Issue 32 Editorial

The devil is in the detail

In this edition of Field Exchange we have a number of field articles that address very detailed programming issues.

A field article by ACF deals with the experience of implementing the supplementary sucking technique (SST) for the many infants under six months presenting at therapeutic feeding units in Kabul, Afghanistan. Although the technique appears to lead to good outcomes when correctly applied, there were many instances where the SST was not well implemented. For example, many infants were considered cured when still mixed feeding and even where infants were discharged on breastmilk alone, mothers often reverted to mixed feeding at home. Unit staff found the admission criteria vague and difficult to apply, and were also confused by the treatment protocols and discharge criteria. Many of the infants presented with breastfeeding difficulties but were not severely malnourished. The author's frank evaluation of their programming has led them to question whether the admission criteria used in the Kabul context were the best ones and whether the risks of managing young infants, who need skilled support but may not specifically need to be in these intensive care centres, outweighs the benefits.

Another field article by Yara Sfeir of UNHCR, describes the challenges of feeding a small number of infant orphans amongst Rohinga refugees in a camp in Bangladesh. Befitting the local context, it was decided to locate wet nurses for these infants. However, locating wet nurses was not straightforward, even though there were only five orphans. Eventually, wet nurses were found in the wider community, i.e. not just amongst relatives. Even then, a number of practical problems emerged, for example one husband didn't want his wife to breastfeed another person's child while one wet-nurse found it difficult to come to the centre to feed eight times a day as she lived some distance from there. There were also security issues about attending the centre at certain times. All these challenges were eventually met through 'creative' adaptation and according to the author, were well worth the effort.

An article by Chloe Angood from Southampton University describes the problems of using scoops provided with Nutriset F75/F100 therapeutic milk formula. Through her work in a paediatric ward in Tanzania where mortality rates amongst severely malnourished children were very high, she observed a number of difficulties in using the Nutriset scoops. These included over-feeding children, nurses finding it difficult to calculate the correct recipe for different feed volumes, miscounting of scoops and the difficulty of making up individual feeds for each child. A number of practical recommendations are made by the author to address these problems. Nutriset have written a post-script addressing some of these issues.

These articles remind us that although we may think our programme approaches and implementation tools are the right ones, reality on the ground may, at times, cause us to re-assess how we do things.

Approaches cannot just be devised and implemented from 'on-high'. We need to hold the old mantra about 'bottoms-up' programming at the forefront of our thinking. In other words, not only is the devil in the detail, but so is the answer. We also have our usual 'bigger picture' material in this issue of Field Exchange. There is a particularly interesting field article about nutrition sector coordination in the current Zimbabwe crisis, written by Dianne Stevens from UNICEF Zimbabwe. The article describes how UNICEF and partners have gradually plugged the coordination vacuum in Zimbabwe through establishing a Nutrition Technical Consultative Group (NTCG) that nominally focuses on consultation and best practice, but in effect has become a coordination mechanism that is accepted by government. Achievements of the NTCG to date, especially given the challenging programming environment, are considerable. These include greatly expanding reliable data to inform programming and mapping activities in the nutrition, water and health sector thereby strengthening inter-sectoral coordination.

We know from recent history how important it is to get humanitarian co-ordination right and what happens when we don't. Coordination is essential for strategic planning, gathering data and managing information, mobilising resources, ensuring accountability, having a clear division of labour and providing leadership. The work of the IASC global cluster (see Field Exchange issue 31 news section) is making striking headway in strengthening country level coordination across a range of sectors including nutrition. As highlighted by Dianne Stevens, while the cluster approach has not yet been officially activated in Zimbabwe, the approach has been collectively endorsed at a Workshop on Humanitarian Reform in June 2007, and endorsed by the IASC Country Team.

This issue of Field Exchange also contains a wide range of research, evaluation and news pieces. Research topics include summaries of papers on the development of the WHO growth reference for school-aged children and adolescents, and on livelihoods-based drought responses in pastoralist areas of Ethiopia. There are also summaries of a real-time evaluation of the response to the Pakistan floods in 2007 and of a retrospective evaluation of the targeted supplementary feeding component of WFPs protracted relief and rehabilitation programme (PRRO) in Ethiopia from 2005 onwards.

We hope you enjoy this issue of Field Exchange and, as always, please feel free to write in with contributions and opinions.

Jeremy Shoham
Editor

Any contributions, ideas or topics for future issues of Field Exchange? Contact the editorial team on email: office@ennonline.net