (LEO) (2016). Ensuring escapes from poverty are sustained in Uganda.

https://www.microlinks.org/sites/default/files/resource/files/Transitory_escapes_and_Resilience_UgandaCaseStudy_ final_edited_LS_002_....pdf 4 At the time of the CSI posting, the CDCS is not public. Applicants are encouraged to check the USAID/Uganda website for the new CDCS which will be released to the public in the next several weeks.

https://www.usaid.gov/documents/1866/fanta-food-security-desk-review-karamoja-uganda-2017 https://www.usaid.gov/documents/1866/fews-net-karamoja-uganda-enhanced-market-analysis-2016 https://www.usaid.gov/documents/1866/fews-net-karamoja-uganda-enhanced-market-analysis-2016 https://www.usaid.gov/documents/1866/food-peace-climate-risk-screening-uganda-karamoja https://www.microlinks.org/sites/default/files/resource/files/Transitory_escapes_and_Resilience_UgandaCaseStudy_final_edited_LS_002_....pdf https://www.microlinks.org/sites/default/files/resource/files/Transitory_escapes_and_Resilience_UgandaCaseStudy_final_edited_LS_002_....pdf

In the two years prior to the launch of the CDCS 2.0 development process in March 2015, USAID/Uganda conducted a series of learning exercises from the implementation of CDCS 1.0.

These exercises ultimately generated several top-line, strategic-level lessons learned which impact this activity:

● The systematic application of a thoughtful and deliberate Collaboration, Learning and

Adapting (CLA) approach to activities achieved better results;

● When integration is built into activity design, and deliberately managed through implementation, results are transformational;

● Neither Ugandan systems nor USAID assistance has to date given appropriate weight to the youth bulge and its attendant effects, raising questions about long-term sustainability.

Uganda is in the midst of a demographic tsunami - based on current projections, the population is set to double to nearly 80 million by 2040. Recognizing that over 78 percent of Ugandans are under the age of 305, USAID/Uganda’s CDCS 2.0 focuses on the median Ugandan - the 14 year old girl. In order to drive sustainable development, new investments will need to focus on reaching her and her peers, more broadly on positive youth development.

FFP Strategy

The investments made in Karamoja align directly with Food for Peace’s 2016-2025 Food

Assistance and Food Security Strategy and with FFP’s strategic goal: Food and nutrition security of vulnerable populations improved and sustained. To achieve this goal, FFP has set out two strategic objectives that cut across both emergency and development programs and encompass work to support change at the individual and household level, as well as work to strengthen local systems and support more sustainable and transformative change.

Strategic Objective 1: Lives and livelihoods protected and enhanced

FFP works to protect and enhance the lives and livelihoods of those affected by crisis, and those vulnerable to crisis due to chronic poverty and hunger. In acute emergency situations, this may be by meeting immediate food and nutrition needs of those most vulnerable to food deficits. In recovery and development settings, the emphasis may shift towards improving the lives of the most marginalized and protecting development investment through capacity building, knowledge transfer, household asset-building, or other productive investments contributing to improved food security across a range of sectors.

Strategic Objective 2: Communities and institutions transformed

Development work that not only avoids doing harm but also succeeds in strengthening local systems can lay an important foundation for transformative change. Under SO2, FFP works to strengthen communities and institutions which then serve as catalysts for greater and more sustainable change in emergency, recovery and long-term development settings alike. SO2

5 Republic of Uganda (2014). National Population and Housing Census. Provisional Results.

https://www.usaid.gov/sites/default/files/documents/1867/FFP-Strategy-FINAL%2010.5.16.pdf https://www.usaid.gov/sites/default/files/documents/1867/FFP-Strategy-FINAL%2010.5.16.pdf provides a pathway to address root causes and drivers of food insecurity through efforts to strengthen the capacity of institutions, reduce risks, and provide engines of growth, opportunity and change.

U.S. Government’s Global Food Security Strategy

The U.S. Government’s Global Food Security Strategy (GFSS) is an integrated whole-of-government strategy and includes agency-specific implementation plans as required by the

Global Food Security Act of 2016. This strategy reflects the unique skills, resources, and lessons learned from U.S. federal departments and agencies that contribute to global food security, as well as input from partners throughout the private sector, academic institutions, and civil society. It charts a course for the U.S. Government to contribute to the achievement of global food security and the range of Sustainable Development Goals, together with partners across the globe.

