Case study Islamic Republic of Afghanistan - Review of Opportunities and Challenges for Strengthening Humanitarian and Development Linkages for ...
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Review of Opportunities and Islamic Republic of Afghanistan
Challenges for Strengthening
Humanitarian and Development
Linkages for Nutrition with
Examples from Myanmar, Niger
and Afghanistan
case study
Global
NUTRITION
CLUSTER
This project consists of the
following publications:
Lessons learned from
Humanitarian-Development
Nexus reviews in Myanmar,
Niger and Afghanistan
y Report
y Policy brief
Review of opportunities and
challenges for strengthening
humanitarian and development
linkages for nutrition with
examples from Myanmar, Niger
and Afghanistan
y Afghanistan
y Myanmar
y Niger
All publications and recording
of accompanied webinars are
available in French and English
at the following links:
GNC website
Scaling Up Nutrition website
© UNICEF/UN060153/Nybo
contents Acronyms 04 Introduction 05 1. Persistent and widespread malnutrition 06 highly sensitive to shocks 2. Despite being the main recipient of 08 development assistance from DAC countries, Afghanistan’s investment in nutrition remains very low 3. The AFSeN-A was launched in 2017 10 4. Shock sensitivity of government policies 12 related to nutrition remain limited 5. Humanitarian-Development Nexus could 13 become a reality 6. The role of the coordination mechanisms 15 7. Conclusions and recommendations to the 17 SUN movement and the Nutrition Cluster to strengthen the Humanitarian-Development Nexus for nutrition in Afghanistan Annex 1: Scope, methodology, 21 background and documents referred to during desk review Scope 21 Methodology 21 Background 22 Documents referred to during desk review 24 Annex 2: People interviewed 25 References 26 Acknowledgements 26
Acronyms
AFSeN-A Afghanistan Food Security and Nutrition Agenda
BPHS/EPHS Basic Package of Health Services and Essential
Package of Hospital Services (Afghanistan)
FANTA Food and Nutrition Technical Assistance
GNC Global Nutrition Cluster
GSS SUN Global Support System
HDN Humanitarian-Development Nexus
HRP Humanitarian Response Plan
IHSAN Initiative for Hygiene, Sanitation and Nutrition
IMAM Integrated Management of Acute Malnutrition
IYCF Infant and young child feeding
MAIL Ministry of Agriculture, Irrigation and Livestock
MNS Micronutrient supplement
MQSUN+ Maximising the Quality of Scaling Up Nutrition Plus
MoPH Ministry of Public Health
MSP Multi-Stakeholder Platform
NC Nutrition Cluster
NCC Nutrition Cluster Coordinator
NGO Non-governmental organization
ODA Official development assistance
RUTF Ready-to-use therapeutic food
SAM Severe acute malnutrition
SAG Strategic advisory group
SDG Sustainable development goals
SUN Scaling Up Nutrition Movement
SMS SUN Movement Secretariat
SUN UNN UN Network for SUN
UN United Nations
UNAMA United Nations Assistance Mission in Afghanistan
4 Afghanistan Case study
introduction
This country case study and its triple-nexus approach links three key
accompanying recommendations plans: the Humanitarian Response Plan
include inputs from members of the (HRP), the One UN Plan and the United
Nutrition Cluster (NC), members of the Nations Assistance Mission in Afghan-
Afghanistan Food Security and Nutrition istan’s (UNAMA) peace mandate. For
Agenda (AFSeN-A) multi-stakeholder this study, only the humanitarian and
platform, representatives from the civil development dimensions were studied.
society and United Nations (UN) agen-
For this study, the HDN is understood
cies and secondary data and informa-
as the central point where humanitarian
tion sources. The lists of key documents
and development actions converge
and persons interviewed can be found
around the need to prevent, prepare
in the annex and reference sections.
and address crises – particularly for the
This study has been commissioned most vulnerable and at-risk populations
by the Global Nutrition Cluster (GNC) – balancing short-term responses with
and the Scaling Up Nutrition Movement longer-term solutions, allowing humani-
(SUN) Secretariat to capture experi- tarian and development interventions to
ences from crisis affected States and be more genuinely complementary and
to suggest options to strengthen the mutually reinforcing.
Humanitarian-Development Nexus
The study found great progress had
(HDN) for greater nutrition outcomes.
been made towards a multisectoral
The objective of the study is to identify
approach to nutrition with the adoption
practical opportunities and solutions.
in 2017 of AFSeN-A and its strategic
The analysis is therefore not exhaustive
plan: the integration of nutrition treat-
but purposive. Only relevant aspects of
ment in the BPHS, acknowledging
the contexts are presented. A partic-
its development dimension, and the
ular emphasis is given to the factors
well-developed and functioning coordi-
impeding and enabling collaboration
nation mechanisms offering space for
and commitment for nutrition.
the actors to exchange and collaborate.
This country case study is part of a The resources allocated to nutrition
series of three country case studies, remain limited and the coverage of all
comprising of Afghanistan, Myanmar nutrition interventions – nutrition-specific
and Niger. The study was conducted and nutrition-sensitive – is insufficient.
between July and September 2020. The AFSeN-A implementation will gain
Due to the COVID-19 pandemic, the from involving more actors – especially
case studies had to be conducted humanitarian and local civil society
remotely, limiting the representativity of organizations – technically and opera-
the contributors, due to language and tionally, as well as reinforcing planning
technical limitations. and accountability to strengthen
advocacy and resource mobilisation.
