UNICEF

East Asia and the Pacific Regional Office

Regional Nutrition in Emergencies (NiE) Strategy

April 2017 – DRAFT

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ContentsI. Key introductory messages.................................................................................................................2II. Purpose of the Regional NiE Strategy Package....................................................................................3III. Background.........................................................................................................................................4

1. UNICEF and Humanitarian Action....................................................................................................4

2. Nutrition in Emergencies (NiE).........................................................................................................5

3. EAP regional features......................................................................................................................6

IV. State of Nutrition emergency preparedness in the EAP region...........................................................7V. Support toward achieving NiE objectives in the EAPR.......................................................................10VI. Annexes.............................................................................................................................................15

1. Annex 1. Generic ToC for more effective protection of the nutritional status of population........15

...............................................................................................................................................................15

2. Annex 2: The Emergency management cycle: expended version..................................................19

I. Key introductory messages

This document complements the UNICEF Strategic Approach to Nutrition Programming in East Asia and Pacific Region (EAPR) 2014-20251 therefore, background on general nutrition issues and EAP regional context is not repeated here.

The World Bank estimated that since 2000 more than 1.6 billion people were affected by disasters in the region2. EAP’s communities experience both recurrent small scale shocks as well as devastating large scale catastrophes and with 61% of global losses from disaster being sustained by the region in the last 20 years, the EAP is the world’s most natural disaster-prone area. On that backdrop and given the return on investment Emergency Preparedness and Response Planning (EPRP) has (see text box 1 and the UNICEF-WFP RoI for emergency preparedness study report3), Nutrition EPRP is a must toward more cost-effective nutrition responses.

This document proposes an overall Nutrition in Emergencies (NiE) strategy package including a ToC-informed results framework toward cost-effective nutrition responses, i.e., toward cost-effective nutrition programs and interventions that positively impact on the nutritional status of boys, girls, women and communities during crisis and during normal times as well.

The NiE package also includes a Nutrition emergency readiness analytical matrix and an NiE toolkit. The content of this NiE package is based on the fundamental principles and international standards that guide the humanitarian system, the UNICEF Core Commitments for Children (CCCs) in humanitarian action, and existing global guidance and recommendations.

1 UNICEF Strategic Approach to Nutrition Programming in the East Asia and Pacific Region 2014-2025 Vol 1 http://www.unicef.org/eapro/12205_22043.html2 The World Bank, Bangkok 2013 press release (http://www.worldbank.org/en/news/press-release/2013/06/03/losses-from-disasters-in-east-asia-and-pacific-raise-concerns-for-poverty-reduction) and “Strong, safe, and resilient: strategic policy guide for disaster risk management in East Asia and the Pacific” Report (http://documents.worldbank.org/curated/en/2013/02/17423304/strong-safe-resilient-s-strategic-policy-guide-disaster-risk-management-east-asia-pacific)3 UNICEF/WFP Return on Investment for Emergency Preparedness Study, BCG January 2015

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Nutrition staff are encouraged to use this NiE package as a basis to develop their own contextualized, country-specific, NiE strategy. This strategy package also aimed at providing guidance to Nutrition Specialists and UNICEF COs in reviewing the status of Nutrition emergency preparedness in their country, strengthening their Nutrition EPR planning and monitoring progress toward achieving results.

This NiE Strategy package is a work in progress comprising of living documents therefore, any feedback on their usefulness and any suggestions for improvement are most welcome. To do so please, contact Cecile Basquin, NiE Consultant at cbasquin@unicef.org and Christiane Rudert, EAPRO Nutrition Regional Adviser, at crudert@unicef.org

II. Purpose of the Regional NiE Strategy Package

Communities everywhere are facing humanitarian crises at both increasing frequency and severity, driven largely by the effects of climate change, depletion of natural resources, population growth, and the economic and social interdependencies created by globalizing trade and communication. At the same time, related trends such as rapid urbanization, social and ethnic marginalization, and growing economic inequality are leaving many communities more vulnerable to these risks than the previous generations. The resultant effects of these forces will likely slow the overall rate of social and economic development and cause stagnation or deterioration in the most vulnerable and exposed communities. These trends are in many ways being experienced most acutely in Southeast Asia and the Pacific. As a strategic partner with Governments in promoting sustainable social and economic development and protecting children’s rights, UNICEF’s interest in preventing and mitigating the impact of natural disasters and conflicts is unquestionable. Particularly in Southeast Asia and the Pacific, where the line between emergency and development is increasingly blurred, UNICEF further recognizes the importance of supporting Governments to both increase their capacities for emergency preparedness and response and to integrate disaster risk prevention and reduction as core elements of their development agendas.4

The evidence for strengthening NiE capacities within UNICEF and among its Government and NGO partners is long and growing. UNICEF’s recently updated Global Nutrition Strategy notes that:

[h]umanitarian crises are associated with food shortages, lack of safe drinking water, inadequate, disrupted health care systems, overcrowding, poor hygiene practices, and an abandonment of breastfeeding, especially when unsolicited donations of breastmilk substitutes are permitted and distributed, resulting in a rapid increase in acute malnutrition and exacerbating pre-existing nutritional deficits.5

This strategy aims to provide a sound rationale for UNICEF to maintain a NiE role at the East Asia and Pacific Regional Office (EAPRO), to propose a Theory of Change (ToC) toward more cost-effective nutrition responses, to describe a results framework that supports the design, implementation and monitoring of the organization’s humanitarian action objectives. This strategy package aimed to provide

4 “For several reasons, UNICEF also is committed to strengthening its involvement in systematic reduction of vulnerability to disaster and conflicts through risk-informed country programmes that help build resilience.” UNICEF Strategic Plan, 2014--2017.5 UNICEF Global Nutrition Strategy, 2014--2015.

