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November 2004 Issue 23ISSN 1743-5080 (print)• Inappropriate interventions in the Great Lakes• Market support programme in Zimbabwe• Selective feeding in war-ravaged Uganda• Measuring impact of humanitarian aid

ContentsFrom the EditorField Articles3 A Market Support Programme toAddress an Urban Food Crisis inZimbabwe10 A New Household Economy Methodfor Assessing Impact of Shocks18 Estimating the Target Under FivePopulation for Feeding Programmesin Emergencies20 Selective Feeding in War-RavagedNorthern Uganda5 Research• Global Trends in Malnutrition• Appropriateness of ReplacementMilks in South Africa• Measuring the Impact ofHumanitarian Aid• Nutrition Programming in theSouthern Africa Emergency• New Sphere Standards for FoodSecurity, Nutrition and Food Aid• Inappropriate Interventions in theGreat Lakes• Can Sphere be Used in ComplexEmergencies?12 News & Views• Refugee Numbers Decline• World Health Organisation AdmitsTargets on AIDS Drugs May beUnrealistic• New Nutrition Policy Papers for WFP• Infant and Young Child Feeding inEmergencies Meeting• New Sections on SCN/NICS Website• International Conference onHIV/AIDS, Food and NutritionSecurity, 14-16 April 2005• MSF Close Their AfghanistanProgramme• Relief Food Factory to Open inKenya.16 Letters22 Evaluation• Comparative Experiences ofCommunity Managed Targeting inTanzania, Zimbabwe and Malawi23 Agency Profile• Valid International25 People in AidThis edition of Field Exchange carries anumber of articles which challenge theeffectiveness of our standard responsesto food and nutrition emergencies. Areview undertaken in the Great Lakes region(see research section) is highly critical of foodsecurity responses over the past 5 years.Criticisms included the adoption of too narrowa range of interventions, many of which werejudged to be inappropriate, short-term andoverly focused on the food production siderather than market access. Issues of cost-inefficiencywere also highlighted when alternativeinterventions may have been implemented at a'fraction of the cost'. Another review of nutritionprogramming in the southern Africaregion undertaken on behalf of UNICEF andWFP included a focus on the emergencyresponse during 2001-3 emergency (seeresearch section). This element of the reviewraised serious questions over the effectivenessof selective feeding programmes with regard tocoverage and impact. A field article by JohnMoore and Mara Berkley-Matthews in thisissue on difficulties of attending and managingSFPs in war-ravaged northern Uganda highlighthow the success of many such programmesare highly context specific althoughprogramme staff did manage to introducemeasures to circumnavigate some of the securityrelated problems of attendance,In shining contrast Field Exchange carries afield article by Kristy Allen about a highly successfulmonetisation programme in Bulawayo .The Market Assistance Pilot Program (MAPP)is providing beneficiaries in Zimbabwe's secondlargest city, Bulawayo, with a low-costmaize alternative - sorghum - through existingcommercial channels.The price of sorghum is determined byincome, household size, and the retail price gapbetween maize and sorghum. Retailers are alsopermitted a 15% mark-up on the product toensure profitability. Local processors, distributorsand retailers are also encouraged to investin producing the product locally, the first steptowards ensuring sustainable production at thelocal level.The MAPP targeted more than 800,000 familiesin the Bulawayo area. Preliminary estimatessuggest that the sorghum meal pricesallowed most poor families in the target area topurchase sufficient food to feed all familymembers three meals per day for the six monthduration of the pilot program. 77% of the highdensitypopulation (460,000 people) werebeing fed per month by the MAPP. In recognitionof the MAPP's impact and its potential toassist many more vulnerable households,USAID Food for Peace has approved a MAPPexpansion to Gweru, targeting over 100,000urban poor; an expansion to Chitunguiza, targeting250,000 urban poor; and the continuationof the original program in Bulawayo.Findings of a recent CIDA funded systematicliterature review (to be reported in the nextissue of FEx) on six types of emergency intervention(GFD, SFP, TFP, measles, vit A and bednets)show very little published literature onthe impact or cost of these programmes. Areview by HPN (see research section of thisissue) of both the published and grey literatureof the impact of a broad range of humanitarianresponses found a similar dearth of information.This review states that the humanitariansystem currently lacks the skills and capacity tosuccessfully measure or analyse impact.There would now appear to be a growingbody of support for introducing systems toensure more effective monitoring of impact ofhumanitarian responses and awareness thatknee-jerk standard responses often involvingfood aid may not always be appropriate oreffective. At the same time, newer types of programmingin the era of HIV/AIDS involvingfood aid need careful monitoring especiallywith regard to cost-efficiency. The soon to bepublished CIDA review will argue that there iscurrently no agency with overall responsibilityfor monitoring cost-efficiency of interventions.Thus, standard interventions are routinely trottedout by agencies for a variety of reasons(many of which do not necessarily relate toneed, i.e. agency mandate, area of expertise,visibility, ease of accountability, availability offood aid rather than cash, etc). This means thatthere is no overall collation of information oneffectiveness or cost, there is a lack of analysisof the grey literature and that opportunitieswhich may arise in certain emergency contextsfor controlled impact assessments are not capitalisedupon. At the same time donors do notapply cost-efficiency criteria to proposals.There is a pressing need to remedy this situation.One solution may be to appoint an agencywhose primary mandate is to compare costefficiencyof different types of intervention inthe humanitarian sector. Such an agency wouldalso need to keep a close eye on assessingimpact and cost-efficiency of newly emergingtypes of intervention, e.g. HIV/nutrition programming,before such programmes are rolledout on a large scale or become part of standardagency practice.Finally, Field Exchange is pleased to be ableto publish the findings of one of the first studieson impact of HIV/AIDS on food and economicsecurity at community level. The articlewritten by Celia Petty and John Seaman isbased on a study of a modified form ofHousehold Economy Assessment conducted infour countries. In two of the countries(Swaziland and Mozambique) researchersexamined HIV/AIDS impact and found that inSwaziland, omitting the costs associated withillness and funerals, extra adult mortalityattributable to HIV/AIDS over the past 5 yearshas caused a fall of approximately 8%-12 % intotal community disposable income. However,the economic impact on individual affectedhouseholds is specific to that household, andranges from a small improvement inincome/adult equivalent (e.g. death of anunemployed adult) to devastating loss (e.g. lossof one or more salaried/public sector workers).Overall, the net effect is to make very littlechange to the proportion of households fallingbelow the defined poverty line.The research provides a measure of the distributionof poverty in the study communitiesand casts doubt over the feasibility of deriving'simple' HIV/AIDS related poverty indicators.This has implications for the design of socialprotection and welfare policies, as well aswider macro economic policy debates. Forexample, if only orphans were identified as eligiblefor free primary education or health care,many poor children would be excluded andsome better off children included.We hope you enjoy this issue of FieldExchangeJeremy ShohamAny contributions, ideas or topics forfuture issues of Field Exchange? Contactthe editorial team on email: office@ennonline.net2

C-SAFE, Zimbabwe, 2004A Market Support Programme toAddress an Urban Food Crisis inZimbabweField ArticleZimbabwe's case the needs in urban areas are equallycritical. Massive market failures, the evaporation ofinfrastructure and critical wounding of the local economymeans that the ability of urban households to recuperatelosses is limited. At the same time prospects forhunger relief are poor.The MAPPAs an alternative to traditional food distributions, C-SAFE approached existing commercial entities thatcould facilitate a program aimed at 'filling the marketgap' with an affordable maize substitute. A proposal touse sorghum initially encountered resistance from bothretailers and consumers, given its lack of commercialpresence in the local market for several generations.However, within weeks, 150 retailers in 40 high-densityBulawayo suburbs agreed to sell the cereal. Demandexploded from 30 tons to 300 tons a day and byNovember 2003, seven local millers were milling andpackaging the USAID sorghum to meet consumerdemand.At the height of demand, MAPP sorghum had anaverage shelf life of less than one hour. Retailer CarolineMakoni of Lucky 7 store in the high-density suburb ofPumula is quoted as saying “During November, thesorghum would sell out in no time. The availability of acereal in our store really provided a much-needed andaffordable essential to customers. Today there is a littlemaize available on the market, though it is comparativelyexpensive, so most of my customers still rely on thesorghum.” Lucky 7's three tonne orders now sell out inabout two weeks. Each 10kg bag currently retails forZ$6000 (USD1.20).The price of sorghum set by C-SAFE is determined byincome, household size, and the retail price gap betweenmaize and sorghum. When cereal prices rise, the potentialfor side marketing increases, so C-SAFE monitors themarket activity and adjusts the sorghum price accordingly.Retailers are also permitted a 15% mark-up on theproduct to ensure profitability. The sorghum is an easyto sell commodity and although it is priced to move, itstays in the target market.Profits made by the purchase of sorghum are thenreinvested in the programme. Local processors, distributorsand retailers are also encouraged to invest in producingthe product locally, the first step towards ensuringsustainable production at the local level - which isthe ultimate goal of the MAPP initiative.MAPP has also contracted the country's fourth largestmilling operation (Induna Foods) to begin processingthe sorghum meal.By: Kristy AllenKristy Allen-Shirley is the CommunicationsCoordinator for the Consortium for SouthernAfrica Food Security Emergency (C-SAFE),based in Johannesburg, South Africa. C-SAFE is in its second year of implementationfor a coordinated 'developmental relief' programin Malawi, Zambia, and Zimbabwe. TheC-SAFE membership includes World Vision,Catholic Relief Services, CARE, ADRA,Emmanuel International, Save the ChildrenUS, Save the Children UK, Africare, SalvationArmy and Malawi Red Cross, and is fundedby USAID's Office of Food For Peace.It is extremely difficult to address urban foodemergencies through traditional general rationprogrammes. The logistic and targeting challengesare particularly daunting. The market supportprogramme described in this article demonstratesan alternative type of intervention whichcircumvents many of these difficulties. This typeof programme may also be suited to certain ruralcontexts and may offer a model for future programming(Ed).A 10kg bag of sorghum will feed sevenmembers of the Tshuma household.During a time when Zimbabwe'surban population has seen its purchasingpower slashed by soaringinflation and widespread unemployment,at a time of limited access to food,an innovative market intervention is workingto rebuild the flailing commercial sector andsustain the urban poor.The USAID funded Market AssistancePilot Programme (MAPP) is providing beneficiariesin Zimbabwe's second largest city,Bulawayo, with a low-cost maize alternative- sorghum - through existing commercialchannels. C-SAFE, comprised of CatholicRelief Services (CRS), World Vision (WV) andCARE, took the step of piloting the programmein September 2003 as the combinedeffects of drought, poor economic policy andHIV/AIDS had left livelihoods frayed andurban communities powerless to emergefrom a state of chronic food insecurity.Relief and development projects have traditionallyfocused on rural areas, however inImpact of the programmeMAPP has been instrumental in the resuscitation ofthe milling sector. By September 2003, most of the biggermilling companies were operating for at most, oneday a week, while some smaller companies were lyingidle. Prior to MAPP, only one miller had experience inmilling sorghum. By the end of the pilot phase, six additionalmillers had gained expertise in milling sorghum.MAPP was instrumental in building capacity of themillers. Retailers also reported increased sales of commoditiesas a result of retailing sorghum, indicating thatMAPP also helped revive business in the retail sector.The MAPP targeted more than 800,000 families in theBulawayo area. Preliminary estimates suggest that thesorghum meal prices allowed most poor families in thetarget area to purchase sufficient food to feed all familymembers three meals per day for the six month durationof the pilot programme.The vulnerable low-income households could easilyaccess the sorghum meal from the retail outlets.However, retail outlets did not exclude the higherincome households and targeting will continue to be achallenge, especially during periods of maize mealshortageCase studiesSibusiswe Tshuma, 31, a mother of five and sorghumconsumer explained that prior to the MAPP interventionin her area, her family, whose children range from 7to 15 years of age, would consume just one meal a day.The sorghum bought from her local store has provided3

