Special focus on Nutrition Cluster coordination - December 2017 Issue 56 - Emergency Nutrition ...
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December 2017 Issue 56 Special focus on Nutrition Cluster coordination
Contents...............................................................
WFP/Marie Vennize
1 Editorial
Field Articles
5 Accountability to affected populations: Somalia Nutrition
Cluster experiences
11 Development and added value of the Nutrition Cluster in
Turkey
16 Development of multi-cluster rapid and in-depth assessment
methodologies in Afghanistan
20 Cluster coordination in a government-led emergency
response in Ethiopia
25 Experiences of Nutrition Sector coordination in Syria
47 Call for action
News
29 Partnership and accountability in the South Sudan Nutrition 47 Promoting an integrated famine prevention package: Breaking
Cluster (2015-2017) bottlenecks. Global Food Security and Nutrition Cluster
meeting, 26 April 2017 at World Food Programme HQ, Rome
76 Global Nutrition Cluster Rapid Response Team
Field Articles
50 Post-Rome integrated action: Experiences from North-
79 Experiences of the ‘Whole of Syria’ coordination for nutrition eastern Nigeria
84 From cluster to Nutrition Sector coordination: Government 53 Somalia Nutrition Cluster: integrated famine prevention
leadership in coordination for effective nutrition emergency package
response in Borno State, Nigeria 56 Yemen Nutrition Cluster: Integrated famine-prevention
package
89 Nutrition in health response in emergencies: WHO
59 South Sudan Nutrition cluster 2017: famine lessons learnt
perspectives and developments
55 Nutrition Tech RRT
Field Articles
© UNICEF/Modola
62 Nutrition Technical Rapid Response Team: Experiences and
lessons learned
66 Tech RRT CMAM Adviser: Experiences from Nigeria and
Yemen
68 Tech RRT IYCF-E/CMAM Adviser: Experiences from Niger,
Haiti and Nigeria
71 Tech RRT Assessment Adviser: Experiences from South
Sudan, Mozambique, Iraq and Yemen
73 IYCF-E Tech RRT support: Experiences from Iraq
74 Tech RRT IYCF-E support for Aleppo response, Northern Syria
News
35 Update of the Nutrition in Emergencies Coordination
Handbook: A product of the Nutrition Cluster
36 Global Nutrition Cluster Strategy 2017-2020
37 Nutrition Cluster advocacy strategy/framework and toolkit
37 Guidance on accountability to affected populations
38 Global Nutrition Cluster HelpDesk
41 Inter Cluster Nutrition Working Group (ICNWG)
Views
42 Strengthening nutrition humanitarian action: Supporting
humanitarian cluster/sector coordination transition
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Editorial
Dear readers
S
ince its inception over ten years ago,
the Global Nutrition Cluster (GNC) has
progressed from its early focus on the
development of technical tools and
materials and filling research gaps to a much
greater emphasis on strengthening country
coordination and providing surge support to
© UNICEF/Sebastian Ric
secure appropriate and high-quality nutrition Child being weighed in an
programming in emergency contexts. outpatient therapeutic feeding
programme in Dalxiiska IDP
As well as the changes evident at country settlement, Kismayo, Lower
Juba, Southern Somalia, 2017
level, the GNC has very strong strategic part-
nerships with its members. Referred to as the
GNC Collective, members are guided by the rapid, flexible, nutrition technical expertise. shape and design of programmes. We see AAP
GNC Standard Operating Procedures and a small Both are vital cogs in the Nutrition Cluster in action in Somalia, where the Nutrition Cluster
elected group serve as representatives on the wheel as they provide immediate support for has led development and adoption of an AAP
GNC Strategic Advisory Group (SAG), which national coordination and the design of technical Framework and where pooled funding is now
helps guide priorities and positioning of the programmes and they help strengthen national contingent on minimum AAP implementation,
GNC within the wider architecture. Today the capacities. Surge is a support, not a substitute, and in South Sudan, where partnership and
GNC has 44 partners (including ten observers) for longer-term Nutrition Cluster Coordinators accountability cut across all cluster activities
contributing their time and efforts, often freely. (NCCs) and Information Management Officers and are crucial to programme quality.
Without them, the Cluster would not be able to (IMOs) – a vital partnership in coordinating the
4Ws (Who, What, When, Where) – and an in- GNC work is enabled by constant develop-
achieve the progress evident today.
credible resource at the heart of the Nutrition ments in information management, which has
The ambitious GNC Strategy (2016-2020), involved toolkits to help standardise the use
Cluster. In addition to these key on-the-ground
summarised in this issue of Field Exchange, of information across the Nutrition Cluster –
personnel, the GNC manages and staffs a 24-
and the related work plan guide the work of although how information is managed between
hour helpdesk, which provides country teams
the Collective. Indeed, a review of the previous clusters is an ongoing challenge. Knowledge
with immediate support; be it in soft skills (co-
GNC strategy concluded that strong partnership Management (KM) is another cross-cutting ac-
ordination, advocacy, etc) or in technical re-
was most evident where partners led aspects tivity and crucial to the GNC in order to capture
sources (survey design, access to global or nor-
of the work plan in line with their respective what is working well and identify where change
mative guidance, etc).
strengths and skillsets. Maintaining and growing is needed. The body of work reflected in this
this commitment is always a challenge, however, The GNC also has key overarching docu- issue has involved considerable support by
as much of the work of the Collective relies on ments which guide its focus and work. These ENN to help NCCs unpack, dig into and docu-
the continued goodwill of the individuals rep- include an Advocacy Framework and tool kit, ment their wealth of insights and experience
resenting their agencies and organisations – a Framework for Accountability to Affected through 2016 and 2017. The engagement of
with an uneven distribution of the workload Populations (AAP), a Framework for fostering NCCs in this process in the face of huge oper-
that is perhaps inevitable. linkages with the Scaling Up Nutrition (SUN) ational demands, and the quality and number
Movement in fragile and conflict-affected states of articles in this special issue of Field Exchange,
When an emergency is declared, several im-
(FCAS) and an emerging inter-cluster collabo-
mediate steps are taken by the GNC. First, there are testament to the desire by NCCs, IMOs and
ration with the Food Security Cluster (see news
is the deployment of the stand-by surge capacity, RRTs to share their learning.
