Terre des hommes

Interview by Jeremy Shoham

Field Exchange interviewed Philippe Buchs, joint head of the Terre des hommes (Tdh) programmes department, and Rebecca Norton, headquarters (HQ) nutrition advisor based in Lausanne, Switzerland. Philippe has worked for Tdh for 20 years (most of his working life). Five years of this has been spent in the field and the remainder at HQ. His background is in political science. Rebecca has been a nutritionist at Tdh HQ for almost three years.

Tdh feeding centre, Haiti. 1999

Tdh was formed in 1960 following the 'war of decolonisation' in Algeria. This war had a profound effect in France and French speaking Switzerland, raising awareness for many of the extensive problems in developing countries. Tdh continues to work in Algeria to this day, typifying how the agency tends to become involved in a country following an emergency and then stay on to undertake longer-term development work. This pattern has recurred in countries like Vietnam, Bangladesh (following partition), Ethiopia, Rwanda, and Kosovo. However, there is no institutional split within Tdh between emergencies and development. In fact, the very first emergency co-ordinator was only employed in 2003.

Tdh is a relatively small non-governmental organisation (NGO) - the budget in 2002 was a modest 22.7 million euro. Approximately 83% of the revenue comes from private donations and the remainder from public funds, e.g. the Swiss government development agency and decentralised government at canton and commune level. The cantons hold a development budget, which a 'federation of NGOs' allocate to members. Tdh have working groups in the 23 Swiss cantons - approximately 2,500 volunteers in all. The volunteers support Tdh through fund-raising and profile building, e.g. events in shopping centres. Tdh is also a member of the Tdh alliance, which has ten members (the principal ones being Germany, Switzerland and Italy). As Tdh funding sources are diverse, their funding base is relatively stable. For emergencies, most funds come from a centralised body called 'Swiss Solidarity'. This body generates funds through the media, with a commission deciding how to distribute monies amongst the various NGOs.

Tdh now operates in 30 countries. In 2000, there were 43 country programmes, but this has slowly been reduced as country situations have improved - Tdh moved out of Bosnia two years after the war ended, for example. If Tdh move into a new country, they will usually phase out gradually from another programme.

Tdh feeding centre, Haiti. 1999

Philippe explained how Tdh is a child-focused agency whose two main pillars of work are "operational and advocacy." He outlined three main sectors of Tdh work, which are maternal and child health (MCH) and nutrition, children in difficult circumstances, e.g. street kids, and child rights, such as fighting against child trafficking. Rebecca explained how there are currently seven specialist advisors at HQ. As the nutrition advisor, she advises the desks, partners and delegations on request. She is only the second nutrition advisor in the organisation, the first one being appointed four years ago.

In the past, Tdh nutrition programmes were mainly selective feeding, e.g. supplementary and therapeutic feeding. Nowadays, these activities are often coupled with education and health interventions. According to Philippe, "there has been an evolution towards a more integrated and holistic approach, with greater focus on community based interventions over the past five years. The idea is to listen to the community more and not give out ready made messages". Rebecca explained how the emphasis is now on greater integration of nutrition programmes into existing mother and child health programmes, so that improved treatment of malnutrition becomes longer-term and sustainable. Rebecca also stressed that Tdh are not an organisation like Medecins sans Frontieres, who are able to rush into emergencies and hit the ground running. Tdh lack the capacity for this and only really work effectively where they have long-term experience and local knowledge.

Philippe reasoned that as Tdh is a small NGO, it has to specialise in areas like improving inadequate maternal and child caring practices or improving health services (at the district level). It, therefore, has little capacity for food security work and will team up with other agencies that have complementary abilities. Also, as a small agency, Tdh tend to work at health district rather than national level. While the agency always attempts to integrate programmes into local public health systems, this can be a problem in more remote areas where health systems are not working well. The temptation is then to set up Tdh's own programme independently. Rebecca identified difficulties in holding onto good staff as a problem. Tdh are putting a lot of effort into training local nutrition and health staff but the good ones tend to be snapped up by the better paying agencies.

Two other 'nutritional' challenges are faced by Tdh, according to Philippe. First, the small size of the agency with only one nutritionist (supported by a public health doctor) means that local teams have a lot of autonomy, but not always a lot of support from HQ. As a result, Tdh try and work in networks of other agencies in order to obtain support from elsewhere, when needed. Secondly, too little emphasis has been placed on the psychosocial components of malnutrition. The emotional and social environment of families needs to be addressed much more. This is also very important in emergencies. Tdh are currently involved in operational research in Nepal, which started in 2001, looking at psychosocial factors leading to malnutrition. The research is very much based on listening to mothers and then providing appropriate counselling. Results from the study show how long it takes to provide the necessary psychosocial support and train community people in taking on this role. The study report and a film of the study 'Down by the river - listening to mothers' are now available (see news section of this issue).

Rebecca went on to outline the following new developments and initiatives in the nutrition sphere:

• Greater emphasis on integrating nutrition programmes within existing Mother and Child Heath programmes.
• Providing more psychosocial support for families with malnourished children.
• Strengthening capacity to provide breastfeeding counselling - the first Tdh breastfeeding counselling course will be held in Africa this year.
• Collating and disseminating key lessons learnt/best practice, and providing this in the form of a knowledge management system with software to field staff. It is hoped that this will be available by the end of 2004.

When asked about the specific strengths and uniqueness of Tdh, Philippe made a number of points. Tdh are present when an emergency arises (as they work in emergency prone countries) so they know the culture, region and people. Prior knowledge is critical in the early stages of emergency response. They are a very 'grass roots' agency and know their partners and their abilities well. Most of these partners are local NGOs, the majority of whom have been helped by Tdh to establish themselves as an NGO. By helping the institutional development of partner NGOs, this engenders a deep relationship with partners of shared culture and tradition. Tdh attempts to be flexible and not impose ready made solutions - field staff have a decentralised approach and Tdh will always aim to add value to a project rather than just fund, i.e. they take part in project planning.

When asked to describe the 'culture' of his agency, Philippe commented that, in many regards, it was a 'typical Swiss entity'- "the Swiss government has been politically stable, since 1959 and very much consensus driven. Tdh has no political affiliation and advocates based on what it sees in the field, rather than ideology or global theories. With some exceptions - being openly against the recent war in Iraq, for example - Tdh does not make political statements. It is an agency which bases programmes on field reality and trying to change reality where necessary". Rebecca's response to the same question was that Tdh is a very people-oriented agency and nowhere is this better epitomised than in the excellent way in which staff are treated.