the family with two bonus meals each day. “It isso very important to have the sorghum availableto us at a good price. For us, it has become soexpensive to pay for schooling, clothes and othernecessities. Basic supplies are hard to find andwe continue to struggle each day. The extra mealseach day are improving our health and energyfor my children.”Faith Ncube has been purchasing sorghumregularly over the last six months from her localstore in suburban Luveve. The 10kg bag she buyseach week feeds her household of four adultsand three children. She admits that she wouldprefer maize if she could afford it, but the family'sincome will only stretch to a sorghum purchase.Faith affirms, “We use the sorghum forbreakfast and lunch, which is better than sixmonths ago. Before we had sorghum, we only ateone meal a day. It's still hard today as we onlyhave enough money for food - we just can'tafford anything else.” The Luveve grocery storesells around 400 10kg bags a week to its urbanpoor customers.The Bulawayo market is now consumingaround 1000 tonnes of MAPP sorghum eachmonth. In fact, 77% of the high-density population(460,000 people) are being fed per month bythe MAPP.Evaluation of the programme.Following implementation for eight months,C-SAFE requested an external evaluation.Specific objectives of the evaluation were:(i)4Field ArticleAssess compliance to donor (USAID),Government of Zimbabwe (GoZ) and internal NGO (CRS, WV and CARE) operationalrequirements, regulations and standardsfor food distribution.Small-scale retailers say the low-cost MAPPsorghum is popular with customersC-SAFE, Zimbabwe, 2004(ii) Assess programme performance in accordance with programme objectives.(iii) Make recommendations for MAPP expansion.A team of independent consultants conductedthe external evaluation from 15 April - 31 May2004.Data collection was in two parts(a) The implementation of a quantitative endof project survey involving 540 randomlyselected households where data collectionwas conducted by C-SAFE and data analysisby the consultants.(b) Stakeholder consultations, key informantinterviews and review of project documents by the consultants.The main lessons detailed in the evaluation maybe summarized as follows:(i) Contrary to the initial misconceptions byretailers, the urban population in Bulawayoaccepted sorghum meal. This findingemphasized that sorghum was appropriateto local conditions and preferences.(ii) Low-income households will always selfselect and continue purchase of sorghummeal as long as it is affordable compared tomaize meal.(iii) Sorghum meal was preferred as a breakfastcereal rather than thick porridge.(iv) To increase the nutritive value of sorghummeal, there is scope for fortification withvitamins and essential minerals for use byHIV/AIDS patients.(v) The rate of milling should be determinedby demand. However, it is difficult to forecast demand in an environment whereGMB grain supplies are erratic. This pilotphase has been vital in indicating monthlytrends in consumer demand for sorghummeal. This will help effective planning forthe production of sorghum meal during(vi)expansion.Extraction rates are crucial in sorghummilling. There is need to understand thedeterminants of extraction rates.(vii) It took approximately nine months to clearthe first consignment of sorghum. It istherefore important to note that storagecosts will always be high due to the slowmovement of the commodity.(viii) Beneficiaries prefer 5kg packages as themajority of the low-income households areon weekly wages or petty trade and therefore cannot afford purchase of large quantities at a time.(ix)Leakage and side marketing will alwaysoccur if sorghum meal prices are too lowwhen compared to maize meal. This invariably occurs during periods of maize mealshortages.In order to improve implementation of the intervention,the following recommendations wereproposed:(i) The format of the monthly reports shouldbe standardized. It is critical that data presentedin all reports is adequately checkedfor accuracy.(ii) A Working Group made up of relevant expertsfrom the C-SAFE consortium shouldbe set up to regularly review the implementationof the expansion.(iii) Stakeholder participation and support iscritical to the success of the programme.(iv) Debtors Age Analysis records should bemaintained so as to monitor that agreedcredit limits and periods are not exceededby debtors.(v) MAPP has identified millers who are capableof delivering a quality product at therequired extraction rate. These millersshould be given first preference to participatein expansion of the programme.(vi) Targeting criteria should be continuouslyreviewed to ensure that the most vulnerableare reached.(vii) The hyperinflationary environment willdemand frequent reviews of sorghum mealprices making it impossible for MAPP tokeep to the prices printed on the packages.MAPP should consider abolishing theprinting of the retail price on the packagebut instead, insist on the display of a bigbanner indicating the price of the meal atthe retail outlets. Consistent display of thisbanner would be a requirement for theretailers to remain on the programme. Inaddition, during expansion, the programmecould invest in a bi-weekly bulletinto inform beneficiaries on sorghummeal price and other related issues.(viii) Cleaner sorghum grain should be imported from the USA. If this is not possible,the programme should consider cleaningthe bulk grain before bagging to get rid ofthe dust and plant residue. Quality assessmenttests should be conducted on eachconsignment. It is not essential that thesorghum be de-hulled as most of themillers have the capacity to do this.(ix) A study to look at the sorghum extractionrates and its determinants should be commissioned.(x) Sorghum milling has been commercializedin Botswana and South Africa. The qualityof the sorghum meal should be standardizedacross millers. Before expansionacceptable 'quality parameters' should bedefined for each miller to adhere to. Inaddition, spot-checks on the quality of thesorghum meal should be conducted both(xi)at the miller and retail premises.A clear strategy for bran disposal shouldbe developed. It is strongly suggested thatbran disposal should be left to the millers.(xii) The programme targets vulnerable groupswho, due to financial constraints, haveproblems accessing sufficient food to meetnutritional requirements. To increase thenutritive value of the sorghum meal, fortificationwith micronutrients, vitamins andessential minerals should be considered.Expansion of the programmeIn recognition of the MAPP's impact and itspotential to assist many more vulnerable households,USAID Food for Peace has approved aMAPP expansion to Gweru, targeting over100,000 urban poor; an expansion toChitunguiza, targeting 250,000 urban poor; andthe continuation of the original programme inBulawayo.This vital expansion will support C-SAFE'sgoal to improve and maintain the nutritional statusof targeted vulnerable groups; increase supportto households affected by HIV/AIDS;increase and maintain agricultural productivityand improve market linkages.C-Safe partners believe that the MAPP is ahighly promising intervention with a workableexit strategy that leaves behind sustainable workingrelationships. It links all levels of communityfrom consumers to small-scale traders to experiencedmillers and eventually aims to link withlocal producers of sorghum. Because sorghum isalso a drought resistant crop, it's better suited tothe semi-arid climate of Matabeleland thanmaize. MAPP had anticipated that proceeds fromthe programme would be used to support initiativesthat would promote local production ofsorghum. Though this programme did notdemonstrate any progress on this objective thiswill be a focus for the future.For further details contact; Kristy Allen:kristy_Allen@c-safe.orgphone +27 (0) 11 679 3601, cell +27 (0) 72 7833696, fax +27 (0) 11 679 3597,website: www.c-safe.org

Global Trends inMalnutritionSummary of published paper 1Arecent study set out to estimate trendsin childhood underweight by geographicregions of the world in order todetermine whether the UNMillennium Development Goals (MDGs) wereon track. The MDGs aim to reduce by half theprevalence of underweight among childrenyounger than 5 years between 1990-2015. Thesource of data for the study was the WorldHealth Organisation (WHO) global database onchild growth and malnutrition which includesdata on approximately 31 million children underfive years participating in 419 national nutritionalsurveys in 139 countries from 1965 through to2002. The work was based on a time series studyof prevalence of underweight, defined as: weight2 standard deviations below the mean weight forage of the NCHS 2 and WHO reference population.Linear mixed-effects modelling was used toestimate prevalence rates and numbers of underweightchildren by region in 1990 and 2015 andto calculate the changes to these values betweenthe two years.Worldwide, underweight prevalence was projectedto decline from 26.5% in 1990 to 17.6% in2015, a change of -34% (95% confidence interval,-43% to -23%). In developed countries, the preva-lence was estimated to decrease from 1.6% to0.9%, a change of -41% (95% CI, -92% to 343%). Indeveloping regions, the prevalence was forecastedto decline from 30.2% to 19.3%, a change of -36% (95% CI, - 45% to -26%). In Africa, the prevalenceof underweight was forecasted to increasefrom 24% to 26.8%, a change of 12% (95% CI, 8%to 16%). In Asia, the prevalence was estimated todecrease from 35.1% to 18.5%, a change of -47%(95% CI, -58% to -34%). Worldwide, the numberof underweight children was projected to declinefrom 163.8 million in 1990 to 113.4 million in2015, a change of -31% (95% CI, -40% to - 20%).Numbers are projected to decrease in all subregionsexcept those of sub-Saharan, Eastern,Middle and Western Africa, which are expectedto experience substantial increases in the numberof underweight children.A number of limitations to the study are highlighted.These include limited availability oftrend data, surveys not always done randomly,variations in data quality and not accounting foruncertainty in each survey's prevalence estimate(an estimate of variance for each prevalence wasnot included in the regression analysis so confidenceintervals are likely to be too narrow)The authors conclude that an overall improvementin the global situation is anticipated; howeverneither the world as a whole nor the developingregions, are expected to achieve the MDGs.This is largely due to the deteriorating situationin Africa where all sub-regions except northern1De Onis. M et al (2004): Estimates of Global Prevalenceof Childhood Underweight in 1990 and 2015. JAMA, June2nd, 2004, vol 291, No 21, pp 2600-2606.2National Center for Health Statistics / CDC Atlanta US.ResearchAfrica, are expected to fail to meet the goals. Thisdeterioration is likely to be partly due to theeffect of HIV/AIDS together with the politicaland social instability in many African countries.Child with Kwashiorkor in Kalongo,Pader.GOAL, Uganda, 2004.Appropriateness of ReplacementMilks in South AfricaSummary of published paper 1Feeding recommendations for infants ofHIV-infected mothers in developing countriesremain controversial. The WorldHealth Organisation (WHO) recommendsthat “when replacement milk is acceptable, feasible,affordable, sustainable and safe, avoidanceof all breast-feeding by HIV-infected mothers isrecommended; otherwise, exclusive breastfeedingis recommended during the first months oflife”. WHO/UNAIDS/UNICEF recommend severalvariations of exclusive breastfeeding andreplacement milk for infants of HIV-infectedmothers. The replacement milks include commercialinfant formula and home-prepared modificationsof evaporated milk, powdered fullcream milk (PM), and fresh full cream milk (FM).Little is known about the nutritional adequacyand feasibility of breast milk replacement optionsrecommended by WHO/UNAIDS/UNICEF. Arecent study set out to explore suitability of the2001 feeding recommendations for infants ofHIV-infected mothers in a rural region ofKwaZulu Natal, South Africa. The study lookedspecifically at suitability with respect to adequacyof micronutrients and essential fatty acids,cost, and preparation times of replacement milks.Nutritional adequacy, cost, and preparationtime of home-prepared replacement milks containingpowdered full cream milk (PM) and freshfull cream milk (FM) and different micronutrientsupplements: (1) 2g UNICEF micronutrientsachet, (2) government supplement routinelyavailable in district public health clinics, and (3)the best available liquid paediatric supplementfound in local pharmacies were compared. Costsof locally available ingredients for replacementmilk were used to calculate monthly costs forinfants aged one, three and six months. Totalmonthly costs of ingredients of commercial andhome-prepared replacement milks were comparedwith each other and the average monthlyincome of domestic or shop workers. Time neededto prepare one feed of replacement milk wassimulated.Nutritional adequacy:When mixed with water, sugar and eachmicronutrient supplement, PM and FM provided< 50% of estimated required amounts of vitaminsE and C, folic acid, iodine and selenium and

6ResearchMeasuring theImpact ofHumanitarian AidSummary of published paper 1Arecent HPG Briefing Paper reports onresearch into how the humanitariancommunity measures and analyses theimpact of humanitarian assistance. Thestudy is based on a review of the published andgrey literature within the humanitarian sectorand more broadly, interviews with aid agencystaff and two commissioned papers coveringimpact measurement in the food and nutritionand health sectors.The review concludes that the humanitariansystem has been poor at analysing impact thoughpromising approaches are now starting to bedeveloped. It states that a major constraint hasbeen the lack of an accepted definition of impactwithin the humanitarian sector and that the definitionscurrent within the development field maynot fully capture the particular nature of humanitarianwork. In particular, the concept of positivechange is central in developmental definitions ofimpact, but in humanitarian aid the aim is oftento avert negative change (for example to preventfamine). The review also points out thatanalysing the impact of a humanitarian interventionis not straightforward, particularly in thedynamic and chaotic environments of complexemergencies. The difficulties of the operatingenvironment, the need to act quickly in situationsof immediate crisis, an organisational culturethat values action over analysis and the fact thatthere is little consensus around the core objectivesof humanitarian aid - all make analysingimpact difficult. Techniques that are standard inthe social science community, such as the use ofcontrol groups, are not widely used, and humanitarianpractitioners tend to lack the skills neededto gather and interpret information.Key findings of the research are as follows;Moving beyond the project level• Concern for the impact of humanitarian aidshould not be narrowly restricted to the project level. There is a need for greater investmentin research, sector and system-wideevaluations that can ask difficult and importantquestions about; the overall impact andcoverage of the humanitarian enterprise,roles and responsibilities for humanitarianoutcomes, and the broader political dimensionswithin which the humanitarian systemoperates.• Project-based approaches that focus ondetermining the impact of a particular intervention through a causal pathway frominputs to impact should be complementedby approaches that start with changes inpeople's lives and that situate change in thebroader external environment.• Questions of impact should not be limited tothe evaluation process. In the humanitariansphere, a concern with change in the shortterm implies a need for impact to be considered in ongoing monitoring processes, andthrough techniques such as real-time evaluation.Measuring impact: skills, capacity andresources• Impact in any context is difficult to measureand attribute; this difficulty is exacerbated inthe dynamic and chaotic environments ofcomplex emergencies. This does not mean,however that it is impossible, and greaterefforts could be made.• The humanitarian system often lacks theskills and capacity to successfully measureor analyse impact. Greater investment therefore needs to be made in human resourcesand research and evaluation capacity if thedesire to focus more on results is to berealised.Measuring impact: science and participation• The humanitarian system has been consistentlypoor at ensuring the participation ofaffected populations. Much could be learntfrom innovations in participatory approachesin the development sphere, and possiblyfrom customer-focused approaches in theprivate sphere.• There is a place for both art and science inimpact measurement: scientific, analyticaland participatory approaches can often becomplementary.Indicators and objectives• Analysis and impact could be improvedthrough greater clarity about the objectivesof humanitarian assistance, and by moreconsistent assessment of needs.• Process indicators can sometimes be used asproxies for impact when there is strong evidenceof a link between the action beingmonitored and an expected impact. There isa need for greater investment in strengtheningthe evidence base for how activities,such as supplementary feeding or support tohealth clinics, relate to humanitarian outcomes such as reductions in mortality ormalnutrition.Results-based management; potential anddangers• Results based management systems (focusing on outcomes and impact rather than outputsand activities) are being introduced in anumber of humanitarian organisations.However it is too early to say whether theywill significantly improve the measurementand analysis of impact. Experience fromelsewhere suggests that there will be a needfor caution; in particular, measurement mayremain largely focused on outputs and notimpact.• The increased focus on results which comeswith such systems carries a risk that theharder-to-measure aspects of humanitarianaction such as protection could be neglected.The way forwardThe study suggests that sufficient and appropriatetools and methods exist to provide reliableanalysis of the impact of humanitarian aid whateverthe context. It is the appropriate use andadaptation of these tools to the particular contextand constraints that is lacking as a consequenceof insufficient investment in skills and capacitydevelopment within the humanitarian sector.The study suggests that addressing this gapwould have implications beyond the improvedpractice of impact assessment but would alsolead to clearer objectives for aid, more robust riskand needs assessments, better research into whatworks and what doesn't and greater emphasis oncommunity participation.1Hofmann. Charles-Antoinne et al (2004): Measuring theimpact of humanitarian aid. A review of current practice.HPG Research briefing, no 15, June 2004NutritionProgrammingin theSouthernAfricaEmergencySummary of unpublished report 1Areview of UNICEF and World FoodProgramme (WFP) nutrition programmingwas carried out in six southern African countries(Lesotho, Malawi, Mozambique,Swaziland, Zambia and Zimbabwe) in thecontext of recent emergency programmingand longer-term nutritional challenges in theregion. The overall goal was to enhanceappropriate and effective nutrition programmingby UNICEF, WFP and their partners inthe southern Africa region.Three main areas were covered:(i) the pre-crisis nutrition context;(ii) the emergency nutrition programmingundertaken by UNICEF/WFP, bothjointly and separately; and(iii) the way forward for both agencies.The focus was on selective feeding (therapeuticand supplementary feeding),HIV/AIDS and nutrition, prevention ofmaternal to child transmission of the HIVvirus (PMTCT), orphans and vulnerable children(OVC), home based care (HBC), nutritioninformation (surveys and surveillancesystems) and on partnership, capacity andresource issues.The review arose out of an understandingthat the southern Africa crisis has long-termdimensions, and that these need to beaddressed through increasingly innovativeapproaches that are appropriate to the com-1Dolan. C and Shoham. J (2004): UNICEF/WFPNutrition Review. Regional Synthesis Report, July 2004.

