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Field ArticleT Keegan, Dafur, 2006GOAL staff meet local sheiks to discussaccess and programme activities inKutum town and IDP campsDeveloping strong communication with communities,local leaders, and authoritiesGood communication systems are crucial for anumber of reasons. First, because of the threatof insecurity and the restrictions placed on NGOmovement, agencies often have very limiteddirect access to local communities, making screening and community sensitisation impossible fortown-based staff. Instead, community volunteers, locally-based staff, and local leaders mustbe enlisted to bring messages to communities.In GOAL’s Jebel Mara programme, between4 and 8 outreach nutrition workers operatedout of each programme hub. On distributiondays, the outreach workers helped provide SFPservices. During the rest of the two-week cycle,they visited the homes of children who hadbeen absent at the distribution to reducedefaulters, and conducted screening and communitysensitisation. Outreach workers wereselected from local communities; although theywere still subject to some danger while travellingin rural areas, they had better knowledgeof the local security situation, and were betterable to access rural communities.In GOAL’s North Darfur programme, locally-basedCommunity Health Promoters (CHPs)conduct house visits to follow up on childrenabsent from SFP or CTC services, to conductscreening and education, and to raise awarenessamong the community. In rural areas,where distances are great, CHPs are providedwith donkeys in order to travel between villages.In areas where no CHPs are present, localsheikhs are asked to inform community membersabout nutrition services to encourage themto bring thin children for screening.In October 2005, GOAL carried out a householdnutrition survey, covering the entire catchmentpopulation of its North Darfur programme.To enter rural villages, a number ofsteps had to be taken:• Discussions were held with local authoritiesto gain approval to carry out the survey.• Advance approval was sought from authorities,listing all locations selected for the survey,and the dates that villages would bevisited.• Letters were carried by clinic staff to thesheikhs in the selected villages to informRecording theMUAC valuethem of the purpose of the survey, and thedates on which the communities would bevisited.Without effective channels of communication,the survey would not have been possible.Regular communication enhances the acceptabilityof the organisation within the communityand reduces the threats to staff, who cansometimes be regarded with suspicion by militaryand political groups. It is important tomaintain visibility and transparency of programmeactivities, so that communities areaware of who is providing key services, andhow those services are organised. This reducesthe risk to staff by increasing the perceivedvalue of the organisation – there will be less interferencein programme activities if soldiers orcommunity members perceive that the organisationis providing valuable services, and can trustthat the organisation will do what it says it will.Health and Community EducationOne of the most important factors in successfullyproviding nutrition services in insecure areasis community awareness and education.Because agencies are limited in their directaccess to communities, following up on beneficiariesis much more difficult. Instead, nutritionworkers must stress at each distribution theimportance of returning every two weeks forservices. In order to increase the perceived benefitsof the programme, mothers are encouragedto think of Corn Soy Blend (CSB) as treatmentfor a sick child, rather than as food. At each distribution,caretakers have to be reminded of theimportance of not sharing CSB.In both of GOAL’s Darfur programmes, SFPservices are provided in conjunction with clinicservices, located on or near the grounds of alocal health centre. This encourages the idea ofSFP as a treatment, and also allows easy referralbetween health and nutrition services.Planning for the futureAs in most emergency situations, there was alarge influx of funding and agency support afterthe early, critical stages of the Darfur conflict,resulting in a quick improvement in health andnutritional status among children in the region.Funding for food aid and nutritional serviceshas slowly waned since the initial crisis passed.However, hundreds of thousands of householdsare still dependent on food aid as their primaryfood source, and still lack access to livelihoods,productive land and alternative sources of foodbecause of ongoing insecurity.A number of challenges have emerged in2006. The WFP recently announced that food aidrations in Darfur will be cut in half because of ashortage of funds. This will directly reduce theeffectiveness of SFPs, as food rations are sharedamong other family members. Donor supportfor SFPs and TFPs has declined as a result oflowered admissions following the early nutritionalcrisis. The majority of agencies providingsupplementary and therapeutic feeding inDarfur have demonstrated poor performance incomparison with internationally accepted standardsfor cure and default rates, resulting in furtherquestions about the effectiveness of feedingprogrammes given the context of insecurity anddifficult access.It is difficult to get a true sense of the nutritioncontext in the region because of the constraintsin carrying out surveys and rapidassessments. Surveys can only be conductedamong accessible populations, such as in IDPDrug distribution during an SFP atGOAL clinic, Kassab IDP camp, northDarfurcamps, towns, and more stable rural areas. Themost vulnerable children are often missed bythese surveys. However, several recent assessments,including one carried out by GOAL inOctober 2005, have found that GAM rates arestill above emergency thresholds in many areas,and increasing admissions in feeding programmesindicate that the situation is worsening.Food security has been further compromisedby the conflict, especially for the manyvulnerable populations still living in camp settings.Faced with a reduction in internationalassistance, many agencies are having to adoptnew strategies to sustain the gains that havebeen made since 2003.Given the precarious state of donor funding,the dependence of two million Darfurians onfood aid, and the inability to predict the effectthe Abuja peace deal will have on the securitysituation on the ground, it is clear that effectiveprovision of nutrition services in Darfur is contingenton a number of external factors. On theone hand, reduced general food rations willcompromise the effectiveness of the SFPs andTFCs, where implemented. On the other,renewed fighting between opposing factions –currently divided over the recent peace agreement– will undermine the ability of agencies toprovide SFPs and TFPs.Providing nutritional services in conflict settingsis particularly challenging, but can beeffective with planning, flexibility, and goodcommunication. While high rates of malnutritionpersist, populations in Darfur will continueto require emergency feeding services over thecoming months. However, it is clear that shorttermnutrition solutions, such as emergencyfeeding programmes, are at risk of being discontinuedgiven the constraints that have developedover the last few months. In order to sustainthe improvements that have been seen innutrition over the last 3 years, greater attemptswill need to be made to build the capacity ofexisting community and health structures toaddress malnutrition in the long-term.For further information, contact: GwynethHogley Cotes, Nutrition Coordinatoremail: ghogley@gmail.com, and Dennis Curry,Field Coordinator – Kutum, Darfuremail: dcurry@goalsudan.com12T Keegan, Dafur, 2006