review, lessons learnt of and recommendations the global ... · review of global nutrition cluster...

Review lessons learnt of and recommendations

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

Mija-tesse Ververs Independent Consultant

Review of Global Nutrition Cluster tools ndash July 2009

Acknowledgement This report was prepared by Mija-tesse Ververs independent consultant based in Geneva (Switzerland) for the United Nations Standing Committee on Nutrition (SCN) A specific note of appreciation is extended to Taru Saloheimo 4th year student in Nutrition Science at the University of Helsinki who assisted in this review as an intern for SCN Also a special lsquothank yoursquo need to be given to Leah Richardson for her very useful contributions during the peer review A special recognition also goes to Kaia Engesveen and Marzella Wuumlstefeld from SCN for being so helpful during the process of the review The preparation of this document would not have been possible without all those 83 people who took time to respond and share their experiences for this review Their inputs were instrumental for the successful completion of this study This review was funded by the Global Nutrition Cluster

2


Abbreviations ACF Action Contre La Faim ADPC Asian Disaster Preparedness Centre CDC Centers for Disease Control and Prevention CMAM Community Management of Acute Malnutrition ECHO European Commissions Humanitarian Aid Office ENN Emergency Nutrition Network FANTA Food and Nutrition Technical Assistance FAO Food and Agriculture Organization GNC Global Nutrition Cluster HC Health Cluster HNTS Health and Nutrition Tracking Service HKI Helen Keller International HQ Headquarters HTP Harmonised Training Package IASC Inter-Agency Standing Committee ICRC International Committee of the Red Cross IEC Information Education and Communication IMC International Medical Corps IRA Initial Rapid Assessment NAG Needs Assessment Group NC Nutrition Cluster NGO Non-Governmental Organization NiE Nutrition in Emergency NiETK Nutrition in Emergency Tool Kit OCHA United Nations Office for the Coordination of Humanitarian Affairs SCN Standing Committee on Nutrition UN United Nations UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Childrenrsquos Fund WFP World Food Programme WG Working Group WHO World Health Organization WVI World Vision International

3


Contents Acronyms and Abbreviations 3 Executive Summary 5 1 Introduction 7 2 Brief description of the tools 8 3 Methodology 10 4 Findings 11 41 Participants 11 42 Awareness and Use of tools 12 43 The Initial Rapid Assessment Tool (IRA) 13 431 The utilization of the IRA 13 432 The process of compiling the IRA 14 433 Conclusions 15 44 The Nutrition in Emergency Tool Kit (NiETK) 15 441 The utilization of the NiETK 15 442 Conclusions 16 45 The Harmonised Training Package (HTP) 16 451 The utilization of the HTP 17 452 Some results from pilot testing the HTP 19 453 HTP as a tool for training and capacity building 20 454 Conclusions 21 46 Previous Findings lsquoFuture Directions Questionnairersquo related to tools 21 47 Impact of tools on strategic areas of focus of the Global Nutrition Cluster 23 48 Ownership hosting and maintenance of tools 25 49 Dissemination of tools 26 491 How tools were disseminated 26 492 Lessons learnt on dissemination of tools 27 493 Responsibility for dissemination 28 494 How tools should be disseminated 28 410 Development of other tools 29 5 Conclusions 32 6 Recommendations 34 61 Recommended use of the IRA 34 62 Recommended use of the NiETK 34 63 Recommended use of the HTP 34 64 Recommendations for Country Regional and Global levels 35 7 Annexes 37 Annex A Terms of Reference Review lessons learnt of and recommendations on the use of products developed by the Global Nutrition Cluster 38 Annex B Names and Contact details Participants 40 Annex C Questionnaire for HTP trainees unable to be interviewed by phone 53 Annex D Objectives of inter-agency Needs Assessment Group 55

4


Executive Summary In 2005 the Cluster Approach was established by the Emergency Relief Coordinator and endorsed by the Inter-Agency Standing Committee The Nutrition Cluster (NC) is one of 11 global clusters 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) - The Assessment WG that in collaboration with the Health and Wash Clusters developed an Initial Rapid Assessment Tool (IRA) The 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 The review evaluated through analysis to what extent the tools were used what was feasible to do with them how they should be adopted how they could maintain their relevance as well as how to generate support to use tools produced by the WGs 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 - in emergency nutrition Additionally people were included if they had specific attributes for this review (Sphere process HTP trainers contractors for HTP etc) Twelve out of 14 countries where formally the Nutrition Cluster was activated were included in the review The review found that approximately 20 of the participants had never heard or heard but not seen any of the tools This was similar for each of the toolsThe most prominent weakness of the tools appeared to be that there was limited awareness on their existence amongst some key actors working in or with countries with an active nutrition cluster This was caused by a lack of a good dissemination strategy to date and was not a reflection of their usefulness Those that knew of the tools and used them appreciated their quality and potential The IRA tool was appreciated as having brought sectors and different types of information together in one document It particularly served as a reference function for existing or the compilation of new assessment tools The current IRA will have limited use as such until it is adjusted to specific countryemergency contexts The NiETK was particularly used at the country level by cluster members including Governments It was well appreciated as an advocacy tool on nutrition-related interventions with (non-technical) managers It has great potential to guide health professionals in emergencies From those review participants that were aware of the HTP many used it as a training support tool or as a handbookreference guide in different ways The tool was considered to be of good quality and to be comprehensive Incorrectly the HTP was positioned as a comprehensive training package In fact it was lsquoonlyrsquo a tool to use during trainings and needed additional materials to make it a training package The tool has large potential when used as a support in larger capacity building strategies on NiE

5


The value of both NiETK and HTP depend partially on how congruent they are with the most recent guidelinesprotocols and state-of-the-art practice and views The tools contributed mostly to focus areas of a) Capacity Building and b) Emergency Preparedness Assessment Monitoring Surveillance and Response Triggers) of the GNC 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 which came with many lessons learnt Though the tools served their own purpose in different contexts and on different levels (global regional in-country) their use on regional level was marginal The review found that it was slightly too early to show in depth how people used the tools and what their impact was However the review was timely by evaluating the processprogress to date and guiding the roll out and to further plan the activities of the WGs The review concluded with recommendations for the use and roll out of each tool as well as for stakeholders working in nutrition on global regional and national level To date all tools deserve the lsquotest of timersquo and are of sufficient quality to justify their use in NiE work in or outside a NC context

6


1 Introduction In 2005 the Cluster Approach was established by the Emergency Relief Coordinator and endorsed by the Inter-Agency Standing Committee The Nutrition Cluster is one of 11 global clusters established and Unicef has the lead As of 1 January 2009 the responsibility of the Global Nutrition Cluster (GNC) approach shifted to the Nutrition Cluster lead agency Unicef that continues GNC as part of its core programming The current GNC role evolves from the existing activities centred around improving emergency response to supporting countries transitioning into recovery and improving emergency preparedness In 2007 two Working Groups (WGs) were established within the GNC 1 The Capacity Development WG was comprised of 16 cluster member agencies who were committed to a collaborative effort for building local and international capacity to response to nutrition in emergencies This WG produced a Nutrition in Emergencies Toolkit and a Harmonised Training Package 2 The Assessment WG was comprised of 15 cluster member agencies who were committed to a collaborative effort for improving information management and collection in emergencies This WG has in collaboration with the Health and Wash Clusters developed an Initial Rapid Assessment Tool The next chapter provides a brief description of the tools To continuously improve the functioning of the Nutrition Cluster and its projects and products a review by the Standing Committee on Nutrition (SCN) was commissioned in early 2009 to look at the Initial Rapid Assessment Tool (IRA) the NiE Toolkit (NiETK) and Harmonised Training Package (HTP) (Annex A)The objective was to identify lessons learnt gaps and impact of the use of products of the WGs in areas of strategic importance to emergency nutrition response and preparedness The review evaluated through analysis to what extent the tools were used what was feasible to do with them how they should be adopted how they could maintain their relevance as well as how to generate support to use tools produced by the WGs Where it was possible the review looked into the impact on affected populations when the tools were used

7


2 Brief description of the tools This review looked at the following three tools Initial Rapid Assessment tool The IRA is a tool that assists in the process of rapid assessments It should be initiated after the onset of a new sudden-onset crisis (within 72 hours maximum 1 week) and the whole process including analysis and preparation of a report should be completed within 1 to 3 weeks An IRA may also be undertaken when an area in an ongoing conflictcomplex emergency becomes newly accessible or in a protracted emergency affected by a sudden additional shock or deterioration in conditions The purpose of the IRA is to provide a rapid overview of the emergency situation in order to identify the impacts of the crisis make initial estimates of needs and define the priorities for humanitarian action in the early weeks of response It should answer the following core questions 1 What has happened Is there an emergency situation and if so what are its key features 2 How have the population and essential services been affected Who are worst affected and likely to be most vulnerable Why How many people are affected Where are they 3 Are interventions required to prevent further harm or loss of life If so what are top priorities 4 What continuing or emerging threats could escalate the emergency 5 What resources and capacities are available What are the most important immediate capacity gaps 6 What are the key information gaps that should be addressed in follow-up assessments The IRA consists of a data collection form an associated aide meacutemoire and an Excel-based IRA data entry and analysis software In addition there are guidance notes that are intended to help people involved with an IRA prepare for organize and carry out an IRA and analyse the data collected to make essential decisions on immediate response funding andor follow on assessments The IRA was finalised in March 20091 Nutrition in Emergency Cluster Toolkit The NiETK is intended as an easy-to-use field guide that outlines the key basic interventions for nutritional support to individuals and groups during an emergency situation It provides the what why when and how for different nutrition interventions including basic monitoring benchmarks and expected standards The Toolkit offers guidance and support for nutritionists and humanitarian workers to ensure that basic guidelines are followed and the basic nutritional needs of populations in emergencies are met It is not intended to be an exhaustive resource for each intervention presented but rather an overview for interventions to be considered with references and links to more detailed technical guidance for each issue The NiETK was finalised in June 20082 1 Website httpwwwhumanitarianreformorghumanitarianreformDefaultaspxtabid=75 2Website httpwwwhumanitarianreformorghumanitarianreformPortals1cluster20approach20pageclusters20pagesNutritionGlobal_Nutrition_Cluster_Nutrition_Emergencies_Toolkit_June_2008pdf

8


The Harmonized Training Package The Global Nutrition Cluster (GNC) in partnership with NutritionWorks as one of several capacity development initiatives undertaken by the GNC has developed a Harmonized Training Package (HTP) for Nutrition in Emergencies The need was based on the fact that various organisations used different training materials with different messages and there was a need for harmonising this The HTP materials cover a broad range of subject areas concerned with nutrition in emergencies in order to meet the differing needs of Governments and international agencies in different contexts Based on priority capacity gaps in nutrition in emergencies 21 areas were identified as training modules for inclusion in the training package Each module is comprised of four sections i) briefing paper for senior decision makers ii) technical notes for practitioners iii) trainers guide and iv) reference materialsources The HTP was finalised in October 20083

3 Website httpwwwhumanitarianreformorgDefaultaspxtabid=488

9


3 Methodology The focus of the reviewrsquos methodology was on interviewing people who were selected through their engagement (in their current or previous function) - in cluster work at country level - at regional level with a link to cluster work in countries - in GNC work - in emergency nutrition Additionally people were included if they had specific attributes for this review (Sphere process HTP trainers contractors for HTP etc) The period of interviews comprised 6 months People were encouraged to speak freely with confidentiality and no direct quotes were to be used Secondary information sources such as meeting minutes evaluation reports of pilot studies GNC survey questionnaire cluster websites etc were used to cross-check findings if relevant The review evolved around six questions bull Who is using the tools (and when why and how) bull What is the impact on the four strategic areas of focus of the GNC bull What action points have been taken in order to roll out the use of the tools in order to reach the maximum audience and effectiveness bull The existence and lsquoroll outrsquo of other but similar kinds of Cluster working group tools and identify successes in their usefulness bull Who or what benefits from the use of the tool bull Is there a need for further development of (other) tools by the working groups Despite the fact that this review was not an appraisal of any training it examined evaluation material of training courses that used HTP in 2008 and trainees were interviewed from Uganda Sri Lanka Zimbabwe and Somalia Interviews were done by phone with relevant stakeholders and the total number of participants was 834 The IRA was being finalised during the time of this review and became available in its final version by March 2009 However there were numerous older (more elaborate) versions available in the last two years and the interviews referred mostly to those previous copies (not the one available now on the website) The HTP and NiETK versions that were evaluated are more or less similar to the current website versions (see chapter 3 for a brief description) and are also available on the GNC website 4The original terms of reference proposed the analyses of one or two specific country case studies (for example Myanmar Somalia or Uganda) with particular focus on the WG products in the setting where the Cluster Approach has been implemented As tools had been used on a limited scale there were insufficient reasons to justify the travelling costs related to compiling these case studies This decision enabled the review to double the number of people interviewed for the review as more resources came available to broaden the interview audience

