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Final Draft 29 April

ReportNational Nutrition ClusterPlanning Workshop

Overview

The Nutrition Cluster Planning Workshop held on the 11 th of April at the World Health Organization in Islamabad bought 26 participants from 16 organizations together to develop a six month work-plan outline. The objective of the National Nutrition Cluster work-plan is to ensure that all preparatory measures for an optimal nutrition emergency response under the given scenarios are in place, and priority cluster activities are progressed. The cluster work-plan aims to specify key activities, timelines, responsibilities as well as outputs, and will act as a monitoring framework for cluster progress during the preparedness phase.

The workshop objectives were to:

1. Review findings/recommendations of the 2011 Nutrition Cluster Evaluation and Cluster performance in 2012.

2. Identify the strengths of the cluster and the opportunities for improvement.3. Decide on priority activities for April to September.4. Decide on relevant working groups and task forces to achieve priority activities.5. Identify how the Nutrition Cluster can most effectively link to other coordination mechanisms.6. Identify key capacity building requirements for cluster partners.7. Review Information Management products and formats for relevance.8. Develop a work-plan outline.9. Update the 2012 Nutrition Cluster Preparedness Plan.

Session 1: Introductions and overview of provincial cluster coordination mechanisms and challenges.

Provincial Nutrition Cluster Coordinators (NCCs) were present from Khyber Pakhtunkhwa (KP), Balochistan and Punjab Provinces. The NCC from Sindh province was unable to attend due to SQUEAC survey implementation commitments.

Khyber Pakhtunkhwa

- During the earthquake emergency in 2005 Nutrition was part of the Health Cluster.- The current Nutrition Cluster for KP/FATA was activated as an independent cluster in August 2008 after

the flood emergency in Peshawar district followed by the Internally Displaced Persons (IDPs) from Bajaur Agency response in September 2008.

- Initially, in 2008 there were only few members of the Nutrition Cluster including Department of Health (DoH) as Chair, UNICEF as Lead Agency, WHO, WFP and a limited number of NGOs with nascent capacity. With the passage of time the number of NGOs continued to increase. During 2009-2012 there were 20 to 25 regular members of the cluster, occasionally reaching as many as 40. As of now more than 100 cluster meetings have been conducted. Frequency of meetings depends on the emergency. Currently meetings are convened bi-monthly.

- During 2010-2011 there was a dedicated Cluster Coordinator for the Nutrition Cluster in KP/FATA. In 2009, 2012 and 2013 the Cluster Coordinator is ‘double hatting’ as a UNICEF Nutrition Program Officer.

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- The Cluster initially focused on capacity building (training's on CMAM, IYCF and Nutrition in Emergencies) with considerable number of people trained especially on CMAM/IYCF (more than 3,000 Health Care Providers, Managers and Outreach Workers). Most of the trained staff from KP have now worked in other provinces of Pakistan.

- During 2009-2011 the Nutrition Cluster was working under the cover of Pakistan Humanitarian Response Plans [PHRPs] and 2012-13 under the Humanitarian Operation Plan [HOP].

- The main donors for UNICEF’s emergency nutrition programs are mainly ECHO, DFID, OCHA (CERF and ERF), UNICEF-EPF, Danish Govt, SIDA and CIDA, and a close cooperation with USAID is envisaged in 2013. Currently main donor for Nutrition is ECHO, Danish and CIDA. The current ECHO funding will expire in June 2013. More ECHO funding is expected in 2013-2014.

Punjab- During 2010, UNICEF along with DOH and partners activated the Nutrition Cluster upon request of

NDMA/PDMA. UNICEF provided a NCC and an Information Management Officer (IMO).

- During 2010 and 2012 UNICEF entered into Project Cooperation Agreements (PCAs) with 8 national and international NGOs; Save the Children, Merlin, International Medical Corps (IMC), Global Peace Pioneers (GPP), Relief Pakistan (RP), National Rural Support Programme (NRSP), World Vision (WV), Cap Anamur, plus the Government’s National Programme for Family Planning & Primary Health Care (FP & PHC). In addition, an MoU was signed with Nishtar Hospital in Multan and King Edward Medical University (KEMU) Preventive Paediatrics Department Lahore, to manage Stabilization Centres in their hospitals, with technical support from WHO, UNICEF and Save the Children.

- During mid-2012, the Nutrition Programme was handed over to Government’s National Programme for FP & PHC, which is currently the only partner for Nutrition in Southern Punjab.

Four main activities in nutrition:

1. Infant and Young Child Feeding (IYCF), including promotion of early breastfeeding initiation, exclusive breastfeeding and continued breastfeeding and appropriate complementary feeding.

2. Treatment of acute malnutrition through the community-based management of acute malnutrition (CMAM) approach involving four main components; Community Mobilization (CM), Outpatient Therapeutic Program (OTP), Stabilization Centre (SC) and Supplementary Feeding Program (SFP). To fulfill the need to promote, support and protect breast feeding, a breastfeeding corner is established at each CMAM site.

3. Micronutrient supplementation4. Programme integration with other interventions (e.g. Emergency Obstetric and Newborn Care,

hygiene promotion, food security and livelihood activities)

- UNICEF in collaboration with DoH (National Programme for FP & PHC) initiated the development of integrated manual on IYCF and community based management of malnutrition for Lady Health Workers in Punjab. The final draft of the integrated Urdu manual is ready after several consultative meetings with National Programme, MNCH Programme and UN Partners over the period of six months during 2012. Provincial Trainers of Trainers (TOT) in Lahore, District Level training and Facility Level training will be completed by mid-April in all target districts of South Punjab.

