N4D IN PARTNERSHIP WITH MINISTRY OF HEALTH GoE
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Overview
Since 2019, there have been challenges to such progress due to multiple factors such as climate shocks, COVID-19 and conflict as well as changes in the national and global economic and political landscape. 2024 was viewed as an exceptional year in terms of compounded shocks or ‘poly crises’ affecting many already vulnerable people facing extreme hardship in accessing food and income due to drought and poor harvests. In response the 2024 Humanitarian Response Plan targeted approximately 10.4 million people for food aid and requested over US$3 billion in aid to respond for that year.
CHILDREN REQUIRE HUMANITARIAN ASSISTANCE
PEOPLE ARE INTERNALLY DISPLACED
PEOPLE NEED HUMANITARIAN ASSISTANCE
PEOPLE FACING FOOD & NUTRITION INSECURITY
%
CHILDREN AGED UNDER 5 YEARS ARE WASTED
%
CHILDREN AGED UNDER 5 YEARS SUFFER FROM MODERATE TO SEVERE STUNTING
Source:Ethiopia Humanitarian Needs Overview (February 2024)
N4D PARTNER: MINISTRY OF HEALTH, GoE
Ethiopia’s Ministry of Health (MoH) leads and guides the nation’s Food and Nutrition Policy and the National Nutrition Programme. Since malnutrition is a multisectoral problem, the MoH ensures the coordination of multiple nutrition-relevant ministries and partners to deliver the country’s vision.
Ethiopia has been a country member state of the global SUN Movement since 2010; the national SUN Focal Point, Dr. Sisay Sinamo Boltena is also the Senior Programme Manager for the Seqota Declaration Federal Programme Delivery Unit and based in the MoH. In 2015, the GoE made a high-level 15-year commitment to end stunting in children aged under two years by 2030. This commitment, known as the Seqota Declaration (SD), is operationalized through a multisectoral programme involving 14 different sector ministries, including Agriculture; Education; Finance; Health; Women and Social Affairs; Trade and Regional Integration, Industry, Planning and Development; Irrigation and Lowland Development; Transport and Logistics; Water and Energy; Urban and Infrastructure; and Innovation and Technology.

Dr. Sisay Sinamo Boltena
Senior Programme Manager, SD Federal Programme Delivery Unit
LISTEN TO DR. SISAY SINAMO BOLTENA DISCUSS GLOBAL AID FINANCING
Visit Ethiopia’s MoH website
Listen to the full N4D podcast with Dr Sisay Sinamo Boltena
Episode 9
1.1
Key characteristics of a NEXUS approach to nutrition
A HDPN approach to nutrition is guided by wider HDPN approaches such as the OECD DAC Recommendation on the Humanitarian-Development-Peace Nexus (see pdf download below).
N4D defines a HDPN approach for nutrition as:
“… [when] all humanitarian, development and peace actors draw on their comparative advantages and work in collaboration and coherence with each other, under national leadership, in order to achieve the collective outcome of sustained improvements in nutrition for all people. All stakeholders align with national and sub-national priorities as outlined in one overarching, national and multisectoral nutrition action plan.”
Key elements of a HDPN approach:
- Collective outcomes to sustainably reduce needs, risks and vulnerabilities by preventing, preparing and responding to malnutrition;
- Collaborative and coherent ways of working between humanitarian, development and peace-building actors;
- Drawing on respective comparative advantages; and
- Convergence of HDPN actions on the same at-risk populations.
Learn more
DAC Recommendation on the OECD Legal Instruments Humanitarian-Development-Peace Nexus (pdf)
Strengthening the Humanitarian-
Development Nexus for Nutrition in Protracted Crises (pdf)
Lessons learned and recommendations from
the humanitarian-development nexus for nutrition (pdf)
1.2
The Ethiopian Context
Ethiopia has made significant progress in reducing the rates of malnutrition over the past two decades (see graph below), although high levels of child stunting, wasting, underweight and micronutrient deficiencies persist. By 2023, levels of child stunting and wasting remained high at 39 per cent and 11 per cent respectively, indicating the additional efforts needed to maintain the gains and the marked improvements attained in previous years.
