Public nutrition from an approach to a discipline: concern's nutrition case studies in complex emergencies

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue--through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC--that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.     

Public Nutrition in Emergencies: An Overview of Debates, Dilemmas and Decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'.
Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition.
Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use.
Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectoral working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

Public nutrition in emergencies: an overview of debates, dilemmas and decision-making

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'. Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition. Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use. Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectorial working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.     

The Role of Food Aid in Drought and Recovery: Oxfam's North Turkana (Kenya) Drought Relief Programme, 1992–94

Regional droughts carry the seeds of catastrophe: the immediate risk is famine; the long-term risk is destitution. Preventing both situations is an appropriate, if not essential, goal for relief agencies. In the past, responses to hunger in Turkana District (north-west Kenya) have taken the form of traditional feeding programmes. A better understanding of the boom/bust cycles in pastoralist systems has, however, produced new relief strategies. A central tenet of these strategies is the acceptance that relief aid should assume two roles: humanitarian—to overcome food deficits—and economic—to overcome 'income' deficits. Arguments in favour of a broader role for food aid are tested with a case study of a drought relief programme in north Turkana between 1992–1994. Field studies confirmed that when food aid is integrated as an asset into household resources, it can strengthen economic recovery. Ultimately, the extent to which relief operations are able to protect both people's lives and their livelihoods is the key to more sustainable development in drought-prone areas.     

Computer Simulation as a Means of Dialogue between Local Committees and Relief Agencies: A Case from Southern Sudan

Computer simulations, using modest equipment – a portable computer with a familiar spreadsheet programme – can facilitate dialogue between local committees and relief agencies in the management of disasters. An example is given from the southern Sudan in which the outcomes of different relief strategies, some urged by the donors, were simulated. This helped the local committee to defend difficult choices and the donors to realise that the decision-making autonomy of the affected community should be respected.     

Entitlements and the Wollo Famine of 1982–1985

The traglic recent events in Ethiopia and other parts of Africa have again foccussed attention on the different anaytical approaches to the problems iof famine. Perhaps the most important analytical contribution to this field has been Sen's "entitlements approach." One of the case studies Sen used to articulate this approach was of the 1972–1973 famine in Wollo Province, Ethiopia. This article provides a provisional assessment of the famine process in the Wollo during 1982–1985 to set against the analysis by Sen of the earlier famine. Some striking contrasts are revealed.     

Index to Volume 23, 1999

In the 'chronically vulnerable areas ' (CVAs) of East Africa a smooth linear transition away from emergency programming towards rehabilitation and long-term development is difficult, if not impossible. This makes uncritical application of the 'relief-to-development ' continuum to programming unhelpful at best, and perhaps counter-productive. This paper is the result of CARE's efforts to review its own programmes – and those of some of its sister agencies – in chronically vulnerable areas in the East Africa region, to derive important lessons learned and to identify areas where improvements are needed. The paper focuses on strategic considerations and decision-making in relation to entry, programme design and strategies for transition and exit.     

Childhood Immunisation in Rural Afghanistan: The EPI Programme, 1987-91

A decade of outright war followed by civil strife and conflict has hindered the development of health care services for the population of rural Afghanistan. Despite the absence of a functional health care system and the fragmentation of the Afghan resistance, and despite widely held views to the contrary, it has proved possible to set up a technically valid and politically acceptable Expanded Programme of Immunisation (EPI). This paper discusses some of its technical and programmatic aspects and the rationale behind some of the very unusual choices made – such as the use of DPTP, the inclusion of girls 3–14 years old for TT immunisation, a vertical programme structure and a predominance of mobile and outreach strategies. The paper argues against the mindless use of global or handbook recipes. The keys to success have been strategic vision, intimate knowledge of the local context and pragmatic choices for options that are simple and effective.     

