tech the news (septiembre 2010) - nutrición y salud

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© Action Contre la Faim International Network /// Newsletter N°10 /// September 2010 1

ISSUE N°10 – SEPTEMBER 2010 //// NUTRITION

EDITO (by Amador Gomez)

Accompanied by a scale up

of country political wlll

and capacities

•Promotion of breastfeeding

•Complementary feeding practices

•Hearth model programmes

•Handwashing & hygiene behaviour

•Child Health Days

•Vitamin A campaings

•Deworming & parasite control

•Anaemia & iron supplementation

•Micronutrientes supplementation

•Diarrhoea & Zinc supplementation

•Seasonality and blanket feeding

•Conditional cash transfer

•Communtiy /clinic base

management (outpatient/inpatient)

•Integration into basic package of

health services

© Amador Gómez. 2010

Nutrition in ACF-S: taking actions against the differents faces of undernutritionInfant undernutrition is one of the main mechanism for the transmission of poverty and inequality between generations,becoming a heavy mortgage on the future of the next generation.. Today’s undernourished are tomorrow’s poor. That iswhy undernutrition is not just a priority health problem; it is also a major barrier to development.Having a sustainable impact in undernutrition is not just a question of ready to use food or CMAM approach.Undernutrition is not simply acute. Stunting and carence of micronutrients are also very relevant in many contexts whereACF is working.In ACF-S we give priority to acute undernutrition in our operations, but at the same time, we are implementing anddeveloping our nutritional approaches on differents contexts like seasonal hunger, emergency situations or chronichunger.Most of the world’s acute hunger occurs during the annual hunger season. As an answer to this nutritional vulnerabilitygap, we are promoting the scale up of a basic intervention package against seasonal hunger which targets theprevention of children undernutrition. This seasonal anti-hunger intervention combines different approaches like cashbased interventions to minimise the nutrition vulnerability and seasonal blanket feedings programmes to protect nutrition

during the hunger gap.Other ACF-S nutritional interventions are oriented to impact in chronic undernutrition and micronutrients deficiencies likeanaemia. Nutritional care practices are promoted through Hearth Model Programmes, complementary feeding practices,micronutrients supplementation and promotion of breastfeeding.

Making progress in the fight against undernutrition and its positive effects on health and development is possible only ifnutrition becomes a priority. ACF is working to Scale Up Nutrition at international level making part of initiaves as SUN(promoted by SCN). ACF has also developed a strategy on advocacy (AMAI) and some filed activities are already goingon (e.g. Niger).

All this approach integrate advocacy and capacity building components oriented to support the political commitmentagainst undernutrition, achieve adequate coverage and the integration of nutrition interventions in the health policiesand strategies at national level.





This Newsletter was prepared in Madrid with the participation of all headquarters and missions.Thanks to all for your contributions.

NEWS FROM THE HEAD UARTERS

London

• Sandra Mutuma is the Senior Nutrition adviser at ACF-UK.

Saul Guerrero (former Valid International) has joint ACF-Uk as

responsible of monitoring and evaluation.

Madrid

• Elisa Dominguez is the Head of Health and Nutrition Dpt.

She is in charge of Central and South America, Middle East

(Palestina, Syria) and Asia (Phylippines) and focal point for all

surveys (SMART, KAP,…).

• Marisa Sanchez is the Health, Nutrition and HIV technical

adviser in Madrid. She is in charge of Western and Southern

Africa.

• Oscar Serrano is leaving the Health and Nutrition Coordinator

for the emergency pool. Position in process of replacement.• Liselot Lemmens has started an internship of 4 months in

September. She will be responsible of Nutrition Forum

organisation (former CMN meeting) in Toledo end of October

and to support Nut Dpt.

Montreal

• Asmaa Ibnouzahir is nutritionist, expert & trainer on SMART.

New York

• Marie-Sophie Whitney is the senior nutrition advisor in charge

of DRC, Uganda, Kenya, Southern Sudan, Pakistan and now

also of Nigeria. [email protected]

• A second nutrition advisor position has been open to replace

David Doledec, and is still vacant. If you are interested to come

and work in New York or would like to know more about this

position, check out the following link:

http://www.actionagainsthunger.org/get-involved/jobs/hq/nutrition-advisor

Paris

• Arrival of Anne Dominique Israel at the position of Senior

Technical Advisor in Nutrition. Recruitment of a Nutrition

advisor for Asian missions is now finalised.

▪ Departure of Rebecca Brown from the position of Senior

Technical advisor at the end of June: However, she will

continue working with ACF as part-time position.

▪ Arrival of Ioana Kornett as Technical Director.

