1 February 2012 to 31 January 2013nnual Report

EmergencyNutritionNetworkA

The ENN’s AimTo increase the capacity of national, regionaland international practitioners to respond tothe food and nutrition-related needs of vul-nerable and emergency affected populations.

The ENN’s Objectives1. Improve learning in the sector, targeting

practitioners involved in emergency response, policy makers and donors.

2. Close knowledge and practice gaps in the sector through a focus on evdenced based operational research.

3. Increase the capacity of national and regional level actors through the active promotion and development of strategic partnerships.

4. Contribute to improvements in leadership/stewardship through advocacy, partnerships and support for key agen-cies and institutions at international level.

The ENN’s MissionThere are three cross-cutting themes to all ofENN’s activities:• Building up capacity – at all levels, from

international non-governmental organ-isations to local community organisations,and from policy-makers to field workers, to respond more effectively to crises. Thisinvolves developing a shared institutionalmemory of what does and does not workin different crisis situations and deliveringthat knowledge as widely as possible.

• Network-building – so that organisations and individuals support and learn fromeach other as much as possible. The over-arching purpose of ENN is to speed up thesharing of knowledge and wherever poss- ible, reduce the communication chain.

• Impartiality and independence – toencourage reporting on failures as well assuccesses, the independence of the ENN isvital. Protecting this means ensuring thatno one source of income predominates.

The ENNs Strategy (2010-2015) four areas offocus to consolidate and develop upon theENN’s existing work:• Improving knowledge management and

learning • Closing gaps in the evidence base • Strengthening national and regional

capacity

The ENN was set up in 1996 by aninter-agency group of humanitari-an organisations to improve prac-tice and strengthen institutional

memory of humanitarian agenciesinvolved in the food and nutrition sector ofemergencies. The ENN endeavours toimprove the effectiveness of interventionsthrough the identification and rapid dis-semination of lessons learnt and throughresearch and evaluation. Cross-cutting allof the ENN’s activities are capacity devel-opment, network building and maintain-ing impartiality and independence.

The ENN’s flagship publication, FieldExchange, was developed as a means ofachieving this. To date (31 January 2013)there have been 44 editions of FieldExchange as well as many complementaryactivities, including research initiatives, theproduction of three Special Supplementson areas of ‘cutting edge’ programming,development of operational guidance andtraining resources on Infant and YoungChild Feeding in Emergencies, research ini-tiatives, workshops and reports on interna-tional technical meetings.

The ENN is a participatory-based initia-tive, with networking and collaboration atthe core of its activities. The ENN targetsthose concerned with humanitarianresponse at all levels, from internationalpolicy-makers to field workers ‘on theground’. The Emergency Nutrition Network(ENN) was set up in 1996 by an inter-agency group of humanitarian organisa-tions to improve practice and strengthenthe institutional memory of humanitarianagencies involved in the food and nutri-tion sector of emergencies.

The ENN was initially established as aself-financing activity in the Departmentof Community Health and General Practicein Trinity College Dublin, Ireland and laterincorporated as a limited company inIreland (30th April 2001). In September2003, a transfer of ENN activities to Oxford,UK was initiated and completed in July2004. Initially operating as a UK companylimited by guarantee (not-for profit), theENN was granted UK charitable status inJuly 2006. The ENN is governed by a Boardof Trustees.

• Strengthening partnerships for improved leadership

The ENN’s Activities• The ENN’s tri-annual print/online publi-

cation, Field Exchange, records field level programming experience and dissemi-nates this worldwide, to those working inthe emergency nutrition and food securitysectors. Producing Field Exchange offers a unique perspective of emergency pro-gramming that continues to help identify ‘gaps’ and challenges in the field and informs the development of ENN’s other activities.

• A new ENN publication, Nutrition Exchange(piloted as Field Exchange Digest) sum-marises articles and information from previous issues of Field Exchange and aims to increase access to information amongstbusy workers and across sectors.

• ENN ‘Special Supplements’ collate recent experience of best practice in specific ‘cutting edge’ areas of emergency pro-gramming. Three ENN Special Supple- ments have been produced to date.

• The online technical forum, en-net, pro-vides field practitioners with access to prompt technical advice from experts andpeers for operational challenges faced in emergency programmes.