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- During non-emergency phase, a Provincial Review and Planning Meeting is held monthly at the Provincial level, chaired by the Director General Health Services, Provincial Coordinator National Programme and UNICEF. The participants are district coordinators of the National Programme (who are the focal persons for nutrition) and WFP and WHO. In this meeting the operational aspects of the CMAM programme are reviewed. Minutes are taken and shared with UNICEF, WFP, WHO and the district focal point staff.

Balochistan

- In Balochistan, prior to 2011 the Nutrition Cluster was led by UNICEF and the Line Department

- Since 2011, the PDMA has been more actively involved in the Nutrition Cluster. This has pros and cons; coordination with PDMA has been very good but the coordination between the line department and PDMA is a challenge

- Similarly the linkage between the PDMA and DDMA also needs to be strengthened

- There is opportunity for improvement in the capacity of the local NGOs in the Nutrition Cluster

- The technical capacity of PDMA in terms of nutrition is also an area that required on-going support.

Session 2: Cluster Review

Cluster Evaluation 2011: review of progress of bringing recommendations into action

In this session participants worked in small groups to decide if the recommendations of the 2011 Nutrition Cluster Evaluation had been fully, partially or not at all achieved. Each group was allocated five recommendations to review. The results were as follows:

Achieved: CLA should support the establishment of a coordination mechanism that would ensure some

coordination exists when an emergency strikes. As over 70 percent of supplies comes from the CLA, it is important to orient CC on CLA’s internal

systems particularly supply related issues

Partially (in order from more to less achieved) Orientation or training by the cluster on how to use or interpret information to improve program results

and decision making.

The cluster should create a pool of Master Trainers in priority subject areas.

It was discussed that while there has been great effort to create a pool of master trainers, there is need for on-going monitoring and quality assurance.

Action point: A database of trainers for CMAM, IYCF and NiE should be developed and maintained by the cluster. Sharing of best practice should be discussed and documented within the cluster forum.

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Ensure that information on nutrition situation is available: Government and NGOs to ensure the institutionalization of regular nutrition surveys and harmonization of a database on admission and discharge for centers.

It was agreed that this has been mostly achieved, through the recent surveys and the NIS. There is opportunity for improvement of harmonizing data from SC’s and other CMAM sites.

Regular meetings should be put in place between partners and IM to identify reporting gaps and enhance reporting skills.

Action point – an Information Management working group should be created, led by the Nutrition Cluster IMO to address challenges in IM and reporting

Build in country survey capacity

It was discussed that progress in this area has been made, through MIRA trainings, the 2013 SQUEAC survey, the National Nutrition Survey (NNS 2011) and the Flood Affected Areas Nutrition Survey 2010 (FANS)

Capacity building for government and partners to ensure that needs of vulnerable groups are integrated.

National nutrition strategy developed with institutional strengthening and capacity building.

The Pakistan Integrated Nutrition Strategy (PINS) has progressed in all four Provinces .

Clear phase out plan and strategy be discussed and developed by the national and hub level clusters and decisions to phase out should be supported by credible evidence.

Clear roles, responsibilities and reporting lines between central and hub level cluster coordinators needs to be established.

It was agreed by the cluster coordinators at the federal and the provincial levels that this can be further clarified during the preparedness planning phase and document in the Cluster Preparedness Plan

The Government should take a more active role in advocating for nutrition sector.

There is a need for training and support to partners and government for the NIS to be maintained

Progress has been made since the evaluation in 2011. The NIS has been completely rolled out in KP, FATA and Sindh and more than 150 implementing partners and government staff have been trained on NIS. The new short version of NIS has been developed for Punjab and Baluchistan.

Action point: The Punjab and Baluchistan partners and Government are to be trained in the short version of NIS.

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In order to improve the recruitment process, clear deployment mechanisms should be developed as this will ensure that experienced Cluster Coordinators are available when needed.

Action point: UNICEF to review this mechanism internally, including the deployment of IMOs.

Encourage technically specialized partners to work with local partners as early as possible and use implementation time as training opportunity.

There is a need to build a pool of trained local staff to perform Initial Rapid Assessment (IRA).

A total of 172 NGO and Government staff (75 in Sindh, 65 in Punjab and 32 in Balochistan) have been trained in the MIRA in 2012.

Action point: the roster of staff trained in MIRA to be included in the nutrition cluster IM database. http://pakresponse.info/MonsoonUpdates2012/Clusters/Nutrition.aspx

To address the delays in the activation of the Nutrition Cluster, it is recommended that clear guidelines and standards for cluster activation be developed.

Harmonize reporting between the food security and the nutrition cluster

This was identified as a priority and it was acknowledged that the Food Security and Nutrition TWG Terms of Reference (TOR) was developed in 2012 but has not yet been finalized.

Action point: the TWG should meet and finalize the TOR as soon as possible.

The cluster at hub level needs to encourage and advocate more strongly with the government and local agencies to take ownership and be pro-active members.

Orientation training in NiE for partners’ staff should happen before deployment not only during the emergency response.

Cluster partners to be sensitized about cluster approach.

A cluster preparedness plan that includes a list of guidelines translated into local languages is recommended.

Action point: the list of guidelines in local languages will be included as an annex in the 2013 cluster preparedness plan.

