The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) @#&OPS~Doctype~OPS^blank@pidaprcoverpage#doctemplate Project Information Document (PID) Appraisal Stage | Date Prepared/Updated: 11-Feb-2025 | Report No: PIDIA01243 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) @#&OPS~Doctype~OPS^dynamics@pidaprbasicinformation#doctemplate BASIC INFORMATION A. Basic Project Data Project Beneficiary(ies) Region Operation ID Operation Name WESTERN AND CENTRAL Accelerating Nutrition Nigeria P507935 AFRICA Results in Nigeria 2.0 Financing Instrument Estimated Appraisal Date Estimated Approval Date Practice Area (Lead) Investment Project Health, Nutrition & 21-Oct-2024 27-Mar-2025 Financing (IPF) Population Borrower(s) Implementing Agency Federal Ministry of Health Federal Republic of Nigeria and Social Welfare Proposed Development Objective(s) Increase utilization of quality, cost-effective, convergent, nutrition-specific and nutrition-sensitive services for pregnant and lactating women, adolescent girls and children under five years of age in select areas of the recipient's territory. Components Basic Package of Nutrition Services Convergence with Food Systems Data-Driven Multisectoral Coordination and Accountability @#&OPS~Doctype~OPS^dynamics@pidprojectfinancing#doctemplate PROJECT FINANCING DATA (US$, Millions) Maximizing Finance for Development Is this an MFD-Enabling Project (MFD-EP)? Is this project Private Capital Enabling (PCE)? SUMMARY Total Operation Cost 80.00 Total Financing 80.00 of which IBRD/IDA 80.00 Financing Gap 0.00 Page 1 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) DETAILS World Bank Group Financing International Development Association (IDA) 80.00 of which IDA Recommitted 30.00 IDA Credit 80.00 @#&OPS~Doctype~OPS^dynamics@envsocriskdecision#doctemplate Environmental And Social Risk Classification Moderate Decision The review did authorize the team to appraise and negotiate B. Introduction and Context Country Context 1. Nigeria, Africa's most populous country, largest economy and home to the second-largest population living in poverty, below US$2.15 per day, possesses substantial untapped economic potential yet is one of the least developed nations globally. Economic growth over the past decade has not maintained pace with population growth: real income per capita in 2023 was US$2,455, lower than US$2,490 recorded in 2010. Nigeria’s key development constraints include the high dependence on oil, insufficient economic diversification and inclusive growth, and a poor scorecard on good governance and service delivery including investments in human capital.2 As a diverse federation of 36 autonomous states and 220 million people, federal-state coordination is a challenge.3 Pathways for development include improving economic governance and generating more trust in State institutions, boosting government investments in human capital, expanding social assistance programs to sustain the move away from fuel subsidies, and improving opportunities for the young and entrepreneurial to diversify the economy and invest in inclusive economic growth. 2. In recent years, the economy has been hit by the COVID-19 pandemic, a fall in global oil prices, increasing insecurity, and weak domestic oil production. The post-COVID recovery was short-lived with real GDP growth dropping from 3.6 percent in 2021 to 3.1 percent in 2022-2023, due to low oil production, flood-related low agricultural output, and the disruptive currency demonetization policy instituted in Q1-2023. The fiscal space is limited by the need to service debts (101.5 percent of revenues in 2022) and vulnerable to fully realizing the fiscal transfers from the oil and gas sector, thus restricting public investments. 3. Climate change threatens development gains in Nigeria, with a disproportionate impact on the poor. Nigeria is highly vulnerable to climate shocks, including extreme heat, floods, and drought, all of which are predicted to become more frequent and severe with climate change. The country has low adaptive capacity to address climate change, ranking 154 Page 2 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) out of 185 countries on the Notre Dame Global Adaptation Index (ND-GAIN) of climate vulnerability and readiness.1 Climate change already has negative impacts on the country’s economic growth, with an estimated GDP loss of between 6 percent and 30 percent by 2050, worth an estimated US$100–460 billion, due to climate change.2 Recent climate shocks and overarching climate change including deforestation, floods and variable rainfall amplifies the impacts of conflict and shocks on agricultural yields, food production, and trade, thus raising food security problems and compound the severity of the issue.3 3. Women and youth are disproportionately affected by Nigeria’s interconnected shocks due to their greater reliance on the informal sector and absence of social protection. Recent evidence shows that Nigerian women of childbearing age are more likely to be poorer than men of the same age. For example, childbirth severely limits women’s ability to pursue education, and unequal