The UN System Standing Committee on Nutrition welcomes this public consultation and would like to give the following feedback on the Zero Draft of the Agenda for Action for Addressing Food Insecurity in Protracted Crisis (CFS-A4A):
Comments on question 1. In general terms do the ten principles presented in the Zero Draft adequately address the key issues required to address food insecurity and malnutrition in protracted crises? If not, what might be changed?
General comments:
The immediate causes of malnutrition are insufficiently addressed in this zero draft A4A.
The CFS reform document states that the nutritional dimension is integral to the concept of food security and to the work of the CFS. Food security includes the pillar of utilisation of food that is part of the direct / immediate causes of malnutrition. The outline of the A4A zero draft is very comprehensive. However, in order to adequately address malnutrition, which most probably refers to undernutrition and micronutrient-deficiencies in the context of protracted crisis, we would like to propose a stand-alone principle that specifically focuses on nutrition. This additional principle should be phrased:
new Principle 5: Ensure and support nutrition security of vulnerable groups through programmes and policies that address the direct causes of undernutrition in protracted crisis.
This principle would outline the particular consideration of the nutritionally vulnerable groups of infants, young children and mothers and the importance of nutrition specific programmatic actions to address their particular needs in protracted crisis situations.
This principle could follow after principle 4, that addresses the resilience focused policies and actions to address food insecurity and malnutrition in protracted crisis.
The particular situation of refugees and internally displaced people should be incorporated in the various principles and in this Agenda for Action (A4A).
Chronic and stagnating refugee situations are a growing challenge for countries and the international community. Their total number has increased dramatically over the past decade, and host states and regions of origin feel their effects. More significantly, protracted refugee situations now account for the vast majority of the world’s refugee population. They often live in poverty and food insecure conditions.
We propose that UNHCR to provide relevant inputs into the document on this particular vulnerable population group, and are already in contact with them.
With regard to Principle 3:
Focus should also include monitoring and evaluation, early warning systems and national information systems and measures to strengthen these systems.
An in-depth understanding of populations’ and individuals’ existing coping mechanism, food systems, and nutrition needs, as well as environmental and social synergies, is a key starting point to contextualize food security and agriculture sectorial actions. The importance of nutrition should be stronger emphasized. Not only nutritional situation and response analysis are needed, but greater integration of nutrition-related information also in food security and agriculture information systems is needed. Including indicators of food consumption, (such as dietary diversity and number of meals) and nutrition status indicators (such as stunting) in assessments, early warning systems, and food and agriculture information systems can support the early detection of shocks and particular vulnerable groups. This has several benefits in terms of better monitoring of shocks, situation, context and causal analysis. Food consumption and nutrition status indicators may be early indicators of a crisis and should be used to effectively identify which groups need urgent help.
With regard to Principle 4:
With regard to resilience focused policies and actions to address food insecurity and malnutrition, this principle focuses mainly on the underlying and structural causes of food insecurity and malnutrition. Equally emphasize needs to be put on the direct immediate causes of malnutrition. Therefore we propose the new additional principle on Nutrition as mentioned above.
Particular comments on Para (vii): ……..on other relevant programmatic options:
School-feeding and school gardening is definitely one relevant programmatic option that needs to be included.
The para singles out ‘community-based therapeutic feeding to treat acute malnutrition’. However, this is only one possible action out of the continuum of care and the nutrition-specific actions to address malnutrition in protracted crises situations. Breastfeeding as the most safe food and that ensures nutrition security during the first 6 months of life needs to be mentioned as essential action (‘promotion of breastfeeding’). This needs to be embedded in access to safe water and sanitation, as well as in access to essential health services, as well as women empowerment programmes.
Particular comments on Para (ix): the first 1000 days of live should be mentioned. Infants need to be mentioned and included, and the most important breastfeeding phase has to be mentioned before the supplementary feeding phase! Therefore we propose the following changes:
Particular attention must be paid in the design and implementation of policies and actions to the nutritional needs of mothers, including pregnant and lactating women, infants and young children, particularly between from conception, breastfeeding phase, and complementary feeding phase until aged two.
With regard to Principle 5:
Para (i): malnutrition needs to be included after the word ‘hunger’ in line 4.
Para (vii): second line: the word ‘energy’ right after ‘food’ can be misleading.
With regard to Principle 6:
Particularly here the issue of displaced populations and refugees and their vulnerability to food insecurity and malnutrition need to be addressed.
Para (v): last line should read: …and clearly reflect food security and nutrition considerations.
Comments on question 2. Are the roles and responsibilities of relevant stakeholders outlined in the Zero Draft sufficiently clear and defined in order to facilitate implementation of the principles? If not, what should be changed?
This should be look at again in light of the proposed CFS draft monitoring framework.
Comments on question 4. The CFS-A4A is intended to be a guidance document, aimed at encouraging high-level political commitment by all stakeholders in developing appropriate policies, actions, investments, institutional arrangements. As such: a) Are the current structure and language of the principles sufficiently clear and accessible for all relevant stakeholders?