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Text box 1: Return on Investments were analyzed looking at 49 emergency preparedness activities (UNICEF and WFP combined) in Chad, Pakistan and Madagascar, key findings include:• Cost savings: $5.6 million invested in 49

preparedness activities, activities that saved a total of $12 million toward future emergency response net savings of $6.4 million.

• Time saving: 93% of preparedness investments saved time toward emergency response implementation Preparedness interventions can speed response time by 2 to 50 DAYS or an average more than 1 week.

• No preparedness interventions resulted in lost time or slower future response speed.

• Time-savings are particularly critical in emergency response since the speed of program implementation has direct implications to lives saved during a crisis.

contextualized and appropriate guidance for the regional context and grounded foremost in approaches that aim for sustainability. It is informed by recent work exploring how UNICEF Nutrition is performing in core emergency-related areas -- e.g., preparedness and response for effective coordination, assessments and nutrition interventions, -- and seeks to provide guidance for strengthening NiE capacities throughout the EAP region in line with global disaster risk reduction objectives.

III. Background

1. UNICEF and Humanitarian Action

UNICEF’s priorities for humanitarian action are defined in the Strategic Plan 2014--2017. In that document, which serves to guide the agency’s initiatives through the post-2015 agenda transition, the topic of humanitarian action is emphasized as an integral part to the organization’s overall efforts to promote and protect children’s rights around the world. The strategy achieves this primarily by noting the growing global caseload for humanitarian action and acknowledging the need for a more integrated approach to implementing its emergency-related activities. The strategic Plan 2014 - 2017 identifies three important reasons why efforts in humanitarian action must direct more energy towards reducing underlying vulnerabilities to disasters and conflicts:

a) To more effectively prevent and respond to humanitarian crises;b) To improve the linkages between humanitarian response and development programs;c) To promote rapid recovery and build community resilience to shocks that affect children.

For the Executive Board first regular session in 2014, a more systematic review of the key strategies and challenges for improving humanitarian action in line with the Strategic Plan were detailed.6 A key component in this process is the Strengthening Humanitarian Action (SHA) initiative, which the organization is undertaking to increase efficiency and effectiveness in core areas of operation and implementation. Specifically, the SHA process seeks to improve UNICEF’s performance in humanitarian crises through a set of thirteen individual work streams which consider and promote:

Adaptation of humanitarian action to emerging operational contexts with specific methods and tools to address emergencies in these diverse program environments;

Strengthening and expanding humanitarian partnerships; Structural and investment adjustments that UNICEF needs to undertake to be an even more

predictable and effective humanitarian partner.7

Drawing upon this background and various on-going processes and platforms, EAPRO has elaborated how it will tailor its efforts around humanitarian action into concrete goals and actions for the countries under its mandate. The Regional Office Management Plan (ROMP) 2014 - 2017 summarizes many of the key opportunities and challenges for humanitarian action in the EAP region, as well as strategies for addressing these. It notes in particular that UNICEF in the EAP region will “[…] invest in child-centered disaster risk reduction and define [its] role in supporting development of resilience and capacity of communities and vulnerable areas in ways that deliver results for disadvantaged and excluded children, protect them from exploitation and ensure their rights are fulfilled.”

EAPRO has also developed an overview on how it aims to roll-out the humanitarian-related imperatives from the Strategic Plan 2014 - 2017 based on the unique contexts found within the EAP region. The roll-out strategy emphasizes that, for countries in the EAP region, “increasingly a strategy to strengthen

6 Thematic discussion on the work of UNICEF in humanitarian situations. E/ICEF/2014/CRP.4, January 2014.7 Strengthening Humanitarian Action (SHA) in UNICEF. 2013.

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preparedness and response is targeting supporting Government capacity (upstream policy; influencing financial allocations; contributing to training and other capacity strengthening initiatives) when and where possible.”8

2. Nutrition in Emergencies (NiE)

The core business of Nutrition in Emergencies (NiE) is to protect the nutritional status of vulnerable populations during humanitarian crises. The underlying rationale for this stems from the following logic:

Emergencies have an impact on a range of factors that can increase the risk of malnutrition, illness (morbidity) and death (mortality). If a population has a relatively good nutritional status at the onset of an emergency, it is important to protect this as it can deteriorate with the impact of the emergency. Populations that have a poor nutritional status at the onset of an emergency are, in general, even more vulnerable to widespread nutritional crises as a result of an emergency.9

Because UNICEF plays such an outsized role in defining and implementing the global strategies for improving the nutritional status of women and children through its development programming, it follows that these responsibilities and leadership extend into the realm of emergency nutrition programming as well. UNICEF’s responsibilities and activities for nutrition in emergencies are defined in its Core Commitments for Children in Humanitarian Action.10 This document details a set of six areas for which the organization has committed itself to delivering on in the area of emergency nutrition:

1. Effective leadership is established for nutrition cluster interagency coordination, with links to other cluster/sector coordination mechanisms on critical inter-sectoral issues.

