Issue 15 Editorial

Two of the field articles in this issue of Field Exchange address to varying degrees the subject of advocacy. The dictionary definition of the word is 'recommendation' or 'active support of an idea'. In the humanitarian aid sector the term tends to have a specific connotation, i.e. advocacy takes place on behalf of some disadvantaged group or in order to right some wrong. What is often overlooked by 'advocating agencies' is that the key to successful advocacy is 'process'. At field level there is frequently a fine line between successful advocacy and jeopardising working relations with those agencies being lobbied. In a sector where programme efficacy is highly dependent upon good relations and co-ordination between agencies and individuals, the process of advocacy is all important. Countless evaluations have highlighted that good inter-personal relations and process of advocacy adopted by agency staff is critical to the success of agency coordination. Conversely, where advocacy has been over-zealous and insensitive, agency relations and co-ordination have often broken down with significant adverse impact on programme efficacy.

The field article by Dr Jean Gladwin concerns the process of establishing an 'Emergency Nutrition Coordination Unit' within the Disaster Prevention and Preparedness Commission (DPPC).of the Ethiopian government. Jean describes the importance of identifying the key decision-makers in government who would potentially use information from this unit, and then consulting with them on key objectives and modus operandi of the unit. In Jean's view, this kind of stakeholder analysis and consultation was critical in obtaining the support necessary for establishing a workable unit.

The article by Hassan Taifour from SC UK is about successful advocacy with WFP in Eritrea. It details the type of anthropometric and food consumption data that SC UK were able to present to WFP in order to convince them that a full ration (rather than a 60% ration) was necessary for returnee IDPs. Hassan highlights the advocacy lessons learnt. "This experience has demonstrated that the provision of timely, reliable, and accurate field data can be used to advocate for programme change. In this instance an effective and trusting working relationship was established with WFP. A key element of effective advocacy is the field presence of experienced and dedicated staff who can make, and support clear recommendations".

On a completely different subject, we have an article by Saskia van der Kam from MSF Holland on the difficulty of introducing F75 into an adult therapeutic feeding programme in Wau, southern Sudan at the height of the 1998 famine. Saskia questions the extent to which the use of F75 is able to reduce mortality in severely malnourished adults in this type of situation. She describes a range of strategies for therapeutic feeding in difficult circumstances and calls for these strategies be evaluated as a matter of urgency. This subject is receiving a lot of interest as of late (see letters and news section). The postscript to the article by Michael Golden and Yvonne Grellety highlights the beneficial properties of F75 for severely malnourished children.

One other piece to highlight in this issue is the review of pellagra outbreaks in Kuito, Angola by Professor Mike Golden. This review, conducted last year during a visit to the area, highlighted a number of worrying as well as interesting features of the pellagra problem. Particularly worrying was the fact that the outbreak was the third in the previous three years and appeared to be affecting at least 10% of IDPs. Furthermore, 'limited' diagnostic capacity of health staff noted by Golden may have meant that the problem was more widespread than thought, i.e. existed in other areas of the country. A point of interest to nutritionists and others dealing with this type of outbreak was that those affected were often not wasted (the prevalence of wasting in the population was low - 3% in March 1999). Golden explains how pellagra is a type 1 nutrient deficiency that is not associated with wasting. This finding may well mirror those documented in a recent issue of Field Exchange (issue 13) where an outbreak of scurvy in north Afghanistan was associated with low levels of wasting among the population.

Enjoy!