The GoE’s flagship SD programme has shown very promising results in terms of stunting reduction (an annual reduction rate of 3 per cent) and the prevention of related deaths. Key success factors for the SD are the high-level leadership commitment, implementation of innovations, female empowerment approach, use of data for informed decision-making and sustained government and development partners’ financial commitments.
Other important policies and programmes in Ethiopia include the National Food and Nutrition Security Strategy, the Nutrition Sensitive Agriculture Strategy and the PSNP. All these efforts provide multisectoral nutrition guidance to improve the food and nutrition security of the Ethiopian population, as part of the national development agenda.
The Ethiopian Disaster Risk Management Commission (EDRMC) is responsible for preparing disaster prevention and preparedness policy, strategy and implementation. Under the EDRMC sits the well-established Ethiopia Emergency Nutrition Unit (ENCU), which leads and coordinates nutrition partners at federal, regional and district levels for a coherent, effective emergency nutrition preparedness and response to save lives and improve the nutritional status of vulnerable populations during emergencies. Both EDRMC and ENCU are key stakeholders in the development of the Nutrition Centric HDP Triple Nexus Operational Guide (OG) and Implementation Roadmap (IR).
Trends in nutritional status of children aged under 5 years in Ethiopia
Source: Ethiopian DHS for 2000, 2005, 2011, 2016 and 2019; Ethiopian Public Health Institute & Food & Nutrition Strategy baseline survey for 2023
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Humanitarian, development and peace financing in Ethiopia
Ethiopia has experienced multiple complex and protracted crises for decades with billions spent in response. In the last 10 years, people in need of humanitarian assistance increased 10-fold, with two thirds of those being women and children. Although funding more than doubled between 2017 and 2023, actual funds received were below half of the required amount in six of the seven years. The 2023 Humanitarian Response Plan was funded at just 34 per cent.
Longer-term resilience building and multisectoral nutrition programmes such as the PSNP and SD have yielded significant improvements for the population including lowering rates of stunting and associated mortality. Ethiopia was the fourth highest recipient of official development assistance (ODA) globally, with US$5 billion received in 2022. The World Bank Group is the lead in developing multi-donor programmes to reduce transaction costs, aligning support with the country’s decentralized model and enhancing the predictability of aid. However, recent reductions in development investments have left such programmes as the PSNP facing acute funding shortfalls.
The MoH and EDRMC are now proposing a ground-shift in ways of working to maximise the collective impact of available resources for preventing malnutrition, through a Nexus approach that brings together humanitarian, development and peace building initiatives.
Source: States of Fragility
WORKING WITH GoE SUN FOCAL POINT
“Working alongside the GoE SUN Focal Point on the evolution of the Nutrition Centric Nexus Approach has been a highlight of N4D’s programme of work in 2024. There is no ‘one size fits all’ for tackling the complexity of responding to poly-crises, malnutrition and the institutional and financial silos that inhibit much-needed transformative change; but if any country can demonstrate proof of concept, it is Ethiopia. Thank you for letting us be a small part of this journey.”
From N4D Directors
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Nexus approach in action
2.1

Breakout groups at NIPFN workshop in Addis Ababa facilitated by N4D, April 2024
Developing a Nutrition Centric HDP Triple Nexus approach
N4D’s Directors have had a long-standing engagement with different initiatives in Ethiopia spanning many decades and over numerous country visits. In 2023, N4D looked at the potential for greater nutrition sensitivity of the national PSNP, followed by a detailed evaluation of the Ethiopia National Information Platform for Food and Nutrition (NIPFN) in 2024.
The MoH team asked N4D to support its evolving Nutrition Centric HDP Triple Nexus approach, a process that required N4D to update its understanding of the existing nutrition situation, the main policies, programmes and actors and to interact with different actors before starting this work.