To reflect the complexity of the Afghan
© UNICEF/UNI118803/Noorani context, the UN has developed a
triple-nexus model. The model
encompasses short-, medium- and
long-term humanitarian, development
and peace-sensitive actions. The
Afghanistan Case study 5
Persistent and widespread
malnutrition highly sensitive
to shocks
Infant and child mortality rates in in 2019 by the extended impact of the contribute to consistently poor infant
Afghanistan are among the highest drought in 2018. Micronutrient deficien- and young child feeding (IYCF) prac-
in South Asia and poor nutritional cies are also widespread in Afghani- tices and high malnutrition rates.
status contributes significantly to this stan. Iodine deficiency is of significant
Progress on IYCF has been chal-
mortality. Despite significant progress concern affecting an estimated 41 per
lenging. Despite an estimated 98 per
made on addressing stunting with a cent of women of reproductive age and
cent of all children 0-59 months being
reduction of one third in the prevalence 30 per cent of children aged seven to
breastfed, just 58 per cent of children
across the country from 60 per cent in 12. Half of children aged six-59 months
are exclusively breastfed for the first
2010 (Afghanistan Multiple Indicators were found to be vitamin-A deficient.
six months of life. Survey results also
Survey 2010, p 5) to 38 per cent in Rates of anaemia are estimated at 40
indicate that young children receive a
2018 (Afghanistan Health Survey 2018, per cent for women of reproductive age
monotonous, cereal-based diet limited
p 48), malnutrition is persistent and and 45 per cent for children aged six-59
in diversity and lacking in adequate
widespread across Afghanistan in months, while 47 per cent of women
nutrients for optimal growth. This is
all its forms, with major differences aged 15-49 are anaemic.
likely not entirely due to a lack of avail-
across geographies.
The factors leading to malnutrition in ability of food but to unequal access
According to the Nutrition Cluster, an Afghanistan are complex and multi- within the household.
estimated 2.9 million children under dimensional: ongoing humanitarian
five (about 1 in 3 children) are acutely crises, chronic underdevelopment,
malnourished, including more than weak investment in basic services and
780,000 who are suffering from severe other socio-economic factors such as
acute malnutrition (SAM). Out of 34 the poor status of women. This leads
provinces, 26 are currently above the to a lack of access to health care, poor
emergency-level threshold of acute immunization, low levels of sanitation
malnutrition of 15 per cent. The poor and a high incidence of diarrhoea and
nutritional situation was aggravated poor care practices. These factors
Figure 1: Prevalence of global acute malnutrition in Afghanistan – June 2020
6 Afghanistan Case study
© UNICEF/UN0339436/Dejongh
Despite progress in recent years, the community has supported the scale-up with a community-based nutrition
coverage of health services remains of nutrition services and has provided package. However, the implementation
insufficient as are the preventive funding for the ready-to-use therapeutic at scale of all these nutrition services
interventions and the investments in food (RUTF) pipeline, however gaps has been challenging. Indeed, on top
nutrition, in a particularly challenging remain and almost 50 per cent of SAM of resource-mobilisation issues, the
operating environment. cases remain without access to IMAM coverage and the quality of nutrition
services. One of the main reasons for services is severely constrained by
The Integrated Management of Acute
the disparities in coverage of IMAM ser- limited human and physical resources,
Malnutrition (IMAM) is integrated in
vices is the necessary gradual nature the lack of capacity development at
the Basic Package of Health Services
of the scale-up process, which is not scale, poor supervision of the commu-
(BPHS) and Essential Package of
possible because of a lack of resources nity health workers (CHW) network,
Hospital Services (EPHS) that do not
as well as the difficulties to access lack of incentives to the CHW, poor
cover the whole country. Although all 34
hard-to-reach areas, due to persistent infrastructure and insecurity.
provinces of Afghanistan are imple-
insecurity and poor infrastructure.
menting IMAM services as of December
2019, 38 per cent of all health facilities The BPHS also includes some
in Afghanistan currently do not provide preventive nutrition services, such
IMAM services for SAM children and 55 as growth monitoring and promotion
per cent for moderately acutely mal- (GMP) and support for IYCF and
nourished children. The humanitarian maternal nutrition, and is associated
Afghanistan Case study 7
Despite being the main
recipient of development
assistance from DAC countries,
Afghanistan’s investment in
nutrition remains very low
In 2018, the OECD Development Assis- Afghanistan received more than US$57 decentralised institutions. This massive
tance Committee (DAC) donor coun- billion in ODA during the period 2001- financial flow has created a rentier econ-
tries committed almost US$2.7 billion 2015. However, the massive amount omy, which is highly diverse but also
towards the development of Afghani- of aid has had only a limited impact on highly dependent on external financing.
stan. This amount is 6 per cent lower poverty reduction and social indicators,
In recent years, significant development
compared to 2017 and it seems this partly because a large portion of the
funding has been provided to the health
decreasing trend is continuing. Over the assistance went to the security sector.
sector, which has supported the scale-up
past 10 years, Afghanistan has been The assistance is also managed through
of community and facility-based nutrition
consistently the greatest recipient of a highly centralised system, which
services, as part of the overall support to
official development assistance (ODA) has hampered the development of
health services in the country.
from DAC countries.
Table 1: Top 10 recipients of ODA from DAC countries - 2018 (USD, m)
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Afghanistan 5,132.2 5,546.3 5,937.5 5,603.7 4,259.2 4,023.2 3,584.3 3,150.5 2,830.6 2,660.9
Syrian Arab
62.1 44.4 78.4 501.3 1,732.5 1,597.5 1,824.6 2,467.0 2,566.3 2,504.4
Republic
Bangladesh 717.8 872.6 1,082.4 1,311.0 1,447.3 1,381.2 1,200.5 1,221.6 2,224.8 2,354.4
India 1,578.4 2,225.2 2,054.3 1,515.6 1,837.8 1,892.0 2,110.3 1,662.7 2,569.8 2,248.6
Ethiopia 1,818.3 1,856.8 1,929.7 1,798.6 1,913.6 1,914.0 1,854.4 2,049.2 2,206.6 2,061.4
Jordan 486.6 411.6 464.5 853.1 753.1 1,496.4 1,480.9 1,832.3 1,878.1 1,972.1
Iraq 2,629.4 1,994.3 1,814.0 1,113.7 1,343.2 1,131.5 1,202.6 1,890.3 2,278.9 1,961.1
Nigeria 688.3 846.0 852.2 895.0 1,138.7 1,061.9 1,124.4 1,227.3 1,742.9 1,724.4
Colombia 998.7 560.9 926.7 700.3 774.0 1,137.5 1,287.6 988.3 738.6 1,637.0
Kenya 1,224.9 1,156.8 1,563.7 1,668.7 2,018.4 1,601.9 1,496.0 1,387.9 1,502.9 1,537.1
Source: OECD
8 Afghanistan Case study
Although the Government has the Figure 2: Official development assistance to Afghanistan (USD, m)
overall oversight of the service delivery,
the majority of these services are
ODA Total (CRS) Basic nutrition (CRS)
contracted out to NGOs to manage 7.000
implementation. Across regions, the
1 2
NGO sector is critical for service 6.000
6
delivery in health but also other areas
5.000
of development and delivery of public 19
14
services such as agriculture and 4.000 12
9
education. Public services and project 20
3.000 34
interventions are undertaken through
partnerships between the central 2.000
government and NGO-implementing
1.000
organizations, often with the support
of international organizations such as -
5,889 5,896 5,537 4,198 4,008 3,771 3,370 2,941 2,678
bilateral donors, UN agencies and 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
the World Bank. This modality
Source: OCDE CRS
redresses the limited capacities of the
public sector in terms of human and
financial resources and access Humanitarian Aid Total (FTS) Nutrition (FTS)
to remote communities. 1.000
31
900
The amount of ODA dedicated to the
800
nutrition sector remains very low. The 6
data from the 2014 System of Health 700
40
72 68
Accounts (SHA) show Afghanistan 600
26 47 34
spent about $97 million or $2.00 per 500 42
28 21
capita on nutritional disorders. Only 400
a small proportion of this funding 300
came from government – $820,000 or
200
$0.02 per capita came from the public
100
budget. The rest of the funding, $95.9
731 895 516 526 510 424 524 396 542 614 392
-
million, came from development part-
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
ners ($56 million or $1.62 per capita)
and out-of-pocket expenditure ($39.9 Source: OCHA FTS
million or about $1.15 per capita).