The GFSS advances the overarching goal of Feed the Future to sustainably reduce global hunger, malnutrition, and poverty through three interrelated and interdependent objectives:

● Inclusive and sustainable agricultural-led economic growth, as growth in the agriculture sector has been shown in some areas to be more effective than growth in other sectors at helping men and women lift themselves out of extreme poverty and hunger. It does this by increasing availability of food, generating income from production, creating employment and entrepreneurship opportunities throughout value chains, and spurring growth in rural and urban economies.

● Strengthened resilience among people and systems, as increasingly frequent and intense shocks and stresses threaten the ability of men, women, and families to sustainably emerge from poverty.

● A well-nourished population, especially among women and children, as undernutrition, particularly during the 1,000 days from pregnancy to a child’s second birthday, leads to lower levels of educational attainment, productivity, lifetime earnings, and economic growth rates.

USAID’s 2012 Policy and Programming Guidance on Building Resilience to Recurrent Crisis defines resilience as “the ability of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth.” In short, resilience is the ability to manage adversity and change without compromising future well-being. As this suggests, resilience is a necessary condition—or set of capacities—for reducing and ultimately eliminating poverty, hunger, malnutrition, and humanitarian assistance needs in the complex risk environments in which USAID works and poor and chronically vulnerable people live. For more information on

USAID's resilience work, visit: https://www.usaid.gov/resilience.

https://www.usaid.gov/what-we-do/agriculture-and-food-security/us-government-global-food-security-strategy https://www.usaid.gov/sites/default/files/documents/1870/USAIDResiliencePolicyGuidanceDocument.pdf https://www.usaid.gov/resilience

IV. Guiding Principles

The following principles should inform the design and implementation of this activity:

● Sustainably strengthen and support existing markets, social systems, and

Government of Uganda strategies. Effective and well-functioning systems relevant to implementing sound policies and strategies are drivers of sustainability and positive change. Applicants are encouraged to identify and support local systems6 in their manageable interest that are critical to the delivery of goods and services for this activity. Where appropriate and feasible, applicants should link and contribute to the

Government of Uganda’s strategic plans for Karamoja (e.g., Karamoja Integrated

Development Plan II).

● Coordinate and link with others to leverage comparative advantages and catalyze investment for collective impact. Development in Karamoja features a plethora of actors who often do not act in coordination with one another. Without coordination, development efforts are at risk of, at best, not realizing potential synergies, and, at worst, undermining investments. Where appropriate, working with other USAID/Uganda, Government of Uganda, including the Office of the Prime

Minister, and other donors’ investments in Karamoja as well as any USAID cross-border investments is encouraged. Specific methods of collaboration with other USAID implementing partners include but are not limited to coordination of annual work plans, sharing information on which participant households they are working with, making joint field visits, proactively sharing reports with one another, co-design of layered activities, and generally having regular productive communication with other implementers, unprompted by USAID.

● Support the enfranchisement, aspirations, and agency of women and youth.

As a result of the shift from pastoralism and cattle-raiding to agro-pastoralism, the roles of men, women, and youth are evolving rapidly. Women and girls are particularly vulnerable to poverty and deprivation and they face a high risk of discrimination and social exclusion. Prioritizing inclusive development is fundamental to realizing equitable development gains in Karamoja. Understanding what demographic and societal changes are underway and how to promote positive changes in how older and younger men and women relate are essential—both for social stability and attaining food security programming objectives. Where appropriate, applicants are encouraged to engage youth strategically, through youth-focused programming and the integration of youth throughout the proposed interventions.

6 Refer to USAID’s Local Systems: A Framework for Supporting Sustained Development for more information.

https://www.usaid.gov/sites/default/files/documents/1870/LocalSystemsFramework.pdf

● Use resource transfers and subsidies strategically. FFP supports the use of tailored resource transfers to meet the food security needs of participants and to build capacity of and leverage households and local systems to ensure long-term food security and to become more resilient to shocks and stresses. Doing so not only provides direct support to activity participants but also can strengthen markets, leading to wide reaching multiplier effects.

● Integrate and leverage all pathways to better nutrition. Addressing food insecurity and chronic malnutrition requires holistic and integrated interventions in support of vulnerable households. Applicants are encouraged to ensure the convergence of nutrition sensitive and nutrition specific interventions and strategies targeting vulnerable 1,000-day households.