DEVELOPING THE NUTRITION-CENTRIC TRIPLE NEXUS IN ETHIOPIA
PRE 2016
RELIEF TO DEVELOPMENT CONTINUUM
- Relief to Development Continuum
- Disaster Risk Reduction
- Linking Relief, Rehabilitation and Development
- Resilience
2016
WORLD HUMANITARIAN SUMMIT
- World Humanitarian Summit, resulting in ‘The Grand Bargain’: a pledge between humanitarian actors and donor to improve effectiveness and efficiency of humanitarian actions through “Nexus Approach”
- Recognition of significance of Peace pillar
2017
A NEW WAY OF WORKING
- The New Way of Working (a Nexus approach) calls on humanitarian and development actors to work towards ‘collective outcomes’ that reduce need, risk and vulnerability over multiple years.
2019
PUBLICATION OF OECD-DAC
- Publication of Organisation for Economic Co-operation and Development’s (OECD) Development Assistance Committee (OECD-DAC) criteria: 11 Nexus principles
2020
UN-DAC PARTNERSHIP FOR PEACE
2023
HDP-NEXUS AGENDA
- HDP Nexus agenda identified by MoH as advocacy priority
2024
GoE NEXUS APPROACH LAUNCHED
- GoE launches its first Operational Guidance and Implementation Roadmap for the Nutrition-Centric Triple Nexus approach
2.2
Supporting the Operational Guidance and Implementation Roadmap
Globally, the idea of an HDP nexus has been around since 2016; however, there is no clear road map, framework or tool to facilitate the implementation of a Nutrition Centric HDP Triple Nexus in Ethiopia. Under the leadership of the MoH SUN Multi-stakeholders Platform, the SUN Networks made the Nutrition Centric HDP Triple Nexus an advocacy priority during their 2023 SUN Joint Annual Assessment. To kick-start the process, MoH presented the approach to Action Against Hunger (ACF) during a high-level engagement meeting in March 2023. ACF then made its commitment and leadership in mobilizing the technical and financial support to take this agenda forward. Since then, ACF has engaged, assigned a national HDP Nexus technical advisor and provided financial commitment to operationalize the Nutrition Centric HDP Triple Nexus in Ethiopia through the development of the Operational Guide and Implementation Roadmap, in close collaboration with other engaged partners, donors, networks and government line ministries.
Substantial progress has been made since then. To facilitate technical coordination, MoH with the support of ACF has established two groups: an Advisory Team (MoH) and a Technical Working Group, which have been actively involved in the first three phases of the process. This team comprises experienced stakeholders and HDP actors in Ethiopia and globally, including government sectors, civil society organizations, research institutes and academia, private sector, the UN family including the Resident Coordinator’s Office and donors. The main purpose of establishing these platforms is to engage wide stakeholders, gain professional input and experience in the operationalization process.
N4D was invited to these platforms by MoH through the SUN focal person, and have provided technical assistance and brought international experiences to the development of these two important national frameworks (the OG and IR). N4D presented learning on supporting a Nexus Approach from Niger and Yemen at a Technical Working Group training in October 2023. At the event, the technical coordinating team at the Ministry lead by the SUN Focal person (here after called the Technical Team) outlined six phases for rolling out the Nutrition Centric HDP Triple Nexus approach (see below).
Phase One was a Situation Analysis, followed by Phase Two developing the Operational Guidance (OG) and the Implementation Roadmap (IR) (all documents are in download section below); and in Phase Three, validation and dissemination of the OG and IR. All three phases were completed in July 2024.
See members of the Advisory Team and Technical Working Group here
MoH requested that N4D review the Situation Analysis that would underpin the development of the OG and IR: as a result, N4D advised the Technical Team at MoH to provide more detail on the wider nutrition coordination mechanisms in Ethiopia and information on existing programmes and approaches employing a nutrition centric nexus lens. Both these suggestions were addressed in subsequent drafts of the Situation Analysis, which was finalised in November 2023.
