The following measures are proposed to improve nutrition and household food security of vulnerable groups in rehabilitation.
None of these activities are unique to rehabilitation. It is precisely because of the relief-rehabilitation-development continuum that most of them are established concepts either in relief or in rural development. What distinguishes them as rehabilitation activities is primarily their timing - they require implementation shortly after an emergency, and the acute food insecurity of the populations they address.
Underpinning all the proposed interventions for improving the nutrition security of vulnerable groups in post-emergency situations is the need for a precise articulation of the nutrition problem. This requires developing an understanding of how households acquire and manage the food available to them in the post-emergency period and how to reinforce and improve on the local food and farming systems16. It must be based on micro-level information which begins to characterise local vulnerability and can be used to identify the types of interventions which are needed. This needs to be done at the outset of formulation and planning of rehabilitation and reconstruction programmes, and needs to be up-dated as part of a monitoring process which can guide appropriate reorientation of programmes as rehabilitation progresses and needs change.
National capacity to carry out this kind of assessment and liaise with local agricultural and food aid departments needs to be supported and developed as follows:
capacity to undertake micro-level household food and nutrition security assessment and analysis of the constraints,
capacity to identify vulnerable groups and their constraints,
capacity to introduce nutritional constraints as a consideration in national reconstruction planning,
capacity to propose and help formulate interventions which address nutrition constraints in conjunction with other relevant line ministries and external assistance agencies,
capacity to monitor and evaluate the effectiveness of assistance programmes on nutrition security.
If not already existing (e.g. from the emergency relief phase), setting up expeditiously appropriate administrative mechanisms at national and regional level will be instrumental in coordinating the above-mentioned activities.
Developing a strong national nutrition capacity and a clear focal point for nutrition within government agencies could provide a valuable resource for other agencies by providing information, guidance and training on aspects relating to food and nutrition.
National planners need to be made aware of the nutritional issues and potential constraint of poor nutrition to national recovery. They need to be provided with appropriate information on which to base their decisions and appropriate technical support. It is important that technical assistants from other disciplines which are involved in the planning process make full use of technical assistance in nutrition security assessment which is available from agencies such as FAO. Areas which could be supported include:
national workshops on the post-emergency nutrition situation which review the constraints and point out areas for consideration by national planners,
assessment of the impact of food aid interventions, food-for-work, market disintegration on household food and nutrition security and making recommendations for improvements,
assessment of the impact of refugee departures upon local household food and nutrition security where a country has been host to large numbers of refugees for several years.
Introducing nutritional considerations into agricultural rehabilitation programmes, for example, in the targeting of programme beneficiaries, the choice of seeds in seed distributions, and the development of community level agricultural extension interventions requires introducing nutrition concerns in national and regional agricultural departments, international food and agricultural agencies and NGOs. This requires closer links between respective national and international nutrition and agriculture sectors along the following lines:
including nutrition security assessment in crop and food supply assessments; this should include an assessment of access to food preparation equipment,
including nutritional needs as a factor in determining the choice of seed for seed distributions and the mechanisms of distribution,
liaising with national nutrition departments and other agencies, which are carrying out anthropometric nutrition surveys to coordinate and correlate information on food and crops,
supporting joint workshops on agriculture, food and nutrition to discuss findings from nutrition and agriculture assessments and formulate rehabilitation interventions.
Regional and district administrators need to be able to identify local rehabilitation needs, formulate and monitor projects, coordinate local implementing agencies and be aware of long term food, agriculture and nutrition issues relating to the use of food aid. They need to be sensitive to the changing situation as recovery progresses. In post-war conditions training at all levels is necessary to overcome skill shortages that tend to accompany prolonged conflicts. Similar needs may prevail in post-drought situations.
The distribution of agricultural inputs and a general ration provides an ideal opportunity to back-up the distribution with nutrition extension on the value of producing and consuming a variety of foods, on safely storing, preserving and preparing them, and on their appropriate intra-household distribution. Where there are existing networks of agricultural extension, home agents or community workers, these can be given training and support. In the absence of such networks, training can be given to individuals nominated by the community, perhaps using a food-for-training programme. Extension messages should be based on full understanding of the practical constraints households face during the post-emergency period. Support needs to be given along the following lines:
training of local and regional level agricultural extension staff on food and nutrition security and nutritional aspects of food production, in particular the beneficial effects of the production and consumption of fruits and vegetables,
training of female home agents and community workers on the production of nutritionally diverse crops, appropriate food storage, preservation and preparation techniques and basic nutritional concerns relevant to post-emergency conditions,
encouraging links between the health and agriculture sectors through integrated training of health and agriculture workers enabling them to work as a team.