10


4 Findings 41 Participants In total 83 people were interviewed Interviews lasted on average between 45-60 minutes (90 between 30-70min) Sixty nine people were interviewed (66 by phone 3 by face-to-face) on the use of all three tools Additionally 14 people were questioned on the HTP only They were selected because they had been trained on nutrition in emergency (NiE) and HTP was used as support material From those 14 people 6 were unable to be interviewed by phone but responded using email to a questionnaire (Annex C) From the 14 countries where formally the Nutrition Cluster was activated 12 countries were included in the review (only Nepal and the Central African Republic were not included because people could not be reached) Table 1 provides an overview of the organizational background of people interviewed Annex B contains a list of all review participants with their contact details Table 1 Overview of the organizational background of people interviewed Organization Numbers Non-Governmental Organization (NGO) 10 Country Cluster coordinatorsfocal points 10 Other Unicef staff (nutritional advisers on country (mostly) Regional Office and HQ level)

10

Global Nutrition Cluster staff 3 WFP WHO UNHCR FAO 7 Clusters ndash Wash Health Shelter 5 OCHA 3 National Government 3 Universities 6 Donors 2 Technical Agencies (CDC ENN HNTS FANTA)

5

HTP trainees (based in Asia and Africa) 14 Miscellaneous ndash NutritionWorks ICRC Sphere ADPC

5

Total 83 Some people were classified under their former employerposition as they were interviewed for the experience gained with cluster work during that time Some people declined participation for the review as they had never heard of these tools In the end the study did include a few of these people as participants

11


42 Awareness and Use of tools The review looked at the awareness and use of the tools amongst the participants The 14 that were interviewed specifically as trainees of the HTP were not included since their introduction to the tools differed from the average population Table 2 shows how well people were aware of the tools and how they used them Under category lsquonot applicablersquo few people were included as they were not working in the field of nutrition (anymore) or were involved in making the tools as consultants Where appropriate the review participants were asked whether they had heard of any of the three GNC tools seen or used them Approximately 20 of the participants had never heard or heard but not seen any of the tools This was similar for each of the tools In terms of usage the IRA was the least used Almost one-third of the review participants used NiETK and HTP in a wider work environment (either in their own organization or with partners) Some people worked as co-chair in Nutrition Cluster (NC) meetings but had never seen or heard of certain tools Some did not know of the existence of the website either whilst being cluster coordinator The fact that interviews were scheduled for this review made various people search for those tools (which caused lsquounintentionalrsquo awareness of the GNC tools) Table 2 Awareness and use of tools (n=69 persons)

-5

10152025303540

na never heardof tool

heard of butnot seen

seen but notused

used exclfor

himherself

used inbroader

workenvironment

Per

cent

age

of P

eopl

e

IRANiETKHTP

Some organizations did not use the tools because of already existing tools developed by their own organization or Government The use also varied because of the difference in lsquoendorsementrsquo of these tools within an organization Headquarters (HQ) of strongly decentralized organizations had little lsquopower of endorsementrsquo to use GNC tools at field level If the country cluster andor the Government were not using these tools organizations in the field had little influence or interest in using the tools for their work Some organisations were particularly positive on the process of making the tools in their lsquoalliancersquo work With an increasing demand on having standardized approaches across lsquoalliancersquo partners or international lsquosisterrsquo organisations organisations were able to harvest from ground work of the GNC The attempts that were made globally by the cluster working towards a

12


common tool spared time for alliance partners who would have needed to do the same The GNC tools that were developed were well-regarded had global consensus and alliances did not have to go through the whole process themselves to create a similar tool In the following section more detailed findings are described for each of the tools 43 The Initial Rapid Assessment Tool (IRA) The final version of IRA was completed in March 2009 Most people that were interviewed for this study refered to older much longer versions of the IRA (those versions were pilot tested in 6 countries5) As opposed to the former version the current one contains a strategy of analyses and an excel data sheet that provides automatic results for reporting This additional data tool was developed by information and technology experts and questions from previous versions were adjusted to make them interpretable and codable When data is entered now an automatic report (ie transformation of data from boxes ticked off) will appear amongst others in bar charts 431 The utilization of the IRA Many people that had seen the IRA stated they shared versions with their colleagues The utilization of the IRA can be categorized as follows bull The IRA was used by organizations (NGOs UN donor) to cross check and to update their own institutional assessment tools bull The IRA was used by organizations as a checklist during a rapid assessment bull The IRA was used by Governments and cluster members bull The IRA was shared but discarded for use An illustration The IRA was sent to various countries In some cases a country had already a common or a formal Governmental rapid assessment tool and disregarded the IRA (eg Democratic Republic of Congo Ethiopia) However in other cases the IRA was used to improve their existing ones (Governmental cluster related) or a new one was created (egSri Lanka Somalia Myanmar Zimbabwe Philippines) In two cases the IRA was used as such with some country adjustments (eg Kenya Darfur in Sudan) Note in Ethiopia they plan now to re-examine at their assessment tool and possibly use (parts of) the IRA Some people claimed that the IRA was used as a base for the McRAM in Pakistan6 The IRA was seen as useful in any acute (new) emergency or during a flare up of an old emergency It was felt not be useful in countries with more slow onset and chronic emergencies (as in parts of West or East Africa) Those that had not used the IRA themselves were positive on 5 The Democratic Republic of Congo the Central African Republic Ethiopia Chad Sri Lanka and Colombia 6 The IASC in Pakistan has developed a multi-cluster rapid assessment mechanism (McRAM) for emergency data collection to determine immediate needs of the affected populations The mechanism has been activated several times in 2008 following a cyclone floods conflict related displacement and an earthquake In the latter case the Government has adopted the McRAM results for official reporting and data has been essential in formulating inter-agency funding appeals including the UN Central Emergency Respond Fund for the humanitarian response

13


its potential for their countries and claimed that they would use it as a reference in their future work Some people questioned whether the purpose of a rapid assessment within the first 72 hours was actually reached with (the older version of) the IRA Review participants were divided on whether the IRA was too complex for generalists or not Some regarded it as weak on food security and livelihoods issues Those that had seen the latest March 2009 IRA version mentioned that is was possibly also too limited on nutrition 432 The process of compiling the IRA The process of compiling the IRA was as important as the tool itself and needs particular mentioning It started in 2006 with the Assessment WG of the GNC taking the lead When almost lsquoreadyrsquo a meeting was organized by the Assessment WG to share the tool and advocate amongst the Health Shelter and Wash Clusters for a more multi-sectoral tool After almost 3 years of reworking the IRA was finalized in 2009 with endorsement from GNC and Health Cluster (HC) The Wash Cluster supported the tool if country clusters wanted to use it but did not intend to promote it actively OCHA had an ambiguous engagement in the development of the IRA from the very intiation of the process It was long unclear where and who within OCHA was going to deal with the portfolio of rapidneeds assessments and this was only clarified in late 2008 Whilst the Wash and Shelter Clusters were waiting for OCHA to lead the IRA within a multi-sectoral approach the HC and GNC proceeded OCHArsquos engagement in the IRA never came The review participants regarded the process as ambitious and almost as a lsquomission impossiblersquo to develop a multi-sectoral tool with so many stakeholders ie various clusters with each a large sometimes divided constituency Many people became frustrated as different versions kept coming and it was confusing on who had the final say on the tool Chairs of WGs were bound to serve their constituency but at the same time needed to negotiate with the other cluster(s) It was challenging to obtain consensus amongst the members of the GNC Assessment WG on contents of the IRA Once it was obtained it was even more challenging to obtain consensus in the multi-sectoral cluster process with yet more stakeholders When the GNC started to work together with the Health and Wash Clusters the process and timeline were not well laid out The majority of people that had seen (andor used) the IRA found the previous IRA versions too long heavy impractical and there was no clear strategy on analyzing the data that it would obtain Some people perceived that the IRA process started at the wrong end of the stick indicators should have been identified at the onset instead of starting with the formulation of the information people wanted to obtain Despite the fact that many people regarded the IRA creation as a process full of hardship many appreciated the process as such The fact that a multi-sectoral audience was able to dialogue on common tools and that people tried to mainstream questions was welcomed

14


One participant of this review was explicitly positive on getting more insight into how people (both from HC and GNC) perceived certain nutritional sections It gave her better understanding as to how colleagues approached her specific field of interest and she used that to her advantage for communication purposes One person used the process as a didactic example of multi-agency collaboration Review participants were divided on the concept of whether it is possible or not to have one common multi-sectoral assessment tool but most were hopeful Retrospectively the process could have gained from the process the SPHERE project used in compiling multi-sectoral standards in a multi-agency context The process should have been mapped out at the onset in detail with clarification on end responsibility and decision taking power The facilitation role should have probably been played by non-technical people with limited stake in the actual products Facilitation should have done (as was done with the SPHERE project) by dedicated project negotiators with a role of leading the process and the various stakeholders 433 Conclusions The IRA tool was appreciated as having brought sectors and different types of information together in one document Most people found the process cumbersome and lost some interest in the tool From the onset the process of drafting the IRA was unclear in terms of timeline phases and decision taking power of various stakeholders and failed to identify the needed indicators immediately at the beginning People that used the tool as an aid for their specific purposes and harvested from it in different ways found it beneficial It served particularly a reference function for existing or the compilation of new tools It was seen also very useful for new acute emergencies There was no consensus on whether the nutrition part is too limited in the March 2009 version 44 The Nutrition in Emergency Tool Kit (NiETK) The NiETK was disseminated in June 2008 and was a result of joint forces from members within the Capacity Building WG The review participants did not raise any specific issues on the process of compiling the tool 441 The utilization of the NiETK The NiETK was regarded by most people as good lsquoone-stoprsquo reference tool and a quick summary of technical nutritional issues for mostly non-nutritionists eg decision makers desk officers generalists field workers It was seen as the only available package showing key interventions and was regarded as very user friendly comprehensive and concise It was considered not to contain necessarily new information but because key issues were compiled together this lsquoone-stoprsquo concept was appreciated The tool was seen as complementary to the HTP A few review participants stated that NiETK became obsolete with the existence of HTP or saw NiETK as a lsquomini-HTPrsquo Most people tended to disagree albeit that some acknowledged some duplication

15


The utilization of the NiETK can be categorized as follows bull The NiETK was used as guidance documents by donors UN and NGOs to inform their staff (eg managers field staff programme designers) bull It was used as advocacy documents by and for NGOs UN and Governments especially for senior managers bull It was used for individual professional guidance (esp on interventions such as severe and moderate acute malnutrition infant and young child feeding micronutrient deficiencies) bull It was used to upgrade and update country protocolsguidelines for and by UN NGO Government and Nutrition Clusters such as in the Philippines Kenya Liberia Somalia Ethiopia7 Zimbabwe and Myanmar bull It was used for training of non-nutrition staff particularly health staff (eg doctors nurses midwives) Some people regarded the NiETK as an under-utilised tool and specifically advised to advocate for use of this tool especially amongst health professionals Some stated that is was too restrictive on food security and livelihoods A few mentioned that it needs additional Information Education and Communication (IEC) material and explanatory flowcharts in order to facilitate and increase its use 442 Conclusions The NiETK was particularly used at country level by cluster members including Governments It was well appreciated as an advocacy tool on nutrition related interventions with managers It was valued as a tool to upgrade country protocols and guidelines The tool has potential to be used more widely outside the NC where it is not sufficiently known Advocacy for the tool to be used by health professionals is needed 45 The Harmonised Training Package (HTP) The HTP was developed for the GNC by NutritionWorks over a 15 year period and peer reviewed by select GNC members and external experts The collaborative approach was appreciated as well as the peer review The process brought a certain feeling of ownership Some stated that without this concerted multi-partner effort no single organization could have done this With access to so many minds and so many agency resourcespackages the HTP consolidated a lot of experience and knowledge It was piloted in various countries in 2008 in order to incorporate user feedback before the finalization of the package As the version used during the pilot did not differ much from the finalized version a specific chapter is dedicated to the pilot findings with a particular focus on the tool (chapter 472) It is not possible to speak about the HTP whilst not also taking into account the context of training (chapter 473) 7 Planned to use it for national guidelines

