Nutrition  Works 
                                       
               International Public Nutrition Resource Group 
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
              A Review of Save the Children UK’s 
             Nutritional Surveillance Programme in 
                                Ethiopia 
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                       
                                  May 2006 
                                  Fiona Watson 
                                  Carmel Dolan 
                                 Jeremy Shoham 
                               Margie Buchanan-Smith 
        Contents 
         
        1. Executive Summary..............................................................................1 
        2. Introduction...........................................................................................8 
        3. History of NSP.....................................................................................10 
          1978-1986 Antecedents to the NSP..................................................10 
          1986-1991 The Nutrition Surveillance Programme is established...11 
          1991-1995 Seeds of the Household Food Economy Approach.......12 
          1995-2001: A focus on credibility and communication...................15 
          1998-2001 Phase out of NSP............................................................17 
          2001-2006 From nutrition surveillance to rapid nutrition assessments
           ..........................................................................................................18 
          Conclusions.......................................................................................20 
        4. Design of the NSP................................................................................22 
          Design strengths and weaknesses.....................................................23 
          The role of nutrition trend data.........................................................23 
          Coverage...........................................................................................24 
          Concentration on the under-fives .....................................................25 
          Food first bias...................................................................................26 
          Appropriate nutrition indicators .......................................................26 
          Nutritional status as an early warning indicator of food crises........28 
          Nutritional status as an early warning indicator of humanitarian 
          crises (increased mortality)...............................................................31 
          The role of nutrition in EWS............................................................32 
          Conclusions.......................................................................................33 
        5. Implementation of the NSP................................................................35 
          Implementation strengths and weaknesses.......................................35 
          Ensuring objective and high quality information.............................35 
          Lack of integration............................................................................36 
          Lack of capacity development..........................................................36 
          Separation between information and response.................................37 
          Dependence on agency core funding................................................37 
          Conclusions.......................................................................................38 
        6. Interpretation and use of information from the NSP......................39 
          Views on NSP information...............................................................39 
          Disseminating the NSP findings.......................................................39 
          Follow-up and advocacy...................................................................40 
          The NSP warns of crisis and elicits a response................................40 
          The NSP warns of crisis but is ignored............................................41 
          The NSP elicits a response by highlighting declines in nutritional 
          status .................................................................................................42 
          The NSP fails to elicit a response due to over-emphasis on 
          anthropometry...................................................................................43 
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          The NSP advocates for a non-food aid response..............................45 
          Conclusions.......................................................................................46 
        7. Sustainability.......................................................................................47 
          Financial sustainability.....................................................................47 
          Systemic (institutional) sustainability ..............................................48 
          Cost effectiveness.............................................................................49 
          Conclusions.......................................................................................52 
        8. Current nutrition situation................................................................53 
          The changing donor and agency climate..........................................53 
          Trends in malnutrition......................................................................54 
          Nutrition institutions.........................................................................55 
          Nutrition strategy..............................................................................57 
          Nutrition programmes.......................................................................57 
          Conclusions.......................................................................................58 
        9. Role of nutrition information in Ethiopia today..............................59 
          Priority nutrition problems ...............................................................59 
          Existing sources of nutrition information.........................................61 
          Conclusions.......................................................................................65 
        10. Conclusions and lessons learnt........................................................66 
          Design...............................................................................................66 
          Implementation.................................................................................68 
          Use of data........................................................................................70 
          Sustainability ....................................................................................71 
        11.   Recommendations...........................................................................72 
          Recommendations for SC UK Ethiopia Office................................72 
          Recommendations for agencies involved in nutrition in Ethiopia...73 
          Recommendations for SC UK globally............................................76 
        Annex 1: Time-line of events in Ethiopia .............................................80 
        Annex 2: Key Informants.......................................................................82 
        Annex 3: Key Documents.......................................................................83 
        Annex 4: Terms of Reference................................................................87 
         
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              List of Acronyms 
               
               
              CSA         Central Statistical Authority 
              CTC         Community Therapeutic Care 
              CIDA        Canadian International Development Assistance 
              DPPC        Disaster Prevention and Preparedness Commission 
              ENCU        Emergency Nutrition Co-ordinating Unit 
              EHNRI       Ethiopian Health and Nutrition Research Institute 
              ENI   Ethiopia Nutrition Institute 
              EU   European Union 
              EWS         Early Warning System 
              FA   Farmers Association 
              FSIS        Food Security Information System 
              GAM         Global Acute Malnutrition 
              HEA         Household Economy Approach 
              IDP         Internally Displaced People  
              MoARD       Ministry of Agriculture and Rural Development 
              MoH         Ministry of Health 
              MUAC        Mid Upper Arm Circumference 
              NFW         Nutrition Field Worker 
              NGO         Non-Governmental Organisation 
              NNS         National Nutrition Strategy 
              NSP         Nutrition Surveillance Programme 
              NTF         Nutrition Task Force 
              PRSP        Poverty Reduction Strategy Paper 
              RATS        Rapid Assessment Team 
              RATSO       Rapid Assessment Team Somali Region 
              RRC         Relief and Rehabilitation Commission 
              SAM         Severe Acute Malnutrition 
              SC UK       Save the Children United Kingdom 
              UNICEF      United Nations Children’s Fund 
              USAID       United States Agency for International Development 
              WFL         Weight-for-Length 
              WFP         World Food Programme 
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