The document seems long and it could benefit from avoiding repetitions.
Furthermore, the document could benefit if the individual Principles would follow a similar outline and structure. We would further recommend to move the key issue of a para to the beginning of the para. This would facilitate reading particularly if the reader looks for specific information on a particular key word.
A one page summary on the key principles, and a one page summary or better an overview table of the illustrative examples of policies and actions would encourage the easy access to the presented information.
Glossary: equally important as the term ‘food security’ also the term ‘malnutrition’ needs be included in the glossary.
Malnutrition
Malnutrition is defined as nutritional disorder in all its forms and includes both undernutrition and overnutrition. It relates to imbalances in energy, and specific macro and micronutrients- as well as in dietary patterns. Conventionally, the emphasis has been in relation to inadequacy, but it also applies to both excess and imbalanced intakes. Malnutrition occurs when the intake of essential macro- and micronutrients does not meet or exceeds the metabolic demands for those nutrients. These metabolic demands vary with age and other physiological conditions and are also affected by environmental conditions including poor hygiene and sanitation that lead to food- as well as water-borne diarrhoea (WHO Global Nutrition Policy Review). When micronutrient malnutrition occurs in persons who are of a normal weight or who are overweight or obese, it is sometimes referred to as hidden hunger. Hidden hunger often has no visible warning signs, leaving sufferers unaware of their dietary deficiency and its potentially adverse impact on their health. Malnutrition is especially serious for infants during the first 1000 days of life (from conception through the age of two), and infants and young children and has largely irreversible long-term effects on the ability of children to grow and learn, and to develop into productive adults later in life. This can restrict the development potential of whole societies and nations, and create a costly and continuing health and humanitarian burden for the country.
Additional Reference documents:
Finally, we would like to urge for the inclusion of the following reference documents into the Appendix C, that will help Member States, Governments and their partners in their efforts to make informed decisions on the appropriate nutrition actions:
SCN
The UN System Standing Committee on Nutrition welcomes this public consultation and would like to give the following feedback on the Zero Draft of the Agenda for Action for Addressing Food Insecurity in Protracted Crisis (CFS-A4A):
Comments on question 1. In general terms do the ten principles presented in the Zero Draft adequately address the key issues required to address food insecurity and malnutrition in protracted crises? If not, what might be changed?
General comments:
The CFS reform document states that the nutritional dimension is integral to the concept of food security and to the work of the CFS. Food security includes the pillar of utilisation of food that is part of the direct / immediate causes of malnutrition. The outline of the A4A zero draft is very comprehensive. However, in order to adequately address malnutrition, which most probably refers to undernutrition and micronutrient-deficiencies in the context of protracted crisis, we would like to propose a stand-alone principle that specifically focuses on nutrition. This additional principle should be phrased:
new Principle 5: Ensure and support nutrition security of vulnerable groups through programmes and policies that address the direct causes of undernutrition in protracted crisis.
This principle would outline the particular consideration of the nutritionally vulnerable groups of infants, young children and mothers and the importance of nutrition specific programmatic actions to address their particular needs in protracted crisis situations.
This principle could follow after principle 4, that addresses the resilience focused policies and actions to address food insecurity and malnutrition in protracted crisis.
Chronic and stagnating refugee situations are a growing challenge for countries and the international community. Their total number has increased dramatically over the past decade, and host states and regions of origin feel their effects. More significantly, protracted refugee situations now account for the vast majority of the world’s refugee population. They often live in poverty and food insecure conditions.
We propose that UNHCR to provide relevant inputs into the document on this particular vulnerable population group, and are already in contact with them.
With regard to Principle 3:
Focus should also include monitoring and evaluation, early warning systems and national information systems and measures to strengthen these systems.
An in-depth understanding of populations’ and individuals’ existing coping mechanism, food systems, and nutrition needs, as well as environmental and social synergies, is a key starting point to contextualize food security and agriculture sectorial actions. The importance of nutrition should be stronger emphasized. Not only nutritional situation and response analysis are needed, but greater integration of nutrition-related information also in food security and agriculture information systems is needed. Including indicators of food consumption, (such as dietary diversity and number of meals) and nutrition status indicators (such as stunting) in assessments, early warning systems, and food and agriculture information systems can support the early detection of shocks and particular vulnerable groups. This has several benefits in terms of better monitoring of shocks, situation, context and causal analysis. Food consumption and nutrition status indicators may be early indicators of a crisis and should be used to effectively identify which groups need urgent help.
With regard to Principle 4:
With regard to resilience focused policies and actions to address food insecurity and malnutrition, this principle focuses mainly on the underlying and structural causes of food insecurity and malnutrition. Equally emphasize needs to be put on the direct immediate causes of malnutrition. Therefore we propose the new additional principle on Nutrition as mentioned above.
