There are three themes running through this issue of Field Exchange. We have four field articles which describe the very real practical challenges of having to adapt programming in the face of conflict and insecurity. An article by Mustafa Ghulam and Mohammed Alshama’a, Save the Children, describes adapting a resilience improvement programme in conflict affected Yemen and how a scaled up e-voucher scheme still managed to improve dietary diversity in spite of the high level of insecurity. Meanwhile, an article by Mercy Laker and Joy Toose, World Vision, documents how a CMAM programme had to be adapted in South Sudan when conflict broke out but still managed to provide critical life-saving treatment to young children. Afghanistan is the setting of a field article by Action Contre la Faim, which describes measures taken to allow sampling during programme coverage assessments that both maintained data integrity while protecting the safety of enumeration staff. Finally, an article written about WHO’s emergency nutrition response in South Sudan documents the development of a specific medicines kit (and associated training package) for the treatment of complicated severe acute malnutrition (SAM), which allowed programming to continue in the face of a marked deterioration in security. What all these articles have in common is adaptation and innovation based upon on an ‘on the ground’ perspective about what is possible and how best to preserve programme equity and effectiveness in the face of overwhelming challenges for programme staff and beneficiaries. You have to ask if someone somewhere is going to pull all these programming approaches together to produce some sort of guidance on ‘how to adapt nutrition-related programming in insecure areas’?

A second theme emerging in Field Exchange 53 is the role of multi-sector programming in addressing undernutrition. There are a number of relevant research summaries. Complementing the recently released Lancet series on early childhood development (ECD), we have a summary of a series of articles on the role of nutrition in integrated ECD, which makes the case for multi-sector programming that considers responsible parenting, learning stimulation, education, and social protection, in addition to health and nutrition. Another summary presents the findings of a study on the impact of a cash support grant in South Africa on stunting. No impact is seen and this is explained by high levels of HIV and unemployment, which may confound any effect. There is also a summary of a study in 13 countries looking at the degree to which nutrition is explicitly mentioned in water, sanitation and hygiene (WASH) policies and vice versa. Perhaps surprisingly for this day and age, there is limited incorporation of nutrition and WASH in the respective policies of the other sector. Interestingly, the report authors suggest that the nutrition sector has more of a vested interest in incorporating WASH objectives since we depend on WASH to achieve nutrition outcomes; typical WASH outcomes do not depend on nutrition and so there may be less incentive for integration. There are also two research summaries about the national school feeding programme in Brazil which has managed to legislate for procurement from local farmers who provide the food for the programme. One of the studies looks specifically at lessons learnt about engaging across sectors from more of a political economy perspective and what is required to maximise success.

A final theme, and one which effectively provides an overarching framework for the themes discussed above, is the relationship between development and humanitarian programming and how there are strong conceptual, epidemiological and institutional rationales for closer integration. A critical online article by IRIN (an independent non-profit media venture) highlighted a number of recommendations from the Grand Bargain (a package of reforms to humanitarian funding, launched in May 2016 at the World Humanitarian Summit).  Commitments are packaged under 10 measures/areas for reform. One of these measures is ‘Enhance engagement between humanitarian and development actors’. This is about working collaboratively across institutional boundaries on the basis of comparative advantage" and   “the use of existing resources and capabilities better to shrink humanitarian needs over the long term, with the view of contributing to the outcomes of the Sustainable Development Goals (SDGs)”. A summary of a research prioritisation exercise on the relationship between wasting and stunting concluded that the highest priority is to find evidence from evaluations and studies on the optimal timing of treatment and prevention programmes to impact wasting and stunting as part of the same programme. An ENN interview with Rebecca Alum Williamand Shishay Tsadik from the Ministry of Health (MoH) in South Sudan highlights the challenges of integrating an effective nutrition information system (NIS), developed largely by nutrition cluster partners over a period of years to inform humanitarian programming, with government health information systems. There are also two articles related to chronic disease in the context of emergency programming, One is a summary of a study looking at mortality and risk factors for chronic disease in children who had been ‘successfully’ treated for SAM seven years earlier in Malawi. Functional deficits were found and most alarming, nearly one-third of discharged cases had died and another 15% were lost to follow-up. These findings really challenge our notion of ‘cure’ when it comes to SAM; a return to normal anthropometry is not matched with a return to pre-SAM risk level, with long term morbidity and mortality implications.  The second article summarises a meeting held by MSF recently which focused on improving care of people with non-communicable disease (NCD) in humanitarian settings. The strand linking all these pieces, either explicitly or through implication, is that there are inextricable links between so called emergency and development nutrition, yet the analytical frameworks and architecture which underpin responses do not reflect this adequately. Availability of resources for nutrition is undoubtedly a common challenge for all; a study by the World Bank provides a timely reminder of what it will cost to achieve global targets for stunting, anaemia, exclusive breastfeeding and SAM treatment – applicable to both humanitarian and stable contexts. The bill comes in at $70 billion over ten years!

Finally, we would like to draw attention to a new section of Field Exchange which we are trialling in this issue. We call this ‘snapshots of research’ where the ‘bare bones’ of studies are summarised. The reason for introducing this section is partly economic (to cut down on printing costs), partly appreciating our readers may value a digested read, and partly expedience (there is more and more research being published and given the common ground between emergencies and development, there is a broader spectrum of research relevant to our readership). The short articles in this ‘snapshot’ are hopefully all of interest and include studies on; the social inequality of child malnutrition in Mozambique, climate change modelling on the effect on food production and global and regional health, trends in adult Body Mass Index (BMI) in 200 countries, the impact on child anaemia of a wheat fortification programming in Jordan and the effect of Lipid Nutrient Supplements (LNS) on morbidity in rural Malawian children. Please let us know if this new section works for you.

We hope you enjoy this issue of Field Exchange. As ever, articles, ideas and feedback always welcome.

Jeremy Shoham & Marie McGrath

Field Exchange Co-Editors 

 

 

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