The different NUT technical advisors of ACF-France are then:

Emergency response poolStarlène Barthelot (leaving soon)

Asian missions

Astrid de Brandebere (interim for 3 months-August-October)

Emergency pools

Olivia Freire following Sudan & Darfour, Chad, Central

African Republic and North Caucasus

([email protected])

Fabienne Rousseau following Burkina, Ethiopia, Liberia

and Somalia

([email protected])

Post-crisis pools

Béatrice Mounier following Ivory Coast, Haiti, Zimbabwe,

Afghanistan, Mongolia and Sierra Leone

([email protected])

• NEWS FROM THE HEADQUARTERS 2

• DID YOU KNOW...? 3

• QUESTIONS ASKED TO 4

• ZOOM ON A PROJECT 5

• RESEARCH AND TECHNICAL DEVELOPMENT 7

• WHAT HAPPENED? Publications, surveys, reports, meetings, fora… 9

• WHAT’S NEXT? Publications, surveys, reports, meetings, fora… 10

• WHAT CAN YOU FIND IN THE PREVIOUS & NEXT NEWSLETTERS? 12

CONTENTS





Closure of Angola mission (ACF Spain)

The mission in Angola closed in the middle of July 2010 after

more than 15 years of presence there.

HIV International World Conference

Amador Gomez, Marisa Sanchez and Cécile Salpeteur

represented ACF at the 2010 HIV International World

Conference that was held in Wien between the 17th

and the

21st

July. A study implemented on HIV patients in Donka

hospital in Guinea-Conakry was presented as poster.

Exploratory mission in Mozambique

An exploratory mission was set up by the Nut team in

Swaziland in May 2010. A proposal to support a TFC at a

hospital in Maputo has been prepared and it is under funding

search.

Response to crisis in Corredorr Seco (Guatemala), Niger

and Mali

Several emegency responses are currently ongoing: in

Guatemala (Food security and Nutrition interventions), in

Niger, a new base was opened (Gouré), in Mali, a blanket

intervention with BP5 during the hunger gas has been

implemented.

Identification missions ongoing (AECID Convenio)

Nutrition identification missions were implemented in Mali,

Philippines and Peru through integrated approach (Nut-SA).

HIV workshop in Paris

An HIV workshop was held by ACF in the last week of June.

Experiences from Haiti, Zimbabwe and Swaziland wereexchanged. Contact: [email protected] or

[email protected].

Training on KAP surveys (Madrid)

A training on KAP surveys was organised in Madrid HQ

based on the new CARE manual: IYCF Practices: a step-by-

step manual. CD is available for those interested. Contact:

[email protected].

ACF-S Nutrition policy ongoing

Based on the ACF White paper, ACF-Spain is launching its

Nutrition policy paper that will describe main strategis actually

implemented in ACF-S missions.

FAMOS database development

ACF-S is developing a database which should support the

teams in the field in the daily management of data from

nutrition centres. This database was developed by

NOVATIVE, a suitwerland foundation, and before

implementation should be tested in the field. Test survey is

expected to be implemented in Mauritania in October-

November.

Update of ENA for SMART surveys

ACF-Ca has informed on the validated use of the last version

of ENA (ENA-delta). Software can be dowloaded at

www.nutrisurvey.net/ena_delta. Updates concern mortality

component, a more developed plausibility checks including

MUAC and a new component on Food Security based on the

Household Economic Approach (HEA). More info on:

http://www.nutrisurvey.de/ena_beta/food_security.htm

Some pilot tests of this FS component are under study for

upcoming SMART surveys in Guatemala and Filipinas.

Research study in Peru

ACF-S is preparing a research in Peru in collaboration with

University of Lima and University of Cadiz, under AECIF

funds. Aim of this research is to compare efficacy, impact on

growth development and cost/efficacy of differents products

to prevent stunting and anemia. LNS vs a local product vs a

fortified local product will be compared. The study will start by

October and will take 2 years including preparation,

distribution (12 months) and data collection and analysis.

Technical Indicators Working Group

In November, ACF-S will launch a working group on technical

indicators in order to set up an ACF indicators database

composed by “standards indicators” proposed by WHO,

UNICEF or international institutions. Aim is to support field

teams when writing proposals or implementing KAP surveys.

People interested to participate in such working group can

contact Elisa Dominguez at [email protected].

Infant and Young Child Feeding Practices

WHO manual indicators was launched in 2007

(http://www.emro.who.int/cah/pdf/IYCF-Indicators-2007.pdf).

recently WHO published the manual to collect these

indicators(http://whqlibdoc.who.int/publications/2010/9789241599290_

eng.pdf).

DID YOU KNOW…





Gilbert Manyoukou

Management of Nutrition programme at remote control

Q1. Which projects have been developed in Gao in 2009?

There was one nutrition project funded by ECHO in Gao andAnsongo. Another project on food and nutrition security fundedby Government of Navarre, then, a third project was on HIVprevention in partnership with MDM and Nouveaux Horizonsfunded by the European Union. Finally, an emergencyresponse was implemented during the hunger gap fromSeptember to December.

Q2. What happened at the end of 2009 to start working onremote control? In November last year, security situationworsened: some cars were stolen and embassies releasedalerts on risk of kidnapping risk for Europeans. At the sametime, an expatriate was kidnapped in Menaka. All these issues

led to the evacuation of ACF international staff from Gao toBamako.