Particular comments on Para (vii): ……..on other relevant programmatic options:
School-feeding and school gardening is definitely one relevant programmatic option that needs to be included.
The para singles out ‘community-based therapeutic feeding to treat acute malnutrition’. However, this is only one possible action out of the continuum of care and the nutrition-specific actions to address malnutrition in protracted crises situations. Breastfeeding as the most safe food and that ensures nutrition security during the first 6 months of life needs to be mentioned as essential action (‘promotion of breastfeeding’). This needs to be embedded in access to safe water and sanitation, as well as in access to essential health services, as well as women empowerment programmes.
Particular comments on Para (ix): the first 1000 days of live should be mentioned. Infants need to be mentioned and included, and the most important breastfeeding phase has to be mentioned before the supplementary feeding phase! Therefore we propose the following changes:
Particular attention must be paid in the design and implementation of policies and actions to the nutritional needs of mothers, including pregnant and lactating women, infants and young children, particularly between from conception, breastfeeding phase, and complementary feeding phase until aged two.
With regard to Principle 5:
Para (i): malnutrition needs to be included after the word ‘hunger’ in line 4.
Para (vii): second line: the word ‘energy’ right after ‘food’ can be misleading.
With regard to Principle 6:
Particularly here the issue of displaced populations and refugees and their vulnerability to food insecurity and malnutrition need to be addressed.
Para (v): last line should read: …and clearly reflect food security and nutrition considerations.
Comments on question 2. Are the roles and responsibilities of relevant stakeholders outlined in the Zero Draft sufficiently clear and defined in order to facilitate implementation of the principles? If not, what should be changed?
This should be look at again in light of the proposed CFS draft monitoring framework.
Comments on question 4. The CFS-A4A is intended to be a guidance document, aimed at encouraging high-level political commitment by all stakeholders in developing appropriate policies, actions, investments, institutional arrangements. As such: a) Are the current structure and language of the principles sufficiently clear and accessible for all relevant stakeholders?
The document seems long and it could benefit from avoiding repetitions.
Furthermore, the document could benefit if the individual Principles would follow a similar outline and structure. We would further recommend to move the key issue of a para to the beginning of the para. This would facilitate reading particularly if the reader looks for specific information on a particular key word.
A one page summary on the key principles, and a one page summary or better an overview table of the illustrative examples of policies and actions would encourage the easy access to the presented information.
Glossary: equally important as the term ‘food security’ also the term ‘malnutrition’ needs be included in the glossary.
Malnutrition
Malnutrition is defined as nutritional disorder in all its forms and includes both undernutrition and overnutrition. It relates to imbalances in energy, and specific macro and micronutrients- as well as in dietary patterns. Conventionally, the emphasis has been in relation to inadequacy, but it also applies to both excess and imbalanced intakes. Malnutrition occurs when the intake of essential macro- and micronutrients does not meet or exceeds the metabolic demands for those nutrients. These metabolic demands vary with age and other physiological conditions and are also affected by environmental conditions including poor hygiene and sanitation that lead to food- as well as water-borne diarrhoea (WHO Global Nutrition Policy Review). When micronutrient malnutrition occurs in persons who are of a normal weight or who are overweight or obese, it is sometimes referred to as hidden hunger. Hidden hunger often has no visible warning signs, leaving sufferers unaware of their dietary deficiency and its potentially adverse impact on their health. Malnutrition is especially serious for infants during the first 1000 days of life (from conception through the age of two), and infants and young children and has largely irreversible long-term effects on the ability of children to grow and learn, and to develop into productive adults later in life. This can restrict the development potential of whole societies and nations, and create a costly and continuing health and humanitarian burden for the country.
Additional Reference documents:
Finally, we would like to urge for the inclusion of the following reference documents into the Appendix C, that will help Member States, Governments and their partners in their efforts to make informed decisions on the appropriate nutrition actions:
WHO (2012): Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition. April 2012. A65/11. http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_11-en.pdf?ua=1 and http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_11Corr1-en.pdf?ua=1
WHO (2013): Essential Nutrition Actions. Improving maternal, newborn, infant and young child health and nutrition. http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/
WHO (2013): Updates on the management of severe acute malnutrition in infants and children. Guideline. http://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren/en/
IASC Inter-Agency Standing Committee (March 2012): Multi Cluster/Sector Initial Rapid Assessment (MIRA), IASC, Version March 2012.
IASC Global Nutrition Cluster (2011): The Harmonised Training Package: Resource Material for Training on Nutrition in Emergencies and Protracted crisis situations (HTP). Available at http://www.unscn.org/en/gnc_htp/howto-htp.php#howtousehtp and http://www.unicef.org/nutritioncluster/index_67812.html
UNHCR (2011): Food Security of Refugee and Displaced Women: Best Practices.
We thank the Working Group and the CFS secretariat for this opportunity to provide further inputs into the A4A, and look forward to the next draft.
With kind regards
UNSCN Secretariat Team