Case study Ethiopia

ETHIOPIA CASE STUDY Review of Nutrition Cluster Experiences and Learning for Transition (RFPS-USA-2014-501871)

PREPARED BY:

INTERNATIONAL SOLUTIONS GROUP Nutrition Expert and Author: Vivienne Forsythe PREPARED FOR:

UNICEF

Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

TABLE OF C ONTENTS List of acronyms ................................................................................................................................................................ 3 Acknowledgements.......................................................................................................................................................... 4 1.

Background on Nutrition Cluster activation ............................................................................................... 5

2.

Current status of Cluster in Ethiopia.............................................................................................................. 6

3.

Key informant/stakeholder understanding of Cluster transition and deactivation................... 6

4.

Influences of context ............................................................................................................................................. 6

5.

Encu relationships with various stakeholders ........................................................................................... 8

6.

Strategic decision-making process ................................................................................................................. 9

7.

Capacity of existing coordination mechanism ........................................................................................... 9

8.

Harmonisation of Nutrition reporting systems ......................................................................................... 9

9.

Workload of national-level ENCU ................................................................................................................. 10

10. Transition and deactivation process ........................................................................................................... 10 11. Recommendations for Ethiopia..................................................................................................................... 11 12. Learning with specific reference to Nutrition Clusters working in partnership with government ...................................................................................................................................................................... 11 Annex I: Key reference documents ......................................................................................................................... 12 Annex II: List of key informants............................................................................................................................... 12

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

List of Acronyms CLA CMAM DPPA DRMFSS ENCU EWD FAO FMOA FMOH GoE INGO KI MAM MANTF MoA MoH NNGO OCHA REACH SAM SUN UNICEF WFP WHO

Cluster Lead Agency Community-based Management of Acute Malnutrition Disaster Preparedness and Prevention Agency Disaster Risk Management and Food Security Sector Emergency Nutrition Coordination Unit Early Warning Department Food and Agriculture Organisation Federal Ministry of Agriculture Federal Ministry of Health Government of Ethiopia International non-governmental organisation Key informant Moderate acute malnutrition Multi-Agency Nutrition Task Force Ministry of Agriculture Ministry of Health National non-governmental organisation Office for the Coordination of Humanitarian Affairs Renewed Efforts against Child Hunger and Undernutrition Severe acute malnutrition Scaling Up Nutrition United Nations Children’s Fund World Food Programme World Health Organisation

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

Acknowledgements The Nutrition Expert for this assignment would like to thank everyone at UNICEF HATIS who were involved in this assignment and who gave so generously of their time and insights. The Nutrition Expert gratefully acknowledges the support of key stakeholders who took the time to meet virtually to share their perspectives and support the research on Cluster transition in Ethiopia. Additionally, the case study benefited from comments and discussions around the report from the Nutrition Reference Group for this assignment (Diane Holland and Josephine Ippe of UNICEF), which were also very helpful. The findings and opinions in this report are those of the Nutrition Expert and should not be ascribed to anyone else.

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

1. Background on Nutrition Cluster Activation Ethiopia has a well-documented history of drought, food insecurity, and nutrition emergencies going back for the last three decades. Drought has often been associated with poor production performance, poor pasture and water availability for humans and animals and humans. This has resulted in increased acute malnutrition of vulnerable population and considerable death of animals in some parts of the country. Limited sustainable recovery interventions, coupled with continuous loss of assets (animals), reliance on red fed agriculture on decreasing farm sizes has resulted in a situation where the poorest communities have depleted their capacities to cope and failure of the short- or long- term rains, triggers small- or large- scale food insecurity and nutrition emergencies in affected areas on an annual basis, especially in the six major regions that are prone to recurrent/cyclic droughts.1 As part of the Ethiopian Government strategy to address food insecurity and nutrition emergencies the Emergency Nutrition Coordination Unit (ENCU) was established in 2000 within the Early Warning Department (EWD) of the then Disaster Preparedness and Prevention Agency (DPPA) now the Disaster Risk Management and Food Security Sector (DRMFSS) under the Ministry of Agriculture (MoA). At inception, the ENCU was charged with fulfilling three major functions: a) Coordination of emergency nutrition assessments, quality assurance and response; b) Establishment of a Multi-Agency Nutrition Task Force (MANTF) for coordination, information sharing and discussion of technical issues among nutrition partners working in Ethiopia; and c) Collection and collation of reports and results of nutrition surveys conducted throughout the country and nutrition information database. The Cluster Approach was endorsed by the Government of Ethiopia (GoE) in 2007 and the Nutrition Cluster was activated at that time along with a number of other Clusters. The ENCU role was then expanded to include the core Functions of the Nutrition Cluster. In addition to its previous roles on coordination and quality assurance of emergency nutrition assessments, information management and dissemination, and coordination amongst partners, the ENCU assumed three new functions: a) Capacity strengthening of early warning system at federal and regional levels: b) Coordination of Nutrition Cluster activities; and c) Coordination of operational research on emergency nutrition assessments.2 Since 2007, along with the FMOA, the FMOH has also had a co-leadership role in the Nutrition Cluster.3