Q3. Hos the remote control-work was implemented?The evacuation was abrupt and neither local or expatriateworkers were able to work in such way, on remote control. Thismade a fracture in the dynamic of projects monitoring. Therewas a very difficult time because we were in a fully process ofnationalization of key positions and at the end of theemergency. For all of us, it was very difficult to support thenational team in Gao from Bamako.

In December, Gao's team came to Bamako for a meeting to

discuss the management of projects and support activities thatwould be necessary for the team. Later on, in February, wehad another meeting in a mid-point between Gao and Bamako,to discuss the situation of the teams that were in a state ofimportant frustration and incapacity to plan activities along2010.

Q4. How do you maintain the quality of the projects? Areexpats allowed to visit the area for track-monitoring?To maintain the quality we have relied on two aspects:ensuring a timetable of activities that is updated in acontinuous basis and to maintain a very regular contact with

teams in the field to support them. At the beginning, the teamin Gao required high support from the coordination team inBamako to meet their needs. Over time, a system ofcommunication and responsibilities has been well defined andso many meetings are not needed anymore but based onspecific issues to monitor or in specific needs.

He is a nutritionniste with professional

work experience for almost 20 years

and in humanitarian organization

since 1996. At the moment of the

interview, he was acting as CMN in

Mali since March 2009.

Questions& Answers

UESTIONS ASKED TO…

We have been allowed recently to make short visits

to Gao. Myself, I visited Gao last week for a trainingof the team on SMART surveys and Anne, the headof base, is currently there for a week time.

Q5. This year 2010 is expected to be difficult forSahel due to poor harvest last year. How is thesituation Gao regarding vulnerability in food andnutrition security?The vulnerability on SAN is under a surveillancesystem since last year and we expect that this will bea tough year. The rains were not sufficient last yearand several warnings were released by differentactors in the field. Whereas analysis was not easy

ACF decided to do a vulnerability survey in our areasof intervention to document the situation. The surveyconfirmed a worsening of the vulnerability inAnsongo. It was also decided to complete this studywith a SMART survey which was performed in June.

Q6. How the vulnerability study and the SMARTsurveys were carried out on remote control?What has been done to maintain quality andreliability of data without supervision ofexpatriate staff?The vulnerability study included both nomadic andagro-pastoral households in the area. The SMARTsurvey only considered the agro pastoral zone tocompare results with the ones from last year.To ensure the quality of the SMART survey, I movedto Gao for team training and we recruited anadditional supervisor to assist the nationalresponsible in the supervision. In addition, theproject manager did the daily data entry for earlydetection of flags and monitoring was strengthened.Final results showed the same performance degreeas in previous years under expat supervision. Q7. Which are the positive and negative points ofworking on remote control?Local staff feel more responsible and confident now,but is difficult to verify operational performance ofactivities. There have also been some delays inproject execution.





Another way to face hunger: the integrated approach in Peru

ZOOM ON A PROJECT

Bronwen Gillespie, Anthropologist

Social Coordinator, ACF-Spain, Peru

Children in the rural Andes in Peru are not necessarily hungry; they are stunted from the double handicap of anaemiaand chronic malnutrition. They may not be extremely thin, but they are noticeably short. This is the consequence of longperiods exposed to a diet low in calories, protein and micronutrients. 32.8% of children under five are malnourished ona national level, and in some rural communities the percentage reaches 72.7%

1. More than 265,000 children currently

suffer from malnutrition and the concurrent negative effects on growth and development expressed in reduced motorskills, diminished ability to concentrate, reduced periods of attention, low motivation levels, and other irreversibledevelopmental problems

1.

The situation is additionally complex given that it is in some sense invisible: mothers do not perceive of their children as

ill; rather they are just small or quiet. The problem represents a threat to the development of the region as a whole inthat it self perpetuating. Malnourished children, with less ability intellectual ability and continual health problems, strainthe already overburdened education and health systems. Every person with malnutrition suffers from an average 10%reduction in their potential earnings during the course of their lives

1, and these adults, in turn, face constraints in caring

for their own children, becoming stuck in an intergenerational cycle of poverty and malnutrition.

ACH is planning a four year integrated response to malnutrition in the Andean communities of Ayacucho, Peru with theaim of demonstrating sustained improvements in child health so that similar approaches can be initiated in other regionsat risk. What are we “integrating” and why? Who will be involved in this integrated approach, and how will it be done?

The multiple causes of malnutrition are interdependent and therefore should be addressed as such. Theimmediate causes of malnutrition are inadequate food intake and disease. These are fed by the underlying situation ofhousehold food security, psycho-social environment and care practices, and the level of services in public health, water

and sanitation. There are many practical examples of the overlap of these factors: communities often need to improveirrigation systems before diversifying their production. Once food availability has improved, with the acquisition oflivestock or poultry, for example, this does not automatically translate into consumption, as products may be sold or fedto “productive” household members rather than infants. Even if children are offered a more complete diet, poor sanitaryfacilities increase prevalence of diarrhoea which reduces their ability to absorb nutrients. Furthermore, habits that definethe type of foods children are given, and when, where and how children are fed and cared for must be taken intoaccount. Any intervention aiming to reduce malnutrition must simultaneously consider the role and responsibilities offamily members and other caregivers and the cultural aspects of infant care as well as responding to more immediatelyobvious constraints.





