Review of Nutrition Cluster Experiences and Learning on Transition: Kenya

KENYA

CASE STUDY

Review of Nutrition Cluster Experiences and Learning for Transition

(RFPS-USA-2014-501871)

PREPAREDBY:

INTERNATIONALSOLUTIONSGROUP

Nutrition Expert and Author: Vivienne Forsythe

PREPAREDFOR:

UNICEF

TABLE OF CONTENTS

LIST OF ACRONYMS

LIST OF FIGURES

ACKNOWLEDGEMENTS

PREFACE

1.1. COUNTRY CONTEXT

1.2. OVERVIEW OF GOVERNMENT EMERGENCY COORDINATION MECHANISMS (MAY 2015)

1.3 BACKGROUND ON CLUSTER IN KENYA AND IASC ACTIVATION OF CLUSTER SYSTEM

1.4 INFLUENCES OF CONTEXT

2.1. NUTRITION COORDINATING MECHANISMS PRE-2008

2.2. ESTABLISHMENT OF NTF AND EVOLUTION OF THE NUTRITION SECTOR COORDINATION FRAMEWORK

2.3. NTF COMPOSITION

2.4. HUMAN AND FINANCIAL RESOURCE AVAILABILITY TO SUPPORT EMERGENCY COORDINATION MECHANISMS

2.5 KEY MILESTONES OF THE NATIONAL NTF

3.1. COORDINATION CAPACITY AT NATIONAL AND SUBNATIONAL LEVEL

3.2. WHAT HAS WORKED WELL/GOOD PRACTICE IN TERMS OF COORDINATION FUNCTIONS

CORE FUNCTION ONE: SUPPORTING SERVICE DELIVERY

CORE COORDINATION FUNCTION TWO: TO INFORM THE HC/HCT’S STRATEGIC DECISION-MAKING

CORE COORDINATION FUNCTION THREE: TO PLAN AND IMPLEMENT CLUSTER STRATEGIES

CORE COORDINATION FUNCTION FOUR: TO MONITOR AND EVALUATE PERFORMANCE

CORE COORDINATION FUNCTION FIVE: TO BUILD NATIONAL CAPACITY IN PREPAREDNESS AND CONTINGENCY PLANNING.

CORE FUNCTION SIX: TO SUPPORT ROBUST ADVOCACY

3.3. WHAT HAS WORKED WELL/GOOD PRACTICE IN TERMS OF MANAGEMENT OF COORDINATION FUNCTIONS

3.5. WHAT COULD HAVE BEEN BETTER?

4.1 KEY DETERMINANTS CONTRIBUTING TO THE SUCCESS OF THE EMERGENCY NUTRITION COORDINATION MECHANISM

ANNEX I: KEY REFERENCE DOCUMENTS

ANNEX II: LIST OF KEY INFORMANTS

List of Acronyms

4W / Who, What When and When
ACF / Action Against Hunger
ASAL / Arid and semi-arid areas
CDMC / County Disaster Management Committee
CLA / Cluster Lead Agency
CMAM / Community-based Management of Acute Malnutrition
CNC / County Nutrition Coordinator
CNTF / County Nutrition Technical Forums
CSG / County Steering Group
CTC / Community-based therapeutic care
CWW / Concern Worldwide
DFID / Department for International Development
DHMIS / District Health Management Information System
ECHO / European Commission’s Humanitarian Aid and Civil Protection Department
FGD / Focus group discussion
GAIN / Global Alliance for Improved Nutrition
GNC / Global Nutrition Cluster
GoK / Government of Kenya
H&NWG / Health and Nutrition Working Group
HC / Humanitarian Coordinator
HCT / Humanitarian Country Team
HDI / Human Development Index
HINI / High Impact Nutrition Interventions
HSSC / Health Sector Coordinating Committee
IASC / Inter-Agency Standing Committee
IMO / Information Management Officer
IYCF / Infant and Young Child Feeding
JICC / Joint Interagency Coordinating Committee
KDHS / Kenya Demographic and Health Survey
KFSSG / National Platform for DRR and the Kenya Food Security Steering Group
KII / Key informant interview
KRC / Kenya Red Cross
LRA / Long Rain Assessments
M&E / Monitoring and Evaluation
MAM / Moderate Acute Malnutrition
MOH / Ministry of Health
MOHS / Ministry of Health Services
MoMS / Ministry of Medical Services
MOPHS / Ministry of Public Health and Sanitation
NCC / Nutrition Cluster Coordinator
NDMA / National Drought Management Authority
NDU / Nutrition and Dietetic Unit
NGO / Non-governmental organisation
NICC / Nutrition Interagency Coordinating Committee
NIWG / Nutrition Information Working Group
NRAG / Nutrition Response Advisory Group
NSO / Nutrition Support Officer
NTF / Nutrition Technical Forum
OCHA / Office for Coordination of Humanitarian Affairs
OFDA / USAID’s Office of U.S. Foreign Disaster Assistance
RTE / Real-time evaluation
SAM / Severe Acute Malnutrition
SC / Steering Committees
SMART / Standardised Monitoring and Assessment of Relief and Transitions
SRA / Short Rain Assessments
ToR / Terms of reference
TWG / Technical working group
UN / United Nations
UNDP / United National Development Programme
UNICEF / United Nations Children’s Fund
USAID / United States Agency for International Development
WFP / World Food Programme
WG / Working group
WHO / World Health Organisation