Researchplex situation in the region. In addition, there isincreasing corporate recognition and support forcollaborative programming amongst UN agencies.Onemanifestation of this is a newMemorandum of Understanding (MoU) beingdeveloped between UNICEF and WFP . Thereview arose out of an understanding that thesouthern Africa crisis has long-term dimensions,and that these need to be addressed throughincreasingly innovative approaches that areappropriate to the complex situation in theregion.This summary of the review only deals withemergency related issues. A large section of thereview deals with issues and recommendationsaround longer-term nutrition programming inthe region and opportunities for joint agency programming.These findings are not summarisedhere but can be found in the full report.The emergencyThe emergency followed widespread cropfailures and substantial shortfalls in domesticproduction in the 2001/2 growing season. Thesituation was exacerbated by a number of countryspecific institutional and governance factors.Thirteen million people were reported to be facingsevere food shortages and, in the absence of amassive humanitarian response, widespreadfamine was predicted.A number of factors underpinned the focus onfood aid distribution and selective feeding thatdominated much of the UNICEF and WFP emergencyresponse. Key amongst these was the highlevel of HIV/AIDS in the region in conjunctionwith pervasive concerns around the possibility ofa 'new variant famine' 2 . Furthermore, the keyassessment methodology employed at the outsetof the emergency was based on a food deficitmodel. Although subsequent vulnerabilityassessments generated substantial data on foodaccess and household vulnerability these datawere used almost exclusively to determine allocationof food aid by district. Opportunities foralternative forms of response such as cash transfers,monetisation of food aid, agricultural supportprogrammes, water and sanitation andhealth care provision were therefore largelymissed.In the event, the anticipated nutrition emergencydid not occur. While this may in part beattributed to the substantial food aid response,there are unanswered questions for the futureregarding how significant food insecurity in theregion can coexist with high levels of HIV/AIDSand low levels of wasting. The need for a moresophisticated evidence-based analysis of the relationshipbetween these factors is crucial.‘There are unanswered questions for thefuture regarding how significant food insecurityin the region can coexist with highlevels of HIV/AIDS and low levels of wasting.’UNICEF emergency responseUNICEF's country plans include nutrition surveillance,nutrition guidelines for people livingwith HIV/AIDS, the nutrition elements of preventionof mother-to-child HIV transmission(PMTCT), Orphans and Vulnerable Children(OVC) and home-based care (HBC) programming,the treatment of severe malnutrition and,to a lesser degree, community based or managednutrition activities.UNICEF's response to the crisis varied acrossthe region. In some countries, the on-going programmecontinued with expansion in some keyareas. In other countries, there was a rapid scaleup of national capacity to provide treatment forthe anticipated increase in numbers of severelyand moderately malnourished children and infilling the significant nutrition information andcoordination gaps that typified the crisis. In general,these activities represented new areas ofnutrition programming, placing considerablestrain on the agency in terms of external recruitmentof emergency nutritionists and in managingthe frequently tense engagement with governmentnutrition departments 3 .In general, given the high level of investment,the focus on selective feeding yielded very disappointingresults. In particular, the level ofdemand and uptake of services for therapeuticfeeding was grossly overestimated in some countriesin the region, and there was insufficientcapacity to strengthen national services toaddress chronic malnutrition. Nonetheless, theopportunity for modifying and strengtheninglonger-term strategies, capacity and preparednessfor selective feeding (both therapeutic careand supplementary feeding) has emergedthrough the crisis. Similarly, the considerablenumber of nutrition surveys that UNICEF supportedduring the emergency, whilst filling a criticalinformation gap, also highlighted the urgentneed for more functional national nutrition surveillancesystems. This is a priority area thatUNICEF must invest in both with regard to it'sown human and technical support capacity aswell as in helping to strengthen early warningand longer-term nutrition planning in the region.‘The level of demand and uptake of servicesfor therapeutic feeding was grosslyoverestimated in some countries in theregion, and there was insufficient capacityto strengthen national services to addresschronic malnutrition.’The emergency and ensuing increase inresources has led to greater attention on orphans,other vulnerable children and chronically sickadults affected by HIV/AIDS. UNICEF firmlyestablished HIV/AIDS as an organisational priorityin 2002 and in some countries UNICEFoffices have seized the opportunity to increasethe focus on integrated community basedapproaches to meeting the diverse needs ofHIV/AIDS affected groups. These projects,though relatively small-scale, provide considerablescope for replication, dissemination of keyfindings and, critically, for programme expansionwith WFP.‘In some countries UNICEF offices haveseized the opportunity to increase the focuson integrated community based approachesto meeting the diverse needs of HIV/AIDSaffected groups.’Bethesda international, Uganda, 2002WFP emergency responseFollowing FAO/WFP Crop and Food SupplyAssessment Missions conducted during the mainharvest season in April and May 2002, the firstRegional Emergency Operation (EMOP) waslaunched in July 2002. This appealed for assistancefor over 10 million people largely throughgeneral food distributions. The second regionalEMOP by contrast, was more targeted (6.5 milliontarget group) and focused on nutritional wellbeing and livelihood objectives. This re-focusreflects a growing shift in the organisation todiversify modes of emergency intervention andto develop more sophisticated responses.Activities included targeted food distributionand vulnerable group feeding, food for work andfood for training, and food provision throughnutrition and maternal and child health carefacilities. HIV/AIDS programming also expandedand some new areas of programming weredeveloped over the crisis period e.g. HIV sensitisationlinked to general ration distributions. Mostof WFP's relatively new and more innovativeprogramming, which in large part has an HIVfocus, is currently small-scale. Throughout thecrisis period, WFP also supported the food securityand vulnerability assessments which wereinstrumental in geographic and temporal targetingand also in generating information on particularlyvulnerable population groups.WFP faces considerable challenges in ensuringthat the intended scaling up of projects eitherunder the protracted relief and recovery operationor under country programmes allows forappropriate and more finely tuned targeting aswell as integration with non-food responses tomaximise the food element and to avoid standalonefeeding programmes that have been thehallmark of certain types of WFP feeding programmesin the past. Furthermore, evidencedbased programming will be the basis on whichWFP is increasingly judged. It is therefore vitalthat programme objectives are carefully considered,prioritised and made explicit. Effectivemechanisms for monitoring and evaluation willbe crucial to determine whether objectives arebeing met, and to ensure that food aid has a positiveimpact and does not undermine local systemsand structures. The importance of drawingon lessons learnt from prior WFP longer-termprogramming experiences cannot be overstated.‘Evidenced based programming will bethe basis on which WFP is increasinglyjudged. It is therefore vital that programmeobjectives are care- fully considered, prioritisedand made explicit.’HIV orphans in Jinja District,Eastern Uganda.2The term 'new variant famine' (NVF) was coined toreflect growing concerns about the impact of HIV/AIDS onfood security. The theoretical premise of NVF is thatHIV/AIDS increases vulnerability to food insecurity througha number of mechanisms i.e. increasing dependency ratios,increasing household expenditures on health care, loss ofeconomically active adults etc. Hence, when a shock suchas drought and crop loss occurs, households are far lessable to employ coping strategies. The result, according toNVF theory, is that such shocks will lead to far worsefamine than would normally occur. However, the NVFhypothesis is as yet unsubstantiated.3Tensions emanated partly from the failure of some newlyrecruited emergency staff to fully consult with their nationalcounterparts and partly from a reluctance on the part ofnational nutrition bodies to adopt an emergency approachand therefore neglect regular nutrition programming activities.7

ResearchNew Sphere Standards for Food Security, Nutrition andFood AidSummary of published paper 1An article in Disasters examines the recent revisionof the Sphere Minimum Standards in disasterresponse relating to Food Security, Nutritionand Food Aid.The new standards on Food Security reflectthe importance of guaranteeing key food securityelements, i.e. access to adequate food throughown food production or other sources of entitlement,stability of food supply and availabilitythrough local markets, nutritional adequacy, culturalacceptability and adequate quality of foodassistance (see box 1).The article also describes how the revisionattempted to incorporate the principles of theHumanitarian Charter, as well as relevanthuman rights principles and values into theSphere Minimum Standards. The initial aim ofthe revision was to ensure that the standards betterreflected the principles embodied in theHumanitarian Charter. This was later broadenedto ensure that key legal standards and principlesfrom human rights and humanitarian law wereconsidered and also incorporated, in part to fillthe 'protection gap' within the existing standards.For example, in the food aid chapter itstates “Monitoring and evaluation: at communitylevel, random visits to households receivingfood aid can help to ascertain the acceptabilityand usefulness of the ration, and also to identifypeople who meet the selection criteria but whoare not receiving food aid. Such visits can alsoascertain if extra food is being received andwhere it is coming from (e.g. as a result of commandeering,recruitment or exploitation, sexualor otherwise (p.171)”.In relation to the food security, nutrition andfood aid standards, it was agreed by participantsin the revision process that the human right toadequate food and freedom from hunger shouldbe incorporated. In relation to more general principlesunderlying the Humanitarian Charter,itself drawn largely from human rights andhumanitarian law, it was agreed that there was aneed to strengthen 'protection' elements withinthe standards and a need to incorporate the basicprinciples of the right to life with dignity, nondiscrimination,impartiality and participation(see new food security standard 1 above), as wellas to explore the relevance of the concept of theprogressive realisation of the right to food.The questions raised in linking rights to operationalstandards required thought, on the onehand, about whether the technical standardsreflected a deep understanding of the valuesexpressed within the legal instruments, andwhether the existing standards were adequate inrelation to those legal rights. On the other hand,it also required reflection on how operationalstandards like Sphere could give concrete contentto human rights, such as the right to food and theright to be free from hunger. However, theauthors acknowledge that there remain challengesin examining what a rights-basedapproach will mean in terms of the role ofhumanitarian agencies as duty-bearers of rights,given that the primary responsibility rests withstate governments. It will also require reflectionon the modes and mechanisms of accountabilitythat are brought to bear in ensuring the implementationof the Minimum Standards.The authors conclude that it will be importantto evaluate how meaningful the rights basis ofSphere is to users of the hand-book and how thataffects actions and decisions in the midst ofhumanitarian crisis.The initial aim of the revision was to ensurethat the standards better reflected the principlesembodied in the Humanitarian Charter. This waslater broadened to ensure that key legal standardsand principles from human rights andhumanitarian law were considered and alsoincorporated, in part to fill the 'protection gap'within the existing standards.‘The authors acknowledge that thereremain challenges in examining what arights-based approach will mean in terms ofthe role of humanitarian agencies as dutybearersof rights, given that the primaryresponsibility rests with state governments.’Box 1: Minimum Standards on FoodSecurity, Nutrition and Food Aid,some examples:Assessment and analysis standard 1:Food SecurityWhere people are at risk of food insecurity,programme decisions are based on a demonstratedunderstanding of how they normallyaccess food, the impact of the disaster oncurrent and future food security, and hencethe most appropriate response.Food security standard 1: General foodsecurityPeople have access to adequate and appropriatefood and non-food items in a mannerthat ensures their survival, prevents erosionof assets and upholds their dignity.Food Security standard 2: Primary productionPrimary production mechanisms are protectedand supported.Food Security standard 3: Income andemploymentWhere income generation and employmentare feasible livelihood strategies, people haveaccess to appropriate income-earning opportunities,which generate fair remunerationand contribute towards food security withoutjeopardising the resources on which livelihoodsare based.Food security standard 4: Access to marketsPeople's safe access to market goods andservices as producers, consumers and tradersis protected and promoted.1Young. H et al (2004): Linking Rights and Standards: TheProcess of Developing 'Rights-based' Minimum Standards onFood Security, Nutrition and Food Aid. Disasters, 2004, 28(2): pp 142-159R. Gill. Sierra Leone, 2001.Selling rice in Bo Market, Sierra Leone.8