The country is also facing a dire and
worsening humanitarian situation. A
major food crisis in the early 2000s led Table 2: Afghanistan’s investment in nutrition – 2019
to a massive humanitarian intervention.
Only one nutrition-investments-tracking 2019 Nominal upper-bound
exercise has been done so far. The
AFSeN-A analysed the investments in Amount (USD) Per capita (USD)
nutrition in 2019 across 82 nutrition-rel-
evant programmes overseen by
Nutrition-specific 4,906,666 0.13
13 ministries, departments and
agencies (MDAs).
It found that the proportion of interven- Nutrition-sensitive 153,529,118 4.04
tions under the multisectoral strategic
framework – the AFSeN-A – with Total 156,835,784 4.16
funding, was only slightly higher than
10 per cent. In 2019, the Ministry of
Source: Nutrition Investment Snapshot 2019
Public Health (MoPH) experienced a
budget cut of 30 per cent.
Afghanistan Case study 9
The AFS N-A was
launched in 2017
The development of a multisectoral As well as the five-year strategic y Financial resources from UNICEF,
approach for nutrition in Afghanistan plan, the AFSeN-A is supported by WFP and FAO totalled almost
started in 2012 with support from the an advocacy plan and a coordination US$500,000 over two-and-a-half
Food and Agriculture Organization structure involving focal points at each years). IHSAN/FHI3603 also
(FAO), United Nations Children’s core ministry and agency, from the UN, supported the creation of the
Fund (UNICEF) and the World Food private sector, donors and civil society. provincial committees.
Programme (WFP). Several attempts at The strategic plan has been translated
y Technical assistance from MQSUN+,
policy development were made. Despite into local languages and endorsed
consultants mobilized by the different
efforts by UN and international non-gov- by the Government. The AFSeN-A
partners, IHSAN, FANTA
ernmental organizations (INGO) strategic plan provides a shared
nutrition staff to raise awareness of understanding of the food-security and Until then, the functions of the AFSeN-A
nutrition needs across multiple sectors, nutrition situation, stipulates a long-term have been conducted regularly. Those
no significant impact was made outside vision with nine strategic objectives functions include:
the work done by the Ministry of Agri- aligned with Afghanistan’s sustainable
y High-level steering committee
culture, Irrigation and Livestock (MAIL).1 development goals (SDGs), spells
meetings twice a year since May
Malnutrition continued to be considered out the roles and responsibilities of
2018, led by the chief executive, at
a health issue, with the MoPH leading government and non-government
ministerial level
nutrition programming. stakeholders and identifies specific
interventions and results. y Regular meetings of the executive
It took an alignment of factors, such as
committee since November 2017, at
the Lancet publication in 2013 and The AFSeN-A has a technical secre-
deputy ministry level
the Copenhagen Consensus in 2015, to tariat, previously located in the Chief
progress. In 2017, the visibility and the Executive Office and now to move y Regular technical committee
political commitment behind the nutri- to the administrative office of the meetings since November 2017: the
tion agenda reached a tipping point with President.2 The Director-General of food security working group chaired
the election of the Unity Government. Afghanistan’s Council of Ministers’ by MAIL, the nutrition working group
Under the leadership of Chief Executive Secretariat was serving as the SUN chaired by MoPH, the advocacy and
Dr Abdullah Abdullah, the multisectoral political focal point until this change. public awareness working group
platform AFSeN-A was launched and The coordinator of the Technical chaired by MoCI4
Afghanistan joined the SUN movement Secretariat serves as the technical focal
in October 2017. Subsequently, the point. The Technical Secretariat for
AFSeN-A five-year strategic plan AFSeN-A received substantial support,
(2019-2023) was developed as a stra- from its creation in October 2017
tegic framework aimed at addressing through to April 2020.
hunger, food security and nutrition. The
This support played a crucial role in the
adhesion to the SUN movement and
promotion of the multisectoral approach
AFSeN-A was directly supported by Dr
to nutrition, its visibility and its ability to
Abdullah until the government reshuffle
mobilise political commitment:
in May 2020.
1
Prior to the creation of AFSeN-A, the Ministry of 2
While waiting for this change to take effect, 3
IHSAN is the Integrated Hygiene, Sanitation and
Public Health and Ministry of Agriculture, Irrigation the functions of the Technical Secretariat and its Nutrition project supported by USAID, which ended
and Livestock were primarily responsible for financial support officially suspended, but the staff in May 2020.
programmes related to food security and nutrition. continued their coordination work.