• Coordination and technical input in the area of infant and young child feeding in emergencies (IFE) and research initiativesare geared towards filling gaps in know-ledge and developing guidance and resource material to make a difference to ‘on the ground’ implementation.

• Facilitating and reporting on internationaltechnical meetings is a means of achievingspeedier consensus on best practice and disseminating findings to those in the field and/or responsible for programmingat headquarters level.

• Operational research to strengthen the evidence base for emergency nutrition and food security programming. For ex- ample, research into the prevention andtreatment of moderate malnutrition,development of a minimum reporting package for supplementary feeding pro-grammes (SFPs) and research into the prevention and management of anaemiain refugees.

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Introduction

Field ExchangeIn 2012/13, three issues ofthe ENN’s core publication,Field Exchange (Issues 42,43 and 44), were pro-duced. Field Exchange 42was published in January2012 and gave extendedcoverage to a briefingpaper just released byOxfam and SC UK on the2011 response to theHorn of Africa crisis. FieldExchange 43 was pro-duced and distributed inJuly 2012. This was aspecial double editionfocused on scale up ofCMAM, and centred on

the nine case studies presented atthe ENN/Ethiopia MOH CMAM Conference inAddis Ababa in November 2011. Additionalfield articles from Nigeria and Zimbabwe, aswell as a progress report on developmentspost-conference in India, also featured. FieldExchange 44 was produced in December 2012.Examples of content included articles abouttackling Konzo in DRC through introduction ofcassava retting techniques and improvingaccess to water, and a comparative study of fourrelief and emergency response activities – Cash-for-Assets (CFA), Goat-for-Assets (GFA), and twoFood-for-Assets (FFA) projects – implemented byWorld Renew in response to the 2011 drought inKenya. Increasingly, programming experiencesfrom countries with chronically high burdens ofstunting and wasting and where humanitarianagencies are working long-term to support gov-ernments in challenging contexts are also beingcaptured in the publication. On average, 4,132print copies per edition of Field Exchangewere dis-tributed in 2012/13 to readers working in a varietyof sectors (nutrition, food security, health, liveli-hoods, water, sanitation and hygiene and agricul-ture) in 131 countries worldwide. This is a 13%increase on the number of copies distributed in2011/12. Also, 4,987 electronic editions of FieldExchange were downloaded while over 12,300individual articles were accessed via the onlinesearch repository (http://fex.ennonline.net).

Planning and content preparation was also initiat-ed in 2012 for a special Field Exchange issue onurban programming in emergency contexts duein mid-2013. ENN is collaborating with Oxfam,who have an urban nutrition lead, to source keycontacts, agencies and resources.

Between July and November 2012 an evaluationof the use of Field Exchange amongst recipientswas carried out. This explored the profile of users,impact of Field Exchange on programming, policyand research, preference for print versus online,and use of social media for professional purposes.A total of 170 people took part in the online sur-vey. Key findings included: • A large proportion (41%) of the respondents

were based in Africa, with 27% in Europe and 21% in Asia

• A third of respondents (32%) had been sub-scribed to FEX for 5 years or more

• There was a sharp increase in subscriptions over the last year; 22% of readers had signed up in the last 12 months.

• Most respondents (95%) used Field Exchange for learning and updating knowledge, to guideprogramming, in training, to gain research ideas and to share experiences.

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Output• About 40% of the respondents reported that FEX

has influenced their agency programming or policy.

• The print version was still the most popular form (half of respondents preferred it) but 60%of readers also accessed content online

• Over half of respondents had shared experi-ences in Field Exchange

Target areas for improvement identified in theevaluation include: greater marketing of FieldExchange online resource (one third of respon-dents were not aware of it) and updates to themailing request system to maximise targetingprint copy. A limitation of the evaluation was thatit relied on online access to the survey (althoughtelephone interviews were also an option). In 2013we plan to look more closely at M&E of activities toenable us to delve more critically into the accessi-bility and impact of our work. The full report isavailable at www.ennonline.net

NutritionExchange(piloted as FieldExchange Digest)

In 2012/13, a second issue ofField Exchange Digest wascompiled and published inEnglish, French and Arabic.For issue 2, the name of thepublication was changed

to Nutrition Exchange based on user feed-back (to distinguish more clearly from FieldExchange) and to reflect the broad scope of nutri-tion content. Nutrition Exchange (NEX) summaris-es key articles and information from previousissues of Field Exchange, targeted at a nationalaudience. The aim is to increase access to informa-tion published in Field Exchange among nationalstakeholders, amongst busy workers and acrosssectors. A longer term aim is to encourage andsupport national stakeholders to write up theirprogramme experiences in future issues of NEX orField Exchange.