item in this issue of Field Exchange). Together,
either for coordination or for technical support
these are all steps in the right direction in Despite all these achievements, the GNC
or both, depending on context. Two valuable
terms of better linkages with global initiatives faces a number of challenges and opportunities
rapid response mechanisms have been devel-
and other clusters. as it looks towards the next decade of emer-
oped to meet need: Rapid Response Teams
gency coordination and response in a rapidly
(RRTs) that provide coordination and information The AAP has built on and more formally
changing global architecture.
management ‘surge’ support and an inter- recognised the work done over the past ten
agency Nutrition Technical Rapid Response years, which is to ensure that affected popula- It is apparent that there is a limited under-
Team (Tech RRT), funded by the Office of US tions are consulted and that they participate standing among donors and other actors of
Foreign Disaster Assistance (OFDA) (see article throughout the response, so they are not passive the impact the Cluster is having, as evidenced
by Andi Kendle in this issue), that provides recipients of aid but active stakeholders in the by the gradual decline we are seeing in the
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Editorial
financing of the GNC work plan (see below). ority in the Turkey cluster-led, cross-border re- Firstly, are we focused on the right nutrition prob-
There is now an urgent need to better showcase sponse in Syria; while strategic planning has lems? Looking at the history of the GNC, the
the vital work going on in countries, particularly been taken to a whole new level through the default nutrition problem we have focused on
as we are facing an unprecedented number of Whole of Syria (WoS) coordination mechanism is the treatment of acute malnutrition. This is
emergencies that are often chronic in nature established in Jordan that constitutes one highly appropriate in contexts where prevalence
and span years. We share experiences from comprehensive framework, a common response of global acute malnutrition (GAM) has increased
Somalia, South Sudan, Ethiopia and Syria in plan and a supporting coordination structure or is in danger of increasing, such as in the
this issue; all have featured in our pages many across three operational hubs (Turkey, Syria famine-risk countries of Somalia, Yemen, South
times before. and Jordan). Sudan and Nigeria highlighted in this issue, but
what about other high-impact interventions,
Added to this, we are witnessing a profound We also need the CLA to take a greater
and what do we do when faced with populations
deterioration in the nutrition status of popu- leadership role in technical support for the
with low levels of acute malnutrition but high
lations in FCAS contexts which, if left unchecked, Nutrition Cluster and implementation of the
levels of anaemia, stunting, non-communicable
will prevent the realisation of important global structures for technical leadership, with broad-
disease, low prevalence of breastfeeding and
targets for reductions in malnutrition. The ap- based engagement from GNC partners. By do-
plication of cluster coordination performance sub-optimal infant and young child feeding
ing so, it will enable the GNC to focus on the
monitoring (CCPM), rolled out in several coun- (IYCF) practices in general? Over the many
wider strategic engagement needed to deliver
tries, captures some of the impact story but decades of emergency response, our default
on the recent global pledges and targets as
this, too, needs to be better documented and has been to treat acute malnutrition (we call
set out in the Grand Bargain, the New Ways of
more widely shared. There is also a need to this “the GAM ghetto”). The narrative hasn’t
Working, the Sustainable Development Goals,
develop and ensure more robust monitoring changed, yet the contexts in which emergencies
World Health Assembly targets and other ini-
and evaluation. are taking place has and the nutrition problems
tiatives which call for much greater linking of
that populations present with are as diverse as
While the GNC has an ambitious strategy, humanitarian and development efforts and
the contexts they live in. We have been unwit-
to realise it we need to ramp up strategic- for greater localisation.
tingly shooting ourselves in the foot by not
level engagement with the other clusters In this special issue of Field Exchange, the having changed the narrative to ensure the co-
(Water, sanitation and hygiene (WASH), Health, 18 articles by NCCs, IMOs and RRT staff aim to ordination and delivery of a package of high-
Food Security/Cash, etc), development actors, share the work of the Nutrition Cluster across impact, nutrition-specific interventions.
UNICEF as Cluster Lead Agency (CLA) and widely varying and challenging contexts. These
donors, as well as with local actors and gov- The experiences shared in this issue show
articles provide frank, open and honest accounts
ernments. Central to this is a need to focus on some progress. For example, stunting and IYCF
of their achievements as well as the critical
preparedness, contingency planning, the hu- feature strongly in the three-year strategy of
barriers that need to be addressed and over-
manitarian-development nexus and support the Turkey Nutrition Cluster, but what are con-
come through actions taken by the GNC, the
for workable models of coordination, with sidered ‘life-saving’ interventions dominate. In
CLA and all those concerned with protecting
greater support for strategic decision making order to effect change in our story, we need
the nutrition status of populations living in
in ‘forgotten’ and complex crises. different partnerships at global and local levels
emergency contexts. This is KM in action: it
to have the capacity to deliver and, in turn, a
Many of these elements are touched on in delves deep into country experiences, it ex-
reorientation of staff at various levels. Changing
the articles in this issue. In Ethiopia and Nigeria, amines context-specific experiences and it
the narrative is one step, but how we advocate
NCCs describe alignment with and capacitating helps the GNC to see what we are doing well,
to donors to fund more comprehensive pack-
existing government sector coordination mech- what we need to do better and what we need
ages of nutrition interventions while ensuring
anisms; preparedness, contingency planning to do differently. The following highlights some
the partner skillset needed to scale up these
and longer-term ‘development’ goals are a pri- of the common themes from these articles.
interventions is a work in progress.
