From the editor

An aerial view of Darfur, Sudan

The role of data and analytical tools in guiding and evaluating emergency programming figures strongly in this issue of Field Exchange. There are two field articles which shine light on the causes of malnutrition in very different contexts. ACF-USA carried out a baseline survey in an area of the Democratic republic of Congo (DRC) where high levels of Konzo are reported. The survey identified key causes of Konzo which included not using enough water during cassava preparation underpinned by lack of access to water. Programme recommendations were framed accordingly. The second article, written by FSANU, examined trends in rates of malnutrition amongst pastoralists in Somalia and showed how these are strongly correlated with milk availability and seasonal factors. This finding is in line with other work reported in Field Exchange¹.

A further two field articles report on the impact of cash-based interventions on a variety of outcomes. The first is a cash for work programme in Guinea where impact on food consumption, income and coping strategies are measured. The second is an income generating activity programme involving cash grants and training in southern Sudan where impact on coping strategies, hunger levels and MUAC are measured.

The importance of monitoring is a key issue in the WFP evaluation of their 2009 EMOP (Emergency Operation) in Darfur. Here, the evaluation describes how the Darfur Food Security Monitoring System (DFSMS), which WFP established in 2009, showed not so much the impact of the General Food Distribution (GFD) but the lack of impact of a reduction in the GFD. For a variety of reasons, WFP had to reduce the ration during 2009, first to 70% and then 60% of a full ration. Taking account of milling and transport costs, as well as taxes to sheiks, there were times in the year when beneficiaries were making do with less than a half a full ration. However, the DFSMS showed no change in prevalence of malnutrition, mortality or coping strategies/ livelihood activities. The evaluation concluded that this reflected the disconnect between numbers registered and actual numbers, i.e. there was significant over-registration, as well as the reasonable harvest in many parts of Darfur and alternative livelihood options amongst the internally displaced population (IDP).

The research section of this issue of Field Exchange also has a strong focus on assessment and evaluation. An article by World Vision analyses the causes of malnutrition amongst the Dinka in southern Sudan. These are found to be largely embedded in social and cultural practices. There are two research pieces relating to food security measurements in Zimbabwe. The first looks at food security differences between adults and children in the same household and concludes that children tend to have worse food security. The implication being that household level targeting of interventions is not always appropriate. The second article describes the use of different measures of food security, i.e. Household Dietary Diversity Score (HDDS), months of food shortages, and the Household Food Insecurity Access Scale (HFIAS). It found that used separately, these different measures provide unique insights into the level and type of food security. The authors conclude that it may be best to combine different measures of food security to obtain a fuller picture of the situation and therefore enable the design of more appropriate responses.

Another study examined data from Indonesia during 1998 when prices of foods went 'through the roof' - the consumer food price index went up 188% at a time when various subsidies on food were removed. The authors conducted the analysis at two levels in an attempt to assess impact on food access. First, using the Starchy Staple Ratio (SSR) as the summary measure of household nutritional welfare, they assessed the impact of the dramatic change in food prices on household dietary composition. Secondly, the authors examined how the income elasticity of the SSR differs in the two survey rounds characterised by very different relative prices between cereals and other major food groups. The results suggest that cash transfer programmes may be even more effective during crises to protect the consumption of many essential micronutrients compared with non-crisis periods. However, in order to ensure that all micronutrients are consumed, specific nutritional supplementation programmes are also likely to be required, especially for nutrients like Vitamin C.

A study based on nutrition and mortality data from the Horn of Africa set out to assess criteria for emergency intervention decision-making based on associations between child wasting and mortality from 2000 to 2005. The analysis found that higher rates of global acute malnutrition (GAM) were associated with increased mortality of children under 5 years of age and that the association was stronger among populations with pastoral livelihoods than with agricultural livelihoods. Although GAM is therefore more effective in identifying groups with higher mortality risk for those practicing some pastoralism, there is still a useful predictive power for agricultural populations, with lower GAM cutoff points. In all groups, spikes of GAM and under five morality rate (U5MR) corresponded with drought (and floods). The authors conclude that different GAM cutoff points are needed for different populations. For example, to identify 75% of U5MR above 2/10,000/day, the GAM cut-off point ranged from 20% GAM in the Rift Valley (Kenya) to 8% in Oromia or SNNPR (Ethiopia) or from 15% for pastoralists to 10% for agropastoralists.

Another article questions the appropriateness of current Sphere standards for protracted (IDP) situations. The summary focuses on the current nutrition standards. The authors argue that there is no framework that analyses particular risk factors for nutritional deficiencies in protracted displacement and thus no appropriate standardised recommendations exist. They suggest a collaborative effort - modelled on the Sphere process - is needed to address this.

Finally, there are two summaries of studies on the cost-effectiveness of community managed programmes for the treatment of severe acute malnutrition - in Ethiopia and Malawi. The Ethiopia study compares community based therapeutic care (CTC) cost-effectiveness with centre based therapeutic feeding programmes costeffectiveness, whereas the Malawi study determines cost-effectiveness of community based management of acute malnutrition (CMAM) in terms of disability-adjusted life years (DALYS). In both cases, the community-managed interventions are found to be highly cost-effective.

A number of cross-cutting issues and conclusions emerge from all these articles and studies. First, there appears to be an unstoppable process whereby measurement and analytical tools are continuously being refined or developed anew. In one sense this is encouraging, as these analytical advances provide greater insight into problems and how best to address these.

Second, and admittedly based only upon the snap-shot of experiences and research in this issue of Field Exchange, those agencies with an interest in impact measurement of food and nutrition programmes appear to be placing less emphasis on anthropometric indicators and more on a range of nutrition-related indicators or tools. These indicators or tools are able to help explain cause of malnutrition or how an intervention may be impacting nutrition, i.e. they provide plausible models of impact. Again, this is encouraging as nutrition and/or mortality data on their own may tell us little about processes that either lead to malnutrition or positively impact malnutrition.

Finally, and perhaps on a more discouraging note, this expansion of indicators and tools may lead to less standardisation of approaches used in assessment, monitoring and evaluation, and therefore greater difficulty in making comparisons between programmes and their impact. In this issue of Field Exchange this is seen most obviously in two sets of articles (cost effectiveness of CMAM/CTC and impact of cash transfer programmes). While it may be argued that a 'free market' for the development of different analytical tools will lead to more creativity, innovation and ultimately better practice, the down-side is that decision-makers are less able to make comparisons and learn from the myriad of field experiences out there. Donors in particular are affected by the plethora of approaches used by agencies to justify interventions and then measure their impact and are increasingly calling out for greater standardisation of assessment and monitoring tools amongst agencies. There is clearly a balance to be struck here and it is perhaps difficult to say where the line should be drawn. However, the current free-for-all and resulting lack of standardisation may well undermine achievements and should alert us once again to the need for stronger leadership in our sector to guide how we make assessments and then evaluate our response.

Jeremy Shoham, Editor

¹Analysis of the 1996 Konzo outbreak in Democratic Republic of Congo. Field Exchange, Issue No 17, November 2002. p7. http://fex.ennonline.net/17/analysis.aspx