A 'Principled' Approach to Complex Emergencies: Testing a New Aid Delivery Model in the Nuba Mountains

This paper provides an analysis of the Nuba Mountains Programme Advancing Conflict Trans-formation (NMPACT) as an example of an operational response in a complex emergency that innovatively addressed an incipient food security crisis. NMPACT is notable for having brought together an array of actors around a common principled agenda and for being the only operational programme in the Sudan to which both warring parties subscribed during the conflict. The key features of the programme are presented and the main innovative elements are reviewed, including the role of the principles of engagement and the 'political humanitarianism' of NMPACT. The paper looks at how NMPACT broke from traditional externally driven responses to food insecurity, and, drawing on lessons from Operation Lifeline Sudan, adopted an approach that focuses on capacity building, sustainable agriculture and market revitalisation, alongside conflict transformation and peace-building. The limitations of the model are also assessed, and preliminary lessons regarding its replication in other complex emergency contexts are presented.     

An Account of Co-ordination Mechanisms for Humanitarian Assistance During the International Response to the 1994 Crisis in Rwanda

This paper examines the co-ordination strategies developed to respond to the Great Lakes crisis following the events of April 1994. It analyses the different functions and mechanisms which sought to achieve a co-ordinated response – ranging from facilitation at one extreme to management and direction at the other. The different regimes developed to facilitate co-ordination within Rwanda and neighbouring countries, focusing on both inter-agency and inter-country co-ordination issues, are then analysed. Finally, the paper highlights the absence of mechanisms to achieve coherence between the humanitarian, political and security domains. It concludes that effective co-ordination is critical not only to achieve programme efficiency, but to ensure that the appropriate instruments and strategies to respond to complex political emergencies are in place. It proposes a radical re-shaping of international humanitarian, political and security institutions, particularly the United Nations, to improve the effectiveness of humanitarian and political responses to crises such as that in the Great Lakes.     

Flood vulnerability and commercial activities: the case of the city of Girona, Spain

This paper is based on a case study of the city of Girona in Catalonia, Spain, and analyses the vulnerability of commercial establishments to floods caused by the Onyar River. A mapping and statistical approach (cluster analysis) was applied to the information obtained from 568 questionnaires answered by the shops and the workshops located in the flood risk area. The results obtained allowed the authors to determine five different flood vulnerability profiles of the commercial establishments analysed. These profiles paint a picture of little individual adaptation to the risk and the possibility of suffering, sooner or later, large economic losses due to overflowing of the Onyar River. The authors established a methodology for carrying out a detailed multidimensional analysis of the flood vulnerability of the city's commercial establishments in order to provide the foundations for local government policies and for strategies for shop owners to reduce flood vulnerability.     

Planning environmental sanitation programmes in emergencies

Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies.     

Operational value of anthropometric surveillance in famine early warning and relief: wollo region, ethiopia, 1987-88

In this article I examine the operational implications of the findings reported in 'Entitlements, Coping Mechanisms and Indicators of Access to Food: Wollo Region, Ethiopia, 1987–88' (Kelly, 1992). The usefulness of anthropometric and other indicators for early warning and relief planning in Wollo is assessed by comparing the findings of Save the Children Fund's nutritional surveillance programme with those of the Early Warning and Planning Service of the Ethiopian government's Relief and Rehabilitation Commission. Case studies are used to illustrate the value of anthropometric and other indicators for targeting relief food and monitoring its effects. The costs of monitoring various indicators are then considered, and the cost of the Save the Children Fund programme is compared with that of other programmes. It is argued that in Wollo, anthropometric surveillance is a cost-effective means of improving early warning, planning, targeting and monitoring.     

Climate change and disaster management

Climate change, although a natural phenomenon, is accelerated by human activities. Disaster policy response to climate change is dependent on a number of factors, such as readiness to accept the reality of climate change, institutions and capacity, as well as willingness to embed climate change risk assessment and management in development strategies. These conditions do not yet exist universally. A focus that neglects to enhance capacity-building and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks. Reducing vulnerability is a key aspect of reducing climate change risk. To do so requires a new approach to climate change risk and a change in institutional structures and relationships. A focus on development that neglects to enhance governance and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks.     

The creation of vulnerability to natural disaster: Case studies from the Dominican Republic*

This paper argues that natural disasters are not a category of events which can be separated from the broader Issues of development, since economic change can create vulnerability to natural disaster. The analysis of case studies from the Dominican Republic shows how the development of large scale commercialized agricultural production has created such vulnerability by reducing or restricting the resource base of certain sectors of the population. It b suggested that the vulnerable state of a population should be considered as much a cause of natural disaster as the extreme physical phenomena Involved. Therefore there Is a need both for a broader framework for analysis of disasters and for strategies to reduce such vulnerability to be an Integral part of long term development planning.     

