NGOs Share Field Lessons at Global Health Council

Steven Hansch

The 2002 annual meeting of the Global Health Council, primarily of NGO field staff, included more attention to food and nutrition than usual, due to the one-time conference thematic focus on "crises."  Held in Washington, DC the last week of May, the conference provided a common forum for people from several hundred different agencies to discuss the latest tools and techniques for assessment, program planning and implementation to reduce hunger.

One keynote speaker, well known in the humanitarian relief world for his decade as coordinator for the Centers for Disease Control and Prevention, Dr. Mike Toole, recounted the history of how aid agencies learned to anticipate the major priorities in relief operations.  Measles epidemic prevention, vitamin and mineral deficiency diseases and oral rehydration solution for diarrhea remain, to this day, consistent challenges; though cheaply and easily addressed, aid agencies too rarely deploy their staff or other resources to these primary care problems.

 Toole's successor at CDC, Dr. Brad Woodroff sparked controversy by arguing that even in complex emergencies, the classic two-stage random cluster sample methodology for nutrition surveys should be revised.  Based on recent experience among displaced persons camps in Afghanistan, Woodruff believes that within the lowest-level clusters, it is possible to generate household lists that can be selected through random number generation, not through the more common manner of spinning a bottle to determine which house to start with.

Traveling from England, and speaking from experience with Concern Worldwide, Dr. Stephen Collins talked about his novel strategy to provide community-based therapeutic feeding, a cheaper and more broad-coverage approach than the classic in-patient means of feeding severely malnourished children.  Collins is testing this model now with community health worker teams in several countries, including Malawi.

Mid-way through the conference, the Administrator of the United States Agency for International Development, Andrew Natsios, called attention to the current, ongoing health problems in Afghanistan, not only highlighting the still high under-five and maternal mortality rates, but arguing that the severe, four-year-long drought continues, meaning that basic water supply will pose an unprecedented risk of death over the next year to hundreds of thousands of Afghanistan's civilians, particularly in the southern provinces.

 In his presentation, Natsios quoted extensively from a new report produced by the Tufts Famine Center.  Based on field surveys this year in Afghanistan, led by Principal Investigator Sue Lautze, the report "Food Insecurity in Afghanistan 1999-2002" stresses that "the drought is not over," remains life-threatening, and underlines food shortages that continue to affect most of the country.  "Continuing currency instability is limiting goods available on markets, especially in rural areas where transportation problems generate costly delays between wholesale purchases and retail sales."  The authors argue that the greatest need is for aid that restores livelihood, such as livestock, and increase water supply.  "Food security will only result when Afghans are able to grow, buy or rely on their kinship networks for their own food and water needs."  Readers can access the full report from the Famine Center's website at http://www.famine.tufts.edu.

 Lessons from the reconstruction effort in East Timor were reflected on in another plenary presentation by former head of child health for WHO, Jim Tulloch, who served until April as the UN's Minister of Health in East Timor.  Dr. Tulloch advised that too much effort is spent conducting needs assessments (such as weight for height surveys of malnutrition prevalence) and too little effort is commonly devoted, at the earliest stages of intervention, to surveys that appraise the capacity of local health and feeding centers.  Tulloch urged aid workers in the future to move earlier to measure the health care system itself, including buildings, health posts, community referral systems in place and the specific needs for their repair.

 The last panel of the conference was focused on emerging forms of food security seen in the 1990s, including economic crises in former Soviet states and Southeast Asia.  World Vision presented a new software tool they developed in Indonesia that for the first time combines population-nutritional assessment (measuring, calculation of a child's anthropometric Z-scores), growth monitoring over time (sequential tracking of the same child), and food distributions.  This software will be piloted in other countries and may be a model other NGOs will use in the future to merge into one software database their monitoring of both nutrition and food distribution.

 At the same panel, the Aga Khan Foundation's child health coordinator, John Tomaro, described the extensive outreach his group has done to neglected, hard-to-reach, and food insecure regions of eastern Tajikistan, suffering many of the same drought and economic problems as in nearby Afghanistan.  In these areas, Aga Khan has weighed and measured all children and provided comprehensive food and integrated child health services.

 The final presentation of the conference was Alisher Ibragimov, of Abt Associates, who described the use of theater, TV-spots, radio and other social marketing techniques to increase the dietary consumption of iron-rich foods in the Fergana region of Uzebekistan and other parts of Central Asia where levels of anemia are high.  Abt found that television reached almost 95% of the target population, far ahead of other sources of outreach.  Uzkekistan and other Central Asian states have had decreasing food security during the 1990s, with economic ties with Russia and hyperinflation.  The Fergana valley region, a cross-roads of several countries, remains one of the flashpoints for possible future complex emergencies.

Steve Hansch is the editor of the Humanitarian Times and is an editor of Hunger Notes.

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