childcare responsibilities and domestic burden restrict them from pursuing productive activities outside the home. Millions of Nigerians are facing several large-scale and increasingly interconnected shocks, including high inflation, food insecurity, climate change, natural disasters, and fragility, conflict, and violence (FCV). While in the past, most of Nigeria’s poor lived in rural areas, the recent shocks have significantly affected the urban population, increasing their share among the poor.4 Sectoral and Institutional Context 4. Deployed as the first slice of a long-term programmatic engagement, the ANRiN Project focused sharply on the scaling of nutrition-specific interventions whilst testing out the mechanisms for multisectoral coordination and accountability. Implemented in eleven high-burden states, and predominantly in the health sector, the operation reached over 13 million Nigerian women, adolescents and children with a Basic Package of Nutrition Services. Concurrently, the project strengthened national mechanism for multisectoral convergence, information systems management, public financial management and introduced innovations in Social and Behavior Change Communication (SBCC). The gains of ANRiN were tempered by extenuating factors including macro-fiscal challenges, climate shocks and persisting low grade conflict in various regions of the country. ANRiN 2.0 represents a strategic shift to improve multisectoral coordination and delivery effectiveness aligned with global best practices on improving nutrition security and nutrition outcomes. 5. The Accelerating Nutrition Results in Nigeria 2.0 Project seeks to address the dual objectives of acute food and nutrition security of an unprecedented scale, while maintaining the longer-term focus on stunting reduction. The project will optimize nutrition-specific interventions delivered through the primary healthcare system and scale-up nutrition- sensitive agricultural interventions. The project seeks to achieve its objective targeting pregnant and lactating women, adolescent girls and children under five years of age, across twenty-one states faced with a high burden of malnutrition and exposed to food insecurity. Recent estimates indicate that over 32 million people, or 15.9 percent of the population across 26 states plus the Federal Capital Territory were in critical phases (Crisis to Emergency phases i.e., Integrated Food Security Phase Classification (IPC) Phase 3 to 4) of food insecurity during the lean season of June to October 2024, implying that households are already adopting negative coping strategies.5 The food and nutrition crisis has adverse effects on morbidity and mortality, compounds an already significant malnutrition burden with one in every three children stunted, disproportionately worsens poverty and could result in social unrest. As a result of teeming population facing food and nutrition insecurity since May 2024, Nigeria exceeded the World Bank’s Crisis Response Window - Early Response Financing threshold of five million people living in crisis areas and/or a five-percentage point increase.6 1 Notre Dame Global Adaptation Initiative (NDGAIN), Readiness Index, 2021: https://gain.nd.edu/our-work/country-index/rankings/ 2 Department for International Development. 2009. Impac t of Climate Change on Nigeria’s Economy 3 National Bureau of Statistics – CPI Report, 2024 4 World Bank. 2022. A Better Future for All Nigerians: Nigeria Poverty Assessment 2022. Washington, DC. World Bank. https://openknowledge.worldbank.org/handle/10986/37295 5 Cadre Harmonise for Identification of Risk Areas and Vulnerable Population in the Sahel and West Africa March 2024: Nigeria 6 IDA20 Crisis Response Window Early Response Financing (CRW ERF) Food Security Trigger Notification | May 2024 Page 3 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) 6. Multiple factors are exacerbating economic distress and worsening food and nutrition security across the country’s regions. Annual inflation reached 32.15 percent, slowing for the first time in almost two years but still not far from the 28-year high of 34.19 percent in June 2024. Food inflation reached 37.52 percent in August 2024, declining slightly from 41 percent in June 2024 taking a toll on food prices, basic non-food items, and services across the country, with an average increase in staple food costs of more than 185 percent..7 At an average of NGN 1,255 (US$0.78) per day, juxtaposed against a minimum wage of NGN 70,000 (US$43.8), at least a third of Nigerian households8 cannot afford the lowest-cost nutritious diet. Agricultural sector performance has been weak, resulting in an annual national expenditure of over US$10 billion on food imports. Poor access to markets and supporting infrastructure, low penetration of improved seeds and extension services, and climate change contribute to low agricultural productivity. Recent climate shocks and overarching climate change impacts—including deforestation, floods, and variable rainfall—amplifies the impacts of conflict and shocks on agricultural yields, food production, and trade, thus raising food security problems and compounding the severity of the issue. 