DRAFT 12-05-2010
PD-HATIS
SELECT NUTRITION LESSONS LEARNED
PLANNING/MANAGEMENT/COORDINATION
RBM/M&E
 A qualitative analysis of coping mechanisms is essential for revealing true malnutrition rates and causes
and for informing emergency nutrition programmes and supplementary feeding targeting. Coping
mechanisms, rather than food rations, can be the reason why surveys might show falling malnutrition rates.
People in drought-affected regions often have coping mechanisms to deal with the conditions. Indicators of acute
malnutrition (wasting) and mortality will usually come too late when the crisis is already reaching a high peak.
Understanding coping mechanisms is crucial for properly targeting nutritional interventions; constructing a
method of analyzing these mechanisms can inform when and what kind of food targeting programme is
necessary for a given geographical region. (Lesson from Tanzania)
 Especially for nutrition, caution is needed when using data specific to a few areas as the basis of action
towards larger populations. In emergency environments, data collection and mapping can be far from
comprehensive. There is a danger in assuming that collected data reflects broader figures and populations since
quantitative data, can be estimates, based on small samples or ‘sentinel sites’ representing larger areas with
similar agro-ecological and demographic conditions. Inferring that such data samples are representative of unassessed areas can be confusing and produce erroneous assumptions. This can result in over or under
estimates for food aid and either neglect those in need or cause wastage of resources. (Lesson from Ethiopia)
 A critical consideration in the assessment of need is that since the earthquake is the latest in a long line of
problems to beset Haiti: in-depth analysis of pre-existing conditions, vulnerabilities, gaps and capacities is
critical to the planning of response and recovery interventions. (Lesson from Tsunami)
 Ongoing situation mapping and analysis of different vulnerabilities, different modes of exclusion and different
capacity gaps, is a critical part of effective response. Ways of addressing these issues and identifying also
capacity strength is an essential complementary component to analysis of weakness. (Lesson from Tsunami)
 Ensure capacity at field level to undertake ongoing monitoring. Decentralized approaches to disaggregating
data are critical. This monitoring should include participatory approaches also. (Lesson from Tsunami)
 Use needs assessment as a means of sowing the seeds of a capacity development approach early. The
early undertaking of assessments constitutes a recurring opportunity for capacity development – in training
national staff and/or partners to conduct assessments. (Lesson from Haiti)
 In conflict situations, it is essential that supplementary food distributions are sensitive to and relevant to
the context; follow up monitoring is critical to understand their impact and the power dynamics involved.
Supplementary Food aid and supplies can undermine local strategies and coping mechanisms and can be a
catalyst for insecurity, especially in conflict scenarios. The distribution of food (general rations and/or
supplementary food) supplies must be sensitive and relevant to the context. Food can be diverted or sold or
used for different purposes. Food aid linked to participation in a SFP may become an incentive to maintain one
or more children in marginal nutritional condition. Follow up is therefore essential to understand the utilization
and impact of food supply. (Lesson from Somalia)
PROGRAMME
Strategy
 Recognize that early response programmes can be used as rudimentary building blocks for system
building, to aid the transition from emergency to recovery. Ensure ongoing service provision builds on
approaches and elements already in place or being developed. Putting parameters around emergency response
objectives and building upon these with systems in mind are two key sequential steps. (Lesson from Tsunami)
 Scaling up programmes requires identifying how best to scale up supporting administrative and
operations capacities or streamline procedures; whether for UNICEF or partners. Bringing in new NGO
partners can be slow administratively, as can efforts to boost government staffing at district level when going
through more complicated centralized channels. Decentralizing support to government, and hiring logistics in the
field can be critical. (Lesson from Kenya)
 The onset of an emergency, combined with the adoption of the cluster approach, can provide an entry
point to integrate new policy and program strategy change. Breakthrough during the course of the
emergency response is possible; for example in Myanmar, community-based therapeutic feeding for severely
malnourished children was introduced, which has been lacking in regular program. The onset of the emergency
and the rapid adoption of the cluster approach allowed for consensus on introduction of community based
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PD-HATIS
management of acute malnutrition. Guidelines drafted by the cluster were adopted and training and supplies
were launched immediately. The mass and rapid scale of the initiative paves the way for the successful
expansion throughout the country. (Lesson from Myanmar)
It is essential to understand community lines of communication and their role in mobilizing women to
bring their children to health/supplementary feeding centres. In Ethiopia, social mobilization is an effective
process to ensure women bring their children to an Enhanced Outreach Strategy centres to receive health
services. It involves a widening cascade of communication from the regional or zonal level, where the EOS is
planned, through the districts to women in villages. Mobilization is dependent not just on the quality and
uniformity of messages but on reliable and consistent lines of communication, which are largely word-of-mouth.
