Yara Sfeir, GNC Technical Helpdesk GNC Meeting, Amman October 2018 Review of the Nutrition Cluster National Technical Working Groups (TWGs) Yara Sfeir, GNC Technical Helpdesk GNC Meeting, Amman October 2018

Background I think it is better to ask Josephine to say 2 minutes on the background

Objectives Main objective: understanding how program quality and effectiveness of nutrition in emergency can be improved. Specific objectives: 1-To understand the current functioning of TWGs, 2- the challenges faced by TWGs, and foreseen challenges for the Global Technical Mechanism 3- What recommendations and actions are required to improve the technical program quality in nutrition in emergency

Methodology Documents review Online survey (33 responses) Key informants interviews (22 informants) Triangulation Here I can say what is written on pages 6 and 7 of the report.

Findings

Current functioning of TWGs Types of TWGs Presence of TWGs ToRs TWGs main tasks TWGs composition The TWGs that were most present according to the online survey respondents are the Assessment, IYCF-E and CMAM TWGs with Assessment being the most Overall, 12 types of TWGs were listed by respondents: Assessment/Surveys TWG, IYCF-E TWG, CMAM TWG, Emergency Preparedness and Response Plan (EPRP) TWG, Integrated with other sector TWG , Capacity Building TWG, Accountability to Affected Populations/ Perceived Quality TWG, Advocacy TWG, Supplies Monitoring TWG, Micronutrients TWG, Information Management TWG and WASH in Nut TWG. Note that these working groups were mainly at the national level but some were also at the subnational level. Although the list is not exhaustive, it gives an idea on the wide range of possible working groups that are formed at country level. Over 85% of TWGs had ToRs but often abiding by the ToRs was an issue. Taking a closer look at the assessment TWGs, the deliverable cited most frequently revolve around reviewing and validating each step of different types of surveys. Other deliverables frequently mentioned were training and capacity building and promote the sharing of articles and best practices. For the IYCF-E and CMAM TWGs, the deliverables cited most frequently were updating or developing IYCF-E and CMAM related policies or guidelines as well as harmonizing tools. Other deliverables frequently mentioned were to monitoring the program quality, training and capacity building and design the response plan. On the technical group composition, it is notable that NGOs, local NGOs, UN agencies and at times the Ministry of Health are present in systematically most technical working groups; however, only two respondents mentioned the presence of an academic institution or a university and only one mentioned the presence of the country’s pediatric association. Among the UN agencies, UNICEF was the most cited member of a TWG followed closely by WFP, then UNHCR and the one least cited among the four agencies was WHO.

Challenges faced by TWGs and at different levels Pages 14 to page 22

The Assessment TWG the main challenge faced by the Assessment TWGs was the lack of expertise of TWG members in assessments

The IYCF-E TWG The main two challenges faced by the IYCF-E TWGs were the lack of dedicated leadership and the delays due to conflicting priorities. Our capacity to deliver a good quality IYCF-E program is very limited Moreso, a number of key informants stated that there is much for us to do to ensure that IYCF-E programming is up to the mark. Our capacity to deliver a good quality IYCFE program is still very limited. As a key informant said ‘it seems that IYCF-E is less structured less well understood than the other technical areas we work in’.

The CMAM TWG The main four challenges faced by the CMAM TWGs were the lack of endorsement of the government, the lack of attendance, the lack of funding and the lack of technical capacity

Challenges the weak commitment of the members Staff turnover and at times no handover

Challenges TWGs leads are not stepping up to their role The main theme that the TWG work on is national nutrition guidelines. Is it up to the working groups amidst an emergency to do this work or should this be done as a preparedness measure collectively?

