Fragile states need more donor flexibility to improve nutrition

KATHMANDU, Nepal — Fragile states say they need more support from donors and the international community tailored for their circumstances if they are to make successful strides in nutrition indicators in both humanitarian and development contexts.

Two key global nutrition efforts have acknowledged there is a gap in progress in fragile and conflict states. Both the Scaling Up Nutrition Movement and the 2020 Nutrition for Growth summit list an improved response in those contexts as one of three goals vital to fighting malnutrition. As crises around the world become increasingly protracted, efforts to meet Sustainable Development Goal 2 must be effective at the humanitarian-development nexus and build resilience, according to nutrition advocates.

“The main part of the problem is the architecture,” said Jeremy Shoham, director of the Emergency Nutrition Network. “The architecture is not currently configured in a way — both within the U.N. and civil society, INGOs, and donors — to think about these contexts to work in a way where you can join up humanitarian short-term acute crisis with longer-term programming for chronically vulnerable populations.”

Shoham said there needs to be a way for the international community to assess the needs of a particular country and respond accordingly to both short- and long-term nutrition problems — but that the institutions behind programming make it difficult to change.

“What really needs to happen is that in contexts where you have protracted crisis, the whole system of early warning, early response, response and recovery, etc. — that has to have a coordination mechanism which allows it to say, ‘OK, this country is clearly having repeated crises. It’s chronically in emergency … We can no longer sanction business as usual, which is short-term humanitarian response every six to twelve months,’” Shoham said.

Caught at the nexus

Somalia is one example of a country that has found its nutrition response caught at the humanitarian-development nexus.

Dr, Mohamed Abdi Farah, a health and nutrition adviser in the Office of the Prime Minister of Somalia, said that because Somalia has been considered a humanitarian emergency context for so long, there has been no focus on improving nutrition outcomes in a development context, despite commitment from the government.

“That question of how do you prevent a child from becoming malnourished in the first place — and getting funding for it — is a problem,” Farah said. “What we would like to see is: The millions of dollars that go into treating one child who is already severely acutely [malnourished] could save maybe 10 children from becoming severely acutely malnourished.”

Farah said that too frequently, Somalia hasn’t been involved in the initial stages of program planning, which doesn’t allow the government to provide its input for preventive malnutrition strategies to build resilience.

It would be much more cost-effective, Farah said, to spend money on preventive nutrition programming in Somalia rather than importing food aid to fight acute malnutrition. He said his government is working to integrate nutrition into the education system so it can reach children at a young age to teach them about positive nutrition habits, as well as educate their mothers on how to prevent malnutrition. Infusing cooking oil with vitamin A, for example, is one way Somalia aims to address the issue.

“But implementing that and funding that is the problem because everybody, either donors and implementing partners and U.N. agencies, are only geared towards the emergency,” Farah said. “Turning a small portion of their efforts to this is what the government is trying to coordinate.”

‘They quit’

When it comes to nutrition, coordinating an effective transition from humanitarian responses to development is a challenge due to a muddled view of who is responsible for what, Shoham said.

“Here is the crux of the problem: Firstly, the lead agency for nutrition, UNICEF, does not really coordinate this type of programming. It doesn’t see it as its role,” Shoham said. “It’s much more interested in treatment of wasting and strengthening health systems to deliver that. It doesn’t see itself as an agency with a mandate to prevent malnutrition. There is no agency with that mandate.”

Humanitarian emergency funding typically operates on a cycle of six to twelve months, which is a barrier to implementing longer-term, multisectoral malnutrition programs, Shoham said. Such development programs would usually operate on a basis of three to five years.

Donor response can also cause nutrition indicators to fluctuate as attention on a country intensifies during a humanitarian response, then wanes as an emergency fades. In Haiti, Joseline Marhone Pierre, director of food and nutrition at the Ministry of Public Health and Population, said that the increase in international attention after the 2010 earthquake improved nutrition indicators.

“We had money. We had financial support. And it was not a problem to have the civil society, the international civil society, NGOs, because I was able to coordinate them,” Marhone Pierre said.

But when donors left after the situation stabilized, there was backsliding. Marhone Pierre said she noticed a shift in 2014 when international money began to dry up. She said NGOs told her that because severe acute malnutrition levels were around 1%, their work in the country was done.

“They quit,” Mahone Pierre said. The nature of the response left the country without the resilience and resources to continue pursuing its nutrition agenda beyond a humanitarian response into development, she said.

Security takes precedence

In some fragile states, such as Afghanistan, governments have a hard time getting donors focused on programs to improve nutrition outcomes while the country is facing complex security issues. Even though the highest levels of the Afghan government are engaged in improving nutrition, the country produces budgets in consultation with other actors. This means Afghanistan itself is not wholly in control of how its spending is prioritized, said Nasrullah Arsalai, director-general of the country’s Secretariat of the Council of Ministers.

The international community has a bigger stake in Afghanistan because of the country’s fragility, according to Arsalai.

“In some unstable countries and conflict situations, all countries and all nations — they do not have a stake there. But in Afghanistan, the entire world has a stake. So for that reason, now we are more — our government, our resources — are just focused on fighting this terrorism,” he said.

Arsalai said he asked SUN Movement Coordinator Gerda Verburg for help in advocating for nutrition to be on the agenda with donors and the U.N. system because they are both so involved in the ongoing response in the country.

“In development issues and priorities like improving nutrition … we do need here support, contribution of our partners and international community,” Arsalai said. “Unfortunately, from the donor side in these last over two years, we do not observe that much focus and interest and engagement in nutrition and in this agenda.”

Editor’s note: SUN facilitated Devex’s travel to the SUN Global Gathering in Kathmandu, where this reporting took place. Devex retains full editorial control and responsibility for this content.

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