To improve mobilization, it is therefore important to understand these processes: 1) learning where social
mobilization and access is effective; 2) how parents hear of the programme, and thus the most effective methods
of communication, which may vary from district to district; 3) why parents had attended, what their experience
had been; 4) what messages they had been given, and whether they had been transmitted correctly and
understood; 5) why parents had or had not returned to the next EOS centre; 6) and why some parents had not
attended an EOS centre at all. (Lesson from Ethiopia)
Develop regional strategies. As drought can be a recurring feature, a regional strategy could be helpful to
guide each CO in engaging with government and NGO partners. Such a strategy may include: obtaining more
convincing data to help UNICEF engage in cross-sectoral drought mitigation discussions; study and exchange
on strategies to reach vulnerable pastoral societies with different services in the different country contexts and
identification of key preparedness actions for rapid scaling up in a likely crisis. (Lesson multiple emergencies)
Inter-sectoral Linkages
 It is critical that nutritional interventions (e.g. supplementary feeding programmes) are linked to wider
food aid/security measures and actors (e.g. WFP), to ensure maximum impact. Supplementary food
programmes targeting nutritional deficits must be supported by measures which address food security (e.g.
GFD); otherwise the emergency intervention is undermined. It is important for UNICEF to see nutrition in terms
of the surrounding framework, and to understand the importance of linking with other related partners (e.g. WFP,
UNDP). UNICEF must appreciate the linkages between food security and its emergency nutritional interventions
mandated in the CCCs. SF distribution can be often ineffective if the supplementary ration is consumed by the
entire family, in circumstances in which the general ration was insufficient. (Lesson from Kenya)
 The inter-sectoral nature of nutrition and food security requires that integrated, inter-sectoral
discussions, actions and policies are developed. A food focus, without due attention to nutrition, health and
WASH aspects, can annul the usefulness of emergency interventions. Nutrition interventions can be integrated in
the programming activities of ‘non-food’ sectors to ensure wide coverage of programme activities and holistic,
sustainable response to malnutrition. This can involve having focal points for supplementary food distribution in
other non-food sectors, targeting children and OVCs at schools and targeting HIV/AIDS cases through homebased care, and so on. (Lesson multiple emergencies)
IYCF
 Prioritize the promotion of IYCF. Specifically within the Nutrition sector in Haiti, infant and young child feeding
(IYCF) was not seen as a glamorous, high profile area of emergency response and thus was not well
understood. Prioritizing this area for raising awareness and understanding was critical. (Lesson from Haiti)
 Breastfeeding ‘messages’ must be accompanied by protection and support also in order to effectively
influence infant feeding practice. Protection and support are crucial and should be combined with IYCF
messages to effectively influence breast feeding practices. These measures can include creating enabling
environments for breast feeding and providing structural support for mothers (such as ensuring protection and
implementing practical interventions). The innovative integration of Child Protection and Nutrition in Haiti has
been particularly effective, resulting in “baby-friendly” tents where mothers had space to undertake breastfeeding and dialogue on sensitive issues. (Lesson from multiple emergencies, Haiti)
 Infant and Young Child Feeding interventions must clarify their targeted age range. Excluding active
support in campaigns for exclusive breastfeeding in infants under six months of age risks that young infants may
be treated as if they are ‘beneficiaries in waiting’ for Ready to Use Foods (RUFs). In the absence of any other
interventions, this approach also risks that use of RUF will spill over into the younger age-group. Apart from
displacing breastmilk, this may also have negative implications for HIV transmission. Active support for safer
breastfeeding practices is needed for child survival. (Lesson from multiple emergencies)
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PD-HATIS
Intervention Targeting
 Understanding how and why distributed (SF) is used in a context must inform programme
communication on how SF should be used. It seems unlikely that a woman who has to mix and then cook
distributed supplementary food would exclude other children whom she considered were hungry, and who may
also be malnourished. Sharing may vary between regions and cultures, and may depend on the number and age
of other children in the family and on the household food security situation at the time. Therefore supplementary
food targeting must take in to account cultural sharing traditions, which occur between and within communities
and households, and can lower the potential impact of food aid. (Lesson from the Horn of Africa)
 Effective targeting guidelines and follow up can improve supplementary food distribution impact. When
targeting guidelines are developed, these need to be accompanied by training at sub-national and community
