Listening to SUN country actors: A face-to-face interview with Dr Mohamed Abdi Farrah, Somalia SUN Focal Point

Background

Somalia has been affected by civil war since 1991 and suffers from recurrent droughts, characterising it as a complex political environment with extreme poverty, food insecurity and instability. Somalia’s malnutrition rates are consistently among the worst in the world, with currently 13.6 per cent wasting in children under five years of age, high levels of stunting (>26%), low levels of exclusive breastfeeding rates for infants under six months (5%) and widespread micronutrient deficiencies. Somalia has a well-established Nutrition Cluster, which since 2006 has grown to almost 100 active partners. This has been a forum for representing all actors, including UN and civil society organisations, in emergency nutrition concerns over many years. More recently, the Nutrition Cluster members have been able to engage with newly established SUN  activities in Somalia. Somalia joined the SUN Movement in 2014 and now has a national-level SUN Focal Point (SUN FP), Dr Farah, who is based in the Office of the Prime Minister. There is also a sub-national SUN FP based in Puntland and there are plans to expand to have more sub-national-level FPs in every state, including Somaliland. While the SUN Movement approach has been endorsed in Somalia, an official public launch is planned in 2016 which is seen as a way to bring people together and a chance for advocacy to further embed nutrition issues within government.

In January 2016 Tui Swinnen, the ENN Global Knowledge Management Coordinator, met with Dr Farrah at a Somalia Cluster meeting in Nairobi, Kenya. This presented an ideal opportunity to interview Dr Farrah to obtain his perspectives on scaling up nutrition in such a challenging and rapidly changing environment.

1. Can you tell me about the nutrition context in Somalia when government joined the SUN movement?

• Somalia is a context where there was no funding for nutrition and no solid evidence/knowledge base for nutrition due to the volatility and conflict situation. Research in Somalia is underdeveloped and has been haphazard. It was a difficult environment for establishing a SUN platform.
• I recognised early on that the SUN FP, in having responsibility for setting up the multi-stakeholder platform (MSP), must be placed in the Prime Minister’s or President’s office or another high post in order to ensure the power to convene different ministries. The location of the SUN FP within a ministry, often the Ministry of Health, in other SUN countries has proved to be a big challenge as this person does not have the authority to convene other ministers or ministries, which is critical to be able to successfully undertake nutrition sensitive and multi-sector planning and programming.

2. As the Somalia context is unique, do you think actors working to scale up nutrition in Somalia would benefit from learning exchanges with other countries in the Movement?

• There is certainly an interest in adapting sensitisation materials for parliamentarians, which is something that has been done elsewhere in the SUN Movement. There is also an interest in understanding what other countries have put in place in terms of monitoring and evaluation frameworks for their MSP and what the expectations are. These structures are in a nascent stage in the Somalia context as there is no precedent to draw on.
• There is also a keenness to develop a multi-sector plan and a Common Results Framework (CRF); therefore there is an interest in hearing how this has unfolded in practice in other contexts – specific practical aspects such as who is on the MSP, how many members are viable, etc.

3. Since Somalia joined the SUN Movement in 2015, nutrition has become a priority in Somalia with buy-in from the highest levels of government. Can you tell me how this shift came about?

• With security being the top priority in a country like Somalia, the focus of leaders and government has been on fighting insurgents, basic state-building and reclaiming the country; it was very difficult to make the case for the importance of investing in nutrition activities such as stunting reduction. It was important to make the leaders at a high level understand the importance of nutrition and to take the right arguments to them. This process is about educating leaders, building trust and bringing them along. There is no quick fix – this process takes time.
• I was involved in a key meeting in the early stages of establishing SUN in early 2015 in Somalia and put nutrition in perspective for the Prime Minister, with figures on the daily and monthly deaths relating to malnutrition in the country. The success of SUN depends on establishing the legitimacy of the issues and getting support from the leadership. The Prime Minister then appointed me as SUN FP in his own cabinet, giving me the ability to bring together different ministers and the legitimacy to set up an MSP in the country. A challenge to overcome is not only other pressing priorities, but also the lack of understanding of nutrition and health at a high level. The need for statistics as well as materials that explain the science and fundamentals of nutrition to someone with no background in this is essential.
• SUN is seen as a journey. It is about adaptation to unique contexts and seeing what works for different people. There will be a number of deep challenges to overcome in setting up SUN structures and to scaling up nutrition.