Public health aspects of volcanic hazards; Evaluation and prevention of excessive morbidity and mortality due to natural disasters

This is a summary of the proceedings of sessions on Volcanic Hazards at the First International Symposium on Public Health in Asia and the Pacific Basin, held 3–11th March 1983, in Honolulu, Hawaii. The Symposium was sponsored by the Association of Schools of Public Health, the U.S. Public Health Service and the Centers for Disease Control (CDC), the World Health Organization (WHO), the South Pacific Commission, and the East–West Center of the University of Hawaii. The full proceedings are being prepared for publication. The Symposium was supported in part by: The Pan American Health Organization and The Amoco Foundation.     

Speed or deliberation: a comparison of post‐disaster recovery in Japan,Turkey, and Chile

This paper compares recovery in the wake of three recent earthquakes: the Great East Japan Earthquake in March 2011; the Van earthquake in Turkey in October 2011; and the Maule earthquake in Chile in February 2010. The authors visited all three locations approximately 12–18 months after the incidents and interviewed earthquake specialists, disaster managers, urban planners, and local authorities. A key challenge to post‐disaster recovery planning is balancing speed and deliberation. While affected communities must rebuild as quickly as possible, they must also seek to maximise the opportunities for improvement that disasters provide. The three case studies bring this dilemma into stark relief, as recovery was respectively slow, fast, and just right in the aftermath of the events: the Government of Japan adopted a deliberate approach to recovery and reconstruction; speed was of the essence in Turkey; and an effective balance between speed and deliberation was achieved in Chile.     

Cyclone preparedness and response: an analysis of lessons identified using an adapted military planning framework

The United Kingdom uses the Defence Lines of Development (DLOD) framework to analyse and understand the key components and costs of a military capability. Rooted in the Resource Based View (RBV) of a firm, an adapted DLOD approach is employed to explore, analyse and discuss the preparedness, planning and response strategies of two markedly different countries (Australia and Bangladesh) when faced with a major cyclone event of a comparable size. Given the numerous similarities in the challenges facing military forces in a complex emergency and humanitarian agencies in a natural disaster, the paper demonstrates the applicability of the DLOD framework as an analysis and planning tool in the cyclone preparedness planning and response phases, and more broadly within the disaster management area. In addition, the paper highlights the benefit to disaster managers, policymakers and researchers of exploiting comparative cross-learning opportunities from disaster events, drawn from different sectors and countries.     

Examining the impacts of disaster resettlement from a livelihood perspective: a case study of Qinling Mountains,China

Disaster resettlement, as a mitigation and preparedness measure, entails significant economic, physical, and social impacts, which continue to challenge understanding of recovery from major events, especially regarding the extent of the context and environmental efforts to rebuild livelihoods. Based on a case study of Qinling Mountains, China, this research investigates the effects of disaster resettlement from a livelihoods perspective. Methodologically, it proposes a framework that combines the pressure–state–response framework and the sustainable livelihoods approach, and it employs a structural equation model to examine how specific factors affect disaster resettlement. The results indicate that conflicts may occur during and after resettlement owing to the difference or disparity between the concerns of resettled peasants and those of the government. Consequently, the risks related to livelihoods need to be taken seriously. Effective risk communication is critical to bridge the gap between different stakeholders. The paper concludes with some practical and policy recommendations.     

Emergency relief,crop diversification and institution building: the case of sesame in The Gambia

This article examines the case of the Catholic Relief Service's (CRS) sesame support programme in The Gambia which has spanned more than 25 years. It outlines the transformation process from relief to development and the role that the production of an agricultural commodity, sesame, has played as a key building block. Following the drought of the 1980s, concerns to move away from dependence on food aid first led to agronomic trials of imported oilseed, then to the selection and dissemination of improved sesame varieties accompanied by an elaborate and costly support programme. This gradually developed into a long-term development-oriented intervention, paving the way for the development of a national women's farmers' organisation. The paper provides a case study of an intervention that has gone beyond the provision of seed to address agronomic research and extension, policy, marketing and institutional issues necessary for successful crop diversification.