Not Achieved:

A community communication strategy and plan forming part of a preparedness strategy should be considered. Standard activities messages can be prepared and standardized.

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It was discussed that this has not been a focus of the nutrition cluster or the inter-agency coordination to date. An inter-agency communication group is not currently functional. Some organizations have their own communications strategies.

Action point: key communication products such as key messaging should be addressed in the preparedness plan.

Address capacity gaps in grant writing and understanding of CERF

Some participants questioned the validity of this recommendation, given the CERF is prepared by the UN agencies. It was agreed that all partners should understand how the CERF and other pooled funds work.

Action point: The NCC will inquire if there are any resource mobilization trainings planned by OCHA, and if not, the NCC could provide an overview of the CERF to cluster partners as an agenda item in a future cluster meeting.

CC and other surge staff related to the cluster to be dedicated to the cluster work only.

There is currently only one dedicated cluster lead in Sindh province, and the federal Nutrition Cluster Coordinator who is a RedR Australia emergency roster staff. The three other staff in the provincial cluster coordinator position are ‘double-hatting’ as UNICEF nutrition programme staff. It was acknowledged that it is more critical to have dedicated cluster staff during an active emergency.

It is strongly recommended and suggested that the transition process be consultative and a joint effort and the Early Recovery Working Group needs to streamline its processes with the cluster.

Cluster Survey April 2013

Prior to the survey, the cluster partners were requested to complete a short online questionnaire of 25 questions covering a range of topics including leadership and partnerships, coordination and management, information management and needs assessment, service delivery, resource mobilization, and preparedness and capacity building. There was an opportunity to provide comments in each section, and identify priority activities for the cluster over the next six months. It is envisioned that this questionnaire will be repeated in three and six months, to track progress in achieving the cluster objectives.

Seventeen responses were analysed in the report attached in annex 3.

The Humanitarian Project

The NGOs and Humanitarian Reform Project (NHRP) conducted a baseline analysis for the purposes of identifying obstacles and structural challenges preventing NGOs from fuller participation in humanitarian coordination, and to identify capacity gaps among NGO cluster partners that require support in order to increase NGO engagement in coordination mechanisms.

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Consultations were conducted with I/N-NGOs based in Islamabad, Peshawar and Hyderabad between July and August 2012, to capture information regarding NGO participation, representation, and leadership in humanitarian coordination.

Data collected from an opportunity sample of I/N-NGOs available to participate in Islamabad, Peshawar and Hyderabad during the activity period. Qualitative information was collected from participating NGOs using semi-structured interviews of between 45 and 60 minutes in length.

Interviewees focused their comments on 7 distinct areas when discussing their coordination experiences:• Cluster coordination models• Participation of Government• Notification of meetings and circulation of minutes• Management of meetings• Capacity building of cluster partners• Cluster successes• Resource mobilization

Overall, there was clear agreement that coordination was an essential part of effective humanitarian response in Pakistan, and that the clusters are playing a vital role in facilitating NGOs to avoid duplication, as well as programming to cover gaps in sectoral interventions. Clusters provide a platform for I-NGOs and UN agencies to establish relationships with N-NGOs, and for engaged N-NGOs to distinguish themselves as credible actors from a field that is saturated with contractors and opportunist actors.

Problems identified with the information flows between clusters at national and field level: lack of strategic timing of meetings to feed in to national level discussions; failure to circulate minutes from field-level clusters; limited report back from Islamabad clusters to field clusters. Interviewees reported finding field-level coordination meetings more useful for resolving operational issues than national cluster meetings, despite the limited resources invested in coordination at district-level. Practical focus, proactive advocacy work and supportive dynamic of NGO cluster partners cited by many as a key strength of field (particularly district-level) coordination.

Performance of clusters (and consequently NGO engagement) was perceived to have diminished following the immediate emergency response phase in both 2010 and 2011. Interviewees were clear that due to the degree of variance between the different clusters, it would be erroneous to speak of ‘the cluster system’ as an amorphous whole when discussing coordination successes and challenges. Across the cluster system, those clusters with sufficient funding for field-level coordination teams were evaluated as more successful by cluster members in implementing coordinated sectoral response.

Overall RecommendationsInterviewees presented some useful perspectives on how coordination challenges may be addressed through joint UN-NGO dialogue, and on the need for improvements in coordination structures to be focused at the district level, building up to the provincial and national levels after the foundational levels of coordination have been strengthened.

Further consultation with NGOs working in North Sindh and Balochistan needed.

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Cluster-specific discussions could help identify the structural and practical obstacles to participation in cluster coordination in more detail, and could also be combined with refresher training to clusters as part of NHRP capacity-building activities.

Summary of Recommendations1: Sharing of good practice between clusters about district-level coordination2: Clarification of cluster coordination structure and strategy at field level3: Critical analysis of obstacles and challenges affection cluster partners (including CLA)4: Inter-cluster review of information-sharing mechanisms between the field and Islamabad 5: Strengthened commitment from cluster partners and active engagement with coordination structures6: Increased support for cluster coordination from global clusters and cluster lead agencies

For further information please contact: Mette Hartmeyer (Ms), Programme Manager, NGO Humanitarian Reform Project - PakistanACTED | Agency for Technical Cooperation and DevelopmentCell: + 92 (0) 345 655 5219 | Fax: + 92 (0) 51 263 5037Email: [email protected] | Skype: mette.hartmeyer | Web: http://www.acted.org

Session 3: Information ManagementThe Information Management Officer (IMO), Ms Samra Hanif opened the session with a brief overview of the information sources, analysis and products that are routinely received and created by the cluster. Qutab Alam, IM Officer for NIS at UNICEF provided an overview of the NIS and its applications.