level. It is therefore important to ensure a systematic supervision of the distribution committees, as well as
agencies and donors to ensure that the criteria listed are consistently applied. Continual monitoring and
reviewing of the set of targeting criteria actually applied is needed and it is essential to strengthen the community
participation into the targeting process. (Lesson from Ethiopia)
CROSS-CUTTING ISSUES
Participation/Gender/NCD
 Balance national capacity development with programmatic activity. A preoccupation with programming can
preclude effective and extensive attention to capacity. Ambitious programme goals cannot be achieved where
there is widespread system weakness. A strategy for strengthening national capacity can be critical to utilizing
the opportunities presented in the early recovery stage. (Lesson from Tsunami)
 Building community participation into programming entails elements of accountability. Greater
transparency and accountability requires a proactive approach to information communication, including active
dissemination and public analysis of agency information. (Lesson from Tsunami)
 Progammes which promote community participation should consider power dynamics existing in the
community. The uncritical use and support of community participation could lead to weakening the community
support as often individuals with power are those that represent the community while they mainly represent
themselves. The more powerful and affluent members of the community tend to have the most influence in the
decision-making process thus raising equity issues. (Lesson from Myanmar)
 Build in gender considerations early. Addressing gender dimensions of humanitarian response must start
immediately - as relief efforts are in their very early stages (as camps are set up, infrastructure installed, food
distributed, services established) - rather than only at the recovery stage. Doing this will ensure that different
needs and vulnerabilities are actually addressed, and this will also end up saving time later on (avoiding the
need to undo badly designed responses). (Lesson multiple emergencies)
Communication for Development/Advocacy
 High expectations among the population for rapid improvements in the situation can be a challenge;
communication is critical in informing the population and managing expectations. Programme and media
communication can be an essential step in outlining plans and progress to the population and mitigate misplaced
expectations and any resulting political tensions. Articulate clearly next steps, developed by or in collaboration
with national and local authorities - this can generate realistic expectations. Government must be supported to
effectively do this. (Lesson from Haiti)
 Particularly for IYCF, communication is essential, especially with affected populations. However, it was reiterated
that communication for development and advocacy with partners, media and government is also a critical
activity to ensure the right response and practices are promoted. (Lesson from Haiti)
 Communication may also have to address long-standing cultural beliefs, which impact population habits. In
Haiti, cultural feelings and assumptions surrounding the earthquake have had an influence on the nutritional
habits of the people. The belief is that evil spirits surround the earthquake and in one documented instance this
affected a decision of a mother to breastfeed her child – she did not want any of the evil spirits passed on
through breastfeeding. (Lesson from Haiti)
 Similarly, since the father often has a strong influence on nutrition/breastfeeding practices, nutrition
programmes and programme communication should involve and target the father, to explain the benefits,
address cultural stigmas and sensitively address gender relations. (Lesson from Haiti)
 In countries with chronic food insecurity, advocacy may need to address the perception that child
malnutrition is normal and inevitable. Where there is chronic food insecurity, malnutrition can be seen as
normal - even by UNICEF staff. The existence of malnutrition thresholds considered as alarming in other
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PD-HATIS
countries is not considered so alarming in the Sudan-Sahelian zone. There is a need to ensure that situational
analyses take into account nutritional data and use internationally agreed thresholds as trigger for action. On that
basis, there is a need to conduct advocacy with the government and all partners (including development) to
adopt these thresholds, to address the causes of malnutrition and to take early action. (Lesson from Niger)
It may be necessary to advocate for a long-term nutrition strategy geared at health and food security in
the broad sense. Development and emergency are not mutually exclusive; the limits between development and
emergency are never clear-cut. Both approaches supplement each other to reach the objective of a reduction in
the mortality of children under five. It is appropriate to raise donor awareness, so the necessary resources can
be mobilized on time – not only when shocking footage is broadcast on television screens. If high rates of acute
malnutrition demands urgent action in nutrition management, the fight against chronic malnutrition (size/age
ratio) is more relevant to a long-term strategy geared at health and food security in the broad sense. (Lesson
from Niger)