UNICEF framework fosters collaboration in Afghanistan

Courtyard garden in Afghanistan

Summary of published report1

Recent nutritional survey data have shown that malnutrition amongst women and children under five is endemic in Afghanistan. Fifty four percent of under-fives are stunted, 38% are underweight, 38% are anaemic and over 70% suffer from iron and iodine deficiency. Twenty-one percent of reproductive age women are underweight, 70% iodine deficient, 48% iron deficient and 25% anaemic. Given the importance of problem definition in developing policy to decrease malnutrition in Afghanistan, a recent paper examines the varied perspectives on the food and nutrition situation amongst diverse stakeholder groups. The following questions are addressed: i) using the UNICEF malnutrition framework as a guide, how is the food and nutrition situation understood by stakeholders at different administrative levels (community, provincial and national) and ii) how do perspectives on problem definition, underlying causes and solutions vary between the health and agriculture sectors.

The study was conducted from May 2006 to February 2007 in four locations in Afghanistan. Community level data were obtained from two districts within Balkh province with differing water availability, through key informant interviews and focus group discussions. Provincial level data were gathered in Mazar-i-Sharif, the capital city of Balkh province. Eighteen indepth key informant interviews were held with stakeholders, primarily in the agriculture and health sectors. Thirty-eight national level interviews were conducted with stakeholders based in Kabul, replicating the methodology used in Balkh province. The results of the study illustrate how the UNICEF framework may be adapted to a country context and used to organise over 250 issues related to the food and nutrition situation.

The issue most frequently mentioned by stakeholders at all administrative levels was economics. Political insecurity was also noted at each administrative level as an overarching barrier to progress on improved food and nutrition. Community-level key informants and provincial and national stakeholders frequently highlighted nutrition knowledge as the secondary food or nutrition problem. Men and women's focus groups, however, did not perceive a lack of nutrition knowledge. Many professionals noted their own lack of training in nutrition and lack of institutions in the country offering such education. Issues such as nutrition training, basic professional skills and nutrition policy were salient at Balkh province and national levels, but not at the community level. The implications of these differences relate to where policy makers devote energy and resources. Some policy makers acknowledged a tension between the emphasis on capacity building of professionals and building the capacity of communities to achieve food and nutrition security, resulting in a diversion of resources from community activities.

The data collected suggest that acknowledgement of a policy problem depended on having technical knowledge about public nutrition and food security. Stakeholders from agriculture and health sectors had varying understandings of malnutrition and food security concepts. Apart from the few with specific nutrition training, most agriculture or health sector stakeholders did not highlight the documented high prevalence of chronic malnutrition or specific micronutrient deficiencies. Health sector stakeholders defined food and nutrition problems often using broad malnutrition terms or highlighting less prevalent but dramatic conditions, such as severe acute malnutrition. Micronutrient malnutrition (with the exception of anaemia) was typically mentioned in the context of interventions rather than in the context of patients affected by deficiencies. Agriculture sector stakeholders broadly defined food and nutrition problems in terms of dietary quality, which was seen as an outcome. The differences in views found in Afghanistan illustrate that both nationals and expatriates, particularly within the agriculture sector, are using definitions from different historical periods with different emphases within and between sectors. This lack of common definition complicates policy dialogue and poses a barrier to achieving consensus in programme and policy making. Health sector and community stakeholders addressed food security indirectly, by reference to components of food availability, access and/or utilisation. These findings highlight the importance of having a shared vocabulary and access to relevant technical information to facilitate policy discourse and common understanding or problem definition.

Women attending a health clinic

Provincial and national data show that stakeholders tended to provide information about underlying causes of malnutrition pertaining to their professional field. Underlying causes emphasised by health sector stakeholders were largely located in domains within the purview of the health sector, with occasionally mention of issues pertaining to agriculture and other sectors. Similarly, there was rarely discussion of health sector issues by agriculture sector stakeholders. Domains noted by stakeholders from both agriculture and health sectors often highlighted different issues within those domains - for example, in the socio-political environment domain, agriculture sector stakeholders noted a need for agricultural extension and health sector stakeholders highlighted the role of a strong nutrition policy.

These findings suggest that to foster greater linkages between agriculture and health sectors in nutrition across administrative levels and sectors, existing efforts at disseminating the UNICEF framework are necessary but still insufficient. Many barriers still exist to achieving a common problem definition and coordinated solutions. To make the framework more useful it should be adapted to local conditions as has been done in this study. This helps to identify sectoral perspective and biases in problem definition and to determine underlying causes and solutions. Using a locally adapted version of the UNICEF framework facilitates inclusion of community viewpoints in the process of policy development. These perspectives are often omitted by policy makers who frequently lack direct contact with community-level stakeholders. This formative research provides numerous insights into pathways for agriculture-health sector collaboration in the Afghan context and a methodology applicable and adaptable to similar initiatives elsewhere.