Ethiopia Cluster Lesson Learned Document Sept 2014 Field Exchange Special Publication on Ethiopia, Emergency Nutrition Network 2010 3 Cluster Performance Monitoring Report January 2015 1 2

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

2. Current Status of Cluster in Ethiopia The Nutrition Cluster in Ethiopia is currently active under the leadership of the Government and supported by UNICEF, and is composed of the ENCU and the MANTF. At the national level, the ENCU coordination team is located in DRMFSS sitting within the FMOA. The ENCU is composed of four staff seconded from UNICEF (one international and three national staff members) and one government staff member. The UNICEF-appointed Cluster Coordinator is the ENCU Team Leader. There are ten regions in Ethiopia and (subnational) ENCUs have been set up in six of the most vulnerable regions; five of the six regions have two staff members, one region has one staff member. These staff are technically government employees – although the salaries are funded by UNICEF.4 At the national level, the MANTF is made up of around 30 agencies including INGOs, NNGOs and church-based agencies; UN agencies, donors, and government institutions.5 ENCU reporting lines:6 At national level, within government, the ENCU reports directly to the Director of the Early Warning Report Directorate and to the Disaster Risk Management Technical Working Group and provides updates to the FMOH and the Emergency Public Health Institute with respect to emergency situation, assessment and responses. The ENCU also reports to OCHA through the inter-cluster working groups and to UNICEF as CLA. At subnational level the ENCUs directly report to the Regional Early Warning and Response and/or Health Bureaus with respect to administrative issues, but technically the regional ENCUs report to the Federal level ENCU. 3. Key Informant/Stakeholder Understanding of Cluster Transition and Deactivation There appears to be some lack of clarity and/or confusion around the term Cluster. On the one hand, key informants indicated that the term Cluster is rarely used in Ethiopia, and that instead people refer to the ENCU and the MANTF. The Humanitarian Requirement Document of 2015 makes reference to the ENCU, while on the other hand other key documents refer to the Cluster.7 It seems that the Nutrition Cluster, ENCU, and MANTF are terms that may be used interchangeably. 4. Influences of Context a) Nutrition Context The 1980s famine in Ethiopia resulted in many thousands of deaths and the destruction of livelihoods. While there has been significant progress since then, nevertheless, a significant proportion of the population of Ethiopia continue to live on or below the poverty line, food insecurity is widespread and rates of acute malnutrition are often at or above the international threshold that defines an emergency situation. Levels of chronic malnutrition are also high. Food and nutrition crises arising from the effects of drought, floods, fluctuations in the market and, at times, political instability are frequently faced. The Humanitarian Requirements 2015 document highlights that while the food security situation is expected to have improved for 2015, significant humanitarian challenges remain - with food aid required for 2.9 million and emergency nutrition interventions required for close to 2.5 million. Emergency nutrition interventions include the treatment of SAM (projected for 250,000 children under five years), screening of children under-five 4 Prior to 2012 these staff were seconded by UNICEF, but since 2012 these ENCU staff have been government employees,

with salary support from UNICEF. 5 Lessons Learned Document September 2014 and Cluster Performance Monitoring Report January 2015 6 Cluster Coordination Performance Monitoring Report - January 2015 7 Lessons Learned Document and CCPM document as referenced in footnotes 3 & 4