16


451 The utilization of the HTP The review could clearly distinguish three purposes for the utilization of the HTP - a referenceguide book or handbook with lsquothe-state-of-the-artrsquo knowledge on NiE - a support tool for a training on NiE and sometimes - a tool to be used as part of a larger capacity building strategy on NiE The HTP was bull used as a base for training potential HC coordinators bull used to upgrade and update their knowledge as it was regarded as lsquothe-state-of-the-artrsquo knowledge bull used in Bangkok for institutional training and capacity building in the region by Unicef (with plans for West and East Africa) bull used for internal non-technical staff like managers in the field or at HQ (eg NGOs UN donors Governments) bull used or there are plans to use it to support in-country trainings of operational organizations for their own staff and or partners (eg NGOs UN) bull used for graduate and post-graduate trainings (eg Public Health courses) by institutions in both Northern and Southern hemisphere as well as for summer schools bull used parts for background documents in meetings bull used for training of Governmental staff (Philippines) and plans to use as such (eg Rwanda) bull used and piloted in Sri Lanka Somalia Uganda and Zimbabwe (see chapter 472) bull used as support material for staff bull used as guidance in absence of protocols or to extract from for guidelinesprotocols Similarly to the NiETK the HTP was seen as a lsquoone-stoprsquo document that covered most aspects of NiE The modules were regarded as easy to use independently and of overall good quality If people used the HTP for training they used only a few selected modules Different people liked different components of the package Some especially liked the key messages others more the summaries references case studies or the technical notes Some especially saw potential of using the HTP in regional or country offices if limited nutritional expertise was present Almost everybody that had seen andor used the tool were disappointed that the HTP did not include some generic powerpoint slides and more visual material Two reasons were given for the expressed need of generic slides - to ensure quality (to prevent lsquopeople drifting away from the key messagesrsquo) - to catalyse the use of the modules in their training work by gaining time not having to create them themselves The absence of slides practically meant that some people did not use the HTP for training as creating these slides was considered to be too laborious Some preferred therefore to stick to their own previously designed materials or use materials from other trainings

17


The fact that HTP never included ready-to-use powerpoint slides was a conscious decision taken by the GNC at the time The original idea was that HTP was a source to be used to create a training that would be tailor made for the audience and context Review participants regarded the HTP as a tool mostly focusing on knowledge and to a limited extent on skills Retrospectively people involved in this decision acknowledged that perhaps this was a mistake or that the reasons for not including them should have been better communicated Some people criticized the HTP name as such as it was not a training package but a tool to use within a training If it were a training package people stated it should have had much more didactic materials session plans etc One person preferred to have a clear link to nutrition in the toolrsquos name Many review participants stressed that the HTP was too much Africa focused (both in terms of contextsubjects as well as case studies) For the Asia context more focus was needed on short and quick onset emergencies For the Middle East people desired less focus on severe acute malnutrition A few people emphasized that the HTP was insufficiently taking into account Government perspectives and the materials were limited on Governmentrsquos roles and structures Some review participants pointed out some confusion on FANTArsquos Community Management of Acute Malnutrition (CMAM) guidelines and the HTPrsquos contents on acute malnutrition which they felt needed to be merged or at least linked Most people felt that the level of detail described in the HTP was adequate with only a few people mentioning that is was too simple too difficult or too detailed Some people felt the HTP was a consensus document with too many views and thought it could have been more normative whilst others praised exactly the fact that it was not The majority felt no need for GNC to print hard copies of the HTP Many people stated that if sufficient number of CD-roms were provided it would have a positive impact on the HTPrsquos use However some added that the availability of minimally formatted press-ready electronic versions would be an added value As such the electronic files could be printed by organisations and if desired to reach those in the field with limited printing resources Overall the review participants felt it was more important to keep HTP updated than to resource a lsquosoonrsquo to be outdated package Many expressed the need to have the HTP be updated on MUAC management of moderate acute malnutritionsupplementary feeding growth standards and CMAM Some people expressed concerns about too much focus in the HTP on responsive rather than preventative strategies They regretted that not more was emphasized on mitigation strategies (for example those that were marked in The Lancet Series8) with proven impact They advised to include more on strategies that could be applied and prepared for prior to a response These strategies should address working towards the mitigation of the impact of emergencies

8 httpwwwthelancetcomseriesmaternal-and-child-undernutrition

18


On the question whether there were certain elements missing in the HTP the following areas were stated simulations session plans role plays hand outs more scenarios(including non-African case studies) lessons learnt (participatory) exercises and much more on practical aspects of NiE With regard to the selection of topics covered by the modules everybody was more or less content 452 Some results from pilot testing the HTP The HTP was pilot tested in 4 countries in 2008 (Sri Lanka Zimbabwe Kenya and Uganda) A summary report on this has been published9 For this review trainees were contacted on the impact of training on nutrition in emergencies and whether the training had an impact on the traineesacute work (see chapter 41 and Annex C) Fourteen trainees participated in the review from 10 different countries Most of them had 2 to 6 years of work experience in nutrition in emergency The main issues brought up by the participants are presented in the Table 3 Table 3 Results of trainee interviews concerning Increase in knowledge and application of new knowledge in the work

- Ten people stated that the training was a good refresher for them and that they got a stronger basic knowledge in nutrition in emergency

- Nine people named specific areas of knowledge improvement - Six people stated that they had improved ability to implement programmes - Four people stated that their ability to train others improved - Three people stated they had improved skills and knowledge with regards to

international and national quality standards monitoring and evaluation tools for capacity building of partners organizing and analysing nutritional data

- Two people mentioned constraints in applying the new knowledge at work (related to insufficient staffing of the Nutrition Unit in the Ministry of Health lack of collaboration with partners lack of materials needed)

- One person stated that heshe used the training material to train other colleagues On the question how the training could have been more useful to the trainee half of the participants mentioned the inclusion of field visits and practical training sessions Nearly one quarter of the participants would prefer that the training be conducted by trainers with more practical experience in the field and who are not too theoretical and academic An illustration

- Practical and hands on was not done at all The kind of people whose capacity was built needed a practical experience in nutrition in emergencies (Ministry of Health person trainee)

- The training was provided by the academicians who have no sufficient practical experience in undertaking nutrition intervention in emergency situations (UN person trainee)

Two participants mentioned that the sharing of experiences across countries was very important

9 Nutrition in Emergency Training Modules Piloting Overall Summary httpwwwhumanitarianreformorghumanitarianreformPortals1cluster20approach20pageclusters20pagesNutritionNiE20Piloting20-20Summary20reportdoc

19


All trainees interviewed judged the training to have been useful for them It seems that the pilot trainings contributed mostly to increased knowledge rather than skills 453 HTP as a tool for training and capacity building The HTP name was misleading and some people perceived mistakenly the HTP as a training course (see Figure 1) However it was (and is) seen as a tool with huge potential for training and subsequently for being a part of a broader capacity building strategy on NiE Figure 1 The place of the current HTP within a broader capacity building strategy on NiE

Capacity building on NiE

Training on NiE

HTP tool

The review found a strong support amongst various national institutionsuniversity networks in Africa Middle East and Asia to use the HTP within their curricula for expanding NiE expertise in regions and countries As such the HTP facilitated the work of the NiE Training Network a newly formed international network which aims to improve the quality and quantity of nutrition in emergencies training in emergency-affected countries and regions Their first inaugural workshop was held in April 2009 Many review participants were particularly excited about this network improving national response capacity using HTP as one of the resources It was felt as a gap that to date not enough universities in Africa or Asia incorporate NiE in their curriculum in order to build up a national base of qualified personnel Half of the people that had seen andor used the HTP expressed caution on what it could do Many who used it for training acknowledged that it should be part of a much larger capacity building strategy and that knowledge gained from HTP was no guarantee for good practice after the training Everybody agreed that one lsquoHTP trainingrsquo could not bypass years of training and experience Some felt that the HTP was lsquojust some materialrsquo and that application through practical experience interactive learning discussions etc were all needed to get the optimal results namely building capacity on NiE There were strong concerns on the impediments in the environment of the trained practitioner to apply knowledge and the lack of opportunities to

20


practice in real life settings Therefore some suggested to accompany the training using the HTP tool with - practical (including lsquobed sidersquo) training andor - internships in organizations with mentors ensuring that the learners get to learn what they need In the Philippines substantial effort was made to accompany the HTP during a NiE training with as many scenarios practical learning role plays etc as possible to simulate more real life settings Some people expressed their interest in creating an online training on NiE using the HTP However the online course would be yet another (training) tool with possibly limited impact on skills and practice change in NiE Therefore some questioned the usefulness of such an online course 454 Conclusions Most review participants were aware of the HTP and many used it as a training support tool or as a handbookreference guide in different ways The tool was regarded of good quality and comprehensive The absence of generic powerpoint slides negatively impacted on the extent of its potential use Though people saw the value of HTP for training purposes they did not regard it as a training package despite its name For that some basic support materials still have to be developed The majority did not see the need for making costs to have printed HTP versions They preferred to use financial resources rather for its regular update The value of the HTP depends partially on how congruent it is with the most recent guidelinesprotocols and state-of-the-art practice and views 46 Previous Findings lsquoFuture Directions Questionnairersquo related to tools In October 2008 as part of a different review the GNC team distributed an online lsquoFuture Directions Questionnairersquo to all cluster partners and colleagues through the extensive GNC mailing list Participants were invited to respond to a series of questions to examine from a wider perspective the possible role and responsibilities of the GNC in 2009 and beyond These series of questions and the responses received were meant to help guide the GNC as to how best to promote the network that has been created by the GNC in the past few years The questionnaire had a total of 35 questions covering the areas of respondent background meetings WGs focus areas for the cluster support to countries structure of the cluster resources for the cluster partnerships and communication There were a total of 87 review participants of whom approximately half were from United Nations (UN) agencies one fifth were NGO respondents and the rest were respondents from academic organizations technical groups individuals and others10 There were two questions in the lsquoFuture Directions Questionnairersquo relevant to review of GNC tools and are discussed below

10httpwwwhumanitarianreformorghumanitarianreformPortals1cluster20approach20pageclusters20pagesNutritionGNC20Future20Direction20Questionairre20Report20Finalpdf

21


Question 31 Do you agree with the statement that inter-cluster coordination has been important in the development of shared tools such as the multi-sectoral immediate needs assessment tool (IRA) A majority of review participants somewhat agreed or strongly agreed with the statement that cluster coordination has been important in the development of shared tools Review participants from the technical group (n=5) had the most positive opinion whereas review participants from NGOs (n=14) gave the least points to the question (Figure 2) Figure 2 Scoring of questions by organization type Do you agree with the statement that inter-cluster coordination has been important in the development of shared tools such as the multi-sectoral immediate needs assessment tool (IRA) (N= 71)

Strongly disagree 1 somewhat disagree 2 neutral 3 somewhat agree 4 strongly agree 5 Question 21 What suggestions do you have to strengthen support to country emergency preparedness and response This was an open-ended question about NC support to countries that had some relevant answers about existing NC tools or developing new tools Two comments of interest are shared below A respondent from technical group stated that the tools should be more adaptable to field circumstances The technical leadership cannot be driven from HQ because as we saw with the IRA tool such a tool becomes burdensome and not tailored to the needs on the ground Instruments and tools provided from the global cluster to countries should take the form of a toolbox from which countries can easily choose and adapt to suit field realities Also national institu ions (eg disaster preparedness in health or other ministries) should be involved at the highest level in these activities

t

Another respondent from technical group recommended to continue rolling out tools and to make sure that country level is aware of them Deliver on priority areas identified in the capacity development strategy Continue to roll out the tools and resources developed by the global cluster which will strengthen preparedness and capacity for response provide clarity for the country level about the tools and resources now available advocatecreate the demand for their use and provide the resources (technical financial)

22


47 Impact of tools on strategic areas of focus of the Global Nutrition Cluster

There are four main strategic focus areas of the GNC as shown in Table 4 Table 4 Overview of four main strategic focus areas of the GNC (1) Coordination organisations often focus on one or parts of the underlying causes of under-nutrition often without coordination Part of this is due to a lack of leadership among the normative agencies and part is the lack of incentives to work together as agencies compete for diminishing funds and position Defined and measurable goals with negotiated strategies and benchmarks to achieve these goals will provide the basis to coordinate (2) Capacity Building changing needs combined with mobile technical staff and often depleted national capacity strongly suggests that to have a predictable standardised and sufficient response in emergencies requires a strategy that understands the needs organizes the materials and is flexible enough to start to meet the needs

