We've been on a high this week with the publication of the Viewpoint from the ENN coordinated Wasting-Stunting Technical Interest Group (WaSt TIG). 'Beyond wasted and stunted - a paradigm shift is needed to fight child undernutrition' in the Lancet journal of Child and Adolescent Health. The Viewpoint reflects the combination of work we have been coordinating over the last 5 years with a dedicated and inspiring group of experts. For further information about this work, see the WaSt TIG project page
We have just visited Ethiopia to understand how the country is succeeding in strengthening the ‘nexus’ between humanitarian and development actions. Both of us have a long history with Ethiopia, starting our careers working at the time of the 1984 famine in Ethiopia and with refugees in Sudan. Since then, we have been privileged to have worked in Ethiopia on numerous occasions, witnessing substantial change and progress. A memorable event was when we co-hosted a 3-day conference in 2011 with the Government of Ethiopia to share learning across many countries on how to scale up CMAM.
In 2019 ENN, continuing its case studies series on Multisectoral programming at the Subnational level, plans to study two more countries -Philippines and Zimbabwe, within the final year of the TAN project. With this in mind, in July, accompanied by the Global Knowledge Management Coordinator, Natalie Sessions, I visited the Philippines’ capital Manila for a scoping visit. In this week we intended to understand the history of nutrition plans and programmes in the country, the burden of malnutrition and district level variance, the structure of implementation hierarchy for nutrition programming and how this fits in with the existing governance structure in the country, the different multisectoral nutrition programmes in place and the factors that have supported nutrition improvement in the country.
ENN attended the Global Nutrition Cluster (GNC) annual gathering in Brussels in early July (Tanya Khara as Technical Director, Isabelle Modigell and Linda Shaker-Berberias as ENN consultants and myself as staff nutritionist). This is a key event in the calendar for nutrition actors in the humanitarian sector – a chance to take stock of progress in countries of operation and steer the course of future action at country, regional and global levels.
Today, over 50 million children are wasted, which comes with an elevated risk of death. Even more, wasting prevalence hasn’t declined in recent years. The United Kingdom’s Department for International Development (DFID) are calling for a focus on how to prevent wasting to complement existing evidence-based treatment of children who are already affected.
Since early 2018, the Emergency Nutrition Network (ENN) has been working—through the MQSUN+ project—to improve the understanding of what is needed to prevent children from becoming wasted. ENN carried out two reviews as part of this project. We started with a rapid review of the state of knowledge about ‘The Aetiology of Wasting’ and then moved into a more detailed review of what the literature tells us about the ‘Current State of Evidence and Thinking on Wasting Prevention.’
My winter began in Kathmandu last week where I attended the 6th Annual Scientific Symposium on Agriculture- Nutrition Pathways organised by Feed the Future Innovation Lab for Nutrition. I have attended the Annual event 3 years in a row and this year was extra special as the event also was celebrating 25 years of Nepal’s Progress in Nutrition. What makes this event unique is that it attracts students and young researchers in equal numbers as persons from academia, policy makers and programme implementors in the field of agriculture- nutrition research relevant to Nepal.
Le 15 novembre dernier, le gouvernement nigérien a fait un grand pas en avant dans la lutte contre la malnutrition en adoptant sa toute première politique nationale de nutrition dite « politique nationale multisectorielle de sécurité nutritionnelle ». Cette politique a pour objectif d’éliminer toutes les formes de malnutrition pour atteindre la vision où chaque nigérien jouit d’un statut nutritionnel adéquat pour assurer le développement, la résilience et la prospérité du Niger. Cette vision pose la nutrition comme un outil de développement et de résilience et pas seulement comme une stratégie d’urgence. Elle définit les rôles et les responsabilités de toutes les parties prenantes (tels que les donateurs, les partenaires techniques, les organisations non gouvernementales, la société civile et le secteur privé, etc.) dans l'amélioration de la sécurité nutritionnelle du pays, soulignant ainsi l'importance de la participation de tous les acteurs dans la réduction de la malnutrition.
On the 15 November this year, the Niger government took a big step forward in tackling malnutrition by adopting its first ever nutrition policy known as the “national multisectoral nutrition security policy”. The policy aims to achieve the vision of the citizens having adequate nutritional security, in order to ensure the development, resilience and prosperity of the country as a whole. Notably, the policy aims to make nutrition programmes part of development and resilience work in the country, rather than simply being seen as emergency focused interventions. Furthermore, the policy sets out roles and responsibilities of all stakeholders (such as donors, technical assistance providers, non- governmental institutions, civil society and the private sector) in relation to improving nutrition security in the country, thus emphasizing the importance of everyone playing a role in reducing malnutrition.