Each participant then identified what IM products are most critical to their organization. The following information was noted was important:

Federal Level:Regular sharing of:

Compiled ‘who does what, where and when’ data (4Ws) Compiled Need Gap Analysis Guidelines for nutrition Success stories and lessons learnt to be shared with partners. Monthly/quarterly Bulletin

Further, it was requested that the pool of master trainers list (on CMAM, IYCF, NIS, NIE, SC) to be available on Nutrition Site.

Action point: The cluster IMO to upload this information on the site:

http://pakresponse.info/MonsoonUpdates2012/Clusters/Nutrition.aspx

Provincial level: Feedback from the Provincial IMOs on routine data reports to Implementing Partners. Compiled 4W to be shared. Compiled Need Gap analysis to be shared. District level demographic data should be available (Information from Census Department and District

Coordination Officers (DCOs) to be collected for each District and Union Council. Caseload for each union council should be available.

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Supplies status from UN agencies at hub level to be shared. Supply calculator for each district to be shared. Timely report compilation to avoid duplication of programs. Aggregated data which is quantitative, analytical and narrative to be shared with all the partners at

district level. Monthly/quarterly Bulletins

Action points: - The compiled 4Ws, needs gap analysis documents are uploaded to the pakresponse.info site. To

alert all partners that there is new information on the site, an email will be circulated by the IMO when new information is uploaded.

- The IMO will work with the provincial IMOs to ensure that adequate feedback is reaching the IP’s, identifying any blockages to the transmission of the regular maps, bulletins and sitreps that are developed from the information submitted by the IP.

- Provincial cluster coordinators and IMOs will follow up on the demographic information at the district level and share this information to the national level for inclusion in the common operational datasets.

- The NCC will share the supply calculator for each district

- The contingency supplies status has been shared and reported by the NCC.

Nutrition Information System Participants raised the issue of the multiple information systems in circulation at present including the NIS, the Minimum Reporting Package (MRP) and the Government Health Management Information Systems (HMIS) and District Health Information Systems (DHIS). It was noted that a number of improvements are required to the NIS to appropriately link to the other systems.

It was recommended that the IM Task force should be re-formed to review the systems and develop recommendations for how the NIS and the MRP can be aligned, with the view of moving towards an integrated, government owned national nutrition information system.

Session 4: Cluster Planning

The cluster planning session was divided into group work and a discussion of the draft work-plan. Firstly the participants divided into small groups to identify what are the priority activities for the nutrition cluster for the next six months, and identify who should lead, what is the timeframe, are any sub-cluster working groups required and any assumptions. Each group developed statements on coloured cards and taped them to the six months work-plan on one wall of the training room. The participants then came together, to review the statements and decide upon a set of priority activities.

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Photo: Cluster planning session, 11 May.Table 1: Priority Activities

Activity Lead Timeframe Working Group AssumptionsPreparedness Planning NCC April-May No, all partners None

Prepositioning of supplies UNICEF, WFP April-May No Available funds, accessibility, security

IYCF community mobilization strategy

TBD May Yes, IYCF working group to be reformed, previously led by Save the Children

None identified

Review of the CMAM guidelines, and translation to Urdu

TBD Review May-JuneTranslation – June-July

Yes, reform the CMAM working group previously led by Merlin

None identified

Linkages are strengthened between nutrition and food security, and key tasks identified

NCC July-August Yes, the FS and N TWG

Adequate Technical and human resources, time

Capacity building of partners in CMAM, IYCF, Nutrition in Emergencies, Infant Feeding in Emergencies, and proposal writing

NNC On-going No None identified

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Review of different nutrition information management systems and strategy development for government ownership

UNICEF IMO April-June Yes, reform the nutrition IM working group

None identified

Expanded NIS training UNICEF On-going No None identifiedInformation dissemination – updated 4Ws, list of master trainers etc.

Cluster IMO April-May No None identified

M&E tools that are standardized for the nutrition cluster for monitoring CMAM programs

NCC May-June No None identified

Develop and plan for joint monitoring of CMAM activities

NCC, with support from the CMAM working group

May CMAM working group

Participation. Resources are available

Ensure regular cluster meetings and coordination

NCC On-going No None identified

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Table 2: Nutrition Cluster Work-plan

Proposed Nutrition Work-plan April-Sept 2013Task April May June July Aug Sept

Consultations and development of the comprehensive preparedness plan, including partner mapping and contingency stocks

Prepositioning of contingency supplies

Review of the different nutrition information management systems and strategy development for government ownership

Development and implementation of IYCF community mobilization strategy

Expanded NIS trainingInformation dissemination – updated 4Ws, list of master trainers etc

Review of the CMAM guidelines, and translation to UrduStrengthen linkages between nutrition and food security, finalize TOR and work-plan

Capacity building of partners in CMAM, IYCF, Nutrition in Emergencies, Infant Feeding in Emergencies and proposal writingStandardize Nutrition Cluster M&E tools for monitoring CMAM programs

Develop a plan for joint monitoring of CMAM activities, and implement monitoring

Regular coordination through cluster meetingsEvaluation of the nutrition cluster

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Session 5: Preparedness Planning

1. To provide guidance to the clusters following the completion of the Monsoon Humanitarian Action Plan (MHOP) in March, OCHA has developed an Operational Guidance for Clusters for Natural Disasters document. This document is currently being circulated to all cluster partners for their review and feedback to OCHA by Tuesday April 23. The document was introduced to the participants via email prior to the workshop and nutrition cluster partners are invited to provide feedback by April 22.