(3) Emergency Preparedness Assessment Monitoring Surveillance and Response Triggers At the onset of a humanitarian disaster there is a need for

- Further development of clear and unambiguous internationally accepted criteria to classify the different types of a nutrition emergency

- Clear standards to guide the response including eligibility and exit criteria

- Transparent processes and accountability that are established and supported by all stakeholders

- A commonly agreed upon methodology for data collection (what to collect from whom by whom) and a process for analysis interpretation and reporting

(4) Supply Too many examples exist of humanitarian response delayed by a lack of appropriate supplies Stockpiling supplies facilitating in-country procurement and clarifying operational procedures for procurement would greatly remedy this gap The selection of products hampers response especially in the area of the recently developed special foods such as Ready to Use Therapeutic or Supplementary Foods

All tools contributed to the four main focus areas albeit not all directly The IRA (as a generic or adjusted version) is meant to provide lsquoa commonly agreed upon methodology for what to collect from whom by whom and a process for analysis interpretationrsquo if used in-country by the various actors and therefore particularly contributed to focus area 3 Emergency Preparedness Assessment etc It also contributed indirectly to areas of Coordination and Capacity Building (if rolled out well) Both HTP and NiETK contributed to focus areas Emergency Preparedness Assessment etc and especially to Capacity Building to have a predictable standardised and sufficient response in emergencies The HTP has been instrumental for support to capacity building regionally and nationally through the various trainings provided (both the pilots with HTP as well as other trainings such

23


as the ones in Bangkok and Philippines) Staff in the Cluster countries of Philippines and Somalia claimed that the use of HTP had improved the level of common understanding amongst practitioners and increased sensitivity of programme quality by staff respectively Some strong criticism was given by various people that the tools were insufficiently used as part of emergency preparedness and lsquoonly put out in times of emergencyrsquo This was felt as a missed part in the chain of preparing for and responding to emergencies Some felt strongly that the tools should not be rolled out only in times of emergency but that they should be imbedded gradually in the national response system with the various partners in countries prone to emergency The HTP and NiETK could be seen albeit indirectly as addressing the fourth focus area of Supply as they contribute to clarifying operational procedures for use of products The review also evaluated in-depth contributions of the tools to the Cluster work in general Some of the key findings (mostly on NiETK and HTP) are The tools could (and sometimes already did) contribute to quality improvement (good

practice) of NiE work They would bring in more quality and consistency in (national) programmes11 It was felt that if people were informed or trained in NiE whilst tools like HTP and NiTK

were used it could (and sometimes already did) contribute to harmonisation transparency and standardisation of approaches (and terminology) Colleagues in-country would be better able to work together as they would lsquospeak the same languagersquo and receive the same technical directions The potential of HTP for NiE Training Network use is significant The Training Network

if able to implement their objectives could largely contribute to improvement of NiE globally and therefore better humanitarian response in nutrition People stated that to achieve the above the tools would have to be rolled out widely amongst a large audience People cautioned on the impact of HTP use as it did not guarantee application of good practice and that a completely different process would be needed to ensure this On the new IRA people saw great potential if the results of IRA information would be put online immediately after an initial assessment It would support not only the lead agencies to determine gaps in response and information availability but also inform all other stakeholders Overall the tools contributed to the general mandate of the cluster approach12 in terms of addressing effectiveness partnership and in lsquomaking the international humanitarian community more structured accountable and professionalrsquo Compiling and working with the tools also had strengthened partnerships on all levels

11 They would not necessarily contribute to quality of implementation of actual programming as people felt one would need more for that than these tools 12 httpwwwhumanitarianreformorghumanitarianreformDefaultaspxtabid=70

24


48 Ownership hosting and maintenance of tools The ownership of the tools was not regarded as controversial almost everybody regarded the NiETK and HTP as being owned by GNC This was a more contentious area for the IRA as it was being seen as owned by three clusters Overall OCHA was considered as a good host for IRA as it was perceived as a neutral interlocutor among the Clusters involved When people were asked where the tools should be hosted (ie a place (website) where the latest more updated version should be placed) the majority said SCN GNC or Unicef (Table 5) Table 5 Places of hosting13 the tools with advantages and disadvantages Organisation Advantages Disadvantages SCN neutral delinked with one

particular agency closest to NGOUNCivil Society as a whole group well known website

Currently people question SCNrsquos longevity and capacity

GNC Neutral owner of tools interagency forum

Website not well known for many people not the first place to look for tools

Unicef Cluster Lead Agency for Nutrition should could have resources to host it

Too agency specific not neutral

ENN Technical specialized in NiE good dissemination potential

No links with Governments not always perceived as neutral not always well peer reviewed

OCHA IASC Neutral Not well known by many people

WHO Excellent for reaching health professionals

Less used by nutritional staff cluster lead agency for health sector

FANTA NutritionWorks HNTS

Mentioned only once

The darker the area the more people stressed the organisationrsquos importance to host the tools People identified mostly GNC and Unicef as initiators for updating NiETK and HTP (ie taking the initiative to ensure NiETK and HTPrsquos accuracy) They were also seen as responsible for fundraising for the process of updating as well as leading andor outsourcing the actual updating There was no consensus about which organization should technically update the NiETK or HTP as many were mentioned to be capable to do so (amongst others ENN SCN 13 Hosting defined as being caretaker of it and housing it ie main host for material on website ensuring that the latest version is always obtainable etc

25


NutritionWorks WHO Unicef and CDC) Some review participants mentioned features of an agency that would actually update the tools these included being sustainable reliable lsquofindablersquo trustworthy having capacity and being able to be reached for feedback Review participants preferred to have links to the tools on all websites of the organisationsagencies that are members of the cluster ensuring outreach to a wide audience Unicef SCN and ENN were suggested as good organizations to compile feedback on the tools that would feed in the updating process Seventy percent of the review participants mentioned the desired frequency of updating NiETK and HTP as once every 1-2 years over half of them clearly preferred once per year It was preferred that the updates of NiETK and HTP would occur simultaneously Most people stressed the importance of maintaining both NiETK and HTP up to date and that the current momentum should not be lost This was felt particularly crucial for those that regarded the tools as a reliable document that always contains the latest insight on good practice 49 Dissemination of tools 491 How tools were disseminated There was overall consensus that insufficient effort had yet been made in rolling out the tools HTP was pilot tested in Uganda Sri Lanka Zimbabwe and for Somalia in Kenya In addition a GNC initiated meeting was held in Nairobi in November 2008 and organised by NutritionWorks These events were in itself instrumental for many people to learn of the existence of the tools in particular the HTP During these events CD-roms containing HTP and NiETK were disseminated which was highly appreciated by the review participants During the review if people had the tools many of them shared them with their colleagues in their own organisation but often without any follow up or dissemination strategy Little was done on rolling out NiETK Some HQs had sent them out to regional offices but they were not further disseminated to the field Some HQs assumed the regional offices would use the tools automatically and therefore actively disseminate them further For those organisations without regional offices tools were sent straight to the field with a very lsquotop downrsquo approach and limited results Some NGOs felt they needed a lot of active internal brokering on behalf of the tools One NGO noted the different pace of rolling out of cluster tools from other clusters within their own organisation The new IRA had little visibility amongst the review participants as the finalisation process was ongoing during this review However many people had seen older versions mainly through pilot

26


testing through GNC meetings or by their engagement in working with the Assessment WG of GNC None of the review participants stated they were using tools of other clusters 492 Lessons learnt on dissemination of tools The problems with dissemination can be captured in a few lessons learnt as described below Inadequate linkage between Global Regional and Country levels Through the review it became clear that many people felt there was a failure so far to link - global and country levels - global and regional levels - regional and country levels The review came across people working as a cluster coordinator or a co-chair of nutrition cluster meetings in a country who had never seen or heard of the tools In particular the role of the regional offices on usedissemination had not been strong The review found that some regional offices of Unicef were not informed of the existing tools nor were some of their related country offices (whilst being involved in NC work in-country) A possible explanation of what happened The cluster approach as designed by IASC never really included regional entities The focus was solely on country and global levels Both WHO and Unicef had emergency health or nutrition advisers regionally but they were often not designated for cluster work This meant that the HC and NC needed to heavily rely on global and in-country cluster coordinators for rolling out materials without necessarily the connecting regional chain This was very different for the Wash Cluster for example Unicef did not have emergency advisers regionally (apart from two in the Tsunami affected areas) The Wash Cluster sought funds to install Wash cluster staff ie regional emergency advisers to roll out tools and support clusters in their region This was seen as a vital part of the chain in rolling out the approach and materials These regional Wash advisers were catalysts and connected global and regional levels as well as regional and country levels Tools available in English only Especially for review participants working in Mozambique Chad Madagascar Niger and the Democratic Republic of Congo the absence of the tools in French (and Portuguese) had been perceived as a major impediment for their use This is especially remarkable considering that from the top 10 countries with the highest levels of wasting of children under five years of age (in the period 1996-2005) the availability of tools in French language would have been more appropriate in 6 out of 10 countries (see HTP module 1 Technical notes page 11) Lack of access to implementers on national level

27


The GNC link to implementers of NiE work at the national level was weak There has been no strategy developed on how staff working on national level could be reached systematically Lack of knowledge of GNC website The humanitarian reform website where each cluster including the GNC has its specific site is poorly known Even some of the cluster coordinators were not aware of these sites However if one used the search engine Google and looked for lsquonutrition clusterrsquo the site would come up as the first result Lack of integration of GNC tools in other clusters GNC tools are unkown by many health professionals working within HC apart from the IRA Some review participants regarded this as particularly unfortunate for the NiETK Those participants that worked on health in various countries greatly valued the NiETK for its use in emergency health Some people stated that as WHO often have few nutritional oriented staff the dissemination amongst non-nutritionists was rather difficult and needed a different kind of roll-out strategy A few people saw a big disconnect between the GNC and HC as well as GNC and other clusters on tools design and sharing (with the exception of the IRA) Lack of NC Coordinator trainings To date there have been no specific NC coordinator trainings on nutrition However there have been two tri-cluster trainings where there was a day devoted to Nutrition A specific training could have been essential in awareness raising and utilisation of the tools 493 Responsibility for dissemination The majority of people interviewed found it everybodyrsquos responsibility to disseminate and create awareness of the cluster tools particularly all the 32 GNC agency members The GNC Global Team and Unicef as cluster lead agency were considered to be particularly the key actors for actively disseminating the tools Concerning the IRA people saw also OCHA IASC WHO and the HC as vital disseminators 494 How tools should be disseminated First and foremost people stated that the tools should be translated For NiETK and HTP translation was seen a definite lsquomustrsquo for further roll out and this was not controversial amongst the review participants Languages that were listed as priority included French and Portuguese (and possibly Arabic) Some people suggested to have the tools lsquoendorsedrsquo by IASC and by country clusters Country Cluster Coordinators could then actively push for those tools whilst being given the means to do so People stated that there was a clear need for a budget to disseminate the tools To emphasise the mutual ownership of the tools it was suggested to package the HTP and NiETK under the name of the GNC adding the names of all cluster members

28


Table 6 provides an overview of all suggestions from the review participants on when to whom how and where to roll out the tools There was a particular interest to bring the GNC and the country clusters closer as one participant phrased it lsquo2009 needs to be the year that the disconnect between country clusters and GNC will be narrowedrsquo Table 6 Dissemination of tools When To whom How Where bull Preferably not during emergencies bull As part of emergency preparedness bull Starting in phases with pre-identified countries at risk first

bull Governmental staff bull Field staff (both on capital and field level) bull Country Cluster Coordinators (especially nutrition but also in HC) bull Regional offices bull Organizationsagenciesrsquo own constituency bull Stakeholders in NiE work also in non-cluster countries bull Head of agencies

bull Use andor dissemination to be included in work pans of GNC WGs UN NGOs etc bull Through active marketing bull During numerous different face-to-face interactions through explanation of added value of toolswith active sensitization bull During joint missions bull Ensuring availability of large numbers of CD-roms

bull During a regional cluster meeting (newly organized and hosted by Unicef) bull During meetings such as GNC country cluster meetings SCN meetings bull During International Congress of Nutrition (Bangkok 4-9 October 2009)bull During trainings bull In-country Cluster meetings bull During any nutrition related gathering bull Wide network of website links bull Via Health and Nutrition Tracking Service (HNTS) bull Via newsletters bull In (public) health in emergencies-fora