/// SUITETherefore, the technical components of food security, water and sanitation, local management, and nutritionare to be integrated as one action, with a cross-cutting emphasis on socio-cultural comprehension andawareness of gender roles, to promote cohesion in the fight against child malnutrition. The definition ofproblems, project planning, educational workshops and technical solutions will be carried out from an integrated

perspective. Community members should not be involved in separate food security, health, or water mini-projects;rather the aim is for all actions to respond visibly and directly to improving childhood nutrition. From an operational pointof view this is an interesting challenge and learning experience as professional training, program design and field workmethods often unintentionally reinforce technical divisions, even when it is agreed that integration is a priority.

All participants, from village level to government level, will have a role in a common process. The aim of thisprocess is to fight malnutrition by articulating a relationship between people, their organizations, and their government,in order to help public services respond effectively to the problem. ACH and the local partners will foment activeparticipation from local, district and provincial government representatives and corresponding technical services, fromuniversities and networks already present in the area, from community-based organizations such as mothers’ groups,and from all family members, as without their awareness of the damage of malnutrition, little can be done to improvechild-care decisions. ACH has been active in advocacy forums with the national government, spurring the adoption ofcountry-wide goals in the fight against malnutrition. Peru already has legislation regarding the inclusion of human rights,

gender equality and intercultural perspective in healthcare1. The challenge is to help health services strengthen theiroperations in predominantly rural districts, to ensure the quality and adequacy of care in these isolated areas, to adaptmaterials, advice and methods to the local context. Community vigilance systems will play an important role in assuringchildren show healthy growth, as government services cannot cover all attention due to the isolated conditions. Thissystem will contribute to community ownership of the process, and is expected to be more affordable. ACH’soverarching goal is to test an integrated approach that government and local actors can manage to replicate in otherregions at risk.

Success will depend on our capacity to understand the local socio-cultural context, concepts of well-being, and

beliefs behind childcare practices, and integrate this within our strategies and communication tools. This willallow us to suggest solutions that are acceptable, sustainable and relevant. The intervention will work to understand andstrengthen traditional food systems: The World Health Organization now recognizes that nutrition policy must refer toalimentation, that is, to food, not to nutrients

1. Change will often be in the hands of mothers, and these mothers must be

considered as equals, enabled in dialogue rather than as recipients of information, so that become able to reflect onnutrition issues for their children, drive the process, make decisions and motivate other women. The years of civil warand resulting migration and social dislocation, and a rapid transition into a global society has lead to the loss oftraditional knowledge. At the same time, the experience of poverty, marginalization and discrimination, as well asilliteracy and domestic violence leaves women ill-positioned to have access to new information. Basic aspects ofchildcare are not natural for any of us; they are learned and depend on access to resources and a support system.“Feeding infants and young children is a complex challenge for all species, including our own, and now, when rapidsocial and cultural change has become the human condition, we no longer have the advantage of long-term culturalevolution to guide our management of the process”

1. A look at urban industrialized societies makes this lesson clear:

children in the UK and USA suffer from rising rates of obesity and governments have begun to legislate to reducechildren’s access to ‘food’ products deemed as dangerous for their health

1. This integrated public health approach in

Peru may turn out to be relevant for other contexts around the world.





BHAMI HISTORY : Exploring under-nutrition in mycountry, India

By Bhami Shah, Deputy Medico Nutrition Coordinator, ACF India Exploratory Mission

Going from the beginning to the end of my first field visit in India as a new team member with ACF – Indiamission, I was unaware of the under nutrition issues faced within rural and tribal areas. My pre departurevisualization was one of me entering remote villages with my colleagues, and after briefly surveying theproblems, we would swiftly come up with ideas and solutions to better the life of villagers and improve upon theexisting problem of child under nutrition. However, I did not understand the challenge of such a task and nor didI realize how crucial it was to finding solutions to overcome the problem. My pre imagination of child undernutrition was always the one that was linked with Africa, as most Indians in the field of nutrition have a myth thatunder nutrition is a problem of Africa and not of India. It was only after my visit, I realized that Madhya Pradesh(one of the 28 states in India, and second largest amongst them) reports equal number of malnourished childrenas in Chad and Ethiopia together. Being a nutritionist, my curriculum during my education years always focusedon the green revolution and the hope of abundance it gave to millions of people in India. However, the bleakreality of under nutrition in India has been untouched by most of the people working in the fields of medicine andnutrition.