ENN has returned from the Global Nutrition Cluster (GNC) annual meeting in Amman, Jordan, where it seemed that everyone was talking about the humanitarian development nexus as a means to ensure a continuum of care.
ENN provided its usual brand of knowledge management (KM) support to Nutrition Cluster Coordinator (NCC) presenters and, for the first time, the GNC, with ENN support started the annual event with a one-day meeting devoted to Yemen and Sudan. UNICEF had requested this smaller side-meeting to shine a light on the particular challenges faced and to move forward on a call to action to end malnutrition in Yemen and a nutrition investment case for Sudan. Both countries have been in protracted crises for several years, have very high rates of wasting, stunting, micronutrient deficiency, low birth weight and maternal malnutrition, and rely on annual humanitarian response plans (HRPs) to implement nutrition activities.
I attended Kenya’s 2nd Agri-nutrition conference held in Nairobi from 11th – 13th of September 2018. The 3-day forum was co-hosted by the Ministry of Agriculture, Livestock, Fisheries and Irrigation and the Ministry of Health, with support from USAID-Accelerated Value Chain Development Program and partners.1
The Conference’s objective was to provide a learning platform on the role of agriculture in improving nutritional outcomes, summarised in the conference theme: “Accelerating Nutritional Gains Through Agriculture”. ENN attended the conference to share learnings and disseminate the findings of an in-depth documentation exercise on multi-sector programming for nutrition - a sub-national study done in Kenya, Nepal and Senegal in 2017. Kenya’s case example had a strong agrinutrition bias and the agrinutrition forum was therefore a relevant forum to share the findings.
Over two decades of civil conflict in Somalia interspersed with periodic droughts and floods have profoundly changed what used to be one of the most beautiful countries in east Africa to a nation which regularly receives huge amounts of humanitarian aid. The latest humanitarian response plan (HRP)(2018) comes in at around one billion dollars. 90% of all aid to Somalia is humanitarian and the small amounts of development aid it receives means that the country is stuck in a cycle of humanitarian crisis and response. The country has regularly teetered on the edge of, or experienced, full blown famine in 2017 and 2011 respectively. Rates of acute malnutrition (mainly wasting) have consistently been over the international emergency threshold and in 2018, a relatively good year, prevalence is estimated at 18%. These depressing facts are one reason why ENN determined to carry out a country study in Somalia as part of its ongoing work to identify ways to increase the nutrition resilience of vulnerable populations in fragile and conflict contexts through strengthening the humanitarian development nexus (HDN). Somalia is ENN’s second country case study, (after Kenya), with a further three or four country studies planned until the end of 2019.
The private sector in nutrition - a player by default or choice? Reflections from a multi-stakeholder meeting
I participated in a Round Table organised by South Asia Food and Nutrition Security Initiative SAFANSI In Colombo in June which was titled “Putting the Lens on the Consumer in Nutrition-Sensitive Agriculture and Food Systems in South Asia”.
Before I share highlights from the 2-day event, here is some background on SAFANSI -
Marie has worked on infant and young child feeding in emergencies since 2001. She coordinates the IFE Core Group, an international interagency collaboration on infant and young child feeding in emergencies.
In the Irish language, there’s a phrase “rírá agus ruaille buaille” (trans: uproar, hubbub, tumult, commotion, ruction, rough & tumble)” which captures the essence of the escapades of the recent World Health Assembly (WHA) around the Infant and Young Child Feeding (IYCF) Resolution in which ENN has been closely involved. Here’s our version of events.
Plus tôt ce mois-ci, j'ai assisté à une conférence organisée conjointement par l'Association sud-asiatique de coopération régionale (SAARC), le Bureau régional de l'UNICEF pour l'Asie du Sud (ROSA) ainsi que Nutrition International afin de débattre et d’identifier quelles actions pourraient permettre d’accélérer les soins nutritionnels des femmes durant leur grossesse et après l’accouchement en Asie du Sud. Des représentants des huit pays de la SAACR ont participé à la conférence, chacun ayant envoyé des hauts fonctionnaires représentant leurs gouvernements respectifs, ce qui est peut-être un gage de l’importance donnée à ce problème dans la région.