A recent look at 20 humanitarian response
© UNICEF/Karel Prinsloo
plans over a two-year period showed that, in
all contexts, treatment of acute malnutrition
is systematically included – unlike the rest of
the high-impact nutrition interventions. NCCs
describe significant barriers with donors and
with government, such as in Turkey and Syria,
to accommodating a more holistic approach
to nutrition in emergencies (NiE), with any
progress eventually achieved being through
determined cluster advocacy. Getting ourselves
out of the GAM ghetto is going to be a signifi-
cant challenge.
Next in line with treatment of acute mal-
nutrition is the focus on infant and young
child feeing in emergencies (IYCF-E). In many
countries, our response is typically to issue a
joint statement on IYCF-E, but we struggle to
implement the full range of IYCF-E activities;
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Editorial
i.e. from promotion, protection and support it a reality. Many agencies house the relevant nutrition preparedness needs to be a key activity,
of recommended feeding practices to sup- sectors, such as Food Security, WASH and Health, particularly in FCAS and countries prone to
porting the policy environment, including and it is here where the discussion on integration large-scale natural disasters.
Code violations, and supporting mothers who is needed which is slowly happening. For ex-
The article from North-eastern Nigeria is
do not breastfeed. Even in countries where ample, an article by WHO describes internal re-
an example of a government decision to avoid
one would expect a strong IYCF programme form around nutrition and health in emergencies
the formal activation of the cluster mechanism
to be in place before a crisis hits, it has been within the agency and this sets the policy frame-
(as it was seen as a sign of government failure)
necessary to deploy a Tech-RRT to produce a work for a more operational approach, with
and instead adopt a sector coordination mech-
strategy and develop plans for a comprehensive nutrition integrated into health goals; we look
anism, with stronger government leadership
IYCF package. In fact, across the range of ex- forward to seeing how this unfolds in program-
with support from the CLA. If this is a growing
periences shared by the Tech-RRT advisors in ming. The questions are, can it progress faster,
trend, we need to better document these de-
this issue across many different contexts, IYCF who leads this visionand how can government
velopments and influence the Inter-Agency
was the dominant technical support ‘ask’ from and operational partners be brought on board
Standing Committee discussion on how we
the Collective. This raises questions about lead- to apply the approach quickly?
classify the various contexts that are emerging
ership and accountability to ensure a compre-
Thirdly, coordination needs a strong sector to and how the Nutrition Cluster can support
hensive IYCF-E response that should be ground-
embed emergency preparedness, response and and engage with them.
ed in preparedness planning; arguably, the
transition. Over the past ten years, particularly
only difference between IYCF-E and IYCF is Fourthly, localising nutrition response and delivery:
across protracted emergencies, coordination,
the context. Several partners have developed The new paradigm. The commitment to promote
whether in countries with an activated cluster
tools and have been building capacity on IYCF- responses that are both “as local as possible”
or in sector-led settings, the cluster has been
E, but there is still limited capacity among im- and “as international as necessary’ underpins
filling a critical gap. This is because, with few
plementing partners and NCCs for the effective one of the new targets set out in the Grand
exceptions, there are no strong sector coordi-
integration of IYCF-E programmes. Part of the Bargain. Localisation is the process by which
nation mechanisms that embed the coordina-
problem may be poor appetite to invest in the humanitarian response is reconfigured to
tion of NiE and support the coordination and
IYCF programmes in emergencies because meet this collective commitment. There are
scale-up of response to emergencies when
they are viewed as preventative and not urgent, times when local actors may be overwhelmed
needed, then scale down the response when
an issue raised in experiences in Iraq and Syria. by the scale or complexity of the humanitarian
the situation improves. This is reflected in the
This raises a further issue: without programmatic crisis and/or may be confronted with technical
findings of a review commissioned by UNICEF
capacity to scale up (and down), cluster coor- and/or institutional capacity, access or resource
in 2016 to examine what is needed to opera-
dination loses its meaning. How can we be constraints. There may also be other reasons
tionalise transition of cluster coordination
predictable in all technical areas and use the why local actors are unable or unwilling to ad-
structures into national coordination platforms
specific capacity of global partners effectively here to humanitarian principles (particularly if
– less than one third of clusters had transitioned
and strategically to strengthen capacity at they are party to a conflict, are perpetrating
to deactivation, despite guidance on how to
country level in order to deliver a package of human rights violations or are compromised
transition out of cluster-led coordination. We
interventions at scale? How can we ensure by their actual or perceived political or other
see prime examples from South Sudan and
that, when short-term technical surge is nec- affiliations). In these cases, the international
Yemen in this issue, where cluster coordination
essarily deployed to support the Collective, community would respond – as much as nec-
is central to the coordination of response and
there is continuity with what has gone on essary. However, at all times, local and inter-
with no prospects of deactivation or transition.
before and follow-through on what happens national actors are expected to continuously
The authors of the review propose working
afterwards, and what is the CLA responsibility review their involvement and contributions
principles to link emergency and development
in this regard? and ensure that they remain in line with the
coordination, based on government leadership
principle – as local as possible, as international
Secondly, how do we enable multi-sector activ- and support, a systems approach and capaci-
as necessary.
ities? In recent years, there has been much ty-gaps analysis, whereby emergency coordi-
global and country-level emphasis on multi- nation is embedded within sector nutrition co- One of the core cluster coordination func-
sector approaches to prevent stunting and ordination and phasing out of support is deter- tions is to strengthen local capacities to better
micronutrient malnutrition, and more recently mined by changing context and competencies. prepare and respond to the humanitarian
attention has also been shifting to the double needs, while the cluster partners and the CLA,
The challenge is to operationalise such think-
burden of undernutrition co-existing with as well as the operational partners, have a role
ing and there are promising working examples
overweight and obesity. Facilitating stronger in ensuring technical capacity before, during
to draw on. In the absence of an existing sector
linkages with other sectors is a challenge in and after an emergency. Although the GNC
coordination mechanism, the GNC often works
stable contexts, so it is not surprising that the does not have a formal position on localisation,
in countries to build longer-lasting coordination
humanitarian community is also struggling there are actions that we collectively need to
capacity, as well as the mechanisms needed
with this way of working. take, while we also have examples that can
for emergency response. Kenya, Ethiopia and
support our actions.