4
Each supporting UN agency, the FAO,
UNICEF and the WFP, cochairs one of the three
technical committees
10 Afghanistan Case study© UNICEF/UNI358977/Fazel
Afghanistan does not have its own The current functional issues of the such. Some interventions, under the
SUN UN network, but UN agencies Technical Secretariat are raising sectoral policies and plans, are funded,
contribute to nutrition improvement questions on its sustainability and, if representing around 10 per cent of the
via the Development Partners’ Forum. unaddressed, could lead to renewed overall plan, as mentioned above. It
There is an acknowledgement within leadership ambitions and competition. therefore requires massive strategic
Afghanistan that specific UN agencies Commitment from the transversal min- advocacy to increase nutrition financ-
(FAO, UNICEF, WFP) and the Civil istries (such as information, religious ing. Moreover, no information is avail-
Society Alliance (CSA) have played affairs, finance) is still difficult to secure able on the level of disbursements and
a critical role in supporting the Gov- and the current functional issues faced implementation, representing a major
ernment to advance the multisectoral by the Technical Secretariat could have concern in terms of accountability.
nutrition response. an impact on their level of representa-
tion, participation and the operationali-
The AFSeN-A platform involves 18
sation process.
ministries and four authorities. The
participation and engagement of the It is important to mention that all sec-
ministries grew progressively as the toral policies predate the AFSeN-A and
multi-stakeholder platform mandate its strategic plan. While the AFSeN-A
and shared responsibilities were better took into account the existing sectoral
understood. However, the level of policies, those have still to be updated
participation continues to vary across for the AFSeN-A strategic plan to be
ministries, as does the understanding effectively translated into actions and
of the multisectoral nature of nutrition budget lines.
and its causal pathways. The specific
The AFSeN-A strategic plan (2019-
roles and focused interventions of
2023) launched in 2018 has indeed
each ministry were established at the
not started to be implemented as
inception of the MSP.
Afghanistan Case study 11Shock sensitivity of government policies
related to nutrition remain limited
Nearly four decades of conflict, coupled Aid continues to be largely provided by BPHS services to populations in need,
with climate change and environmental international organizations and NGOs, including during disasters and in disas-
degradation make Afghanistan very with the support of a large network of ter-affected areas, but nutrition response
vulnerable to natural disasters, such as local organizations ensuring the field is not included specifically. They also
earthquakes, flooding and drought and implementation. After 15 years of mas- include an emergency preparedness
its population is very vulnerable to any sive development aid and humanitarian and disaster-management strategy.
shock or stress. assistance, Afghanistan has a relatively The BPHS document introduces a
well-developed aid architecture. flexibility clause to allow implementers
The risks posed by natural disasters
However, the ability of aid organizations to address variations between localities,
are often overshadowed by the more
to prevent and respond to disasters is local demand, and other local condi-
immediate and highly visible effects
often limited to the geographical areas tions requiring flexibility, (i.e., disaster
of conflict and poverty. However, in
where they have a presence and by response and mobile health teams) as
Afghanistan natural disasters affect on
short funding cycles. a way to ensure access to basic health
average a quarter of a million people
services in remote areas as well.
annually. (UNOCHA, 2017, p. 7). In The need to provide an appropriate
2018, the worst drought in decades response to disasters is reflected in the On the other hand, faced with a wors-
affected more than two-thirds of Afghan- Specific Objective 2 of the AFSeN-A, ening of the humanitarian situation, the
istan, devastating already-impoverished through specific interventions directly humanitarian community has developed
communities, reducing incomes by half. derived from the MAIL Food Security a multi-year strategy (2018-2021), rec-
The current COVID-19 pandemic is also National Strategy 2015-2019 (strategic ognizing the transition to development
expected to have a severe and lasting food reserve, preparedness and rapid programming. While the HRP 2020 does
socio-economic impact. According to the response) but is not mainstreamed not provide clear directions on the triple
UN (OCHA 2017, p. 6) an estimated 35 across sectors. Humanitarian issues, nexus (humanitarian, development,
million people (of a total population of disaster preparedness and response peace), which is only mentioned as
37.6 million) require a social safety net. have not been discussed regularly a cross-cutting issue, it clearly states
and systematically during AFSeN-A how humanitarian assistance links up
Despite this sensitivity to disasters,
executive meetings, and there are with development programming in the
disaster preparedness and response
still limited interactions between the nutrition sector, gradually scaling up
is not appropriately reflected in the
AFSeN-A and the humanitarian- nutrition services in priority locations,
sectoral policies, limiting the opportu-
coordination mechanisms. building capacities of the BPHS and
nities to provide an appropriate and
EPHS partners to respond during
comprehensive disaster response Sectoral policies constituting the foun-
emergencies, but also increasing its
and to create a humanitarian-develop- dations of the AFSeN-A do not cover
investment in prevention. This includes
ment nexus. While provinces are receiv- disaster preparedness and manage-
the promotion of social-protection
ing training in developing preparedness ment, except for the National Social
mechanisms to improve nutrition linking
and response plans, these might not Protection Policy (2014) and the latest
with development actors.
systematically include a nutrition compo- National Health Policy (2015-2020).
nent, and their implementation can be The National Health Policy highlights
further strengthened. maintaining services and extending
12 Afghanistan Case studyHumanitarian-Development
Nexus could become a reality
While the awareness of the triple nexus still very much perceived as a “human- contracted by the MoPH through the
is being raised in Afghanistan through itarian intervention” or an “emergency multi-donor development trust fund
the One UN, OCHA and the clusters, response”, mainly due to the nature of the Sehatmandi project.5 These
the understanding of the nexus and of its funding and the preponderant partners are responsible for providing
its particular nutrition outcomes is role played by NGOs in the delivery of primary and secondary healthcare
still uneven among stakeholders and nutrition services. services – including nutrition services
between the national and the sub-na- – routinely and during an emergency,
For example, despite the treatment
tional levels. While the intersection of but treatment products are not included
for SAM being part of the package of
humanitarian and development pro- in the package. As a result, RUTF is
BPHS/EPHS, the nutrition therapeutic
gramming around the scale-up of the mainly financed by the humanitarian
products (RUTF) are not included in the
IMAM is intuitively creating a human- sector regardless of whether the
Government’s essential-drugs list and
itarian-development nexus, there are location is a district prioritised for
are not financed through the BPHS/
very few other areas of convergence. humanitarian action.
