Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...

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Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
Review of Opportunities and    Islamic Republic of Afghanistan
Challenges for Strengthening
Humanitarian and Development
Linkages for Nutrition with
Examples from Myanmar, Niger
and Afghanistan
                               case study

Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
This project consists of the
following publications:

Lessons learned from
Nexus reviews in Myanmar,
Niger and Afghanistan

y Report

y Policy brief

Review of opportunities and
challenges for strengthening
humanitarian and development
linkages for nutrition with
examples from Myanmar, Niger
and Afghanistan

y Afghanistan

y Myanmar

y Niger

All publications and recording
of accompanied webinars are
available in French and English
at the following links:

GNC website

Scaling Up Nutrition website

                                  © UNICEF/UN060153/Nybo
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
Acronyms                                       04

Introduction                                   05

1. Persistent and widespread malnutrition      06
   highly sensitive to shocks

2. Despite being the main recipient of         08
   development assistance from DAC
   countries, Afghanistan’s investment in
   nutrition remains very low

3. The AFSeN-A was launched in 2017            10

4. Shock sensitivity of government policies    12
   related to nutrition remain limited

5. Humanitarian-Development Nexus could        13
   become a reality

6. The role of the coordination mechanisms     15

7. Conclusions and recommendations to the      17
   SUN movement and the Nutrition Cluster to
   strengthen the Humanitarian-Development
   Nexus for nutrition in Afghanistan

Annex 1: Scope, methodology,                   21
background and documents referred
to during desk review

 Scope                                         21

 Methodology                                   21

 Background                                    22

 Documents referred to during desk review      24

Annex 2: People interviewed                    25

 References                                    26

 Acknowledgements                              26
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...

AFSeN-A         Afghanistan Food Security and Nutrition Agenda

BPHS/EPHS       Basic Package of Health Services and Essential
                Package of Hospital Services (Afghanistan)

FANTA           Food and Nutrition Technical Assistance

GNC             Global Nutrition Cluster

GSS             SUN Global Support System

HDN             Humanitarian-Development Nexus

HRP             Humanitarian Response Plan

IHSAN           Initiative for Hygiene, Sanitation and Nutrition

IMAM            Integrated Management of Acute Malnutrition

IYCF            Infant and young child feeding

MAIL            Ministry of Agriculture, Irrigation and Livestock

MNS             Micronutrient supplement

MQSUN+          Maximising the Quality of Scaling Up Nutrition Plus

MoPH            Ministry of Public Health

MSP             Multi-Stakeholder Platform

NC              Nutrition Cluster

NCC             Nutrition Cluster Coordinator

NGO             Non-governmental organization

ODA             Official development assistance

RUTF            Ready-to-use therapeutic food

SAM             Severe acute malnutrition

SAG             Strategic advisory group

SDG             Sustainable development goals

SUN             Scaling Up Nutrition Movement

SMS             SUN Movement Secretariat

SUN UNN         UN Network for SUN

UN              United Nations

UNAMA           United Nations Assistance Mission in Afghanistan

4      Afghanistan Case study
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...

                             This country case study and its              triple-nexus approach links three key
                             accompanying recommendations                 plans: the Humanitarian Response Plan
                             include inputs from members of the           (HRP), the One UN Plan and the United
                             Nutrition Cluster (NC), members of the       Nations Assistance Mission in Afghan-
                             Afghanistan Food Security and Nutrition      istan’s (UNAMA) peace mandate. For
                             Agenda (AFSeN-A) multi-stakeholder           this study, only the humanitarian and
                             platform, representatives from the civil     development dimensions were studied.
                             society and United Nations (UN) agen-
                                                                          For this study, the HDN is understood
                             cies and secondary data and informa-
                                                                          as the central point where humanitarian
                             tion sources. The lists of key documents
                                                                          and development actions converge
                             and persons interviewed can be found
                                                                          around the need to prevent, prepare
                             in the annex and reference sections.
                                                                          and address crises – particularly for the
                             This study has been commissioned             most vulnerable and at-risk populations
                             by the Global Nutrition Cluster (GNC)        – balancing short-term responses with
                             and the Scaling Up Nutrition Movement        longer-term solutions, allowing humani-
                             (SUN) Secretariat to capture experi-         tarian and development interventions to
                             ences from crisis affected States and        be more genuinely complementary and
                             to suggest options to strengthen the         mutually reinforcing.
                             Humanitarian-Development Nexus
                                                                          The study found great progress had
                             (HDN) for greater nutrition outcomes.
                                                                          been made towards a multisectoral
                             The objective of the study is to identify
                                                                          approach to nutrition with the adoption
                             practical opportunities and solutions.
                                                                          in 2017 of AFSeN-A and its strategic
                             The analysis is therefore not exhaustive
                                                                          plan: the integration of nutrition treat-
                             but purposive. Only relevant aspects of
                                                                          ment in the BPHS, acknowledging
                             the contexts are presented. A partic-
                                                                          its development dimension, and the
                             ular emphasis is given to the factors
                                                                          well-developed and functioning coordi-
                             impeding and enabling collaboration
                                                                          nation mechanisms offering space for
                             and commitment for nutrition.
                                                                          the actors to exchange and collaborate.
                             This country case study is part of a         The resources allocated to nutrition
                             series of three country case studies,        remain limited and the coverage of all
                             comprising of Afghanistan, Myanmar           nutrition interventions – nutrition-specific
                             and Niger. The study was conducted           and nutrition-sensitive – is insufficient.
                             between July and September 2020.             The AFSeN-A implementation will gain
                             Due to the COVID-19 pandemic, the            from involving more actors – especially
                             case studies had to be conducted             humanitarian and local civil society
                             remotely, limiting the representativity of   organizations – technically and opera-
                             the contributors, due to language and        tionally, as well as reinforcing planning
                             technical limitations.                       and accountability to strengthen
                                                                          advocacy and resource mobilisation.
                             To reflect the complexity of the Afghan
© UNICEF/UNI118803/Noorani   context, the UN has developed a
                             triple-nexus model. The model
                             encompasses short-, medium- and
                             long-term humanitarian, development
                             and peace-sensitive actions. The

                                                                                       Afghanistan Case study       5
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
Persistent and widespread
malnutrition highly sensitive
to shocks