For me under nutrition was always associated with the grades I- IV (weight-for-age), absolutely unawareof MUAC tapes being widely used around the world for active detection of under nourished children. Ourprofessors always highlighted the importance of using Indian standards for detection purposes and internationalstandards to be used as standbys for secondary reference or never to be used, with a notion that thesestandards might either distort or skew all the results due to differences in the growth pattern among the Indianand international population. Malnutrition during my studying years was generally linked to the per capitaincome and the associated poverty but not with the hygiene and sanitation and public health services. Most ofthe people in India working in the field of nutrition agree to the fact that the curriculum of both medical andnutrition colleges do not cover under nutrition issues in depth and many issues like prevention and treatment

require more updated and organized technical knowledge.

Though being an Indian urbanite, not only was my vision extremely unclear about rural life and theassociated malnutrition in rural and tribal contexts, but what I imagined to be the proper way to conduct anassessment of under nutrition was also inaccurate. My first fascinating experience in the field was that of avillage community meeting. At the beginning of the meetings most of the women who attended had their backspartially or fully turned to us, a lot of women were totally veiled. They completely distrusted us, rightfully so as awhite person (my colleagues) had not been to their village in a generation. As the meeting went on theygradually began to open up, with most of them removing their veils and turning to face us. The women weregiggling and whispering with each other throughout the meeting and very few answering questions which attimes made it difficult for us understand the dynamics of the village life. The rest were too shy to speak,especially so since the men, alerted to our presence, had gathered in the backdrop to keep tabs over theproceedings. The meetings though had some communication difficulties; it gave us a very good insight in

understanding the cycle of social determinants affecting life of the under nourished children amidst the villageswe visited. A lot of factors were identified during the meeting as reasons for malnutrition, ranging fromdangerous traditional practices during pregnancy and lactation to weak immunization coverage and poortransition to complementary foods – perpetuating the calorie protein gap. In most of these community meetingsyou could easily identify 3 - 4 children with SAM and what was surprising for me was that most of the women inthe villages had an idea of what a under nourished child looked like. When inquired, they could easily point outon the child who was weak and fragile and would fit into the category of being under nourished.

My visits into the villages were hosted by various NGO’s and it was quiet startling for me to see the waythese NGO’s functioned. The supervisor of the NGO’s would walk around the villages with their communityworkers who had pre identified SAM children within the villages. These supervisors would further regulate thesecommunity workers to take these children to the Nutrition Rehabilitation Centre (NRC) irrespective of anycommunication with the family or the community worker. The NGO’s identified the villages and the problems,

but very few NGO’s we visited would actually try to understand the complexity of the problem. They undertookthe projects that kept the funds flowing (like all other NGO’s), but they failed to consult the affected villages. Theprojects weren’t collaborations with the people and the result was a lack of sustainability. The villages we visitedhad particularly high number of under nourished children and extremely low levels of admission in NRC.





On communicating the reasons, we realized that these indigenous people were not comfortable to take theirchildren to NRC as they had to live there alone, they had other children in the house to be looked after, they feltsuffocated in the tiny room provide by NRC. They also complained of the toilets to be stinking as they were used to the

fields and open spaces for sanitation purposes, they were scared of doctors in white coats as they resembled ghosts,they had transportation problems and other reasons which were most of the times not taken consideration by peoplein charge of reversing the problem.

Another very important characteristic we noticed during our travel was that of the Indian social caste system.The Indian culture typically has a tendency of families and neighborhoods living together in particularly closerelationships over generations, struggling to extort a living from the same limited area of land and water resource.Closely inspecting, some people grow fat and influential while others remain frail and dependent, fellow villagers areprone to conflicts, opposition, and even violence. Most villages of India include what villagers call "big fish," affluent,commanding people, fed and serviced through the labors of the struggling "small fish." This paradoxical behavior ofthe people seems to represent a general trend I noticed among most of the districts we visited in Madhya Pradeshwhere more than 50% people are pushed in the survival struggling to migrate in search of more income opportunities.Such paradoxical nature is also experienced in villages where village feuds were not uncommon and hostility towards

these innocent villagers continue, where they are paid minimum wages for maximum output during the migrationperiod. Villagers complained of their inability to look after children during the migratory work and a resultant high levelof under nourished and sick children post migration period.

The shock came to me when I inquired about the money they get back with them post the migration to whicha fellow replied around Rs 20 – 30 for the whole migration trip. The migration pattern in Madhya Pradesh is out ofnecessity and the survival process, where the poorest of the poor migrate in need of 2 meals per day for themselvesand their families. This trend of middle to upper class is extremely common in the Indian setting where Indians areincredibly kind to those in their social sphere, but when it comes to those of lower caste or lesser financial standing,they treat them very poorly.

The various examples highlighted above present the current scenario of Indian villages where the situation isgrave and requires urgent attention. Empowerment of local people to be participants in development of community

can act as a good method to reverse the problem. According to me most families can practically pay for the quantity offood required to feed a young child which is nothing more than half a chapatti/half a banana and half bowl of dal withsome vegetables. Food availability within the household is not the only grave factor causing malnutrition; it is also thelack of knowledge and opportunities about appropriate feeding practice which makes the difference. The denial of aslittle as 200 – 300 calories in a young child’s daily diet is what makes the differentiation between the normal growth ofa child and the faltering that begins the fall towards sickness and loss.

