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performance and ability of participants is difficult
to quantify; however there were some signs
that the courses had a positive impact. The
average score for the MCQ increased from
52.0% at the start of the course in Uganda to
63.5% at the end. In Thailand the average score
increased from 52.5% to 65.5%. Only 29 of the
67 participants responded to the follow-up
email. Among these 29, there were numerous
examples of positive actions resulting from
attendance on the courses. The majority of
responders had provided training to their own
staff or to others. A group from Lebanon had
developed a country-specific emergency
preparedness plan for nutrition. Others had
been identifying ways to strengthen the
management of moderate acute malnutrition as
part of CMAM.
Based on feedback from the course evaluations,
an 11-day ‘standard’ NIE course has now
been developed and this will be the model that
will be implemented by each of the training
partners. This course includes the emergency
simulation exercise but the field-based training
is designed as an optional add-on to the standard
course, depending on the opportunities
available and the logistic feasibility at each
training site.
Discussion
On one level, the overall goal of the NIERTI to
increase the availability of high quality training
in NIE has been met. There are also indications
that the training model will be sustained by our
partner organisations. The courses have gained
a positive reputation among the NIE community
and, at the time of writing, all three
institutions have taken steps to implement their
next course. Each institution has started to
investigate ways to strengthen their own capacity
and to institutionalise the training. This
includes engaging regional practitioners to
develop a network of known NIE facilitators
and incorporating the course (or elements of the
course) into post-graduate training. There also
appears to be a reasonably steady market for
the courses. Despite increased focus on the
development of NIE capacity, we are only
aware of one other specific course in NIE that is
run on a regular basis. Other training initiatives
that have emerged over the past few years are
still predominately ad-hoc or one-off events
hosted by international agencies. In light of the
extent of the capacity gap in nutrition and the
high turnover of staff within the humanitarian
sector, investment in occasional training, while
being very useful, will not be sufficient.
The process of setting up the NIERTI has
highlighted a number of issues that will need to
be considered if we are to make further
progress in addressing the lack of capacity in
the sector. These have been grouped into three
major themes: the cost of capacity development,
providing practical training in NIE and
standardisation of training.
facilities in Thailand were excellent value for
money and it is difficult to achieve similar at a
lower cost.
The other main contributor to the cost of the
courses is also challenging to solve. The main
reason why NIE training is expensive is
because of the reliance on relatively few NIE
practitioners who need to be flown in to teach
on courses. We were not able to run the NIE
courses using only staff from the partner organizations.
None of the available facilitators had
experience of working in emergency contexts
and all felt that practical experience was an
essential prerequisite. As such, external facilitators
had to be employed. Significant effort went
in to identifying experienced facilitators based
in each region. However, the NIE community is
still relatively small, the
work commitments of
potential facilitators are
unpredictable, experienced
staff are in high
demand and expect to be
paid a fee that is commensurate
with their
experience, and relatively
few NIE practitioners have
sufficient teaching experience.
The latter point is
particularly important;
although course participants
appreciated the
extensive experience of the
facilitators while the ability
to transmit information
and to manage teaching
sessions effectively was
also valued highly.
The most obvious solution
to this is to build the
capacity of national practitioners and academic
staff. This approach would reduce costs and
could promote sustainability. Development of
the capacity of academic staff will require exposure
to emergency nutrition programmes. A
recent piece of research looking at pre-service
training in NIE found that academic staff can be
isolated from the work of NGOs and UN agencies
10 . This gap needs to be bridged in order to
enable academics to gain hands-on experience.
Training in the sector is still more commonly
undertaken by agencies rather than higher
education institutions. Although this approach
can improve capacity within the humanitarian
sector, it has the potential to further weaken the
academic system that could provide a sustainable
approach to strengthening capacity in the
longer term (8).
The other constraint to strengthening
national academic capacity is the continuing
issue of low salaries, high staff attrition and
conflicting demands among academic staff in
developing countries 11 . In order to establish
academic institutions as providers of high quality
nutrition training, this problem will need to
be addressed. This might also help to attract
experienced NIE practitioners in to the
academic sector.
One solution to this is to include classroombased
teaching as part of an integrated
work-based training programme that includes
field exposure. In 2010, the Consortium of
British Humanitarian Agencies (CBHA)
launched a competency-based training
programme for humanitarian staff, which
includes field placements. More recently, Save
the Children UK and Concern Worldwide initiated
1 and 2-year emergency nutrition
internships, which include placements at head
quarters as well as at field sites. Another option
would be to develop partnerships between
academic institutions that can provide theory
training and humanitarian agencies operating
in relevant countries. Practitioners could attend
training and then opt for a shorter and more
affordable work placement in their country of
origin. This arrangement would also help to
bridge the gap between the academic and operational
agencies in these countries. For
practitioners already working within the
humanitarian system, a relevant work placement
could be one of the pre-requisites for
attending the theory training.
The cost of capacity development
The NIERTI course fee is undoubtedly prohibitively
high for some individuals and agencies.
professional competencies
Standardisation of training and the need for
However, the fees provide an indication, and
A recurrent issue that emerged during the
Providing practical training in NIE
perhaps an under-estimation of the real cost of
development of the NIERTI was the lack of
Two key themes emerged from the evaluations
running a course of this nature in the current
common understanding of the competencies
and course participant follow-up. First, participants
emphasised the importance of the
climate. The cost of accommodation/meals
required by NIE staff. Although experienced
seems quite high but in fact it is extremely difficult
to find alternatives at a lower cost in
practitioners have a reasonable sense of what
problem-solving course exercises, field-based
training and the emergency simulation for
10
Uganda, other than in hostel-type settings. The NutritionWorks (2011). In-service and pre-service training
enabling them to put into practice the theory
A Perry/NIETN, Beirut, 2010
covered. Second, participants felt that postcourse
internships, work placements and
mentoring would have enabled them to consolidate
their learning further. The role of practical
training in NIE was emphasized in the 2007
capacity review by Gostelow. The field-based
training included in the course held in Uganda
was well received but this is a difficult activity
to maintain. Running field training in an emergency
programme can be disruptive and the
nature of emergency response does mean that
from one year to the next it is difficult to guarantee
that relevant programmes exist or are
accessible in the country/region where training
is being held. Field training also lengthens the
duration of courses, which increases both the
time and financial commitment for participants.
Training session on infant and young child
feeding in emergencies, Beirut, 2010
in NIE. http://www.ennonline.net/meetings/servicetraining
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