7. The emerging food security and nutrition crisis is worsening an already serious baseline malnutrition challenge and threatening recent gains. Nationally, the prevalence of stunting (height-for-age) as an indicator of chronic malnutrition is high at 39.5 percent worsening after having stagnated at 37 percent for almost two decades.9 Nigeria accounts for the largest cohort of stunted children on the African continent and the second-highest burden in the world, accounting for 8.2 percent globally.10 As of 2023, wasting in children under five years of age (weight-for-height) ratio has been trending upward, increasing to 8 percent from 6.8 percent after an 11-percentage-point decline between 2013 and 2018. The total number of acutely malnourished children is expected to rise above 10 million in 2024, of which an estimated 2.6 million children will be suffering from severe acute malnutrition (SAM). The malnutrition burden impedes human capital accumulation with Nigeria recording an extremely low Human Capital Index of 0.36, for its income level. 8. The national indices hide major disparities in nutritional status among geopolitical zones, states, and socioeconomic groups, as well as across the rural–urban divide. Stunting for instance, is most prevalent in the North-West region, at 53 percent, which is significantly higher than the national average, and lowest in the South-South region, at 18 percent.11 Though about 17 states, including the FCT, made remarkable progress between 2018 and 2023, stunting has generally worsened across all other states with the worst drops in the North Central. The proportion of wasted children is approximately twice as high in the North-East (17 percent) and three times as high in the North-West (34 percent) as in the other regions. Increasing disparities in sociopolitical stability (armed insurgency in the North-East continuing, though on the decline, banditry in the North-West, and conflict between farmers and pastoralists in the Middle-Belt and Savanna region) have adversely affected food and nutrition security. Children, women and the elderly from rural poor households in climate vulnerable areas particularly in the North are at the greatest risk of food insecurity and malnutrition.12 The prevalence of stunting is almost twice as high among children in rural areas (48 percent) as in urban areas (28 percent). While over half of the children in the bottom two quintiles are stunted (56 percent in lowest quintile and 53 percent in second-lowest quintile), it is important to note, that stunting rates are high even in the highest income quintile (30 percent in the second-highest quintile and 15 percent in the highest quintile). 9. Women, particularly those of childbearing age, are especially vulnerable to micronutrient deficiencies due to their greater physiological need for essential vitamins and minerals. The gender nutrition gap refers to the ways in which 7 National Bureau of Statistics. 2024. Consumer Price Index (August). 8 The average household size in Nigeria is five persons. See Nigeria Living Standards Survey 2020. 9 https://dhsprogram.com/publications/publication-PR157-Preliminary-Reports-Key-Indicators-Reports.cfm 10 United Nations Children’s Fund (UNICEF), World Health Organization (WHO), International Bank for Reconstruction and Development/The World Bank. 2023.“Levels and trends in child malnutrition: UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition.� New York : UNICEF and WHO. CC BY-NC-SA 3.0 IGO. 11 Federal Ministry of Health and Social Welfare of Nigeria (FMoHSW), National Population Commission (NPC), and ICF. 2024. “Nige ria Demographic and Health Survey 2023 –24: Key Indicators Report.� Abuja, Nigeria, and Rockville, Maryland: NPC and ICF. 12 UNICEF. (2023 January, 16). 25 million Nigerians at high risk of food insecurity in 2023. https://www.unicef.org/press-releases/25-million-nigerians-high-risk-food-insecurity-2023 Page 4 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) women’s and girls’ unique biological needs, disparities in access to food and services, and harmful social norms influence their health and economic outcomes. Approximately 58 percent of pregnant women in Nigeria are anemic predisposing them to maternal mortality, poor birth outcomes such as stillbirth, small for gestational age, and low birth weight, and exposing newborns to wasting and stunting even in utero.13 Curtailed female agency and decision-making in the household, coupled with early marriage, premature child bearing and high fertility rates (6.1 and 5.9 children per woman in the North-East and North-West regions, respectively, compared to less than 4.2 in the southern zones), contribute to women’s limited influence on household food and dietary choices and overarching poor maternal, infant, and young child feeding and caring practices. Children of adolescent mothers in particular are 33 percent more likely to be stunted. 