List of Figures

Figure 1 – Taken from OCHA presentation March 2015 (structure in 2014)………………………………8

Figure 2 – Taken from OCHA presentation March 2015 (proposed structure)……………………………8

Figure 3 – Nutrition Coordination Structure 2007…………………………………………………………………..11

Figure 4 – Nutrition Coordination Framework 2008/2009……………………………………………………..12

Figure 5 – Nutrition Coordination Framework 2015………………………………………………………...…….14

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 the UNICEF Country Office in Kenya (Nairobi) as well as the UNICEF Zonal Office in Lodwar. Similarly, she wishes to note her appreciation of the Government of Kenya staff at all levels, non-governmental staff, and other key stakeholders who took the time to meet in person or virtually to share their perspectives and support the research on Cluster transition in Kenya.

The case study benefited from comments on the draft report from Country Office Staff Brenda Akwanyi, Grainne Maloney, and Marjorie Volege. Comments and discussions around the report from the Nutrition Reference Group for this assignment (Diane Holland and Josephine Ippe of UNICEF) 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.

Preface

This assignment explores the establishment and evolution of the Nutrition Technical Forum (NTF). This is not an evaluation of the work of the Nutrition TechnicalForum rather it is an attempt to extract learning from the experience of the Nutrition Technical Forum in terms of effective Nutrition emergency coordination.

The following definitions were taken from the Cluster Coordination Reference Module (July 2014) and used during this research:

Clusterdeactivation is the closure of a formally activated Cluster. Deactivation includes the transfer of core Cluster Functions (in line with the Cluster Reference Module) from Clusters that have international leadership and accountability to sectors or structures that are led nationally. Functions may be transferred to existing or pre-crisis coordination and response structures, or new ones.

Cluster transitionrefers to the process (and potentially the activities) by means of which the transfer of leadership and accountabilities is planned and implemented, leading to de-activation. A plan is required to map phases of the transition, set transition or deactivation benchmarks for each phase, and schedule activities to meet them.

Methodology

Kenya country visit was conducted between 7th and 15th May 2015.Thematic subject areas were explored through a consultative process and analysis of key documents from Ministry of Health, UNICEF and OCHA.The following areas were explored during the visit.

  • Influences of context including the level of commitment to Nutrition of both the Government and UNICEF prior to 2007 and the emergency response coordination mechanisms prior to 2007 and since 2007 to date.
  • Establishment and evolution of the Nutrition Technical Forum and participation of key stakeholders in the Nutrition Technical Forum at national and subnational levels
  • Coordination capacity of the Nutrition Technical Forum.
  • Human resource availability for maintenance of support for emergency coordination functions

Key informant interviews (KIIs) and focus group discussions (FGD) were conducted in Nairobi and in Turkana, with UNICEF staff, government representatives, UN and NGO cluster partners and OCHA representatives in Nairobi.[1]

Limitations

While the consultant met with a wide range of stakeholders during the visit, it must be appreciated that many of the key individuals involved in the establishment and support of the Nutrition Technical Forum in the past were no longer in country.Two former UNICEF staff were contacted and interviewed by Skype however many key individuals were not interviewed. The limited time allocated for this assignment did not allow for in-depth exploration and analysis of many of the key issues.

