WHAT WORKS?

Measuring Resilience

Nutrition status indicators good for resilience indicators because

Undernutrition is an unambiguous marker of poverty and deprivation (causal framework),

Livelihood programmes often tend to target better off households so changes in livelihoods based resilience indictors may not show the impact of the programme on the most deprived,

Undernutrition is a good indicator to bring gender issues into focus. A women’s livelihood status is one of the most important influences on a child's nutritional status.

Undernutrition

Measuring Resilience

Chronic undernutrition is standard Nutrition Development Indicator.

Used in many Resilience programmes as an impact indicator.Chronic malnutrition improves ~1pp/year if good

integrated programme implemented. Age and height difficult to get quality measures.

Stunting most appropriate for end programme monitoring of Resilience programmes.

Acute and chronic undernutrition different manifestations of same causal factors.

Acute undernutrition trends can also be used for monitoring more regularly.

Chronic and Acute Undernutrition

Desired 5 year Goal.

PRESENT SITUATION DESIRED SITUATION.

Continued reduction in maximum GAM Prevalence by 1.5% a year from 21% in 2014 to 13.5% in 2019.

Continued reduction in maximum SAM Prevalence by 0.5% a year from 4% in 2014 to 1.5% in 2019.

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2009-2014 Yearly Max. GAM and SAM Prevalence

GAM. Linear (GAM.) SAM. Linear (SAM.)

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What is special about the Nutrition situation in Karamoja?

CHANGEABLE SITUATION FOR GAM AND SAM EXAMPLE

Acute Undernutrition improving 2009 – 2014

6 year average is 23.3% GAM and 4.6% SAM

Very changeable

18 % difference between highest and lowest GAM and 8.4% for SAM.

Up to 16.7% GAM and 6.3% SAM difference between years.

N=22

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2009-2014 Yearly Max. GAM and SAM Prevalence

GAM. Linear (GAM.) SAM. Linear (SAM.)

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Change and ResilienceCHANGES’ IMPACT ON RESILIENCE

Shocks are inherent to Karamoja nutrition system – cause negative changes in facility, community, household and for an individual.

Negative changes in Karamoja nutrition system are caused by many small shocks , a few medium shocks and rare big shocks.

Each shock challenges the nutrition systems capacity to cope.

Many shocks to the nutrition system synergistically combine also combine with stresses to challenge development progress.

PROPOSED DEFINITION FOR NUTRITION RESILIENCE IN KARAMOJA

Nutrition Resilience could be described as being achieved when a person, population or system has the capacity to mitigate, adapt and transform in response to shocks and stresses without long term impact on their nutritional status.

Measuring

Resilience

Change for nutrition can also be measured by looking at anthropometric indicators.

GAM and SAM are most changeable and easily measured so can also be used for yearly monitoring of progress.

Example goals:

Reduce 5 year variability of GAM and SAM from 18% and 8% by half to 9% and 4% respectively.

Reduce average annual variability in GAM and SAM from x% and X% by half to x% and x% respectively.

Measuring Change

Development Pathways, Shocks, Stresses.

Population in Karamoja experiences constant stresses (chronic) on their development pathway.

Also experience regular shocks (acute) e.g. drought.

Long term trends in either indicator indicate long term trends in nutrition system represented by the causal framework.

Therefore, trends in chronic and acute undernutrition can be used to measure longer term impact of resilience programming.

Nutrition Resilienc

e Program

ming

Combination of three types of programming at district, facility and community levels:

Chronic Nutrition Insecurity – Positive development pathway. (reduction of impact of stresses)

◦ Nutrition system strengthening, community based nutrition, facility based nutrition services, Nutrition Sensitive and Specific programming. = good programming.

Acute Nutrition Insecurity – Reduce negative impacts of shocks on development pathway.

Emergency – Respond to large extra-ordinary shocks to save lives.

◦ General Food Distribution, Cash transfers, emergency OTPs and SFPs, mass screening.

SO WHAT ARE NUTRITION RESILIENCE INTERVENTIONS?

Acute Nutrition Insecurity Models

Facility Based Surge Models. Small and medium shocks happen at a local level affecting one or a group of Health Facilities offering Nutrition services. (idiosyncratic)

A shock on the facility causes challenges to the facilities nutrition services to cope. Usually this involves an increase in numbers attending the service producing challenges to:

Human resources availability and capacity

Supply Resources

Space

The challenges result in reduced quality and coverage of the service.

The facility surge model uses data and thresholds on admissions and capacity to monitor a shocks effect on the system and to predefine the response of the health facility and the DHT and external stakeholders.

Facility Based Surge Models.

Facility Based Nutrition Surge Model in Karamoja.

AcuteNutrition Insecurity Models

Community based nutrition programme:Integrated (specific and sensitive)Prevention + Promotion,Referral and follow up.In process of being defined in Karamoja. Work in progress.Capacities and vulnerabilities, barriers and

promoters etc. Formative research.MethodologiesLinkages

To adapt for Acute Nutrition ResilienceRisk InformedContext specificCapacity basedE.g. Diarrhoea

COMMUNITY BASED MODELS

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