Additional suggestions on rolling out the HTP were categorized in three ways - via NiE Training Network with academia that will work towards a sustainable way of building NiE capacity through inclusion within Public Health in Emergency Nutritional trainings andor nursemidwifephysicianextension worker trainings (with the possibility of creation of centres of excellence) - through capacity building strategies in countries (selected by GNC based on degree of NiE vulnerability) with the use of HTP (adjusted to country) by Governments local and international NGOs UN and cluster coordinators - via internal capacity building strategies in organisations (eg NGO UN) with or without inclusion of partners such as Government staff (Unicef already having started this in April 2009) Some review participants raised the need for a roster of HTP trainers 410 Development of other tools The study reviewed also the need for other tools that could enable review participants to improve NiE work on country regional and global levels Slightly less than half of the interviewed people responded with suggestions

29


Especially experienced Global Cluster staff raised unanimously the need for tools that would help the cluster process that would bring people together to prepare and respond Such tools should foster better relationships and improve ways of lsquodoing businessrsquo together The tools developed by the Wash Cluster that were found particularly popular included mainly enabling rather then pure technical tools (eg capacity mapping and assessment mapping roles and responsibilities lessons learnt evaluations hygiene promotion and information management) The Shelter Cluster had developed a useful lsquotraining on skills and coordination toolkitrsquo Some review participants that worked within clusters stressed the need for support to improve skills on leadership negotiations coordination and management rather than technical support as most of them were already technically skilled They were more interested in for example how to meet expectations of the role of the NC coordinator the main bottlenecks in their work and how to solve these etc Others stressed the need for tools on monitoring of the nutrition and food security situation in a country (prior to or just after the onset of an emergency) ndash a kind of surveillance They felt there were not enough toolssystems in place that enabled them to keep a close watch on the evolution on the ground prior or after an emergency was declared Table 7 provides an overview of subjects mentioned by the review participants Table 7 An overview of lsquomissingrsquo tools and subjects Mostly mentioned

bull Tools on monitoring of nutrition and food security ndash a kind of surveillance needed to keep a close watch on the evolution on the ground prior to or after an emergency is declared Food SecurityLivelihoods need to be included)(this would also possibly help supply issues) bull Support to improve skills on leadership negotiations coordination management (rather than technical support as most were technically skilled how to meet expectations of role of NC coordinator what are the bottlenecks in this work and how to deal with them what does it mean to be a NC coordinators etc)

Mentioned more than once

bull Extensive and up-to-date roster of trained cluster or NiE staff (for example Wash cluster has a coordinator roster ndash currently 120 trained 92 on roster and regularly deployed) bull Support on prioritization in an emergency what should be done first concerning nutrition and differentiation of this in different contexts (eg floods earthquakes slow onset disasters etc) bull More hardware ndash IEC materials in low resource environments flowcharts based on NiETK messages photos etc

30


Mentioned once

bull Transition from NiE to post-emergency how should programmes be adjusted towards a post-emergency phase how to maintain the lsquonutritional momentumrsquo once created during an emergency and how to evaluate impact of emergency nutrition programmes on long term nutritional programmes bull Support on practically issues what to do in case you run out of nutritional products such as plumpy nut what in case you really need infant formula etc (so-called lsquotrouble shootingrsquo) bull Support in which nutritional product to use in what context bull How to monitor programmeshow to measure performance of your programme bull Support on how to mitigate an upcoming (nutritional) crisis bull More practical on programming ndash how to do eg IYCF concretely bull How to link different programmes bull Linkage to food securitylivelihood in NiE work bull Treatment of malnutrition for infants lt 6 months of age malnutrition and diabetes bull Reporting tools bull More on adult malnutrition treatment bull A comprehensive pocket book on nutrition bull NiE in urban areas bull How to link NiE work more and better with national systems bull Software for emergency nutrition assessment bull Standardisation on feeding centre statistics

The darker the area the more people stressed the need for this It was stressed by a few people to use more existing Ministry of Health protocols and not to disregard regional tools even if they were more difficult to obtain It was also recommended to have new tools only developed if countriesfield requested them GNC could make generic tools if needed those could be adapted to the local context

31


5 Conclusions The review on the tools developed by the GNC was slightly too early to show in depth how people used the tools and what their impact was However the review was timely by evaluating the processprogress to date and guiding the roll out and to further plan the activities of the WGs Approximately 20 of the participants had never heard or heard but not seen any of the tools This was similar for each of the toolsThe most prominent weakness of the tools appeared to be that there was limited awareness on their existence amongst some key actors working in or with countries with an active nutrition cluster This was caused by a lack of a good dissemination strategy to date and was not a reflection of their usefulness Those that knew of the tools and used them appreciated their quality and potential It was clear that if the country cluster andor the Government were not using the tools organizations in the field had little influence or interest in using the tools for their work One major impediment for the tool dissemination was the disconnection of workers on regional level with cluster activities Additionally lack of knowledge of GNCrsquos website and absence of NC coordinator training was not favorable for advocacy of the toolsrsquo potentials Overall review participants appreciated the concerted action of drafting tools together (intra- and inter-cluster) Especially SCN but also GNC Unicef and ENN were regarded as good places for hosting the tools GNC and Unicef were seen as responsible for the quality control on the NiETK and HTP (ie initiating updates (through outsourcing) and fundraising) The processes of drafting and reviewing tools were often burdensome for most stakeholders as for many this work came on top of their normal work but for many this paid off once tools were finalized Overall the drafting of tools was a good learning experience within the GNC which came with many lessons learnt The IRA tool was appreciated as having brought sectors and different types of information together in one document It particularly served as a reference function for existing or the compilation of new assessment tools The current IRA will have limited use as such until it is adjusted to specific countryemergency contexts The NiETK was particularly used at the country level by cluster members including Governments It was well appreciated as an advocacy tool on nutrition-related interventions with (non-technical) managers It has great potential to guide health professionals in emergencies From those review participants that were aware of the HTP many used it as a training support tool or as a handbookreference guide in different ways The tool was considered to be of good quality and to be comprehensive Incorrectly the HTP was positioned as a comprehensive training package In fact it was lsquoonlyrsquo a tool to use during trainings and needed additional materials to make it a training package The tool has large potential when used as a support in larger capacity building strategies on NiE The value of both NiETK and HTP depend partially on how congruent they are with the most recent guidelinesprotocols and state-of-the-art practice and views

32


The tools contributed mostly to focus areas of a) Capacity Building and b) Emergency Preparedness Assessment Monitoring Surveillance and Response Triggers) At this stage it remains unclear whether the tools contribute to better programming Though the tools served their own purpose in different contexts and on different levels (global regional in-country) their use on regional level was marginal To date all tools deserve the lsquotest of timersquo and are of sufficient quality to justify their use in NiE work in or outside a NC context

33


6 Recommendations 61 Recommended use of the IRA The large majority regard the IRA as a generic tool that should be adapted in country for assessment purposes The adaptation should be made according to context of emergency and country specifics It should be adapted as part of a countryrsquos contingency planning (Note the adaptation of the data analysis form requires Information and Technology expertise this might become problematic when substantial adjustments are desired Therefore it is recommended that this service is provided to country clusters) If a sudden onset emergency occurs and the country has no such rapid assessment tool it can be used as lsquoready-made-from ndashthe ndashshelfrsquo tool It is strongly recommended to use this tool for a few years and then evaluate it in two years to assess its usefulness and its evolution in various countries Suggestions for future use - Previous IRA versions should be used when compiling the comprehensive assessment tool for GNC (if the latter is deemed necessary) - A future revision of the IRA should distinguish between life saving and life sustaining indicators - The developments concerning other lsquorapid assessment toolsrsquo such as McRam in Pakistan and ECHOrsquos rapid assessment checklist (to be finalised in 2009) should be followed and serve as potential instruments for the improvement of the IRA 62 Recommended use of the NiETK The tool has potential to be used widely outside the NC where it is poorly known It should be lsquomarketedrsquo 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 would be incorporated based on NiETK messages 63 Recommended use of the HTP Parallel to the use of HTP directly for training within the NC system (eg members partners cluster coordinators) the HTP should be used as a base for academia in Africa Asia Middle East (and possibly Southern America) to strengthen national capacity in NiE It should be updated on a few standards at the end of 2009 The HTP does not need to be published as a hard-copy but could be reformatted into a simple press-ready document It is recommended for those countries or organisations that use HTP in a training to

34


- accompany the HTP with a larger capacity building strategy - enable trainees to apply knowledge by providing a full enabling environment through ensuring facilitation and support by supervisorsdecision makers (ie the lsquofull chain of commandrsquo) and through more practical learning opportunities There should be a high priority to create internships Solutions should be explored how operational NGOsoperational Government structures and training institutes could better serve each other (practitioners for the future need to acquire practice skills) Current impediments (ethical logistical financial) within NGO structures to include people during internships shadowing professionals need urgent examination The impact of training with the HTP should be evaluated in 2-3 years (rather than simply using the process indicator of the number of people being trained) 64 Recommendations for Country Regional and Global levels Country If countries are interested to use the tools they need to be introduced as part of emergency

preparedness and ideally not during emergencies The focus therefore should be more on emergency preparedness and rolling out in a preparation phase whilst taking into account overall country strategies on nutrition

If deemed relevant countries should use the generic version of a tool and adapt it to country context (eg to improve ownership appropriateness of tool speed up and increase its use etc)

Where appropriate countries should include tools (such as NiETK) in national guidelines NCs should have clear strategies how to disseminate relevant tools to all stakeholders

ensuring that people are explained what the tools entail as well as been given demonstrations on their use

The NC should encourage Governmentsagenciesorganizations to endorse (ie formally approve and support) the (country adapted) tools if appropriate

Regional Unicefrsquos role should be more supportive in rolling out GNC toolsservices especially at

the regional level as the regional offices provide normative advice to Unicef offices and as the cluster lead agency regional offices often also provide support to national cluster coordinators and to people involved in cluster work nationally

Regional offices (UN NGOs) should have NC related issues in their work plan (for example NC preparedness plans)

Global Management The GNC should encourage agenciesorganizationsGovernments to endorse (ie formally

approve and support) the GNC tools and encourage the useadoption of the tools within the individual agencies

35


The GNC should not concentrate only on technical tools but develop support systems (eg services tools) for lsquogood nutrition cluster coordinationrsquo The GNC should re-examine its work plan and decide on the balance between support on technical versus 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 ndash 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 (eg UN NGOs) more in its work and vice versa

The GNC could consider to develop support on how to set priorities in emergencies (specific for various contexts) and maintain an adequate roster of trained cluster or NiE staff However this should not be its priority for 2009

The GNC WGs should re-examine their work plan priorities taking into account the findings of this review This could and should be done during a strategic review of focus areas and mid- and long-term goals

The GNC should focus more on building up NiE capacities in countries and regions Tools The GNC should draft a clear dissemination strategy for the tools and fundraise for its

implementation (see Table 6 for details) The tools should be translated first and foremost into French The GNC (Assessment WG) should engage in OCHArsquos process of creating a common

needs assessment methodology and be part of the inter-agency Needs Assessment Group established by IASC in March 2009 (see Annex D) This is of great importance as this group aims to develop a brief multi-sector needs assessment guide and toolbox as well as to support capacity building in this domain

A process of maintenance and updating of the tools should be mapped out for the NiETK and HTP as they are lsquoliving documentsrsquo and keep their value only when up-to-date with good practice

The GNC could consider to developinclude a tool on monitoring of nutrition and food security ndash a kind of surveillance - to keep a close watch on the evolution on the ground prior to or after an emergency is declared

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 discuss amongst others their toolsrsquo successes and to see how well perceived tools could be used in other clusters

36


Annexes

37


Annex A UNITED NATIONS SYTEM

Standing Committee on Nutrition wwwunsystemorgscn

Terms of Reference Review lessons learnt of and recommendations on the use of products developed by the Global Nutrition Cluster

the Nutrition Cluster Toolkit the Harmonised Training Package and the Initial Rapid Assessment Tool16 March - 15 June 2009