To end my journey here I would conclude by saying that, the days we spent visiting the villages during myfield visit were enlightening, interacting with people of different cultures and traditions, being received by theinhabitants in the most welcoming way, some of them who had not seen an outsider enter before in the past years, thewhole experience was absolutely surreal and unforgettable. Time and again, I remember my parents who are now citydwellers referring nostalgically to their “simple village life”, representing colorfully dressed village women gracefullycarrying water pots on their heads. It’s only now after my visit I understand that village life is now no longer simple but

it is indeed under severe threat where communities are struggling to pull themselves out of poverty and hunger. A lotof potential to overcome the problem of child malnutrition exists but it needs to be empowered and nourished whichwould help the villages get a step up to the ladder of alleviating under nutrition.





Increasing ACF capacity and impact in preventing nutritional and

humanitarian crises in areas affected by cyclical natural hazards and

climate change – Project brief

Where undernutrition, natural hazards and climate change prevail (by Philippe Crahay, ACF-F)

Maternal and child undernutrition is the underlying cause of 3.5 million deaths each year and 35% of the disease

burden in children younger than 5 years (Black et al, 2008). The neglected crisis of undernutrition now receives more

attention globally – as reflected by the Scaling Up Nutrition (SUN) initiative. Most of the countries where

undernutrition prevails are located in disasters and climate change hotspots, e.g. in India, Bangladesh, Ethiopia,

Pakistan and Sudan (the 5 worst countries in terms of GAM and disasters), but also in Indonesia, Niger, Somalia,

Burkina Faso, Chad, Philippines, Kenya, Haiti, Central America, etc. – in others terms, the majority of ACF countries

of intervention.

The number of reported climate-related disasters (droughts, floods, cyclones) has more than doubled this decade

compared to the nineties. Since the 1980s, the average number of people reported as affected by climate-related

disasters has doubled, from 121 million to 243 million a year. According to Oxfam (2009), this number could rise up

to 375 millions a year as soon as by 2015. Besides causing suffering and death, natural disasters cause many

vulnerable communities and households to suffer serious setbacks, in terms of livelihood, water, food and nutrition

security. When a population’s nutrition is poor before the hazard hits, the limited nutritional stores of young children

are soon depleted, increasing their risk of severe malnutrition, disease, and death. Nutrition crises are amplified by

the effects of the hazard on the underlying risk factors of undernutrition. Climate change magnifies disaster risk

everywhere; it amplifies the risk of undernutrition through different pathways, related to food security and livelihoods,

water, public health and care practices (ACF, 2010). Today, there are some solutions to better prepare vulnerable

communities and reduce disaster risk and some negative impacts of climate change, through disaster risk

management.

So far, too little has been done in managing the growing impacts of natural disasters and climate change on nutritionand increasing the resilience of poor communities and households to natural disasters and climate change. Besides

the nutrition sector remains largely disconnected from climate change-related agendas and field initiatives, whereas

these are now reshaping humanitarian agendas and interventions.

A tailored ACF project

ACF is developing a project whose objective is to increase its capacity and impact in preventing nutritional and

humanitarian crises in areas heavily affected by cyclical natural hazards and climate change. More specifically, this

project aims to:

Improve ACF analysis and conduct assessments in communities affected by undernutrition, cyclical natural

hazards and climate change.

Develop integrated nutrition-disaster risk management programming in these communities. Conduct trainings on nutrition-DRM programming and build ACF capacities.

Share ACF knowledge and experiences in these fields to the nutrition and humanitarian communities.

Advocate for a better integration of nutrition in key climate change agendas and initiatives, particularly through

participation in the UNSCN Nutrition and Climate Change eGroup (see below ).

3 case studies will be conducted, respectively in Ethiopia, Bangladesh and Guatemala. Project outputs will be

delivered early 2011. For information, contact Philippe Crahay [email protected]

UNSCN Nutrition and Climate Change eGroup

The Nutrition and Climate change eGroup is an ad hoc online discussion forum, created with the aims of bringing a

nutrition lens into climate change issues and increasing the participation of interested sectors to discuss how this canbe done and what the priorities are. This eGroup also intends to identify opportunities for the nutrition agenda and

weaknesses that hinder the participation of nutrition in such debates. It also intends to influence the agendas of the

research community and the traditional nutrition donors.

For more information, please see: http://www.unscn.org/en/nut-working/nutrition_and_climate_change/





WHAT’S NEXT?Publications, surveys, reports, meetings, fora…ACF Nutrition Forum (Toledo, October 2010)- former CMN meeting: ACF-S is organising this Forum that will takeplace since the 25

thuntil the 29

thOctober in Toledo. External guests will be invited during 1 day to present strategies

and interventions regarding new strategies on prevention and management of malnutrition. ACF Nutrition Steering Committee (Madrid 21st, 22nd and 29

thOctober 2010): The Responsibles of Nutrition Dpt

at HQ level of different ACF HQ have been organised in such committee in order to share regular information, discussabout technical issues and strategies and fix guidance and collaboration on Nutrition technical issues at ACF network.This meeting will be organised prior to the Nutrition Forum to share annual action plans and organise collaborationbetween HQ in 2011. ACF Nutrition meeting (Toledo, 29

thOctober): Nutrition advisors from different HQ will meet in Toledo after the

Nutrition Forum to evaluate the meeting, share information and discuss on technical issues.ACF CMAM integration into health system guideline: expected early 2011.

