ENN secures funding for SFP Research Projects

The ENN has just received a grant from USAIDs Office of U.S. Foreign Disaster Assistance (OFDA) to carry out two projects related to emergency supplementary feeding programmes (SFPs). Both projects emanate from specific recommendations made following the review of 82 emergency SFP data sets conducted by Save the Children UK (SC UK) and ENN in 2006¹, which were to:

• define and implement minimum reporting standards on SFP, and
• increase understanding of the role of default and access in programme performance.

Minimum Reporting Project

The Minimum Reporting Project will develop and implement a standardised Minimum Reporting Package on SFPs. It is hoped that this will help:

• provide a reliable way of monitoring and evaluating the performance of SFPs using approved and standard definitions.
• help identify problems and where programmes need to be adapted.
• facilitate supervision of programmes for managers, officials at agency and country level and donors.
• provide a resource for evaluating the impact on efficacy of a change in protocol, or other change in the intervention context (e.g. a new influx of refugees, a change in season, etc.).
• the implementation of a common set of accepted reporting standards, that will be key to enhancing accountability of programming to both donors and beneficiary populations.

The Minimum Reporting Package will involve development of three main tools:

1. A set of guidelines and data collection templates
2. Supporting manuals and training materials
3. A database application for data entry, analysis and reporting based on the guidelines, and employing user-friendly software developed for this purpose.

An inter-agency central data repository will be created, where nutrition programme data can be stored and accessed, to enable programme comparison, strengthening of institutional memory, lessons learning and to inform research. The central repository will have a dedicated person to receive, clean and provide data that is readily accessible. It will produce regular programme performance reports and ad hoc analysis on demand from participating agencies.

Stages of implementation

Draft minimum reporting guidelines have already been prepared and presented at the ENN/SC UK workshop in May 2008. A small number of modifications have been made based on comments received at the workshop. A critical mass of organisations has endorsed the Minimum Reporting Package and is willing to implement it in their respective field operations (World Vision, Save the Children UK, NICS, FANTA, IRC, WFP, Nutrition Cluster, UNHCR, Concern Worldwide and Valid International). Subsequent stages are as follows:

• Development of final guidelines and report templates among agencies endorsing the Minimum Reporting Package
• Translation into a software tool by I.T. experts
• Field piloting of the reporting package and guidelines
• Developing final version of guidelines and software tool
• Training and dissemination of the package
• Rollout to other agencies
• Formalising agreements between endorsing agencies and the ENN on data ownership and sharing.

Defaulter and Access Study

The Defaulter and Access Study aims to improve the design of programmes addressed to reducing moderate and severe acute malnutrition, by adapting them to the constraints faced by potential beneficiaries in a variety of emergency settings.

The objectives of the study are:

• To describe the baseline and nutritional characteristics of beneficiaries likely to default from nutrition programmes.
• To understand the determinants of defaulting from nutrition programmes in variety of emergency settings.
• To compare the determinants of defaulting between different emergency settings.
• To translate observations into strategy and policy recommendations to adapt nutrition programming in emergencies.
• To develop field tools to understand defaulting in particular settings and respond with appropriate programme adaptations.

The subjects of this study are children between 6 to 59 months admitted to SFPs. This study intends to capture:

• Frequency and baseline characteristics of patients who default (socio-demographic, nutrition status, evolution under treatment).
• Unexpected events that trigger defaulting through change in family priorities (i.e. determinants that can only be collected post-hoc - once the event has happened).
• Reasons for non-attendance of malnourished children to SFP (i.e. malnourished children who never enrol in an SFP).

The causes of defaulting from SFPs are considered to be context-specific and due to seasonal factors. Therefore several independent studies will be implemented, to allow description of the causes of defaulting in specific contexts.

Four sites will be selected, each study taking place over a complete agricultural season. Settings to be included are a refugee camp, a long term intervention (protracted emergency) in a secure setting, a recent crisis in a volatile setting with insecurity, and a centre where displaced and resident populations attend. Selection of sites will aim to include programmes from Africa and Asia, as well as a mixture of programmes with high and low defaulting rates.

Stages of implementation

The study will involve a number of stages. The preliminary phase will include developing hypotheses of the main causes of defaulting and non-attendance in different contexts and questionnaires based on these hypotheses for data collection in the quantitative phase of the study. This will be followed by qualitative data collection in two pilot settings and development of questionnaires to identify potential causes of defaulting and non-attendance and inform questionnaire design. Two questionnaires will be developed based on this information:

1. The Baseline Questionnaire, for obtaining baseline information on the family.
2. The Unexpected Events Questionnaire, a (shorter) questionnaire to identify unexpected events thatmay be related to defaulting.

The next stage will be the prospective data collection phase in each study site and subsequent analysis. The study will involve case control of those children who do not default, as well as follow up of those who do not attend the programme.

The analysis will first be undertaken for each independent study site. This will involve analysis of different categories of defaulting groups as follows: early defaulting (first two weeks), defaulting after weight gain, and defaulting after weight loss or noweight gain. Secondary analysis will involve nonstatistical comparisons of the results obtained in each study site, with the aim of identifying context specific results and those which are common to all programmes.

Additional analysis will be conducted in countries where a change in programme characteristics (protocols, strategy or external events) may have affected the likelihood of defaulting or its causes. This will be carried out as a 'before-after' comparison of time series data, with defaulting as the event of interest. This will be treated as opportunistic research.

For further details, contact Jeremy Shoham, email: jshoham@easynet.co.uk.

¹Field Exchange Issue 31.