In early November 2023, N4D were asked to review the proposed structure of the OG and suggested various changes to the structure and bulleted the range of topics to be elaborated under each structure heading. N4D were also asked to review the draft Theory of Change (ToC) (see below, click image to enlarge) and present learning from other ToCs (e.g., Niger) on which N4D had worked, at a three-day MoH and EDRMC co-hosted workshop supported by ACF in November and attended by stakeholders working on initial drafting of the OG.
NEXUS Theory of Change
The first draft of the OG was sent to N4D for comment mid-December 2023 with N4D feeding back with detailed comments a week later. The main suggestions from N4D were to provide greater clarity around the governance mechanisms for the Nutrition Centric HDP Triple Nexus Approach, as well as to strengthen the monitoring and evaluation (M&E) section by identifying nexus-specific indicators to increase accountability for the roll-out of the approach.
In mid-January 2024, the Technical Team at MoH asked N4D to provide comments on the draft structure of the IR. N4D emphasised the need for greater clarity on the costing of the IR and the different phases, as well as including details on other nexus initiatives in-country to align advocacy efforts.
At the end of January 2024, the Technical Team at MoH sent N4D a draft of the OG for further comment and review. N4D recommended detailed changes and additions around justifications for the approach, financing (domestic versus external) and key indicators to monitor achievements and progress.
The Technical team at MoH sent a first draft of the IR to N4D in mid-March 2024 for comment ahead of a planned N4D visit to Ethiopia. This visit focused on discussing the final iterations of the OG and IR and the overall Nutrition Centric HDP Triple Nexus Approach with a range of government and development partner stakeholders.
After a high-level official launch of the OG/IR in May 2024, the Technical Team at MoH asked N4D to support them in advocacy for raising resources to operationalize the Nutrition Centre HDP Triple Nexus Approach in SD woredas.
DOWNLOAD KEY DOCUMENTS
2.3
Outline of N4D’s main areas of activity during the rest of 2024
N4D’s country visit began the process of scoping donor views on financing the Nutrition Centric HDP Triple Nexus Approach. This short visit in April 2024 by two N4D Directors enabled N4D to better understand the nutrition ecosystem, financing arrangements and the link between the Nutrition Centric HDP Triple Nexus Approach and the SD.
Following the country visit, N4D developed a summary document of the OG and the IR (see download documents below) in close cooperation with MoH colleagues. This document serves as a distillation of the two in-depth and detailed OG and IR documents for advocacy purposes.
N4D was also asked by the Technical Team at MoH to reach out to the main HQ level donor representatives to support efforts in driving up investment in the Nutrition Centric HDP TripleNexus Approach in the selected SD woredas. This is an ongoing area of focus, and N4D are working with MoH colleagues to produce a generic concept note outlining the Nexus Approach in six SD woredas in three crisis-prone regions.
Ethiopian stakeholders are keen to share their learning and views on developing the first Nutrition Centric HDP TripleNexus Approach blueprint with others in similar country contexts. To support this, N4D is coordinating writing a viewpoint piece for publication in a well-known peer reviewed journal. This viewpoint will serve to capture key learnings and observations of the need for a new way of working in Ethiopia to overcome the major institutional and financial silos that are limiting further population-level nutrition improvements.
KEY RESULTS
- Technical support for developing the Nutrition Centric HDP Triple Nexus OG/IR
- Support to produce an advocacy summary about the Ethiopian Nutrition Centric HDP Triple Nexus Approach, including a Call to Action (see below)
- Country scoping visit undertaken
- Donor engagement supported
- Viewpoint on the Ethiopian Nutrition Centric HDP Triple Nexus Approach prepared for publication



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Lessons learned
Lessons learned: How to promote multi-stakeholder engagement across the Nutrition Centric HDP Triple Nexus and support more locally led processes for scaling up multisectoral actions for nutrition
Cross learning between countries developing nutrition centric nexus thinking is hugely valuable
Presenting experiences from Yemen and Niger to the Ethiopia Technical Working Group helped in the early stages of the Nexus initiative. Specifically, N4D was able to distill elements of the Yemen Nexus Approach to benefit the evolution of the Ethiopia OG and IR.