EPHS. BPHS and EPHS partners are
Formulating a shared vision of the HDN
for nutrition and defining its practicali-
ties are challenges not yet fully tackled.
This is further undermined by:
y Nutrition-specific interventions
The COVID-19 crisis response
being still largely considered as
emergency responses Due to its magnitude, the current COVID-19 crisis revealed dramatic gaps
y Disaster response being largely in the aid system and in the public services for disaster preparedness and
delegated to international assistance response. A few examples were gathered during the study.
and organizations The crisis highlighted the lack of disaster preparedness and contingency
y The absence of prevention planning in many public services/ministries, hampering the continuity of
interventions at scale essential services but also timely, comprehensive response plans. Crisis
impacts are therefore neither mitigated nor responded to, increasing
Analysis of past years’ responses the risk of diverting resources from crucial development programmes –
shows more than half of all children aimed at reducing poverty and food insecurity – to potential responses to
with acute malnutrition live in areas immediate needs.
not prioritised for assistance by the
HRP and therefore receiving limited The crisis also clearly disrupted the daily service delivery and programme
assistance and services. The per- supervision, undermining past efforts and investments and generating a
sistently high levels of undernutrition competition between the COVID-19 response and routine activities.
highlight that undernutrition is not only On the other hand, it was reported that it also provided more opportunities
a result of shocks and emergencies to work through a multisectoral approach and to kickstart joint humanitari-
but induced by chronic deprivation and an-development programming, due to the magnitude of the crisis, as well
under-development. However, nutrition as prompting innovative approaches to cope with access issues.
treatment, and the specific needs of
infants, adolescents and women, are
5
The development objective of the Sehatmandi
Project for Afghanistan, supported by the World
Bank, is to increase the utilization and quality of
health, nutrition, and family planning services
Afghanistan Case study 13© UNICEF/UNI119758/Noorani
This set-up is complemented – through space for actors across humanitarian-
mobile teams and a surge system – to and development-assistance sectors
provide a timely response to emergen- to undertake a prioritisation exercise to
cies/shocks in terms of health services, cope with the scarcity of the resources.
including nutrition treatment and coun- The promotion of a full multisectoral
selling. However, the other deprivations package is indeed currently not realistic
resulting from a disaster and impacting in a resource-scarce environment.
on the nutrition status, such as access
There is a generally shared understand-
to water and nutritious food, remain the
ing of nutrition needs and a consensus
responsibility of impoverished commu-
on the need to prevent malnutrition, but
nities or NGOs highly dependent on
limited consensus among stakeholders
resource-mobilisation mechanisms.
on how to prevent malnutrition and
AFSeN-A is providing an opportunity to where to start, despite a great deal
scale up the implementation of nutri- of nutrition-security and longer-term,
tion-sensitive interventions and the pre- nutrition-prevention programmes
vention of malnutrition in all its forms. implemented over the years. There
However, the main sources of funding is unfortunately no coordination or
for nutrition remain humanitarian funds systematic mapping (geographic
and health-sector financing (Nutrition distribution, scale and resources) of
Investment Snapshot 2019, p. 3), which such programming. Local knowledge
are largely treatment focussed. When and humanitarian-assistance expertise
it comes to prevention interventions, could however be leveraged to fill
there is no curation of evidence for part of this gap.
the effectiveness of nutrition-security
programming, nor is there dedicated
14 Afghanistan Case studyThe role of the
coordination mechanisms
Despite increasing dialogue and areas Technical committees have been set up the level of participation and engage-
of convergence, the coordination as part of the AFSeN-A. For example, ment is also impacted by the lack of
mechanisms are still working very the Nutrition Working Group met every operationalisation, an action plan and
much in silos, and humanitarian and month until March 2020, chaired by the visible results. The committees are
development actors are interacting on MoPH and co-chaired by UNICEF and supposed to work through small task
different platforms. the Ministry of Education (MoE). Techni- forces within the ministries, preparing
cal working groups have a small number proposals and budgets to be presented
Opportunities for bridging this gap exist.
of active members. They offer a space to the executive committee, but it seems
The NGOs and the UN agencies are
to discuss issues but are limited in their this function is not active.
often double-hatted and are involved
ability to generate proposals and results.
in both humanitarian and development AFSeN-A provincial committees were
According to the interviewees, the repre-
programming. However, the structure also established between 2018 and
sentation in the technical committees
and the dynamics of the coordination 2020 but are not yet functional. It
is not senior enough. Representatives
mechanisms do not provide sufficient requires another round of sensitisation
often face competing priorities, which
flexibility and incentive for these oppor- by AFSeN-A. However, in each prov-
impact on their presence and level of
tunities to materialise. ince, pre-AFSeN-A food and nutrition
participation. According to interviewees,
committees remain functional, providing
monthly needs updates
and gathering representatives from
different sectors.
The Nutrition Cluster (NC) is providing
a forum to exchange information and
coordinate nutrition responses with
a focus on nutrition treatment and
associated activities, such as IYCF in
emergencies. It has a large membership
(45 members) including many national
organizations. Despite very blurry lines
between humanitarian and development
programming when it comes to nutrition
treatment, the representation is mainly
ensured by humanitarian staff. The level
of participation is uneven and depen-
dant on funding streams, especially
for national organizations relying on
funding cycles as short as three months,
to support their core functions and
representation in coordination forums.
The agenda of the NC is highly depen-
dent on the rhythm of emergencies and
the resource-mobilisation calendar.