2. Timely nutritional assessment and surveillance systems are established and/or reinforced.3. Support for appropriate infant and young child feeding (IYCF) is accessed by affected

women and children.4. Children and women with acute malnutrition access appropriate management services.5. Children and women access micronutrients from fortified foods, supplements or multiple-

micronutrient preparations.6. Children and women access relevant information about nutrition program activities.

In addition to these response-related directives, UNICEF is putting more and more efforts into integrating emergency nutrition programming into its routine programming (and mainstreaming NiE into country programs and work plans with Government counterparts) not only to bridge the divide between humanitarian action and development but as well as a resilience building strategy.

3. EAP regional features

Strong Government leadership: The Government plays a lead role in responding to (and determining the nature of response to) disasters in most of the countries, usually through a dedicated and well-

8 UNICEF Strategic Plan 2014--2017 -- Roll-Out Strategy in EAPR. March 2014.9 The Harmonised Training Package (HTP): Resource Material for Training on Nutrition in Emergencies, Version 2 (2011) Module 1: pg. 4 . NutritionWorks, Emergency Nutrition Network, Global Nutrition Cluster.10 Core Commitments for Children in Humanitarian Action, United Nations Children’s Fund. May 2010.

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trained disaster management agency (e.g., BNPB in Indonesia and NDRMC in the Philippines). This strength also often comes across as heavy handed, especially when there are political considerations or dimensions involved (which is generally the case). This means that humanitarian partners, including UNICEF must identify the appropriate level/angle of support to provide and ensure that actions and recommendations are relevant and heeded.

Decentralization: With the exception perhaps of DPR Korea, EAPR countries have succeeded in (or are in the process of) decentralizing to the sub-national level many of the key functions played by Government.11 While this is generally a positive marker for political and economic progress, it also presents some challenges for humanitarian partners who are mandated to ensure predictable emergency coordination, preparedness, and response at all levels, including at the sub-national level. Local authorities and government units often see no need to coordinate or communicate plans with those developed at the central level.

Relatively limited of interest in emergencies-related issues: In some countries, the level of interest within the Health and Nutrition sector on emergency issues is limited in part because of the often fractured way that responsibilities for emergencies are divided. Likewise, given their orientation towards development activities and limited resources, the UNICEF COs often do not concentrate enough on emergency issues (especially as these are usually conceptualized as an outdated dichotomy of “humanitarian response” and “development programming” instead of the more modern idea of risk-informed programming).

Room-to-strengthen coordination: Long-standing Institutional arrangements seem to govern how emergency preparedness and response activities are coordinated especially within countries of low to moderate disaster risks. Often two or more similar sectors are grouped into a single sector/cluster which is headed by the Governments and/or the organization with greater resources and interest (e.g., the food security and nutrition sectors are combined in Cambodia and led by WFP, in the PICs the Health and Nutrition sectors are combined and led by WHO). This has the effect of reducing UNICEF’s perceived responsibilities and accountabilities for coordination on emergency nutrition (e.g., child’s rights perspective is not promoted).

Minimal human resources and funding: In countries with relatively small populations and less intense/frequent disasters, the funding available (and sought) for emergency preparedness and response, both internally within UNICEF and in external coordination structures, is substantially less than that in countries at high risk of disasters of important impact level. For example, the Cambodia CO does not have emergency staff personnel, instead relying on a focal point system for participation in external coordination meetings and events.

Complex/high-threat operating environments: The emergencies within medium to high risk countries are often the product of several factors that are not readily understood or navigated, including those resulting from religious, ethnic, or political disagreements. Operating in these environments is especially challenging for humanitarian partners as the easiest response/course of action often runs counter to the core principles inherent to the humanitarian system, such as impartiality, neutrality, etc.

IV. State of Nutrition emergency preparedness in the EAP region

11 The Pacific Islands present an even greater challenge, being as it represents a collection of independent nations.6

The overarching goal at the core of UNICEF’s humanitarian action agenda is to save lives and protect children’s rights. This imperative extends seamlessly into its leadership on nutrition in emergencies, where preventing malnutrition-related deaths and protecting the nutritional status of girls, boys, and women guides the organization’s interests and actions before, during, and after disasters. Meanwhile, there is perhaps no better example of reducing a community’s vulnerability to a disaster than through improving the nutritional status of its children and women – healthy and well-nourished bodies translate into resilience.

Yet meeting these ambitious goals of preventing deaths, protecting nutritional status, and building resilience will require UNICEF to leverage its organizational strengths effectively. For the EAP region, this means taking a more nuanced approach to understanding the nature of risk and vulnerability as well as the specific social, economic, and political contexts that will affect the organization’s efforts around NiE.

The types of emergency risks found throughout the East Asia and Pacific (EAP) region cover a broad spectrum, from natural hazards (typhoons, earthquakes, volcanic eruptions) to conflict and social unrest. Similarly, the frequency and scale of these risks vary widely from country to country, as does the level of underlying vulnerability.