Earlier this month, I attended a meeting organised jointly by the South Asian Association for Regional Cooperation (SAARC) and the UNICEF Regional Office for South Asia (ROSA) together with Nutrition International to discuss and identify actions to accelerate the nutritional care of women during pregnancy and postpartum in South Asia. The meeting was attended by representatives from all 8 SAARC countries with all countries sending high level officials from Governments perhaps indicative of the importance of the issue in the region.
Dan is the Henry J. Leir Professor in Food Security and Research Director at the Feinstein International Center and the Friedman School of Nutrition Science and Policy at Tufts University. He is the author, with Nisar Majid, of Famine in Somalia: Competing Imperatives, Collective Failures published by Oxford University Press in 2016 (and reviewed in Field Exchange 57). For the past four years, he has served on the Famine Review Committee for Integrated Phase Classification (IPC) analysis—a committee that is mobilised whenever a possible famine declaration is a possible result of an analysis.
We recently attended the Global Nutrition Cluster Annual meeting in Geneva. ENN, as part of the process of pulling together a special issue of Field Exchange on Nutrition Cluster Coordination (which will be out in November), worked behind the scenes with cluster coordinators from 6 countries to help them to set out and synthesise what is going well in their focal countries, what challenges they face, what steps they can take to overcome these challenges and, what ‘asks’ they have of the global level. They presented on Day 1 to around 90 participants from UN agencies, NGOs, donors, academia and from other clusters. It was a day of very rich learning.
Recherche sur la programmation multisectorielle de nutrition : réflexions sur une approche intégrée nutrition et cash et eau, hygiène assainissement
Il y a quelque temps j'ai eu l'opportunité de participer à un événement régional à Dakar en Sénégal sur les approches nutritionnelles multisectorielles, organisé par ACF et ses partenaires. Cette rencontre rentrait dans le cadre de la restitution de l’étude "Research on Food Assistance for Nutrition Impact" (REFANI) réalisée au Niger en 2015. En plus de l'étude du Niger, le projet REFANI a également été mené au Pakistan et en Somalie par un consortium de partenaires dont ENN. Le projet de recherche REFANI avait pour objectif global d’évaluer l'impact des transferts monétaires (cash) sur la prévention de l’émaciation (malnutrition aigüe) dans les pays ciblés. ENN était responsable (avec ACF, partenaire de mise en œuvre) de l'étude au Pakistan où nous avons mis en place un essai contrôlé randomisé dont les résultats ont été publié dans l’article Impact evaluation of different cash-based intervention modalities on child and maternal nutritional status in Sindh Province, Pakistan, at 6 mo and at 1 y: A cluster randomised controlled trial. at 6 mo and at 1 y: A cluster randomised controlled trial. L’étude REFANI Pakistan a été une des toutes premières études à démontrer un impact du cash sur la malnutrition aigüe. ENN a également constaté des réductions importantes du retard de croissance lors de cette étude. A la rencontre de Dakar, à laquelle ont pris part plusieurs institutions, notamment les institutions gouvernementales et non gouvernementales, les organismes des Nations Unies, les instituts de recherche et les entreprises privées, les présentations ont été axées sur l'impact du cash et du WASH sur la malnutrition à travers 3 panels successifs :
Research on multi-sectoral programming: reflections on a cash and WASH, nutrition integrated approach
Some time ago I had the opportunity to attend a regional event for sharing multi-sectoral nutrition approaches, organized by ACF and its partners in Dakar, Senegal. This meeting was organised to share results of the "Research on Food Assistance for Nutrition Impact" (REFANI) study conducted in Niger in 2015. Apart from the Niger’s study, the REFANI Project was also conducted in Pakistan and Somalia by a consortium of partners who aimed to evaluate the impact of cash transfers and its impact pathway on the prevention of wasting in these countries. ENN was responsible (with the implementing partner ACF) for the study in Pakistan where we implemented a four-arm randomised control trial published here. The REFANI Pakistan study was amongst the first showing a reduced risk of wasting from a cash transfer programme in an area with very high levels of wasting. Interestingly, ENN also found significant reductions in stunting. At the Dakar meeting, attended by governmental and non-governmental institutions, United Nations agencies, research institutions and private companies, presentations focussed on cash and WASH impacts on nutrition as follows:
The SUN Civil Society Network (SUNCSN) has as we speak 2500 member organisations organised as National Civil Society Alliances (CSA) spread across 39 countries globally.