Targeted distribution was expanded from five tar-get countries in 2011 (Kenya, Ethiopia, Niger,Sudan and Bangladesh) to a total of 10 targetcountries (addition of South Sudan, Chad, Haiti,Pakistan and Afghanistan). Over 4,000 hard copiesof Issue 2 were distributed (English: 2900; French:800; Arabic; 400) in addition to thousands of softcopy downloads.

Extensive efforts were made to expand the data-base of NEX readers in target countries as well aspromoting e-version uptake to as wide an audi-ence as possible. Work also started in this periodon exploring social media outlets for NEX (Twitter,Facebook, blogs etc.) and specialists in this areahave been interviewed to help inform the NEX dis-semination strategy.

An evaluation was conducted in October andNovember 2012 to inform content, format, andscope of future issues. It also sought insight intohow best to engage and communicate with thetarget audience in the future. Individuals interest-ed in submitting original content were self-identi-fied. The evaluation documented the highdemand for current information on nutrition-relat-ed issues within our target audience. It also high-lighted the need to further develop ourFrancophone and Arabic speaking readership. Toaddress this, regional contacts will be identified toregion-specific targeting work in 2013.

ENN’s online technical forum (en-net)Now in its fifth year, en-net has evolved from aforum with eight discussion areas to fourteen. Itcontinues to provide fast technical response tourgent field issues for which text book answers arenot readily available. During the reporting perioddiscussions continued to be primarily peer-led,allowing experiences to be shared and advice pro-vided by others working in similar situations, whilea team of 15 technical experts is on-call to respondto questions that receive no spontaneous answersor to clarify complex technical issues from aninformed and balanced perspective. The forum isopen for anyone to view, though people can signup to receive email alerts of new discussions orresponses. Approximately 800 people have signedup to receive en-net updates to date (many morecan view exchanges without having to register).Over a 12 month period, there were 33,374 visitsto the site by 21,324 people.

The most popular forum areas continue to beAssessment and Prevention and treatment of severeacute malnutrition, followed by Prevention andtreatment of moderate acute malnutrition andInfant and young child feeding interventions. Thisreflects the key areas for the nutrition communitywhere both guidance and practice are evolving.Two new forum areas were launched during thereporting period in response to developments inthe field of nutritional emergency response:Coverage assessment and Urban programming.

An en-net evaluation completed in 2012 foundthat 96% of 135 respondents to a survey found en-net to be user-friendly. The site has been kept sim-ple and functional for ease of use by people withless than optimal internet access and slow connec-tions. “It is ...very well-designed web page for forumdiscussion” .The main purpose for members to joinen-net was to obtain useful advice for program-ming (34%) and to keep up with the latest debatesin nutrition in emergencies (30%), however 15%said their main purpose was to share their knowl-edge and experience with others. “I have beenimplementing a malnutrition project and some ofen-net discussions were very helpful when somedoubts arose”.

The vast majority (97%) felt it was a useful space toshare ideas and field dilemmas with others work-ing in similar situations. “I have seen so many diffi-cult issues about surveys; it may not be clear beforeand after discussion it is clear for me”. “It has helpedme in designing CMAM programme factoring chal-lenges people have encountered and also sharingthe responses during training sessions that I haveconducted hence increased broader understanding.”“I've used en-net to help me draft a policy paper onnutrition supplements for the NGO I work for. Theforum gave me lots of tips on controversial issuesand resource pages.”

En-net is the forum for technical questions for theCMAM Forum (www.cmamform.org) and theCoverage Monitoring Network Project(http://www.coverage-monitoring.org/forum/);both sites refer their visitors to en-net

IFE Core GroupThe ENN is the facilitator and institutional homefor an international interagency collaboration oninfant and young child feeding in emergencies(IFE Core Group) (www.ennonline.net). The ENNrepresents the IFE Core Group in key fora, includ-

Operational researchThe ENN has significantly expanded its operationalresearch programme portfolio to strengthen theevidence base for emergency nutrition and foodsecurity programming. All research activities haveinvolved steering groups of agencies and academ-ics. Collaborators and funders include bilateraldonors, UN agencies, and international NGOs. Twoon-going projects in 2012 were:

I. Reviewing the evidence base and exploring alternative approaches for the prevention andtreatment of moderate malnutrition (MAM) in children under five years of age.