● Ensure activity plans for flexibility to respond to likely shocks. Karamoja is vulnerable to recurrent shocks, especially climate shocks, and it is likely that one or more major shocks, such as a drought, will stress the sub-region during the implementation period. Applicants are encouraged to articulate how proposed programming will reduce vulnerability to cyclical shocks common to the sub-region and respond in the event of a shock.

● Build upon existing knowledge base. Over the course of multiple decades, humanitarian assistance and, more recently, development resources have been provided throughout the sub-region. Applicants are encouraged to build upon existing knowledge base of participants across technical areas. Ultimately, the aim is to transition knowledge into practice.

V. Collaborating, Learning, and Adapting

Collaborating, learning, and adapting (CLA) is fundamental to USAID/Uganda and FFP investments. Applicants are strongly encouraged to apply CLA throughout the award’s lifecycle, as well as through the creation of an enabling environment that promotes leadership and resilience. The key elements of the CLA concept are:

● Collaborating. This should enable cross-sector integration, convergence, and enhanced development results, and resilient, effective interventions internally within the awards;

and, externally, to maximize development resources, to build trust, and to continuously engage inclusively with other stakeholders, particularly local government, the Ministry for Karamoja Affairs, and other implementing partners.

● Learning. An intentional, systematic and resourced approach should be taken to learning from data of all kinds, as well as drawing out tacit knowledge to inform better programming. This should apply at all levels of programming, as well as to management approaches, processes, and staff engagement.

https://usaidlearninglab.org/faq/collaborating-learning-and-adapting-cla

● Adapting. Adaptability will enable change within the activity, while recognizing the incentives and behavioral changes necessary for that adaptation to take place.

Critical to the CLA agenda, applicants can consider their ability to respond to the potential for iterative, adaptive, flexible, and responsive shifts in the development context. Applicants can anticipate incorporating a learning and communications agenda into the award with intentional and explicit emphasis on ongoing analytical approaches to validate and/or inform adjustments in the activity itself. As learning is critical to the sustained impacted of activities as well as scaling the successful components, applicants should actively and regularly share progress with local government and other development partners.

Awardees will have the opportunity to collaborate with other USAID and other donor investments as part of a larger resilience approach within Karamoja, more broadly within

Uganda, and within the Horn of Africa Region. This activity is expected to contribute to

USAID’s overall resilience efforts in the Horn of Africa, as articulated in The Horn of Africa

Resilience Network (HoRN) Regional Resilience Framework 2.0. This could include participating in joint work planning and implementation, co-location of activities, and contributing to national and regional learning efforts. Successful applicants should anticipate:

● Coordinating with other USAID and other donors’ partners and specifically working with the Karamoja Resilience Support Unit.

● Strengthening the evidence base on resilience programming. This effort will build on and benefit from the evidence base from resilience efforts in other countries, especially similar activities in pastoralist zones in Kenya and Ethiopia. It will also systematically collect evidence on what activities and approaches are working in Karamoja.

● Adapting its activities as conditions change and learning evolves. Karamoja is a dynamic sub-region, and the shocks and stresses that drive the need for resilience programming in the sub-region will impact implementation. Regular and systematic coordination between partners, reinforced by a GIS-based monitoring system, will allow more rapid and analytically sound adjustments.

VI. Geographic Targeting and Activity Participants

Based on analyses of key indicators of food security; nutritional and health status; educational and water and sanitation deficiencies; historical need for humanitarian assistance; and other considerations, the seven districts of Karamoja have been chosen as the geographic focus for

FFP investment.

The Karamoja sub-region experiences the highest levels of vulnerability in Uganda and has a history of marginalization and underdevelopment. Previous years of insecurity exacerbated widespread poverty and the sub-region suffers from the worst development indicators in https://www.usaid.gov/documents/1866/food-peace-regional-resilience-framework-20 https://www.usaid.gov/documents/1866/food-peace-regional-resilience-framework-20

Uganda: over 80 percent of the Karamojong7 live in absolute poverty8, acute and chronic malnutrition rates among children remain persistently high, and illiteracy rates among women reach over 77 percent9. Weak and underfunded local governments lead to non-governmental organizations (NGOs) and civil society organizations filling gaps and providing social services.