© UNICEF/UNI119758/Noorani Afghanistan Case study 15The strategic advisory group (SAG) is over resources, leading to overprotec- programmes is ensured by NGOs
playing its role in providing strategic tion of its mandate, its relationship with (international, national and many local).
leadership, but prioritisation and plan- selected governmental departments and They are largely represented at sub-na-
ning, resources and capacities within agencies and its geographical area of tional level but under-represented at the
the cluster members are not always influence (flag-planting), which under- national level and in national initiatives.
sufficient, and informants regretted not mines joint action and programming The national and local organizations are
being able to cover more strategic topics and reinforces the silos. The inter- usually present only in a few districts
during the NC meetings and exchanges. cluster coordination on nutrition, despite or regions. Due to the small scale of
aiming to provide a framework of joint their projects, their financial turnover
Despite dedicated resources for a Nutri-
planning and programming, is not is low and irregular and they need
tion Cluster Coordinator (NCC), the NC
playing this role and is limited to the to mobilise additional resources to
coordination has suffered from a gap of
exchange of information. support their capacity building and to
a dedicated NCC between November
ensure their participation in coordination
2019 and March 2020 and this role was According to interviewees, several initia-
mechanisms and the Multi-Stakeholder
covered by the cluster co-lead. tives for nutrition – overlapping human-
Platform. When sufficient resources are
itarian and development interventions
At the sub-national level, the coordi- available, they could play key technical
and mandates – are being supported
nation is regular and focuses on the and strategic roles, thanks also to
by the ONE UN joint advocacy (e.g.,
exchange of information to cope with their broader mandate often working
IMAM and IYCF scale-up) but are falling
operational challenges, avoid overlaps, across sectors.
short of dedicated staff to support the
maintain the supply chain for nutrition
convergence between humanitarian It is only recently (early 2020) that the
products and resource mobilisation. Ad
and development programmes and joint interactions between the AFSeN-A and
hoc meetings are organised to coordi-
programming in general. the Nutrition Cluster started but they
nate emergency responses when
have been limited by the COVID-19
a crisis occurs. Insufficient access to resources is
crisis and the AFSeN-A institutional
impacting the capacity of some orga-
The fact that the cluster at national and issues. The NCC, Famine Early Warning
nizations to participate in coordination
provincial levels is very focused on Systems Network and its integrated
mechanisms and to support joint
implementation coordination, avoiding phase classification have been partici-
activities and programmes. While the
overlap and resource mobilisation also pating in the AFSeN-A committees since
UN agencies are having a predominant
hinders the capacities for dialogue early 2020 and the AFSeN-A Technical
role in the nutrition agenda – through
with government and to support the Secretariat in the NC meetings.
their capacity to mobilise and manage
transition between humanitarian and
large human and financial resources
development-led interventions. Another
– the implementation of activities and
major barrier is the enduring competition
© UNICEF/UNI309866/Dejongh
16 Afghanistan Case studyConclusions and recommendations to the
SUN movement and the Nutrition Cluster to
strengthen the Humanitarian-Development
Nexus for nutrition in Afghanistan
Afghanistan has been able to develop The study observed that the coordina- The NCC, SAG and AFSeN-A Techni-
an MSP (AFSeN-A) and an MS policy tion mechanisms structured around spe- cal Secretariat should:
and strategic framework very swiftly cific objectives, strategies and activities
y Review the organization of the
after joining the SUN movement. were more accountable, more inclusive
Nutrition Cluster and Nutrition
However, this strategic framework and more dynamic. Each committee,
Technical Group to organise joint
still needs to be translated into action. network or technical group should report
meetings (including frequency,
Humanitarian and development systematically on their annual plan
agenda, membership, action plans)
activities are often co-located, meaning implementation. The annual plan should
humanitarian and development actors be based on specific and achievable y Identify thematic and working
could easily combine their capacities, priorities (few rather than many). priorities and define shared
experience and knowledge to support annual objectives/outcomes and
The membership should be devolved
sub-national planning, mapping and report accordingly
to a set team, rather than to individuals,
implementation of the AFSeN-A and to
to cope with workload, turnover and y Establish sub working groups
enhance national and local capacities
political change. It could also help corresponding to needs to work on
to anticipate and respond to disasters to
in managing egos, which often under- HDN priorities
sustainably reduce humanitarian needs
mine collaboration.
and malnutrition in all its forms. Stronger The GNC/SMS-GSS should:
inclusiveness would also facilitate the Of utmost importance is the role of the
y Support the NC and the SUN focal
mobilisation of more resources, support coordinator/facilitator dedicated to the
point to advocate to mobilise the
and capacities. role, who should have a background in
required technical assistance
both development and humanitarian/
and/or resources
emergency response.
1.
Promote joint coordination
platforms for humanitarian
and development partners
for nutrition
© UNICEF/UN0339431/Dejongh
Humanitarian and development actors
should have a platform to exchange
information. Acknowledging the limited
resources stakeholders have, instead of
creating a new coordination mechanism,
it is proposed to organise joint sessions
of the AFSeN-A nutrition working group
and the Nutrition Cluster. Task forces
could then be created to support timely
action, as defined, to support planning
and implementation of the AFSeN-A.
Afghanistan Case study 172.
Develop further the common the HDN is effective and risks diluting The Nutrition Cluster, SAG and SUN
narrative on the HDN for specific nutrition objectives and the government focal point should:
nutrition in Afghanistan shock-responsive aspects of the HDN.
y Agree on immediate actions to
The theory of change should identify
engage Nutrition Cluster and
which nutrition outcomes to target
The triple-nexus approach is a UN-led AFSeN-A members on creating an
– through a strengthened HDN for
process that needs to be disseminated HDN for nutrition (presentation of the
nutrition – and which changes it
more widely at national and sub-na- case study and its recommendations
wants to see.
tional levels and needs to include in joint meetings, participation in
all humanitarian, development and This should then be translated into webinars, sharing existing guidance,
government actors. specific actions and programmes, engaging members to participate
within the frameworks of the HRP and in nexus information sessions
Stakeholders working at sub-national
AFSeN-A, prioritised according to effi- organised by UN agencies)
levels should be systematically involved
ciency and/or feasibility criteria. Specific
in all activities related to HDN building y Use opportunities to integrate HDN
entry points have been mentioned,
as the main implementers and in planned trainings and events, at
such as the transition and continuum
first responders. This also requires both central and local levels
from humanitarian to development
sufficient capacity building and
programmes, including: reclassifying y Organise joint specific sessions to
resource mobilisation.