InappropriateInterventions inthe Great LakesSummary of published research 1The aid community has reacted to manycrises in the Great Lakes region with amultitude of interventions aimed explicitlyat improving the food security of peopleaffected by the crisis. A recent study under thedirection and support of Save the Children UK setout to answer the following questions about theseinterventions.• What responses have agencies and institutionsin the region used to promote foodsecurity?• How do these interventions compare with theconstraints to food security that can be orhave been identified?• Are there any constraints which agencies havenot addressed, and if so, why?• Are there any institutional or structural factors which affect how organisations have respondedto food insecurity, and what impacthave these had on the quality of response.Seven case studies were conducted. These were:• In Burundi, the responses in 2000 to 2001 tothe lengthy drought in Kirundo Province, andthe forced displacement of the civilian populationof Bujumbura Rural Province from 1999to 2001;• In DRC, two urban crises - the volcanic eruptionin Goma in January 2002 and the ethnicwar in Bunia town in 2003, and interventionsas displaced people returned home to theMasisis plateau in 1999-2003;• In Uganda, the displacement in KaseseDistrict from 1996 to 2000 caused by armedconflict, and the situation in Gulu District,where war with the Lord's Resistance Armyhas led to the displacement of almost therural population.The case studies were chosen on the basis of representingthe full range of crises and the range ofinterventions used in the region as well as therebeing good information available on people'slivelihoods and food security constraints.ConclusionsAlthough it stresses that the situation is nothomogenous or entirely negative and that individualstake significant risks to deliver assistance tothe crisis affected, the study identified a number ofweaknesses in the aid effort:• Most food security interventions failed toaddress needs.• Agencies used the same narrow range of responsesin nearly all circumstances. Theseshort-term responses were repeated each yearin the region's chronic crises while longerterm efforts to tackle the causes of food insecurity remained too small-scale.• Due to various pressures agencies were unableto think through appropriateness ofresponse. Food was given out where it wasknown to be plentiful and seeds were given topeople who did not need them.• Seed distributions and nutrition interventionsin particular were implemented widely eventhough they were based on a series of questionableassumptions that remained largelyuntested.• Responses focused narrowly on food production• Food for work programmes were seldomappropriate and the relative appropriatenessof food-based versus cash-based interventionswas inadequately examined.• Assessments were not done to determine thereal constraints to food security and livelihoods. On a positive note, the casesshowed that rapid assessment is possibleeven in insecure environments.• In many cases information was alreadyavailable but not used.• Responses were often not cost-effective.• Most actors gave a low priority to learning lessons and finding out about theimpact of the interventions.RecommendationsThe study report makes a number of recommendationsmany of which relate to the programmecycle.Assessment and analysis:• All food security interventions (with theexception of immediate responses lastingup to two or three weeks) should be basedupon assessments of livelihoods. Theseassessments need to be made before decidingwhat to do.• Analysis and programming for food securityneed to focus on much wider issuesthan merely food, and need to incorporateeconomic thinking. This will probably leadto a greater use of market and cash interventions.• A longer-term analytical perspective isneeded, even for relatively short-terminter-ventions. Frameworks also need totake greater account of conflict and discrimination, particularly ethnic or clanrelations, and gender and intra-housholdissues.• All this requires people with the rightskills and experience therefore agenciesneed to invest in capacity developmentof staff.• Donors should be consistent in their demandsfor proper analysis before fundinginterventions.Monitoring, evaluation and inter-agency coordination:• Agencies should spend more time, energyand resources on monitoring, evaluationand learning as emergency responses canonly evolve if lessons are learnt and institutionalised.• There is also a need for a livelihoods securityinformation system in the Great LakesRegion with clear links to an agency witha coordination mandate, like OCHA.Programming ideas:In addition to current responses other interventionoptions need to be considered/investigated.These range from facilitating access toland, to market interventions, increasingaccess to labour, asset creation and retention,and support to the productive environment.New implementation modalities could be consideredin view of the operational constraintsin the region. Some agencies are experimentingwith 'remote access' programming or with'war-proof' projects that support livelihoodswithout having visible targets for attack. Thiswork needs prioritising.Impact and cost-effectiveness:Agencies need wide-ranging reviews of emergencynutrition interventions (supplementaryfeeding, nutrition education, demonstrationgardens, cooking lessons) and the distributionof seeds and tools. Given that resources arealways limited, comparison of cost benefit calculationsfor alternative interventions shouldbe carried out. Currently, the data from whichto make cost-effectiveness comparisons is limited,and simple methods for measuring costeffectiveness,which can be applied by multipleagencies, should be developed and adopted.1Levine.S and Chastre.C et al (2004): Missing thepoint. An analysis of food security interventions in theGreat Lakes. Humanitarian Practice Network Paper,Number 47, July 2004ResearchCan Sphere beUsed in ComplexEmergencies?Summary of published paper 1AP Photo/Visar Kryeziu 2001A U.S Airborne Infantry soldier patrols alongKosovo's border with MacedoniaThe Sphere Project (consisting of both theHumanitarian Charter and MinimumStandards for Disaster Response) hasmade prominent contributions to thedebates, thinking and work on the quality ofassistance and accountability of aid agencies.However, since its inception in 1997, severalagencies expressed concerns regarding Sphere'sapproach, many of which were confirmed by theSphere evaluation (2002/3). A recent articlerestates these concerns, and addresses more fundamentalissues regarding Sphere's cornerstone.It questions the validity of Sphere's rights-basedapproach, which it suggests consists of a tenuouslink between the rights of affected populationsand standards for technical interventions. Sphereis founded on 'the right to assistance', althoughthis right does not exist in international law. Itselaboration would entail solving several complexlegal and political issues, which Sphere fails toaddress.The article also questions the validity and usefulnessof universal standards for technical performancein helping relief agencies provideadapted assistance to disaster-affected populations,in line with their mandates and principles.It suggests that Sphere's approach and contentlargely reflect the concerns, priorities and valuesof technical professionals in northern agencies,leaving limited space to genuine 'participation'by affected populations and partners from thesouth. The authors assert that the Sphere Projectis not 'universal' or 'value neutral' and that if realdivergences exist between French andAnglophone perceptions, ask what divergencesactually exist between northern agencies and ourpartners from the south?Finally, the authors raise questions aboutSphere in the context of humanitarian aidincreasingly being treated as a component of foreignpolicy, making it difficult for agencies todefend a humanitarian space. The authors thereforecaution against the Minimum Standardsbeing used by non-humanitarian actors to legitimisetheir actions. For example, an officer fromthe Coalition in Afghanistan expressed his surpriseat NGO reactions against the engagementof the military in humanitarian operations: 'Whyare they against us? We also use the SphereStandards. The article concludes that there is thereal danger of misuse when technical standardsare clothed in the language of humanitarianismand international law.1Dufour.C et al (2004): Rights, Standards and Quality ina Complex Humanitarian Space: Is Sphere the Right Tool?Disasters, 2004, 28 (2), pp 124-141.9

Field ArticleWelding in Chimoio district.A NewHouseholdEconomyMethod forAssessingImpact ofShocksBy Celia Petty and John Seaman 1The work described in this report was fundedby a grant from the UK Department forInternational Development.10Celia Petty is Social Policy andLivelihoods Adviser at Save theChildren UK. She has workedas an adviser on food securityand livelihoods assessmentmethodologies and on policyand programmes for childrenaffected by conflict.John Seaman is currently aconsultant working on operationalapproaches to measuringpoverty. He was formerlyHead of Policy, andDevelopment Director of theFood Security Unit of Save theChildren UK.C. Petty, Mozambique, 2003This article describes the experiences of using anadapted household economy assessment approach inUganda, Ethiopia, Swaziland and Mozambique. InUganda and Ethiopia the approach was used to look atthe impact of falling coffee prices on household povertywhile in Mozambique and Swaziland the assessmentestimated impact of HIV/AIDS on livelihoodsand economic status. The main focus of the article ison the findings of the Mozambique and Swazilandassessment on impact of HIV/AIDS. This is particularlytopical in the humanitarian sector as in spite ofthe common usage of terms such as 'new variantfamine' and the increasingly accepted view that theHIV/AIDS pandemic is having a marked impact onfood security, there is very little empirical evidence.The work described below is an almost unique snapshotof the impact of HIV/AIDS at community andhousehold level. To some extent the findings counterthe prevailing view that HIV/AIDS decimates localeconomies and livelihoods in high prevalence areas(Ed).This article describes a new approach topoverty analysis and household levelmodelling. The method is based on theestablished Household EconomyApproach (HEA) 1 , and has been designed toassess the effects of policy changes and otherdefined shocks on disposable income and livingstandards. Four pilot studies were carried outduring 2003 in Uganda, Ethiopia, Swaziland andMozambique by Save the Children UK (SCUK).The aim was to test whether the approach was apractical methodology for field use, and whetheroutput would provide a more rigorous basis forpolicy analysis, programme implementation andimpact monitoring.HEA was developed to predict the effect of a'shock' (e.g. a crop failure or price change) onpeople's ability to maintain their income and tomeet their survival and developmental needs. Itis based on a quantitative and qualitativedescription of the economy of a defined population2 . A simple model is used to predict the likelyimpact of a particular event or events on the abilityof households in different wealth categories toacquire sufficient food and meet defined nonfoodneeds.The original purpose of HEA was to providelarge-scale (e.g. national) predictions of foodemergencies. Although it has been applied inother development contexts, its main use is stillin the area of emergency assessment. This islargely due to the use of a simplified data set,with only one 'typical' household defined in eachwealth group. The new model is based on a representativesample of individual households andis designed to handle a more complex data setand to predict the outcome of a more diverse setof problems. It has therefore been termed the'Individual Household Method' (IHM)The focus of the pilot studies was a) the householdimpact of falling coffee prices and b) theimpact of HIV/AIDS on household economy.The effect of falling coffee prices was selected asthe relationship between household poverty andinternationally traded commodities is poorlyunderstood and has attracted wider public interest.The impact of HIV/AIDS on household economywas selected as this subject presents majormethodological problems (e.g. the difficulty ofestablishing control groups) which householdmethods are well suited to deal with. The debatearound HIV/AIDS and food security alsoremains highly controversial. This article mainlypresents the findings from the pilot studies inMozambique and Swaziland, which examinedHIV/AIDS and household economy.It should be noted that the analysis from the casestudies refers to the study sites only 3 .Overview of methodology: the IndividualHousehold Economy ApproachThe individual household method differsfrom standard HEA in three ways:1. A random sample of individual households isused (usually obtained by village mapping/transect walks). Standard HEA is based onanalysis of households that are 'typical' of adefined wealth group.2. Results are expressed in terms of householddisposable income (rather than the ability of ahousehold to acquire food, given some level ofnon-food expenditure). The output producedshows the impact on household living standardsacross the population, given a defined change.3. Because each individual household isdescribed (rather than the 'typical' household),there is the possibility of extending the data setand model to include changes within the householde.g. in the case of HIV, changes to householddemographic composition.Data collection and analysisVillages are mapped and transect walks usedto draw a representative sample of households.Information is then collected using standardmethods. These include desk research, keyinformant interviews, focus group discussionsand interviews with individual households.The basic data set required from each householdis:(i) Household demography, including genderand age.(ii) The sources and amounts of householdincome from each income source.(iii) Land and livestock holdings.Additional extended interviews establish thelocal costs of food and basic items, which areused to establish a standard of living threshold.Fieldwork for each of the case studies was carriedout by teams of around six local staff; selectioncriteria included knowledge of the local languageand prior experience of household levelinterviewing. Although the time required tocover each population varied according to thepattern of settlement and complexity of householddemography, teams found that an averageof around 90 household interviews could be completedover a 6 day period.The Swaziland pilot study was carried out in arural community in the Highvelt region, close tothe South African border. In addition to standardhousehold economy information, details ofhousehold demography were recorded coveringa 5-year period. The previous employment ofhousehold members aged 21-50, who had diedduring this period was documented, as well asdetails of orphaned children who had joined thehousehold.For this study data collection and analysis ofdisposable income was conducted using thesame techniques as in the Uganda and Ethiopiastudies. Households were ranked according todisposable income per adult equivalent andthose falling below the standard of living thresh-1HEA methodology is described in the 'HouseholdEconomy Approach' (Seaman J et al SCF 2000). HEA isbased on Amartya Sen's theory of exchange entitlements.Standard HEA methodology is used extensively in subSaharan Africa by governments, donors (e.g. USAID,DfID) and UN agencies, to assess food security acrosslarge geographical areas and to provide famine earlywarning.2See The Household Economy Approach (Seaman J etal, op cit)3They were designed to test a methodology, and cannotbe generalised to a wider population. A discussion of theoperational costs and human resource requirements forstudies of individual populations and an estimate of thecosts of taking the work to national scale is included inthe final section.

Field Articleold were identified. In the Swaziland study,which used whole village enumeration ratherthan a representative sample 4 , additional informationwas collected on:(i)(ii)Household demography, the presence oforphans in the household, the year inwhich the parent/s of orphans died andtheir parent/s previous employment. Thepresence of orphans in the household wasused as a proxy for HIV/AIDS 5 .Employment histories of currently employedadults. This was undertaken to gaina better understanding of changes in thelabour market.(iii) Maize yields per hectare and the use offarm inputs over the past four years. Thesedata were collected to assess returns onagricultural investments at different levelsof input.The Mozambique study was carried out in asemi-rural community, close to a district tradingcentre, with an HIV/AIDS prevalence of around20%. In this study, a representative sample ofhouseholds was used rather than a completeenumeration.Presentation of the household data.The output of the studies is presented as disposableincome i.e. cash remaining to the householdafter basic food needs have been met. This isstandardised in terms of the number of 'adultequivalents' in each household (i.e. gross householdfood energy requirement / an average adultmale/ adult female energy requirement). A standardof living threshold was developed for eachsite, to identify the proportion of householdswith disposable income below this level. For ourpurposes, the cut off was based on the costs ofprimary education for all children in the household,and the cost of basic household and personalitems required to meet minimum social norms.Review of main findings and policy inferencesEthiopia and Uganda: The economic impact ofcoffee price fluctuationsIndividual HEA analysis showed that in theEthiopia sites, the absence of alternative incomesources either from agricultural or off-farmemployment meant that households across theincome range were extremely vulnerable to theeffects of falling coffee prices. Sensitivity to coffeeprice changes was high (0.7%-1.5% increase inincome for each 1% change in coffee price). Thiscontrasts with low to negligible sensitivity inUganda (see figure 1): (0.02% to 0.14% for each1% change in coffee price).At a macro policy level, this suggests that achange to coffee pricing that had a strong povertyimpact in the Ethiopia sites would have a farweaker effect in the Uganda sites. The Ugandastudy showed that higher levels of wealth wereonly achieved by households that had access tosalaried employment. Even if coffee prices wererestored to pre slump levels, coffee would notprovide a reliable route out of poverty. Moreover,niche market projects (marketing high qualityorganic beans etc) missed the poorest households,although they did benefit households inthe middle income range.Shillings/Adult equivalentFigure 1: Mpigi ii: Estimated change in household disposable income fromspecified price and production change0-5,000-10,000-15,000-20,000-25,000-30,000-35,000-40,000-45,000-50,000Househould: 1= poorestChange with 50% fall in price onlyChange with 50% price fall and 25% fall in number of bushesFigs 2 and 3: Dependency ratio-household members less than 17 6 years : householdmembers over 17 years. Households shown in order of disposable income/adult equivalent.Households with orphans shown in red. (Manica I is the Mozambique site andHhohho I is the Swazi site).Ratio4.543.532.521.510.50RatioFigure 2: Manica 1: Ratio children < 16 years age: people > 16 yearsHouseholds with orphans in redHousehold: 1 = poorestFigure 3: Manica l: Ratio children < 17 years age: people > 17 yearsHouseholds with orphans in red76543210Household: 1 = poorestAs a methodological trial, the coffee studieswere conducted in non-randomly sampled villages.To quantify the relationship between coffeeprices and poverty at a national level, it would benecessary to scale up to include all coffee-pro-4As this was the first time the method had been used toassess HIV/AIDS impacts across a community, whole villageenumeration was carried out for completeness5The use of orphans as a 'best available' proxy, and thedefinition of orphan (loss of one or both parents) are discussedin the case study documents.617 years was chosen as the cut off, as it is the age atwhich young people in the study communities are likely tobecome economically activeC. Petty, Mozambique, 2003Mill in Chimoio district.11