Infant and child mortality rates in        in 2019 by the extended impact of the       contribute to consistently poor infant
Afghanistan are among the highest          drought in 2018. Micronutrient deficien-    and young child feeding (IYCF) prac-
in South Asia and poor nutritional         cies are also widespread in Afghani-        tices and high malnutrition rates.
status contributes significantly to this   stan. Iodine deficiency is of significant
                                                                                       Progress on IYCF has been chal-
mortality. Despite significant progress    concern affecting an estimated 41 per
                                                                                       lenging. Despite an estimated 98 per
made on addressing stunting with a         cent of women of reproductive age and
                                                                                       cent of all children 0-59 months being
reduction of one third in the prevalence   30 per cent of children aged seven to
                                                                                       breastfed, just 58 per cent of children
across the country from 60 per cent in     12. Half of children aged six-59 months
                                                                                       are exclusively breastfed for the first
2010 (Afghanistan Multiple Indicators      were found to be vitamin-A deficient.
                                                                                       six months of life. Survey results also
Survey 2010, p 5) to 38 per cent in        Rates of anaemia are estimated at 40
                                                                                       indicate that young children receive a
2018 (Afghanistan Health Survey 2018,      per cent for women of reproductive age
                                                                                       monotonous, cereal-based diet limited
p 48), malnutrition is persistent and      and 45 per cent for children aged six-59
                                                                                       in diversity and lacking in adequate
widespread across Afghanistan in           months, while 47 per cent of women
                                                                                       nutrients for optimal growth. This is
all its forms, with major differences      aged 15-49 are anaemic.
                                                                                       likely not entirely due to a lack of avail-
across geographies.
                                           The factors leading to malnutrition in      ability of food but to unequal access
According to the Nutrition Cluster, an     Afghanistan are complex and multi-          within the household.
estimated 2.9 million children under       dimensional: ongoing humanitarian
five (about 1 in 3 children) are acutely   crises, chronic underdevelopment,
malnourished, including more than          weak investment in basic services and
780,000 who are suffering from severe      other socio-economic factors such as
acute malnutrition (SAM). Out of 34        the poor status of women. This leads
provinces, 26 are currently above the      to a lack of access to health care, poor
emergency-level threshold of acute         immunization, low levels of sanitation
malnutrition of 15 per cent. The poor      and a high incidence of diarrhoea and
nutritional situation was aggravated       poor care practices. These factors

Figure 1: Prevalence of global acute malnutrition in Afghanistan – June 2020

6    Afghanistan Case study
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
© UNICEF/UN0339436/Dejongh

Despite progress in recent years, the        community has supported the scale-up       with a community-based nutrition
coverage of health services remains          of nutrition services and has provided     package. However, the implementation
insufficient as are the preventive           funding for the ready-to-use therapeutic   at scale of all these nutrition services
interventions and the investments in         food (RUTF) pipeline, however gaps         has been challenging. Indeed, on top
nutrition, in a particularly challenging     remain and almost 50 per cent of SAM       of resource-mobilisation issues, the
operating environment.                       cases remain without access to IMAM        coverage and the quality of nutrition
                                             services. One of the main reasons for      services is severely constrained by
The Integrated Management of Acute
                                             the disparities in coverage of IMAM ser-   limited human and physical resources,
Malnutrition (IMAM) is integrated in
                                             vices is the necessary gradual nature      the lack of capacity development at
the Basic Package of Health Services
                                             of the scale-up process, which is not      scale, poor supervision of the commu-
(BPHS) and Essential Package of
                                             possible because of a lack of resources    nity health workers (CHW) network,
Hospital Services (EPHS) that do not
                                             as well as the difficulties to access      lack of incentives to the CHW, poor
cover the whole country. Although all 34
                                             hard-to-reach areas, due to persistent     infrastructure and insecurity.
provinces of Afghanistan are imple-
                                             insecurity and poor infrastructure.
menting IMAM services as of December
2019, 38 per cent of all health facilities   The BPHS also includes some
in Afghanistan currently do not provide      preventive nutrition services, such
IMAM services for SAM children and 55        as growth monitoring and promotion
per cent for moderately acutely mal-         (GMP) and support for IYCF and
nourished children. The humanitarian         maternal nutrition, and is associated

                                                                                                    Afghanistan Case study     7
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
Despite being the main
recipient of development
assistance from DAC countries,
Afghanistan’s investment in
nutrition remains very low

In 2018, the OECD Development Assis-         Afghanistan received more than US$57         decentralised institutions. This massive
tance Committee (DAC) donor coun-            billion in ODA during the period 2001-       financial flow has created a rentier econ-
tries committed almost US$2.7 billion        2015. However, the massive amount            omy, which is highly diverse but also
towards the development of Afghani-          of aid has had only a limited impact on      highly dependent on external financing.
stan. This amount is 6 per cent lower        poverty reduction and social indicators,
                                                                                          In recent years, significant development
compared to 2017 and it seems this           partly because a large portion of the
                                                                                          funding has been provided to the health
decreasing trend is continuing. Over the     assistance went to the security sector.
                                                                                          sector, which has supported the scale-up
past 10 years, Afghanistan has been          The assistance is also managed through
                                                                                          of community and facility-based nutrition
consistently the greatest recipient of       a highly centralised system, which
                                                                                          services, as part of the overall support to
official development assistance (ODA)        has hampered the development of
                                                                                          health services in the country.
from DAC countries.

Table 1: Top 10 recipients of ODA from DAC countries - 2018 (USD, m)

                      2009      2010       2011       2012        2013       2014       2015        2016        2017        2018

    Afghanistan      5,132.2    5,546.3    5,937.5   5,603.7     4,259.2    4,023.2     3,584.3    3,150.5     2,830.6     2,660.9

    Syrian Arab
                       62.1      44.4       78.4      501.3      1,732.5    1,597.5     1,824.6    2,467.0     2,566.3     2,504.4

    Bangladesh        717.8     872.6      1,082.4    1,311.0    1,447.3    1,381.2     1,200.5    1,221.6     2,224.8     2,354.4

    India            1,578.4    2,225.2    2,054.3   1,515.6     1,837.8    1,892.0     2,110.3    1,662.7     2,569.8     2,248.6

    Ethiopia         1,818.3    1,856.8    1,929.7   1,798.6     1,913.6    1,914.0     1,854.4    2,049.2     2,206.6     2,061.4

    Jordan            486.6     411.6      464.5      853.1       753.1     1,496.4     1,480.9    1,832.3     1,878.1     1,972.1

    Iraq             2,629.4    1,994.3    1,814.0    1,113.7    1,343.2    1,131.5     1,202.6    1,890.3     2,278.9     1,961.1

    Nigeria           688.3     846.0      852.2      895.0      1,138.7    1,061.9     1,124.4    1,227.3     1,742.9     1,724.4

    Colombia          998.7     560.9      926.7      700.3       774.0     1,137.5     1,287.6     988.3       738.6      1,637.0

    Kenya            1,224.9    1,156.8    1,563.7   1,668.7     2,018.4    1,601.9     1,496.0    1,387.9     1,502.9     1,537.1