1.1. Country context

According to the United National Development Programme (UNDP) Human Development Report 2014, Kenya is a low-level income country with Human Development Index ranking of 147/186.[2] The United Nations Development Assistance Framework for Kenya 2014-2018 endorses this low HDI categorisation and goes on to state that Kenya is the tenth most unequal country globally and the fifth most unequal of the 54 African states.[3]

Kenya is an emergency-prone country, affected by chronic largely localised emergencies arising from recurrent floods and drought particularly in the arid and semi-arid areas (ASAL) of the country. Kenya also hosts over 500,000 refugees, primarily (but not exclusively) from Somalia and South Sudan. There are many different ethnic groups within Kenya, resulting in great cultural diversity, but also contributing to inter-ethnic tensions, escalating to serious conflict in various parts of the country. The country experienced serious political violence following the presidential elections in December 2007.

The Kenyan government is currently undergoing significant transition following constitutional reform in 2010. The constitutional reform includes devolution of government powers and functions, with regions being sub divided into counties, which are now the primary administrative level.Today the country is relatively peaceful as evidenced by the non-violent election of March 2013 which brought the Jubilee Coalition government into power.[4]

1.2. Overview of Government Emergency Coordination Mechanisms (May 2015)

At the national level, the Office of the Deputy President is responsible for coordination of emergencies through an ad hoc national disaster coordination committee.[5] Key emergency bodies of relevance for emergency nutrition-related activities include the National Drought Management Authority (NDMA), the National Platform for Disaster Risk Reduction and the Kenya Food Security Steering Group (KFSSG), sitting under the Ministry of Planning and Devolution; while the Department of Refugee Affairs sits under the Ministry of Interior Affairs and Government Coordination.

At the subnational level the following inter-sectoral coordination platforms are found:

  • The County Steering Group (CSG): This group, found in ASAL counties only, is chaired by the Deputy Governor, with the NDMA as Secretariat and is mandated to carry out inter-sector coordination between governmental and non-governmental actors for both development and emergency plans. Food security issues are handled under the CSG, and in Turkana a Food Security Steering Group has been established (hosted by the CSG through NDMA). The CSG collects information on food security issues at local level and the acts as the forum for disseminating KFSSG reports.
  • The County Disaster Management Committee (CDMC): this committee is only activated in case of emergency and is supposed to develop and implement contingency plans.
  • The Food Distribution Committee: is led by NDMA and is activated in case of emergency and its main mandate is to oversee food distribution.
  • The County Peace Committee: this is an inter-sectoral platform that is mandated to carry out initiatives for peacebuilding.

Figure 1 – Taken from OCHA presentation March 2015 (structure in 2014)[6]

According to the Office for Coordination of Humanitarian Affairs (OCHA), new humanitarian coordination mechanisms have been proposed and are in the process of adaptation at national and subnational level. The new structure is expected to streamline the existing mechanisms.

Figure 2-Taken from OCHA presentation March 2015 (proposed structure)[7]

With the change in proposed coordination structures and devolution to county level in process, the existence of and level of functionality of these various committees is understandably somewhat variable across the counties.

1.3 Background on Cluster in Kenya and IASC activation of cluster system

The Inter-Agency Standing Committee (IASC) activated the cluster system in Kenya in January 2008 following the post-election violence in December 2007. As part of this system wide activation, OCHA requested that a Nutrition Cluster be established.

The Nutrition Technical Forum had been established under the auspice of the Ministry of Health Services (MOHS) in September 2007 as an interagency forum to discuss and coordinate nutrition interventions, with leadership from the MOHS as Chair and UNICEF as Co-chair. Right from the early stages UNICEF was providing technical support to the NTF, using the cluster principles, based on the experience of UNICEF Chief of Nutrition at that time.[8]

Given the pressure from OCHA to establish a Nutrition Cluster, after discussion with the MOHS and partners, it was agreed that the NTF would take on and perform cluster functions as articulated in the original IASC generic cluster terms of reference (ToR), although the NTF was never referred to as a cluster.A UNICEF Nutrition Specialist double hatted as a Nutrition Sector co-Coordinator and was the focal point for OCHA attending/participating in OCHA meetings/processes representing the NTF.

OCHA deactivated operational clusters in 2009 handing over to the respective government sector working groups; and the Nutrition Cluster functions continued to be conducted under the NTF.During the Horn of Africa humanitarian crisis of 2011/2012 the cluster system was not activated in Kenya, instead the response was led by Government sector working groups with support from Cluster Lead Agencies (CLAs). OCHA chaired an inter-sectoral working group, and again the UNICEF appointed NS/NSC attended the inter-cluster meetings as NTF focal point representing the NTF.