Field Articleducing districts. The practicality of implementingthis approach at a national scale is discussedlater.Swaziland and Mozambique studies: TheEconomic Impact of HIV/AIDSAlthough it has been widely debated for overa decade, surprisingly little is known about theimpact HIV/AIDS on individual householdeconomy. The complexities of analysis in thisarea are compounded by the fact that theHIV/AIDS epidemic has coincided with a periodof economic restructuring in many of the worstaffected countries, and with major climaticshocks. In assessing the impact of HIV/AIDS onhousehold economy, studies in Mozambique andSwaziland were designed to take these other contextualevents into consideration. In both countries,studies were conducted in areas of highHIV/AIDS prevalence.Swaziland has one of the world's highestrecorded rates of HIV/AIDS (around 38%) andhas also experienced a series of economic shocksover the past decade. These include a substantialreduction in the quota of jobs available to Swazinationals in the South African mining sector; privatesector restructuring and job losses e.g. in theforestry sector; and structural adjustment of thenational economy, including withdrawal of inputsubsidies, cost recovery and privatisation.At both Sites households affected byHIV/AIDS were found across the income distribution.Both HIV/AIDS affected and non-affectedhouseholds were found below the definedstandard of living threshold. However, a disproportionatenumber of households below thisthreshold had suffered an AIDS death, or weresupporting orphans from outside the community.In Swaziland, employment histories allowedus to estimate the level of income lost throughHIV/AIDS. Analysis showed that, omitting thecosts associated with illness and funerals, extraadult mortality attributable to HIV/AIDS overthe past 5 years has caused a fall of approximately8%-12 % in total community disposableincome. The economic impact on individualaffected households is specific to that household,and ranges from a small improvement inincome/adult equivalent (e.g. death of an unemployedadult) to devastating loss (e.g. loss of oneor more salaried/public sector workers). Overall,in this relatively wealthy community, the neteffect is to make very little change to the proportionof households falling below the definedpoverty line.To explore changes in the wider economiccontext, we looked at the effects of the recentwithdrawal of farm input subsidies in Swazilandimplemented as part of a structural adjustmentprogramme. The main agricultural activity in thestudy community is maize production, andyields are highly input dependent. The vastmajority of households, including the very poor,produce some maize. Assuming full use of agriculturalinputs, the effect of the loss of subsidieswas a 24% reduction in the net return on maize.However, it was also found that input use waslow and largely independent of the wealth of thefarmer (for reasons which are unclear, but probablyinclude problems of pest control), and theactual loss of income due to the loss of subsidywould be less than this. The question of agriculturalinvestment has clear implications for povertymitigation and deserves further investigation.As in the coffee studies, the wealthiest householdsin both communities derived most of theirincome from salaried, off farm employment.At both sites the majority of households (bothHIV/AIDS affected and non-affected) remainedabove the standard of living threshold (9% ofhouseholds in the Mozambique site and 23% in12the Swazi site fell below this threshold). InMozambique, it was notable that teachers, healthworkers and policemen made up 26% of allemployment in this community.In both the Swaziland and Mozambique sites,households with orphans were found across theincome distribution (see figs 2 and 3 below).Further analysis of the characteristics of thepoorest households in the two sites showed thatthere was no single 'cause' of poverty.In the Mozambique site, although widowsheaded a disproportionate number of the pooresthouseholds, we were not able to ascertain on theavailable information, whether these householdswere poor before the husband died. A number ofin depth interviews with widows suggested thatwealthier households had been able to diversifytheir income base (e.g. to invest in profitabletrading activities) on the death of a salaried male.Households that did not have the skills or capitalto diversify remained poor.In Swaziland, of the poorest 23 households(those falling below the standard of living threshold),5 had suffered a 'catastrophic' fall in incomeas a result of adult deaths over the past 5 years.However, 10 of the poorest households were classifiedas 'not HIV/AIDS affected', and theremaining 8 HIV/AIDS affected householdsappear to have been poor for reasons that werenot directly related to HIV/AIDS. The householddeath/s had not resulted in a significant loss ofincome, and the overall pattern of employmenthad not changed significantly in the past 5 years.Practical inferences for policy and programmesThe study findings provide information that isdirectly relevant to policy and programmingdecisions, where the aim is to strengthen householdeconomy and resilience to shocks. Theseinclude:1. Measurement of the impact of HIV/AIDS onliving standards.The research provides a measure of the distributionof poverty in the study communities andcasts doubt over the feasibility of deriving 'simple'HIV/AIDS related poverty indicators. Thishas implications for the design of social protectionand welfare policies, as well as wider macroeconomic policy debates. For example, if onlyorphans were identified as eligible for free primaryeducation or health care, many poor childrenwould be excluded and some better off childrenincluded.2. Asset protection and income generationIndividual HEA analysis provides a quantitativeaccount of how a local economy works, ameasure of potential demand and an objectiveassessment of productive capacities at householdlevel. By providing realistic estimates ofreturns on investment for different enterprisealternatives, the approach could be incorporatedin the design of micro credit and other economicinterventions.3. Targeting welfare and other forms of directassistance.HEA methods provide a basis for identifying,costing and targeting safety nets and other interventionsat a community level. In rural contexts,these might range from 'one off' grants or loansto assist restocking or pay for agricultural inputs,to waiving of basic service fees and longer termsocial welfare support.A key inference from the HIV/AIDS studies isthe importance of work at community level.Given the varied circumstances that face thepoorest households, household specific needsmust be identified and connected to relevantservices or resources. Interventions, such as targetedfood aid, distributed through school feedingprojects, mother and child health (MCH), andcommunity based orphan support programmeshave been widely canvassed as a means of mitigatingthe effects of HIV/AIDS (e.g. FAO 2003).However, the view that the households that havelost labour and cash income through HIV/AIDS,could best be assisted by this mechanism, is notwholly supported by either study. There wouldbe some scope for food distribution to selectedpoor households.ConclusionsBetter empirical data on the characteristics ofthe poorest households raises the prospect of amore effective set of responses. This can assist inselecting pro poor interventions, identifyingtypologies of households and targeting resourcesaccordingly, as indicated in the pilot studyresults. At a more general level, it is clear thataction in response to problems that emerge fromthe studies requires coordination and collaborationbetween a range of national and local governmentdepartments, major funding agenciesand local and international NGOs.By providing analysis based on representativesamples of individual households, individualHEA methods allow decision makers to modelthe potential impact on living standards of differentpolicy alternatives and ultimately, to measureactual impact against objectives.Scaling up to larger populations and areasThe four pilot studies were all small scale. Thismay be appropriate for some applications (e.g.NGO project work). Other questions. e.g. monitoringthe impact of coffee price changes or interventionsto increase the value of coffee production(or any other internationally traded commodity,e.g. cotton, tea etc) would require anational system 1 .Scaling up does not seem to present any substantialtechnical difficulties. The only currentquestion relates to the application of confidenceintervals to the ranked values of disposableincome, which would be necessary to establish asample size 2 . With that proviso, it does notappear that samples would need to be very large.A problem that has been repeatedly encounteredwith HEA is that Governments are oftennot well organised to maintain information systemsof this kind, as trained staff are moved toother tasks. A longer-term aim would thereforebe to incorporate training and the operation ofsystems in universities. These methods complementother field research techniques routinelycovered in many social science degrees.For further details, contact: Celia Petty, Save theChildren UK, 1 St. John's Lane, London, EC1M4AR, Telephone +44 (0)20 7012 6400, Fax +44(0)20 7012 6963,www.savethechildren.org.ukBibloigraphyA rural trading community in Manicaprovince, Mozambique: the impact ofHIV/AIDS on household economy (Petty C,Selvester K, Seaman J. SC UK March 2004)Coffee and Household Poverty: a study ofhousehold economy in two districts ofEthiopia (Petty C, Seaman J with Majid N.SC UK March 2004)HIV/AIDS and household economy in aHighveld Swaziland community (Seaman J,Petty C with Narangui H. SC UK March2004)The Household Economy Approach(Seaman J et al, SCF 2000)Poverty and the International Coffee Trade:a role for Household Economy Approaches?(Petty C, SC UK January 2003)7For example, in Uganda, this would cover the six coffeegrowing districts.8This question has been discussed with a DfID basedstatistician.

News & ViewsNew NutritionPolicy Papersfor WFPR. Gill. Sierra Leone, 2001Refugee Numbers DeclineThe global number of refugees fell by 18%to 17.1 million in 2003 - the smallest numberin a decade, according to RuudLubbers the United Nations HighCommissioner for Refugees, who announced thenew data just before World Refugee day on June20th. The decline can be attributed to several factorsincluding increased international efforts tofind solutions for uprooted people. There hasalso been an unprecedented level of voluntaryrepatriation during the past 2 years. Some 3.5million displaced people returned to their countrieslast year, mostly Afghans from Pakistan andIran.From a published paper: Bosch X. Refugee numbersdown as more people return home. TheLancet 2004; 363:2148 (26 June)For further information see; The LANCET, vol363, June 26th, 2004, pp 2148World Health Organisation AdmitsTargets on AIDS Drugs May beUnrealisticIn its World Health report 2004, theWorld Health Organisation (WHO) saidthat AIDS was the leading single cause ofdeath among adults aged 15-59 aroundthe world and that in 2003, three million peopledied of AIDS related diseases and fivemillion became infected with HIV.WHO said funds were sufficient to coverthe $5.5 billion needed to achieve its statedgoal of getting antiretroviral drugs to threemillion people with HIV in poor countries bythe end of 2005 (the three by five target) butadmitted it still had a long way to go. By theend of 2004 WHO will have achieved only25% of the 'three by five' target. “The stakesare high: rapid expansion of antiretroviraltreatment is a large, complex and difficultundertaking” said WHO's director general,Dr Lee Jong-wook, in an introduction to thereport which calls for an unprecedented levelof international coordination. “It certainlycannot be done by one agency working on itsown. Partnerships are indispensable for atask of this magnitude” said Dr Lee, who isstaking his reputation on achieving what headmitted may be an unrealistic goal.Since antiretroviral treatment was introducedin Europe and North America in the1990s, death rates from AIDS related diseaseshave dropped by 80%. In contrast AIDS deathrates elsewhere and particularly in southernAfrica have shot up. In South Africa andBotswana, the AIDS epidemic has nearlyhalved life expectancy over the past decadefrom about 60 years to 35 years. One in 12Africans have HIV infection and as many asnine out of 10 people do not know they areinfected.The report states that expanding antiretroviraltreatment would cost $35 to $40 percapita. Once that was done, more peoplewould volunteer to test for HIV.The trends in HIV prevalence among pregnantwomen attending the same antenatalclinics since 1997 show that the epidemics inthe countries of southern Africa are muchlarger than elsewhere in sub-Saharan Africaand that the gaps seem to be widening. Ineastern Africa there is evidence of a modestdecline. “In western Africa prevalence is nowroughly one-fifth of that in southern Africaand no rapid growth is occurring. Thesestriking differences are supported by datafrom population based surveys and researchstudies” the report says.For further information see; Fleck. F (2004):WHO admits its target on AIDS drugs maybe unrealistic. BMJ volume 328, 15th May,News, pp 11511The report can be accessed atwww.who.int/whr2004Refugee camp, Kenema.WFP's executive board hasrecently endorsed threenutrition policy papers. Thiscoincides with a raised profilefor nutrition within the organisation.One of the papers deals exclusively withnutrition in emergencies but should beread in conjunction with the two otherpolicy papers 'Food for Nutrition:Mainstreaming Nutrition in WFP' and'Micronutrient Fortification: WFPExperiences and Ways Forward'.The 'Nutrition in Emergency' paperstates at the outset that WFP and its partnershave made significant strides in thelast decade towards tackling malnutritionin emergencies and that food interventionsplay an important part in savinglives through their impact on the nutritionand health of affected populations.The paper stresses that humanitarianinterventions aiming to prevent deteriorationor promote recovery of nutritionalstatus have to be carefully tailored to thenature of each crisis and seek to addressunderlying causes. It outlines three elementscrucial to successful action.1. That a nutritionally appropriate foodbasket is formulated to meet local needsand that it is coordinated and arrives ontime, not one commodity one month andanother the next. Some food commoditiesare needed in small amounts, for exampleiodized salt and fortified blended foods,but their inclusion and delivery are oftencritical to positive nutrition outcomes.The importance of micronutrients inachieving the goals of emergency operationsis increasingly understood and thereis evidence of the need for greater use offortified foods than in the past.2. Coupling food with essential nonfoodinputs is important in nutrition programming.WFP requires cash resourcesfor a variety of nutrition and public healthactivities, including local milling/fortificationof cereals, local procurement of fortifiedblended foods and support for complementaryactivities such as nutritioneducation, training and de-worming. Anability to offer sustained improvements innutrition will therefore depend on strongcollaboration with partners skilled innutrition and public health and informationmanagement.3. Improved linking of emergency programmingwith non-emergency activitiesis required so that underlying processescontributing to malnutrition can be effectivelytackled in the long run.For further information contact; RitaBhatia at Rita.Bhatia@WFP.ORG13