These types of activities need support and collaboration between agricultural and health agencies.
Improving nutrition security at the household level requires provision of appropriate resources; seeds, tools, cooking utensils etc, and sufficient time and knowledge to cultivate, prepare and distribute food appropriately between household members. It is important that post-emergency populations are able to recognise malnutrition and have some understanding of its causes so that they can take steps towards improvement. In post-war conditions, or countries where health services are poor, communities need to be able to carry out their own basic health care, for example, preparation of oral rehydration salts, and to know when it is appropriate to seek help from distant health centres. Nutrition education needs to address the particular constraints of the post-emergency period.
These types of activities could be carried out through NGOs and programmes which worked through community development agents. Technical support could be provided through FAO.
Provision of appropriate meals at schools and creches during the rehabilitation period can be a method of protecting vulnerable household members. It needs to be accompanied by education initiatives which ensure that food is appropriately stored, prepared and eaten in addition to food from home. Child feeding programmes of this nature can be of particular use where adults are engaged in FFW programmes, or in busy agricultural seasons when adults have less time for child feeding. In the longer term, school feeding programmes need to be integrated with agriculture and horticulture programmes, whereby schools produce (part of) their own food as an element of vocational agricultural training.
Targeting of assistance during rehabilitation is a priority so that self-sufficiency is encouraged and resources reach those in greatest need first. Targeting requires orientation of implementing organisations, local administrators and community leaders to recognise vulnerability and creating a climate of understanding in the community of how eligibility has been determined. This could be supported by workshops for implementing organisations and local leaders to discuss the nature of vulnerability, based where possible, on household food and nutrition security assessments.
Public works programmes such as FFW are popular with donors and planners as a means of providing assistance without creating dependency. However, ensuring that these projects help rehabilitate vulnerable groups involves:
addressing the particular needs of vulnerable groups,
developing an appropriate methodology for monitoring and impact assessment of FFW,
training those responsible for FFW schemes in appropriate management and project formulation.
In the post-emergency period there needs to be a shift from macro-level consideration of national or regional food needs, to the dynamics of the food system at the community level. This is required so that the legitimate food needs of the vulnerable can be met, whilst promoting restoration of the local agriculture and food market system. This involves:
micro-level (household) information on food availability and crop production to assess food aid needs,
development of food aid procurement and distribution systems which encourage commercialisation as well as promote local food production,
overcoming localised food shortages by local food purchases from neighbouring surplus areas (e.g. Mozambique)
flexibility to divert imported food aid from original destination if it may interfere with the market for local production,
monitoring of the impact of food aid on local markets.
There is a need for coordination which addresses the different mandates of agencies involved in rehabilitation to prevent preferential treatment of one group of beneficiaries over another and to make best use of the different areas of expertise. This includes coordination and cooperation between international agencies, governments and NGOs. This could be supported through:
examining the experience of the cross-mandate approach being used in Ethiopia,
fostering closer links between UN agencies and NGOs to improve sharing of information and technical expertise of the UN agencies,
promoting greater participation of UN development agencies in national emergency relief forums in order to develop the transition into rehabilitation and development.
Meeting the challenge of the relief to development continuum requires developing a shared understanding of the aims and objectives of rehabilitation amongst the various UN agencies, government and NGO's involved. Unless there is widespread agreement that efforts over and above those required to meet emergency needs are valuable in the long term, rehabilitation efforts will struggle to find funding. In addition, rehabilitations interventions by one agency can be undermined by the application of emergency measures by another.
Dealing effectively with rehabilitation of nutrition security requires a shared perspective amongst Governments, agencies and bilateral aid donors, including an analysis of the causes of the nutritional problem, their inter-relationships and a coherent approach to dealing with them and evaluating the results. Separately designed and executed actions may be contradictory or miss mutually supportive complementarity. So long as nutrition and household food security are not a major determinant of policy in rehabilitation, decision makers should not expect their actions to lead to an improvement of the nutritional condition of affected households. They should be aware of the constraints that poor nutritional conditions impose to rehabilitation and be convinced that introducing nutrition considerations at the onset of emergency and rehabilitation interventions facilitates national recovery.