There are over 106 NGOs currently implementing activities in the sub-region across multiple sectors and in all of the seven districts. Their work is often constrained by ineffective coordination of interventions and inconsistent and sometimes conflicting approaches. USAID is implementing efforts to strengthen coordination across NGOs, with other donors and with

Government of Uganda stakeholders at the Office of the Prime Minister, particularly the

Ministry of Karamoja Affairs and elsewhere.

Karamoja is also subject to recurrent drought (and other) crises, during which the vast majority of people in the sub-region are reliant on humanitarian assistance. As recently as 2009, 970,000 out of an estimated 1.2 million people in Karamoja needed life-saving humanitarian assistance as a result of drought and conflict.10 This drought crisis scenario has repeated itself in Karamoja every three to four years for decades and has been exacerbated by past conflict. These conditions disrupt lives and livelihoods and necessitate costly interventions. The U.S.

Government provided an estimated $210 million in humanitarian assistance to Karamoja between 2003 and 2014.11 This is unsustainable and underscores the need to build resilience to recurrent crises by strengthening the capacities of people, households, communities, and systems in the sub-region. Doing so will be essential for achieving sustainable improvements in food security, nutrition, and economic well-being.

Years of outside aid has led to donor dependency, undermining local development and household and community resilience in Karamoja. In recent years, the sub-region has stabilized, setting the stage for resilience and development gains to be realized. With peace came a fundamental shift in many Karamojong’s economic opportunities, resulting in great potential for both development in the livestock sector and diversification of livelihoods. There is an opportunity to better link the sub-region with the rest of Uganda.

Assistance to communities in the identified districts will be integrated across sectors, with other parts of the USAID/Uganda portfolio, and with the Government of Uganda, private sector, and other donor initiatives and activities. Additionally these activities have the

7 For the purposes of the CSI, the term Karamonjong is used to refer to the inhabitants of the districts within the

Karamoja sub-region. This collective includes ethnic groups or sub-tribes of the Dodoth, Jie, Pokot, Bokora, Matheniko, Pian, Tepeth, Nyakwe, Iik, Ngipore, and Ethur.

8 Resilience Analysis Unit (2015). Resilience Context Analysis Resilience to food insecurity and malnutrition in

Karamoja, Uganda 9 UBOS and ICF International Inc. (2012). Uganda Demographic and Health Survey 2011, Kampala, Uganda: UBOS and Calverton, MD: ICF International, Inc.

10 USAID/Uganda estimates.

11 Ibid.

opportunity for engagement with USAID/Kenya and East Africa’s investments in the neighboring

Turkana County of Kenya. Interventions should be socially and ethnically inclusive, sensitive to conflict dynamics, and focused on sustainably improving food and nutrition security and economic well-being at the household and community levels.

Activity Participants: Under this award, FFP plans to target poor and very poor households who routinely experience food gaps, are not able to sufficiently recover between shocks, and may lack the resources or capacities necessary to invest in positive change. These households will be considered the impact group with which the FFP activity aims to achieve positive outcomes. At the same time, FFP realizes that there are other actors and systems that play key roles in achieving these outcomes but do not fit the impact group criteria. Therefore, FFP is supportive of activities aimed at different target groups or systems as long as applicants are able to indicate how these actions will positively affect the impact group.

While Karamoja is an impoverished sub-region, the Karamojong should not be broadly classified as poor, disadvantaged individuals. Entrepreneurship is alive, and there is untapped commercial potential within the livestock sector and in the greenbelt areas. There is also a very robust set of lessons to be learned from indigenous coping strategies. While the traditional pastoralist society may not have wealth in terms of cash, livestock is a critical asset among the

Karamojong, and adequate consideration should be given to its key role both in society and development. Interventions should be based on the relative needs of the participants, specific to the livelihood zone, ethnicity, and seasonal trends.

Role of Resource Transfers: While importation of Title II commodities is not permitted for these activities, applicants are encouraged to consider if resource transfer modalities are appropriate to enable vulnerable households to smooth consumption, adopt healthier practices, and take advantage of opportunities leading to sustainable linkages to services, markets, and employment. These modalities could include any combination of local and/or regional procurement, cash, vouchers, asset transfers, or “smart subsidies” (e.g., improved inputs).

Resource transfer selection should be justified based on market appropriateness (including seasonality), feasibility, activity objective, and cost efficiency while adhering to do no harm principles.

Understanding the role of resource transfers as time-bound, and using them creatively and appropriately as a means to enable communities and households to make strategic and transformational choices for themselves, can help minimize dependence or short-lived impact.