14,15 Pregnant women with disabilities often experience neglect that increases the risks of malnutrition for both them and their children. Children with disabilities are often marginalized and may face additional exclusion, such as limited access to education, which perpetuates the cycle of poor health and development outcomes.16 10. Nigeria’s National Multisectoral Plan of Action for Food and Nutrition and other strategic national plans identifies investments in malnutrition, especially in early childhood, as a strong foundation for a more productive society and future economic growth. The prioritized plan outlines a set of multi-sectoral actions in keeping with global and local evidence on the drivers of malnutrition. Notably, that a contribution of approximately 45 percent of progress comes from the health sector, whilst nutrition-sensitive interventions in other sectors like improving maternal education, increasing household wealth to better afford food, and improving household sanitation, could account for 60 percent. Recent analysis reveals that, if Nigeria were to invest US$4.438 billion toward a full set of anti-stunting interventions, it would record up to US$142 billion in productivity and a benefit-cost ratio (BCR) of 32. The Lancet series on early childhood development estimates that every year, the country loses about 3 percent of its GDP by not addressing the developmental needs of children in the first 1,000 days. Thus, there is an urgency in fully translating national development aspirations into implementable programs. 17 11. Malnutrition also has far-reaching consequences for human capital, economic productivity, and national development, though this has not fully translated to prioritization at national and subnational levels. The economic costs of malnutrition are very high, including costs borne by families themselves, the costs of medical treatments, and costs associated with economic growth foregone. The severe irreversible physical and neurocognitive damage that accompanies stunted growth is a major barrier to human development. This is threatening Nigeria’s future human capital as it leads to poorer school performance, lower school completion rates, lower earnings, and limited contributions towards Nigeria’s shared prosperity. Children are 33% more likely to escape poverty as adults and become productive individuals earning incomes that are up to 50% higher than those of their stunted peers and make better contributions towards the nation’s economic prosperity. Nigeria loses US$1.5 billion in GDP annually due to micronutrient deficiencies alone. However, scaling up high-impact nutrition interventions in Nigeria would generate about US$2.6 billion annually in economic benefits. If Nigeria achieves a 40% reduction in stunting by 2025, this will result in a gain of over US$29 billion throughout 2035 through 206018. Making investing in nutrition one of the best value-for-money development actions. 12. The proposed project—ANRiN 2.0 aims to urgently address the food and nutrition crisis and underlying multifaceted drivers of malnutrition by encouraging both geographical and household level convergence of 13 Federal Government of Nigeria (FGoN) and International Institute of Tropical Agriculture (IITA). 2024. “National Food Consumption and Micronutrient Survey 2021: Final Report.� Abuja and Ibadan, Nigeria: FGoN and IITA. 14 Kravita Sethurama, Tara Kovach, and A. Elisabeth Sommerfelt. 2018. “Adolescent Pregnancy and Its Impact on the Prevalence of Stunting: Programmatic Considerations for Food for Peace Programs that Aim to Reduce Stunting.� Food and Nutrition Technical Assistance Project III: Technical Brief (September). Wash ington DC: USAID. 15 Quentin Wodon, Chata Male, Ada Nayihouba, Adenike Onagoruwa, Aboudrahyme Savadogo, Ali Yedan, Jeff Edmeades, Aslihan Kes, Neetu John, Lydia Murithi, Mara Steinhaus, and Suzanne Petroni. 2017. “Economic Impacts of Child Marriage: Global Synthesis Report.� Washington, DC: World Bank and International Center for Research on Women. 16 World Bank Education Overview: Inclusive Education. 2018. 17 Exemplars Nigeria Stunting Reduction Study. 2021 18 Hoddinott, J., The economics of reducing malnutrition in sub-Saharan Africa. Global Panel on Agriculture and Food Systems for Nutrition Working Paper 2016. Page 5 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) interventions. There is growing evidence on the effectiveness of multi-sectoral convergence in accelerating progress on nutrition outcomes. Countries like Indonesia have significantly reduced stunting from 30.8 percent to 21.6 percent between 2018 and 2022 by converging interventions, including, maternal and child nutrition services; maternal and child health including birth spacing interventions; counseling; household access to water and sanitation facilities; early child childhood education; cash transfer and food assistance program; good fortification and other food security targeting households with children in their first 1000 days of life19. In Uganda, a similar multi-sectoral project improved mothers' knowledge of infant feeding for over 80 percent of participants, enhanced household food security, and increased dietary diversity among children aged 6–23 months with resultant reductions in