Source: OECD

8      Afghanistan Case study
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
Although the Government has the              Figure 2: Official development assistance to Afghanistan (USD, m)
overall oversight of the service delivery,
the majority of these services are
                                                                                 ODA Total (CRS)      Basic nutrition (CRS)
contracted out to NGOs to manage              7.000

implementation. Across regions, the
                                                         1       2
NGO sector is critical for service            6.000
delivery in health but also other areas
of development and delivery of public                                            19
services such as agriculture and              4.000                                                   12
education. Public services and project                                                                                         20
                                              3.000                                                                                    34
interventions are undertaken through
partnerships between the central              2.000

government and NGO-implementing
organizations, often with the support
of international organizations such as           -
                                                       5,889   5,896   5,537   4,198      4,008     3,771      3,370      2,941       2,678
bilateral donors, UN agencies and                      2010    2011    2012     2013      2014       2015       2016          2017    2018    2019    2020

the World Bank. This modality
                                             Source: OCDE CRS
redresses the limited capacities of the
public sector in terms of human and
financial resources and access                                                 Humanitarian Aid Total (FTS)     Nutrition (FTS)
to remote communities.                        1.000
The amount of ODA dedicated to the
nutrition sector remains very low. The                   6
data from the 2014 System of Health            700
                                                                                  72                               68
Accounts (SHA) show Afghanistan                600
                                                                        26                   47                                          34

spent about $97 million or $2.00 per           500                                                     42
                                                                                                                                28                       21
capita on nutritional disorders. Only          400

a small proportion of this funding             300
came from government – $820,000 or
$0.02 per capita came from the public
budget. The rest of the funding, $95.9
                                                       731      895     516      526        510        424        524           396     542     614     392
million, came from development part-
                                                       2010    2011    2012     2013       2014       2015       2016          2017    2018    2019    2020
ners ($56 million or $1.62 per capita)
and out-of-pocket expenditure ($39.9         Source: OCHA FTS
million or about $1.15 per capita).

The country is also facing a dire and
worsening humanitarian situation. A
major food crisis in the early 2000s led     Table 2: Afghanistan’s investment in nutrition – 2019
to a massive humanitarian intervention.

Only one nutrition-investments-tracking                                                                 2019 Nominal upper-bound
exercise has been done so far. The
AFSeN-A analysed the investments in                                                               Amount (USD)                         Per capita (USD)
nutrition in 2019 across 82 nutrition-rel-
evant programmes overseen by
                                               Nutrition-specific                                   4,906,666                                 0.13
13 ministries, departments and
agencies (MDAs).

It found that the proportion of interven-      Nutrition-sensitive                                 153,529,118                                4.04

tions under the multisectoral strategic
framework – the AFSeN-A – with                 Total                                               156,835,784                                4.16

funding, was only slightly higher than
10 per cent. In 2019, the Ministry of
                                             Source: Nutrition Investment Snapshot 2019
Public Health (MoPH) experienced a
budget cut of 30 per cent.

                                                                                                                        Afghanistan Case study               9
Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
The AFS N-A was
launched in 2017

The development of a multisectoral                      As well as the five-year strategic                      y Financial resources from UNICEF,
approach for nutrition in Afghanistan                   plan, the AFSeN-A is supported by                         WFP and FAO totalled almost
started in 2012 with support from the                   an advocacy plan and a coordination                       US$500,000 over two-and-a-half
Food and Agriculture Organization                       structure involving focal points at each                  years). IHSAN/FHI3603 also
(FAO), United Nations Children’s                        core ministry and agency, from the UN,                        supported the creation of the
Fund (UNICEF) and the World Food                        private sector, donors and civil society.                     provincial committees.
Programme (WFP). Several attempts at                    The strategic plan has been translated
                                                                                                                y Technical assistance from MQSUN+,
policy development were made. Despite                   into local languages and endorsed
                                                                                                                  consultants mobilized by the different
efforts by UN and international non-gov-                by the Government. The AFSeN-A
                                                                                                                      partners, IHSAN, FANTA
ernmental organizations (INGO)                          strategic plan provides a shared
nutrition staff to raise awareness of                   understanding of the food-security and                  Until then, the functions of the AFSeN-A
nutrition needs across multiple sectors,                nutrition situation, stipulates a long-term             have been conducted regularly. Those
no significant impact was made outside                  vision with nine strategic objectives                   functions include:
the work done by the Ministry of Agri-                  aligned with Afghanistan’s sustainable
                                                                                                                y High-level steering committee
culture, Irrigation and Livestock (MAIL).1              development goals (SDGs), spells
                                                                                                                      meetings twice a year since May
Malnutrition continued to be considered                 out the roles and responsibilities of
                                                                                                                      2018, led by the chief executive, at
a health issue, with the MoPH leading                   government and non-government
                                                                                                                      ministerial level
nutrition programming.                                  stakeholders and identifies specific
                                                        interventions and results.                              y Regular meetings of the executive
It took an alignment of factors, such as
                                                                                                                  committee since November 2017, at
the Lancet publication in 2013 and                      The AFSeN-A has a technical secre-
                                                                                                                  deputy ministry level
the Copenhagen Consensus in 2015, to                    tariat, previously located in the Chief
progress. In 2017, the visibility and the               Executive Office and now to move                        y Regular technical committee
political commitment behind the nutri-                  to the administrative office of the                       meetings since November 2017: the
tion agenda reached a tipping point with                President.2 The Director-General of                       food security working group chaired
the election of the Unity Government.                   Afghanistan’s Council of Ministers’                       by MAIL, the nutrition working group
Under the leadership of Chief Executive                 Secretariat was serving as the SUN                        chaired by MoPH, the advocacy and
Dr Abdullah Abdullah, the multisectoral                 political focal point until this change.                  public awareness working group
platform AFSeN-A was launched and                       The coordinator of the Technical                          chaired by MoCI4
Afghanistan joined the SUN movement                     Secretariat serves as the technical focal
in October 2017. Subsequently, the                      point. The Technical Secretariat for
AFSeN-A five-year strategic plan                        AFSeN-A received substantial support,
(2019-2023) was developed as a stra-                    from its creation in October 2017
tegic framework aimed at addressing                     through to April 2020.
hunger, food security and nutrition. The
                                                        This support played a crucial role in the
adhesion to the SUN movement and
                                                        promotion of the multisectoral approach
AFSeN-A was directly supported by Dr
                                                        to nutrition, its visibility and its ability to
Abdullah until the government reshuffle
                                                        mobilise political commitment:
in May 2020.