Supporting countries in developing complex concepts requires an ongoing and sensitive approach
N4D worked behind the scenes, responding and advising in a timely and iterative fashion to numerous drafts of the OG and IR. This support was provided remotely through regular email exchanges and frequent video calls. The main approach we took was to be responsive to highly time sensitive feedback and technical guidance as the Ethiopia writing team produced different versions of the two main outputs against ambitious deadlines, which they duly achieved with excellent management of the process in-country.
Ensuring a highly inclusive process is crucial for developing a joint roadmap that represents all stakeholder views
The Technical Team at MoH oversaw a process of developing the OG and IR that included key line ministry representatives as well as the main humanitarian and development partners (see list of stakeholders in section 2.2). This served to ensure that the OG and IR included a consideration of complex coordination and governance arrangements, the financing modalities and the M&E needs. It also served to sustain the commitment of the working group members tasked with writing the drafts. The speed at which drafts were produced was hugely impressive.
Bringing other learning to bear on the approach strengthens collaboration
N4D, as an evaluator of NIPN Ethiopia, was able to advocate for an important data analysis and monitoring role for NIPN within the OG and IR. N4D was also able to actively support the Nexus ToC based on the NIPN ToC approach, which very clearly separated outcomes from outputs and inputs. Conversely, N4D was also able to influence NIPN’s Phase Three ToC to include the Nexus Approach as it had worked across both projects.
Face-to-face meetings are key to increasing mutual understanding
N4D’s country visit in April 2024 clarified the centrality of the SD programme to the operationalization of the Nutrition Centric HDP Triple Nexus Approach. It also served to increase stakeholder awareness of the SD and Nutrition Centric HDP Triple Nexus Approach during meetings held with development partners and donors. Gauging the potential for donor support and the obstacles envisaged was a key focus of stakeholder meetings and pointed the way as to how the next phase of the Nutrition Centric HDP Triple Nexus Approach should be presented to garner donor support.
Government processes and speed of securing funding for operationalizing phase must be taken into account
Working with senior government officials who manage multiple programmes, are part of numerous working groups and who cannot dictate speed of institutional change necessary for the Nexus Approach has meant that N4D has had to manage its own expectations on the pace of progress towards operationalizing the Nutrition Centric HDP Triple Nexus Approach in Ethiopia.
While the Technical Team at MoH successfully achieved the highly ambitious goal of producing an OG and IR within a six-month period, the process of moving forward with operationalization has been slower as more time is needed to mobilise domestic and external donor resources.
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Next Steps
N4D will support ongoing engagement and sensitization with potential donors as part of the MoH and EDRMC’s efforts towards mobilizing actors and resources for the Nutrition Centric HDP Triple Nexus Approach to be operationalized in selected SD woredas. ACF has allocated a small grant for the initial phase of the operationalization in selected woredas, and additional partners such as Right to Grow have also shown its commitment in supporting this work. The Technical Team at the MoH will work closely to reach out to donors and partners to mobilize further resources.
N4D will visit Ethiopia in late 2024 to work alongside the MoH team on the planning for the operationalisation phase. This is likely to include regional level visit/s and country donor meetings. In addition, N4D will support the finalisation of the viewpoint for peer review publication and remain responsive to other requests from the Technical Team at MoH in advancing the Nutrition Centric HDP Triple Nexus Approach, depending on in-country needs.
N4D will support Ethiopia’s continued involvement in the recently formed informal Nexus Advocacy Working Group where country actors from Afghanistan, Ethiopia, Niger and Yemen share their learning and are driving various policy briefs, round table meetings and other activities designed to amplify country actor voices at the global level.
This page will continue to be updated with content and other supporting documents as the project progresses. We welcome any feedback and are always keen to engage in discussion.
All main images © Unicef. Other images N4D.