Objective Identify lessons learnt gaps and impact of the use of products of the working groups in areas of strategic importance to emergency nutrition response and preparedness Duration Total of 40 days including travels

Activities 1 Collating and analysing primary and secondary data from stakeholders related to the three Global Nutrition Cluster tools the Nutrition Cluster Toolkit the Harmonised Training Package and the Initial Rapid Assessment Tool including questionnaires distributed November 2008 Key analysis areas include bull Who is using the tools (and when why and how) and what is the impact on the four strategic areas of focus of the Nutrition Cluster bull What action points have been taken in order to roll out the use the tools in order to reach the maximum audience and effectiveness bull The existence and lsquoroll outrsquo of other but similar kind of Cluster working group tools and identify successes in their usefulness bull Who or what benefits from the use of the tools Expected Output Analysis of stakeholders questionnaires Interviews performed of key actors in nutrition in emergencies Indicator Data are collated from stakeholders questionnaires and gathered from other sources such as interviews and minutes from Working Group meetings Delivery form Electronic submission of draft that will form part of final report Word or similar 2 Analysing the need for further development of (other) tools by the working groups Expected Output Based on analyses determination of the further needs for tools Indicator Needs for further tools are formulated Delivery form Electronic submission of draft that will form part of final report Word or similar 3 Analysing 1 - 2 specific country case studies (for example Myanmar Somalia or Uganda) with particular focus on the working group products in setting where the Cluster Approach has been taken Expected Output Case studies of the use of WG tools in 1-2 countries

38

Rev

iew of Global Nutrition Cluster tools ndash July 2009

Indicator Data are gathered from country visits Delivery form Electronic submission of draft that will form part of final report Word or similar 4 Compiling the results in a report to be posted on the Nutrition Cluster website and if possible publishing the results in a peer reviewed journal Expected Output Lessons learnt from and recommendations on the use of products developed by the Global Nutrition Cluster presented in written report Indicator Technical final report prepared Delivery form Electronic submission of final report Word or similar 5 Presenting the results during a Global Nutrition Cluster meeting mid 2009 Expected Output Lessons learnt from and recommendations on the use of products developed by the Global Nutrition Cluster presented to key stakeholders Indicator Presentation made Delivery form Electronic submission and oral presentation PowerPoint or similar Performance indicators for all activities The planned outputs and indicators are delivered in a timely fashion Technical guidance arrangements The consultant will be at P5 level with high experience in Nutrition Cluster work and emergency nutrition In case of need of technical consultation the SCN Working Group on Nutrition in Emergencies or the SCN Steering Committee will be consulted A draft version of the report will also be peer reviewed by the Global Nutrition Cluster before it is finalized Travel Two travels are envisioned likely Myanmar Somalia or Uganda where the Cluster approach was taken

39


Annex B Names and Contact details Participants

NameFunction Organization Contact details

1 Abla Caroline Public Health Advisor USAIDGHRCS Asia amp ME Previously Public Health Advisor USAIDOFDA

USAIDGHRCS Asia amp ME 1300 Pennsylvania Avenue NW 36181 Washington DC 205237 USA

Tel +1 212 712 569 Email cablausaidgov

2 Acharya Pushpa Programme Advisor-Nutrition

Programme Design and Support Services Via Cesare Giulio Viola 6870 Parco de Medici World Food Programme Rome - 00148 Italy

Tel +39 0665132716 Email PushpaAcharyawfporg

3 Ahmed Tahlil Emergency Response Team (ERT) Health Coordinator

IRC 65 Barry Road Stonebridge London NW10 8DE UK

Tel +44 2089656621 Email tahlilahmedtheircorg

4 Alspach Andrew Information Management Officer

Field Information Services (FIS) Unit - Geneva Communications and Information Services Branch (CISB)OCHA D619 United Nations Geneva Switzerland

Tel +41-2291-74139 Mob +41-79-444 0042 Email alspachunorg

5 Bilukha OlegMedical Epidemiologist Co-chair AWG GNC

International Emergency and Refugee Health Branch Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta GA 30333 USA

Tel +1-770-488-0685 Email OBilukha1cdcgov

6 Buzard Nan Senior Director International Response amp Programs Formerly SPHERE Project Leader

American Red Cross National Headquarters 2025 E Street NW Washington DC 20006 USA

Tel +1(202) 303 5063 Mobile +1(202) 257 0332 buzardnusaredcrossorg

7 Codjia Patrick Nutrition Specialist Previously Cluster Coordinator in Democratic Republic of Congo

UNICEF Botswana PO BOX 20678 Gaborone Botswana

Tel +267 395 1909 395 2752 Email pcodjiauniceforg

8 Cogill Bruce A2Z Project Tel +1 202-884-8000

40


Project Director Previously IASC Global Nutrition Cluster Coordinator until 1 February 2009

Academy for Educational Development 1825 Connecticut Ave NW Washington DC 20009-5721 USA

Email bcogillaedorg bcogillgmailcom

9 Coulibaly Zerbo Ferima Nutrition Officer for East and Southern Africa

World Health Organization ISTHarare 86 Enterprise Road Highlands 773 Belvedere Zimbabwe

Tel +263 4 788220 Ext 382154724138215 Email zerbofzwafrowhoint

10 De Bernardi Roberto Chief of Health and Nutritionfocal point for Nutrition Cluster

UNICEF Mozambique (cluster country) 1440 Zimbabwe Avenue PO Box 4713 Maputo Mozambique

Tel +258 21 481 109 Mobile +258823148100 Email rdebernardiuniceforg

11 Deconinck Hedwig Senior Emergency Nutrition Advisor Previously Senior Emergency Nutrition Advisor Save the Children USA until April 2007

Food and Nutrition Technical Assistance II (FANTA-2) Project Academy for Educational Development 1825 Connecticut Ave NW Washington DC 20009-5721 USA

Land line +1 202-884-8000 Tel +33 9 61 60 49 76 or +33 4 67 96 51 83 Cell phone +33 6 72 49 37 06 Email hdeconinckaedorg

12 Desplats GweacutenolaSpeacutecialiste Nutrition

UNICEF Niger B P NA Agadez Niger

Tel +227 20 72 28 40 20 72 28 41 - Ext 420 Mobile +227 97 39 32 11 GDesplatsuniceforgUnicef Niger office +227 20 44 02 23

13 dHarcourt Emmanuel Senior Health Director

Health Unit International Rescue Committee 122 East 42nd Street 12th Floor New York New York 10168 USA

Tel +1 212 551 3178 Email HarcourttheIRCorg

14 Dhur Agnes WFP Food Security Analyst

WFP Via Cesare Giulio Viola 6870 Parco de Medici World Food Programme Rome - 00148 Italy

Tel +39 0665133650 Email agnesdhurwfporg

15 Dolan Carmel Partner

NutritionWorks PO Box 53616

Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC

London SE24 9UY UK Skype carmeldolan1 Email Cmadolanaolcom

16 Go Marilyn Chief Emergency Preparedness Division

Department of Health Address Health Emergency Management Staff 1st Flr Bldg 12 Department of Health Rizal Avenue Sta Cruz Manila Philippines

Tel +63 2 743-0568 Mobile +63 920-2993329 Email mvgomdyahoocom

17 Godden Kate Senior Lecturer

Kate Godden Centre for Public Health Nutrition University of Westminster 3rd floor Copland Building 115 New Cavendish Street London W1W 8JS UK

Tel +44 (0) 207 911 5000 Email kgoddenwestminsteracuk

18 Guirguis Sherine Programme Communication Specialist Polio Eradication Previously Global Nutrition Cluster focal point (Unicef NY until July 2006) and formerly Head of MampE Unicef Maldives (pilot testing IRA in 2007-2008)

UNICEF India Country Office 73 Lodi Estate New Delhi 110 003 India

Tel +91-11-2469-0401 Mobile +91-99-7117-1065 E-mail sguirguisuniceforg

19 Hailey Peter Nutrition Specialist

UNICEF Eastern and Southern Africa Regional Office PO Box 44145 Gigiri Nairobi Kenya 00100

Tel (+254 -20) 7622204 7622595 Email phaileyuniceforg

20 Heffinck Johan Senior expert sector policies DG ECHO

ECHO European Commission PO Box 45119 Nairobi Kenya

Tel +254 20 2802001 Mobile +254 733 410085 Email johanheffinckeceuropaeu

21 Hernandez Bonilla Ana Nutritionist

Uniteacute Seacutecuriteacute Economique Division Assistance Comiteacute International de la Croix-Rouge-Genegraveve 19 Avenue de la Paix

Tel +41 22 730 2016 Switchboard +41 22 734 6001 Mobile + 41 79 763 2040 Email ahernandezbonillaicrcorg

42


1202 Genegraveve Switzerland 22 Howard Henrietta B

Ass Project OfficerNutrition Co-chair from UNICEF in Nutrition Cluster Liberia

Liberia (Nutrition Cluster Country but transitioned) UNICEF Liberia Sekou Toure Avenue Mamba Point Monrovia Liberia Mail address UNICEF Liberia Grand Central Station PO Box 5747 New York

Tel UNICEF Liberia +231 44 207 084 9761 Email hhowarduniceforg

23 Jayatissa Renuka Consultant Medical Nutritionist

Sri Lanka (A cluster country as of Dec 31 2008) Department of Nutrition Medical Research Institute Colombo 08 Sri Lanka

Tel +94 11 2695999 Mobile +94 77 7788444 renukajayatissayahoocom

24 Kastlander Erik Information Management Officer

Field Information Services Unit Office for the Coordination of Humanitarian Affairs (OCHA) United Nations Geneva Switzerland

Tel +41-22-9171587 Mobile +41-79-4698567 Email kastlanderunorg

25 Kenney Erin Technical Officer

Health Cluster secretariat Health Action in Crises Department WHO 20 Avenue Appia CH 1211 Geneva 27 Switzerland

Email kenneyewhoint Tel +41 22 791 24 48

26 Khara Tanya Advisor Nutrition in Acute Emergencies

Nutrition Section Programme Division UNICEF 3 United Nations Plaza New York NY 10017 USA Rm 752

Tel +1 212 824 6368 Mobile +1 917 402 9134 Email tkharauniceforg

27 Kingori James W Cluster Coordinator Somalia

UNICEF Somalia PO Box 44145 Nairobi Kenya (visitors address Airport Zone Mogadiscio Somalia)

Tel +254 20 7623950 7521218 7623961 Mobile +254 722 300563 (Kenya) +254-733-671503 (Kenya) +252-1-5554984 (Somalia) Email jkingoriuniceforg jameswkingorihotmailcom

43


28 Ladd Kirsti D Nutrition Advisor

Health Technical Unit International Medical Corps 1313 L Street NW Suite 220 Washington DC 20005 USA

Tel +1 212-828-5155 Email kladdimcworldwideorg

29 Lauza-Ugsang Janette Project Manager

Public Health in Emergencies Asian Disaster Preparedness Center (ADPC) Address 97966-70 24th Floor SM Tower Paholyothin Road Samsen Nai Phayathai Bangkok 10400 Thailand

Tel +66 (0) 2 298 0681 to 92 Ext 404 + 66 2 974 0783 +66 81 815 8001 Email janetteadpcnet

30 Luboya JeanNutrition Cluster Coordinator CHAD Previously Nutrition Cluster Coordinator Zimbabwe

UNICEF CHAD Avenue Gouarang NDjameacutena BP 1146 NDjameacutena Chad

Mobile +235 623 1583 Email jluboyauniceforg

31 Manyama Isaack Team Leader Emergency Nutrition Coordination Unit

Disaster Management and Food Security Sector (DMFSS) Ethiopia

Tel +251 115 523556 Mobile +251 913 20 21 51 Email orlaodppcgovet

32 Mason Frances Nutrition Adviser Hunger Reduction Team

Save the Children UK London 1 St Johns Lane London EC1M 4AR

Tel +44 020 7012 6400 fmasonsavethechildrenorguk

33 McCluskey Jean Wash Emergencies Adviser

Global Wash Cluster Manager UNICEF Geneva 5 - 7 avenue de la Paix 1202 Geneva Switzerland

Tel + 41 22 909 56 16 Mobile +41 79 212 73 77 Email jmccluskeyuniceforg

34 McGrath Marie Co-Director Emergency Nutrition Network Coordinator of the IFE (infant and young child feeding in emergencies) Core Group

Emergency Nutrition Network (ENN) 32 Leopold Street Oxford OX4 1TW United Kingdom