Action point: Participants will return comments on the guidance document by April 22.

2. The NCC presented the 2012 preparedness plan, noting that the existing plan provides a good platform for the development of a more comprehensive plan over the coming months. Each of the clusters in Pakistan has developed a preparedness plan, which informs the Pakistan Inter-Agency Preparedness Plan. The inter-agency plan is currently being updated by OCHA. The clusters are not following a uniform template for the preparedness planning, and there is a great variation between the plans in terms of how much detail is provided. The Food Security Cluster plan was identified as a particularly comprehensive plan.

The NCC emphasised the importance of a comprehensive and inclusive preparedness planning process, noting that the plan itself is only the documentation of the agreements that are reached by the cluster partners during the preparedness planning process. The national nutrition cluster plan must be aligned with the Provincial level preparedness processes and plans, which are currently under-way in the four Provinces. Many of the tasks and gaps that have been identified during the course of the workshop can be addressed within the preparedness plan, for example coordination between the provincial and national clusters.

The deadline for the completion of the cluster plan is the end of May. The contingency stocks matrix is due April 30.

Action points: The NCC will call a meeting in early May to begin the preparedness planning consultation process. A template, including the relevant information from the 2012 plan will be circulated for review prior to the meeting.

The NCC will circulate the contingency stocks matrix to the relevant partners.

Session 5: AOB and summary

A National Nutrition Cluster Logo was presented to the participants, and feedback was provided.

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Action point: the logo will be updated according to the feedback and presented to the cluster partners at the next meeting in May.

Dr Jorge Martinez, Chief of Operations at the World Health Organization joined the participants for the Workshop summary session. Syed Qadir, UNICEF, provided an overview of the workshop objectives and thanked the World Health Organization for hosting the workshop.

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Annex 1: Workshop Agenda

Time Agenda Moderator08.30-09.00 Welcome and introduction

- Overview of cluster status (federal and provincial) by cluster coordinators.NCC -Megan

09.00-10.15 Cluster Review- Review of Nutrition Cluster survey findings- Cluster Evaluation 2011: review the progress of bringing recommendations into action- Humanitarian Project findings.

MeganMette - TBC

10.15-10.30 Coffee Break10.30-11.30 Identifying Cluster Strengths and Gaps

Brainstorm of cluster strengths and gaps/opportunitiesMegan

11.30-12.15 Information Management- Presentation of Information Management tools and products- Draft NIS reporting protocol and proposed NIS formats- New 4W’s template, incorporating indicators.

Output: Action points for improvement of IM products

Samra- IMOQutab- NIS

John- OCHA12.15-12.45 Cluster Planning – session one

- Development of cluster work plan (including priority activities for the nutrition cluster, timeframes and responsibilities).

- Formulation of thematic sub-groupsOutputs:

- Prioritized list of activities, and draft work-plan outline- Sub groups and next steps to develop work-plans identified and leads assigned.

Megan

12.45-13.45 Lunch13.45-14.45 Cluster Planning – session two Megan

14.45-15.00 Coffee Break15.00-16.30 Preparedness Planning

- Review of the Operational Guidance for Natural Disasters specific to the nutrition cluster Megan

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- Overview of the Nutrition Cluster preparedness plan 2012 and requirements for updating for 2013- Contingency stocks

Outputs:- Draft preparedness plan for 2013- Outline of next steps for PP completion by end of May

16.30-17.00 Review of Cluster Coordination and AOB- Review of cluster coordination structure, meeting frequency other roles and responsibilities- Key focal points from clusters and working groups

Megan

17.00 Next Steps and Workshop Close Megan

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Annex 2: Participant List

Nutrition Cluster Planning Workshop 11 April 2013Name Organization Position/Title Contact # Email

Najma Ayub ACF Deputy Nutrition coordinator 0334 8406586 [email protected] Ali ACF IMO ACF 0301 85401343 [email protected]

Aliya Tayyaba CDO Executive Director 0300 5007318 [email protected]

Nomeena Anis FAONutritionist and Gender Focal Person 0346 8544210 [email protected]

Louis MarinjnissenMalteser International Health Coordinator 0345 500 48 49 [email protected]

Khalid NawazMicronutrient Initiative NPM MI 0333 9127324 [email protected]

IrfanUllah Muslim Aid Health Nutrition coordinator 0300 9039983 [email protected] Munir NRSP Senior program Officer 0321 5102238 [email protected]

Asif Iqbal Save the Children Nutrition Manager 0343 8929066 [email protected]

Dr Amer Bashir Save the Children Health and Nutrition Manager [email protected] Kaufmann UNICEF Nutrition Manager 0345 5006546 [email protected] Alam UNICEF NIS officer 03333 9196471 [email protected] Hanif UNICEF IMO 0345 5566449 [email protected] Saeed Qadir UNICEF Nutrition Program Officer 0300 9591579 [email protected] Organization Position/Title Contact # Email

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Zulfiqar Ahmed Welt hungerhilfe Project Coordinator 034 752 504 58 [email protected]