In mid-July, I attended the SUN Civil Society Regional Learning Exchange – Asia co-organised by Global SUN CSN Secretariat and the Civil Society Alliance for Nutrition, Nepal (CSANN) in Kathmandu.
I watched fellow Kenyans go through party primary elections this past April in preparation for the August General elections. This is when political parties nominate one candidate to represent them prior to the actual elections. This occurs for the lowest administrative office right up to the presidential seat. I had never really paid attention to party primaries before, but I noticed them this time due to huge voter turn-out - one would think it was the general election. In Kenya’s history, this year’s elections will be the second ever under devolution, and perhaps the first where citizens actually understand what devolution really means. The huge party primary turn-out was probably because Kenyans are serious about whom they want (or don’t want) to represent them at county level. I believe this level of interest in politics front has implications for public service delivery, and specifically, health and nutrition services.
Au fil des années, la portée du travail d'ENN s'est étendue au-delà de l'accent mis initialement sur les contextes humanitaires pour englober un ensemble plus large de problèmes liés à l’émaciation et au retard de croissance dans des contextes d'urgence et/ou des contextes où la prévalence est élevée. Nous sommes de plus en plus intéressés par l'évolution de la politique et de l'environnement de programmation autour du traitement et de la prévention de la malnutrition. ENN est actuellement engagé dans l'exploration de la relation entre l’émaciation et le retard de croissance (voir le récent billet de Carmel Dolan sur le blog ici), le retard de croissance dans les situations d'urgence, et la façon dont les initiatives ciblées sur le retard de croissance et l’émaciation interagissent dans la pratique.
Over the years the scope of ENN’s work has expanded beyond a focus on humanitarian contexts to encompass a broader set of issues around drivers of wasting and stunting in both high burden and emergency contexts. We are also increasingly interested in the evolving policy and programming environment around malnutrition treatment and prevention. ENN is currently engaged in exploring the relationship between wasting and stunting (see the recent blog piece by Carmel Dolan here), stunting in emergencies, and on how stunting or wasting focused initiatives interact in practice.
At the beginning of this year, I attended a Nutrition International (NI) mission in the village of Amadou Bellinaoude-Santhiago, in the Kolda region to visit the Integrated Nutrition Project at Kédougou and Kolda (PINKK) implemented by NI.
En début de cette année, j’ai accompagné une mission de Nutrition International (NI) dans le village de Amadou Bellinaoude-Santhiago, région de Kolda pour visiter le Projet Intégré de Nutrition à Kolda et Kédougou (PINKK) mis en œuvre par Nutrition International.
J'ai débuté en avril avec une visite d'une semaine au Myanmar; il s’agissait de ma première visite en tant que spécialiste régionale de la gestion des connaissances pour ENN. Myanmar et sa « première citoyenne », la prix Nobel de la paix, Aung San Suu Kyi, faisaient cette semaine-là l’objet d’une couverture médiatique importante pour des affaires litigieuses. Je suis cependant repartie, encouragée par le fait que ce pays, et son jeune gouvernement, avance dans la bonne direction pour améliorer l'état nutritionnel de sa population. Pour cette visite, j'ai accompagné Manpreet Kaur Chadha, qui est la responsable régionale pour l’Asie du programme TAN (Assistance Technique pour la Nutrition) de Nutrition International [NI] (anciennement Micronutrient Initiative) dont la mission est d’identifier les besoins d'assistance technique en matière de nutrition dans le pays. Financé par le ministère britannique du développement international (DFID), c’est ce même programme TAN qui comprend à la fois la gestion des connaissances par l’ENN et l’assistance technique par NI pour tous les pays membres du mouvement SUN.
I began April with a weeklong visit to Myanmar, not my first visit but the first in my role as KM Specialist with ENN. Myanmar and its “first citizen” of sorts, Nobel Peace Prize Winner Aung San Syu Kyi were in the news in the same week on contentious issues. However, I returned home encouraged that this country, with its year-old government, is taking all the right first steps to improving the nutrition status of its population. For this visit I accompanied Manpreet Kaur Chadha the Nutrition International (formerly the Micronutrient Initiative) Asia Regional Manager for the TAN programme on her mission to identify nutrition technical assistance needs in the country. The TAN programme is the DFID funded package of support under which ENN provides knowledge management and NI technical assistance support to SUN countries.