    Prior to the creation of AFSeN-A, the Ministry of   2
                                                            While waiting for this change to take effect,       3
                                                                                                                    IHSAN is the Integrated Hygiene, Sanitation and
Public Health and Ministry of Agriculture, Irrigation   the functions of the Technical Secretariat and its      Nutrition project supported by USAID, which ended
and Livestock were primarily responsible for            financial support officially suspended, but the staff   in May 2020.
programmes related to food security and nutrition.      continued their coordination work.
                                                                                                                    Each supporting UN agency, the FAO,
                                                                                                                UNICEF and the WFP, cochairs one of the three
                                                                                                                technical committees

10       Afghanistan Case study
© UNICEF/UNI358977/Fazel

Afghanistan does not have its own          The current functional issues of the             such. Some interventions, under the
SUN UN network, but UN agencies            Technical Secretariat are raising                sectoral policies and plans, are funded,
contribute to nutrition improvement        questions on its sustainability and, if          representing around 10 per cent of the
via the Development Partners’ Forum.       unaddressed, could lead to renewed               overall plan, as mentioned above. It
There is an acknowledgement within         leadership ambitions and competition.            therefore requires massive strategic
Afghanistan that specific UN agencies      Commitment from the transversal min-             advocacy to increase nutrition financ-
(FAO, UNICEF, WFP) and the Civil           istries (such as information, religious          ing. Moreover, no information is avail-
Society Alliance (CSA) have played         affairs, finance) is still difficult to secure   able on the level of disbursements and
a critical role in supporting the Gov-     and the current functional issues faced          implementation, representing a major
ernment to advance the multisectoral       by the Technical Secretariat could have          concern in terms of accountability.
nutrition response.                        an impact on their level of representa-
                                           tion, participation and the operationali-
The AFSeN-A platform involves 18
                                           sation process.
ministries and four authorities. The
participation and engagement of the        It is important to mention that all sec-
ministries grew progressively as the       toral policies predate the AFSeN-A and
multi-stakeholder platform mandate         its strategic plan. While the AFSeN-A
and shared responsibilities were better    took into account the existing sectoral
understood. However, the level of          policies, those have still to be updated
participation continues to vary across     for the AFSeN-A strategic plan to be
ministries, as does the understanding      effectively translated into actions and
of the multisectoral nature of nutrition   budget lines.
and its causal pathways. The specific
                                           The AFSeN-A strategic plan (2019-
roles and focused interventions of
                                           2023) launched in 2018 has indeed
each ministry were established at the
                                           not started to be implemented as
inception of the MSP.

                                                                                                        Afghanistan Case study    11
Shock sensitivity of government policies
related to nutrition remain limited

Nearly four decades of conflict, coupled     Aid continues to be largely provided by     BPHS services to populations in need,
with climate change and environmental        international organizations and NGOs,       including during disasters and in disas-
degradation make Afghanistan very            with the support of a large network of      ter-affected areas, but nutrition response
vulnerable to natural disasters, such as     local organizations ensuring the field      is not included specifically. They also
earthquakes, flooding and drought and        implementation. After 15 years of mas-      include an emergency preparedness
its population is very vulnerable to any     sive development aid and humanitarian       and disaster-management strategy.
shock or stress.                             assistance, Afghanistan has a relatively    The BPHS document introduces a
                                             well-developed aid architecture.            flexibility clause to allow implementers
The risks posed by natural disasters
                                             However, the ability of aid organizations   to address variations between localities,
are often overshadowed by the more
                                             to prevent and respond to disasters is      local demand, and other local condi-
immediate and highly visible effects
                                             often limited to the geographical areas     tions requiring flexibility, (i.e., disaster
of conflict and poverty. However, in
                                             where they have a presence and by           response and mobile health teams) as
Afghanistan natural disasters affect on
                                             short funding cycles.                       a way to ensure access to basic health
average a quarter of a million people
                                                                                         services in remote areas as well.
annually. (UNOCHA, 2017, p. 7). In           The need to provide an appropriate
2018, the worst drought in decades           response to disasters is reflected in the   On the other hand, faced with a wors-
affected more than two-thirds of Afghan-     Specific Objective 2 of the AFSeN-A,        ening of the humanitarian situation, the
istan, devastating already-impoverished      through specific interventions directly     humanitarian community has developed
communities, reducing incomes by half.       derived from the MAIL Food Security         a multi-year strategy (2018-2021), rec-
The current COVID-19 pandemic is also        National Strategy 2015-2019 (strategic      ognizing the transition to development
expected to have a severe and lasting        food reserve, preparedness and rapid        programming. While the HRP 2020 does
socio-economic impact. According to the      response) but is not mainstreamed           not provide clear directions on the triple
UN (OCHA 2017, p. 6) an estimated 35         across sectors. Humanitarian issues,        nexus (humanitarian, development,
million people (of a total population of     disaster preparedness and response          peace), which is only mentioned as
37.6 million) require a social safety net.   have not been discussed regularly           a cross-cutting issue, it clearly states
                                             and systematically during AFSeN-A           how humanitarian assistance links up
Despite this sensitivity to disasters,
                                             executive meetings, and there are           with development programming in the
disaster preparedness and response
                                             still limited interactions between the      nutrition sector, gradually scaling up
is not appropriately reflected in the
                                             AFSeN-A and the humanitarian-               nutrition services in priority locations,
sectoral policies, limiting the opportu-
                                             coordination mechanisms.                    building capacities of the BPHS and
nities to provide an appropriate and
                                                                                         EPHS partners to respond during
comprehensive disaster response              Sectoral policies constituting the foun-
                                                                                         emergencies, but also increasing its
and to create a humanitarian-develop-        dations of the AFSeN-A do not cover
                                                                                         investment in prevention. This includes
ment nexus. While provinces are receiv-      disaster preparedness and manage-
                                                                                         the promotion of social-protection
ing training in developing preparedness      ment, except for the National Social
                                                                                         mechanisms to improve nutrition linking
and response plans, these might not          Protection Policy (2014) and the latest
                                                                                         with development actors.
systematically include a nutrition compo-    National Health Policy (2015-2020).
nent, and their implementation can be        The National Health Policy highlights
further strengthened.                        maintaining services and extending

12   Afghanistan Case study
Nexus could become a reality

While the awareness of the triple nexus      still very much perceived as a “human-        contracted by the MoPH through the
is being raised in Afghanistan through       itarian intervention” or an “emergency        multi-donor development trust fund
the One UN, OCHA and the clusters,           response”, mainly due to the nature           of the Sehatmandi project.5 These
the understanding of the nexus and           of its funding and the preponderant           partners are responsible for providing
its particular nutrition outcomes is         role played by NGOs in the delivery of        primary and secondary healthcare
still uneven among stakeholders and          nutrition services.                           services – including nutrition services
between the national and the sub-na-                                                       – routinely and during an emergency,
                                             For example, despite the treatment
tional levels. While the intersection of                                                   but treatment products are not included
                                             for SAM being part of the package of
humanitarian and development pro-                                                          in the package. As a result, RUTF is
                                             BPHS/EPHS, the nutrition therapeutic
gramming around the scale-up of the                                                        mainly financed by the humanitarian
                                             products (RUTF) are not included in the
IMAM is intuitively creating a human-                                                      sector regardless of whether the
                                             Government’s essential-drugs list and
itarian-development nexus, there are                                                       location is a district prioritised for
                                             are not financed through the BPHS/
very few other areas of convergence.                                                       humanitarian action.
                                             EPHS. BPHS and EPHS partners are
Formulating a shared vision of the HDN
for nutrition and defining its practicali-
ties are challenges not yet fully tackled.