stunting and wasting rates which decreased by 10 and 13 percentage points, respectively, in intervention areas. ANRiN 2.0 aims to strengthen the multisectoral linkages required to achieve nutrition outcomes as outlined in national policies and plans, and in the recently unveiled Nutrition- 774 local action initiative. C. Proposed Development Objective(s) Development Objective(s) (From PAD) Increase utilization of quality, cost-effective nutrition services for pregnant and lactating women, adolescent girls and children under five years of age in select areas of the recipient's territory. Key Results The Project Development Outcome (PDO) indicators are: • Children 6–23 months who receive micronutrient powders as part of complementary feeding (percentage) • Children 6–59 months who receive zinc and Oral Rehydration Salt (ORS) as treatment for diarrhea (percentage) • Children under the age of five years treated for Severe Acute Malnutrition (SAM) (number) • Women 15-49 years feeding practices that meet minimum dietary diversity (percentage) • Children 6-23 months feeding practices that meet minimum dietary diversity (percentage) D. Project Description Component 1: Basic Package of Nutrition Services Component 1 builds on the ANRIN project’s deployment of a basic package of nutrition interventions (BPNS) 20 through a community-based model using performance-based contracts with non-state actors (NSA) and delivering maternal nutrition services21 at health facilities. These services were selected based on national and international evidence of the most cost-effective nutrition services that should be scaled up on a priority basis22. Additional funding was leveraged by Kaduna State to provide quality health and nutrition services to married adolescents to enable birth spacing and for the provision of ready-to-use therapeutic foods (RUTF) to treat severe acute malnutrition (SAM) in children 6-59 months respectively. 19 Also known as 1,000-day households; Investing in Nutrition and Early Years Phase 2 Program-for-Results Program Appraisal Document, June 2, 2023. 20 The BPNS included behavior change communication to improve maternal, infant and young child nutrition (MIYCN), micronutrient powders (MNP) for children 6-23 months, multiple micronutrient supplementation (MMS) for pregnant women, intermittent presumptive treatment for malaria in pregnancy (IPTp), zinc and ORS for treatment of diarrhea in children 6-59 months, vitamin A supplementation for children 6-59 months, and deworming for children 12-59 months. 21 MIYCN, IFA, and IPTp 22 World Bank. Scaling up Nutrition: What will it Cost? Nigeria costing study. 2014 Page 6 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) The enhanced BPNS makes use of data from the most recent National Demographic and Health Survey 2023 to optimize available resources to achieve multiple objectives namely maximizing the number of alive, non-stunted and non-wasted children. The modified package will retain all original seven services, but introduces new high impact interventions, specifically, multiple micronutrient supplementation for pregnant women which has been shown to improve birth outcomes by up to 15 percentage points, and small-quantity lipid based nutrition supplements for children aged 6 to 23 months of age, which address stunting, wasting and iron-deficiency anemia by up to 17%, 31% and 64%, respectively. The project will support the procurement of only those commodities within the package that are not supplied by government or other partnerships, at scale to maximize the use of available resources. The treatment of Severe Acute Malnutrition will also be scale. The BPNS in this phase will continue to be delivered at community-level by public sector community health workers (CHW formerly known as CIPS agents). This approach will also leverage the Primary Healthcare Provision Strengthening Program (P504693)’s focus on institutionalizing community health workers, particularly those already supported by ANRIN. At health facility level, the BPNS will continue to deliver maternal nutrition services. The project will adopt a coordinated procurement approach for all nutrition services and both community and facility-based services will be supervised by the State Primary Health Care Development Agencies (SPHCDA). Component 2: Convergence with Food Systems Component 2 will support the scale-up of homestead gardens in states that are in crisis. Leveraging a review of historic homestead and micro-g gardening activities in Nigeria, and prevailing weather information, a compendium of priority crops and small animals will be adapted for each geographic and dry / wet season specific package. Agricultural input kits will focus on short-duration crop varieties (<90 days) that are high yielding, with adaptability to thrive in diverse ecological and environmental conditions. The current homestead gardening, and food processing and perseveration manuals developed under ANRiN will be updated to be more context-responsive and climate-smart based on the additional mapping. Modules on (ii) available nutrient per serving, (iii) economics of