The four famine-risk countries are trying to North-eastern Nigeria are three countries where
do this (see experiences from South Sudan, emergency coordination is embedded in gov- In Ethiopia, for example, most nutrition in-
Yemen, North-eastern Nigeria and Somalia in ernment and investment is made by both gov- terventions are delivered through government
this issue, sharing their responses to the mid- ernment and the CLA to maintain this capacity. structures; therefore a different role is required
2017 Rome Call for Action to prevent famine Ensuring this happens across a much larger to the one used in the past. On the other hand,
through inter-sector action), but the country- number of countries is a key focus. Indeed, in in South Sudan there is weak government and
level efforts need agency-wide commitments SUN Movement countries which may have mul- minimal or no existing structure. Ideas about
and global-level direction and support to make ti-stakeholder platforms and plans, embedding what is needed to scale up response in these
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Editorial
contexts and the countries that fall between response capacities and gaps and continuously service gaps and lack of attention to nutrition
the two extremes are evolving, as responses assess what is possible and what is necessary; are just some of the problems that characterised
will differ according to each context. There is 3) Model and broker an appropriate balance in the cross-line, cross-border operations in Syria
therefore a need to reorganise our support to local and government leadership and deci- before the Nutrition Cluster was eventually ac-
local actors in a way that is well researched sion-making structures within the cluster setting tivated there and in surrounding countries.
and planned. In South Sudan and Somalia, at country level; 4) Identify capacity needs and These problems were captured in a special edi-
consolidated humanitarian funds (pooled funds) document and share learning and initiatives tion of Field Exchange in 20161; in this special
are being used to support/fund local non-gov- that take the capacity needs of local actors issue of Field Exchange, we feature material
ernmental organisation (NGO) delivery services, into consideration. that shows the added value of nutrition cluster
although this is a funding arrangement and coordination in these very same countries.
Fifth and finally, after ten years of adding value,
not systems building. We need a system that
the GNC faces unparalleled resource constraints. A key challenge for the CLA is how it can
capacitates local NGOs to actually write proposals
The funding situation of the Nutrition Cluster help articulate the funding deficit and advocate
and implement quality programmes based on
has undergone gradual decline from 2010 on- for it to be filled to protect these gains and
strong systems of financial and project man-
wards, with eight regular donors between 2006 help ensure a cluster fit for purpose in the
agement. We also need to explore systems of
and 2009 to a current three donors per year changing global landscape. An ENN blog2 fol-
peer support (e.g. pairing of local NGOs with
since (including the CLA). This drop in funding lowing the GNC 2017 Annual Meeting stated:
international NGOs) and to identify what is
is due partially to the policy of a number of “We refer you to the 1996 Great Lakes Evaluation
needed to develop capacity and build pro-
donors, who have asked the CLA to mainstream if you need reminding of how bad it was pre-
gramme quality. Capacity development works
cluster positions (which has been done) so it is humanitarian reform. We therefore have a very
both ways: local agencies are a rich resource of
not all bad news. Indeed, out of the 21 countries simple message ‘SAVE OUR NUTRITION CLUSTER’.
local knowledge and have good access to
affected populations. They have been the cor- supported by the GNC, about 18 positions have
Josephine Ippe,
nerstone of humanitarian response in contexts dedicated cluster coordinators, many of whom
Global Nutrition Cluster Coordinator
like Somalia and Syria. The Nutrition Cluster are on fixed-term contracts thanks to advocacy
and the response of UNICEF in those countries. Carmel Dolan,
may need to champion local agency participa-
However, there is no funding to recruit for the Technical Director, ENN and Member of the
tion in response as sometimes local partners
other RRT/Tech-RRT positions, the helpdesk – GNC Strategic Advisory Group
are given less credence by government than
international partners. Local NGO roles should or, indeed, to make real progress on the GNC
not be limited to programme implementation work plan activities. The GNC is now facing its
– if organised in such a way, they could be ca- biggest funding shortfall since its establishment,
pacitated and empowered to ensure they lead threatening the very solid ground on which it
the response coordination, not just the grass- stands – at a time when we have more emer-
roots service delivery. A good example comes gencies and more complex contexts, and greater
The findings, interpretations and conclusions in this ed-
from Turkey, where 30 out of 36 cluster members ambitions to link humanitarian and development
itorial are those of the authors. They do not necessarily
are local agencies and a Syrian national NGO is systems, foster multi-sector actions for greater represent the views of UNICEF, its executive directors,
cluster co-lead. At global level, we need to sup- integration, and grow in-country capacities for or the countries that they represent and should not be
port countries to do the following: 1) Map ex- localisation. Sometimes you only appreciate attributed to them.
isting coordination mechanisms and avoid cre- what you have when it is missing. Compromised 1 www.ennonline.net/fex/48/perspective
ating parallel mechanisms; 2) Understand local information management, duplicated effort, 2
www.ennonline.net/mediahub/gncannualmeeting
Dedication to Leo Matunga, 31.01.1977 - 21.05.2017
In recognition of the dedication of Leo Matunga, Nutrition Cluster Coordinator, who died in
May 2017, we dedicate this special edition of Field Exchange to his memory. His huge loss,
personally and professionally, are reflected in the words expressed by Josephine Ippe, in a
condolence book compiled for his family and shared here.