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

and pregnant and lactating women for malnutrition, micronutrient supplementation and deworming, nutrition assessments in hotspot woredas, and capacity building/strengthening of woreda-level nutrition capacities. b) Technical Programme Capacity and level of Political Commitment to Nutrition from the Government of Ethiopia and from UNICEF. The GoE has shown a high level of political commitment to addressing threats to nutrition and food insecurity and has a high level of technical programming capacity. Over the past 25 years, the GoE, with the technical support and budgetary assistance of many donors, UN agencies, non-governmental organisations and academic institutions has developed a wide range of national nutrition, food security, livelihoods and healthrelated policies, programmes and systems, which are driving nutrition and food security improvements and should ensure that the massive loss of lives and livelihoods seen at the height of the famine in the mid-1980s, doesn’t ever arise again. Under the FMOH, a National Nutrition Strategy was developed in 2008 and the National Nutrition Plan of 2008 was revised in 2013, illustrating the GoE’s commitment to addressing nutrition. Under the FMOA a Food Security Strategy was developed in 2007 and an Agricultural Growth Programme followed in 2010 – aiming (among other things) to increase food security and ensure accessible and affordable nutritious food for the population. UNICEF has had a long history supporting emergency nutrition in Ethiopia, including for nutrition assessments, early-warning, nutrition response and coordination activities. c) SUN and REACH Movements The Scaling up Nutrition (SUN) movement was established in Ethiopia in 2010, under the leadership of the MOH. Prior to its establishment a high-level multi-sector platform for nutrition already existed; however SUN is now working to strengthen this platform. The Renewed Efforts against Child Hunger and Undernutrition (REACH) movement was established in Ethiopia in 2010. Since its establishment, FAO, UNICEF, WFP and WHO have been developing joint workplans. d) Strength of the Nutrition Sector The nutrition sector in Ethiopia is composed of government, UN, INGO, LNGO and church based agencies and donors. While nutrition is situated within the FMOH (policies and operations) there is an understanding of the need for a multi-sector approach to address nutrition and a strategy that endorses and supports this approach. Overall the nutrition sector in Ethiopia as a whole is strong. Experienced national agencies and staff work alongside experienced international agencies. Over the last two decades Ethiopia has been open to piloting innovations and rolling out new evidence based approaches in nutrition. e) Disaster Recovery Policy A new Disaster Recovery Policy has been developed in Ethiopia. This will be housed within the Prime Minister’s office and with offices established in each of the respective technical line ministries. Currently the roll out of this policy is under discussion and there have been suggestions that the ENCU may move from the FMOA to the FMOH.

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

5. ENCU relationships with various stakeholders It was reported the working relationships between ENCU and the MoA and MoH had been very poor at one stage, with issues of lack of trust, poor communication, limited collaboration, and lack of transparency; and that this was due primarily to the approach and operational style of a previous Cluster Coordinator/Team Leader. However, the situation turned around in recent years with the appointment of a new Cluster Coordinator/Team Leader who worked hard to establish good relationships with government colleagues, working in an open and transparent fashion, communicating well with government colleagues, keeping colleagues updated on all relevant issues; and facilitating consultation. Over time trust was gained and mutual respect earned. Specific strategies employed by the Cluster Coordinator/Team Leader to foster good relationships included: 

actively facilitating government engagement in the various coordination processes



ensuring briefing of government staff on relevant issues prior to cluster meetings



ensuring regular activity updates



ensuring briefing of government staff prior to wider circulation of reports / key information



where appropriate, discussion of sensitive issues on a bi-lateral basis rather than in a large open meeting



creating and utilising opportunities to have informal discussion/interaction with government counterparts in addition to formal discussions

The ENCU engagement with both emergency and development implementing partners is generally good. All major agencies involved in emergency nutrition will be members of the MANTF at national level and many implementing agencies do both development and emergency work. For those agencies specifically focussing on development work, if they are supporting nutrition specific or nutrition-related activities the ENCU will be in touch at either national or sub-national level. According to the Lessons Learned Document (September 2014) there are around 30 Cluster partners including Government Institutions, UN agencies, NGOs, and donors. ENCU has excellent relationships with the UNICEF Nutrition Section. As CLA, UNICEF has provided an enabling environment for ensuring that coordination functions are fulfilled. This includes providing management and policy support, technical support including for national capacity building, support in sourcing funding for the Cluster, and through ensuring adequate number and expertise for coordination functions at national and subnational level and for UNICEF nutrition programme section staff. UNICEF has also played an active role as a partner (includes capacity building of ENCU and partner staff and plays an essential role in procurement/provision of various resources to implementing partners, including therapeutic product). To date the ENCU has not been engaging with the SUN at all. This would seem to be a missed opportunity for the Cluster, given SUN’s role to facilitate a multi-sector platform for nutrition actors. More understandably, the ENCU has not engaged with the REACH movement.8

