Emergencies

Nutrition

CCC Commitments and Benchmarks

Commitments Benchmarks
Commitment 1

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

Policy  |  Tools
 
Benchmark 1

Coordination mechanism provides guidance to all partners regarding common standards, strategies and approaches, ensuring that all critical nutrition gaps and vulnerabilities are identified; also provides information on roles, responsibilities and accountability to ensure that all gaps are addressed without duplication.

Commitment 2

Timely nutritional assessment and surveillance systems are established and/or reinforced.

Policy  |  Tools
 
Benchmark 2

All emergency-affected areas have an adequate number of skilled IYCF counsellors and/or functioning support groups.

Commitment 3

Support for appropriate infant and young child feeding (IYCF) is accessed by affected women and children.

Policy  |  Tools
 
Benchmark 3

All emergency-affected areas have an adequate number of skilled IYCF counsellors and/or functioning support groups.

Commitment 4

Children and women with acute malnutrition access appropriate management services.

Policy  |  Tools
 
Benchmark 4

Effective management of acute malnutrition (recovery rate is >75%, and mortality rates are <10% in therapeutic care and <3% in supplementary care) reaches the majority of the target population (coverage is >50% in rural areas, >70% in urban areas, >90% in camps).

Commitment 5

Children and women access micronutrients from fortified foods, supplements or multiple-micronutrient preparations.

Policy  |  Tools
 
Benchmark 5

Micronutrient needs of affected populations are met: >90% coverage of supplementation activities, or >90% have access to additional sources of micronutrients for women and children.

Commitment 6

Children and women access relevant information about nutrition programme activities.

Policy  |  Tools
 
Benchmark 6

Communication activities providing information on nutrition services (including how and where to access them) and entitlements are conducted in all emergency-affected areas.

Technical Justification

The CCCs for nutrition aim to address major causes of nutritional deterioration and death by protecting the nutritional status of children and women, including their micronutrient status, and by identifying and treating those already suffering from undernutrition using evidence-based interventions and according to inter-agency agreements and existing inter-agency standards (e.g., Sphere Standards).

Globally, more than one-third of all under-five deaths are attributable to undernutrition, either as a direct cause of death or through the weakening of the body's resistance to illness. The risk of mortality from acute malnutrition is directly related to the severity of malnutrition. A child with severe acute malnutrition is nine times more likely to die than a well-nourished child. The harmful consequences of micronutrient deficiencies for women and infants include greater risk of maternal death during childbirth, giving birth to an underweight or mentally-impaired baby and poor health and development of breastfed infants. For young children, micronutrient deficiency increases the risk of death due to infectious disease and impaired physical and mental development.

Provision of fortified foods and micronutrient supplements is an integral component of the response. In addition, because breastfed children are at least six times more likely to survive in the early months, the support, promotion and protection of breastfeeding is fundamental to preventing undernutrition and mortality among infants in emergencies.

Programme Action

  • Preparedness
  • Response
  • Early Recovery

Preparedness

  • Clarify the responsibilities of UNICEF and its partners regarding nutrition in humanitarian situations; strengthen existing coordination mechanisms or, if unavailable, create them in collaboration with national authorities to ensure that the humanitarian response is timely and coordinated, and that it conforms to humanitarian principles and agreed-upon standards and benchmarks.
  • Support a multi-sectoral rapid assessment mechanism and format that includes priority nutrition information.
  • Ensure the availability of guidelines and capacity for conducting and reporting on rapid nutrition surveys and assessments; advocate for the inclusion of nutritional assessment and programme monitoring data in national early warning systems; and ensure availability of key nutrition baseline data (including data on pre-existing malnutrition and disease prevalence and feeding practices) to inform response.
  • Establish integrated guidelines for management of acute malnutrition; assess coverage of existing services for management of severe acute malnutrition (SAM) and establish a contingency supply and distribution plan.
  • Establish guidance on micronutrient supplementation and set up partnerships to implement emergency micronutrient activities. Form a contingency plan and mechanism for procurement and distribution of all necessary supplies for emergency micronutrient interventions (vitamin A, iodized salt, multiple micronutrient supplements), including stockpiles or standby arrangements with providers of micronutrient supplements.
  • Advocate for and provide guidance on appropriate quantities of quality complementary foods to add to the food basket; define essential infant and young child feeding (IYCF) interventions in emergency scenarios; develop, translate and pre-position appropriate materials for IYCF; and include emergency IYCF in ongoing training of health workers and lay counsellors.
  • Map community capacities and existing communication channels to identify the most effective ones for nutrition information, and draft appropriate nutrition messages to be incorporated into multi-sectoral communication initiatives.
  • With Supply and Logistics, prepare supply plans, distribution strategies and long-term agreements where this is possible locally.