My Dear Brother Leo,
I saw the potential in you back in 2005 when we recruited you in UNICEF as part of my
Nutrition Team based in El Fasher, in Darfur, Sudan. You have since then been more than
a colleague to me. We have shared and celebrated each other’s technical achievements and
talked about our personal challenges over the years. I have been involved in your move from
Sudan to Pakistan, Somalia and Afghanistan and I have seen you grow professionally and
personally in all aspects of life. Your dedication, hard work and professionalism brought you
this far. You were and you will continue to be the best humanitarian worker we have had.
Since the day of your passing, the outpour of condolences received from the Global
Nutrition Cluster partners, UNICEF staff and others, including donors all over the world, is
a demonstration of your good work. I will personally ensure that your good name and work
lives on. Goodbye my baby brother, until we meet again, when my own time comes.
Josephine Iziku Ippe, GNC Coordinator, Geneva, Switzerland
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Field Articles..................................................
Discussion with community elders on project
implementation, Baidoa, Somalia, March 2017
Aden Yusuf/SCI
Accountability Location: Somalia
to affected What we know: Accountability to affected populations (AAP) is a key
Nutrition Cluster function, reflected in five commitments
populations:
(leadership/governance; transparency; feedback and complaints;
participation; design, monitoring and evaluation).
Somalia
What this article adds: “Weak” AAP, identified in a Nutrition Cluster
evaluation in 2014, prompted revitalised coordination and a
systematic approach to address weaknesses. Since 2015, the Somalia
Nutrition Cluster Nutrition Cluster has led development and promoted adoption of an
AAP framework. Three levels of accountability around AAP in
experiences
Somalia have evolved: large-scale (led by WFP), moderate-scale (led
by Save the Children) and a minimum level (access to cluster-
controlled pooled funding is contingent on this). There is increasing
By Samson Desie and Meftuh Omer Ismail donor buy-in, including by DFID. Community conversations have
been introduced in almost all emergency service delivery units/areas.
Samson Desie is a nutrition specialist A comprehensive online platform on monitoring and evaluation has
currently working as Nutrition Cluster integrated AAP for imminent launch; programme quality, coverage
Coordinator in Somalia with UNICEF. and performance will be tracked and transparent. Complaints are
He has over 10 years’ experience in investigated by the cluster in a consultative verification and resolution
managing large-scale and complex
process. Since May 2017 OCHA Somalia, alongside clusters and
programmes in grassroots, national
and international contexts, including in partners, has implemented Common Feedback Project (CFP) for APP
the South Sudan crisis situation, Sudan protracted in prevention of famine. Looking ahead, AAP is mainstreamed in the
emergency and Somalia. Humanitarian Response Plan (HRP) cycle to facilitate uptake.
Meftuh Omer Ismail is a Senior
Nutrition Technical Specialist for Save
I
the Children Somalia, a position he has n 2014, the Somalia Nutrition Cluster scribed by the five commitments to AAP
held since 2016. He has previously (SNC) performance evaluation found displayed in Box 1). Sparked by develop-
worked as a Nutrition Programme that accountability to affected pop- ments in 2015, the SNCC has been working
Manager for Save the Children South ulations (AAP), a key cluster func- to ensure that all cluster partners adopt
Sudan and Nutrition and Health tion, was “weak”. A consultative workshop an AAP framework. Experiences since
Coordinator for Merlin in South Sudan and Ethiopia.
was organised in June 2015 to revitalise then are shared in this article.
The authors would like to thank the Federal Ministry of the coordination mechanism and identify
Health Somalia, UK Department for International a more systematic and integrated approach AAP in Somalia: levels of
Development (DFID), World Food Programme (WFP) and to address all weaknesses (Desie, 2016), accountability
Save the Children International (SCI) in Somalia. A special acknowledging the traditional accounta- Until 2016 the World Food Programme
acknowledgment goes to Paul O’Hagan, Humanitarian bility mechanisms between and among (WFP) and Save the Children International
Advisor for DFID Somalia, for his review, guidance and communities in Somalia which are mainly (SCI) were the main agencies working in
support during the development of this paper. through clan leaders/elders and sheiks. A Somalia with a fully adapted AAP frame-
The findings, interpretations and conclusions in this article work, although other cluster partners were
new way of working was agreed, centred
are those of the authors. They do not necessarily represent beginning to follow suit. ree levels of ac-
on ensuring AAP through coordinated
the views of UNICEF, its executive directors, or the countries
and inclusive systems. e Somalia Nu- countability around AAP in Somalia have
that they represent and should not be attributed to them.
trition Cluster Coordinator (SNCC) con- evolved: large-scale, moderate-scale and a
This field article is based on a presentation made by Samson siders AAP a central element of its Hu- minimum (mandatory) level. e distinc-
Desie, supported by ENN, at the annual Global Nutrition manitarian Response Plan (HRP) (as de- tions between these levels are as follows:
Cluster (GNC) meeting in Amman in October 2016 and
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subsequently updated mid-2017 by Samson and key
stakeholders.
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Field Article
eficiaries using outgoing calls. ese can be
BOX 1 Commitments to accountability to affected populations (CAAP) used to collect information on awareness, food
security, access to nutrition services and ac-
Agreed by the Interagency Standing Committee (IASC) in December 2011, the five commitments to ceptability of the WFP feedback and complaints
accountability to affected populations (CAAP) are: mechanisms for respondents who cannot read.