This is further undermined by:

y Nutrition-specific interventions
                                                  The COVID-19 crisis response
  being still largely considered as
  emergency responses                             Due to its magnitude, the current COVID-19 crisis revealed dramatic gaps
y Disaster response being largely                 in the aid system and in the public services for disaster preparedness and
  delegated to international assistance           response. A few examples were gathered during the study.
  and organizations                               The crisis highlighted the lack of disaster preparedness and contingency
y The absence of prevention                       planning in many public services/ministries, hampering the continuity of
  interventions at scale                          essential services but also timely, comprehensive response plans. Crisis
                                                  impacts are therefore neither mitigated nor responded to, increasing
Analysis of past years’ responses                 the risk of diverting resources from crucial development programmes –
shows more than half of all children              aimed at reducing poverty and food insecurity – to potential responses to
with acute malnutrition live in areas             immediate needs.
not prioritised for assistance by the
HRP and therefore receiving limited               The crisis also clearly disrupted the daily service delivery and programme
assistance and services. The per-                 supervision, undermining past efforts and investments and generating a
sistently high levels of undernutrition           competition between the COVID-19 response and routine activities.
highlight that undernutrition is not only         On the other hand, it was reported that it also provided more opportunities
a result of shocks and emergencies                to work through a multisectoral approach and to kickstart joint humanitari-
but induced by chronic deprivation and            an-development programming, due to the magnitude of the crisis, as well
under-development. However, nutrition             as prompting innovative approaches to cope with access issues.
treatment, and the specific needs of
infants, adolescents and women, are

                                                                                               The development objective of the Sehatmandi
                                                                                           Project for Afghanistan, supported by the World
                                                                                           Bank, is to increase the utilization and quality of
                                                                                           health, nutrition, and family planning services

                                                                                                            Afghanistan Case study               13
© UNICEF/UNI119758/Noorani

This set-up is complemented – through       space for actors across humanitarian-
mobile teams and a surge system – to        and development-assistance sectors
provide a timely response to emergen-       to undertake a prioritisation exercise to
cies/shocks in terms of health services,    cope with the scarcity of the resources.
including nutrition treatment and coun-     The promotion of a full multisectoral
selling. However, the other deprivations    package is indeed currently not realistic
resulting from a disaster and impacting     in a resource-scarce environment.
on the nutrition status, such as access
                                            There is a generally shared understand-
to water and nutritious food, remain the
                                            ing of nutrition needs and a consensus
responsibility of impoverished commu-
                                            on the need to prevent malnutrition, but
nities or NGOs highly dependent on
                                            limited consensus among stakeholders
resource-mobilisation mechanisms.
                                            on how to prevent malnutrition and
AFSeN-A is providing an opportunity to      where to start, despite a great deal
scale up the implementation of nutri-       of nutrition-security and longer-term,
tion-sensitive interventions and the pre-   nutrition-prevention programmes
vention of malnutrition in all its forms.   implemented over the years. There
However, the main sources of funding        is unfortunately no coordination or
for nutrition remain humanitarian funds     systematic mapping (geographic
and health-sector financing (Nutrition      distribution, scale and resources) of
Investment Snapshot 2019, p. 3), which      such programming. Local knowledge
are largely treatment focussed. When        and humanitarian-assistance expertise
it comes to prevention interventions,       could however be leveraged to fill
there is no curation of evidence for        part of this gap.
the effectiveness of nutrition-security
programming, nor is there dedicated

14   Afghanistan Case study
The role of the
coordination mechanisms

Despite increasing dialogue and areas        Technical committees have been set up        the level of participation and engage-
of convergence, the coordination             as part of the AFSeN-A. For example,         ment is also impacted by the lack of
mechanisms are still working very            the Nutrition Working Group met every        operationalisation, an action plan and
much in silos, and humanitarian and          month until March 2020, chaired by the       visible results. The committees are
development actors are interacting on        MoPH and co-chaired by UNICEF and            supposed to work through small task
different platforms.                         the Ministry of Education (MoE). Techni-     forces within the ministries, preparing
                                             cal working groups have a small number       proposals and budgets to be presented
Opportunities for bridging this gap exist.
                                             of active members. They offer a space        to the executive committee, but it seems
The NGOs and the UN agencies are
                                             to discuss issues but are limited in their   this function is not active.
often double-hatted and are involved
                                             ability to generate proposals and results.
in both humanitarian and development                                                      AFSeN-A provincial committees were
                                             According to the interviewees, the repre-
programming. However, the structure                                                       also established between 2018 and
                                             sentation in the technical committees
and the dynamics of the coordination                                                      2020 but are not yet functional. It
                                             is not senior enough. Representatives
mechanisms do not provide sufficient                                                      requires another round of sensitisation
                                             often face competing priorities, which
flexibility and incentive for these oppor-                                                by AFSeN-A. However, in each prov-
                                             impact on their presence and level of
tunities to materialise.                                                                  ince, pre-AFSeN-A food and nutrition
                                             participation. According to interviewees,
                                                                                          committees remain functional, providing
                                                                                          monthly needs updates
                                                                                          and gathering representatives from
                                                                                          different sectors.

                                                                                          The Nutrition Cluster (NC) is providing
                                                                                          a forum to exchange information and
                                                                                          coordinate nutrition responses with
                                                                                          a focus on nutrition treatment and
                                                                                          associated activities, such as IYCF in
                                                                                          emergencies. It has a large membership
                                                                                          (45 members) including many national
                                                                                          organizations. Despite very blurry lines
                                                                                          between humanitarian and development
                                                                                          programming when it comes to nutrition
                                                                                          treatment, the representation is mainly
                                                                                          ensured by humanitarian staff. The level
                                                                                          of participation is uneven and depen-
                                                                                          dant on funding streams, especially
                                                                                          for national organizations relying on
                                                                                          funding cycles as short as three months,
                                                                                          to support their core functions and
                                                                                          representation in coordination forums.
                                                                                          The agenda of the NC is highly depen-
                                                                                          dent on the rhythm of emergencies and
                                                                                          the resource-mobilisation calendar.