the humanitarian nutrition caseload into identify outcomes to achieve through
Based on the work already documented a development caseload; increasing the a strengthened HDN for nutrition, a
(articles, presentations), stakeholders service coverage and the coverage in timeline and what needs to happen/
should be invited to work together on hard-to-reach areas, identifying specific change to achieve these
developing a “theory of change”. Some support and resources (civil-military
y Develop a theory of change
interventions are implemented by both dialogue, adapting the profile of the
humanitarian actors and development/ mobile team, building capacities of local y Develop joint advocacy and
government actors, creating a “natural” organizations); enhancing systems’ resource-mobilisation strategies
blurred line between both. This is the shock-responsiveness; scaling up
y Organise sessions at sub-national
case with IMAM and IYCF. While it IYCF; infant, adolescent and women
level to improve the understanding
could create opportunities for building nutrition; and linking with social
of the HDN and identify specific
HDN, it creates a false sense that protection/safety nets.
areas of convergence and
collaboration. Include the relevant
local-government and non-
government actors
© UNICEF/UNI357134
The GNC/SMS-GSS should:
y Support the Afghanistan Nutrition
Cluster and the SUN focal point
with advocacy to mobilise the
required technical assistance
and/or resources
The SUN movement coordinator/SUN
leadership should:
y Share instructions and guidance with
the RC/HC and encourage country
leadership to embrace the nexus
concept and support the nutrition-
security agenda.
18 Afghanistan Case study3.
Support the implementation
of the AFSeN-A strategic plan Prioritisation Planning Resource
The multisectoral plan is very ambitious
but has not prioritised the effective level
of the resources devoted to nutrition. Implementation mobilisation
It is therefore important to prioritise
interventions that are relevant at the
provincial level, based on the evidence
generated by both humanitarian and Results Accountability
development partners. This should
create a virtuous cycle to mobilize
enduring commitments at the political,
finance and implementation levels:
3A. Leverage knowledge and y The promotion of a full multisectoral Prioritisation would focus
experience from humanitarian package, which is not realistic in on the identification of specific geo-
and local organizations a resource-scarce environment. A graphical locations and/or interventions
prioritisation is indispensable based and support implementation at the
on feasibility and efficiency criteria provincial level.
The expertise and experience
accumulated by humanitarian actors y Stakeholders/organizations’ The NCC, SAG and SUN technical
and grass-roots organizations are mandates, which hinder focal point should:
often underutilised. They need to efficient prioritisation
y Organise specific joint sessions,
contribute more effectively to the
Nutritional vulnerability is frequently a supported by the appropriate
prioritisation of interventions and
social construct (i.e., a result of social technical assistance and led by
strategic development.
characteristics that disadvantage and the AFSeN-A, to identify priority
The Nutrition Cluster should: disempower some groups, commu- interventions and geographical areas
nities, households, and household to start the operationalisation, based
y Share systematically the results of
members). The aid sector and, to a on feasibility criteria
assessment and surveys
lesser extent, the governments, are
y Define clearly the roles of
The SUN technical focal point structured around sector approaches.
humanitarian and development
and AFSeN-A technical working Organizations are often limited and
actors based on their
groups should: prejudiced by their own mandate.
comparative advantages
y Identify the gaps of information Support for analysis and multisectoral
y Include these priorities across the
and evidence and work with the response planning must be strength-
humanitarian multi-year planning and
other stakeholders on sharing ened by challenging the prejudices,
AFSeN-A planning
responsibilities and resources backgrounds and mandates of stake-
holders and organizations, and openly The GNC/SMS-GSS should:
analyse causal pathways, feasibility,
3B. Identify priorities to start y Support the SAG and the SUN
existing evidence and the potential
focal point to advocate to mobilise
the implementation nutrition impact of an intervention.
the required technical assistance
Stakeholders should be opportunistic and/or resources
While stakeholders acknowledge only
and instead of pursuing too many objec-
prevention interventions can sustain-
tives, identify specific entry points able
ably reduce humanitarian needs, the
to foster positive results. It could also
investments in nutrition-sensitive/pre-
help in coping with political changes
vention actions are hampered by:
that affect institutions and processes.
Afghanistan Case study 193C. Involve the sub-national lies only with specialised national already planned and written into their
levels and all organizations in institutions with very limited resources annual plans. However, the finalisation
the process and humanitarian organizations, mostly of the costing of nutrition-sensitive
international. The continuity of services interventions appears as a greater
The implementation of nutrition during a crisis and in conflict-affected challenge, since ministries do not have
activities and programmes are largely areas is not ensured. Building the experience with implementing these
ensured by NGOs (international, HDN requires shared responsibilities interventions. There is no clear protocol
national and local); however, they are on those aspects. Moreover, the first yet available, and limited experience of
under-represented partly due to the responders are often local communities public-sector members in the prepara-
weakness of the sub-national coordina- and local authorities that need to be tion of budget plans and the generation
tion, their limited capacities but also by empowered and resourced to provide of costs, required ingredients, etc. for
the way the representation is organised. an anticipated response to reduce the these types of activities that are not
impact of any disaster. traditionally part of their annual budget
At the sub-national level, the roll-out of
plans and public-sector work plans. As
the AFSeN-A and the development of The AFSeN-A Technical
a result, it was more difficult to assign
provincial implementation plans should Secretariat should:
a cost to nutrition-sensitive activities. If
be supported by the local organizations.
y Review the policies and interventions are prioritised, this should
They need a greater awareness of the
strategies as part of a joint be facilitated.
HDN, to share the joint vision/theory of
humanitarian-development working
change and the agreement on needs The AFSeN-A Technical Secretariat/
exercise, including the AFSeN-A
and priorities. They should therefore be SMS-GSS should:
strategic framework
involved in all the processes.
y Develop protocols and training on
y Use existing tools (NNP
The Nutrition Cluster and AFSeN-A the preparation of budgets,
checklist, CRF)
Technical Secretariat should: generation of costs and a country
The SMS-GSS/GNC should: adapted tracking system.
y Organise the representation of
the sub-national coordination y Support the AFSeN-A Technical y Conduct annual budget tracking
mechanisms to the national Secretariat to advocate to mobilize
The SMS-GSS/GNC should:
coordination. To identify the required technical assistance
representatives and support direct and/or resources y Support the AFSeN-A Technical
and remote participation Secretariat to advocate to mobilize
the required technical assistance
y Ensure that coordination 5.
and/or resources
mechanisms at sub-national levels Strengthen the accountability
have annual strategic objectives,
commit appropriate resources Interviewees highlighted that policies,
to achieve them and report/be strategies and programmes are not
accountable to them being financed, rolled out or imple-
mented, partly due to their lack of
y Support the mobilisation of resources
accountability. It is an important point to
to ensure inclusion and participation
take into account also for the operation-
of the civil society organizations
alisation of the HDN.
