Scoop situation - Field Exchange - Emergency Nutrition Network

Breastfeeding class in progress at 2006 Child Survival SFP siteWFP/Paul Turnbull, Ethiopia, 2006• To prevent the nutritional deterioration ofchildren under five and pregnant andlactating women.• To prevent those moderately malnourishedbecoming severely malnourished.• To rehabilitate moderately malnourishedchildren and pregnant and lactating womenthrough the provision of fortified supplementaryfood.• To promote key nutrition messages.It should be noted that while the objectives of theTSF are typical of traditional supplementary feeding(SFP) programmes, the TSF is not a standard SFP.The TSF operates on the basis of a three-monthlyfood distribution without a general ration, absence offacilities for treatment of severe acute malnutrition(SAM)) and no follow up of a child or women’sweight gain during their enrolment in theprogramme. (Ed).In December 2006, WFP conducted an evaluation4 of the TSF/EOS component of the PRROas part of a larger evaluation of the wholeprogramme. Interviews were conducted withkey stakeholders in Addis Ababa and the evaluationteam visited five regions of Ethiopiawhere the TSF was being implemented.Interviews were conducted in regional capitalsand at field level. The following were the mainfindings of the evaluation team.• The achievements of the TSF in a relativelyshort space of time have been impressive.• Over a one and a half year period, the TSFhas expanded from just one region and 10woredas in April 2005 to 264 woredas in 10regions by the end of 2006.• In 2005, only 62.2% of planned TSF beneficiarieswere reached. This was due to start upproblems related to capacity constraints ingovernment, including a lack of training andcoordination, under-achievement in terms ofnutritional screening targets and delays insecondary transport of food delivery. ByNovember 2006, approximately 400,000 childrenand 190,000 pregnant and lactatingwomen received two distributions of thefood supplement i.e. a total of six months ofsupplementary food. Furthermore, 4,000food distribution agents had been trained.• Considerable resources have been investedin TSF staff training at all levels. In addition,the programme provided a ‘minimum package’for the regions that included cars,motorbikes and computers. In 2006, an estimated54% of all TSF woredas received theminimum package.• Another significant achievement has beenthe substantial network of highly capabletrained local women (Food DistributionAgents (FDAs)) created for overseeing allaspects of the food distribution and forproviding nutrition education. In addition,WFP has made considerable efforts tostrengthen programme implementation –largely through operational research/pilotstudies. WFP have also developed a monitoringsystem especially for the TSF.ChallengesCurrently, there is insufficient evidence that theTSF is having a positive impact on nutritionalstatus of children enrolled in the programme.This is a critical gap given the unusual design ofthis programme and lack of precedent forimplementing this type of programme. Thereare also no population level data (baseline andpost-intervention) on prevalence of acutemalnutrition in children under five and womenor infants and under five mortality rates thatcould be used to demonstrate an impact of theprogramme at population level. However, thescale of the food transfer, the coverage and theintegration with EOS health inputs wouldsuggest that the programme must have somenutritional and health benefit even though themagnitude of this has as yet to be measured.There is also a lack of clarity and policy guidancewith regard to how the TSF should beadapted where acute nutritional crises occur.This has reportedly led to situations where theEOS/TSF has been viewed as a replacement fortraditional SFPs in situations where child wastinglevels have substantially increased.Another challenge is that there are no formallinkages between the TSF and relief/ProductiveSafety Net Programme (PSNP) components ofthe PRRO. Although, according to the PRROdocument, the TSF programme was meant toserve a subset of the relief/PSNP beneficiarypopulation, no operational linkages have beenestablished. A high proportion of TSF beneficiariesmay therefore not be in receipt of an adequategeneral ration. This will lead to sharing (smallscale studies conducted by WFP suggest thatover 50% of TSF beneficiaries may be sharingrations with other family members) and consequentdilution of impact of the TSF ration.However, as a significant proportion of thoseidentified as mild and moderately malnourishedmay not be food insecure but affected by poorhealth and/or caring practices, it may not beappropriate to formalise a linkage between theTSF and relief/PSNP components of the PRRO.This issue requires follow up study to determinewhether a formal linkage between theprogrammes should be established.Another issue is that there is no clearly articulatedexit strategy for the TSF component,although the overall EOS/TSF programme isexpected to phase out as the national HealthExtension Programme (HEP) expands. It isunclear how long the planned HEP expansionwill take although considerable progress isbeing made in training Health ExtensionWorkers (HEW) and in constructing healthposts. In addition, there is currently no statedrole for supplementary food in the HEP documentation.It is therefore unclear how theprogramme will continue if WFP withdrawsfrom programming in the future.The evaluation made a number of recommendationsthat include the following.In order to demonstrate impact of this noveltype of programming, WFP should:• Conduct a robust nutritional impact andefficacy assessment of the TSF as a priority,with all parties and donors involved in thestudy design to ensure shared objectivesand ownership of the results.• Ensure the study involves representativesamples of cohorts of children to assessnutritional outcome and also includeprogramme coverage indicators to understandwhat levels of exclusion and inclusionerror are occurring.• Ensure that if impact and efficacy aredemonstrated, there are discussions withkey stakeholders to determine clearprogramme targets for the future, includingexit criteria.To strengthen linkages between EOS and createopportunities for FDAs to become a bridge tothe HEP, WFP should formalise the role ofFDAs in EOS screening.To ensure that the TSF does not inhibit anappropriate response to acute nutritional crises,WFP should develop clear guidance materialon the role of the TSF in acute crisis, especiallywith regard to emergency targeted SFPs implementedby international non-governmentalorganisations.1Summary Evaluation Report Ethiopia PRRP 0362.0. 10October 2007. Available athttp://www.wfp.org/eb/docs/2007/wfp137560~2.pdf2The screening actually includes older children who arestunted as the entry to the EOS programme is based on aheight less than 110.0cm3Up until March 2006, MUAC screening was followed byweight for height measurements but this was stopped afteragreement among all stakeholders to simplify the system anduse only MUAC as a good predictor of mortality risk.4WFP (2007): Summary Evaluation Report Ethiopia10362.0: Enabling livelihoods protection and promotion.Executive Board 2nd Regular Session, Rome 22nd-26th ofOctober. Agenda Item 624