4. What are some of the ‘deep challenges’ that need to be overcome in Somalia?

• Coordination is an extreme challenge in Somalia, given that the government is not fully functional and not all the stakeholders who need to be ‘around the table’ and ‘under one roof’ for SUN activities can physically come together to do this. The UN actors and the donors operate out of Kenya, while the government and local actors are based in Mogadishu and other parts of the country. The restrictions on international actors travelling to Somalia every time there is a severe explosion or attack can pull the plug on an organised event at the last minute and even the planned SUN launch is at risk of this sudden change of plan.
• Financial tracking is another extremely difficult issue in this context as there is no central repository – for example a national bureau of statistics ¬– that could do this currently and tell us what is being invested in nutrition. However, the nutrition strategy for health in Somalia has a costed plan for the three regions of Somalia and includes a micronutrient and infant and young child feeding strategy, so financial progress is being made.

5. You have mentioned gaps in nutrition research and data in the Somalia context. Are there any plans to fill these gaps?

• There is currently no coordinated system in place for knowledge management. By this I mean the collection, evidence-building, technical assistance, documentation and assessment of nutrition information. This is a huge barrier for SUN activities as there is a need to be able to develop, for example, a CRF or a National Nutrition Plan based on existing information, but this is not readily available.
• Nutrition research for Somalia is lead by the Food Security and Nutrition Unit (FSNAU) of FAO. UNICEF and FAO have the best data on Somalia at present and FAO has conducted several seasonal nutritional surveys in Somalia with a focus on vulnerable areas. They are open to sharing the data with government and other partners.
• SUN will be used to form a research centre for nutrition for Somalia. There is a need to create a database of all research, assessment and related health and nutrition findings for the country. SUN provides new opportunities to make use of information from neighbouring countries in the region that would be relevant to the Somalia context and could help fill the gap in research from Somalia itself. We will eventually also be able to share information with other countries. As the Somali Government cannot oversee or control the research and knowledge-management activities, individual organisations conduct their own research and produce results to inform their own programmes. There is a need for a central repository to coordinate research in nutrition and to set national priorities.

6. What has been the Somalia experience of setting up a multi-stakeholder platform?

• Multi-sector engagement and structures are critical to the success of scaling up nutrition, but cannot be rushed. Building up new links between ministries and convincing new sectors to engage in nutrition simply takes time and there are no shortcuts. It has taken me a year of meetings and follow-up and engagement activities to bring everyone onto the same page on nutrition for SUN in Somalia.
• Selling nutrition to leaders and framing the issues is critical. This must be presented in a way that resonates with leadership and must be evidence-based. Even in such a difficult and volatile context as Somalia, available data and well-crafted arguments can go a long way to making the case for nutrition. If it can be done in Somalia, it can be done anywhere!
• I believe we need to create an ‘introductory’ package of information, guidelines and templates for SUN. In Somalia we have had to start from the beginning and develop documents and plans after joining the SUN Movement.

The SUN ‘blueprint’ must be adapted to meet the needs of individual countries and contexts. In Somalia this means adapting national structures to a context in which there are three separate governments operating in the three regions and half the network stakeholders (donor and UN) located outside the country (in Kenya). The need for adaptability and creative ways of setting up SUN structures cannot be overstated.

Special thanks go to Samson Desie, Somalia Nutrition Cluster Coordinator, for helping arrange this interview.