production (include input requirements and costs), (iv) labor effort, (v) agricultural management practices, (vi) duration to maturity, (vii) expected yield, and (viii) profitability, making allowances for household consumption will also be refined and included in the implementation guide for agricultural extension agents, community health extension agents and other technical project implementers. Leveraging the National Social Register designed under the National Social Safety Nets Program, the homestead gardening intervention will target 1,000 day- households, ensuring that mothers whose babies are transitioning to complementary feeding from breastmilk, have sufficient access to a range of diverse foods. Female headed households with young children as well as rural communities and the urban poor will also be prioritized. Emphasis will be place on working with women led agricultural and community health extension workers to deliver training activities at community and household levels. Component 3: Data-Driven Multisectoral Coordination and Accountability This component aims to enhance critical coordination and accountability functions at both the national and state levels. The Ministry of Budget and Economic Planning (MBEP) will lead the multi-sectoral coordination to address the food and nutrition security crises and to ensure that all implementing entities are held accountable. This component will prioritize the following three areas: (a) Generating evidence for decision-making through the development and dissemination of (i) an Annual National State of Nutrition Report, which provides a comprehensive assessment of Nigeria’s current nutrition and food security landscape and (ii) mapping reports of interventions implemented by development partners in selected states to improve coordination of partners active in the state to achieve harmonized, informed, efficient, and effective actions for improved food and nutrition security; (b) Enhancing multi-sectoral coordination and collaboration by strengthening and funding the State Committee of Food and Nutrition to respond to Food and Nutrition Security Crisis; Page 7 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) and (c) Ensuring a Nutrition-Responsive Public Financial Management System through the institutionalization of an operational Budget Tagging and Tracking System in all 36 states of the federation facilitated by the Nigeria Governors’ Forum, to ensure that all states are equipped to effectively allocate, tag and track funding for nutrition activities. @#&OPS~Doctype~OPS^dynamics@pidaprlegalpolicy#doctemplate Legal Operational Policies Triggered? Projects on International Waterways OP 7.50 No Projects in Disputed Area OP 7.60 No Summary of Screening of Environmental and Social Risks and Impacts The overall environmental and social (E&S) risks rating is Moderate. Based on initial screening, the Scale Up activities are not anticipated to cause significant adverse environmental or social impacts. However, Five (5) of the ten (10) Environmental and Social Standards (ESSs) are applicable to the ANRIN 2.0 SU: ESS1 (Assessment and Management of E&S Risks and Impacts), ESS2 (Labor and Working Conditions), ESS4 (Community Health and Safety), ESS 3 (resource efficiency and pollution prevention and management) and ESS10 (Stakeholder Engagement and Information Disclosure). The Parent project was prepared under the Safeguard policy, and the risk rating was low. The project triggered the Bank (OP/BP 4.01 -Environmental Assessment) based on its ES category (B-partial) The existing safeguard document (Health Care Waste Management Plan will be updated to be consistent with the ESF and disclosed prior to appraisal, together with the Stakeholder Engagement Plan (SEP). The environmental risks and impacts associated with this project are linked to the distribution of the nutrient packages to household beneficiaries and the activities of homestead gardening and farming. These include small volumes of waste generation from health services, transportation of fertilizers and commodities and their use in small household farms and occupational health and safety (OHS) and community health and safety risks to households that will be involved in homestead garden & farming during implementation. The interventions may involve the use of livestock vaccines on the small animals and poor disposal of such animal wastes could constitute odor nuisance in the neighborhood. Additionally, the contextual risks of climatic events, insecurity, prevalent nationwide may pose safety risk, limiting access to household beneficiaries in high-risk locations during implementation. The risks and impacts are site –specific and at moderate scale and can be easily mitigated by the implementation of Environmental and Social Code of Practice (ESCoP), Standard Operating Procedures/ Guidelines, health care waste management plan and the farming manual. The project is anticipated to significantly benefit women and vulnerable households in the participating states. A key social aspect is its potential impact on women, children, and households. Recognizing the severe