Given that the NTF was established under the auspice of the Government of Kenya (GoK) Health Sector leadership right from the outset, there has obviously not been a formal transition leading to deactivation to a nationally led coordination mechanism in the classical OCHA definition of transition and deactivation. However there has been a shift in the level of responsibility undertaken by the MOHS and subsequently the MOPHS, vis-à-vis by UNICEF as the mechanism has evolved and the MOPHS Division of Nutrition gained experience and confidence in fulfilling emergency coordination functions.

1.4 Influences of context

Government commitment for Nutrition prior to 2007

Since independence in 1963 the GoK has developed policies and programmes to address malnutrition based on the national situational analysis, however the impact of these policies and programmes has been limited due to low prioritisation of nutrition and subsequent inadequate investment in Nutrition, resulting in limited coverage of nutrition interventions. According to the 2008-09 Kenya Demographic and Health Survey (KDHS), the trends of under-nutrition among children under the age of five years from 1993 to 2008/09 which shows little or no improvement (for stunting, underweight and wasting).[9]

Technical programming capacity and level of commitment to Nutrition of UNICEF prior to 2007

UNICEF has been supporting Nutrition-related activities in Kenya for many years as a subcomponent of the Child Survival and Development Programme as the technical lead agency in nutrition to the GoK.UNICEF Nutrition programme activities included monitoring of the nutritional situation and supporting delivery of nutrition services (including IYCF, micronutrient supplementation and treatment of acute malnutrition); working with/through MOH and a number of NGO implementing partners.

2.1. Nutrition Coordinating Mechanisms pre-2008

Sector coordination 2006-2008

In 2006 the Kenya Health Sector Coordinating Framework was revised for implementation of the second National Health Sector Strategic Plan.Under this framework, a Joint Interagency Coordinating Committee (JICC) was established with a mandate to provide leadership for overall health sector policy direction. JICC functions included (1) Approval of the Kenya Health Sector Policy and Strategic Plan (2) Advocacy for the health sector and (3) Lead resource mobilisation efforts for the health sector.A Health Sector Coordinating Committee (HSCC) was also established. Answerable to JICC, the HSSC was mandated to formally coordinate all operational and strategic actions in the Health Sector with scheduled quarterly meetings. Health and nutrition activities were coordinated jointly through this mechanism.

Emergency coordination pre-2008

Pre-2008 a Health and Nutrition Working Group (H&NWG) reported to the KFSSG under the NDMA, which then reported to the Crisis Response Centre/Committee within the Office of the Prime Minister.It was reported that that Chairmanship of the H&NWG of the KFFSG changed in 2007 and subsequently nutrition issues were not adequately represented/addressed through this mechanism… “Following this switch of leadership, nutrition issues received limited attention thus were often not well represented and addressed.”[10] This view was endorsed by KIIs: “Key Nutrition players were concerned about early warning reports of a potential drought – but these concerns were not being addressed adequately by the Health and Nutrition Working Group”.

Thus, despite the existence of an emergency coordination forum, the reality was that in 2007 while there were many international and national partners and faith-based agencies doing emergency nutrition work in Kenya, these groups were not well coordinated. It has been documented that while many of these programmes were of high quality, they were fragmented, some focused purely on treatment of acute malnutrition, often the interventions were of short duration, the various agencies were using different approaches, the agencies did not consistently work with government structures and did not include sustained capacity development.[11]

As one respondent stated, “prior to the NTF, multiple nutrition implementing partners were operating independently across the country, these agencies had varying levels of expertise; the central MOH (Nutrition Division) were not really aware of what the implementing partners were doing and the partners were not reporting to the MOH.”

UNICEF participated in the existing joint health and nutrition coordination mechanisms and was co-Chair of the Hand and Nutrition Working Group reporting to the KFSSG through to 2007 and subsequently UNICEF strongly advocated for establishment of a coordination mechanism specifically for nutrition in 2007 (see below).

2.2. Establishment of NTF and evolution of the nutrition sector coordination framework

National level

In September 2007 the Nutrition Technical Forum was established at the national level, under the auspice of the MOHS with technical support from UNICEF Nutrition Specialist who co-chaired the NTF.“The mandate of the NTF is to provide a forum for information sharing, coordination, support and advisory services. Emergency coordination is one of the key component in the terms of reference for NTF. The NTF also serves as an umbrella for all nutrition coordination bodies. The forum is active since September 2007 and feeds back to the health and nutrition working groups under the KFSSG.”[12]