FFP encourages applicants to consider imposing conditionalities in exchange for resource transfers, as appropriate. Applicants should detail the proposed delivery mechanisms, their feasibility and timing in relation to livelihood group and seasonality. Considering the life of the award, applicants should detail the time-bound nature of the proposed resource transfers and the long term plans to graduate participants from assistance.

The World Food Program (WFP) is currently piloting its participant and transfer management system, SCOPE, in Karamoja. SCOPE is a web-based application used for participant registrations, intervention setups, distribution planning, transfers, and distribution reporting.

Ultimately, it is envisioned that SCOPE will be used across development actors in Karamoja. If

SCOPE is successfully implemented by the time of the award(s) being awarded, or during the lifetime of the award, it is anticipated that awardees will work within WFP’s SCOPE system.

VII. Activity Priorities: Context, Challenges, and Opportunities

FFP believes there are four key thematic areas which should be addressed in order to achieve a food secure future in Karamoja sub-region of Uganda: community-level governance, preventing chronic malnutrition, water, sanitation and hygiene (WASH), and sustainable livelihoods. In addition, the guiding principles noted in section IV improve the potential for success of our work in these thematic areas. When these thematic areas are addressed and guiding principles applied, Karamojong households should be better placed to achieve food security and weather future shocks.

Applicants must address each thematic area, unless they provide a thorough explanation of why working in a particular thematic area would not be appropriate for the proposed approach.

Applicants are only expected to respond to relevant challenges and opportunities that underpin their theory of change. Unless otherwise noted, applicants may address other challenges or identify opportunities that further the achievement of the activity’s goal that are not addressed in the CSI. Applicants must also articulate how interventions or activities proposed under each thematic area will leverage and reinforce interventions or activities in the other thematic areas to ensure synergy and complementarity of efforts.

A. Community Level Governance Structures

Context

The Karamoja sub-region is shaped by a complex range of conflict and security dynamics, all linked to different governance, social, cultural, and development issues. The sub-region has long been characterized by violent conflict, illicit small arms proliferation, and insecurity.

Owing to years of tradition and history, the Karamoja sub-region has dual systems of governance coexisting in the same communities. First, the traditional, informal structures of the council of elders, although waning, still retain significant power and authority over assets, behaviors, decision-making, provision of security and roles in the community. Second, the formal governance structure in Karamoja is that of Local Councils (LCs). The local councilors are the elected representatives of the people, who serve on the LCs, and are most trusted among the communities, supported by technical and administrative personnel. These councils cascade at different administrative levels (village (LC1), parish (LC2), sub-county (LC3), and district (LC5)). However, these LCs often lack planning and budgeting skills, knowledge of their responsibilities, and are short of funds and human resources to deliver needed social services, as well as to coordinate development interventions by other stakeholders. As a result, the sub-region has weak ownership of a coherent development process.

As good governance is a foundational component of development, improved community level governance structures in Karamoja should have ripple effects across the other thematic areas highlighted in the CSI.

Challenges

Poor stakeholder coordination: The Karamoja sub-region has attracted a considerable number of development practitioners, each coming with different objectives, approaches, and expected results, with limited synergy built around their interventions. From faith-based organizations, NGOs, United Nations agencies, community groups, and private sector entities, each actor places emphasis on its niche or mandate. The lack of coordination means interventions do not draw from synergies, often even contradict each other, as well as miss opportunities for a more concerted response to development challenges. In particular, the weak local government capacity deprives the communities of the framework to which stakeholders can align their interventions and provide oversight and ownership.

Untapped participation of communities: After decades of protracted humanitarian crises, outside engagement and resources are deeply rooted in Karamoja. In many ways the role of different charities has undermined rather than strengthened communities’ resilience and self-reliance. The dependency culture is also witnessed among government officials who condition their participation in meetings to fees and allowances. Additionally there is limited participation of communities in development interventions targeted “at” them. The communities are often not adequately consulted on planned development interventions, especially regarding their own knowledge and local context. In the long run, the community reliance on charity perpetuates cyclical vulnerability.