News & ViewsNew Training MaterialNow AvailableInfant Feeding in Emergencies. Module 2 Version 1.0for health and nutrition workers in emergencies.Available for download at www.ennonline.netInfant Feeding in Emergencies MeetingOxford, 19-21 July, 2004ACore Group of agencies and expertshave been working together for a numberof years to develop a training manualon infant feeding for emergencyfield workers. Infant feeding issues have graduallycome to light over the past decade as moreyoung infants presented at therapeutic feedingcenters and more emergencies occurred in “bottlefeeding cultures”.The 'Core Group' started to engage around theneed to properly train emergency field workerson appropriate infant feeding and continued in aspirit of inter-sectoral collaboration to produce aset of comprehensive training materials on thesubject.A meeting in Oxford in July 2004 hosted bythe ENN (at its new home) was the latest in aseries. Its main objectives were to agree andfinalise the production of Module 2 of the trainingmanual, to explore appropriate disseminationand awareness raising about the trainingmaterials, and to initiate strategic thinkingbeyond development of materials for capacitybuilding.On the third day of the meeting ACF presenteda description of its infant feeding program inAfghanistan, outlining practices, experiences anddifficulties managing severely malnourishedinfants less than six months, and lactation difficultiesin this age-group. This included nutritional,psychosocial and environmental influencesand perspectives.It was proposed and agreed that ENN could,in addition to its technical input, provide an'institutional home' for the Code Group coordination.14Agreed short term priorities for the Core Groupwere:• Making the finalized Module 2 available onthe web• Dissemination and awareness raising amongagencies working in nutrition in emergencies• Orientation workshop for major INGOs• Field testing of the module in collaborationand as a part of the CARE project on InfantFeeding in Emergencies• Development of a plan for rolling outtrainingModule 2 is the second in a series of trainingmaterial developed for emergency field workers.Module 2 to is to be treated as a living documentwhich will be updated and changed according tofeedback and emerging evidence. The CoreGroup responsible for the development of themodule are keen to receive feedback on the use ofthe module, particularly from field workers.Send any comments to office@ennonline.net.Target audienceFor Module 1, the target is all emergencyrelief workers, including those involved in sitemanagement, or responsible for technical taskssuch as water, sanitation, and supplies. Thesepeople are important in establishing conditionsfor adequate infant feeding, but may be onlyindirectly concerned with the care ofmothers/caregivers and infants.For Module 2, the target is health and nutritionworkers who are directly concerned with the careof mothers/caregivers and infants. It providesspecific practical knowledge about how to helpindividual mothers and other caregivers withinfant feeding.Module 2 should be used after trainees havestudied Module 1.Each Module consists of :• A Manual to be given to each participant.• Overhead Figures, for use as transparencies ora flip chart.• Presenter’s Notes (in Module 1).The Manuals include small copies of all theoverhead figures, to make private study easier.Those studying Module 2 should alreadyhave studied Module 1, and should have itsManual available for reference. Module 1 canbe rapidly presented in one hour, although it isrecommended to allow two or three hours, for amore interactive approach. The Presenter’sNotes for Module 1 give plans for one-, two-,and three-hour use.Module 2 consists of five Core Parts, whichcan be covered in five hours of group teaching.Additional Parts give more details on specialisedtopics.Each Additional Part can be studied ortaught separately. If they are all included withthe Core Parts in group teaching, the entire sessionwould take a full day.Module 1 trainers pack complete with participant´smanuals is available from theEmergency Nutrition Network, Unit 13Standingford House, Cave Street, Oxford OX41BA, UK.(post and packaging charges apply)Module 1 and Module 2 are both available freefor download from www.ennonline.net

News & ViewsNew Sections onSCN/NICSWebsiteThe United Nations System StandingCommittee on Nutrition/NutritionInformation in Crisis Situations (SCN/NICS)has two new sections on its website atwww.unsystem.org/scn/Publications/html/rnis.html.The section "Articles by country" providesall the articles over the ten years RNIS/NICShas been reporting, classified by country.The results of the random sampled nutritionsurveys which have been reported in theRNIS/NICS bulletins are available in the section"Database". They are classified by countryand have direct links with the contextualinformation and the methodology reported inthe RNIS/NICS reports.These two sections are updated quarterly.InternationalConference onHIV/AIDS, Foodand NutritionSecurity, 14-16April 2005IFPRI and partners are organizinga global conference toenhance learning about the interactionsbetween HIV/AIDS, foodand nutrition security and theirimplications for food and nutrition-relevantpolicy. The conferencewill be held in Durban,South Africa, 14-16 April 2005.For more information, please visitwww.ifpri.org/events/conferences/2005/20050414HIVAIDScall.pdf or contact Stuart Gillespie(s.gillespie@cgiar.org)New InformationSheet onNutrition SocietyWebsiteMSF Close Their Afghanistan ProgrammeOn the 28th of July 2004 Médecins SansFrontières (MSF) announced the closureof all medical programmes inAfghanistan. The decision was taken inthe aftermath of the killing of five MSF aid workersin a deliberate attack on June 2nd, when aclearly marked MSF vehicle was ambushed inthe North-western province of BadghisAlthough government officials presented MSFwith credible evidence that local commandersconducted the attack, they have neither detainednor publicly called for their arrest. MSF havedeclared in a press statement that the lack of governmentresponse to the killings represents a failureof responsibility and an inadequate commitmentto the safety of aid workers on its soil.Following the assassinations, a Talibanspokes-person claimed responsibility for themurders and stated that organisations like MSFwho work for American interests, are targets andwould be at risk of further attacks. MSF arguethat not only is this accusation false but it is particularlygalling given MSF's commitment to separateaid from political agendas.MSF has continued to provide health carethroughout difficult periods of Afghanistan's historyover the past 24 years, regardless of thepolitical party or military group in power.The MSF press statement declared that “TheNutritional Surveillance - Kabulviolence directed against humanitarian aid workershas come in a context in which the US backedcoalition has consistently sought to use humanitarianaid to build support for its military andpolitical ambitions. MSF denounces the coalition'sattempts to co-opt humanitarian aid anduse it to win hearts and minds”. Only recently, onMay 12th 2004, MSF publicly condemned the distributionof leaflets by the coalition forces insouthern Afghanistan in which the populationwas informed that providing information aboutthe Taliban and al Qaeda was necessary if theywanted the delivery of aid to continue.Until the assassinations, MSF provided healthcare in 13 provinces with 80 international volunteersand 1,400 Afghan staff. Projects includedthe provision of basic and hospital level healthcare as well as tuberculosis treatment and programmesto reduce maternal mortality. In theweeks following the statement, MSF intend tocomplete the hand over of its programmes to theMinistry of Health and other organizations.The statement concludes by stating that “AsMSF leaves Afghanistan, we mourn the loss ofour five colleagues. At the same time MSF takesthis decision with great sadness for the peoplewe will fail to assist”Further information is available at:http://www.msf.orgACF, Afghanistan, 2002The Nutrition Society has a newInformation Sheet on its website atwww.nutritionsociety.org/careers/studentsinfo.htm. This isInformation Sheet #4 and it listsemail listservers and forums, webbasedforums, e-advisory servicesand sites giving free or low costaccess to online journals. The sitegives links to three otherInformation Sheets that list free orlow cost newsletters, sources ofpublications and CD-ROMs.Please send any information forupdating or correcting theInformation Sheets to SandraSmart (s.smart@nutsoc.org.uk) orAnn Burgess(annburgess@sol.co.uk)15

News & ViewsRelief FoodFactory toOpen inKenyaPan-African food giantPromasidor is settingup a Ksh 550 millionrelief food factory inKenya. The company namewill be `Nutro ManufacturingEPZ’. It is anticipated that 11countries in the Horn of Africaand Great Lakes region namely:Somalia, Djibouti, Ethiopia,Eritrea, Sudan, Kenya, Tanzania,Uganda, Rwanda, Burundiand Eastern DRC will beserved by the factory helpingto bridge the gap between thefortified blended foods demandand supply in the region.The food will be targeted atNGOs and relief organizationsworking in famine situations.The factory is located inthe Export Processing Zone inAthi River, 30 Kilometres fromthe Jomo Kenyatta InternationalAirport and will beginoperations on August 31st.Nutro's location in Africa willenable a more rapid responsein times of need than is currentlypossible where agencieshave to await shipments toarrive from overseas.Annual production isexpected to reach 35,000 metrictonnes per year. An immediateimpact on local farming isanticipated as Nutro will purchase27,000 tonnes of maize(300,000 bags) and 8000 tonnesof Soya beans (160,000 bags)every year, when operating atfull capacity.The new blended fortifiedfood plant will utilize state ofthe art technology to ensurethat the products meet theexact standards of aid agenciesand NGOs. The manufacturingprocess will allow for the additionof different elements tocater for special cases e.g.HIV/aids patients, malnutritionand starvation. Additiveswill include sugar, milk powder,vitamins and proteins.The company will alsoboost school feeding programmesinitiatives by NGOsand relief food organizationsacross the region as the nutritionalvalue of the foods areappropriate for such programmes.For more information pleasecontact:Bob OdhiamboAccount ManagerSilver Bullet PR&EventsTel. 254-020-556011,Fax. 551335/6Mobile:254722203406/254733605778Bob_Odhiambo@ke.yr.comLettersDear ENNAndré Briend has made an error in his valuable article onelimination of deficiency disease epidemics (FE 21 March2004). He refers to suspicion of the food industry as part ofnutritionists' professional culture and then speculates thatthis 'may stem from previous dishonest attempts to promotebreastmilk substitutes by some well known companies.'Regrettably there is no 'previous' about these practices.Current monitoring of all the breastmilk substitute (bms)manufacturers and retailers reveal sustained unethical promotionalpractices which violate both the international andnational codes. Both emergency situations and the highprevalence of HIV can be exploited for promotional tacticsrather than ethical provision.Gabrielle PalmerCambridgeDear Editors,The Field Exchange is a publication that never sitsunopened for very long. It is always eagerly awaited andwe, in our respective positions, make sure that our colleaguesin the field are aware that a new issue is available.They always benefit from the information and experiencesthat you so well present in this publication. The same wasabout to happen when the July Issue 22 arrived. But we werestopped in our tracks.And we are now writing to you jointly to bring to yourattention a serious concern that this issue raised: conflict ofinterest.On page 24-25, the issue gives a so-called “agency” profile,featuring Nutriset as a unique instance of a private sectorcompany that provides “an ideal model for potentialpublic and private sector partnerships”. Our concern is notthe semantics - whether a privately held, for-profit companyshould or should not be called an agency - but about usingthe Field Exchange as an advertising medium for one selectedmanufacturer of foodstuffs under the guise of an informationalarticle. The Field Exchange has always been a publicationthat strives to give objective, high quality informationand provide a platform for exchange of innovative ideas andexperiences. To now promote rather than discuss a privatesector entity and its products seems entirely inappropriateand disturbing, blurring the line between information andadvertising. What message does this send to the field aboutimpartiality of the publication, especially since the company'slogo now also features high on the list of sponsors?The Field Exchange has an obligation, when discussing aproduct, to not only provide accurate information about itsuses and formulation, but also to discuss the implications ofintroducing and using the product in a field setting. Missingcomponents in the discussion of the Nutriset productsinclude issues of expense, creation of dependency and sustainability.Also missing is discussion of the use of alternativesto F100 and F75 based on oil, milk, sugar and cerealflour, with additional mineral and vitamin mixes. The FieldExchange is shared among many partners and countries, andread by all working in the fields of health and nutrition, notonly by people involved in emergencies. Surely the issues ofdependency and expense need to be raised to avoid puttingacross a controversial message regarding the universal needfor such products.As its very name suggests, the unique quality of the FieldExchange is the forum it provides for discussion of issuesthat impact practice in the field. Because the Nutriset article,as presented, failed to provide such a forum, we suggest thatthe Field Exchange balance the Nutriset promotion by elicitingexperience from the field with these products and sharingthem - good, bad, mixed - as a set of lessons from whichwe can all learn.With best regards,Rebecca Norton,Nutrition advisor,Fondation Terredes hommes,IBFAN.Mary Lung'aho,Lida Lhotska,RegionalCoordinatorfor Europe,IBFANDear Field ExchangeA need for quality control,consistency and diligence forarticles published in FieldExchangeAs an experienced practitionerand trainer in refugee publichealth nutrition, I have enjoyedreading the various nutritionrelatedarticles published in thisnewsletter. There is no doubt that“Field Exchange” has become areference for both expatriate andfield staff with and without abackground in nutrition in termsof planning, implementing andevaluating emergency food andnutrition programs. However,over the last four years I have realizedthat the quality of publishedarticles is highly variable. I thereforetook a content analysis of articlesand pictures published in thisnewsletter from issue 13 throughto issue 21. The following are myfindings:Inconsistent and inaccurate definitionof “global acute malnutrtion”:The article by Regine Kopplow,Field Exchange 2003, Issue 20page 22-26 is an appropriateexample.• In this article, the classificationof moderate malnutrition byMUAC was “≥ 110 ≥ 124mm”and “≥ 185 ≥ 220 mm” in children and women respectively.The correct cut-off points thatshould have been used by internationaldefinition of moderatemalnutrition are: MUAC “≥110≤124 mm” for children and“≥185 ≤220 mm” for women.• The BMI has been expressed as% rather than “kgm -2 ”.• The global acute malnutritionprevalence as defined by W/Hand BMI did not include bilateral oedema (usually the cut-offpoint for global acute malnutrition should read as W/H

Lettersstated: “all households with at least one personfulfilling MUAC criteria (women £220mmand children £124mm) were issued with aration card”. What do £220 mm and £124mmmean? If this was a typographic mistake,why was the same error repeated throughout the article under the headings “ MUACscreening”, “Weight for Height”, and “BodyMass Index”? Similarly, under the heading“nutrition and food security”, of the samearticle, it is reported that “36.5% of femalesmeasured had a MUAC

Field ArticleEstimating theTarget UnderFive Populationfor FeedingProgrammes inEmergenciesBy Anna TaylorAnna Taylor has been the nutritionaladvisor for Save theChildren UK for a number ofyears. She has recently takenup a new post of Head of BasicServices in the Policy andCommunication Department ofSCUK.Thanks to Kate Sadler and Mary Corbett fordiscussions on this issue.School feeding recipients in ZimbabweSCUK, Zimbabwe, 2003.This article discusses the problem of accuratelyestimating the target population for the planningof emergency nutrition programmes and presentsa tool developed by Save the Children UKaimed at improving the process.The problem of not finding the predictednumber of malnourished children whenyou start a nutrition programme is widelyreported. This can often be becauseprogramme coverage is poor and outreach systemsare weak, because the response is late andmalnutrition rates have spontaneously improvedor because the target population was overestimatedin the first place. This latter problem willbe dealt with in this article, drawing on the experienceof Save the Children UK's emergencynutrition programmes in Darfur, Sudan (2002)and Gola Oda, Ethiopia (2003).The accuracy of the estimate of target populationsize has a knock-on effect on the size of thebudget requested in the proposal, the design ofthe programme (to maximise coverage and speedof operations) the capacity put in place at eachdistribution point or feeding centre and themorale of staff as they seek to reach all those eligiblefor the programme.Estimating the target population inDarfur, SudanWhen Save the Children UK developed proposalsfor emergency feeding in Darfur, Sudan in2002, it estimated that the drought-affected populationliving in the eight rural councils was476,195 people. The number of direct beneficiariesof the project was estimated to be 43,724 peopleof whom there were 32,528 moderately malnourishedchildren, 6,434 severely malnourishedchildren and 4,762 pregnant or lactating women.The proposal was written to cover eight ruralcouncils but due to funding constraints wasreduced to the five worst affected. The figures forthe numbers of malnourished children for theprogramme were calculated as follows:The total population in each rural council wasmultiplied by 17% to obtain the number of childrenunder five years. The number of childrenunder five years was then multiplied by the percentageof children found to be moderately andseverely malnourished in the survey: the figurewas different for each rural council because separatesurveys were done for each (see Table 1).This number was then doubled as it was anticipatedthat the project would last for 4 monthsand would therefore be able to admit two roundsof children in the time it was open. The inbuiltassumptions were that the rate at which childrenwere becoming malnourished would not change,that the proportion of malnourished children atthe start of the programme would all be admittedand that admissions would continue throughoutthe programme as more children became malnourished.Problems with the method of estimationThere were however certain problems withthe calculation of numbers of malnourished peopleresulting in over-estimations of the numbersof beneficiaries expected in both programmes.SCUK, Zimbabwe, 2002Table 1: Prevalence of malnutrition in surveys conducted in April / May 2002Food Economy ZoneRural CouncilPrevalence of globalmalnutrition(

