Improving Nutrition in Protracted Crises: how can we do better?

by | Jun 22, 2020 | Latest News

Transforming knowledge into action for nutrition & development

Over the last few years many of us in the international nutrition world have talked about the need to strengthen the humanitarian and development nexus (HDN). This isn’t a new idea and harks back at least 30 years to notions of better linking relief and development efforts. What is new, especially in the last decade, is the realisation and evidence that the vast majority of humanitarian crises are protracted. Over 75% of them have been ongoing for 8 or more years. This means cyclical annual humanitarian funding and programming renegotiated each year under a humanitarian response plan (HRP). We are not talking just refugee and IDP contexts here but also stable population settings.

From a nutrition perspective, this situation appears increasingly counterproductive. More and more resources are being poured into treatment of acute malnutrition rather than its prevention and into infant and young child feeding which do not alter the profound underlying drivers of poor diets and feeding. Critically, there is no long-term improvement in rates of malnutrition or indeed people’s resilience to shocks through these responses. Indeed, the numbers of people falling under HRPs in protracted crises increase year on year. New data contained in the 2020 Global Nutrition Report analysing fragile contexts shows us that these contexts have a disproportionate burden of three major forms of malnutrition across different age groups: overweight, anaemia and stunting.  Although many HRPs increasingly purport to incorporate resilience building and prevention of malnutrition, the reality is that from a nutrition programming perspective, we are still largely pushing out RUTF, other products and encouraging mothers to breast-feed for as long as they can.

N4D of are of the view that if we are to get anywhere near the WHA and SDGs for nutrition in the next 5-10 years, then a number of issues around nutrition programming in protracted fragile contexts need to be urgently prioritised and addressed. 

After carrying out four country studies with ENN and MQSUN+ between 2017-19, looking at how to strengthen HDN to improve nutrition programming in Yemen, Somalia, Ethiopia and Kenya, we began to develop a series of recommendations and a framework for programmes. We hope these ideas help challenge and interrupt for the better, what has become business as usual in protracted crises. Some of these recommendations are well known, informed by wider international guidance on strengthening the HDN in general, while others may have been given less attention.

In all protracted crises, there is a need to massively scale up multi-year financing and programming in order to both prevent and treat malnutrition. This means doing far more to support government led, multi-year programmes through development assistance with concerted efforts to right size humanitarian assistance. The concept of right sizing is captured in the OECD DAC Recommendation on the nexus: “prevention always, development wherever possible, humanitarian action when necessary”. A scale up of development aid should enable a refocusing of humanitarian resources on life saving action in contexts where humanitarian principles are jeopardised. The role of nutrition in vulnerability to COVID-19 and the impacts of the pandemic on nutrition make this shift even more necessary and urgent.

The question then becomes, how on earth are we going to make this happen and target the juggernaut of humanitarianism where it is most needed in these contexts of protracted fragility? Here are a few of N4D’s thoughts and suggestions:

Develop shared understanding of needs and causes: There has to be clearer distinction between programming to address acute shocks and those that build resilience and prevent malnutrition in contexts where nutrition is under chronic threat. In countries with protracted crises and escalating numbers of people falling under HRPs, there needs to be a re-examination of how numbers are being determined differentiating between those affected by acute shock and those who are chronically vulnerable. HRPs and other plans, e.g. resilience building, UNDAF, need to then distinguish between programmes which are to be funded under these plans, e.g. treatment versus prevention, surge versus system strengthening. 

Bring humanitarian and development actors together: In order to achieve this clarity, there have to be functional national and sub-national level coordination platforms which bring humanitarian and development actors for nutrition together for joint analysis, planning, coordination, resource mobilisation and reviews of progress. The leadership and composition of these mechanisms will vary according to context, in particular the level of political commitment, and in some contexts of extreme political fragility, coordination will need to be IASC cluster led.

Determine who is best placed to do what: Who does what depends on context. No two protracted crises are the same. Nutrition actors have to leave their technical comfort zone and get their heads into political economy analysis to assess the strength of government commitment to nutrition in order to determine appropriate roles and ways of working of humanitarian and development actors. Without this, humanitarian action risks undermining local political ownership, technical capacities and sustainable solutions whilst development assistance may risk undermining humanitarian principles and life-saving action. 

Response to acute shocks should be funded through both humanitarian systems and contingency or blended financing as part of development financing to allow for surge capacity in programme areas like treatment of acute malnutrition and social protection. Addressing protracted needs, building resilience and prevention should be financed through longer-term multi-year development assistance channels.

Where possible assistance should be delivered through government led fiscal and service delivery systems. However, multi-year financing does not necessarily mean development aid. In some contexts, where government commitment is lacking and humanitarian principles are at risk, there is a need for more multi-year humanitarian planning, financing and programming. It is extraordinary how there have been so few examples of multi-year HRPs given the massive transaction costs of reconfiguring humanitarian programming every year in these protracted crisis contexts. 

At a regional and global level, technical assistance has to be better adapted to contexts of protracted fragility to enable multi-stakeholder analysis, planning and coordination processes. Closer collaboration between global SUN Movement structures and the Global Nutrition Cluster could be important here.

At the same time, we need far more advocacy and public campaigning to make the political case for longer-term, development financing as well as a commitment to overcome political and fiscal risk aversion.

Finally, and we really shouldn’t have to wait for this before acting on the above, we need further research as well as documentation and sharing of good practice. Research into how HRPs derive the caseloads and the transaction costs of large cyclical humanitarian programming would be a start. We also need to begin documenting examples of success. For example, after many years of humanitarian response in the ASAL region of Kenya, the Government of Kenya and its partners have managed to substantially reduce annual humanitarian responses in favour of government led and development partner supported resilience building. There are also important experiences from refugee contexts where the global compact for refugees provides a solid HDN strengthening framework. Finally, what we learn about the humanitarian and development nexus from the responses to the current COVID-19 crisis across multiple protracted crisis contexts might shed a light on what is possible, innovative and necessary.

Much of the HDN narrative has been framed and owned by global level actors, e.g. the UN New Ways of Working. Perhaps this isn’t surprising given the reasons for the resurgence of interest in HDN, i.e. escalating international humanitarian budgets which support life-saving objectives but struggle to provide lasting solutions. What is so clearly missing from this narrative is the national and sub-national government perspective and experience. Our concern is that without listening to, understanding and utilising this ‘lived’ experience, progress will be limited.