Review of tools developed by the Global Nutrition Cluster

Summary of review¹

In 2005, following a review of humanitarian response capacity, the Cluster Approach² was established by the Emergency Relief Coordinator and endorsed by the Inter-Agency Standing Committee (IASC). The Nutrition Cluster (NC) is one of 11 global clusters (a designated area of humanitarian activity) established and UNICEF has the lead. In 2007, two Working Groups (WGs) were established within the Global Nutrition Cluster (GNC):

• The Capacity Development WG that produced a Nutrition in Emergencies Toolkit (NiETK) and a Harmonised Training Package (HTP)³.
• The Assessment WG, in collaboration with the Health and Wash Clusters, developed an Initial Rapid Assessment (IRA) Tool.

The United Nations Standing Committee on Nutrition (SCN) was commissioned in early 2009 to look at these three tools to identify lessons learnt, gaps and impact of their use in areas of strategic importance to emergency nutrition response and preparedness.

In total, 83 people were interviewed. They were selected through their engagement in cluster work at country level, at regional level with a link to cluster work in countries, in GNC work and in emergency nutrition. Individuals with specific experience and perspectives relevant to this review were also interviewed, e.g. those involved in the Sphere process, HTP trainers, consultants working on the HTP, etc. Twelve out of the 14 countries where the Nutrition Cluster had been formally activated at country level were represented in the review.

Main findings

The review found that approximately 20% of the participants had never heard of the tools or had heard but not seen any of the tools. This was similar for each of the tools. Most worrying was that there was limited awareness about the tools amongst some key actors working in, or with, countries with an active NC. This indicated a lack of a good dissemination strategy rather than a reflection of the use- fulness of the tools; those that knew of the tools and used them appreciated their quality and potential.

The IRA tool was valued for having brought sectors and different types of information together in one document. In particularly, it served as a reference point for existing tools or for the compilation of new assessment tools. Further development of the IRA tool adapted to specific country/emergency contexts is needed.

The NiETK was used particularly at the country level by Nutrition Cluster members, including Governments. It was highly valued as an advocacy tool for nutrition-related interventions with (nontechnical) managers and has great potential to guide health professionals in emergencies.

The intended purpose of the HTP was as a source of harmonised content on nutrition in emergencies (NiE) as a training support tool. Many respondents used the HTP in this way and as a handbook/reference guide. The tool was considered to be of good quality and comprehensive. However, the HTP was also considered by some to be a comprehensive training package, which it is not. The tool has large potential when used as a support in larger capacity building strategies on NiE. The value of both NiETK and the HTP depend partially on how congruent they are with the most recent guidelines/protocols and state-of-the-art practice and views.

Overall review participants appreciated the concerted action of drafting tools together (intra- and inter-cluster) and it was seen as a good learning experience within the GNC.

Though the tools served their own purpose in different contexts and at different levels (global, regional, in-country), their use at regional level was considered to be marginal.

The review found that it was slightly too early to demonstrate how people used the tools and their impact. However, the review was timely with regard to evaluating the process/progress to date and guiding the roll out and further WG plans and activities. The review concluded with recommendations for the use and roll out of each tool, as well as for stakeholders working in nutrition at global, regional and national level.

Recommendations

To date, all tools deserve the 'test of time' and are of sufficient quality to justify their use in NiE work, within or beyond the Nutrition Cluster context. Amongst the key recommendations in the review were the following:

IRA tool

The large majority regard the IRA tool as a generic tool that should be adapted in-country for assessment purposes. The adaptation should be made according to the emergency context and country specificity. It should be adapted as part of a country's contingency planning. If a sudden onset emergency occurs and the country has no such rapid assessment tool, it can be used as an 'off -the -shelf' tool. It is strongly recommended to use this tool and then evaluate it in two years to assess its usefulness and its evolution in various countries.

Suggestions for future use include:

• Previous IRA tool versions should be used when compiling any comprehensive assessment tool for the GNC (a development on the agenda of the Assessment WG, and if still deemed necessary).
• A future revision of the IRA tool should distinguish between life-saving and life-sustaining indicators.
• The development of other rapid assessment tools, such as McRam in Pakistan, and ECHO's rapid assessment checklist (to be finalised in 2009) should be followed and serve as potential instruments for strengthening the IRA tool.

