Somalia: Changes to Nutrition Cluster governance and partnership to reflect learning and

operational realities

GNC Annual meeting 13-15 October 2015

Overview

• Somali context• Governance– Limitations from 2013-2014– Restructuring 2015

• Service delivery partnerships– Challenges – Rationalisation 1.0 (2013)– Rationalisation 2.0 (2015)

• Learning• Nutrition coordination moving forward

Context

• ‘Somalia’- 3 autonomous regions• 2006 Nutrition Cluster activated (IASC)• 2011/12 famine- huge scale-up of treatment of SAM• 2013-2014

– Slight improvement in nutrition situation– Remaining gaps at policy level- SUN, nutrition policy and

health strategic plan• 2015

– serious deterioration in situation – GAM >15%, est 203,000 children with acute malnutrition

Nutrition service delivery• 2011-2012 rapid scale up of IMAM services

Implications of rapid expansion of nutrition service delivery

• Locations for service delivery based on accessibility, not part of strategic planning process

• Geographic coverage not optimal (50% in 2014)• Duplication and overlap of services• Limited integration of health and nutrition

services, SAM/MAM services • Concentration of partners and multiple layers of

partnership

Rationalisation 1.0 (2013)• Why?

– improvement and decreased funding– Nutrition services disproportionate to need

• Aim? – To identify partners/area based on comparative advantage – To develop district level service plans for nutrition

• Process (limited consultation –only at higher level)– What services are needed?– Who can fill?

• Defined Criteria for partner selection – in absence of principles/rationle

Challenges to Rationalisation 1.0

• Other programmes started mid 1.0 (BPHS, GHNP)• Overlap in partnership inevitable due to limited

capacities- referral challenges• Clan linkages to service delivery remained• Non-existence of sites (GPS)• Lack of strategy on how to integrate health and

nutrition services and develop service plans• Lack of consensus on partner selection in some areas• Lack of agreement among agencies on a partners ‘risk’

Limitations to governance 2013-2014

• Lack of NC leadership– 10 month absence of NCC – Weak government engagement

• Dormant SAG and Working Groups • NC meetings shifted from NBO to Mogadishu to support

Somali government– limited partners based in Mogadishu – limited decision making power– Insecurity prevented attendance by international staff

• No NC coordination at regional level – CLA represented NC – Shift from cluster to programme perspective, unofficial ‘transition’

in absence of IASC de-activation

Governance restructuring process

• Early 2015 with new NCC• NCC and CLA agreement to

– Clarify roles and responsibilities– Identify and formalise strategic and technical working groups

with an aim to eventually shift leadership to gov over time• Consultative workshop to endorse strategic documents

– Roadmap for Nutrition Cluster– NC Strategic Operating framework– Work plan

• SOPs and WG TORs developed

New governance structure

• 141 active partners (80% local NGOs) by 2015• Co-led by the NGO/Federal Ministry of Health• Current staff (CCT)– Nutrition Cluster Coordinator (NCC)- NBO– Nutrition cluster coordination assistance - Mogadishu– Nutrition Cluster Coordinator co-chair (NGO)- NBO– Information Management Officer (IMO)- NBO– Data entry clerk – NBO

• 11 Sub-national coordination mechanism chaired and co-chaired by volunteers

Rationalization 2.0 (2015)

• Similar process except unique concept/model of applying singly primary partner per district, defined principles, inclusive consultation at all level for six months and well defined steps (3S)

• GHNP partner given priority in district• Ideally: 1 partner for all services/ district• Primary, secondary and tertiary partners• Independent geotagging of sites• Matching capacity to case load expected in assigning

partners

New way of working• Inclusive- key cluster functions taken on by

partners• SAG -highest decision making body • WGs chaired by partners• Human resources- 2 additional staff (change in

position and contract)• Cascading meeting schedule (different levels

of autonomy and issues)– RegionalMogadishuNairobi

Results from changes

• Credibility of NC and SAG• Consistency in efforts• Respect by partners of NC structure• Engaged partners• Less resistance on initiatives• Transparency• Decreased work load on agencies• Could be sustained if gap in NCC

Learning• Honest discussions around problems have resulted

in effective solutions• Tremendous partners support and buy-in• Expansion of SAG to include 3 local NGOs increased

NC credibility, partner engagement, inclusiveness• Increased credibility of NC has resulted in better

working relationships among partners• Incorporating AAP has shifted focus from partner

interest to affected population• Partners chairing WG distributes work load and

rotation allows for wider participation

Somali nutrition coordination moving forward

• NC advocating and supporting SUN• SAG to be more proactive at country level to engage

partners• More decentralized coordination mechanism and

decision making process• Universal geotagging/mapping exercise• Evidence based advocacy supported by research – NCA• Capacity development and IKM• Innovation – mNutrition, RapidPro• AAP – client feedback mechanism, MoU outlining

accountability FW b/n members and cluster