Tahir Nawaz WFP Program Officer 0300 8566209 [email protected] Ghaffar WFP Program Assistant 051 8312424 [email protected]. Wisal M Khan Merlin Nutrition Coordinator 0300 8552489 [email protected] Yazdani ECHO PO 0308 5550531 [email protected] Cantoni ECHO Technical assistant 0300 8566895 [email protected] Khurram Bukhari UNICEF Lahore 0321 9800095 [email protected] Khan Afridi UNICEF Peshawar 0300-5002598, [email protected]

Dr. Muhammad Faisal UNICEF Quetta 0332-3536493 [email protected] Gayford NCC Islamabad 03008112749 [email protected] Hartmeyer ACTED Consultant 0345 65555219 [email protected] Khan WHO Nutrition Officer 0303 5552282 [email protected]

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29 April 2013

Annex 3: Nutrition Cluster Survey Report

Q1. To which stakeholder group do you belong?

The majority of the respondents were from INGO cluster members (41%), followed by UNICEF staff (29%). There were no respondents from Government or Donors.

Part 1: Leadership

Q2. To what extent has an enabling environment for participation, mutual problem solving, and collective decision-making been created in the nutrition cluster?

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INGO cluster member 7 41%

IFRC cluster member 0 0%

National NGO cluster member 3 18%

UN agency cluster member 2 12%

Cluster Lead Agency 5 29%

Government 0 0%

Donor 0 0%

score frequency %1 1 6%

2 2 12%

3 5 29%

4 9 53%

5 0 0%

N/A 0 0%

29 April 2013

The majority of respondents (5 percent) reported that that an enabling environment for participation, mutual problem solving, and collective decision-making has been created in the nutrition cluster. The other respondents were neutral or disagreed (reporting 3 or less out of 5).

Q3. To what extent does UNICEF as the Nutrition Cluster Lead Agency meet the responsibilities to lead a cluster (i.e. to ensure coordination of emergency response, ensure proper planning and implementation, meet standards, avoid overlaps and gaps, mobilize resources or act as provider of last resort?

Out of 17 respondents 59 percent agreed that UNICEF meets the responsibilities of the Cluster Lead Agency. A further 30 percent were neutral or disagreed with the statement, suggesting that there is room for improvement.

Q4. In the 2012 floods, to what extent was there participation of organizations involved in the response in the nutrition cluster national coordination mechanisms (including information sharing, linking to ERF, and providing access to CERF etc)?

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1 1 6%

2 0 0%

3 4 24%

4 10 59%

5 0 0%

N/A 2 12%

29 April 2013

An almost equal proportion of respondents reported that there was active participation (reporting 4 out of 5) as those who did not agree that there was active participation (reporting 3 or less). A large number of respondents were unable to comment on this question, most likely due to the respondent not being present in the nutrition cluster during the 2012 floods.

Comments and Suggestions

CERF exceptionally for UN to apply, however, all funds are then utilized through partner agreements. The ERF is new and most probably no being used so intensively yet for nutrition, but possibly more advanced for other clusters and it looks as the NGOs did not show a big interest for nutrition applications.

Time is very important factor, thus involvement in planning and decision-making must be taken into account. At the eleventh hour sharing of funding opportunities sharing and proposal submission verdict does not make any sense, so in the future must be considered

The cluster has the tendency to speak from UNICEF’s behalf and support the Government, rather than problem solving and keeping a check on UNICEF programmatic, PCA and supply delays.

The co-cluster lead should also come from an INGO to make the approach more participatory and unbiased. The cluster also involves in making new reporting tools, new dimensions increasing the workload rather than making good use of the existing tools and databases. At the end of the day they have started numerous discussions and initiatives which hardly reach to completion.

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1 1 6%

2 1 6%

3 3 18%

4 5 29%

5 2 12%

N/A 5 29%

29 April 2013

Part 2: Coordination and Management

Q5. To what extent are the opinions of the Cluster partners considered in the Nutrition Cluster decision-making?

A total of 41 percent of respondents answered this question positively, however more (47 percent) were either neutral or negative, indicating that the NCC must improve how consultative and inclusive the decision making process is within the nutrition cluster.

Q6. To what extent is the Cluster Coordinator perceived as being an independent and impartial representative of the Cluster?

More than half of the respondents (53 percent) responded positively to the question, finding the NCC to be an independent and impartial representative. A significant proportion were neutral or

1 1 6%

2 1 6%

3 6 35%

4 5 29%

5 2 12%

N/A 2 12%

1 1 6%

2 3 18%

3 3 18%

4 7 41%

5 2 12%

N/A 1 6%

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29 April 2013

negative (40 percent), highlighting a need for greater independence and impartiality of the NCC. The concern of the NCC’s at the provincial levels ‘double hatting’ as UNICEF programme staff is a likely contributing factor to the loss of independence and impartiality.

Q7. To what extent have coordination meetings been effective (i.e. meet their purpose, are inclusive, are well managed and action-oriented?

Half of the respondents (49 percent) have a positive view about coordination meetings. A further 35 percent neither agreed nor disagreed and 18 percent are dissatisfied, indicating that more effort must be invested in ensuring the coordination meetings are meeting needs of the nutrition cluster partners.

Q8. To what extent has the IYCF sub group been effective in serving the needs of the cluster?