I hope some of you have heard of No Wasted Lives. For those who haven’t, now is the time to join forces with this coalition of partners working to address the biggest challenges we face today in the prevention and treatment acute malnutrition.Our ambitions are large and we need your help to accelerate global action to double the number of children receiving treatment to 6 million a year by 2020.
Hello, I am Bridget Fenn, ENN’s long standing lead research investigator. I recently I gave a virtual presentation about the REFANI to participants at a research conference in Islamabad organised by Action Against Hunger. Despite the early start (5.30 a.m.), presenting remotely and missing the all-important human interaction afforded by face-to-face meetings, the presentation was very well received and there were plenty of questions and comments from the attendees…more about these below.
Some of you will know that ENN has been coordinating a project with the expert steer of around 30 child growth and nutrition specialists from academia, donor and operational agencies. Collectively, we are known as the Wasting-Stunting Technical Interest Group (WAST-TIG) and we have been interacting across various work streams for a few years thanks to generous funding from Irish Aid and USAID OFDA.
How relevant are Africa’s political blocs in advancing the Scaling Up Nutrition (SUN) Movement agenda? Can the movement tap into the initiatives by the region’s political blocs to achieve its goals?
In my experience with the Scaling Up Nutrition (SUN) Movement activities, I have noted the quest to establish multi-sectoral platforms to tackle malnutrition worldwide. Thus, nutrition experts and nutrition advocates have embraced the multi-stakeholder approach to drive forward their agenda – bringing together governments, donors, UN agencies, civil societies, business/private sector, research and academic, to play their roles in this noble goal.
Coordination multisectorielle pour la nutrition Tchad : une plateforme multi-acteurs complète et dynamique
Je suis Ambarka Youssoufane, en tant que Spécialiste Régional Gestion de connaissance pour l’Afrique de l’ouest et du Centre de ENN, il m’arrive souvent de visiter les pays de la sous-région et discuter avec différents acteurs de la nutrition et du Mouvement SUN. C’est dans ce cadre que j’ai visité le Tchad du 23 au 28 janvier dernier, où j’ai pu constater une forte dynamique autour du point focal SUN pays dans le cadre de la plateforme multi-acteurs pour une coordination multisectorielle des actions de nutrition dans ce pays. C’est de cette plateforme que je voudrais vous entretenir aujourd’hui.
We’ve recently been to meet with two Rome based UN agencies – World Food Programme (WFP) and Food and Agriculture Organisation (FAO), as well as the UN Network for SUN (UNN). Our trip had a number of objectives; to discuss ENN’S SUN KM Project, highlight a forthcoming ENN hosted meeting to explore the need for a systematic review of nutrition sensitive interventions, share the latest issue of Nutrition Exchange, promote the new ENN Media Hub and to pick up on conversations held in late 2016.
Greetings! I am Dr Charulatha Banerjee, one of ENN’s Regional KM specialists working in Asia.
On the 9th of January I visited the Indian state of Jharkhand to meet stakeholders working in nutrition. Jharkhand is a very recent “member state” of the Scaling Up Nutrition (SUN) Movement, joining in September 2016, it is the 3rd Indian state to sign on to this global initiative. Jharkhand joins the states of Uttar Pradesh and Maharashtra, and 58 national governments in Asia, Africa and Latin America that have committed to working towards reducing their high burden of malnutrition.
Firstly, a very warm welcome to ENN’s blog! We are very excited to launch this today as part of our new Media Hub.
For those of you who know ENNs work well, this new platform and digital work may seem like an exciting (even radical!) departure from what we currently do. In this post I will make the case that despite the appearance of being new-fangled, it is consistent with ENN's existing approach and way of working. The Media Hub was set up to support sharing and learning in the nutrition sector giving priority to the experiences and voices of those at the “sharp end” of programming and policy making. It is ENN embracing a new set of tools to achieve some rather old (but still very relevant) goals. So let’s look at how we got here.
Ambarka is the Emergency Nutrition Network (ENN) knowledge management specialist in West and Central Africa. He is based in Dakar, Senegal. He has years of experience with roles in governmental and civil society authorities in Niger.
According to International Land Coalition, advocacy is “the strategic use of information to influence a policy, which affects the life of the weakest populations”.