© UNICEF/UNI119758/Noorani                                                                            Afghanistan Case study   15
The strategic advisory group (SAG) is       over resources, leading to overprotec-       programmes is ensured by NGOs
playing its role in providing strategic     tion of its mandate, its relationship with   (international, national and many local).
leadership, but prioritisation and plan-    selected governmental departments and        They are largely represented at sub-na-
ning, resources and capacities within       agencies and its geographical area of        tional level but under-represented at the
the cluster members are not always          influence (flag-planting), which under-      national level and in national initiatives.
sufficient, and informants regretted not    mines joint action and programming           The national and local organizations are
being able to cover more strategic topics   and reinforces the silos. The inter-         usually present only in a few districts
during the NC meetings and exchanges.       cluster coordination on nutrition, despite   or regions. Due to the small scale of
                                            aiming to provide a framework of joint       their projects, their financial turnover
Despite dedicated resources for a Nutri-
                                            planning and programming, is not             is low and irregular and they need
tion Cluster Coordinator (NCC), the NC
                                            playing this role and is limited to the      to mobilise additional resources to
coordination has suffered from a gap of
                                            exchange of information.                     support their capacity building and to
a dedicated NCC between November
                                                                                         ensure their participation in coordination
2019 and March 2020 and this role was       According to interviewees, several initia-
                                                                                         mechanisms and the Multi-Stakeholder
covered by the cluster co-lead.             tives for nutrition – overlapping human-
                                                                                         Platform. When sufficient resources are
                                            itarian and development interventions
At the sub-national level, the coordi-                                                   available, they could play key technical
                                            and mandates – are being supported
nation is regular and focuses on the                                                     and strategic roles, thanks also to
                                            by the ONE UN joint advocacy (e.g.,
exchange of information to cope with                                                     their broader mandate often working
                                            IMAM and IYCF scale-up) but are falling
operational challenges, avoid overlaps,                                                  across sectors.
                                            short of dedicated staff to support the
maintain the supply chain for nutrition
                                            convergence between humanitarian             It is only recently (early 2020) that the
products and resource mobilisation. Ad
                                            and development programmes and joint         interactions between the AFSeN-A and
hoc meetings are organised to coordi-
                                            programming in general.                      the Nutrition Cluster started but they
nate emergency responses when
                                                                                         have been limited by the COVID-19
a crisis occurs.                            Insufficient access to resources is
                                                                                         crisis and the AFSeN-A institutional
                                            impacting the capacity of some orga-
The fact that the cluster at national and                                                issues. The NCC, Famine Early Warning
                                            nizations to participate in coordination
provincial levels is very focused on                                                     Systems Network and its integrated
                                            mechanisms and to support joint
implementation coordination, avoiding                                                    phase classification have been partici-
                                            activities and programmes. While the
overlap and resource mobilisation also                                                   pating in the AFSeN-A committees since
                                            UN agencies are having a predominant
hinders the capacities for dialogue                                                      early 2020 and the AFSeN-A Technical
                                            role in the nutrition agenda – through
with government and to support the                                                       Secretariat in the NC meetings.
                                            their capacity to mobilise and manage
transition between humanitarian and
                                            large human and financial resources
development-led interventions. Another
                                            – the implementation of activities and
major barrier is the enduring competition

© UNICEF/UNI309866/Dejongh

16   Afghanistan Case study
Conclusions and recommendations to the
SUN movement and the Nutrition Cluster to
strengthen the Humanitarian-Development
Nexus for nutrition in Afghanistan

Afghanistan has been able to develop          The study observed that the coordina-         The NCC, SAG and AFSeN-A Techni-
an MSP (AFSeN-A) and an MS policy             tion mechanisms structured around spe-        cal Secretariat should:
and strategic framework very swiftly          cific objectives, strategies and activities
                                                                                            y Review the organization of the
after joining the SUN movement.               were more accountable, more inclusive
                                                                                              Nutrition Cluster and Nutrition
However, this strategic framework             and more dynamic. Each committee,
                                                                                              Technical Group to organise joint
still needs to be translated into action.     network or technical group should report
                                                                                              meetings (including frequency,
Humanitarian and development                  systematically on their annual plan
                                                                                              agenda, membership, action plans)
activities are often co-located, meaning      implementation. The annual plan should
humanitarian and development actors           be based on specific and achievable           y Identify thematic and working
could easily combine their capacities,        priorities (few rather than many).              priorities and define shared
experience and knowledge to support                                                           annual objectives/outcomes and
                                              The membership should be devolved
sub-national planning, mapping and                                                            report accordingly
                                              to a set team, rather than to individuals,
implementation of the AFSeN-A and to
                                              to cope with workload, turnover and           y Establish sub working groups
enhance national and local capacities
                                              political change. It could also help            corresponding to needs to work on
to anticipate and respond to disasters to
                                              in managing egos, which often under-            HDN priorities
sustainably reduce humanitarian needs
                                              mine collaboration.
and malnutrition in all its forms. Stronger                                                 The GNC/SMS-GSS should:
inclusiveness would also facilitate the       Of utmost importance is the role of the
                                                                                            y Support the NC and the SUN focal
mobilisation of more resources, support       coordinator/facilitator dedicated to the
                                                                                              point to advocate to mobilise the
and capacities.                               role, who should have a background in
                                                                                              required technical assistance
                                              both development and humanitarian/
                                                                                              and/or resources
                                              emergency response.
Promote joint coordination
platforms for humanitarian
and development partners
for nutrition
                                                     © UNICEF/UN0339431/Dejongh

Humanitarian and development actors
should have a platform to exchange
information. Acknowledging the limited
resources stakeholders have, instead of
creating a new coordination mechanism,
it is proposed to organise joint sessions
of the AFSeN-A nutrition working group
and the Nutrition Cluster. Task forces
could then be created to support timely
action, as defined, to support planning
and implementation of the AFSeN-A.

                                                                                                       Afghanistan Case study     17
Develop further the common                  the HDN is effective and risks diluting        The Nutrition Cluster, SAG and SUN
narrative on the HDN for                    specific nutrition objectives and the          government focal point should:
nutrition in Afghanistan                    shock-responsive aspects of the HDN.
                                                                                           y Agree on immediate actions to
                                            The theory of change should identify
                                                                                             engage Nutrition Cluster and
                                            which nutrition outcomes to target
The triple-nexus approach is a UN-led                                                        AFSeN-A members on creating an
                                            – through a strengthened HDN for
process that needs to be disseminated                                                        HDN for nutrition (presentation of the
                                            nutrition – and which changes it
more widely at national and sub-na-                                                          case study and its recommendations
                                            wants to see.
tional levels and needs to include                                                           in joint meetings, participation in
all humanitarian, development and           This should then be translated into              webinars, sharing existing guidance,
government actors.                          specific actions and programmes,                 engaging members to participate
                                            within the frameworks of the HRP and             in nexus information sessions
Stakeholders working at sub-national
                                            AFSeN-A, prioritised according to effi-          organised by UN agencies)
levels should be systematically involved
                                            ciency and/or feasibility criteria. Specific
in all activities related to HDN building                                                  y Use opportunities to integrate HDN
                                            entry points have been mentioned,
as the main implementers and                                                                 in planned trainings and events, at
                                            such as the transition and continuum
first responders. This also requires                                                         both central and local levels
                                            from humanitarian to development
sufficient capacity building and
                                            programmes, including: reclassifying           y Organise joint specific sessions to
resource mobilisation.
                                            the humanitarian nutrition caseload into         identify outcomes to achieve through
Based on the work already documented        a development caseload; increasing the           a strengthened HDN for nutrition, a
(articles, presentations), stakeholders     service coverage and the coverage in             timeline and what needs to happen/
should be invited to work together on       hard-to-reach areas, identifying specific        change to achieve these
developing a “theory of change”. Some       support and resources (civil-military
                                                                                           y Develop a theory of change
interventions are implemented by both       dialogue, adapting the profile of the
humanitarian actors and development/        mobile team, building capacities of local      y Develop joint advocacy and
government actors, creating a “natural”     organizations); enhancing systems’               resource-mobilisation strategies
blurred line between both. This is the      shock-responsiveness; scaling up
                                                                                           y Organise sessions at sub-national
case with IMAM and IYCF. While it           IYCF; infant, adolescent and women
                                                                                             level to improve the understanding
could create opportunities for building     nutrition; and linking with social
                                                                                             of the HDN and identify specific
HDN, it creates a false sense that          protection/safety nets.
                                                                                             areas of convergence and
                                                                                             collaboration. Include the relevant
                                                                                             local-government and non-
                                                                                             government actors
© UNICEF/UNI357134
                                                                                           The GNC/SMS-GSS should:

                                                                                           y Support the Afghanistan Nutrition
                                                                                             Cluster and the SUN focal point
                                                                                             with advocacy to mobilise the
                                                                                             required technical assistance
                                                                                             and/or resources

                                                                                           The SUN movement coordinator/SUN
                                                                                           leadership should:

                                                                                           y Share instructions and guidance with
                                                                                             the RC/HC and encourage country
                                                                                             leadership to embrace the nexus
                                                                                             concept and support the nutrition-
                                                                                             security agenda.

