Issue 33 Editorial

This issue of Field Exchange is published in the 'after-glow' of the high profile and long-awaited Lancet series on 'Maternal and Child Undernutrition.' The series of five papers are summarised in this issue with various comments posted in the letters section. In essence, the Lancet series sets out the scale of nutrition problems globally, their human and economic impact, evidence for interventions that have (or have not) made some inroads into the problem, culminating in an analysis of what needs to change if the global burden of undernutrition is to be addressed. Nutrition in emergencies gets very little attention in the series (mainly in paper 5). This may well be appropriate given the scale of endemic undernutrition in non-emergency contexts. However, the limited discussion and analysis of nutrition in humanitarian crises is piece-meal, poorly developed or substantiated and contributes little to current debate and thinking. A major opportunity has been missed.

Emergency issues raised in the series include politicisation of food aid, remittances, role of private sector funding, early warning and needs assessment, assessment of programme coverage and the lack of evidence base for what does and does not work. Many critically important and challenging areas do not get a mention. To name a few, the cash versus food debate, effective means for addressing moderate malnutrition at population level, scaling up livelihoods interventions, the institutional 'blind spot' around internally displaced populations (IDPs), collaborative efforts on infant and young child feeding in emergencies, the need for operationally feasible methodologies for determining programme impact and lack of accountability of donors. It may well be that the authors of paper 5 had to prioritise topics given an extremely limited word count with which to work - if so, it would have been useful to alert the reader to this constraint. Notwithstanding this piecemeal approach to topic coverage, the content of the sections dealing with emergencies also lacks historical perspective, coherence and most importantly, creative thinking around solutions. In effect, the series tends to regurgitate what is already out there in the published literature rather than substantially move the subject forward.

In a comprehensive nutrition series such as this, some form of historical analysis is critical. This is partly because institutional memory is very weak in our sector (reflecting factors like the lack of career development structures and poor coordination between a multiplicity of stakeholders) and also because the past has the ability to bring into sharp relief what is absolutely critical to progress in our sector. It can show us what has worked and changed for the better and why, as well as where we have become stuck or even gone backwards and the explanation for this.

Perhaps the most unforgivable weakness in the series is the failure to advance thinking. Paper 5 (to its credit) discusses the lack of evidence base and information on costs for emergency interventions. As emergency nutrition interventions are very much the 'bread and butter' of this publication, we welcome this focus. Indeed this is something that the ENN have been arguing for years and have repeatedly (perhaps too often) flagged in editorials. The Lancet series has also highlighted the absence of an agency or body with responsibility for taking an overview of the effectiveness and cost-effectiveness of different types of intervention as a reason why the status quo prevails. Again, the ENN has argued this very same point over a number of years. Unfortunately, these ideas are not developed or elaborated in the series. How useful it would have been if the authors had discussed potential institutional locations and processes for such a body. The case for this could have been strengthened by showing historically what might have been achieved had such an institutional arrangement existed previously. Given the profile and considerable public relations on this series, we feel that an important advocacy opportunity for change has been missed.

The same criticisms cannot, however, be levelled at the interventions and pilot studies described in field articles in this issue of Field Exchange. All, without exception, entail new or modified approaches to programming introduced to address specific problems.

An article by Hanna Mattinen working for Action Contre la Faim describes how blanket distribution of BP5 biscuits to children under five succeeded in bringing down global acute malnutrition rates dramatically in internally displaced persons (IDP) camps in Darfur, following reduction of amounts of Corn Soya Blend in the general ration. Although costly, the approach was seen as a temporary measure to address a short-term problem. Tom Oguta, Grainne Moloney and Louise Masese from FAOs Food Security Analysis Unit write about a pilot study comparing Lot Quality Assurance Sampling (LQAS) with 30 by 30 cluster nutrition surveys in IDP camps in Hargeisa, Somaliland. Although similar results were found for prevalence of malnutrition, morbidity and health programme coverage, there were significant discrepancies for household level data such as dietary diversity, access to water, etc. Furthermore, confidence intervals with LQAS were far wider. The authors conclude that although LQAS is up to 60% cheaper and takes many less person days than a traditional nutritional survey, its most appropriate role is probably where monitoring of hot spots is needed or when there is limited access to an area.

An article by Elena Rivero, Núria Salse and Eric Zapatero of Action Against Hunger describes how an integrated food and nutrition system has been established in Malawi and used effectively for decision making. The authors highlight the advantages of a longitudinal surveillance system over a system of regular cross-sectional surveys and also demonstrate how nutrition and food security information, which is specific to the Malawi context, can be integrated into one information system. Finally, an article by a regular contributor to Field Exchange, Mark Myatt, describes the development and application (in Ethiopia) of a new method to assess nutrition programme coverage. The method, which has the easily remembered acronym SQUEAC (semi-quantitative evaluation of access and coverage), has been developed by Valid International in collaboration with Concern Worldwide, World Vision, and UNICEF. It is less resource intensive than CSAS (see Field Exchange issue 27¹) and makes use of routine data collection as part of programming and small scale surveys.

All these field articles demonstrate a degree of adaptive programming and pragmatism on the part of implementing agencies. The approaches used are not 'one-size fits all' approaches but more 'why not try this in such and such a context'. It is always encouraging and inspiring to see such innovation on the 'front line'.

We hope you enjoy this issue of Field Exchange and find something in here that helps you in your work.

Jeremy Shoham
Editor

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

¹Field Exchange 27 (March 2006). The challenge of applying CSAS in DRC. Jason Stobbs, AAH- USA. P28- 30. Postscript by Mark Myatt.