Field Article1. The multiplier (17%) used for children underfive includes children

Field ArticleSelective Feeding inWar-RavagedNorthern UgandaBy: John Moore and Mara Berkley-MathewsJohn Martin Moore completed training as aRegistered General Nurse at National UniversityIreland, Galway in 1999. In 2000 he joined theGOAL team in Angola working in emergency publichealth programmes. He is currently working as aPublic Health Coordinator in Northern Uganda.Mara Berkley-Mathews trained as a RegisteredGeneral Nurse in Bristol, qualifying in 1993. Shecompleted a Diploma in Tropical Nursing at LondonSchool of Tropical Medicine and Hygiene in 1998 andworked in Guyana, South America in 2001.Since then she has worked for GOAL in Angola,Mozambique and (currently) Uganda.Thanks to Mark Adams (GOAL Uganda CountryDirector),Stephanie Frame (GOAL Ireland), JohnO'Shea (Chief Executive Officer, GOAL).GOAL, Uganda, 2004Implementation of selective feeding programmes in highly insecureenvironments can throw up a number of difficult operationalchallenges. In this article GOAL describe specific challenges relatedto default and programme monitoring and their attempts toaddress these (Ed)Mothers receiving supplementary rationSince 2002, Agago County in Pader district,Northern Uganda, has been at the centre ofthe 'world's biggest forgotten emergency'. In2002 the Ugandan Government's attempt toextinguish the Lord's Resistance Army,'Operation Iron Fist', precipitated the return ofrebel forces into Ugandan territory from Sudanand a wave of killing and displacement that hadnot subsided by the middle of 2004. As a result,the people of Agago County have suffered twoyears of intensive, continuous terror and displacementat the hands of rebel forces.Humanitarian needs are immense. The WorldFood Programme has warned it will soon beunable to cope with the escalating food needs ofthe displaced population in Northern Uganda,which now numbers at least 1.6 million.Another 200,000 refugees have also been affectedby the conflict. OCHA estimates that thereare 279,256 people displaced within PaderDistrict.Nutrition Survey FindingsGOAL has carried out two nutritional andhousehold surveys in the past 12 months (Table1) and is about to implement a third assessmentin the coming weeks.In the six month period between the August2003 and February 2004 surveys there was aTable 1:dramatic decrease, from 83.1% to 19.3%, in thenumber of households relying on their owncrop production as a main food source, whilethe percentage of households utilizing the marketas the primary source of food increased from13.7% to 71.6%. These trends were reflected inan increase in the market prices of millet,sorghum and beans. The predominant underlyingfactor behind these findings was the highlevel of insecurity acting to discourage agriculturalproduction. In excess of 70% of householdsinterviewed by GOAL were registered toreceive WFP food rations.Other key factors adversely affecting nutritionalstatus were found to be poor environment,water, sanitation and public health facilities.The GOAL surveys found that just 17.4% ofchildren over 9 months of age had evidence ofany vaccination coverage, almost 30% of householdsused unprotected water sources, and over27% of children were weaned onto solid foodsinappropriately. Child Mortality Rates in Under5 year olds were found to be at the threshold ofemergency levels (2.1/10,000/day in August2003, increasing to 2.8/10,000/day in February2004). These survey findings prompted GOALto undertake a number of measures in order tomeet humanitarian needs.Malnutrition prevalence from nutrition surveys in Kalongo town inAugust 2003 and February 2004August 2003February 2004GOAL's support for SupplementaryFeeding Programmes (SFPs) andTherapeutic Feeding Centres (TFCs) inAgago countyIn June 2002 GOAL had begun activitieswithin Agago County, providing support to thenutrition unit (TFC and SFP) at the MissionHospital in Kalongo (the urban centre of AgagoCounty), managed by the Comboni Fathers.This support increased in July 2003 with additionalfunding from OFDA, and GOAL began towork with the Directorate of District HealthServices (DDHS). In May 2004 GOAL alsoundertook to help set up and monitor SFPactivities in six outlying village locations inAgago County.The six satellite Supplementary FeedingCentres (SFCs) were opened in response to thedifficulties reported by mothers travelling withtheir malnourished children to Kalongo eachweek. Food is now taken to where the need is,and the mothers do not need to use unsaferoads. The SFCs are all run from existing DDHShealth centres in towns, villages and IDP campsunder military protection. All SFCs are operationalover two days every second week, distributinga two week supplementary ration tobeneficiaries.The TFC operates over 24 hours despite limitedhuman resources. The programme functionswith three trained nurses and additionalstaffing provided predominantly by unqualifiedGlobal Acute Malnutrition (GAM)11.6% (8.6 - 14.3)4.7% (3.5 - 6.4)1UN Emergency Relief Coordinator, Jan Egeland, 10November 2003.2OCHA Kampala, Humanitarian Update, May 2004.Severe Acute Malnutrition (SAM)2.9% (1.6 - 4.2)0.7% (0.3 - 1.5)20

nurse aides. The ratio of staff to patients duringthe harvest period (November - May) is approximately1:10. However this ratio can increase to1:57 during the hunger gap period, as the numberof TFC admissions increases and problemswith recruitment exacerbate the problem of poorstaff to patient ratios. Education and health infrastructuresthroughout Northern Uganda havebeen significantly paralyzed as a direct consequenceof the conflict. Appropriately qualifiedstaff are therefore in short supply, and agenciesexperience chronic difficulties in locating and'coaxing' appropriate staff back into the conflictaffectedarea.Data available from Kalongo TFC and SFPrecords reflect the dramatic upsurge in populationdisplacement and food insecurity as a resultof insecurity and the consequent disruption ofplanting and harvesting activities. Programmeattendance increased abruptly, by 255% in theSFC and by 149% in the TFC between 2002 and2003.The harvest period for the north of Ugandaruns from July/August to November/Decemberwith a three month 'hunger gap' between Mayand July. Admission trends so far for 2004 indicatethat the food security and nutritional situationis worsening. The SFP in Kalongo is currently(May 2004) treating the highest number of beneficiariesso far recorded (155 in May 2004),almost three times higher than the numbers forMay last year. TFC numbers give a similar picture,with 59 beneficiaries in May 2004, doublethe number treated in May 2003.These trends are somewhat reinforced by thebi-annual surveys carried out by GOAL inKalongo town (Table 1). The first of these wascarried out in August of 2003 and the second inFebruary of 2004. Not surprisingly, the GAMand SAM were both worse in 2003 at the end ofthe hunger period, with GAM at 11.6% (95% CI:8.6% -14.32%) and SAM at 2.9% (95% CI: 1.6% -4.2%), as opposed to the end of the harvest periodin February 2004 where GAM was 4.7% (95%CI: 3.5-6.4%) and SAM was 0.7% (95% CI: 0.3-1.5%).In addition, as a result of continued sporadicterrorizing activities of rebel factions in the area,planting and harvesting practices have reducedsignificantly over the last 18 months to two years.GOAL therefore anticipates an extension of thehunger period in 2004 due to limited crop yieldswith programme beneficiary numbers to remainhigher for longer as more families have less food.Monitoring of the nutrition programmeThe operation, control, support and monitoringof a feeding programme in such an insecureenvironment presents unique challenges andproblems. First, access is severely limited makingdirect supervision of all the satellite SFCsimpossible. Secondly, rebel activities in the areamake security a significant obstacle for the localpopulation who risk ambush and abduction ifthey travel between towns or outside the protectedlimits of any Government-controlled area.This is identified as a primary explanation forhigh and unacceptable feeding programmedefaulter rates not just for GOAL but for allNGOs working in nutritional support in thisregion.SolutionsSolutions to these problems are not easilyfound. The security situation significantlyreduces GOAL's capacity to maintain a physicalpresence, necessitating 'remote controlled' monitoringof ongoing satellite nutritional programmesand distributions. This creates continuouschallenges for maintaining the quality, efficiencyand impact of programmes. GOAL's closeworking relationship with the DDHS and localofficials who have been trained in managementand support of programme activities, beneficiarycriteria, evaluation and analysis of programmedata, has been a key strategy in addressing theseconstraints. GOAL also facilitates a monthlymeeting for discussion and training of the satelliteprogramme staff, which enables GOAL tocritically review and analyze all data recordedwith a view to identifying and ratifying inconsistenciesand errors in SFP implementation.GOAL has also employed a 'Defaulter Tracer'who works alongside Community ResourcePersons in order to identify and locate defaultersfrom feeding programmes. This strategy hasenjoyed considerable success with 90-95 % ofdefaulters located in Kalongo and returned to theprogramme.The six satellite SFP centres were establishedas a means of increasing accessibility to morefamilies in Agago County as well as reducingdefaulter rates. GOAL has also tried to create anincentive for parents to continue to bring vulnerablechildren to the programme by providingnon-food items to all attendees at various stagesthroughout treatment and upon successful dischargefrom the programme.Whether this strategy will have a significantimpact remains to be seen. As the situation worsensit is likely that the population will becomemore needy and defaulter rates may thereforeimprove automatically. Recent studies carriedout by GOAL staff investigating defaulter ratesindicated that the main reason for programmedefaulting is insecurity. Other explanationsincluded conflicting demands on time - such asfamilies attempting to maintain land and crops,forgetting the appointment, losing their card oran illness within the family. The majority ofKalongo-based women have two households tomanage, a daytime residence as well as a nocturnaltemporary residence in a more secure locationwhich also needs to be maintained. Thisunique phenomenon of daily household displacementbefore dark impedes family routineand restricts their ability to engage in agriculturaland income generating activities.In contrast, current defaulter rates from theTFC are well within accepted levels, indicatingthat the feeding programmes are valued, trustedand well accepted and that people are willing tobring their children for nutritional and medicaltreatment when it is necessary.The Future?The current political and security dynamicsdo not suggest that there is likely to be animprovement in the nutritional and food securitysituation in the county in the near future. GOALanticipates that it will be engaged in nutritionalsupport programmes throughout Agago Countyas long as needs exist and security and donorresources allow. The sight of abandoned farmplots from the air tells a chilling story regardingNorthern Uganda - there is a war and Ugandansare losing. The organization of teams, the cryingand screaming of children suspended from Salterscales and stretched along height boards, thepaper chain of surveys and data entries and thetapping of nutritionist's computers in quest of Z-scores and global malnutrition rates will be justifiedhere for some time to come. Agago County isa textbook example of war and its effects on civilianpopulations. The impact of this crisis onnutritional status continues to unfold, presentingGOAL with new challenges. Our greatest challengeis to compliment nutritional activities withprovision of adequate shelter, water, sanitationand health - otherwise, our impact will beinsignificant, and we owe more than that to thepeople of Agago County.For further details, contact Monica Corish at:mcorish@goal.ieField ArticleChild with naso-gastric tube in feeding centre.Child with Marasmus in Kalongo, Pader.Mother and children in feeding centre.21GOAL, Uganda, 2004GOAL, Uganda, 2004 GOAL, Uganda, 2004

Evaluationsocial, cultural), Tanzania and Malawi werebest able to achieve true community managedtargeting and distribution. In contrast,the Zimbabwe programme diverged fromthe original CMTD protocols in the face of avery complex and challenging political environment.In this case the control of foodresources was (and continues to be) highlypoliticised and decision-making responsibility more centralised in the hands of localauthorities. This required SC UK Zimbabweto develop innovative mechanisms for promotingaccountability of decision makers tobeneficiaries.ii) While CMTD requires less agency staffinvolvement during the distribution processitself than traditional agency-run distributionprogrammes, the initial sensitisation ofgovernment leaders and targeted communitiescan be quite time-consuming. The processinvolves village level public meetings atthe outset to ensure full community participation.It also involves establishing partnerships with central, district and local leadersand the transfer of responsibility from formalleaders to community members or communitybased committees.iii) Considerable effort was invested in establishinga detailed Household EconomyAssessment (HEA)-based needs assessmentas a foundation for developing appropriatetarget criteria. However beneficiary communitiesdiverged from these criteria to somedegree according to local perceptions ofneed. In Zimbabwe, for example, 70-81% ofhouseholds were under-registered. Therewere also many reports of insufficient foodsupply relative to need leading to a degreeof community support for redistribution.Redistribution of food aid from targetedpoor households to those who are better offwas also believed by some to promotelong-term food security of the community,given the vital role of the better off in supportingthe poor. In addition many of thosewho were appropriately targeted sharedtheir food with others. In Tanzania, over 15%of the food was consumed by individualsconsidered to be outside of the household.iv) Where circumstances are appropriate for theimplementation of CMTD, it should be considereddue to its relative success (such as inTanzania) and the potential long-term communitybenefits of local programme managementand participatory decision-making.CMTD will be most feasible where theagency has a long term presence in the targetcommunity and the programme is directedtowards livelihood support rather than preventionof mortality in an acute emergency.v) Additional field-level research should beconducted on how CMTD might be implementedmore quickly, given the clear benefitsof community managed targeting in theera of HIV/AIDS and the urgency of findingmeans of targeting HIV/AIDS affectedhouseholds. Increasingly, implementingagencies report that targeting householdswith AIDS-related vulnerability is difficult inthe field. CMTD allows communities themselves to target such vulnerable householdswithout requiring outside agencies to seekdocumentation of beneficiaries' HIV status.Communities themselves are best placed toidentify those in need of assistance, andCMTD allows communities to identify andtarget the chronically ill without the administrative,stigmatising, burden of identifyingPLWHA explicitly.For further information, contact Anna Taylor,email: a.taylor@savethechildren.org.ukSCUK, Zimbabwe, 2002SCUK, Zimbabwe, 2004Monitoring food distributionin ZimbabweComparativeExperiences ofCommunityManagedTargeting inTanzania,Zimbabweand MalawiWomen carrying food from distrubution siteSummary of an evaluation by Savethe Children UK and TulaneUniversity reviewing their experiencesof utilising the CommunityManaged Targeting Distribution(CMTD) approach in SouthernAfrica 2 .SC UK recently conducted an evaluationof the Community Managed TargetingDistribution (CMTD) approach to foodaid targeting in three countries; Tanzania(1998-99, in Singida and Dodoma regions),Zimbabwe (2001-3, in Binga, Kariba andZvimba districts) and Malawi (2002-3, in Salimaand Mchinji Districts). CMTD is an approachdesigned to enhance community participationin, and leadership of, the distribution process. Itis based upon the principle that beneficiarycommunities themselves are best placed both toidentify and target the most vulnerable or crisisaffectedhouseholds in their communities, aswell as to undertake and manage the distributionprocess itself.The three country settings varied considerably.The Tanzania programme was designed toprotect livelihoods in populations facing repeatedadverse seasons; the Malawi programmeaimed to prevent nutritional deterioration inwhat was perceived to be a rapidly worseningfood security crisis; and the Zimbabwe programmeaimed to prevent deterioration in asimilar agricultural context to Malawi, but compoundedwith a highly complex political, agriculturaland economic climate. The CMTDapproach was adapted to each context givingrise to significant differences in 1) the targetingguidelines developed for project staff to follow;2) the issues that arose; 3) the targeting proceduresactually followed in the field; and 4) successof the programmes as defined by varioustypes of monitoring data.The author of the evaluation undertook acomprehensive review of reports related tothese programmes, both those written by SCUK and those written by external evaluationconsultants. Key informant interviews werealso held with SC UK programme staff for eachof the country programmes. Gaps in the monitoringdata were identified and highlighted inthe evaluation report. There were five majorconclusions from the evaluation. These were asfollows:i) Due largely to contextual factors (political,1Community Managed Targeting and Distribution of FoodAid: A review of experiences of SC UK in southern Africaby Ellen Mathys. December 200322