During 2012, research was completed in two sitesin Niger and Chad, identified in 2011. Thisinvolved an observational study on unconditionalcash transfers in Niger (programme implementedby Save the Children UK) and a blanket supple-mentary feeding programme in Chad (pro-gramme implemented by Oxfam/WFP). An econo-mist joined the team in 2012 to supportanalysis. Both studies provide uniqueinsights into the effectiveness of pro-grammes in preventing moderate malnutri-tion. A plan for peer review publication in2013 has been developed in collaborationwith Save the Children UK and the principleinvestigators.

II. Preventing and managing anaemia in refugee populations

In 2013, collaboration between the ENN andUniversity College London (UCL) continued toprovide technical support and analytical servicesto UNHCR for the assessment of anaemia andmicronutrient malnutrition and the implementa-tion of nutritional services.

During the reporting period, a review of theimplementation of the UNHCR anaemia strategyin the initial 7 countries targeted for interventionhas been completed. A review of UNHCR surveydata was also conducted, to explore how theprevalence of different categories of anaemiachange in response to the interventions imple-mented under the UNHCR’s anaemia strategy.Findings have been shared in the UNHCR Anaemiatechnical advisory group (December 2012).

Under this project, UCL-CIHD led the implementa-tion, analyses and reporting of cross sectionalnutrition surveys in the Dadaab refugee camps,Kenya and in the Kakuma refugee camps. A num-ber of analyses were also conducted using exist-ing data led by ENN consultants: a) an analysis ofthe impact of Nutributter® distribution using avail-able data on the prevalence of anaemia in chil-dren aged 6-24 months in the Dadaab, Kakuma,and Djibouti camps and b) analysis of the impactof Plumpy’Doz® (PD) distribution on the preva-lence of seasonal acute malnutrition and anaemiain the Rohingya refugee camps in Bangladesh (incollaboration with ACF).

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A paper on the double burden of malnutrition inrefugee camps in Algeria produced from work in2012 was published in a peer review journal in 2013.

III. Management of acute malnutrition in infants under 6 months (MAMI)

From July to November 2012, the ENN collaborat-ed with UCL CIHD in a prioritisation exercise onresearch questions on MAMI. The Child Health andNutrition Research Initiative (CHNRI) of the GlobalForum for Health Research has been successfullyapplied to many child health areas; the CHNRIframework was applied to MAMI in order to priori-tise research on this age group. A steering groupof contributors from the MAMI 1 project definedthe context and criteria for priority setting. A totalof 150 technical experts and policy makers wereinvited to take part and 64 individuals participatedin the survey. Results were presented at a meetingon MAMI in London in December 2012. A peer-reviewed publication is planned for 2013.

Follow up on CMAM conference In November 2011 the ENN, in col-laboration with the Government ofEthiopia hosted a 4-day conferencein Addis Ababa at whichGovernment representatives from22 countries in Africa and Asia, aswell as members of international

non-governmental organisations (NGOs),United Nations (UN) agencies, the private sector,academic institutions and donor agencies cametogether to share experiences and to identify lessonsfor future Community-based Management of AcuteMalnutrition (CMAM) scale up (meeting reportsonline at www.ennonline.net). A follow up surveywas conducted in 2012 to assess impact of the con-ference. ENN approached government delegatesfrom each represented country regarding progresswith committed actions/next steps, whether the con-ference (and the development of the case studies)was a useful exercise, and any other consequences oftheir participation in the Addis conference.Responses were elicited from 17 out of the 22 coun-tries in attendance (77%). The co-funders - DIFD, IrishAid and CIDA - also provided feedback.

