Hello from Field Exchange’s New Co-Editor and Reflections on FEX 64

By Nicki Connell on 28 January 2021

Happy 2021 to all! With any new year comes new opportunities and for me this means taking up the reins as the Co-Editor of Field Exchange (FEX) at ENN. What a privilege to have the chance to support the strategic direction of this critical publication in the nutrition sector, which has been an essential read for me over my career working with NGOs and as a donor. I am looking forward to working with many of you and learning about your latest programming experiences, innovations and research, and supporting you with the development of Field Exchange content in my editorial role with the FEX team.

I have a long history reading and contributing to FEX, indeed FEX was one of the first resources flagged to me on my MSc course at LSHTM in 2007! I then went on to work for many years in the field as an emergency nutritionist, responding to refugee influxes in Bangladesh, flooding in Pakistan, conflicts in South Sudan and cholera outbreaks in Yemen, to name a few. I have also managed research projects related to the management of at-risk mothers and infants (MAMI) and infant and young child feeding in emergencies (IYCF-E), and more recently worked for the Eleanor Crook Foundation (ECF) managing their research portfolio.

In the early days I looked forward to receiving Field Exchange in care packages sent to me by post, before ‘online’ was as possible as it is now, and over the years have published many times in Field Exchange. When I look back at my career and in particular my time in the field, I do wish I had shared more through FEX. I don’t think I realised how valuable the work my team and I were doing on the ground was, and how it paved the way for future efforts in nutrition in those settings and even globally. I thought I was doing nothing particularly extraordinary and that there were probably hundreds of others doing the same or more important things than me. It is only now I realise that all of us have had unique and interesting experiences and if we can share them then the evidence base would be far bigger than it currently is. So please do reach out to the FEX team to share your experiences and also look around you to identify others who you could support to contribute with their unique perspectives, such as government staff or those working with national NGOs.

With a new year also comes our latest FEX edition, FEX 64, and I have read with interest several articles and other pieces of content on the latest from the nutrition sector. Several themes stood out to me which reflect many of the challenges we are all grappling with in the nutrition sector, not least government ownership of and leadership around nutrition service provision. It is critical that governments are supported to build nutrition services into existing health systems, take service provision to scale to improve coverage and think how this work can be sustainably maintained. We should learn from the experiences highlighted in Kenya and from other sectors and contexts too where there has been success. That said, my experience with ECF has made it clear that it is equally critical, if not more so, to also be transparent on failures and challenges. We have so much to learn from what doesn’t work and in the interests of efficiency, it is invaluable to share these insights with others to avoid wasting time and money trying the same thing. With significant progress made with CMAM surge, this is a great example where it is time for non-government implementers to hand over the responsibility to governments and support them to take responsibility and own wasting treatment services. UNICEF’s new strategy puts governments front and centre in terms of who they work with and support. It is time for this to be put into action and for others to support this effort. We should remember that in many ways, success means putting ourselves out of a job!

Of course, it is very easy to state what is needed and gloss over the challenges with getting there. I strongly believe that one way to support government ownership is to invest a lot more in measuring cost-effectiveness. We have very few examples where we have measured cost-effectiveness systematically and robustly. Yet the first thing governments ask before agreeing to an intervention or approach is how much does it cost! There is an urgent need to standardise cost-effectiveness methodology and ensure we invest in this in all our work, to build up the evidence base of the cost-effectiveness of nutrition services, to assist governments with their decision-making.

The other thing we have a tendency to do in the nutrition sector is over-complicate everything. We need to agree and simplify our key messages and then communicate with others to show that nutrition can actually strengthen an approach and increase impact, rather than it be an additional burden or responsibility. Can we nuance our communication to ensure it is appropriate for the audience, such as other sectors, government departments and funders interested to support nutrition, whilst internally understanding there is a more complicated explanation in reality? This takes some careful management as simplifying does not necessarily mean ‘dumbing down’, it just means better marketing for nutrition. This would require bigger picture thinking but is critical if we want to advocate successfully for nutrition and ensure it is elevated up the priority list.

On another note, I have had the pleasure of working with Mubarek Abera in Ethiopia and in his letter to the editor in FEX 64 he raises an extremely important point on the participation of voices from the Global South at the global level. Given Concern Worldwide’s CMAM conference in March 2021 is virtual, it is a great opportunity to have greater participation of those from the Global South. So often these critical voices are excluded, often due to issues of funding or obtaining visas, but should we really be having a conversation at all without the perspective of those who often know the situation better than those in the Global North, and who have a unique and far better understanding of what is needed to make progress? If Covid has taught us anything it is how to engage remotely, so moving forward let’s build on that to ensure we move away from convenings where attendance is skewed to participation predominantly from the Global North. Concern are working hard to ensure such participation in their conference, so let’s think creatively on how to continue that trend. We have been asking ourselves at ENN what we can do to support this, and national co-authorship of every article is a great step forward. Please do support our efforts here to make this happen.

Finally, I am absolutely delighted that the issue of adolescent nutrition will be a feature for FEX this year, culminating in a Special Edition in November 2021 (watch out for the call for content coming soon!). Adolescent nutrition is such a critical yet largely ignored area of nutrition, perhaps due to its inherent complexity, which was reflected well in the findings of the adolescent mapping exercise mentioned in FEX 64. How do you effectively measure adolescents to detect those at risk or those with malnutrition? Beyond weekly iron folic acid, what evidence exists on interventions that successfully improve the nutrition status of adolescents? What advocacy work is ongoing to support this important issue? When asked on a special edition topic in my interview for ENN, I suggested adolescent nutrition and was delighted to then learn it was already in the planning.

I am looking forward to hearing and learning from all of you this year, both on adolescent nutrition in particular as well as more broadly, so please do reach out if you have ideas or experiences to share with us. The FEX team is also excited to engage with anyone who has ideas for how Field Exchange can be improved, both in terms of improving the accessibility and use of content and also increasing the diversity of our authorship and readership. We will be thinking strategically in 2021 about the direction of FEX moving forward and how we can make the most of the hard work put in by everyone to capture the content. Creative ideas on how we can ensure we are reaching as many people as possible are very welcome, so please do not hesitate to reach out! In the meantime, stay safe and well.

You can access the full Field Exchange 64 publication here.