Weak local government capacity for service delivery: While generally Uganda has an elaborately decentralized system of governance, meant to bring services closer to the communities, the local government units are grossly underfunded with over 90 percent of central government appropriations allocated to districts’ salaries. In addition, most local governments lack adequate and qualified staff to deliver on their mandate. Therefore, local governments are not only unable to plan, budget, or efficiently deliver services, but also unable to coordinate interventions by other stakeholders to ensure alignment with the needs of communities and local government priorities.

Conflict – resource based, ethnic, and cross-border: Conflict in Karamoja is a confluence of mutually reinforcing factors, including but not limited to, communal violence, ethnic and clan-related warfare, food insecurity, poor human development, displacement, and a deteriorating natural environment. To a significant extent these factors constitute a perennial, almost structural, set of conflict dynamics in Karamoja. There has generally been relative peace in

Karamoja with a significant reduction in the level of violence in the sub-region in recent years.

This is partly a result of the forceful disarmament of livestock raiders in the sub-region. It is also a result of considerable work by local, national, and international NGOs in training peace mediators and promoting peace dividends. Following the recent disarmament by the Uganda

People's Defense Force in the Karamoja sub-region, inter-community dialogues and increased participation of women in peace communities have resulted in relative peace. However, the situation remains fragile, with inter-ethnic tension and livestock raids, contributing to unresolved conflict and resentment. Trauma, domestic violence, and alcohol abuse, among other challenges remain highly prevalent in Karamoja. In particular, with many of the root causes of conflict remaining (inequality, perceived unfairness, community/government mutual distrust) or increasing (pressure on land, hopelessness among young people and women), additional work is needed. In addition, the sub-region’s borders remain insecure and relatively porous between northeastern Uganda, South Sudan, and northern Kenya (linking to Somalia).

Opportunities

Improving monitoring and assessment of inter-ethnic conflict: A number of actors, including faith-based organizations, NGOs, and government institutions, are engaged in conflict monitoring and assessment. These interventions have improved the understanding of the incidences of violence and the trends across the sub-region. A number of stakeholders have also been trained across the sub-region in peace-building, reconciliation and conflict resolution practices. However, better systems are needed to monitor and assess what is actually happening in Karamoja and to measure the impact of programs and security responses in the sub-region.

Building upon existing coordination mechanisms: The Ministry of Karamoja Affairs is an existing Government of Uganda entity that is mandated to coordinate operations and stakeholders within Karamoja. Ongoing district-level technical working groups in protection, health, etc., are led by either district officials or different UN agencies. Although these working groups are narrowly focused on a particular sector, they point to a promise for a more enhanced coordination capability for interventions not only at the district level, but also in lower community levels. Recently, the Karamoja Partners Donor Group has put in place new mechanisms, along with the International NGO Karamoja Group, to promote evidence-based analyses, coordination, and the alignment of their interventions with Government of Uganda policies. The two groups aim to better coordinate with the Government of Uganda through improved information sharing, maintaining up-to-date intervention mapping and joint assessments.

Existing formal and informal structures: The presence of services user committees, such as water user committees, health services committees, hand pump mechanics associations, etc., provides an opportunity to strengthen and deepen governance at lower community levels.

Additionally, there is an opportunity to support informal structures such as the pastoralist council of elders, Kraal leaders, and others to promote decision-making and enhance community security and behavioral change.

Promoting government accountability: Expanding transparency and access to information can advance government accountability and service delivery. Providing technical assistance to and building the capacity of government officials for service delivery have the potential to assist with the sustainability of the investments made under this and other activities. By facilitating and strengthening the coordination capacity of local governments, it is possible to ensure that investments and interventions made by different stakeholders have the potential to draw on synergies and minimize unnecessary duplication and overlap. Additionally, assisting communities with systems to hold government accountable to provide inherently governmental services is a potential investment area to be explored.

B. Preventing Chronic Malnutrition

Context

Compared to the rest of the country, Karamoja sets itself apart by its poor nutritional situation, with simultaneously high levels of stunting, wasting, and micronutrient deficiencies. Chronic malnutrition remains higher in the Karamoja sub-region when compared to the rest of the country: 45 percent in Karamoja, compared to the national average of 33 percent.12 Similarly, global acute malnutrition measured during the lean season has not improved between 2010 and

2015, where it hovers between 12 and 15 percent,13 near the emergency threshold level.