Feedback found that the conference was anextremely useful tool in advancing the nationalagenda for CMAM and for nutrition more generally.This was achieved through encouraging high levelattendance to galvanise political commitment, high-lighting the importance of taking nutrition interven-tions to scale, and by providing a ‘space’ for govern-ment representatives to share their experiences andwork through the various challenges. Active supportfor documentation of experiences proved a goodinvestment that enabled countries to tell their ‘story’,and consequently take stock, learn and share vitallessons for future scale up. The government dele-gates appreciated the resources provided, and the

chance to network, both with each other and withglobal experts, who they now feel able to contact ifthey require support. The full report isavailable at www.ennonline.net

Review of financing arrangementsaround CMAMAs a follow up action to the CMAMConference, the ENN undertook areview of the financing arrange-ments for programmes that man-age acute malnutrition at scale through thecommunity based management of acute malnutri-tion (CMAM) approach. It was funded by Irish Aidand CIDA. The review involved country case studiesfrom Kenya, Ethiopia, Malawi and Nigeria (devel-oped based on interviews with government andother stakeholders, plus review of essential docu-ments); in-person and telephone interviews withdonors, UN agencies and foundations involved inCMAM financing, programming and research, greyliterature review; and donor feedback (CIDA andIrish Aid) on findings. The final report is due out inMarch 2013.

Consultation onanthropometricindicators in acutemalnutritionIn collaboration with and fund-ed by Save the Children UK, ACFand UNHCR, the ENN facilitateda technical consultation withpractitioners and academic specialists on the use ofmid-upper arm circumference (MUAC) and weightfor height (WHZ) indicators in acute malnutritionprogramming. The aim of the consultation was togain a shared understanding of operational issues,current evidence and its application to inform safe,pragmatic ’stop gap’ guidance, and identify knowl-edge gaps and research priorities with regard tothese indicators to assess acute malnutrition. Thefour month consultation involved 19 academic spe-cialists and 10 operational organisations. The con-sultation culminated in a 2 day meeting led by theENN in London on 5-6th December 2012. A finalreport has been produced with recommendationsfor practice (available at www.ennonline.net) andhas been shared with UNHCR as the final stage out-come of the four-month consultation process,which involved 19 academic specialists and 10operational organisations. The consultation hascomplemented and informed the WHO NutritionGuideline Advisory Group (NUGAG) process.

Linked to this review, the ENN reviewed opera-tional issues and challenges faced by UNHCR andits implementing partners regarding anthropo-metric indicators of acute malnutrition, includingrelevant regional and country experiences.

ing the Global Nutrition Cluster (GNC) and during2012, represented the group at the GNC annualmeeting in Geneva (July). During 2012, fundingwas provided from Irish Aid, Save the Children(UK), Terre des Hommes, Concern Worldwide andUNHCR to support group.

In March 2012, the ENN held an IFE Core Groupmeeting in Oxford, to further define the natureand scope of the group’s mode of operation, iden-tify funding sources, to prioritise key activities andto identify which activities to take forward.

Stemming from this meeting and recommenda-tions of the annual GNC meeting in July 2012 inGeneva, the ENN has led a review by a small work-ing group to identify 4-5 common prioritiesemerging in the sector. This formed the basis of aconcept note of activities under development bythe IFE Core Group. Regarding other IFE CoreGroup activities, two agencies were invited to join– IOCC and World Vision. The ENN, as IFE CoreGroup representative, delivered content on HIVand infant feeding to a professional trainingcourse on HIV and infant feeding in Thailand by

remote link. The ENN also coordinated inputs intokey indicators on IYCF-E to include in early needsassessment (assessment WG of the GNC) and thiswork will continue in 2013.

Through 2012, the ENN provided technical inputsinto a Save the Children US-led, Alive and ThriveProject in Ethiopia on research to explore integra-tion of infant and young child feeding in commu-nity based management of acute malnutrition.

ENN Income & Expenditure Statement

For the Year to 31st January 2013

Income

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Income received from donors decreased by £98,121 in the year to£1,091,469 (2012: -8%). ENN returned an operating surplus of £50,473(2012: deficit of £19,163). This increases the total reserves to £194,023(2012: £143,550). The cash balance at the year-end amounted to£171,612 (2012: £367,320).