CMAM Protocol updated: expected early 2011

Baby tent guideline: based on experience in Haiti.

WHAT HAPPENED? Publications re orts meetin s fora…

MM2 Forum in Geneva (Geneva, February 2010): A meeting regarding moderate malnutrition was organised byUNICEF and WHO in Geneva last February. Cécile salpeteur from ACF-F and Elisa Dominguez from ACF-Srepresented ACF in the meeting. Objective was to have a consultative meeting to write the new guidelines on moderatemalnutrition. This guideline should be published by middle 2011. Nutrition Global Cluster (Geneva, July 2010): The annual meeting of the GNC was organized in Geneva last July. AllACF HQ were represented (except USA). Discussions regarding intervention in Haiti or several tools developed by GNCas the rapid assessment and the Harmioniused Training package were hold. Resume and background documents areavailable upon request at your Nut advisor level.World Congress on HIV (Viena, July 2010): ACF was present in this important Congress through a poster presentedby Marisa Sanchez (ACF-S) regarding a study on nutrition in HIV patients carried out in Conakry (Guinea) in 2009. Workshop on Positive deviance experience (Bamako, August 2010): ACF office in Dakar organised this workshop toshare experiences from West Africa ACF missions and discussed actions to follow. Documents available at ACF-Dakar

office (Christophe Breyne [[email protected]].GNC meeting (NY, 21-22 Sept 2010): ACF-F and Ca were present. Objective was to define the next year clusterpriorities and organisation.1000 days meeting: launching of the SUN roadmap on the 21

stof sept with Hillary Clinton and Ban KI-Moon:

ACF-F was invitedWorld Public Health and Nutrition Congress (Oporto, 23-25 Sept 2010) : ACF-France and Spain will present someposters. ACF-UK will do an speech on scaling up nutrition initiative and road map (SUN). Launch on Research on NCA (Nutrition causal Analysis methodology) : with experts as Helen Young and Susan jasper (Tufts university), Yves martin Prevel (IRD) and Kate Ogden (WFP) led by Julien Chalimbaud (ACF).Contribution to writting a paper on MDGs (SCN)- Nutrition and the MDGs: accelerating progress towards 2015 :led by Sandra Mutuma at ACF-UK.Developpement of an international Working Working on CMAM : objective will be sharing information, tools,research, best practices (ongoing). Most information with Anne Dominique Israel ([email protected]).

DRM –CCA-Undernutrition: Guatemala exampleIn Centro American countries, the social and environmental vulnerability is reflected in the frequency of extreme hydrometeorological events. As example, in Nicaragua there is a recurrence of droughts and floods (2008, 2009, 2010), rat pest (2007,2008, 2009, 2010) and hurricanes (Ida and Tropical storms in 2009), that have caused extensive damages on the subsistenceagriculture affecting livelihoods and resilience capacity of population, aggravating the food security and poverty situation,

exacerbating the poor nutritional status of vulnerable population and subsistence farmers.

In Guatemala , in the Jalapa, Chiquimula y El Progreso Departments, ACF is following the increases on undernutrition caseloadcaused mainly by a recurrent phenomena known as “seasonal hunger” that occurs every year between June and October. Lastyear, drought caused a 70% of harvest loss. This was a critical cause of increase of infant undernutrition. This year, heavy rainsand flooding caused again important harvest damages and an increase on hygiene-related diseases (respiratory track infections,diarrhea and animal vectors transmitted diseases). All these factors combined contribute to increase the prevalence of acuteundernutrition.

Due to this situation ACF keeps on the commitment to eradicate Hunger and undernutrition strengthening food security, nutritionsurveillance and support to the Minister of Health and Agriculture.





ACF-IN Workshop on HIV-AIDS, June 2010- Paris

INTERNET RESOURCES

. http://www.who.int/childgrowth/standards/technical_report/en/index.html WHO Multicentre Growth Reference Study Group:WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006

. http://www.fantaproject.org/ Training Guide for Community-Based Management of Acute Malnutrition (CMAM) and Nutrition,Food Security and HIV: A Compendium of Promising Practices. http://www.ennonline.net Fields exchange; internation workshop on the integration of CMAM report; Infant feedding inemergency guidance and moduleshttp://www.who.int/nutrition/topics/hivaids/en/index.html Here are all the documents of the recent HIV/AIDS meeting for WestAfrica held in Burkina Faso in November 2008http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74 This is the website of the IASC Global NutritionCluster with in particular the 21 training modules in nutrition in emergencies (HTP). You can find information on the other Globalclusters as well: Logistics, WASH, Health, Shelter, Protection etc.http://www.nutval.net/ Make sure the food rations distributed in ACFIN programs are balances by checking their nutritional valuewith NutVal 2, the software of WFP.http://www.nutrisurvey.de/index.html - the software & methodology of SMART nutrition surveyshttp://www.micronutrient.org/english/view.asp?x=1 Website of the INGO Micronutrient Initiative, with all information onmicronutrients you need.

