Save the Children

By Jeremy Shoham

The ENN interviewed Tobias Stillman from Save the Children USA (SC USA) for this issues agency profile slot. Tobias is a Nutrition Advisor within the Children in Emergencies and Crisis Hunger and Malnutrition team. Tobias started in this 'business' as a solidarity worker in Nicaragua and then took a degree in international health, focussing on medical and nutritional anthropology. This was followed by a Masters in Public Health at Johns Hopkins School of Public Health in Humanitarian Assistance. Overseas experiences include long-term assignments in Nicaragua, Mozambique, Zimbabwe, Western Tanzania, and Ghana, and shorter term assignments in places like Iraq and Haiti. Tobias joined SC USA in 2003.

The Children in Emergencies and Crisis Hunger and Malnutrition team consists of five health and nutrition experts, three livelihoods experts, and several commodity experts. Apart from Tobias, there are Food Security/Nutrition Advisors based in Uganda, Guatemala, and Mozambique (although they are still considered part of headquarters), one emergency health advisor, one emergency nutrition advisor, one livelihoods advisor and one agriculture advisor. There are also nutrition focussed technical staff in other SC USA departments who play a considerable role in both development and emergency nutrition programming.

Although Tobias hasn't been with SC USA that long, he provided a brief potted history of the organisation. SC USA was set up in 1932, thirteen years after the Save the Children Fund was set up in the UK (1919). SC USA initially focussed on domestic issues, with international work only really starting in 1940. Relationships between the different national Save the Children (SC) organisations became formalised in 1977 with the formation of the SC Alliance. Initial members of the Alliance were Canada, Denmark, UK and the US. This has expanded to 28 members, including some developing countries. Within the Alliance, members of all size collectively support the work of one another to achieve the common goal of helping children in need, in both development and emergency contexts.

Save the Children trained assistant of the commune health centre in Proi Village, Dr. Tran Thi Kim Lien, teaches Ho Thi Em how to wash her daughter Ho Van Chen's hands before eating.

There has been enormous effort in recent years to increase connectedness between the different Alliance members and to create a 'unified presence' within established programme countries. The Alliance is committed to having one Save the Children office per country, although it will take some time before this is achieved. The model is currently being rolled out in several 'learning' countries, including Myanmar, Angola, and Tajikistan. Lessons learned in those countries will be applied to a broader roll out in the future.

Aligning different programme approaches, philosophies, and constituencies between Alliance members, however, has not always been easy. In recent years there has been a great deal of effort put into aligning emergency food security and nutrition programming - evolving collaboration between the US and the UK, in particular, has led to productive outcomes on all sides. Food security and nutrition advisors from SC USA and SC UK now meet regularly to discuss programem directions - and the organisations have developed joint position papers on areas of particular interest, including school feeding and food aid. All major emergency response activities are now conducted in a coordinated fashion as an Alliance.

Large scale emergency food programming was only episodically a element of SC USA's work up until the 2001 Ethiopian drought in Gode. In the past 4-5 years, SC USA continued expanding its work in emergency nutrition and food programmes, following the crisis in Darfur and emergencies in Aceh and Pakistan. SC USA's emergency nutrition portfolio has expanded considerably in recent years and their work now includes cash based programmes as a complement to general food distributions, the treatment of severe acute malnutrition (SAM) (through community therapeutic care (CTC)), infant and young child feeding in emergencies (IFE), and Supplementary Feeding Programmes (SFPs) that are usually part of CTC programming.

Resources available to the Hunger and Malnutrition Unit within Children and Emergencies and Crisis have increased by almost 1000 percent over the past seven years, with concomitant increase in emergency programming. SC USA is fully committed to emergency nutrition and food security responses carried out within the context of the Alliance. SC USAwill respond to a major emergency, whether there is already a programme on the ground or not, if local coping capacity is insufficient to handle the need. However, many of the agencies' response activities take place in countries with established programme portfolios - SC USA has an extensive portfolio of developmentally oriented nutrition programmes in the most food insecure countries in the world. Tobias reflected that the considerable developmental portfolio and experience of SC USA in the nutrition sector serves them well for emergency programmes like CTC, where transitioning from emergency to longer-term programming is critical.

Tobias identified numerous lessons that have been learned through this recent rapid expansion in emergency nutrition programming. Key amongst these has been the difficulty of ensuring quality programming when moving into new programme areas and/or scaling up. In particular, some of the work with severe acute malnutrition has been challenging.

The experience of shifting from TFC to CTC in Ethiopia in 2002/03 has been very influential. In particular, there was a lot of learning in transitioning from centre-based to community-based care, and then in identifying appropriate mechanisms for transitioning out following the crisis. Their early CTC work in Sudan also provided lessons where, with hindsight, Tobias believes SC USA could have been more open to collaboration with other agencies in addressing the various facets of CTC. As the agencies portfolio continues to expand, they have become more adept at both implementation and at saying no: "In some cases it may be better for the agency to let go, say no and let other agencies take responsibility. While General Food Distributions are pretty straightforward for SC USA and we are set up institutionally to implement such programmes rapidly, we have become more careful about rushing in to do more direct nutrition interventions like CTC".

SC USA has ongoing emergency CTC programmes in eight districts in Ethiopia, in West Darfur Sudan, and in two Districts in Malawi. The agency has pilot programmes looking at Community-based Management of Acute Malnutrition in developmental and transitional contexts in Malawi and Ethiopia (targeting those who are HIV+), in Bangladesh and Pakistan, and will have additional pilots in Haiti and Mozambique within the next few months.

In terms of the future, SC USA is in the midst of a strategic planning process that will guide further investments and programme directions. Strategies that are taking shape are the need to be as good at emergency work as development work, increasing focus on newborn and child health in emergencies, and the treatment of acute malnutrition - in particular establishing strong infrastructure for moving from development to emergency treatment of SAM.

Our last topic of discussion was about SC USA funding. With regard to nutrition, most development resources come from USAID's Office of Food For Peace, while emergency resources come largely from USAID's Office for Disaster Assistance (OFDA) and WFP. However, this is slowly changing and there is a growing private funding base including private foundations. Tobias concluded that diversification of funding sources can only be a good thing for SC USA in terms of giving them greater programming flexibility.

It is impossible for the ENN not to reflect on the fact that there have been very few agencies out of the 30 interviewed as part of the Field Exchange agency profile slot over the past ten years that have not raised the issue of independence of action and constraints faced through the pursuit of funding.