1 1 6%

2 2 12%

3 6 35%

4 7 41%

5 1 6%

N/A 0 0%

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The IYCF sub group is not currently active, which may explain the majority of respondents who find the IYCF ineffective.

Q9. To what extent has the CMAM sub group been effective in serving the needs of the cluster?

The CMAM sub group is reported to be more effective than the IYCF group; however the majority of respondents reported a neutral position, indicating that there is opportunity to improve the effectiveness of the CMAM sub-group by establishing priorities and a work-plan.

Q10. To what extent are the Nutrition Cluster partners involved in financial resource mobilization efforts through common instruments such as the CERF?

1 2 12%

2 3 18%

3 6 35%

4 1 6%

5 1 6%

N/A 4 24%

1 1 6%

2 1 6%

3 8 50%

4 4 25%

5 0 0%

N/A 2 13%

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The majority of respondents report some involvement in financial mobilization (53 percent); however there is clearly an opportunity for the NCC to be more inclusive of cluster partners in resource mobilization efforts.

Q11. To what extent does your organization share needs or funding opportunities/status in the Nutrition Cluster forum?

Most of the cluster partners reported that they do share information on funding status within the cluster; however this has been identified by the NCC as an area that needs attention and improvement.

Comments and Suggestions:

1 2 12%

2 3 18%

3 4 24%

4 5 29%

5 0 0%

N/A 3 18%

1 2 12%

2 2 12%

3 4 24%

4 8 47%

5 0 0%

N/A 1 6%

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The National Cluster doesn't have much say in Provincial cluster affairs. In some cases National Cluster recommendations are not been attended to by UNICEF at provincial levels. This scenario causes discouragement among national cluster members and is one of the reasons for the thin attendance and distracted interest of members during National Cluster Meetings.

Reactivation of sub-group is extremely important. It should be task oriented (not only establishing a structure, but also convening to complete a task.

Part 3: Information Management and Needs Assessment

Q12. To what extent is the information provided by the Nutrition Cluster sufficient for your needs?

The majority of respondents reported that their information needs were met or mostly met (53 percent). This indicates that the cluster IM must improve to meet the needs of all of the cluster partners.

Q12. To what extent does data and information fed back by the Nutrition Cluster reflect your experience of field realities?

Most of the respondents (59 percent) responded positively to the consistency between the information fed back from the cluster and the partner’s experience of what is happening at the field level.

1 0 0%

2 2 12%

3 5 29%

4 6 35%

5 3 18%

N/A 1 6%

1 0 0%

2 3 18%

3 4 24%

4 7 41%

5 2 12%

N/A 1 6%

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Q13. To what extent is disaggregated data available which clearly identifies specific vulnerable groups?

An equal proportion of respondents were positive and either neutral or negative to the availability of disaggregated data that clearly identifies specific vulnerable groups, indicating that there is an opportunity to improve in this area.

Q14. To what extent is the quantity of information requested by the Nutrition Cluster was proportioned to the information provided?

1 0 0%

2 3 18%

3 5 29%

4 4 24%

5 4 24%

N/A 1 6%

1 0 0%

2 0 0%

3 6 35%

4 6 35%

5 2 12%

N/A 3 18%

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Slightly more respondents reported that there is a balance between the quantities of information the nutrition cluster requested from the partners, to what is provided in return. This highlights the importance of ensuring the cluster IM is providing relevant information to the cluster partners without placing too much additional burden on cluster partners for reporting of data and other information sources.

Q15. To what extent did the MIRA inform initial nutrition needs in the 2012 monsoon?

The respondents have a mixed view about MIRA’s usability. A high proportion of respondents were unable to comments, most likely due to the respondents not participating in the nutrition cluster during the time of the MIRA.

Q16. To what extent is the Nutrition Cluster prepared to undertake detailed surveys in a timely manner with pre-agreed tools informed by international standards?

The variation in the responses indicates there is a need to review the readiness of the nutrition cluster to conduct a detailed assessment, as part of the preparedness planning process.

Comments and Suggestions to Improvements

1 0 0%

2 3 18%

3 4 24%

4 6 35%

5 0 0%

N/A 4 24%

1 1 6%

2 4 24%

3 5 29%

4 5 29%

5 1 6%

N/A 1 6%

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The NIS is not uniform in all sites in the country, and there is a need to improve how frequently the NIS data is updated.

Quality indicators are not discussed or feedback provided for quality improvement of the programs.

It is always a lengthy discussion where we should have standard procedures and questions already in place. We recommend having not only an inter-cluster assessment, but also a nutrition cluster rapid assessment to inform program decisions.

Part 4: Service Delivery

Q17. To what extent is the response of the Nutrition Cluster guided by a clear set of standards and tools?

1 0 0%

2 2 12%

3 5 29%

4 7 41%

5 3 18%

N/A 0 0%

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The respondents mostly report that the nutrition cluster is guided by clear set of standards and tools, whereas 29 percent neither agreed nor disagreed.

2. To what extent have there been unnecessary duplications in the service delivery?

The wide variation in the responses indicates that there must be more effort in ensuring that duplications in service delivery are minimized.

Q18. To what extent has the response of the nutrition cluster adequately addressed the specific needs of vulnerable/marginalized groups?

Out of 17 respondents, more than half (53 percent) reported that the cluster has been able to address the specific needs of vulnerable groups. This indicates that there is a need to review how sensitive the emergency nutrition programs are to the needs of vulnerable groups.