The analysis presented below is based on a Nutrition emergency readiness analytical matrix, a simple tool used to evaluate the level of Nutrition emergency preparedness of EAPR countries and to map core NiE competencies.

Detailed description of the tool (Nutrition Readiness matrix excel file in the NiE toolkit link here):

The multi-hazard risk score is taken from the INFORM index 12 . The nutrition vulnerability score takes into account wasting (that has a higher weight than other

nutrition indicators), stunting, EBF rate, LBW, and anemia (see excel matrix Nutrition vulnerability tab). For the NiE competency scoring, 12 technical NiE domains (in line with the CCCs) and inspired from the

technical competency framework for NiE practitioners developed by the NIETI consortium 13 are evaluated. These NiE domains include assessment of the following competencies: from coordination to assessment to CMAM, IYCF-E, C4D capacities, understanding of humanitarian system, standards and principles, and more (see excel matrix NiE competency tab).

The analysis also takes into account the current status of the country Nutrition Emergency Preparedness and Response Plan (EPRP), its overall quality and adequacy and grades the overall current commitment of the country to Nutrition preparedness (see excel matrix NiE preparedness tab).

This analysis leads to:

o An overall Nutrition readiness score (with color coding) obtained for each country (Table 1): green = Nutrition ready and/or no need to prioritize for Nutrition EPRP (low risks low

nutrition vulnerabilities and/or high capacity) yellow = Partially Nutrition ready and/or ongoing work toward strengthening Nut EPRP

(moderate risks and nutrition vulnerabilities and/or medium to high capacity level) orange = Partially Nutrition ready and/or need to prioritize for Nut EPRP (important risks

and nutrition vulnerabilities and/or medium level capacity) red = Not ready and urgently need to prioritize for Nut EPRP (high risks and nutrition

vulnerabilities and low capacity)

12 INFORM is a global, open-source risk assessment for humanitarian crises and disasters. It can support decisions about prevention, preparedness and response. http://www.inform-index.org/13 Development of a competency framework for the nutrition in emergencies sector. 2013 Public Health Nutrition: 17(3), 689–699. UCL, ENN, World Vision International, Concern Worldwide, International Medical Corps, Save the Children.

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o Some infographics whereby each country falls into a “low risk / low impact” or “medium level of risk / moderate to important impact” or “critically high risk / major impact” area (Figure 1). Then, for each country, the level of Nutrition readiness is assessed against this level of risk / impact and can serve the definition of priority actions to increase Nutrition readiness accordingly.

Table 1: Nutrition emergency readiness scoring. Source of information for all indicators except anemia: SOWC 2016, source of information for anemia among WRA: GNR 2014, matrix reviewed and inputted by the PICs, the Philippines and Myanmar COs. Kiribati and other PICs are not featured because not enough data available. Countries highlighted in blue = reviewed/inputted by COs

Risks NiE competency score

Nutrition Preparedness

score

total Nutrition Readiness score = multi hazard risk index + nutrition vulnerability score + NiE competency score - Nut EPRP

score

multi-hazard risks

from INFORM

index (1 to 10 range, the higher the more

hazard risks, see INFORM website)

Nutrition vulnerability

score (5 to 20 range,

low score = low nutrition vulnerability

Technical NiE competency

score (12 to 39 range; low score

= high level of competency

high score low level of

competency)

(range 4 to 13, low score = low preparedness,

high score = Nutrition

preparedness)

overall score (sum)< 16 points = green

16 - 32 points = yellow

33 - 49 points = orange

> 50 points = Red

overall readiness and priority to begreen = Nutrition ready and/or no need

to prioritize for Nutrition EPRP (low vulnerability and/or high capacity)

yellow = Partially Nutrition ready and/or working on strengthening Nut EPRP

(some vulnerability and/or medium level capacity)

orange = Partially Nutrition ready and/or need to prioritize for Nut EPRP (high

vulnerability and/or medium level capacity)

red = Not ready and/or urgently need to prioritize for Nut EPRP (high vulnerability

and/or low capacity)Cambodia 4.5 17 28 4 46

China 4.1 8 23 6 29

Fiji 3.1 13 26 5 37

Indonesia 4.3 17 23 7 37 Kiribati 3.6

DPR Korea 5.6 10 30 5 41

Lao PDR 4.3 17 30 4 47 Malaysia 3.4 9 32 2 42 Mongolia 3.8 10 24 5 33 Myanmar 6.7 15 22 8 36 PNG 5.8 15 33 2 52 Philippines 4.9 17 21 11 32

Solomon Islands 5 13 37.5 3 53

Thailand 4 14 29 2 45 Timor Leste 4.2 17 28 6 43

Vanuatu 3.9 11 30 7 38

Vietnam 3.5 11 24 3 36

Figure 1: Countries are represented as colored circles, located in 3 different risk areas. The bigger the circle is the more Nutrition emergency ready the country is e.g., The Philippines. The smaller the circle is the less Nutrition emergency ready the country is e.g., PNG. The closer to the bottom left corner of the graph a country is the less risk of impactful disaster it faces.