1. LEADERSHIP/GOVERNANCE: Demonstrate their commitment to accountability to affected populations Hotline call centres and IVR questions and
by ensuring feedback and accountability mechanisms are integrated into country strategies, programme complaints are managed by professionally trained
proposals, monitoring and evaluations, recruitment, staff inductions, trainings and performance operators, experienced in handling calls from
management and partnership agreements, and highlighted in reporting. beneficiaries and the general public. Systems in
2. TRANSPARENCY: Provide accessible and timely information to affected populations on organisational most areas are supported with dedicated, full-
procedures, structures and processes that affect them to ensure they can make informed decisions and time staff. e system covers ‘hot spots’ and
choices and facilitate a dialogue between an organisation and its affected populations over information obtains information on geographic coverage of
provision. the programme and numbers of staff and exit
3. FEEDBACK and COMPLAINTS: Actively seek the views of affected populations to improve policy and interviews. Messages are sent using bulk short
practice in programming, ensuring that feedback and complaints mechanisms are streamlined, text messages (SMS).
appropriate and robust enough to deal with (communicate, receive, process, respond to and learn from) WFP has incorporated a two-to-three-step
complaints about breaches in policy and stakeholder dissatisfaction. Specific issues raised by affected
verification process of complaints in its AAP
individuals regarding violations and/or physical abuse that may have human rights and legal,
system to identify whether issues raised are im-
psychological or other implications should have the same entry point as programme-type complaints, but
procedures for handling these should be adapted accordingly. portant or trivial. Some issues are discarded
aer two to three case investigations, while
4. PARTICIPATION: Enable affected populations to play an active role in the decision-making processes others, such as questions around cash/voucher/
that affect them through the establishment of clear guidelines and practices to engage them appropriately
food distribution, require follow-up action. WFP
and ensure that the most marginalised and affected are represented and have influence.
takes the need to rectify problems and ensure
5. DESIGN, MONITORING AND EVALUATION: Design, monitor and evaluate the goals and objectives of that services are delivered as planned very seri-
programmes with the involvement of affected populations, feeding learning back into the organisation on ously. e feedback mechanism is still being
an ongoing basis and reporting on the results of the process. developed and does not yet provide a complete
https://interagencystandingcommittee.org/accountability-affected-people loop. However, AAP information is being acted
on and WFP has modified programming as a
result of beneficiary feedback found to be credible
Large-scale and complaints. IVR (complaints) provides pre- and/or valid.
is has been achieved by WFP through the recorded, interactive beneficiary support outside
use of call centres (hotlines/phone lines) and working hours through call centres to deliver Moderate-scale
interactive voice response/recording (IVR). is information on WFP programmes, sensitisation SCI has adopted this approach. Its main component
approach involves a substantial number of staff, on health and nutrition issues and the chance is an online facility and it operates in just a few
a wide scope of activity and coverage and is de- to record a question or complaint for WFP to sites. ere are random checks on beneficiary
centralised through regional service delivery call back and answer. IVR (surveys) involves experiences by programme staff in routine mon-
areas. e IVR has two main functions: surveys pre-recorded, interactive, short surveys to ben- itoring and evaluation (M&E), activities, but no
dedicated, separate staff. is system is known
as MEAL (monitoring, evaluation, accountability
BOX 2 SCI’s approach in ensuring AAP and learning) and operates within SCI both at
the global and Somalia level. e MEAL frame-
SCI believes that real accountability to children and communities affected by crises involves giving work resonates with the SCI quality framework1,
them not only a voice but also the opportunity to influence decisions affecting them and holding the which puts M&E, accountability and learning at
organisation to account by influencing SCI’s policies, priorities and actions at local, national and global the heart of programme quality, together with
levels. Accountability is part of SCI’s core values and is a main component of the organisation’s quality technical excellence and evidence base. SCI’s ap-
framework and management operating standards. SCI ensures APP with its beneficiaries through proach is detailed in Box 2.
various approaches, including:
Minimum (mandatory) level
– Complaints feedback response system (C/FMS): Established by SCI, this comprises hotlines/toll-free
All SNC partners are required to adopt this min-
numbers, focus group discussions, complaints desks and random proactive calls/SMS to
programme/project beneficiaries and non-beneficiaries. Random proactive calls/SMS involves imum level of AAP; pooled funding secured via
systematic listening and setting up formal mechanisms in intervention areas for people to express the SNC, mainly via the Somalia Humanitarian
views and concerns on SCI’s approach, activities and impact, as well as on safety issues and the Fund (SHF) (formerly the Common Humani-
behaviour of SCI staff. In addition, beneficiaries from the health and nutrition service have an exit tarian Fund (CHF)), is contingent on this. is
interview once they finish the cycle of support to get feedback on the service. approach involves exit surveys with those dis-
– Translation of project documents: All SCI programme/project key information is translated into charged from programmes and with defaulters.