18   Afghanistan Case study
Support the implementation
of the AFSeN-A strategic plan                       Prioritisation                         Planning                  Resource
The multisectoral plan is very ambitious
but has not prioritised the effective level
of the resources devoted to nutrition.                            Implementation                     mobilisation
It is therefore important to prioritise
interventions that are relevant at the
provincial level, based on the evidence
generated by both humanitarian and                                                         Results               Accountability
development partners. This should
create a virtuous cycle to mobilize
enduring commitments at the political,
finance and implementation levels:

3A. Leverage knowledge and                    y The promotion of a full multisectoral           Prioritisation would focus
experience from humanitarian                    package, which is not realistic in              on the identification of specific geo-
and local organizations                         a resource-scarce environment. A                graphical locations and/or interventions
                                                prioritisation is indispensable based           and support implementation at the
                                                on feasibility and efficiency criteria          provincial level.
The expertise and experience
accumulated by humanitarian actors            y Stakeholders/organizations’                     The NCC, SAG and SUN technical
and grass-roots organizations are               mandates, which hinder                          focal point should:
often underutilised. They need to               efficient prioritisation
                                                                                                y Organise specific joint sessions,
contribute more effectively to the
                                              Nutritional vulnerability is frequently a           supported by the appropriate
prioritisation of interventions and
                                              social construct (i.e., a result of social          technical assistance and led by
strategic development.
                                              characteristics that disadvantage and               the AFSeN-A, to identify priority
The Nutrition Cluster should:                 disempower some groups, commu-                      interventions and geographical areas
                                              nities, households, and household                   to start the operationalisation, based
y Share systematically the results of
                                              members). The aid sector and, to a                  on feasibility criteria
  assessment and surveys
                                              lesser extent, the governments, are
                                                                                                y Define clearly the roles of
The SUN technical focal point                 structured around sector approaches.
                                                                                                  humanitarian and development
and AFSeN-A technical working                 Organizations are often limited and
                                                                                                  actors based on their
groups should:                                prejudiced by their own mandate.
                                                                                                  comparative advantages
y Identify the gaps of information            Support for analysis and multisectoral
                                                                                                y Include these priorities across the
  and evidence and work with the              response planning must be strength-
                                                                                                  humanitarian multi-year planning and
  other stakeholders on sharing               ened by challenging the prejudices,
                                                                                                  AFSeN-A planning
  responsibilities and resources              backgrounds and mandates of stake-
                                              holders and organizations, and openly             The GNC/SMS-GSS should:
                                              analyse causal pathways, feasibility,
3B. Identify priorities to start                                                                y Support the SAG and the SUN
                                              existing evidence and the potential
                                                                                                  focal point to advocate to mobilise
the implementation                            nutrition impact of an intervention.
                                                                                                  the required technical assistance
                                              Stakeholders should be opportunistic                and/or resources
While stakeholders acknowledge only
                                              and instead of pursuing too many objec-
prevention interventions can sustain-
                                              tives, identify specific entry points able
ably reduce humanitarian needs, the
                                              to foster positive results. It could also
investments in nutrition-sensitive/pre-
                                              help in coping with political changes
vention actions are hampered by:
                                              that affect institutions and processes.

                                                                                                            Afghanistan Case study      19
3C. Involve the sub-national                 lies only with specialised national           already planned and written into their
levels and all organizations in              institutions with very limited resources      annual plans. However, the finalisation
the process                                  and humanitarian organizations, mostly        of the costing of nutrition-sensitive
                                             international. The continuity of services     interventions appears as a greater
The implementation of nutrition              during a crisis and in conflict-affected      challenge, since ministries do not have
activities and programmes are largely        areas is not ensured. Building the            experience with implementing these
ensured by NGOs (international,              HDN requires shared responsibilities          interventions. There is no clear protocol
national and local); however, they are       on those aspects. Moreover, the first         yet available, and limited experience of
under-represented partly due to the          responders are often local communities        public-sector members in the prepara-
weakness of the sub-national coordina-       and local authorities that need to be         tion of budget plans and the generation
tion, their limited capacities but also by   empowered and resourced to provide            of costs, required ingredients, etc. for
the way the representation is organised.     an anticipated response to reduce the         these types of activities that are not
                                             impact of any disaster.                       traditionally part of their annual budget
At the sub-national level, the roll-out of
                                                                                           plans and public-sector work plans. As
the AFSeN-A and the development of           The AFSeN-A Technical
                                                                                           a result, it was more difficult to assign
provincial implementation plans should       Secretariat should:
                                                                                           a cost to nutrition-sensitive activities. If
be supported by the local organizations.
                                             y Review the policies and                     interventions are prioritised, this should
They need a greater awareness of the
                                               strategies as part of a joint               be facilitated.
HDN, to share the joint vision/theory of
                                               humanitarian-development working
change and the agreement on needs                                                          The AFSeN-A Technical Secretariat/
                                               exercise, including the AFSeN-A
and priorities. They should therefore be                                                   SMS-GSS should:
                                               strategic framework
involved in all the processes.
                                                                                           y Develop protocols and training on
                                             y Use existing tools (NNP
The Nutrition Cluster and AFSeN-A                                                            the preparation of budgets,
                                               checklist, CRF)
Technical Secretariat should:                                                                generation of costs and a country
                                             The SMS-GSS/GNC should:                         adapted tracking system.
y Organise the representation of
  the sub-national coordination              y Support the AFSeN-A Technical               y Conduct annual budget tracking
  mechanisms to the national                   Secretariat to advocate to mobilize
                                                                                           The SMS-GSS/GNC should:
  coordination. To identify                    the required technical assistance
  representatives and support direct           and/or resources                            y Support the AFSeN-A Technical
  and remote participation                                                                   Secretariat to advocate to mobilize
                                                                                             the required technical assistance
y Ensure that coordination                   5.
                                                                                             and/or resources
  mechanisms at sub-national levels          Strengthen the accountability
  have annual strategic objectives,
  commit appropriate resources               Interviewees highlighted that policies,
  to achieve them and report/be              strategies and programmes are not
  accountable to them                        being financed, rolled out or imple-
                                             mented, partly due to their lack of
y Support the mobilisation of resources
                                             accountability. It is an important point to
  to ensure inclusion and participation
                                             take into account also for the operation-
  of the civil society organizations
                                             alisation of the HDN.

