From the Editor

A key thematic focus of this issue of Field Exchange is Humanitarian Reform. There have been many reviews and evaluations concerning the level of progress made since the reform process was officially launched some five years ago. The detailed and systematic 'state of the system' review by ALNAP (see research section) found that the 'formal' international humanitarian system (United Nations (UN), international non-governmental organisations and Red Cross) has grown significantly in financial and human resource terms in recent years. Progress was found in areas such as sector coordination (since the advent of the Cluster Approach - see below), in the mechanisms that provide more reliable and predictable funding and in tools for assessment. Significant gaps in areas such as overall leadership for coordination (non-sectoral) at the country level, in accountability to those affected by emergencies and in investment in national capacity development were identified. In fact, the "top-down orientation of the [humanitarian] system" was found to risk undermining local capacities.

Action Contre la Faim's (ACF) review of Humanitarian Reform views reform as a positive step forward but raises concerns about the potential risks where "political, military and humanitarian objectives" are not firmly separated, where the implementation of the cluster approach is patchy and inconsistent and with the lack of emphasis on inter-cluster coordination resulting in sectoral 'silos'. As with the ALNAP review, ACF highlights a pressing need for strengthened humanitarian coordination and stewardship at the country level.

A key element of reform is the Cluster Approach, which has given rise to the formation of dedicated clusters overseeing and coordinating specific technical areas including nutrition. The actions of the Nutrition Cluster in the early stages of the Haiti response is described in one field article where a number of key achievements are highlighted. These include the rapid identification of priority nutrition problems, the development and dissemination of UN endorsed and unified technical guidance on infant and young child feeding, regular situation updates at global level coupled with mapping the 3W's (Who, What and Where) at country level, the formation of a cluster coordination forum at country level chaired by the Ministry of Health and the implementation of a basic package of key nutrition interventions. The article also describes shortfalls. The 'old chestnut' of lack of surge capacity to meet the human resource demands for a large scale emergency response and insufficient understanding of the cluster approach at the global, regional and country level giving rise to a lack of clarity of purpose and separation of roles between coordination and programming and nutrition related supply bottlenecks, to name a few. By documenting the Cluster's performance in Haiti, the lessons, if acted upon, could arguably strengthen current and future emergency response capabilities. A postscript to this article by UNICEF outlines the steps they are taking to strengthen the Nutrition Cluster and UNICEF's programme capacity to better fulfil its mandate as Cluster Lead Agency and 'provider of last resort' for emergency nutrition.

It is salient to contrast the articles dealing with reform and the cluster approach in this issue with the previous issue of FEX which drew our attention (in the editorial) to the media's subjective and poorly evidenced reporting on the international response to the Haiti earthquake (and role of the media more generally in reporting humanitarian emergencies) and their view that the response lacked any meaningful coordination. In contrast, the Nutrition Cluster Haiti experience, though weak in some key areas, gives an insight into what was put in place, at speed, in a hugely demanding and complex emergency situation where dedicated cluster coordination capacity existed. This evidence based snapshot provides a stark contrast to the 'glass is half empty' reporting by the media.

Another thematic area in this issue concerns the rapidly evolving experience of community-based management of acute malnutrition (CMAM/CTC). The first of the articles (Hailey et al) resonates with the findings in the humanitarian system reviews vis-à-vis the need for much greater recognition of existing national capacities, particularly within governments of emergency affected countries. Emergency response should result in the further development (rather than undermining) of national systems and capacities. It is proposed that an analysis of the capacity of existing health systems to cope with the estimated caseload of acute malnutrition forms the basis for determining CMAM support requirements, rather than the current approach which relies on the prevalence of acute malnutrition reaching thresholds which in turn trigger a response. The authors call for the 'stop-start' system of resourcing for CMAM programmes to be replaced with a health systems approach, which builds nation-wide health systems capacity resulting in increased CMAM coverage. What is particularly interesting about the proposed model is that it will require a change in mind-set from the current (and somewhat artificial) emergency-development divide 'way of doing business' and focus instead on integrated, long -term national level CMAM capacity in all situations where this capacity is needed - whether the country has a declared emergency or not.

Accountability of humanitarian actors towards those affected by emergencies is another area of concern highlighted in the humanitarian reform reviews. The article on the integration of CMAM into routine health services in Nepal identifies delays in community mobilisation activities - arguably a key mechanism for ensuring accountability - as the main reason for the lack of awareness of the services available and for the high levels of defaulting. Subsequently, when mobilisation activities were implemented and a dialogue was created between the providers and those in need, coverage of the CMAM programme increased. The Nepal experience is backed up by the article on the study of the determinants of CTC coverage (Valid International and Concern Worldwide). This study looked at 12 programmes across Africa and identified lack of awareness of the programme, previous rejection from the programme and distance to the treatment centres as the key factors inhibiting uptake of the CTC programme.

Servicing the growing demand for Ready to Use Therapeutic Food (RUTF) as more and more governments look to 'roll out' treatment as part and parcel of ongoing child health services is another challenge for those working on CMAM programming. Currently, most RUTF is supplied for the global market by just a few companies who have secured international accreditation for production (according to food standard and safety criteria). UNICEF and MSF are the main global purchasers and suppliers to agencies on the ground. The article from a local RUTF producer in Haiti describes the experience of trying to obtain international accreditation for a small scale RUTF manufacturer aiming to supply agencies operating in Haiti at a price which is competitive with the large scale manufacturers. The author highlights the need for a rigorous analysis of the opportunities and the obstacles to local production involving a dialogue between local producers and key international stakeholders.

The Haiti RUTF article again raises the issue of the role of humanitarian systems in supporting existing capacities and in developing new capacity at national level. Whilst some countries have made considerable progress in developing capacity to meet the day to day demands for locally produced treatment and prevention products, many others are dependent on supplies from just a few international manufacturers. As highlighted in the CMAM health systems articles and the Nepal article, more sustainable approaches to addressing acute malnutrition that would avoid the 'stop-start' nature of current emergency programming will help deliver tangible emergency preparedness actions, a key focus and goal of the reformed humanitarian system.

As highlighted in previous issues of Field Exchange, the nutrition sector (emergencies and development) lacks strong coordination, coherence and stewardship and it is therefore right for all stakeholders, including the media, to ask questions. Are things any better today as a result of the reform process (and the nutrition cluster)? Has real progress been made? What do we still need to address in order to ensure we have the systems, resources and capacities to safeguard the nutritional status of those affected by emergencies? A common feature of the reviews featured in this issue of Field Exchange is that they clearly identify positive developments with the reformed humanitarian system (and within our sector). These reviews also recommend concrete ways to address existing weaknesses and gaps, of which there are many.

The humanitarian 'system' is not only reforming but is also becoming increasingly complex as more and larger institutions evolve, emergency aid spend increases and many complex mechanisms, policies and procedures, tools and guidance are put in place. Furthermore, the sector is witnessing a growing demand for the professionalisation of humanitarian staff, for greater accountability and for evidence of impact. Whether we are better prepared today for the Haiti of tomorrow, six months on from the onset of one of the largest emergencies in recent history will, sadly, only be known when an emergency of this magnitude occurs again and we examine the speed, content and impact of the response. The (less high profile) emergencies of today, however, need a system which firmly focuses on the impact of collective actions at all levels and recognises that new systems for reform (including the cluster approach) are a means to a better end, rather than an end in themselves.

Carmel Dolan
Guest editor & Technical Director, ENN

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