local languages, printed and posted in community gathering places. This communicates information
on beneficiary targeting, beneficiary entitlements, complaint response mechanisms, project duration,
Training on AAP – community
donor and platforms for community participation in implementation of the project activities. There are conversations (CC)
also random checks and calls on beneficiaries to find out whether they have received their e SNC implemented training in Somalia to
entitlements. . help incorporate AAP into community man-
agement of nutrition. e concept of community
– Developing and printing programme accountability standards: These are printed in illustrated form
conversations (CC) was introduced to all partners
(for illiterate people) and in narrative form to explain what behaviour people can expect of SCI staff and
representatives (in line with SCI’s child safeguarding policy and code of conduct), and how people can be with the understanding that it was to be imple-
involved and provide feedback and complaints. mented in almost all emergency service delivery
units/areas. is is mainly being achieved
– Use of accountability system feedback: SCI has developed an accountability database for all
through the adoption of two key communication
beneficiary and non-beneficiary complaints and feedback from its programmes. The information is
approaches in every personal/interpersonal
analysed on a monthly basis and shared with the senior management team for discussion and decision-
making to adjust programme activities in response to the local context, proposal development and 1 https://onenet.savethechildren.net/sci/QualityFramework/
knowledge generation. Pages/default.aspx
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Field Article
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communication with beneficiaries (i.e. negoti- exploration and planning, reflection of process, While cluster funding has provided leverage to
ation with caretakers) and in group conversa- action, intervention and problem exploration. make this happen, some partners have voluntarily
tions/dialogues. ese should not to be confused with traditional bought into the AAP. Donors, such as the UK
behavioural change communication (BCC)/ in- Department for International Development
Negotiations with caretakers involve two key
formation, education and communication (IEC) (DIFD), have shown great interest in the AAP
steps, GALIDRAA and ORPA. ese are
activities: the whole purpose of the CC/com- and have encouraged the cluster to move forward
acronyms for the first letter of part of the
munity dialogue in the AAP is to avoid the with its development. DFID has cited the AAP
intended communication. ‘GALIDRAA’ stands
BCC expert approach and instead focus on as a means of ensuring accountability and trans-
for Greet the mother/caretaker, Ask the mother,
helping the community to assess its own situa- parency and is now implementing a third-party
Listen to the mother, Identify current nutrition
tions/problems, questioning the ‘why’ in an at- monitoring (TPM) system whereby DFID-funded
or care practice and any problems and challenges
tempt to analyse the causes and choosing pri- partners must adopt an AAP as part of their
to taking action on optimal practices, Discuss
oritised courses of action to address the situa- overall monitoring. e new DFID Humanitarian
different options to overcome any challenges,
tions/problems identified. Reform Policy2 has a strong emphasis on people’s
Recommend and negotiate actions, Agree, and
right to participate in the decisions that affect
make an Appointment for a follow-up visit. Training in the use of CC began in 2015 and them, for DFID to be more accountable to them
is approach is supported using visual aids, has since been integrated with all capacity de- and for them to make their own choices.
guided by the acronym ‘ORPA’: have the caretaker velopment efforts, including nutrition in emer-
OBSERVE the illustration, REFLECT on what gencies (NiE) training. e SNC has also given DFID continues to encourage and support
they see, PERSONALISE/put themselves in the training in AAP in Hargeisa, Mogadishu, Bosaso the cluster, pushing for more innovative practice
situation and see if they are willing to ACT on and Nairobi as part of a larger programme of in the field, and appears to be learning from the
what they have seen and discussed. NiE training. Every outpatient therapeutic pro- Somalia experience and applying it to other
gramme (OTP) is now expected to involve a CC country contexts.
CC is an ongoing process of facilitating and
enabling community group to meet regularly to to nurture a basic understanding of malnutrition e SHF has increasingly been used to invest
identify and reflect on its problems and their and what the community can contribute to help in the scale-up of the AAP framework, especially
root causes; analyse and build consensus on address the problem. e aim is to make malnu- the minimum package. In 2016 the SHF funded
possible solutions; develop community action trition visible to the population and broaden 11 partners, including five international, non-
plans; secure the necessary human, material, ownership of its management. ere is now a governmental organisations (NGOs) and six
information and financial resources; and take community group in every service delivery area. local partners. From January to July 2017, 14
collective actions at family, community and in- Using funding as leverage for partners (eight local and six international NGOs)
stitutional levels that will lead to long-term, incorporating the AAP were funded and around
positive change. e main objective of CC is to
AAP $5.6 million dollars was invested by the fund in
Funding provided through the CHF since 2016
generate an effective, community-based nutrition the pre-famine response. rough the SHF
has been contingent on agencies having an AAP
response to social/communal problems/issues mechanism the SNC has played an important
framework in their proposals. ere has been
that integrates individual and collective concerns, role in enabling national NGOs to access funding;
resistance to the AAP from some partners who
values and beliefs and that addresses attitudes, approximately 60 per cent of SHF funding goes
felt that the mandatory requirement was “too
behaviors, practices and other underlying factors to local agencies.
controlling” and that the AAP is effectively an
embedded in social systems and structures.
audit mechanism. However, the cluster has man-
CC is a cyclical process that involves rela- aged to clear some misconceptions and convince 2 www.gov.uk/government/uploads/system/uploads/attach
tionship building, problem identification, resource an increasing number of partners of its merits. ment_data/file/651530/UK-Humanitarian-Reform-Policy.pdf
Figure 1 Screenshot of the collaborative map function on the SNC online platform
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Field Article
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Online platform incorporating
AAP Figure 2 Screenshot of the online nutrition monitoring form
In 2016 the SNC began work on a comprehensive
online platform (ONA – https://ona.io/home/)
that has an integrated component on AAP as
part of a wider M&E system. e platform is
being finalised; almost all components (except
AAP) became operational and were officially
released in July 2017. e platform will be fully
functional in early 2018. is online development
is being supported by UNICEF, WFP and DFID.
e platform allows for geotagging of service
sites, infrastructure assessment, and capacity
assessment of service delivery facilities in terms
of service provision and human resources. An
integrated AAP framework links with benefici-
aries and facilities and a contact database for
beneficiaries allows complaints and a feedback
mechanism (with comments via SMS). e plat-
form covers planning and monitoring and re-
porting (M&R) on top of AAP. https://enketo.aws.emro.info/x/#YYYy
Planning: Service plans are developed and consolidate and strengthen the existing delivery unit. Information is currently
thresholds for scale-up are agreed. Based on as- capacity of emergency nutrition units updated fortnightly to help monitor the
sessment results, planning takes place according across Somalia, develop overall emergency performance of pre-famine scale-up and
to which areas have been identified for scale-up preparedness/resilience and help in the response.