REACH Movement is UN-focussed – so there would not be an expectation that the cluster or government coordination body would engage directly – although UNICEF as CLA could engage on ENCU behalf/represent position of ENCU. 8

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

6. Strategic Decision-making Process While the key operational agencies are involved in strategic decision-making, there is no formal Strategic Advisory Group. As issues arise the Cluster Coordinator/ENCU Team leader liaises with the MANTF and a small group will be nominated to deal with the issue(s), make decisions/give direction. The small group may be established through self-nomination and/or the Cluster Coordinator may propose individuals. It was reported that there was limited involvement of the MoH in strategic decision-making – other than with regard to CMAM-related activities – e.g. scaleup (which comes under routine health services). 7. Capacity of Existing Coordination Mechanism A Cluster Performance Monitoring Process was conducted in late 2014 and the report was finalised in March 2015. It was reported that there was a 76% response rate to the online survey with 84% of Cluster partners participating in the discussion around the results, which would seem to indicate a high level of interest/commitment on the part of the partners. Overall the CCPM report shows a well-performing mechanism and results following discussion with partners are as follows: CORE FUNCTIONS of the Cluster as articulated by IASC ONE

Supporting service delivery

TWO

Informing strategic decision-making for humanitarian response

Current capacity as per CCPM process 2014 Good 2.1 Good 2.2 Satisfactory 2.3 Good

Planning and strategy development

3.1 Satisfactory 3.2 Good 3.3 Good

FOUR

Monitoring and reporting

Satisfactory

FIVE

Capacity building in contingency planning / preparedness

Satisfactory – no national contingency plan, but agencies have their own

THREE

SIX

Advocacy Accountability to affected population

Satisfactory Satisfactory

8. Harmonisation of Nutrition Reporting Systems The ECNU in collaboration/consultation with the MANTF has worked hard to ensure harmonisation of nutrition reporting. The SAM reporting system is well established; partners and operational units submit to regional level, where it is compiled and then sent to Federal ENCU, The ENCU then does an analysis, submits to FMOH and informs partners at cluster meetings. “The ENCU does this on behalf of the FMOH” (KI). In terms of MAM reporting the ENCU is currently piloting the MAM reporting system in forty districts. Reports are submitted directly from partners to the ENCU. ENCU then compiles, summarises and does analysis and submits to FMOH and WFP and informs partners at cluster meetings. The ENCU is developing a data base for MAM reporting – which will be aligned to the existing SAM reporting system.

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

9. Workload of National-level ENCU The five staff members of the ENCU are fully occupied to fulfil core coordination functions, given the level of emergency nutrition programming in Ethiopia and the number of active emergency nutrition partners. Never the less, it was reported that the ENCU has taken on additional responsibility (on behalf of MOH) and that the workload is too much for the number of staff. 10. Transition and deactivation process The Nutrition Cluster in Ethiopia is not in a transition process and from the interviews conducted it would appear that there is currently no plan to transition or deactivate the Nutrition Cluster in terms of the classical definition of transition of responsibility for core functions from international to national leadership in the near future. “There are so many emergencies in Ethiopia there will always be a need (for Nutrition Cluster)” (KI). It could be interpreted that the Nutrition Cluster has already been transitioned or that the Nutrition Cluster doesn’t need to transition as it is already led by government. However, in reality the situation is that the while the ENCU sits within a government ministry, four out of the five ENCU staff members at national level are UNICEF employees, the Cluster Coordinator/Team Leader is a UNICEF staff member and the government staff member in the ENCU is not a senior official/not at Coordinator level. The ENCU functions as a cohesive unit/ almost semi- independently within the DRMFSS, the functions are not embedded into the core activities of the DRMFSS/FMOA. While it was reported that the FMOA does see the ENCU as part of the ministry, never the less engagement of senior staff in the ENCU is not so active.9 Equally with the FMOH, it was reported that while there is a good relationship between the FMOH and the ENCU, with open and transparent communication, nevertheless, FMOH active engagement within the ENCU is less than optimal. At subnational level – it could be argued that there has been greater transitioning, with the ENCU seconded staff now being under the direct employment of the government, with salary support from UNICEF, rather than being UNICEF seconded. To date there has not been any type of formal assessment of national capacity to fulfil coordination functions. It would appear that the intention is to continue with the current model – i.e. an ENCU within a government institution, with staffing from UNICEF. The perception is that this model works and emergency coordination will be required on ongoing basis – so the status quo should be maintained. There is also a perception that currently The Government does not have the capacity to fulfil this role. “Until government has the capacity to fulfil the coordination function there will be need for the cluster” (KI), There is appeared to be a perception that the Government would not take over the funding emergency coordination functions. The four UNICEF staff working in the ECNU at national level– (three national and one international) have fixed-term contracts. The fixed-term contracts clearly contributes to continuity of staff and consequently facilitates building trust with the MoA and MOH. Nevertheless it is likely that the fixed-term contracts also suggests a level of permanency – that these positions are not viewed as short-term temporary positions.