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10 20 30 400

20

40

60

80

100

120

Cambodia

China

Fiji

Indonesia

DPR Korea

Lao PDR

Malaysia

Mongolia

Myanmar

PNGPhilippines

SI

Thailand

TL

Vanuatu

Viet Nam

Cambodia China Fiji Indonesia DPRK Lao PDR Malaysia Mongolia

Myanmar PNG Philippines Solomon Island Thailand Timor-Leste Vanuatu Viet Nam

NiE competencies(high ---> low)

Haza

rds

and

nutr

ition

vul

nera

biliti

es(lo

w --

-> h

igh)

low riskminor impact level

criticaly high riskmajor impact level

medium riskmoderate to important impact level

Example of The Philippines : Overall Nutrition readiness score: Yellow, Partially Nutrition ready

Based on this analysis the Philippines fall in the medium risks / moderate to important impact area mainly because of high nutrition vulnerabilities and high multi-hazard risks compensated by medium to high level NiE competencies yet classified as “Yellow” (partially Nutrition ready). However, as shown in Figure 1, The Philippines is the most Nutrition ready of all EAPR countries (biggest circle). The analysis may give a hint at how to achieve an higher level of Nutrition readiness (on Figure 1 becoming a bigger circle and moving toward the “safer” left side of the graph area, i.e., minimizing the risk of having disasters of high impact on the nutritional status of the population) by either increasing some of the NiE competencies further and/or by strengthening Nutrition emergency preparedness and response planning further.

It is acknowledged that the tool provide a rather “macro” level of analysis, and work is ongoing to adjust the tool so that it could be used by COs also for sub-national level of analysis and mapping.

The analysis indicates three different types of country profile:

The Philippines, Indonesia and Myanmar: Theses countries considered to have medium to high risks of a moderate to important impact level emergencies, generally characterized as experiencing disasters at a high frequency and with a (relatively) large impact. The risks faced by communities in these countries manifest both as natural hazards and conflict, and their increased exposure is due in part to their large populations. These countries however compensate with a relatively high level of NiE competencies and some descent preparedness efforts. The strategy for these countries shall aim

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at increasing some of the NiE competencies further and/or by strengthening Nutrition emergency preparedness and response planning to mitigate risks further.

All the other EAPR countries have low to medium risks of a moderate impact level emergencies, generally have lower frequency and intensity disasters with smaller impacts (affected population, economic and agricultural loses, damages, etc.). The risks faced by communities in these countries primarily come in the shape of natural hazards, though conflict in some cases may not be an insignificant contributor. Several of these countries are also experiencing rapid economic growth and the inequality resulting from unequal distribution of these gains plays a significant role in determining the level of vulnerability of communities. Indeed it could be surmised that humanitarian crises in these low-risk countries, and how they are managed/prepared for/responded to, will play a very large role in determining their overall rate of social and economic development moving forward, as these vulnerable populations are most likely to be impacted.

o Most of these countries still need to prioritize for Nutrition EPRP for example, Fiji can minimize disaster risks further by strengthening the quality and adequacy of their health and nutrition contingency plan and by strengthening capacity in early warning early action / surveillance system and nutrition information management while Vanuatu can gain a lot by finalizing their nutrition contingency plan (and implementing minimum preparedness activities).

o PNG and Solomon Islands. These countries are among the least nutrition emergency ready and urgently need to prioritize for Nut EPRP. SI is on the verge of falling into high risks of disaster of major impact level mainly because very low level of NiE competencies. SI needs to increase further its Nutrition preparedness level both by strengthening Nutrition EPRP / Nutrition contingency plans and by increasing NiE competencies in country. The matrix indicate that SI can gain a lot by strengthening capacity in IYCF-E, rapid assessments and NiE coordination mechanisms.

V. Support toward achieving NiE objectives in the EAPR

The proposed Theory of Change (ToC) toward more cost-effective nutrition responses, its results framework coupled to the above Nutrition Emergency readiness analysis aim to guide UNICEF’s NiE efforts in EAP countries. The vision is that strengthened nutrition EPRP will ensure effective protection of the nutritional status of the population at regular time as well as during emergency situations.

In an effort to achieve this goal, a series of strategic pillars are proposed which are grounded in UNICEF’s dual humanitarian imperatives of strengthening emergency preparedness/response capacities while reducing underlying vulnerabilities to disasters and conflicts in the longer term. These pillars are designed to be complementary (though they do overlap) and the key activities they are comprised of are not meant to be prescriptive but instead flexible enough to accommodate the many different contexts of the region.

Toward reaching the ultimate goal of effective nutrition response that positively impact on the nutritional status of children and women in the region, the UNICEF EAPRO will support the development and institutionalization of policies and strategies for guiding emergency nutrition response activities at all levels while promoting NiE mainstreaming in UNICEF and among implementing partners and

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Government counterparts’ activities; and strengthen capacities of UNICEF and partners in Nutrition emergency preparedness and response capacity by:

Objective 1: EAPR Nutrition actors are guided by NiE regional strategy and tools and are supported toward the implementation / use of these tools.

o A regional NiE strategy including NiE toolkit is finalized and disseminated.o UNICEF NiE focal points receive support (remotely and through missions) in the utilization of

the regional strategy and tools to develop their own country-specific strategies.o UNICEF NiE focal points are consulted for input and feedback toward regular optimization of

the regional strategy and tools.