or where to consolidate services. Planning tools scale-up of IMAM. • Digital and automated upload of facility-
include: • Immediate actions/steps that can be taken level information using a standardised,
• Collaborative maps which can be overlaid by all partners/organisations to improve user-friendly reporting form. is is avail-
with multiple sectors/clusters and refocus standards of specific nutrition sites. able online via mobile/open data kit (ODK),
programming and responses based on • Opportunity for partners to self-report on SMS and off-line (Figure 2). All partners are
objective analysis: progress of nutrition sites (such as whether assigned unique access to the system via the
http://somnutritionsites.onalabs.org/ (using they are new, opened or closed). following links: https://ona.io/unicef_
password ‘ncs’ if required) (Figure 1). somalia/34885/187634 (for Somalia) and
• Well-defined food security risk information Monitoring and reporting: e online plat- https://ona.io/unicef_somalia/34885/
that can be used to formulate comprehensive form enables monitoring and reporting of partner 196108 (for Somaliland)
integrated management of acute malnutrition activities and includes the following functions: • A standard online monitoring framework
(IMAM) coverage/expansion plans. • e presentation of performance indicators that allows monitoring of the combined
• Validated information on service delivery in simple graphics, including a dashboard activity of all partners while maintaining
sites and capacity that can be used to guide, of performance indicators for each service confidentiality
Figure 3 Screenshot of the monitoring and reporting function of the SNC online platform
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via mechanisms such as United Nations Office
for the Coordination of Humanitarian Affairs
(OCHA) regular field missions. Challenges
around the AAP include getting organisations
to sign up to the idea and, once they have, en-
suring that they share all data (currently data
sharing is voluntary). Most feedback is sourced
from contact points, state MoH staff and facility
mangers and partners.
e online platform now maps and links
technical performance indicators, such as ad-
missions and performance, by site. is allows
Abdullahi Nur/UNICEF
for greater transparency and will remedy the
situation where aggregate data can mask poorer
performance of individual sites. e SNC will
Regional consultation in Beletweyn,
Somalia, May 2017 also be able to initiate calls independently to
beneficiaries around facilities/sites that are poorly
performing to gain more insight and information.
AAP: is adds an additional layer to the per- these partners was identified as high-risk and
On launching the platform in July 2017 a
formance indicators which includes a confidential has been denied access to resources until a detailed
joint programme by the World Health Organi-
database of contacts managed by the SNC on audit report is produced. A key guiding principle
zation (WHO) and the Health Cluster was ini-
all service delivery points. e database is used to resolving clan issues is that, as long as a partner
tiated to implement health facility mapping.
to generate bulk SMS/key messaging, IVR and has capacity and resources, it should be able to
Aer 2017 the plan is to overlay health systems
to verify service delivery. Service users interact deliver a programme irrespective of clan.
onto existing nutrition service data. For now,
with the platform via SMS and IVR to commu- As there is no direct communication with however, attention is on consolidating the ap-
nicate directly on the quality of services, geo- beneficiaries yet (this will be possible through proach within the Nutrition Cluster and to fully
graphic coverage and priorities and preferences SMS on launch of the complaints section of the overlay or integrate access, security and food
on services. It is likely that international and online platform), no beneficiary complaints security cluster data, as well as integrated phase
local NGOs will adopt and rely on the AAP have yet been received except those organised classification (IPC) information.
platform for their activities as the system is by community elders. It is anticipated that most
made fully functional and accessible to all. beneficiary complaints will concern ration Sustaining AAP in the face of
size/quality, service access and service quality. programming priorities
Experiences using AAP online Despite the large-scale humanitarian assistance
Currently there is no structured template for
to date feedback (this is in development with UNICEF). delivered, the Food Security and Nutrition As-
So far over 15,000 community contacts/phone sessment Unit Somalia-Famine Early Warning
In the future, the plan is to set up a hotline
numbers have been collected and integrated Systems Network (FSNAU-FEWSNET) post-
which may involve a greeting, key messages
into the online platform. ere are 20 or more Gu (April to June) cereal harvest assessment
and a simple structure for feedback and presenting
contacts for each fixed service delivery point, as (FSNAU-FEWSNET alert, 31 August 2017) in-
a complaint.
well as the headquarters of mobile sites, who dicates a deteriorating situation with sustained
can be reached to provide quality assurance and e SNC is dependent to a large degree on high risk of famine until the end of the year due
monitoring and check functionality of the serv- agency self-reporting regarding the feedback to a combination of severe food insecurity, high
ices. ere are 1,000 facility contacts who can received. Sub-national clusters are also informed acute malnutrition and high burden of disease.
be linked up with regard to specific complaints. of feedback. In addition, feedback is received e number of people in need is estimated to
Although not yet launched online, complaints
are already being lodged with the SNCC, with Regional consultation in Baidoa,
notification of issues by elders who have engaged Somalia, June 2017
government counterparts in the Ministry of
Health (MoH) at state level. e system is oper-
ating in all states and provides an overview of
quality and coverage. To date (September 2017),
nine specific complaints from MoH and clan
elders have been received, largely in relation to
partner neutrality, clan affiliation and misuse of
resources. ese have been filed and addressed
accordingly through a consultative verification
and resolution process. Complaints that come
via the MoH must be documented in a letter,
which is signed and stamped by the MoH. For
complaints from elders, a simple email is suffi-
cient. Following receipt of a complaint, a bilateral
meeting with the complainant is set up by the
organisation.
Samson Desie/ UNICEF
Out of six example cases, four complaints
were resolved by the partner with the community.
In two cases, the organisations withdrew from
the location (due to an incident related to clan
affiliation and recruitment processes); one of
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