http://www.thehnts.org The Health and Nutrition Tracking Service (HNTS) is a collaboration of non-governmental organizations(NGOs), United Nations (UN) agencies, and donors for the review, analysis and validation of critical health and nutrition datagathering methodologies and information in selected humanitarian emergencies. The website conatins information on nutritionindicators, tools and training.http://www.unscn.org/en/ SCN is the food and nutrition policy harmonization forum of the United Nations to promote cooperationamong UN agencies and partner organizations in support efforts to end malnutrition.http://oneresponse.info/GlobalClusters/Nutrition/Pages/default.aspx Website of the GNC (Global Nutrition Cluster). The fourfocus areas for the Nutrition Cluster are strategic and are not meant to be exhaustive and include a) coordination, b) capacitybuilding, c) emergency preparedness, assessment, monitoring, surveillance, and c)supply.http://www.coregroup.org/ Website on community health approaches including the HEARTH model (strategy using positivedeviance).http://www.ibfan.org/ibfan-ibfan.html The International Baby Food Action Network, IBFAN, consists of public interest groupsworking around the world to reduce infant and young child morbidity and mortality. IBFAN aims to improve the health and well-being of babies and young children, their mothers and their families through the protection, promotion and support ofbreastfeeding and optimal infant feeding practices.

http://www.measuredhs.com/ website with information regarding demographic and health surveys (including nutrition) worldwide.http://www.childinfo.org/nutrition.html Monitoring of situation of children and women (nutrition) worldwide.http://motherchildnutrition.org/news/index.html The information and links contained within this site aim to address malnutrition inthe global context, offering online access to the latest worldwide developments in its prevention and management.http://www.reliefweb.int/rw/dbc.nsf/doc100?OpenForm Vacancies and situation in emergencies.

ACF-IN MEETINGS: SOME PICTURESACF Workshop on HIV-AIDS, Paris, July 2010





Issue Sector Releasing date HQ Main articles

#1 WASH September 2008 Paris Caracoli en medio de la sed cuando se esta rodeado de agua - ACF Colombia

Groundwater quantification in coastal area - ACF France

#2 FSL October 2008 Madrid Fuel efficient stoves or not? – when we are able to follow up our own

recommendations - ACF Uganda

Can the environment absorb our activities? The “acadjas”, a pi lot fish

production project on Lake Tanganyika - ACF RDC

Integrated Nutrition and Food Security Surveillance in Malawi - ACF Malawi

Projects including the concept of value chain - ACF Paraguay

#3 Nutrition January 2009 Paris Nutrition communautaire et sécurité alimentaire au Niger, les défis de

l’intégration - ACF Niger

What is Research? – ACF France

#4 FSL June 2009 New York Direct cash after the Post Election Violence in Kenya - ACF Kenya Direct cash project in Lira, Uganda – ACF Uganda

#5 WASH July 2009 Madrid Sustainability factors for Water points in Liberia – ACF Liberia

Light casing for rapid rehabilitation/construction open wells

#6 Nutrition January 2010 New York Integrated Nutrition and FSL activities in Southern Sudan – ACF

Southern Sudan

Projet de support nutritionnel et de sécurité alimentaire des Personnes

Vivant avec le VIH - ACF RDC

#7 FSL December 2009 Paris Direct Cash transfer in Uganda: results and lessons learnt – ACF

Uganda

Partnership in program implementation: an experience of ACF in

Barguna – ACF Bangladesh

Changing general food distributions into cash based interventions,

Cyclone Nargis experience – ACF Myanmar

#8 WASH May 2010 New York Hygiene promotion in emergencies: Capitalisation of ACF experiences in

Nakuru and Molo IDP Camps, Kenya - ACF Kenya

Groundwater research in Uganda - ACF Uganda

#9 FSL July 2010 Madrid Seed Fairs in Eastern DRC – ACF Congo

The Sentinel Sites in Central America – ACF Central America

CFW: Food Processing Activity for Women in Palestine – ACF Palestine

Réponse au séisme en Haïti : spécificités d’une réponse d’urgence en

milieu urbain – ACF Haïti #10 Nut September 2010 Madrid Management at remote control in Gao – ACF Mali

Integrated Approach – ACF Perú

Bhami History – ACF India

Climate change and malnutrition – ACF Int

Issue Sector Releasing date HQ

#11 WASH December 2010 Paris

If you want to contribute to the next NUT edition of TechThe News, that will be released in December 2010 and

piloted by ACF-France, please contact :

Jean Lapègue – [email protected]

WHAT CAN YOU FIND IN THE PREVIOUS…

… AND NEXT NEWSLETTERS?