1. Inter-cluster collaboration: Nutrition, Food Security, WASH and Health GNC Face to Face Meeting 30-31 March 2016, Washington, DC, USA

2. Presentation outline Why cross sectoral collaboration matters and what it entails Example of multi sectoral humanitarian response mechanism in South Sudan Nutrition sensitive programming (Food Security, Health, WASH) Inter-cluster FS and nutrition working group Group work: Partner engagement in inter- cluster work

3. Why is inter-cluster work important for nutrition?

4. A package of interventions is required to prevent and address malnutrition Integrated, multisectoral package of interventions targeted in same geographic areas (convergence) Nutrition sensitive interventions in different sectors (FS, WASH, Health, Protection etc ) to complement nutrition specific

5. Example of a multi sectoral humanitarian rapid response mechanism: South Sudan RRM Established by WFP /UNCEF as a means to access hard to reach people in need with a package of interventions

6. South Sudan: Delivery of an integrated package

7. Modalities of the RRM General Food Assistance used as platform to deliver multi sectoral services; Site selection based on IPC, nutrition data and other criteria ( e.g. displacements) FS & Nutrition responses as starting point; Wash, Health, Protection, Education services added Strong collaboration with logistics cluster, security, communications essential 50 partners involved RRT comprised of sector specialists and coordinators

8. Modalities of the RRM (2) RRM integrated within cluster system -> task forces for mobile responses established in FS, Health, Wash clusters as forum for technical/programmatic discussions and alignment

9. Benefits of the RRM Stabilised a fragile FS and nutrition situation for hard to reach vulnerable populations Re-established presence of certain services that continue (e.g. health care) Significant contribution to overall humanitarian response in SS (slides)

10. RRM : enablers and lessons Enablers : – Strong commitment & collaboration at managerial and technical levels of UNICEF and WFP – Funded, coordinated and monitored within the two agencies and the participating NGOs Lessons to learn moving forward – Perceived as UN-centric – Need to create more convergence between RRM and overall humanitarian programs – Maintain momentum to facilitate more sustainable programming and build local capacity for that

11. Framework for actions to achieve optimum fetal and child nutrition and development- focus on nutrition sensitive

12. Nutrition-Sensitive Definition and Dialogue Nutrition-sensitive consists of interventions or programmes across sectors that address the underlying determinants of fetal and child nutrition and development - food security; adequate caregiving resources at the maternal, household and community levels; and access to health and a safe and hygienic environment—and incorporate specific nutrition goals and actions.

13. Key factors for nutrition-sensitivity (Lancet) Key features that make programmes potentially nutrition-sensitive are: They address crucial underlying determinants of nutrition; They are often implemented at large scale and can be effective at reaching poor populations who have high malnutrition rates; They can be leveraged to serve as delivery platforms for nutrition-specific programmes

14. Design characteristics of nutrition- sensitive interventions: Focus on most nutritionally vulnerable population and areas Include nutrition goals, indicators and actions; monitor nutrition outcomes -> Planning and assessment tools need to support nutrition-sensitive programme design; Minimize unintended negative consequences/ maximize positive impacts on nutrition Be of the right duration/right time to influence nutrition status Optimise women’s nutrition, time, physical and mental health, and empowerment. Include nutrition promotion & Behavior Change Strategies

15. Examples of Nutrition sensitive programming Strengthening nutrition goals and implementation- by Offering nutrition services through antenatal care services, immunization or family planning. Improve targeting - Integrating nutrition into programmes that reach pregnant and lactating women and children 0-24 months. Optimizing focus on women’s nutrition and empowerment - programmes designed from the onset to increase women’s decision’s making power, chances of improved nutrition for the family as a whole are higher. Using conditions to stimulate demand for specific services - CASH transfer programmes can set conditions of payment that requires families to utilize nutrition services and participation in health and life skill education.

16. WASH

17. NUTRITION & WASH COORDINATION ETHIOPIA DROUGHT 2016

18. WASH IN NUT STRATEGY THE FIVE MAIN AXES 1.Ensure geographical integration of WASH and Nutrition projects by focusing WASH projects in high GAM prevalence areas 2.Prioritize the ‘mother & child’ dyad 3.Ensure a WASH minimum package (kit, messages & standards) both at health and nutrition centers and in homes 4.Place emphasis on behavior change 5.Ensure that both coordination bodies (WASH and Nutrition) include representation from the other sector

19. WASHNUTRITION

20. NUTRITION & WASH PRIORITY WOREDAS 429 Nutrition Priorty woredas 180 WASH Priorty woredas

21. Areas of further collaboration Nutrition shares information with WASH on location of malnutrition cases Health and Nutrition to share with WASH cluster database of all health/TFC of priority woredas WASH cluster to work on the development technical guidance of WASH infrastructure in Health center / TFC Training on O&M on WASH infrastructure and water quality Joint message on Hygiene / health promotion