Objective 2: EAPR Nutrition actors receive technical support on all aspects of Nutrition emergency preparedness and response planning.

o Country-specific Nutrition Emergency Preparedness and Response Plan (EPRP) / Nutrition contingency plans are developed / reviewed and meet latest IASC EPRP standards.

o In-country nutrition emergency coordination structures and mechanisms are encouraged and strengthened.

o UNICEF NiE focal points and partners’ knowledge, skills and capacities on nutrition-related assessments, nutrition surveillance and nutrition information management is enhanced and strengthened.

o UNICEF NiE focal points and partners receive strategic and technical support toward CMAM program strengthening and scale up.

o UNICEF NiE focal points and partners receive strategic and technical support on national IYCF-E protocols and operational guidelines development and mainstreaming into CMAM programming and ensure key global IFE/ IYCF-E legislation, framework and strategy are highly prioritized in countries' Nutrition EPRP.

o UNICEF NiE focal points and partners receive strategic and technical support on addressing micronutrient deficiencies (supplementation protocols, operational guidelines, monitoring and evaluation), and encourage the use of IYCF platforms to promote the use of multiple micronutrient powders/tablets.

o UNICEF NiE focal points and partners receive toward the use of C4D and SBCC approaches in emergencies to boost awareness, access and demand for nutrition services/interventions (SAM, IYCF-E, Micronutrient supplementation, etc.).

o UNICEF COs are supported with funds mobilization, i.e., in the development of nutrition response design, concept notes and donor proposals (See also textbox 3).

Objective 3: Technical NiE competencies are strengthened among EAPR Nutrition actors.o NiE capacity building needs within UNICEF and partners at country level (or at sub-national

level) are mapped and NiE capacity building plans developed accordingly.o UNICEF COs and Nutrition partners are supported with the facilitation of NiE training and

Nutrition EPRP events.o UNICEF COs are supported with the mobilization of Nutrition personnel in case of

emergencies as well as for any assignment relevant to NiE.

Objective 4: Multi-sectoral, community-based, system-strengthening approaches and innovations are fostered and promoted in the EAPR.

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o UNICEF COs and their nutrition partners are encouraged to identify and seize opportunities for linkage between regular Nutrition programming, nutrition surveillance, NiE and other sectors (WaSH, ECD, Health) for example, COs to commit to integrate (or mainstream) NiE with at least with 1 sector, e.g. Wash in Nut is part of the Nut and Wash EPRPs, IYCF-E is integrated to Health interventions such as community IMCI; and ECD actions are integrated to Nut EPRPs.

o EAPR NiE focal points are supported toward integrating DRR, climate change adaptation and resilience building in their regular nutrition programming (See also textbox 4).

Objective 5: NiE-related knowledge and information are enhanced, compiled, shared and used across the EAPR:

o NiE-related good practices and lessons learned are documented.o NiE experiences, case studies, and vision shared internally and externally through

publications.

The vast distances and time differences present in the EAP region can make regional travel/support and inter-office communication, collaboration, and learning quite challenging. Thus, a final component essential for promoting and maintaining a higher level of competency for NiE within COs in the EAP region is to ensure that best practices, lessons learned, and supportive tools are well-documented and shared widely and regularly. The core actions that UNICEF should pursue to foster this environment of documentation and sharing include:

(a) Conducting regular searches of literature, research, agency updates and any other relevant information and packages and broadly disseminating relevant findings/applications;

(b) Building, distributing, and routinely updating a resource package for CO Nutrition sections which includes core documentation and guidance around NiE best practices, including examples of standby PCAs/emergency clauses, IYCF-E/BMS advocacy and policy guidance, IEC materials for standard response interventions per CCCs, etc.

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Textbox 3: Resources mobilization and partnerships

Generally, except in response to sudden-onset disasters, UNICEF Nutrition sections appear to be under-funded for emergency-related activities, including for longer-term strategies that integrate disaster risk reduction and resilience-building initiatives into routine programming. Moreover, the humanitarian field is more crowded than ever and to stay current UNICEF must hone its competitive edge and better communicate its role and comparative strengths to donors. None of the NiE objectives, nor the strategies discussed here for achieving them, are possible without the foundation of a robust financial position and very importantly without solid partnerships. Therefore UNICEF must take an aggressive approach towards fundraising for emergency nutrition activities, exploring all possible channels, including:

(a) Exploring private sector partnerships, especially in key areas of interest and overlap, e.g., the life-saving benefits associated with scaling-up management of SAM through a health system strengthening approach;

(b) Responding to and participating in research opportunities jointly with universities and/or research institutes, which may provide or have access to funding to study NiE-related issues;

(c) Liaising with NYHQ, ROs, and/or other COs to initiate and collaborate on fundraising proposals.