                                             Indicators should be few, specific and
                                             measurable, preferably already col-
Enhance shock-
                                             lected by the existing systems. Informa-
responsiveness and conflict-                 tion systems are generally constrained
sensitivity of development                   and not flexible. Requests for routine
policies and programmes                      information should be limited to the
Despite a high vulnerability to disas-
                                             Annual budget tracking is mandatory
ters, conflict and climate change, the
                                             to ensure accountability and to sustain
national policies, related strategies and
                                             commitments. During the exercise con-
implementation plans are not suffi-
                                             ducted on the 2019 budget, the study
ciently risk-informed. The responsibility
                                             team found the ministries were easily
for disaster preparedness and response
                                             able to get information on activities

20   Afghanistan Case study
Annex 1:
Scope, methodology,
background and
documents referred to
during desk review
Scope                                                               Methodology
This report has been commissioned by the GNC and the SUN            The study used a qualitative research design including
Movement Secretariat to capture experiences of crisis affected      secondary data analysis and focus group and key informant
States and suggest options to strengthen the Humanitari-            interviews. Interviews were conducted between July and Sep-
an-Development Nexus for nutrition outcomes. This document          tember 2020. Individual anonymity was assured, and therefore
is based on three country case studies, Afghanistan, Myanmar        identifiable positions have not been reported. Key informants
and Niger, and examines how humanitarian and development            included representatives from central government institutions,
actors do and do not work together to improve nutrition. The        UN, international and national NGO/CSO researchers, and
country case studies also offered the opportunity to involve key    bilateral and multilateral donor agencies in both technical and
stakeholders in this critical review and to formulate, with them,   managerial positions. The interviews were structured around
actionable recommendations.                                         a set of questions to capture the specific experiences of the
                                                                    interviewees. While interviews were semi-structured, the set of
The detailed findings and recommendations are compiled
                                                                    questions were broadly uniform across countries.
in independent country reports, which were presented and
discussed with the key stakeholders in Afghanistan, Myanmar         The desk component of the work consisted of a literature
and Niger. Additional insights were collected from Yemen and        review. A search strategy was developed focusing on literature
contributors working across a large range of countries.             related to multisectoral and sector approaches potentially con-
                                                                    tributing to nutrition, including: policy and strategic frameworks;
The objective of the study is to identify and share examples
                                                                    coordination mechanisms and frameworks; governance,
of good practice and to identify practical, country-specific
                                                                    leadership and political economy; financing; information
opportunities and solutions, to strengthen the Humanitari-
                                                                    and knowledge management; and programmes and initiatives.
an-Development Nexus for nutrition. The analysis is therefore
                                                                    The search was limited to documents and information
not exhaustive but purposive. Only relevant aspects of the
                                                                    published after 2010.
context and studied frameworks are presented. A particular
emphasis is given to the factors enabling collaboration and         The methodology was adapted to the specific constraints
commitment to nutrition.                                            imposed by the COVID-19 pandemic. All interviews and meet-
                                                                    ings were held remotely using video-conferencing applications.
                                                                    It limited both the choice of the informants and the level of
                                                                    interaction with the informants:

                                                                                                         Afghanistan Case study     21
y The consultant could not use the service of a translator.
  Only English or French-speaking informants were                    Background
  interviewed, limiting the representativity of the sample in
  Afghanistan and Myanmar.                                           The country case studies, this global report and the associated
                                                                     policy brief were commissioned jointly by the Global Nutrition
y The majority of the interviews were individual interviews.
                                                                     Cluster and the SUN Movement Secretariat, engaged in the
y The meetings and interviews were limited to one hour,              nexus building as a New Way of Working.6
  acknowledging the fatigue related to remoteness. Additional
                                                                     As a part of the humanitarian reform process, the cluster
  questions and information were collected through email
                                                                     approach was initiated in 2005 to improve the effectiveness
  when necessary.
                                                                     of humanitarian responses through greater predictability,
y The remoteness of the study made it less attractive to             accountability, responsibility, and partnership. This included the
     certain stakeholder groups.                                     creation of the Nutrition Cluster, which has now been officially
                                                                     activated in 24 countries. The GNC also supports in-country
y As much as possible, video was used to ease the personal
                                                                     sectoral coordination mechanisms, as is the case in Niger and
  interactions but the use of video remains limited, with many
                                                                     in Myanmar – included in this study.
  interviewees not being sufficiently equipped or connected.
                                                                     The Scaling Up Nutrition Movement was created in 2010
y On some occasions, technical issues prevented the
                                                                     to inspire a new way of working collaboratively to end mal-
  interviews from being concluded.
                                                                     nutrition in all its forms. It is now active in 62 countries and
While a wide range of stakeholders, across humanitarian,             four Indian states. At the heart of the SUN movement is a
development and government workstreams were contacted,               multi-stakeholder platform (MSP). MSPs are led and chaired
the study was limited by logistical and time constraints and         by a government-appointed focal point and aim to bring
by stakeholders’ availability. The study was conducted over a        together all nutrition stakeholders – including humanitarian
holiday period, when organizations experience a high turnover.       actors – around the same table, to prevent malnutrition in all its
The availability of contributors was also limited by institutional   forms, and therefore reduce humanitarian need.
issues, which were not mitigated in the short time of the study.
                                                                     For this study, the Humanitarian-Development Nexus is
The findings of the study are therefore limited by these             understood as the central point where humanitarian and
specific constraints and their validity limited to one particular    development actors and programmes link up to address more
point in time.                                                       effectively the issues they are facing.

                                                                     Nutrition in crisis affected states is often influenced by both
                                                                     the poverty of the public services, protracted crises, recurrent
                                                                     disasters and climate change. It therefore requires intensified
                                                                     collaboration and focus and adaptive strategies that an HDN
© UNICEF/UN0339438/Dejongh                                           could contribute to develop.

                                                                     In those contexts, with the appropriate support and partici-
                                                                     pation, Nutrition Clusters and MSPs can both contribute to
                                                                     strengthening the HDN by supporting the identification of
                                                                     areas of convergence and efficiency gains. The challenges
                                                                     faced in crisis affected States call for an enhanced flexibility
                                                                     of the traditional mandates and roles of the humanitarian and
                                                                     development actors.

                                                                         Strengthening the Humanitarian-Development Nexus was identified by the
                                                                     majority of stakeholders as a top priority at the World Humanitarian Summit
                                                                     (WHS) in 2016, including donors, NGOs, crisis-affected states and others,
                                                                     and it received more commitments at the WHS than any other area. ‘New
                                                                     Way of Working’

22     Afghanistan Case study
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