Response

  • Strengthen and/or establish a nutrition cluster/inter-agency coordination mechanism to ensure rapid assessment of the nutrition sector; prepare a nutrition cluster/inter-agency plan of action and coordinate the implementation of a harmonized and appropriate response to address all critical nutrion gaps vulnerabilities identified in the rapid assessment including for children and women.
  • Undertake a multi-sectoral rapid assessment, including key priority information for nutrition, within the first week of an emergency, and a rapid household-level nutrition assessment within six weeks.
  • Monitor unsolicited donations, distribution and use of breast milk substitutes or milk powder, and take corrective action.
  • In collaboration with the World Food Programme, ensure appropriate management of moderate acute malnutrition for children and supplementary feeding for vulnerable groups, including pregnant and lactating women, according to identified needs.
  • Support existing capacity for management of SAM for children at the community and facility levels, and initate and support additional therapeutic feeding as required to reach the estimated population in need.
  • Support and establish systems for community mobilization as well as for the identification and referral of acute malnutrition.
  • According to the context, ensure provision of high-dose vitamin A supplementation with vaccination for all children 6-59 months old, and deworm all children (12-59 months old) in collaboration with health sector workers.
  • Ensure that iodized salt is included in the emergency food basket. If this is not possible, and household consumption is less than 20 per cent, consider iodized oil supplement distribution for children 6-24 months old and women of childbearing age.
  • Ensure provision of multiple micronutrient preparations for children 6-59 months old -- unless fortified complementary foods are provided -- and multiple micronutrient supplements for pregnant or lactating women.
  • Protect, support and promote early initiation and exclusive breastfeeding of infants, including establishment of 'safe spaces' with counselling for pregnant and lactating women; support safe and adequate feeding for non-breastfed infants less than 6 months old, while minimizing the risks of artificial feeding; ensure appropriate counselling regarding infant feeding options and follow-up and support for HIV-positive mothers; and, with the World Food Programme and partners, ensure availability of safe, adequate and acceptable complementary foods for children.
  • Consult with the community for development and implementation of programme communication, and include relevant and evidence-based nutrition messages in all programme communication activities.
  • Identify and transmit supply inputs to Supply and Logistics.

Early Recovery

  • Ensure that nutrition coordination and action links to recovery and longterm development by applying sustainable technologies, strategies and approaches to strengthen the national nutrition sector capacity; link to existing national strategies and the early recovery cluster/network; and establish a reporting mechanism to inform decision-making..
  • Introduce, reinforce and/or adapt the nutrition information system (including routine monitoring of data from malnutrition management programmes, results of nutrition surveys and surveillance data) to facilitate national or regional situation analysis and decision-making for enhanced disaster risk reduction and prevention.
  • Initiate discussion on national policy, strategy and guidelines for sustainable management of SAM, if not already in place.
  • Ensure that micronutrient activities build on and support existing national capacities, and initiate discussion of long-term strategies to provide micronutrients and potentially incorporate new approaches introduced during the emergency.
  • Ensure that IYCF activities build on and support existing national networks for infant feeding counselling and support.
  • Adapt the communications strategy for nutrition activities for routine use in health facilities and outreach services, and consolidate such activities to increase coverage and respond to changing situations.
  • Initiate a gap analysis of local and national capacities and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

Guidelines and Tools

  Commitments
GENERAL
The Harmonized Training Package (assessment and all areas of nutrition in emergencies programming. Ppts available on Global Nutrition Cluster website), HTP, 2011 1 | 2 | 3 | 4 | 5
Toolkit for addressing nutrition in emergency situations English;French;Spanish;Arabic 1 | 2 | 3 | 4 | 5
E-Learning: Introduction in Emergencies- Basic Concepts, UNICEF, 2010 1 | 2 | 3 | 4 | 5
COORDINATION
Global Nutrition Cluster Hand Book, UNICEF, 2013 1
Gender and Nutrition in Emergencies 1
Nutrition Gender Marker Tip Sheet 1
ASSESSMENT
Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations, SMART, 2006 2
Training materials for SMART 2
Initial Rapid Assessment Tool, IASC, 2009 2
The Multi Cluster/Sector Initial Rapid Assessment (MIRA) Approach: Process, Methodologies and Tools, IASC, 2012 2
INFANT AND YOUNG CHILD FEEDING
UNICEF Facilitator Guide: the Community and Young Child Feeding Counselling Package, UNICEF, 2011 3
Infant and Young Child Feeding Counselling Cards for Community Health Workers , UNICEF 3
Indicators for Assessing Infant and Young Child Feeding Practices, WHO, 2010 3
Model Joint Statement on Infant Feeding in Emergencies 3
E-Learning: Infant and Young Child Feeding, WHO, 2010 3
ACUTE MALNUTRITION
Generic Guidelines and Job Aids for Community-Based Management of Acute Malnutrition (CMAM), Draft Version, FANTA, 2010 4
Community Based Management of Acute Malnutrition (CMAM) Costing Tool, AED, 2010 4
Moderate Acute Malnutrition: A Decision Tool for Emergencies in English[pdf] and French[pdf] 4
Guidelines for Selective Feeding: The Management of Malnutrition in Emergencies in English[pdf] and French[pdf];, UNHCR/WFP, 2011 4
Training Course on the Management of Severe Malnutrition, WHO, 2002 with update in 2009 4
Integration of IYCF Support into CMAM, Oct 2009 Facilitators Guide and Handouts in English and French 3 | 4
MICRONUTRIENTS
Programmatic guidance brief on use of Micronutrient Powders (MNP) for Home Fortification 5
COMMUNICATION
Media and Telecoms Landscapes Guide, Infoasaid 6