Broadly speaking, CO Nutrition sections in the EAP region have few agreements in place with implementing partners, which leaves UNICEF particularly vulnerable in the event of an emergency in its ability to discharge its core NiE responsibilities as per CCCs. This gap manifests more generally as a weakness in strategic planning, resource allocation, and activity coverage with partners. There are several recommended strategies that UNICEF should pursue to increase the level of collaboration with partners to improve its NiE response capabilities:

(a) Building upon regional-level partnership/cooperation with WFP to facilitate alignment and standardization of emergency response interventions for high-risk countries in EAP region (per global MOU regarding CMAM, MNPs, etc.);

(b) Incorporating well-designed emergency clauses in new/existing PCAs to allow timely “changing of gears” in wake of humanitarian crisis, especially for financial allocation and supply disbursement;

(c) Establishing standby agreement with at least one partner to enable channeling of resources to scale up nutrition response activities quickly;

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Textbox 4: Risk-informed programming, DRR, and building resilience

The countries within the EAP region (a group having mostly reached middle income status) are some of the most susceptible to the impacts of climate change, population growth, urbanization, and income inequality. There is a growing appreciation within COs of the importance of incorporating risk-informed programming and resilience-building initiatives into their development agendas. However, this process remains challenging for COs, especially so for individual sections to lead with still basic understanding of the ideas. Thus there are some important ways could ensure that strategies for reducing underlying vulnerabilities and building resilience are integrated into the design and implementation of Government nutrition policies and programs:

(a) To incorporate child-centered risk mapping, disaster risk reduction, and climate change adaptation into governments partners routine programming;

(b) To leverage existing knowledge/expertise for incorporating these elements into regular programming through sharing of best practices and lessons learned from other thematic sections;

(c) To strengthen nutrition information systems to enable risk-informed programming through various support channels:

- Advocating with Government around how technologies, harmonization of parallel information systems, and statistical techniques can lead to more cost- and time-efficient methods for collecting, processing, and utilizing nutrition information;

- Ensuring that nutrition data which is collected are designed to be insightful and actionable;- Requiring that nutrition information systems are informed by the needs and capacities of

decentralized levels and not only reflect the wants at national level; - Exploring strategies for increasing demand and utilization of nutrition information at decentralized

levels by, e.g., encouraging districts to develop and submit budgets to provinces for resource and activity allocation.

See also the ToC and results framework toward effective protection of the nutrition status of population in Annexes.

VI. Annexes1. Annex 1. Generic ToC for more effective protection of the nutritional status of population

Nutrition Specialists are encouraged to use this generic ToC and results framework as a basis to develop their own contextualized framework. There are various ways a ToC can be designed, the EAPRO WASH and Nutrition toolkit gives some direction on how to design ToC. The user of this framework is also encouraged to keep the emergency/disaster mitigation and management cycle (Annex 2) into account when developing the nutrition sector strategy toward effective nutrition responses.

Generic ToC for more effective protection of nutritional status explained:

Leadership and coordination domain:

Coordination is essential for coherent and collaborative approach to nutrition preparedness and response to humanitarian crisis as well as for regular nutrition programming overall.

National governments and authorities are the ultimate responsible hence, must lead or be empowered to lead the nutrition sector (or nutrition technical work group or Nutrition Cluster when activated), as well as to lead nutrition partnerships and their coordination.

Government-led multi-stakeholders (multi-sectoral) alliances collaboratively advance the strategic planning for nutrition (including nutrition EPRP) and their initiatives bridge gaps between relief and development efforts.

Government-led alliances or partnerships include (or at least consult) with communities’ representative / end users of the nutrition services in the nutrition preparedness and response planning activities.

This domain creates and sustains the enabling environment toward other elements of the ToC to take place, functional and synergetic toward effective nutrition programming and responses.

For more practical guidance on the humanitarian system and humanitarian coordination refer to The Sphere project handbook or the IASC Transformative agenda or the UNICEF CCCs (or

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summarized concepts in the NiE toolkit manual and folders on humanitarian system/principles and coordination).

Nutrition security analysis and risks monitoring Domain:

Multi-sectoral analysis that can identify locally specific determinants of nutrition insecurity14 are required toward comprehensive understanding of the risks (and causal pathways) to maternal and child undernutrition and therefore, contribute to adequate nutrition programs design, and contextualized nutrition preparedness and response plans.

Mapping of nutrition indicators layered with hazard risk aims to identify areas of greatest vulnerability for nutrition and promotes risk-informed nutrition programs. Some countries in the region have completed the child-centered risk assessment, which incorporates multi-sector indicators (child vulnerability with hazard risk, capacity and hazard exposure). Nutrition vulnerability maps/tables can be developed (sometimes called a sectoral map) to inform where is the greatest risk and where programs and efforts should be concentrated. This mapping serves as a useful preparedness tool, for quick reference when there is a disaster to assess underlying vulnerabilities and potentially prioritize the initial response when the affected area is large (For more guidance on this see NiE toolkit folder Risk analysis here)

Nutrition Information System (NIS) Domain:

Good quality nutrition data are collected on a routine basis, analyzed and triangulated by sources and methods and results are disseminated in a timely manner and used for decision-making / program design / contingency planning.

Data generated by routine NIS complement the analysis done under the nutrition security analysis domain toward informed nutrition program design and EPR planning.

Nutrition data generated by NIS can serve as a baseline used to define thresholds included in an early warning system or at the onset of an emergency to inform the nature, severity of the situation /scale of the needs, and inform what scenario of the contingency plan to activate or adjust and implement.

For more practical guidance on nutrition assessment matters see the NiE toolkit manual and NiE toolkit folder “assessment”.

