ACC/SCN Working Group on Nutrition in Emergencies

The annual UN ACC/SCN meeting was held in Nairobi, Kenya between 2-5 April 2001. The Working Group on nutrition in Emergencies meeting was held on the 5th. Highlights of the meeting are included below.

As a follow up to the working group recommendations in 2000, a special meeting was organised and held during the SCN's 28th session in Nairobi in April 2001 (see summary of meeting on Assessment of Adult malnutrition, same page). Other follow-up initiatives reported on, and discussed at this years meeting were as follows:

• Much work on producing operational guidance and training materials on infant feeding in emergencies was undertaken through interagency collaboration and presented during the working group meeting¹.
• The need to prioritise the gaps in knowledge, skills and practice in emergency nutrition was identified in last year's meeting. This led to the design of a matrix questionnaire. It was agreed that once the format of the matrix has been further revised and developed, agencies will complete it by providing information on specific agency guidelines, training materials etc. The process will enable specific gaps to be identified and therefore provide an advocacy and planning tool for the Working Group.
• During last year's meeting, the working group expressed concerns about the cost and inaccessibility of the WHO publication 'Management of severe malnutrition: a manual for physicians and other senior health workers. The manual is now available on the WHO website (www.who.org). WHO is preparing training modules to accompany this.

New Proposals launched at the meeting

• Community Based Therapeutic care

Dr. Steve Collins (Valid International) presented a proposal for community based therapeutic care (CTC).

Community therapeutic feeding is the treatment of severe malnutrition at home, using Ready to Use Therapeutic Food (RUTF), mother to mother support, followup of cases and a strong networking system. The RUTF provides the nutritional equivalent to Formula-100 and can be given to children with uncomplicated severe malnutrition (those with a good appetite, no persistent diarrhoea and no major medical complications) and to early discharges from local, small TFCs or local clinics, after initial complications and severe infections have been treated and appetite has returned.

A principle underpinning CTC is the integration of emergency nutrition interventions with longer-term programmes by establishing community-based structures that can be re-activated in future emergencies. Although the need for, and strengths of, 'traditional' therapeutic feeding centres (TFC) are acknowledged (particularly for anorexic, hypothermic, hypoglycaemic, dehydrated and septicaemic cases), concerns regarding the related high costs, necessary resources and coverage of such feeding centres were presented. Potential negative impacts of TFCs, such as the removal of the mother from the family, the decrease in household economic production and the increase in public health problems due to cross infection were also highlighted.

Research on CTC programmes is currently limited. Concern Worldwide and Oxfam have undertaken trials in Ethiopia in 2000. Dr. Steve Collins concluded his presentation by reinforcing the need for more 'imaginative' nutritional interventions during emergencies and the belief that the Community Based Therapeutic Care will add flexibility to current practice. Implementation must involve conscientious data collection to evaluate the overall impact.

• SCN/RNIS Publication on The Meaning and Measurement of Acute Malnutrition in Emergencies.

Dr. Helen Young presented a proposal for a new SCN/RNIS publication on "The Meaning and Measurement of Malnutrition in Emergencies: the origins of good practice and actual practice". The main objective is to produce a technical review of the scientific basis and origins of current field practice. The document will aim to serve as a reference point for agency policies, guidelines and training initiatives. The document will be prepared for a wide range of users including nutrition specialists in Government, UN agencies, NGOs universities, research institutes and advisory bodies and will be distributed through the SCN.

• Capacity Building in Training Initiatives in Emergency Nutrition

Dr. Helen Young presented an overview of a number of training initiatives that are currently being undertaken in the humanitarian nutrition sector. These initiatives are part of a wider strategy to professionalise the response to disasters. The World Food Programme/Tufts University Food and Nutrition Training Initiative is one example of a major training initiative that is ongoing. This training initiative was undertaken in a number of stages: beginning with a review of the needs for training within WFP; the development of the WFP Food and Nutrition Handbook; development of training materials; implementation of four regional workshops and subsequent satellite workshops. Other training initiatives that are currently being undertaken or that are in a development phase include; UNICEF's Health and Nutrition Training; SPHERE, and training undertaken by MSF, AAH/ACF, Merlin/NutritionWorks/IHE, ICRC, HELP and Interaction/Columbia University.

Training, is considered one important and essential tool for capacity-building. While many training initiatives to date have generally been driven from agency headquarters, there is a need and scope for institutionalising training capacity on a regional basis. The Africa Nutrition Capacity Development Initiative, which was presented at the SCN Working Group on Capacity Building meeting, provides one potential forum through which training initiatives can be channelled. The priorities of this regional initiative are; advocacy, client-focused training, action-oriented research, and promotion of regional collaborative responses and networking. There is potential for harmonising current training efforts through collaborative training initiatives. A number of initial actions for moving forward a comprehensive collaborative training initiative that would encompass a regional focus, may involve (i) preparing a central directory of training materials, (ii) determining the level and type of interest in such an initiative (iii) an initial meeting to discuss longer-term training strategies.

Co-ordinating Mechanisms for the Working Group

The Working Group on Nutrition in Emergencies will continue to receive support from both the RNIS Coordinator and the Emergency Nutrition Network (ENN) Coordinator. A task force made up of approximately 10 people will continue to lead the activities of the Working Group in 2001-2002.

Thematic groups within the Working Group have been identified to spearhead specific areas of work:

1. Capacity Building,
2. RNIS Technical review
3. Infant feeding
4. Refugees
5. Assessment of adult malnutrition

The next SCN symposium is on the topic of "Nutrition in the Context of Crisis and Conflict" and will be held during the SCN annual session in Berlin from 11-15 March 2002.

The minutes of the meeting are accessible on the website at http://acc.unsystem.org/scn/Publications/AnnualMeeting/SCN28/28emergencies.htm.

For further information or full minutes by email contact either Brian Jones at UN ACC Sub- Committee on Nutrition C/o World Health Organization, 20 Avenue Appia, CH 1211 Geneva 27, Switzerland.
Telephone: +41-22-791 04 56 Fax: +41-22-798 88 91
EMail: accscn@who.int
or Fiona O'Reilly at ENN, Unit 2.5 The Tower, Trinity Enterprise Centre, Pearse Street Dublin 2 Ireland
Telephone 353 1 6752390 Fax 353 1 6752391
Email fiona@ennonline.net

¹See 'Infant feeding in emergencies: new resources' (page 9)