Show footnotes

1Levitt. E, Pelletier. D and Pell. A (2009). Revisiting the UNICEF malnutrition framework to foster agriculture and health sector collaboration to reduce malnutrition: A comparison of stakeholder priorities for action in Afghanistan. Food Policy, vol 34 (2009), pp 156-165

More like this

NEX: Scaling up nutrition: experiences from Balochistan, Pakistan

Muhammad Sheraz and Dr. Ali Nasir Bugti Muhammad Sheraz is the Nutrition Information Management Officer for the Department of Health within the Government of Balochistan. Dr....

FEX: Scaling up CMAM in the wake of 2010 floods in Pakistan

By Dr. M. Suleman Qazi Dr. Qazi was engaged by the ENN to capture the lessons from Pakistan on CMAM scale up. Dr Qazi is a medical graduate with a post graduate degree in...

FEX: Dr Nadera Hayat Burhani

By Carmel Dolan, ENN ENN interview with Dr. Nadera Hayat Burhani, Deputy Minister for Health Care Services Provision, Islamic Republic of Afghanistan Dr Burhani speaking at...

en-net: Vacancy for Nutrition Manager - Mozambique with Concern Worldwide

Reference: RD/MOZ/NM Country: Mozambique Job Title: Nutrition Manager Contract Grade: B Contract Length: 2 Years Date Needed By: October 2013 New Post or Replacement: New...

FEX: Linking PSNP and NNP: experiences and challenges

Summary of report1 Audience of drama held during PSNP meeting (Laygiant) A recent pilot project focused on identifying implementation and eventually scale-up opportunities to...

FEX: From the editor

While there are at least four distinct thematic areas addressed by articles in Field Exchange 37, there is arguably one cross-cutting issue - namely the tendency towards...

FEX: Review of Integrated Food Security Programme in Malawi

Summary of published review1 Areview of an Integrated Food Security Programme (IFSP), implemented by GTZ2 in Malawi from 1997 to 2004, has recently been published by Tufts...

FEX: Community management of acute malnutrition in Mozambique

By Edna Germack Possolo, Yara Lívia Novele Ngovene and Maaike Arts Edna Germack Possolo is Chief of the Nutrition Department of the Ministry of Health, Republic of Mozambique...

FEX: Integrated management of acute malnutrition in Kenya including urban settings

By Valerie Sallie Wambani Valerie Wambani is Programme Manager for Food Security and Emergency Nutrition, Division of Nutrition, Ministry of Public Health and Sanitation. She...

FEX: Making agricultural policies deliver better nutrition

Summary of report1 Location: Burkina Faso, Kenya, Peru What we know: There is increasing international interest in linking agriculture with nutrition. At national level,...

FEX: Food security assessment of high altitude villages of Badakhshan, Afghanistan

By Salim Sumar, Laila Naz Taj and Iqbal Kermali Dr Salim Sumar heads Focus Humanitarian Assistance Europe Foundation, which is an affiliate of the Aga Khan Development...

en-net: WFP DRC IS SEEKING A NUTRITION ADVISOR

Terms of Reference: Nutrition Advisor/World Food Prorgamme/Kinshasa, DRC Background Despite large investment and government renewed committed to combat malnutrition, the...

About us

Who we are The ENN is a UK registered charity. It was set up to improve practice and strengthen the institutional memory of agencies involved in the emergency food and...

FEX: Evaluation of CMAM Pakistan: UNICEF country case study

Summary of evaluation1 A flood affected community in Khyber Pakhtunkhwa province CMAM has been implemented in Khyber Pakhtunkhwa province of Pakistan, with scale up in 2010...

FEX: Viability of an ENN research initiative

Food aid in Afghanistan By Christine Bousquet, Charlotte Dufour, François Grünewald, Hugues Maury, Groupe Urgence Réhabilitation Dévelopement (URD) The Quality Project is an...

FEX: Update on Scaling up Nutrition (SUN) and the ‘1000 Day’ movements

By Tom Arnold and David Beckmann Tom Arnold is CEO of Concern Worldwide and David Beckmann is President of Bread for the World. Recognised globally as non-governmental...

FEX: Regional CMAM meeting in Ethiopia 2011

In collaboration with the Government of Ethiopia and in consultation with national and international agencies, the Emergency Nutrition Network (ENN) is planning a three day...

en-net: GOAL seeks Nutrition Coordinator in Niger

Since the food crises of 2005, GOAL has continuously supported the population of Mirriah district in Zinder Region through the implementation of community-based programmes...

FEX: From the editor

Rabia, seven months, with her mother at an OTP Aim and structure of this special issue This Field Exchange special issue on ‘Lessons for the scale up of Community-based...

en-net: Nutrition Resource Acquisition, Design and Development Manager

*2-Year Contract* Use your leadership skills and public health nutrition expertise to be part of a leading organisation dedicated to improving the lives of children living in...

Close

Reference this page

Levitt. E, Pelletier. D, Pell. A (2009). UNICEF framework fosters collaboration in Afghanistan. Field Exchange 37, November 2009. p5. www.ennonline.net/fex/37/unicef