Strikingly, women age 15-49 years are highly undernourished with over one-fourth having a low

BMI, while 43 percent are anemic. While cattle and small ruminants remain highly prized by most Karamajong, consumption of animal-source foods is limited for children and pregnant women, especially among non-pastoralist households. Dietary diversity remains low, as does the minimum acceptable diet of children 6-23 months. Given the high prevalence of child illness, especially malaria and diarrhea, proper feeding during illness is critical to reducing chronic

12 UBOS, ICF: Uganda Demographic and Health Survey. 2011, Kampala, Uganda: UBOS and Calverton, Maryland:

ICF International Inc, http://www.measuredhs.com/pubs/pdf/PR18/PR18.pdf].

13 Food Security and Nutrition Assessment (December, 2015). UKAid, UNICEF, WFP, School of Public Health, Makerere University College of Health Sciences, January 2016 malnutrition. Additionally, according to the 2011 Uganda Demographic and Health Survey

(UDHS), nearly three in ten children born to mothers residing in Karamoja, were reported as either very small or smaller than average at birth.

Given the persistent food insecurity in the sub-region, successful activities will support a holistic approach, use existing structures, and foster linkages to improve nutrition-specific (maternal, infant and child nutrition) and nutrition-sensitive (including WASH and family planning) community services, along with local capacity strengthening to sustain ongoing improvements.

For FFP, a preventive approach to undernutrition in the first 1,000 days of life includes a strong focus on maternal nutrition, exclusive breastfeeding, and increasing knowledge and use of nutritious and adequate complementary foods beginning at six months. A preventive intervention should also contribute to decreasing the incidence of both chronic and acute malnutrition through improvements in practices such as immunization, deworming, malaria prevention and treatment, community integrated management of childhood illnesses, growth promotion; monitoring and improved pregnancy spacing; use of safe drinking water, and appropriate hygiene. Taking best practices into account, emphasizing the scale-up and integration of sound strategies which will address child and women’s nutrition, along with strategic support to district governments to improve planning and coordination of nutrition-related activities is critical to improving nutritional outcomes in Karamoja.

Implementation of the Uganda Nutrition Action Plan (UNAP) at the district and subcounty levels: As the UNAP continues to be rolled out in Karamoja, there remain many questions as to how this will be done and more importantly, by whom over the long term. The

UNAP calls for District Nutrition Coordination Committees (DNCC) to plan, budget, leverage existing resources, advocate for and monitor nutrition activities at the district level working across all nutrition-sensitive (agriculture, education, social protection, WASH, etc.) and nutrition-specific (prevention and treatment of undernutrition and illness) actors. DNCC leadership is limited due to lack of funding and lack of capacity in planning, budgeting, and coordination skills.

Poor uptake of services to prevent malnutrition, especially in children under two:

While exclusive breastfeeding practices are among the best in the country, minimum acceptable diet of children 6-23 months is very low. With regards to child dietary diversity, most children have vegetarian diets by default and their feeding is not prioritized within the household.

Several successful efforts have been put in place to strengthen management of acute malnutrition in Karamoja, as GAM rates have stabilized over the last two years of drought, however stronger attention to prevention of all forms of malnutrition is needed.

Lack of Diverse, Nutrient Dense Diet: Regarding sources of food, there is a fair degree of variation between pastoralist, agro-pastoralist, and agricultural livelihood groups. An important challenge that remains is how to simultaneously increase the availability (and affordability) of nutrient-rich diverse foods such as animal source foods, while ensuring that the most vulnerable members of the household benefit. A major barrier to better nutrition in the Karamoja context is how to extend the availability of nutrient dense foods during periods where they are scarce, especially during the lean season.

Complex gender dynamics among the Karamojong negatively impact health and nutrition: Women and girls have primary responsibility for hut building, homestead fencing, household cleanliness, childcare, food preparation, and water and firewood collection. Due to women’s conflicting household responsibilities, they often have to rely on their daughters to take care of other children. Low BMI of Karamajong women may likely be due to high energy expenditure given women’s role in agriculture and other labor as well as poor consumption patterns. Some of the major barriers to improving women’s and child nutrition are gender related, including lack of sharing of household responsibilities, gender-based violence, and changing roles of men in a post-conflict Karamajong society. Additionally, early childhood marriage and thus early onset of childbirth remains a common practice among the Karamajong.