Challenges The assessment of the overall nutrition in emergencies response quality remains a gap Assessment numbers are valid and precise but not sensitive Another remaining gap is the assessment of the overall nutrition in emergencies response quality at a given time. TWGs do not take on joint monitoring and visits to programs. Individual agencies, government, UN agencies and donors monitor the programs they implement or fund, however no independent collective monitoring of the nutrition in emergencies program response as a whole takes place. In terms of scale and quality, how do we ensure that the needs of the population are being met? Assessment numbers are valid and precise but not sensitive; a number of key informant mentioned that as a sector we overemphasized GAM and SAM to the point that, if, in an emergency, the GAM is low but IYCF-E practices are far from optimal and dangerous for the survival of infants- yet because the GAM number is low- funding and programs will not reach this area. As a sector, we can a long way to have a strong methodology for assessments of SAM and GAM and it is a methodology that is valid and is now rolled out by all partners. However, in terms of nutrition sensitive related numbers, we lack both an overall analysis of the nutrition situation and also we lack a proactive analysis of the signs for degradation. At times it seems to some key informants that the nutrition teams are focused on getting the numbers and less on analyzing them.

Challenges Composition of the group Knowledge and experience of the local partners in nutrition in emergency response is limited Weak technical expertise of members often exacerbates an already existing power imbalance How can the membership of the TWGs be diversified? How do we tap into the country’s technical resources?

Challenges A perceived a balance of power shifted towards the funding agency or the government. The fact that the impartiality of the cluster coordinator on technical issues is questioned as he reports to the UNICEF chief of nutrition in country Double hatting exacerbates this issue Are we working to keep the strategic niche of an agency and ensure its supremacy and subsequent continuous funding stream or are we here to find ways to deliver better to populations while engaging all partners?

Challenges No forum for cross learning on the technical issues How technical questions are escalated seem person dependent and is not a system

Global Tech Mechanism Global Tech mechanism- a system to track and address the technical requests is much needed according to respondents Respondents expressed what they wanted the Global Technical Mechanism to avoid

Foreseen Global Tech Mechanism Challenges How to avoid global discussions on technical issues be disconnected from the difficulties and the reality on the ground? How to bring together the UN agencies, namely WFP, UNICEF, UNHCR, and WHO and unite their technical voices for nutrition in emergencies? Keep all these slides?

Foreseen Global Tech Mechanism challenges How to avoid the power dynamics and conflict of interests of different agency members at the Global Technical Mechanism? How to avoid the Global Technical Mechanism diminish the authority and sense of ownership and power of the country teams?

Technical issues raised by country teams

Technical questions raised by country teams The two main recurring questions were How to best calculate the SAM and MAM caseload  Support in standardizing or updating the national nutrition protocol (CMAM and IYCF-E) Page 23 of the report

The actions required for an improved technical NiE response Country level Preparedness TWGs to be set up as soon as possible in all countries CMAM and IYCF Guidelines to be updated in countries as a preparedness measure Built the capacity of an in country pool of technical experts and trainers Improve TWGs knowledge management Pages 24 onward at TWG level

The actions required for an improved technical NiE response GNC-CT level Orientation and package to clarify roles and responsibilities of TWGs Map country resources and improve our ability to tap into those resources Criteria for membership and chair Composition of the group

The actions required for an improved technical NiE response GNC-CT level Dedicated technical support to TWGs as needed and especially during L3 emergencies -preferably by an NGO partner Creating global MoUs with NGOs and institutions to deploy dedicated staff Advocate to include the commitment to the cluster and the TWGs in Job Descriptions of nutrition NGO staff in country

CLA level Work on a strategy with the Global Technical Mechanism and the GNC to improve the technical capacities of weaker implementing partners. Work towards improving the preparedness of country teams

The actions required for an improved technical NiE response At global technical mechanism level The UN agencies, namely WFP, UNICEF, UNHCR, and WHO would need to work together to reach a consensus in what they see is best for nutrition in emergencies. The composition of the Global Technical Mechanism working groups needs to be diversified to avoid conflict of interests At global level

The actions required for an improved technical NiE response The importance of including the country teams in the global technical debates is crucial to avoid having disconnected discussions. Have an evaluation after 6 months to reflect and adjust after the roll out of the global technical mechanism. Add a few points

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