Tel +44 (0)1865 324996 Email marieennonlinenet mariemcgrathgmailcom

35 Moloney Grainne Food Security and Nutrition Analysis Unit Mobile +254-(0)734-616882

44


Nutrition Technical Manager Co-chair AWG GNC

Somalia (FSNAU) United Nations Food and Agriculture Organisation (FAO) PO Box 1230 - 00621 (Village Market) Nairobi Kenya

Tel +254-(0)20-3745734 Email grainnemoloneyfsauorke

36 Monsef Elham Nutrition Specialist co-chair with MoH of Nutrition Cluster

Philippines Country Office UNICEF 31st Floor Yuchengco Tower RCBC Plaza 6819 Ayala Avenue 1200 Makati City Philippines

Tel +63 2 901 0140 Mobile +63 920 9602139 Email emonsefuniceforg

37 Nandy Robin Senior Health Advisor - Emergencies Health Section

UNICEF NYC 3 United Nations Plaza New York NY 10017 USA

Tel +1 212 326 7550 Email rnandyuniceforg

38 Obeid Omar Professor Consultant on Nutrition

American University in Beirut Department of nutrition POBox 11-0236 Riad El-Solh Beirut 1107 2020 Lebanon

Tel +961-1-350 000 Ext 4440 Tel +961-3-547824 Email oo01aubedulb

39 Ogden Kathryn FS and Nutrition Specialist

VAM and FS Analysis Service WFP Via Cesare Giulio Viola 6870 Parco dei Medici World Food Programme Rome - 00148 Italy

Tel +39 06513 3227 Email KathrynOgdenwfporg

40 Okuonzi Sam Director of RCQHC

Makerere University Regional Centre for Quality of Health School of Public Health PO Box 7072 Kampala Uganda

Tel +256 392722005 and +256 414237225 Email Sokuonzircqhcorg

41 Oman Allison Senior Regional Nutrition and Food Security Coordinator for the Horn

UNHCR Regional Support Hub Nairobi PO Box 43801 Chiromo Road Nairobi Kenya

Tel +254 20 422 2603 Email OMANunhcrorg

45


and East Africa 42 Omwega Abiud M

Nutrition Specialist

UNICEF Rwanda BP 381 Kigali Rwanda

Tel (Office) +250 592700 Tel (Direct) +250 592727 Mobile +250 788304054 Email aomwegauniceforg

43 Polonsky Jonny Public Health Officer

Health Action in Crises Geneva World Health Organization 20 Avenue Appia CH 1211 Geneva 27 Switzerland

Tel direct +41 22 791 3503 Mobile +41 79 475 5491 E-mail polonskyjwhoint

44 Prendiville Noreen Chief Nutrition Section

UNICEF Kenya PO Box 44145 Nairobi Kenya

Tel +254-20-7621051 Email nprendivilleuniceforg

45 Prudhon Claudine Technical Officer

Health and Nutrition Tracking Service (HNTS) co Health Action in Crisis World Health Organization 20 Avenue Appia CH 1211 Geneva 27 Switzerland

Phone +41-22-791-34-81 Email prudhoncwhoint

46 Richardson Leah IASC Global Nutrition Cluster Advisor (acting Cluster Coordinator)

UNICEF 3 UN Plaza New York NY 10017 USA

Tel +1 212 326 7764 Email lrichardsonuniceforg

47 Sadler Kate Senior Researcher Public Nutrition in Emergencies

Feinstein International Center Friedman School of Nutrition Science and Policy Tufts University 200 Boston Avenue Suite 4800 Medford MA 02155 USA

Tel +1 617 627 4163 Mobile+1 617 909 7283 Email KateSadlertuftsedu Skype katesad

48 Safi Zarmina Director of Breastfeeding Counseling Courses AD

Public Nutrition Department Ministry of Public Health Great Masoud Square Wazer Akbar Khan

Mobile +93 700 246 331 Email zs_healthyahoocom

46


Kabul Afghanistan (cluster country)

49 Salpeacuteteur Ceacutecile Responsable des Programmes Nutritionnels - Nutrition Advisor

ACTION CONTRE LA FAIM 4 rue Niepce 75014 Paris

Tel 01 43 35 88 53 csalpeteuractioncontrelafaimorg Skype acfcecilesalpeteur Email csalpeteuractioncontrelafaimorg

50 Samba Kinday Nutrition Specialist Co-chair from Unicef in Nutrition Cluster Liberia

UNICEF Liberia Mail address UNICEF Liberia Grand Central Station PO Box 5747 New York New York 10163-5747 Visitors address UNICEF Sekou Toure Avenue Mamba Point Monrovia Liberia

Email ksambauniceforg Tel +231 44 207084 97601 Ext 212 Mobile + (231) 6910 94

51 Saunders Graham Head

Shelter Department International Federation of Red Cross and Red Crescent Societies CH -1211 Geneva 19 Switzerland

Tel +41 22 730 4241 Main switchboard +41 22 70 4222 Email grahamsaundersifrcorg

52 Scott Niels Chief Disaster and Vulnerability Policy Section

Policy Development and Studies Branch Office for the Coordination of Humanitarian Affairs Geneva Switzerland Address United Nations 8-14 Palais des Nations CH-1211 Geneva 10 Switzerland

Tel +41 22 917 3518 Mobile +41 79 620 8198 Email scott2unorg

53 Seal Andrew Lecturer in International Nutrition

Centre for International Health and Development Institute of Child Health University College London 30 Guilford Street London WC1N 1EH UK

Tel +44 (0)20 7905 2233 Email asealichuclacuk

54 Sibanda Mulder Flora Previously Senior Adviser Nutrition

UNICEF 3 UN Plaza New York NY 10017

Tel +1 212 326 7562 Email fsibandamulderuniceforg

47


USA 55 Sibson Victoria

Emergencies Nutrition Adviser Save the Children UK 1 St Johns Lane London EC1M 4AR UK

Tel +44 (0)20 7012 6679 Email vsibsonsavethechildrenorguk

56 Situma Ruth Nutrition Information Officer


Tel +254 20 762 1051 +254 - 762 1581 Email rsitumauniceforg

57 Stillman Toby Director Emergency Health amp Nutrition

Save the Children 54 Wilton Road Westport CT 06880 USA

Tel +1 2124138530 Email tstillmansavechildrenorg

58 Sylvester Kerry Director

ANSA ndash Food Security and Nutrition Association Av Agostinho Neto 1607 R-C Maputo Mozambique

Tel +258 823145950 Email ansatvcabocomz

59 Talley Leisel Co-chair CDWG GNC Nutritional epidemiologist

International Emergencies and Refugee Health Centers for Disease Control and Prevention 1600 Clifton Road MS E-97 Atlanta GA 30333 USA

Tel +1 770 488 0696 Tel+1 4044980906 Email lre0cdcgov ltalleycdcgov

60 Teklu Mesfin Emergency Health Technical Director

World Vision International WV Africa Relief Office I PO Box 30473 00100 GPO Nairobi Kenya

Tel +254 204447359 Mobile +254 733628583 Email mesfin_tekluwviorg

61 Thompson Brian Senior Officer and Group Leader Household Food Security Nutrition and Livelihoods

Nutrition and Consumer Protection Division Food and Agriculture Organization of the United Nations Viale Delle Terme Di Caracalla 1 I-00153 Roma (RM) Italy

Tel+3906557054153 Mobile+393492375759 Email BrianThompsonfaoorg

48


62 Thwin Aye Cluster Coordinator (since Sept 2008) Myanmar

UNICEF Myanmar (Nutrition Cluster (May 2008))

Mail Address UNICEF PO Box 1435 Yangon Union of Myanmar

Visitorsrsquo Address UNICEF 14th Floor Traders Hotel 223 Sule Pagoda Road Yangon Myanmar

Tel +95 1 375527-32 375547-48 (ext 1020) Email athwinuniceforg

63 Valenti Paola (Focal Point for the Nutrition Cluster)

Unicef Madagascar (Nutrition Cluster Country) Maison Commune des Nations Unies Zone Galaxy Andraharo BP 732 Antananarivo 101 Republic of Madagascar

Tel +39 331 2913607 Email pvalentiuniceforg

64 Wamani Henry Lecturer School of Public Health (also affiliated with the University of Bergen Oslo Norway)

Makerere University School of Public Health Mulago Hospital Complex Kampala Uganda Postal address PO Box 16705 Kampala Uganda Tel+256 414 5326314

Tel +256 755 443300 or +256 77 6655000 Tel +47 45677204 and +47 55588398 (Norway) Email wamanihgmailcom

65 Watson Fiona Partner

NutritionWorks PO Box 53616 London SE24 9UY UK

Tel +44 207 274 8926 Email fionawatson6btopenworldcom

66 Weise Prinzo Zita Focal point for Nutrition in Emergencies

Nutrition for Health and Development (NHD) World Health Organization HQ 1211 Geneva 27 Switzerland

Tel +41 22 7914440 Email weiseprinzozwhoint

67 Wilkinson Caroline Senior Nutrition Officer Formerly nutritional adviser ACF (Until 1 January 2009 ACF)

United Nations High Commissioner for Refugees Public Health and HIV Section Division of Operational Services rue de Montbrillant 94 Genegraveve Switzerland

Tel +41 22 739 74 86 Email wilkinsounhcrorg

49


68 Zagaria Nevio Co-chair WG on Guidance and Tools Global Health Cluster Coordinator of Recovery and Transition

Unit HACREC WHO 20 Avenue Appia 1211 Geneva 27 Switzerland

Tel +41 22 79 12534 Email zagarianwhoint

69 Zagreacute Noel M Senior Emergency Specialist Nutrition

Asia-Pacific Shared Services Centre (APSSC) UNICEF 19 Phra Atit Road Bangkok 10200 Thailand

Tel +66 2 356 9470 Mobile +66 81 701 9458 Email nzagreuniceforg

Contacts were also sought but did not materialise for interviews with Merlin MSF Concern and HKI HTP contacts list (trainee interviews and questionnaires) NameFunction Organization Contact details Training session 1 Aschalew Feleke

Programme Assistant

World Food Programme Kifle Ketema Kirkos Kebele 26 House No 1041 Marshall Tito Avenue Addis Ababa Ethiopia PO Box 25584 Code 1000 Addis Ababa Ethiopia

Tel +251-5515-188 Ext 2287 Email aschalewfelekwfporg

Uganda (a)

2 Ayenoue Angele National programme officer

World Food Programme Avenue du General de Gaulles BP 465 Brazzaville Congo

Tel + (242) 668 74 93 Mobile +(242) 654 54 09 Email angeleayenouewfporg

Uganda (a)

3 Babughirana Geoffrey Dietician

Ministry of Health Nutrition Section PO Box 7272 Kampala Uganda

Tel +256 712 404 622 Rdbabuyahoocom

Uganda (a)

4 Bertizzolo FloraConseiller Technique Santeacute et Nutrition

Support for the fight against malnutrition TB and HIVAIDS World Food Programme Lot VB 71 GB Ambatoroka Antananarivo 101 Madagascar

Tel+261 20 22 2329131572 FoodSat 1363 - 2410 Email florabertizzolowfporg

Uganda (a)

5 Brouwer JitskeHealth and Nutrition Adviser

Medair Somalia pa Medair East Africa

Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50


POBox 7657500508 Nairobi Kenya

Email jitskebrouwermedairorg

6 Gowriswaran K Health amp Nutrition Officer

UNICEF 31A Lady Manning Drive Batticaloa Sri Lanka

TelFax +94 65 2223824 2226479 2226122 Mobile +94 77 7420316 Email kgowriswaranuniceforg

Sri Lanka (c)

7 Jeftha TommyAssistant Director

Department Social Development Directorate District Offices and Facilities Support 14 Queen Victoria street 4th Floor Union House Cape Town 8000 South Africa

Tel +27 21 483 4624 Mobile 083 463 4804 Email tjefthapgwcgovza

Uganda (a)

8 Maina LucyField coordinator Hiran region

International Medical Corps PO Box 67513 00200 Nairobi Kenya

Nairobi Mobile +254 722744410 Office line +254 20 4454204 Somalia mobile +252 15 813522 Email lucymimcafricaorg

Kenya (b)

9 Misomali AmosProgramme Officer

World Food Programme PO Box 30571 Lilongwe 3 Malawi

Tel +265 9 566 178 Email amosmisomaliwfporg

Uganda (a)