Agency ProfileValid International, 2003Name . . . . . . . . . . . . Valid International Ltd.Address . . . . . . . . . . . Unit 4, Oxford Enterprise Centre,Standingford House, Oxford,OX4 1BA, UK.Telephone . . . . . . . . . (1865) 722180Fax. . . . . . . . . . . . . . (1865) 722180Internet site. . . . . . . . www.validinternational.orgEmail address . . . . . . . office@validinternational.orgYear formed . . . . . . . . 1999Directors . . . . . . . . . . Steve Collins, Alistair Hallam.Staff (global) . . . . . . . 17Annual budget . . . . . . £600,000CTC training workshop participantsValid International, 2003Material used in CTC training.Interview by Jeremy ShohamThe ENN interviewed Steve Collins, cofounderof VALID in a coffee bar nearFarringdon in the City of London. Steve establishedVALID with Alistair Hallam in March1999. They originally met while working onthe multi-donor Rwanda evaluation in 1995.Their first encounter involved an argumentover agency responses in the Great Lakesregion with Steve assuming Alistair to be ‘adesk-bound pen-pusher’ and Alistair seeingSteve as one of the “loud mouthed done itonce before so I'm an expert brigade”. Thefrank exchange of views seemed to sow theseeds of a friendship. Both ended up sharing aflat and working together on a number of evaluationconsultancies and setting up humanitarianoperations together. During this periodSteve and Alistair talked a lot about their frustrationwith the lack of humanitarian agencylearning, the poor evidence base for practice aswell as the generally low level of professionalismamongst humanitarian agency staff. Thesediscussions led to the idea of setting up anagency which would primarily aim tostrengthen the evidence base for practice, supportprofessional development and also allowthem to follow through projects working aspartners with agencies ('unlike consultancieswhere project reports are often left to gatherdust').Incredibly, Alistair signed up for medicalschool in 1998 and continued his studies toqualification while co-directing and managingthe work of VALID. Steve remembers Alistair'sagonising over whether to go to medicalschool -in fact the only time he rememberedbeating Alistair at tennis was when Alistairwas totally preoccupied on the final day forsending in the application form for medicalschool.VALID ticked along for a year or so withSteve and Alistair doing a number of consultancies/evaluationsin the humanitariansphere. Initially the focus of Valid work wasevaluation and they performed a number ofevaluations including the DEC evaluations ofthe response to the floods in Mozambique, theDEC evaluation of humanitarian response inthe Balkans (jointly with ODI), and morerecently the evaluation of the DEC agenciesresponse in Southern Africa. The Communitybased Theraputic Care (CTC) work for whichVALID is most renown began in Ethiopia in2000 when after the regional government inWoliyta forbade agencies from setting up TFC,Valid worked with Concern and Oxfam to setup community based programs to treat severemalnutrition. Steve took the findings fromEthiopia, which were generally positiveregarding CTC, to the annual SCN meeting inNairobi arguing that this was the future oftreatment for severe malnutrition. Some agenciesbought into this while others were eitherambivalent or downright hostile. Steve recognisesthat going in with all guns blazing (aswas his style at the time) may not have beenthe best approach and probably set back thecause for a while. Soon however, ConcernWorldwide agreed to fund the development ofCTC for three years working with Valid in a23

Agency Profilenumber of countries to test and develop themodel. Several experts were assembled, e.g.Andrew Tomkins from ICH, Jeya Henry fromBrookes, Johan Pottier from SOAS and MarkMyatt from UCL. These individuals providedhigh level technical support in the designphase of CTC projects. Additional staff weretaken on with VALID helping a number ofagencies to implement these programmes, e.g.SC UK in Darfur and the DRC, Tear Fund inSouth Sudan,. The funding from Concernallowed VALID to pursue a coherent and wellstructured research program aimed at systematicallydeveloping a strong multi-disciplineevidence base for CTC. CTC is now beingadopted by many agencies while donor interestand support has spiralled. In Steve'swords, 'we have changed a lot with CTC and Idon't think I'm just bigging it up because itwas Valid that did it'.Steve plans to extend the CTC model todeliver other types of services, i.e. health care.VALID are now moving into the HIV/AIDSarena. With the strong linkages betweenhealth, malnutrition and HIV, Steve arguesthat CTC provides the perfect entry point forinterventions to address HIV/AIDS. CTC is inmany ways analogous to Home Based Care(HBC). However, external agency support toHBC runs the risk of undermining the communityethos, while the CTC experienceshows that by starting off treating acute malnutritionCTC interventions gives agencies anon-stigmatizing entry point that gives themtime and space to build confidence in theapproach at community level whilst graduallyexpanding to complement informal supportnetworks rather than usurp them. Anotherplanned development for CTC that relates toHIV is the use of pro-biotics and micronutrientssupplementation in RUTF. Pro-biotics canbe delivered in RUTF and have a markedimpact on diarrhoea - the lacto-bacilli remaindormant until delivery. Furthermore, recentresearch shows how vitamin B, C and E supplementationcan delay the development ofstage four HIV from stage 3 by up to 30%.RUTF can therefore provide treatment fordiarrhoea and essential additional macro andmicronutrients for those suffering fromHIV/AIDS.Perhaps inevitably, the interview turned toa discussion about agency institutional issues.Steve mused on his opinion of INGOs towardswhom he sometimes has an ambivalent attitude.Mostly, he admires the generosity ofspirit behind NGOs and their desire to effectpositive change for the disadvantaged.However, at times, he is disturbed by theirappetite for profile and positive PR to facilitatefund raising. He worries that this requirementfor positive spin erodes the ability of agenciesto be truthful and can lead to overly defensivebehaviour and resulting inability to be transparentabout mistakes. This obviously translatesinto failure to learn. He feels that VALIDhave a culture where owning up to mistakesand activities which have not worked out hasallowed much learning. Steve explained howVALID is legally a company with share-holdersand does not have fund raisers. Instead,funding comes from contracts with donors orINGOs and means that Valid has to be reallyefficient in terms of it's income and expendituresas ultimately money is raised on thebasis of results not profile. VALID are not acharity so cannot guarantee income by appealingto a humanitarian ethos. At the same timeVALID do not operate like a normal profitmakingcompany and although clearly financialsurvival is important, money is not thecentral driving force. The fact that VALID disseminateand develop expertise on CTC byassisting agencies to run these programmes ontheir own is effectively doing VALID out ofwork. CARE, SC US and SC-UK, who previouslycontracted VALID to design, set-up andevaluate CTC programs for them are nowdoing CTC on their own without any VALIDsupport'. 'This however is fine and whatVALID are largely about'.VALID currently have 15/16 employeeswith some staff doing non-CTC related consultancies.Steve acknowledges that this mayincrease in the future as the need to diversifyactivities increases, i.e. as other agenciesdevelop expertise in CTC. Steve reckons thatthe best direction for VALID in the future isquality control and validation. He argues thataccreditation and quality control by VALIDwould be better than an evaluation report.Both Alistair and Steve are optimistic aboutthe future of the organisation. Staff are increasingand acquiring expertise. Many are producingpublications and some are enrolling onPhds.Steve says that he dislikes too formal astructure/organisation and hopes to keep the'vibe' of VALID fairly informal. As he quipped,there haven't been any resignations as yet. Hewants VALID to grow but not to become amonolith. At the same time he sees the potentialfor more experienced staff to 'bud off' andform groups which they manage moreautonomously. There is no question thatVALID has a unique institutional culture -probably a reflection of the individualsresponsible for setting it up. There is also noquestion that VALID has made a unique andvalued contribution to the humanitarian sectorthrough its work on CTC.Valid International, 2003 Valid International, 2004Valid International, 2003Training of outreach workersVolunteers being trained to use MUAC in EthiopiaTraining in screening criteria24

People in AidIFE Core group meetingHeld in Oxford 19th-21st JulyLida Lhotska Gifa.Lida Lhotska GifaLida Lhotska GifaSuzi Villeneuve (unicef), Sultana Khanum (WHO). Mary Corbett, Gabrielle Palmer. Marie Mc GrathPeople in AidLida Lhotska GifaFelicity Savage, Suzi Villeneuve (UNICEF).Lida Lhotska GifaFiona OReilly and Rebecca Norton (TdH), field testing theinfant feeding training manual.Lida Lhotska GifaAnn Burgess and Marie Mc Grath (ENN).Lida Lhotska GifaMary lungaho and Fathia Abdalla (UNHCR).25

People in AidJeremy Shoham, South Africa, 2004.Fiona Watson and Carmel DolanWFP/UNICEFRegional workshop on HIV/ Nutrition programming heldin Johannesburg on 30th June and 1st July.Jeremy Shoham, South Africa, 2004.Magdalena Moshi WFP Lesotho, Augustino MunyiriUNICEF Lesotho, and Dr Rumishael Shoo UNICEFRegional Health AdviserBreak in presentations at WFP/ UNICEF meeting in JohannesburgJeremy Shoham, South Africa, 2004.Jeremy Shoham, South Africa, 2004.Mutinta Hambayi from WFP ODJ and Abdirahman MeygagWFP NamibiaMarie Mc Grath with Ronan, six hoursold, and Alana.Inset: Ronan, six weeks later.26

This publication was madepossible through the supportprovided to the Foodand Nutrition TechnicalAssistance Project (FANTA)by the Office of Health,Infectious Disease andNutrition of the Bureau forGlobal Health at the U.SAgency for InternationalDevelopment (USAID),under terms of CooperativeAgreement No. HRN-A-00-98-00046-00 awarded tothe Academy forEducational Development(AED). The opinionsexpressed herein are thoseof the author(s) and do notnecessarily reflect theviews of USAID.Editorial teamDeirdre HandyMarie McGrathJeremy ShohamRupert GillDesignOrna O’Reilly/Big Cheese Design.comWebsiteJon BerkeleyContributors for thisissueKristy AllenJohn SeamanCelia PettyAnna TaylorJohn MooreMara Berkley-MathewsRita BhatiaAndrew RenzahoGabriele PalmerRebecca NortonMary Lung'ahoLida LhotskaFiona O'ReillySteve CollinsAnn BurgessBob OdhiamboStuart GillespieClaudine PrudhonThanks for thephotographs to:Valid InternationalJeremy ShohamC-SAFERupert GillCelia PettyGOALSCUKACFVisar KryeziuBethesda internationalOn the coverSupplementary feedingprogramme in Hulla.Valid International,Ethiopia, 2003.Field Exchangesupported by:The ENN would like to correct an attribution in thelast issue of Field Exchange made with regard to thesummary of ongoing research entitled 'Taking forwardresearch on adult malnutrition' (page 11 in issue 22).The attribution should have been for both Dr JaneKnight and Laura Wyness.The Emergency Nutrition Network (ENN)grew out of a series of interagency meetings focusingon food and nutritional aspects of emergencies. Themeetings were hosted by UNHCR and attended by anumber of UN agencies, NGOs, donors and academics.The Network is the result of a shared commitment toimprove knowledge, stimulate learning and providevital support and encouragement to food and nutritionworkers involved in emergencies. The ENN officiallybegan operations in November 1996 and has widespreadsupport from UN agencies, NGOs, and donorgovernments. The network aims to improve emergencyfood and nutrition programme effectiveness by:• providing a forum for the exchange of field levelexperiences• strengthening humanitarian agency institutionalmemory• keeping field staff up to date with current researchand evaluation findings• helping to identify subjects in the emergency foodand nutrition sector which need more research.The main output of the ENN is a tri-annual publication,Field Exchange, which is devoted primarily topublishing field level articles and current researchand evaluation findings relevant to the emergencyfood and nutrition sector.The main target audience of the publication are foodand nutrition workers involved in emergencies andthose researching this area. The reporting and exchangeof field level experiences is central to ENNactivities.The TeamThe ENN would liketo correct the captionfor the first picturein the 'Peoplein Aid' section onpage 29 of FieldExchange issue 22.This first teamphoto is in fact ofthe Tearfund teamin southern Sudanand not the ConcernTeam.Jeremy Shoham (Field Exchange technicaleditor) and Marie McGrath (FieldExchange production/assistant editor)are both ENN directors.Rupert Gill is ENN administrator and project coordinator,based in Oxford.Dan George is the ENN finance assistant,working part-time in Oxford.The Emergency Nutrition Network is a company limited by guaranteeand not having a share capital.Registered in England and Wales number: 4889844Registered address: Unit 13, Standingford House, Cave Street,Oxford, OX4 1BA, UKENN Directors: Jeremy Shoham, Marie McGrath27

Emergency Nutrition NetworkUnit 13, Standingford HouseCave Street, Oxford, OX4 1BA, UKTel/fax: +44 (0)1865 722886Email: office@ennonline.netwww.ennonline.net