9

The MoA staff member is an Early Warning Expert, and would not be at the Coordinator level

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

11. Recommendations for Ethiopia Through the process of discussion on the location of the ENCU within government in the future, UNICEF should take the opportunity to discuss the future development/direction/ leadership of the ENCU in Ethiopia and how best to facilitate greater government active engagement in the ENCU. Potentially through embedding the functions within the specific sections of the FMOA and FMOH or through identifying specific sections within the MoA and MoH which the ENCU should work in partnership with for the various functions/activities. During this process the potential of formally establishing a Strategic Advisory Group with a mandate to oversee the work of the ENCU/MANTF should also be explored/advocated for. 12. Learning with Specific Reference to Nutrition Clusters Working in Partnership with government Housing the coordination mechanism within a government institution is clearly seen as advantageous – reportedly increasing trust between UNICEF and the government; and increasing government ownership of the mechanisms. According to the Lesson Learned Document of 2014, it was also considered to give an advantage in terms of advocating for high-level strategic and policy decisions to be made. It is however suggested that the current government leadership is perhaps more nominal than actual, and; that while placing the mechanism within a government institution is certainly recommended as good practice – it is suggested that embedding the specific functions within the core activities of the institution(s) would further enhance genuine government leadership and ownership of the coordination mechanism and increase government engagement in the activities of the ENCU and enhance sustainability of the functions. The emergency coordination mechanism in Ethiopia is composed of the ENCU and the MANTF. In Ethiopia the term cluster appears to be used inter-changeably with the ENCU and the MANTF. While the coordination mechanisms fulfil the Cluster Core Functions and operate in line with the Cluster Approach, based on partnership, the casual use of the terminology – complicates discussion on future direction, leadership and management arrangements of this mechanism. Stated need for continuation of the Cluster, may in fact mean need for continuation of emergency nutrition coordination functions, with UNICEF support. “We don’t talk about transition or deactivation of the Cluster here in Ethiopia – we have ongoing emergency nutrition problems in the country and the cluster will be required for some time” (KI). It is important to have clarity on the definitions of the terms in use – rather than the vague interchangeable use of terminology in Nutrition Cluster-related discussion. Development of relationships based on trust between UNICEF and government institutions takes time and requires particular set of competencies and skills (communication, negotiation, influencing, and diplomacy). It also requires a level of maturity on the part of the Cluster Coordinator, to operate in a respectful and culturally sensitive and appropriate manner with government and other partners.

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Review of Nutrition Cluster Experiences and Learning on Transition: Ethiopia

ANNEX I: Key Reference Documents Cluster Performance Monitoring Report, March 2015. Field Exchange Issue 40, Special Publication on Ethiopia, Emergency Nutrition Network, 2010. Humanitarian Requirements 2015, Joint Government and Humanitarian Partners’ Document, January 2015. Lessons Learned in Ethiopia, Nutrition Cluster Synthesis Report, Global Nutrition Cluster, September 2014. WASH Coordination Report, Ken Maskell, December 2014. ANNEX II: List of Key Informants The following individuals were interviewed as part of this virtual case study through Skype interviews:  

Isaack Manyama; Former Nutrition Cluster Coordinator at UNICEF Ethiopia Adam Bailes; Nutrition Specialist at UNICEF Ethiopia

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