10 Mudenda Joseph Ag Nutrition Specialist

Ministry of Health PO Box 30205 Lusaka Zambia

Tel +260 211 2530405 Email mudendajosephyahoocom

Uganda (a)

11 Musisi JohnProgramme Officer - Network

International Baby Food Action Network IBFAN Uganda Foundation Ltd Plot 39A Martyrs Way Road Ntinda PO Box 27694 Kampala Uganda

Tel +256 414 577096 (Office line) Tel +256 772 978243 +256 752 755707 +256 772 528786 +256 772 867672 Email ibfanugandayahoocom

Uganda (a)

12 Navalogithan Rajaratnam Ministry of Healthcare and Nutrition Tel +94-65-2222863 Sri Lanka (c)

51

52


Rev

(a)= 20 Oct - 1 Nov 2008 in Kampala Uganda

Maternal and Child Health Officer

Office of the Regional Director of Health Services Batticaloa Sri Lanka

Mobile +94-776942611 Email dpdhsbattisltnetlk

13 Sharmarke MohamedProgram Assistant

World Food Programme Somalia UN Crescent Gigiri Nairobi Kenya PO Box 64902 - 00620 Nairobi Kenya)

Tel +252 90728427 Email SharmarkeMohamedwfporg Email sharmaarke20hotmailcom

Uganda (a)

14 Small LizDietician

2147 Highgate Close Glen Lorne Harare Zimbabwe

Home +263 4 499767 Mobile +263 11 215511 Email thymemwebcozw

Zimbabwe (d)

(b)= 11-14 August 2008 in Nairobi Kenya (c)= 24-27 June 2008 in Sri Lanka (d)= 29-31 July 2008 in Harare Zimbabwe


Annex C Questionnaire for HTP trainees unable to be interviewed by phone QUESTIONNAIRE TRAINING ON NUTRITION IN EMERGENCIES The Global Nutrition Cluster has produced three main tools and the SCN is charged to conduct a review on them One of the tools The Harmonized Training Package is used as material in training workshop Nutrition in Emergencies You have attended this training and we are seeking your thoughts on how the training has affected your work afterwards We hope that you may return this questionnaire to scnwhoint by Friday 6th March 2009 Name Title Organization Address Telephone Email 1 WORK HISTORY Please answer shortly to questions a) b) and c) a) Before the training did you have previous work experience in emergency nutrition Please indicate the number of years b) Before the training did you have previous programme implementation experience Please indicate number of years and area (eg breastfeeding promotion) c) What kind of work have you done after the training Please describe shortly 2 IMPACT OF TRAINING Please answer to questions a) b) c) and d) about training a) Do you feel that the training increased your knowledge on emergency nutrition significantly Did you learn new things or did the training just refresh your memory Please describe your level of knowledge on nutrition in emergencies before and after the training b) Do you feel that you need the knowledge from the training in your work Was the training relevant to your work

53


c) Have you had a chance to apply the new knowledge to your work i) If yes What has changed In what specific way are you working differently Please mention 3 most important changes in your work 1) 2) 3) ii) If not why Please describe the 3 most important issues that are hindering you from applying the knowledge to your work 1) 2) 3) d) How would the training be more useful to you How should we change the training and the training material

54


Annex D Objectives of inter-agency Needs Assessment Group (established by IASC) In March 2009 an inter-agency Needs Assessment Group (NAG) was established by IASC The overall objective of the NAG is to harmonise and promote cross-clustersector needs assessment initiatives for consistent reliable and timely data on humanitarian needs in complex emergencies and natural disasters to strengthen informed decision making and improve humanitarian response The NAG will be co-chaired by OCHA initially and a non-UN member of the NAG yet to be identified The work of the NAG will build on already existing initiatives by various stakeholders at the country regional and global levels In particular it will reflect and support needs assessment initiatives at the regional and national level recognising that different regions and countries face different challenges and are differently equipped and prepared for undertaking post-emergency needs assessments SPECIFIC OBJECTIVES The NAG will focus on five thematic sub-objectives 1 Strengthen cross-clustersector needs assessment coordination and leadership by a Agreeing on an overall common framework for needs assessment covering different phases of a humanitarian response and clarifying the linkages between the assessment of needs for and in each of the different phases b Clarifying roles leadership responsibilities and accountabilities including developing standard operating procedures (SOPs) and normative guidance for HCRCs and Country Teams in cooperation with the HC Strengthening Team This work includes ensuring that needs assessments are followed by appropriate and strategic humanitarian action reflecting the reporting lines of the CAPs and Flash Appeals c Examining and clarifying roles leadership responsibilities and accountabilities at the global regional and country level d Providing HCsRCs clustersectors and agencies based on a review best practises at the global and the field level with brief guidance on

i inter-clustersector needs assessment coordination as well coordination with national authorities of needs assessments

ii roles and responsibilities in the preparedness and implementation phases of needs assessment iii determining which type of needs assessments approach (eg common joint and harmonised) are

appropriate and feasible in a given situation e Supporting and promoting regional needs assessment networks f Coordinating with relevant initiatives to promote consistencies and complementarities on assessment related issues including the revision of the Sphere standards OCHArsquos ACE project and the Humanitarian Dashboard the IASC Information Management Task Force and the IASC Sub-Working Group on Emergency Preparedness and Contingency Planning 2 Improve technical support to inter-clustersector needs assessment initiatives through a Agreeing on commonly accepted standard terminology related to assessment and analysis that would be based on standards and terminologies agreed to and provided by clusters and agencies to the NAG b Improving the quality of inter-clustersector needs assessments by

i examining how needs assessments can be undertaken in a systematic and evidence based manner to better capture beneficiary and community level perspectives and cross cutting issues

ii reviewing and developing a toolbox of existing tools methodologies and examples of the good use of the data generated in the assessments

iii identifying agreed-upon core information and data to be gathered and generated in the first phases of an emergency (phases 1-2) per type of crisis and per clustersector to ensure a minimum comparable set of information is available

iv identifying countries with a genuine interest in serving as partner countries to inform the development of tools procedures and preparedness and capacity building efforts c Developing a brief multi-sector needs assessment guide and toolbox

55


3 Increase advocacy awareness raising and resource mobilisation in the area of needs assessment by a Developing and distributing a communication strategy on coordinated and common inter-clustersector needs assessments b Improving advocacy and resource mobilisation for strengthened needs assessment including activities proposed by the NAG 4 Augment needs assessment capacity building efforts through a Providing normative guidance on needs assessment planning within preparedness and contingency planning including promoting data preparedness establishing partnerships with national authorities building on and up national capacities b Reviewing existing rosters and set criteria for the establishment of a complementary roster of accredited sectoral needs assessment experts with adequate skills and considerable emergency assessment experience to support HCsRCs in their overall coordination role in the early phases of the emergency c Strengthening inter-clustersectoragency training capacities through (i) reviewing existing material and capacities available through ongoing initiatives (ii) further developing training material and capacityndashbuilding strategies as required and (iii) facilitating training of roster experts and localregional staff and personnel 5 Enhance information management mechanisms by a Developing a needs assessment site on the One Response Website in order to make guidance handbooks tools and best practises easily accessible b Strengthening and further developing real-time information sharing mechanisms such as the interface between different information management systems This would be based on an examination of best practises and lessons learned and would be included in sample standard operating procedures for Country Teams and shall take into account concerns of information sensitivity and security

56

UNITED NATIONS SYTEM

Standing Committee on Nutrition

wwwunsystemorgscn

SPECIFIC OBJECTIVES


Acknowledgement This report was prepared by Mija-tesse Ververs independent consultant based in Geneva (Switzerland) for the United Nations Standing Committee on Nutrition (SCN) A specific note of appreciation is extended to Taru Saloheimo 4th year student in Nutrition Science at the University of Helsinki who assisted in this review as an intern for SCN Also a special lsquothank yoursquo need to be given to Leah Richardson for her very useful contributions during the peer review A special recognition also goes to Kaia Engesveen and Marzella Wuumlstefeld from SCN for being so helpful during the process of the review The preparation of this document would not have been possible without all those 83 people who took time to respond and share their experiences for this review Their inputs were instrumental for the successful completion of this study This review was funded by the Global Nutrition Cluster

2



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7



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12



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19




Training on NiE

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20




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Mentioned only once


25



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30


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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


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Uganda (a)




Zimbabwe (d)




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HTP tool


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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

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Zimbabwe (d)




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IRANiETKHTP


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HTP tool


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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

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Zimbabwe (d)




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Per

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of P

eopl

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IRANiETKHTP


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Training on NiE

HTP tool


20




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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

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Uganda (a)




Zimbabwe (d)




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himherself

used inbroader

workenvironment

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cent

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of P

eopl

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IRANiETKHTP


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Training on NiE

HTP tool


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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


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Uganda (a)




Zimbabwe (d)




53



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SPECIFIC OBJECTIVES



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seen but notused

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himherself

used inbroader

workenvironment

Per

cent

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of P

eopl

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IRANiETKHTP


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Training on NiE

HTP tool


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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



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wwwunsystemorgscn

SPECIFIC OBJECTIVES



8




9



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10152025303540



seen but notused

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used inbroader

workenvironment

Per

cent

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of P

eopl

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IRANiETKHTP


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Training on NiE

HTP tool


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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



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wwwunsystemorgscn

SPECIFIC OBJECTIVES




9



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10152025303540



seen but notused

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Per

cent

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of P

eopl

e

IRANiETKHTP


12



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Training on NiE

HTP tool


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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



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56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



10



10


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10152025303540



seen but notused

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workenvironment

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cent

age

of P

eopl

e

IRANiETKHTP


12



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19




Training on NiE

HTP tool


20




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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



10


5


5


11



-5

10152025303540



seen but notused

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himherself

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workenvironment

Per

cent

age

of P

eopl

e

IRANiETKHTP


12



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Training on NiE

HTP tool


20




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22











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Mentioned only once


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Annexes

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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



-5

10152025303540



seen but notused

used exclfor

himherself

used inbroader

workenvironment

Per

cent

age

of P

eopl

e

IRANiETKHTP


12



13



14



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19




Training on NiE

HTP tool


20




21




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22











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Mentioned only once


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31



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36


Annexes

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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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44























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49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



13



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Training on NiE

HTP tool


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31



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36


Annexes

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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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44























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Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



14



15



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19




Training on NiE

HTP tool


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Annexes

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Rev



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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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44























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49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



15



16



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19




Training on NiE

HTP tool


20




21




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22











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Mentioned only once


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30


Mentioned once



31



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36


Annexes

37








38

Rev



39


























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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



16



17




18












19




Training on NiE

HTP tool


20




21




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22











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Mentioned only once


25



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Mentioned once



31



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36


Annexes

37








38

Rev



39


























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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















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44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES



17




18












19




Training on NiE

HTP tool


20




21




t


22











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Mentioned only once


25



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30


Mentioned once



31



32



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36


Annexes

37








38

Rev



39


























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Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















43
























44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES




18












19




Training on NiE

HTP tool


20




21




t


22











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24















Mentioned only once


25



26



27



28







29






30


Mentioned once



31



32



33



34













35














36


Annexes

37








38

Rev



39


























40

























Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















43
























44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES












19




Training on NiE

HTP tool


20




21




t


22











23







24















Mentioned only once


25



26



27



28







29






30


Mentioned once



31



32



33



34













35














36


Annexes

37








38

Rev



39


























40

























Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















43
























44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES




Training on NiE

HTP tool


20




21




t


22











23







24















Mentioned only once


25



26



27



28







29






30


Mentioned once



31



32



33



34













35














36


Annexes

37








38

Rev



39


























40

























Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















43
























44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



Tel +254 (0) 724 522545 Tel +254 020 3872725

Kenya (b)

50







Sri Lanka (c)




Uganda (a)




Kenya (b)




Uganda (a)




Uganda (a)




Uganda (a)


51

52


Rev








Uganda (a)




Zimbabwe (d)




53



54










55



56



wwwunsystemorgscn

SPECIFIC OBJECTIVES




21




t


22











23







24















Mentioned only once


25



26



27



28







29






30


Mentioned once



31



32



33



34













35














36


Annexes

37








38

Rev



39


























40

























Tel +44 (0)1252 710006 Mobile 07931 514 410

41


Co-chair CDWG GNC




















42





















43
























44























45
























46





















47























48






















49









Programme Assistant



Uganda (a)




Uganda (a)




Uganda (a)




Uganda (a)



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review, lessons learnt of and recommendations the global ... · review of global nutrition cluster...

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