22. HEALTH

23. Health Currently no conceptual framework for mutli-cluster interventions. Existing health specific frameworks/tools: – 6 health system building blocks = service delivery, health workforce, health information system, essential medicines, financing, stewardship & governance – Health Resources Availability Mapping System (HeRAMS) – Health Service Package (basic/essential) Shift towards health outcomes narrative………

24. Sudan Overall Objective: reduce morbidity & mortality caused by acute malnutrition to below 15% threshold in 4 targeted localities in Red Sea & Kassala states. Specific Objectives: increase access to FSL Provision of blanket food-basket to identified households Supported small livelihood interventions e.g. courtyard gardening Health Human Resources: training on feeding practice, inpatient management, IMCI Service Delivery: establish/strengthen HFs & TFCs (repair, equipment), establish referral system from PHC to rural hospital for inpatient care Drug & Supply Management. WASH Improved access to safe water & sanitation – community & health facilities Nutrition OTP/ CMAM – RUTF provision; training, mass MUAC screening, costs for supervision IYCF – create, train & supervision of Mother support groups

25. Yemen 2011/12 SMART surveys – high prevalence malnutrition – health, WASH, nutrition related factors 2012 WASH, Health & Nutrition clusters initiated joint micro-plans in priority governates of Hodeidah & Hajjah – Nutrition Cluster: TFC/Stabilisation Centres; OTP/CMAM; MAM treatment; integrating IYCF activities; micro-nutrient supplementation; community mobilisation /MUAC screening – Health Cluster: integrated EPHS (including surveillance; RMNCH); supplies & financial support to static and mobile services; Disruption ++ due to insecurity but model has still evolved & increased service access….. – Both clusters heavy reliant on Local NGOs & government Health Office mobile teams (remote support, often parallel) – Opportunities to build capacity within government health services & community – Joint health & nutrition mobile teams – integration of additional health services including MHPSS, NCDs. – Efficiency gains / target whole community - ?? impact 2011/12 SMART surveys – high prevalence malnutrition – health, WASH, nutrition related factors 2012 WASH, Health & Nutrition clusters initiated joint micro-plans in priority governates of Hodeidah & Hajjah – Nutrition Cluster: TFC/Stabilisation Centres; OTP/CMAM; MAM treatment; integrating IYCF activities; micro-nutrient supplementation; community mobilisation /MUAC screening – Health Cluster: integrated EPHS (including surveillance; RMNCH); supplies & financial support to static and mobile services; Disruption ++ due to insecurity but model has still evolved & increased service access….. – Both clusters heavy reliant on Local NGOs & government Health Office mobile teams (remote support, often parallel) – Opportunities to build capacity within government health services & community – Joint health & nutrition mobile teams – integration of additional health services including MHPSS, NCDs. – Efficiency gains / target whole community - ?? impact

26. What works? Improvements? Joint action from inception, planning, implementation, monitoring & reporting Inter-cluster monitoring & field visits (identify gaps/solutions) Common guidance (integrated intervention packages) Improve Early & repeat joint needs assessments & analysis Pre-defined operational frameworks for common responses Strategic planning & resource mobilization – joint proposals

27. ICWG

28. Inter-cluster FS & nutrition working group – Joint letter gFSC GNC to nutrition and FS country clusters appealing to strengthen collaboration in the areas of : – Intercluster nutrition working group revival, focus on : Response planning Needs assessments Implementation Capacity development Advocacy Ensure better coordination between the FS and NC at Global and Country Levels Promote the use of appropriate tools & and guidance to enhance the quality of FS & nutrition responses Promote advocacy efforts for enhanced collaboration between the two clusters Strengthen CD and learning to respond to nutrition & FS crises

29. Work Plan of inter-cluster FS and nutrition working group: Ensure better coordination between the Food Security and Nutrition Clusters at Global and Country Levels – Promote inter-agency initiatives with both FS and nutrition coordination entities (e.g. REACH, SUN, ICN2 and FSNWG). – Undertake joint scoping missions in order to better understand coordination challenges and provide recommendations. Enhance the quality of food security and nutrition responses to maximize nutrition outcomes – Advocate for/support the use of appropriate tools & guidance for conducting joint nutrition and FS assessments and programming in different national contexts. – Develop an example on how joint 3/4W geospatial analysis can look like – Consolidate and share types of nutrition-sensitive interventions

30. Workplan (2) Strengthen capacity development to respond to nutrition and food security crises – Develop and pilot inter-cluster coordination training module – Facilitate documentation & dissemination of best practice/ learning on inter-cluster linkages in programming. Promote joint advocacy efforts for enhanced collaboration between the two clusters – Encourage joint inputs into global /national funding proposals through the development of a standard donor factsheet for in-country clusters. – Develop a Joint Advocacy Statement between the two Global Food Security and Nutrition Clusters.

31. What actions should the GNC and other cluster take to improve inter-cluster work Panel discussion