and far-reaching effects of malnutrition on women and children in Nigeria, the program will improve maternal and child health outcomes, reduce mortality, and support long-term development for Nigeria's most vulnerable populations. Building on the successes of its parent project, the proposed ANRIN SU aims to fast-track actions to reduce the burden of moderate and severe malnutrition in response to the food and nutrition crisis in 20 States with emphasis on states most affected by the food and nutrition crisis in the country. Considering the BPNS would be delivered at community level by public sector community health workers who will be governed by the public service rules law and regulations, additional health and safety measures with abridge code of conduct would be included in the relevant ESF document to manage potential social risk such as exclusion of vulnerable groups / ethnic minority, risk of transmission of communicable diseases, community exposure to medical waste, SEA/SH/GBV risk, and other risk associated with health care provision. M Gender and vulnerability: It is expected that the project will have numerous positive impacts on women and vulnerable households in Page 8 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) the participating states. One key social aspect of the project activities is the possible impact of this operation on women, children and households who will benefit from the program activities. Given the known fact that malnutrition has severe and far-reaching impacts on women and children in Nigeria, the program will positively impact women and children by providing access to essential nutrition services, promoting healthy feeding practices, and integrating nutrition with healthcare services, the project aims to improve maternal and child health outcomes, reduce mortality, and foster long- term development for Nigeria's most vulnerable populations. Potential risks include elite capture, inadequate stakeholder consultation, grievances and complaints, and project-induced Intimate Partner Violence/Sexual Exploitation and Abuse/Sexual Harassment (IPV/SEA/SH) risks. To mitigate these, the project will implement social accountability mechanisms to prevent elite capture, a Stakeholder Engagement Plan (SEP) for continuous engagement, and an efficient grievance redress mechanism (GRM) at various levels. The Project will develop and implement a Gender and GBV Action Plan across the states to mitigate SEA/SH risks. Additionally, through the various stakeholder engagements that will be conducted, emphasis will be placed why the project prioritizes support to female household members for the distribution of the commodities. To prevent exclusion, especially for women in remote areas and Persons with Disabilities, the Project will develop differentiated approaches to ensure they are not further excluded for the Project support. The project will build on the project-specific Grievance Redress and Feedback Mechanism for the parent project so as to ensure that concerns or complaints when people feel unfairly treated or are negatively affected by any of the subprojects. Among other things, the mechanism will: (a) provide information about project implementation; (b) a forum for resolving grievances and disputes at the lowest level; (c) resolve disputes relatively quickly before they become unmanageable; (d) facilitate communication between the project and the project affected people; (e) win the trust and confidence of project beneficiaries and stakeholders to create productive relationships between parties; and (f) allow communities to express views, including any adverse views, on project activities . Ward Development Committees, WDCs are vital in ensuring that primary healthcare services reach the most vulnerable populations in Nigeria. Acting as community representatives, they help bridge the gap between the formal healthcare system and the underserved, facilitating access to health services, advocating for improvements, and promoting healthy behaviors. The project will take advantage of WDCs to ensure that marginalized and vulnerable groups (such as women, children, the elderly, and people with disabilities) are connected to essential services delivered by the project Security: In areas with political, ethnic, or civil unrest, the security of beneficiaries and project staff including community workers can be at risk. This includes risks of extortion, domestic violence, and other forms of violence. The project will address this by leveraging existing state-specific security management plans from health projects to address issues related to security risks The project will be implemented to meet with ESF requirements in accordance with the ESCP. The ANRIN 2.0 Project will be implemented using a multisectoral approach that involves the Federal, State, LGA and community level. All relevant Implementing Entities and State Project Management Units will leverage on the current institutional arrangement for the implementation of E & S activities and the capacity of the project teams on ESF will be strengthened. E. Implementation Institutional and