Indicators should be few, specific and
4.
measurable, preferably already col-
Enhance shock-
lected by the existing systems. Informa-
responsiveness and conflict- tion systems are generally constrained
sensitivity of development and not flexible. Requests for routine
policies and programmes information should be limited to the
minimum/existing.
Despite a high vulnerability to disas-
Annual budget tracking is mandatory
ters, conflict and climate change, the
to ensure accountability and to sustain
national policies, related strategies and
commitments. During the exercise con-
implementation plans are not suffi-
ducted on the 2019 budget, the study
ciently risk-informed. The responsibility
team found the ministries were easily
for disaster preparedness and response
able to get information on activities
20 Afghanistan Case studyAnnex 1:
Scope, methodology,
background and
documents referred to
during desk review
Scope Methodology
This report has been commissioned by the GNC and the SUN The study used a qualitative research design including
Movement Secretariat to capture experiences of crisis affected secondary data analysis and focus group and key informant
States and suggest options to strengthen the Humanitari- interviews. Interviews were conducted between July and Sep-
an-Development Nexus for nutrition outcomes. This document tember 2020. Individual anonymity was assured, and therefore
is based on three country case studies, Afghanistan, Myanmar identifiable positions have not been reported. Key informants
and Niger, and examines how humanitarian and development included representatives from central government institutions,
actors do and do not work together to improve nutrition. The UN, international and national NGO/CSO researchers, and
country case studies also offered the opportunity to involve key bilateral and multilateral donor agencies in both technical and
stakeholders in this critical review and to formulate, with them, managerial positions. The interviews were structured around
actionable recommendations. a set of questions to capture the specific experiences of the
interviewees. While interviews were semi-structured, the set of
The detailed findings and recommendations are compiled
questions were broadly uniform across countries.
in independent country reports, which were presented and
discussed with the key stakeholders in Afghanistan, Myanmar The desk component of the work consisted of a literature
and Niger. Additional insights were collected from Yemen and review. A search strategy was developed focusing on literature
contributors working across a large range of countries. related to multisectoral and sector approaches potentially con-
tributing to nutrition, including: policy and strategic frameworks;
The objective of the study is to identify and share examples
coordination mechanisms and frameworks; governance,
of good practice and to identify practical, country-specific
leadership and political economy; financing; information
opportunities and solutions, to strengthen the Humanitari-
and knowledge management; and programmes and initiatives.
an-Development Nexus for nutrition. The analysis is therefore
The search was limited to documents and information
not exhaustive but purposive. Only relevant aspects of the
published after 2010.
context and studied frameworks are presented. A particular
emphasis is given to the factors enabling collaboration and The methodology was adapted to the specific constraints
commitment to nutrition. imposed by the COVID-19 pandemic. All interviews and meet-
ings were held remotely using video-conferencing applications.
It limited both the choice of the informants and the level of
interaction with the informants:
Afghanistan Case study 21y The consultant could not use the service of a translator.
Only English or French-speaking informants were Background
interviewed, limiting the representativity of the sample in
Afghanistan and Myanmar. The country case studies, this global report and the associated
policy brief were commissioned jointly by the Global Nutrition
y The majority of the interviews were individual interviews.
Cluster and the SUN Movement Secretariat, engaged in the
y The meetings and interviews were limited to one hour, nexus building as a New Way of Working.6
acknowledging the fatigue related to remoteness. Additional
As a part of the humanitarian reform process, the cluster
questions and information were collected through email
approach was initiated in 2005 to improve the effectiveness
when necessary.
of humanitarian responses through greater predictability,
y The remoteness of the study made it less attractive to accountability, responsibility, and partnership. This included the
certain stakeholder groups. creation of the Nutrition Cluster, which has now been officially
activated in 24 countries. The GNC also supports in-country
y As much as possible, video was used to ease the personal
sectoral coordination mechanisms, as is the case in Niger and
interactions but the use of video remains limited, with many
in Myanmar – included in this study.
interviewees not being sufficiently equipped or connected.
The Scaling Up Nutrition Movement was created in 2010
y On some occasions, technical issues prevented the
to inspire a new way of working collaboratively to end mal-
interviews from being concluded.
nutrition in all its forms. It is now active in 62 countries and
While a wide range of stakeholders, across humanitarian, four Indian states. At the heart of the SUN movement is a
development and government workstreams were contacted, multi-stakeholder platform (MSP). MSPs are led and chaired
the study was limited by logistical and time constraints and by a government-appointed focal point and aim to bring
by stakeholders’ availability. The study was conducted over a together all nutrition stakeholders – including humanitarian
holiday period, when organizations experience a high turnover. actors – around the same table, to prevent malnutrition in all its
The availability of contributors was also limited by institutional forms, and therefore reduce humanitarian need.
issues, which were not mitigated in the short time of the study.
For this study, the Humanitarian-Development Nexus is
The findings of the study are therefore limited by these understood as the central point where humanitarian and
specific constraints and their validity limited to one particular development actors and programmes link up to address more
point in time. effectively the issues they are facing.
Nutrition in crisis affected states is often influenced by both
the poverty of the public services, protracted crises, recurrent
disasters and climate change. It therefore requires intensified
collaboration and focus and adaptive strategies that an HDN
© UNICEF/UN0339438/Dejongh could contribute to develop.
In those contexts, with the appropriate support and partici-
pation, Nutrition Clusters and MSPs can both contribute to
strengthening the HDN by supporting the identification of
areas of convergence and efficiency gains. The challenges
faced in crisis affected States call for an enhanced flexibility
of the traditional mandates and roles of the humanitarian and
development actors.
6
Strengthening the Humanitarian-Development Nexus was identified by the
majority of stakeholders as a top priority at the World Humanitarian Summit
(WHS) in 2016, including donors, NGOs, crisis-affected states and others,
and it received more commitments at the WHS than any other area. ‘New
Way of Working’
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