Q19. To what extent did the Cluster strategy included adequate early recovery interventions?

1 1 6%

2 5 29%

3 2 12%

4 4 24%

5 2 12%

N/A 3 18%

1 0 0%

2 0 0%

3 6 35%

4 8 47%

5 1 6%

N/A 2 12%

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The majority reported that ER was adequately addressed in the cluster strategy; however the majority reported a neutral position, indicating that there is an opportunity for improvement.

Q20. To what extent do Nutrition Cluster partners monitor implementation in a common, coordinated way?

There was a wide variation in responses, indicating that improvements are required in the area of joint monitoring.

Comments and Suggestions to Improvements

The response plans always good but the UNICEF and WFP contracting procedures are at times delayed.

1 0 0%

2 1 6%

3 8 47%

4 5 29%

5 2 12%

N/A 1 6%

1 3 18%

2 2 12%

3 6 35%

4 5 29%

5 0 0%

N/A 1 6%

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The gaps in the interventions due to the delayed PCAs have implications on the beneficiaries.

Joint monitoring should be done much more pro-actively, and the financial resources for clusters can easily be available. A joint monitoring approach has been developed for Sindh and Balochistan.

Part 5: Resource Mobilization

Q21. To what extent is the Cluster effective in advocating for funding for the nutrition sector?

The wide variation in the responses indicates that the NCC can improve advocacy for resources for the nutrition cluster.

Q22. To what extent is the Cluster functional in ensuring an effective allocation of financial resources to meet requirements?

1 2 12%

2 2 12%

3 5 29%

4 5 29%

5 1 6%

N/A 2 12%

1 3 18%

2 2 12%

3 5 29%

4 5 29%

5 0 0%

N/A 2 12%

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29 April 2013

A greater proportion of respondents reported neutral or low extent of cluster effectiveness in ensuring allocation of financial resources, indicating that this is another area that requires attention by the NCC.

Comments and Suggestions to Improvement

More transparency of resource allocation and needs of cluster partners. This might need to be approached at a more senior level.

UNICEF staff are more powerful than the Cluster in finalizing selection of implementing partners etc.

In the time when not much funding is available; it would be a good approach to involve cluster members in trainings to build their capacities and maintain their interest level but national cluster members get far less chances of capacity building trainings than local ones.

Part 6: Preparedness and Capacity Building

Q23. To what extent does the Nutrition Cluster promote adequate capacity building of local partners?

1 1 6%

2 2 12%

3 6 35%

4 5 29%

5 1 6%

N/A 2 12%

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29 April 2013

The majority of respondents reported neutral to positive views about enabling opportunities for cluster member capacity building.

Q24. To what extent are inter-cluster preparedness and capacity building measures provided?

The wide variation in the responses indicates that the NCC must be more pro-active in linking the nutrition cluster into the inter-agency preparedness and capacity building opportunities.

Q25. To what extent was the National Nutrition Cluster Preparedness Planning process and plan useful for the emergency response in 2012?

The wide variation in the responses indicates that there is an opportunity in 2013 to undertake a more comprehensive preparedness planning process, to ensure that the preparedness plan is a useful document for emergency response.

1 2 12%

2 4 24%

3 5 29%

4 5 29%

5 0 0%

N/A 1 6%

1 2 12%

2 2 12%

3 5 29%

4 4 24%

5 0 0%

N/A 4 24%

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Comments and Suggestions to Improvement

In the time when not much funding is available, it would be a good approach to involve cluster members in trainings to build their capacities and maintain their interest level.

Part 7: Overall comments and suggestions for improvements of cluster functions

Comments for Improvement of Cluster Functions

Should be practical, neutral, trouble shooting, and have smart approaches. Should focus on the beneficiaries and not on procedures, policies only.

UNICEF is the Nutrition Cluster Lead, but the Cluster and its Coordinator should work hard to remove the perception that Cluster lead would do whatever UNICEF agrees.

Nutrition Cluster should be more proactive in resource and funds hunting to cater for the needs of the vulnerable groups.

Nutrition Cluster should be more proactive in coordinating the efforts of UNICEF, WFP & WHO as all the three agencies are responsible for different components of CMAM.

NGOs & INGOs should be given equal weight in cluster activities.

There should be diversification of implementing partners, meaning that currently most of the PCAs are signed with a few partners whereas others are not getting any projects to implement. It is always good to have a blend of NGO/INGO; small ones/big ones, locals/national based member organizations etc. This approach will create more healthy competition besides it is cluster's responsibility to keep maximum partners/members engaged in its activities otherwise corner meetings with 3-4 big partners are enough and there is no need to invite everyone in the name of cluster.

The Cluster should be financially independent.

An unbiased cluster and cluster coordinator. Everyone should have the equal opportunity whether small or large contributor, resource mobilization on need base and capacity of the partner. Suggest improved accountability and transparency

Strengthen the working groups, especially IYCF and CMAM and recommend concrete actions.

Publish quality nutrition updates and bulletins

Strengthen joint monitoring

Strengthen information sharing at cluster meetings like, achievements, challenges, studies and survey findings, success stories, etc.

Continuity and consistency in having committed and experienced nutrition cluster coordinators was always a challenge. OCHA and UN guidance on cluster operational procedures and requirements, exchanges, reviews and local evaluations would help to

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improve cluster functions. Capacity building and inter-agency preparedness planning should be more supported by OCHA.

There should be more coordination between the federal and the provincial cluster teams.

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