Implementation Arrangements 13. Overall Project Management. ANRiN 2.0 project management will be led by the Federal Ministry of Health and Social Welfare (FMOHSW) who will oversee coordination of the project. The National Project Management Unit (NPMU) will be responsible for the coordination of day-to-day administration, monitoring and reporting on project activities and serve as the liaison with FMOH and the National Primary Healthcare Development Agency (NPHCDA), the MBNP, as well as State Ministries of Health (SMOH) and SPHCDAs responsible for project implementation at the state level. The PMU will ensure Page 9 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) that federal ministries make available to participating states updated national standards, guidelines, manuals, and tools for the scale-up. The PMU will also be responsible for stakeholder management, communications, advocacy, and overall monitoring and reporting against set results, holding all relevant Ministries Departments and Agencies (MDAs) accountable using a performance management system and performance frameworks/subsidiary agreements. The PMU’s primary state counterparts will be the State Committees of Food and Nutrition in the State Ministries of Budget and Economic Planning, which will similarly coordinate sectoral ministries in project implementation and reporting. 14. A National Coordinator will be identified and supported by the PMU to serve as the full-time Project Coordinator for ANRiN 2.0. He/she will be supported by technical experts in the fields of: (a) nutrition and maternal, infant, and young child feeding; (b) communication; (c) procurement; (d) environmental and social safeguards; (e) accounting/finance; (f) internal audit; and (g) M&E. The ANRiN 2.0 team will liaise with component leads in the respective line ministries as follows: (i) Health Component Lead in the Department of Nutrition, Federal Ministry of Health and Social Welfare; (ii) Agriculture and Food Systems Lead in the Department of Nutrition, Federal Ministry of Agriculture and Food Security; and (iii) Multisectoral Accountability Lead in the Department of Social Development, Federal Ministry of Budget and Economic Planning. 15. State-level arrangements. The State Project Management Units, working under the leadership of the Chair of the State Committee of Food and Nutrition in the State Ministry of Budget and Economic Planning will provide day-to-day oversight and administration for ANRiN 2.0. Under the leadership of the State Ministry of Health, the SPHCDA/Board will oversee the delivery of the modified BPNS at the facility and community level and hold state health facilities and CHWs accountable for the achievement of results. The State Ministry of Agriculture will be responsible for agricultural extension services to households for homestead gardening, food processing, and preservation component. The State Ministry of Budget and Economic Planning will be responsive for ensuring sustainable financing through nutrition-responsive budgeting and planning and will manage the mapping and coordination of nutrition investments through the nutrition intervention mapping system. 16. Financial oversight. The Federal Ministry of Finance will provide overall financial oversight to the ANRIN 2.0, ensuring streamlined and timely effectiveness, disbursement and approvals. The PMU will perform day-to-day financial management functions, ensuring timely and efficient funds flow to all relevant implementing entities for scheduled project activities. They will be responsible for the provision of quarterly internal audit reports, semi-annual Interim Financial Report (IFR) and an External Audit due immediately following project closure. 17. The responsibility for establishing and maintaining acceptable financial management (FM) arrangements for the project will be handled by the existing Project Financial Management Units (PFMUs) in the 12 states and the Federal Project Financial Management Department (FPFMD) at the federal level. The Federal Treasury Circular of March 2010 established the FPFMD in the Office of the Accountant General of the Federation (OAGF) to handle the FM responsibilities for funds provided to ministries, departments and agencies by donor partners. At the state level, the PFMUs have been established under the Office of Accountant-General in each state (OAGS). @#&OPS~Doctype~OPS^dynamics@contactpoint#doctemplate CONTACT POINT World Bank Page 10 The World Bank Accelerating Nutrition Results in Nigeria 2.0 (P507935) Ritgak Asabe Sarah Tilley Gyado Senior Health Specialist Borrower/Client/Recipient Federal Republic of Nigeria Lydia Jafiya Permanent Secretary ps@fmof.gov.ng Implementing Agencies Federal Ministry of Health and Social Welfare Kachollom Daju Permanent Secretary kachiedaju@gmail.com FOR MORE INFORMATION CONTACT The World Bank 1818 H Street, NW Washington, D.C. 20433 Telephone: (202) 473-1000 Web: http://www.worldbank.org/projects @#&OPS~Doctype~OPS^dynamics@approval#doctemplate APPROVAL Task Team Leader(s): Ritgak Asabe Sarah Tilley Gyado Approved By Practice Manager/Manager: Country Director: Page 11