NiETK

The tool has potential to be used widely outside the Nutrition Cluster where there is currently limited awareness of it's existence. It should be 'marketed' in the Health Cluster at all levels by the NC, UNICEF and WHO. The NiETK should be updated at the end of 2009. Its use could be increased if some related IEC materials were incorporated based on NiETK messages.

HTP

Apart from being directly used as a training support within the Nutrition Cluster system (e.g. members, partners, cluster coordinators) the HTP should be used as a basis for academic training in Africa, Asia, Middle East (and possibly Southern America) to strengthen national capacity in NiE. It should be updated at the end of 2009. (A 2 year update process of the HTP was initiated at the end of 2009, see news piece in this issue of Field Exchange).

The HTP does not need to be published as hard copy but could be reformatted into a simple pressready document. (This development is now well underway).

It is recommended that those countries or organisations that use HTP in training incorporate the HTP into a larger capacity building strategy. Ensuring facilitation and support by supervisors/decision makers (i.e. the 'full chain of command') and provision of more practical learning opportunities will enable trainees to apply their knowledge. There should be a high priority to create internships. The impact of training with the HTP should be evaluated in 2-3 years

Country

Where countries are interested in using the tools, these should be introduced as part of emergency preparedness rather than wait until an emergency happens. If deemed relevant, countries should use the generic version of a tool and adapt it to country context (to improve ownership, appropriateness of tool, speed of uptake and increased use, etc).

Where appropriate, countries should include tools (such as NiETK) in national guidelines. Country Nutrition Clusters should have clear strategies on how to disseminate relevant tools to all stakeholders, including how to 'explain' and demonstrate the tools. The Nutrition Cluster should encourage Governments/agencies/organisations to endorse the (country adapted) tools, if appropriate.

Regional

UNICEF should take a greater role in rolling out GNC tools/services, especially at the regional level. Regional offices of UN agencies and NGOs should have Nutrition Cluster related issues in their work plan (for example, Nutrition Cluster preparedness plans).

Global Management

The GNC should encourage agencies/organizations/ Governments to endorse the GNC tools and encourage the use/adoption of the tools within the individual agencies. The GNC should develop support systems (e.g. services, tools) for 'good nutrition cluster coordination'. The GNC should reexamine its work plan and decide on the balance between technical support and support for coordination/ management of cluster in the development of tools.

The GNC should look for means to better inform stakeholders on GNC issues, especially at the regional and country levels - through email alerts, Field Exchange, installing links to the GNC websites at websites better known by the NiE network, etc.

The GNC should engage regional offices (e.g. UN, NGOs) more in its work and vice versa.

The GNC WGs should re-examine their work plan priorities taking into account the findings of this review.

Global Tools

The GNC should draft a clear dissemination strategy for the tools and fundraise for its implementation. The tools should be translated as a priority into French. The GNC (Assessment WG) should engage in the Office for Coordination of Humanitarian Affairs' (OCHA) process of creating a common needs assessment methodology and be part of the inter-agency Needs Assessment Group established by the IASC in March 2009. A process of maintenance and updating of the tools should be mapped out for the NiETK and HTP as they are 'living documents'. The GNC should, in collaboration with the regions, task an organization with making powerpoint slides and more didactic material to optimize the use of HTP. The GNC should advocate for inter-cluster exchange on tools.

To learn more on the Cluster Approach, access all tools developed and to keep up to date on developments, visit: http://oneresponse.info

¹Vevers. M (2009). Review, lessons learnt of, and recom mendations on, the use of products developed by the Global Nutrition Cluster; the Nutrition Cluster Toolkit, the Harmonised Training Package and the Initial Rapid Assessment Tool. July 2009

²http://oneresponse.info

³Based on priority capacity gaps in nutrition in emergencies, this package comprises 21 modules to use in training on key topics. Each module comprises four sections: i) briefing paper for senior decision makers; ii) technical notes for practitioners; iii) trainers' guide; and iv) reference material/sources. Available at http://oneresponse.info/GlobalClusters/Nutrition/Pages/CapacityDevelopment WorkingGroup.aspx