During the year, OFDA (USAID) provided the majority of the income in theyear (£650,260), continuing to fund the Research into the Prevention andTreatment of Moderate Malnutrition project that ended in December2012, while funding for another series of projects continues untilSeptember 2013. Irish Aid provided £97,163 for the donor financing ofscale up of CMAM, Field Exchange production, a small allocation to IFECore Group coordination and to support work on Management of AcuteMalnutrition in Infants under 6 months (MAMI). CIDA (Canada) also sup-ported the donor financing of scale up of CMAM, Field Exchange, NutritionExchange and en-net with a combined contribution of £114,985. UNHCRfully funded the Anaemia in Refugees Study to the amount of £190,864.

The ENN has enjoyed the financial support of 12 international non-governmental organisations (INGOs) and United Nations (UN) agenciesthat provide recurrent annual funding. Whilst the current economic cli-mate has impacted on funds accessible to ENN via recurrent funders, rela-tionships with stakeholders remain strong and ENN has sustained goodlevels of recurrent contribution.

Through 2013, the ENN is investing person time to nurture these rela-tionships and actively solicit funding support from established and newagencies working in the humanitarian sector.

Staff

1,091,469

1,041,563

GBP

Emergency Nutrition Network32, Leopold Street, Oxford, OX4 1TW, UK

Tel: +44 (0)1865 324996Fax: +44(0)1865 597669

office@ennonline.net ife@ennonline.net

Chloe Angoodis Nutritionist/HR support

Thom Banks is ENNDesk OperationsOfficer

Marie McGrath isField Exchange Sub-editor, IFE Core GroupCoordinator, MAMIProject Coordinatorand Director/Trustee

Jeremy Shoham isField Exchange Editor,Moderate MalnutritionResearch Coordinatorand Director/Trustee

The Emergency Nutrition Network is a company limited by guarantee and not having ashare capital. Registered address: 32, Leopold Street, Oxford, OX4 1TW, UK

Registered company no. 4889844. Registered charity no. 1115156

Matt Todd is ENN’sFinance Manager

Katherine Kaye isMailing Assistant

Michele Toler isOperations andFinance Assistant

Carmel Dolan isTechnical Directorand Field ExchangeDigest Co-editor.

Additional ENN expertise is provided by:

Orna O’ Reillydesigns and producesall of ENNs publications

Valerie Gatchell isNutrition ExchangeCo-editor

Phil Wilks provides IT expertise

Supporting agencies in 2012/13:

TrusteesJeremy Shoham andMarie McGrath.Bruce Laurence is a Consultant in Public Health in Derbyshire, UK. Previouslyhe was Medical Director of the UK-based NGO, Merlin, and has also workedwith Oxfam and MSF.Nigel Milway was a senior executive with British Telecom for over 14 years andis now director of his own own leadership and coaching consultancy.Victoria Lack is a Lecturer in Public Health and Primary Care, at City University,London and spent years working in the field with ACF.Arabella Duffield is an independent nutritionist with academic and field experience in nutrition and food security, and most recently was a SC UK nutrition advisor.

AuditorsWenn Townsend Chartered Accountants, 30 St Giles’, Oxford, OX1 3LE, UKTel: +44 (0)1865 559900 Fax: +44(0)1865 310019

Expenditure

Cover photos from top: Lucia Zoro, Northern Nigeria, 2011; Mohamed Moalim/FSNAU,Somalia, July 2011; David Rizzi, Mauritania, 2010; UNICEF/NYHQ2011-0273/Dormino;HelpAge International, Pakistan, 2011

ACF ESP 1,448ACF France 4,100BRC - British Red Cross 2,100CIDA 114,985Concern Worldwide 3,600IDS 1,614Irish Aid 97,163Merlin 300OFDA 650,260Save the Children UK 14,575Save the Children USA 2,665Terre des Hommes 625UCL 800UNHCR 190,864World Vision Canada 6,048Sundry 322

Wages and Salaries 233,248Consultancy Fees 528,912Postage, Stationery, Production and Distribution 66,950Rent, Rates, Service charges and Light and Heat 10,959Meeting costs 1,855Equipment & supplies 11,523Office costs, Website and IT 14,366Insurance 1,833Telephone and Fax 11,664Travel Expenses 99,544Auditor’s remuneration - statutory 7,280Auditor’s remuneration - donor 9,897Professional charges 984Bank Charges 889Profit/loss on exchange 41,659

Interest Received 567Operating Surplus/(Deficit) 50,473

Finance andManagement