Nutrition Emergency Preparedness and Response Planning Domain:

As by the leadership Domain efforts are invested in anticipation, planning and foresight, detection and prevention/mitigation of any anticipated risks that could affect the nutrition security of vulnerable population.

The process of nutrition program design and nutrition EPR planning taking place under this domain is informed by and based on evidence from analysis results obtained under NIS and risks monitoring Domains.

This EPRP Domain produces practical, context relevant, actionable and effective Nutrition EPR plans15.

14 The World Bank defines nutrition security as “the ongoing access to the basic elements of good nutrition, i.e., a balanced diet, safe environment, clean water, and adequate health care (preventive and curative) for all people, and the knowledge needed to care for and ensure a healthy and active life for all household members”. In other words, nutrition security is an outcome of good health, a healthy environment, and good caring practices as well as household food security; it is achieved when all household members, have physical, social and economic access to sufficient, safe and nutritious food that meet their dietary needs and food preferences, combined with a sanitary environment, access to clean water, adequate health services, and appropriate care and feeding practices to ensure an active and healthy life - Action Against Hunger (ACF) Nutrition Security Policy; http://www.actionagainsthunger.org/sites/default/files/publications/ACF_Nutrition_Security_Policy_Apr2014_EN.pdf

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For more practical guidance on emergency preparedness guidance and contingency planning see the NiE toolkit manual and corresponding folder on EPR Planning including brief note on goals behind planning for emergency preparedness and response.

Note on resilience: according to researchers from the Humanitarian Policy Group (HPG) at the Overseas Development Institute (ODI) “Building resilience will mean breaking down the barriers between humanitarian and development approaches more fundamentally than ever before.”16 For example, post Horn of Africa crisis in 2011, the EU recognized the 'need to follow on from humanitarian interventions and to strategically build resilience to food insecurity and malnutrition in the Horn of Africa to avoid a repetition of large-scale disasters' and identified areas to be improved, including coordinating response strategies to enhance resilience, focusing humanitarian and development assistance on respective comparative advantages, encouraging 'cross-learning' of humanitarian and development experiences in projects supporting resilience, and organizing early exchanges of information and opinions between humanitarian and development services on all proposed 'resilience' programs and projects.

For more resources on resilience and nutrition see NiE toolkit folder DRR_Resilience here.

Capacity Development Domain:

At national and sub-national levels, technical NiE competencies are mapped against the technical competency framework for NiE practitioners developed by the NIE Training Initiative 17 as proposed in the EAPR Nutrition emergency readiness matrix (See section IV. and link to NiE toolkit here).

Context-specific capacity building plan are designed based on learning needs assessments. Capacity building plans also align to nutrition strategies and their program design and nutrition EPRP

(and Minimum Preparedness Activities). Strengthened technical competencies will in turn strengthen all Domains of the framework hence,

represents a key domain toward effective nutrition programs and responses.

Technical Interventions Domain:

Local government structures and health systems as well as existing service delivery platforms are utilized to integrate CMAM/IYCF-E/MN supplementation interventions (see the NiE toolkit manual chapters 5, 6 and 7 notably) as well as to create linkages with other sectors e.g., WaSH (See EAPRO Wash & Nutrition toolkit here)

Strengthening of the local health system to deliver CMAM/IYCF-E/MN supplementation on a routine basis will maximize the capacity of the health system to roll-out the nutrition emergency response plan.

This domain includes monitoring and reporting of violation of the international Code of Marketing of BMS (see the NiE toolkit manual chapter IYCF-E) and its enforcement (linkages with Leadership Domain)

C4D/SBCC Domain:

Based on the Unicef EAPRO C4D strategy to support public health preparedness and DRR18.

15 IASC 2014 Emergency preparedness guidance: https://www.humanitarianresponse.info/system/files/documents/files/Emergency_preparedness_guidance-24Oct2014.pdf16 Remaking the case for linking relief, rehabilitation and development, March 2014, HPG Commissioned Report http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/8882.pdf17 Technical competency framework for NiE practitioners: https://www.ucl.ac.uk/igh/research/a-z/related-docs-images/technical-competency-framework-for-nie-2013.07.25.pdf18 Unicef EAPRO C4D strategy to support public health preparedness and DRR, 2013. http://www.unicef.org/eapro/Communkcatiln_for_development_support_to_public_health_preparedness.pdf

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Actions undertaken under this Domain can emphasize community dialogue, empowerment and participation and in turn increase demand for the IMAM/IYCF/MN suppl. services and play a key role in nutrition strategy and program design and EPR planning for effective nutrition response.

This Domain intends to go beyond C4D and 1) works toward triggering true social behavior change, e.g., increasing health seeking behaviors, improving child care and feeding practices; and 2) encompasses as well advocacy work aimed at raising the profile of a variety of prevention and preparedness interventions and in developing both national and sub-national capacity for community-based and consultative approaches to improving nutrition security at regular times as well as in emergencies.

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2. Annex 2: The Emergency management cycle: expended version

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Disaster management

cycle

Mitigation

Response

Recovery

Emergency

Linking Humanitarian action to

development/Resilience building

Preparedness cycleCapacity building/development

Risk analysis

Contextualized, capacity mapping, gap analysis

M&E

Contingency planning

Resources mobilization

Long term strategic planning

MPAs

Shock/crisis

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