Alcohol Abuse: Over the past 10 years, women have begun brewing more sorghum beer for sale, an important food and ritual item. The economic importance of beer is perhaps best expressed in the Karamojong saying that ‘‘beer is the cattle of women.” There is limited evidence that women are able to keep the revenue associated with the sales of the beer. The health implications of beer commercialization are multi-faceted, including feeding infant and young children the dredges; the social implications are no less so, including the link between alcohol consumption and sexual and gender based violence. While banned in Uganda, the drinking of locally distilled gin (Waragi) is on the increase. Waragi has a higher alcohol content than sorghum beer and it has led to serious social and health implications. The growing alcohol consumption trend has been noted among communities, development actors, and local governments as an increasingly serious problem facing the Karamojong.

Family Planning Uptake: Karamoja lags behind the rest of the country in many family planning related indicators. According to the most recent UDHS, the percentage of currently married women using a contraceptive method was lowest in Karamoja (8 percent). In terms of fertility desires, married women in Karamoja are the least likely (27 percent) to want to limit childbearing (the Karamoja sub-region has one of the shortest median intervals of birth) and have the highest number of ideal children (7.2 children) of the regions in Uganda. Childbearing begins at a earlier age in Karamoja, where the percentage of teenagers who have begun childbearing was also among the highest in Uganda (around 30 percent). Of note, a much lower proportion of women living in the Karamoja sub-region support negotiation of safer sexual relations compared with women living in the rest of Uganda.

HIV/AIDS: The Uganda AIDS Indicator Survey (UAIS)14 indicated that Karamoja was one of the regions in Uganda that showed a 100 percent increase in HIV prevalence in a five-year period, from 2.4 percent to 5.3 percent. While an updated UAIS is underway, there are several factors in the Karamoja sub-region that increase the risk of HIV transmission. For example, reports from the UAIS and UDHS show low comprehensive knowledge of HIV prevention in Karamoja, including the correct and consistent use of condoms, compared to the rest of Uganda. Karamoja also registers Uganda’s lowest proportion of women who support negotiation of safer sexual relations. Stigma towards people living with HIV is still high among communities. There is also a very low coverage of male circumcision, a growing migratory population (e.g. mining work), and increasing urbanization.

Emphasize girls’, women’s and mothers’ health and nutrition, including family planning: Further emphasis is needed on the health, safety and well-being of adolescent girls and young women, as well as nutrition during pregnancy. Women carry an extremely heavy burden among the Karamojong with regards to labor, caregiving, and myriad other household responsibilities. Additionally, women’s literacy is abysmally low in the sub-region. These factors, among others, may be associated with Karamajong women having the highest prevalence of underweight in Uganda, which is a major contributor to babies being born too small. With a high fertility rate compared to the rest of the country, there is a critical opportunity to address barriers to family planning, including modern contraceptive methods, decreasing social-cultural and gender barriers to use, and capitalizing on the upward trend of

Karamajong women delivering in facilities.

Nutrition Sensitive Considerations: Considerations should be made to enhance availability and affordability of complementary foods with considerations for seasonal variations. A “one size fits all” approach for identifying nutrition-sensitive pathways will not work across the different livelihood zones, and special considerations will be needed for the poorest of the poor and during inevitable periods of drought or other shocks. Given that most Karamojong are pastoralist or agro-pastoralist, there is great potential to increase access to and extend the availability of animal source foods. Other areas such as early child development, family planning and education/literacy could also be explored and potentially mainstreamed into livelihoods activities. As discussed below, social and behavior change (SBC) should target both nutrition-specific and a select number of key nutrition-sensitive practices.

14 Ministry of Health Uganda & ICF International (2012). Uganda AIDS Indicator Survey 2011. Kampala, Uganda.

Strengthen existing community health and nutrition systems: Opportunities to support “bottom up” approaches at lower level health centers and within communities while also forging stronger linkages with district level efforts such as the DNCC are potential investment areas. As mentioned in the guiding principles, it is critical to avoid duplication of other actors’ investments (such as UNICEF’s efforts and DFID-supported investments).

However, there is potential to build upon existing mother-care groups and strengthen community ownership through support to village health teams and Health Unit Management

Committees. Greater buy-in from Government of Uganda officials is required as such structures need to be officially recognized by the local governments to enhance oversight, accountability, and sustainability. Furthermore, community health and nutrition efforts, including support to fill gaps in coverage of management of acute malnutrition, will require a resilience focus, utilizing facilitative approaches which build upon customary institutions of the

Karamojong (e.g., manyatta leadership) as well as other social networks.

Continued support…