Workshop of the Information Platform on Nutrition in Pastoralist areas on

Nutrition mainstreaming in pastoral strategies and programmes

24 May 2018, EU Delegation, Addis Ababa

Introduction

In September 2016, a group of development and implementing partners met to share their experience around nutrition programmes in pastoralist areas. One of the main recommendations from this meeting was in order to fill the numerous knowledge gaps in this area, a group or network should be set up to help information sharing and exchange on issues around nutrition in pastoralist areas. A smaller group of experts met in the beginning of 2017 to start planning the set-up of such a network. The primary purpose of the Network is to provide a platform for sharing knowledge, learning and support the documentation of evidence-based good practice with a view to scale-up on nutrition in pastoralist areas of Ethiopia.

Specific objectives of the network should be to

- Work with government and development partners to raise awareness on the opportunities of improving nutrition in pastoralist areas.

- Organize regular meetings (3-4 per year) for members to come together to share and present project level knowledge and learning in a conducive environment that supports learning

- Identify and circulate studies and evidence-based good practices on programmes aiming to improve nutrition in pastoralist areas, generated inside and outside Ethiopia that can support learning and improved practice within Ethiopia

- Identify gaps and potential opportunities in nutrition interventions in pastoralist areas

- Organize visits to members project areas to share knowledge and learning in the field

Objectives of the workshop

The objectives of this workshop was to present strategies related to pastoral areas to understand what policy frameworks are addressing pastoralists and to understand where there could be a potential to mainstream nutrition. The aim is for the nutrition information platform to understand the policy landscape and identify potential entry points.

Presentations

Health Extension strategy in pastoralist areas – Hentsa Haddush, FMoH

Proposed theory of change for re-optimizing of the health extension programme (HEP) in Pastoral regions

Focus areas are:- Leadership, Governance and Performance Management - Service delivery- Community engagement- Special support - Integration- Monitoring and evaluation

These focus areas should all strengthen the primary health care units.

1. Improve Leadership, Governance and Performance Management- Encourage legal and policy framework for merit-based assignment (for health

workers and HEW), encourage young educated health mangers to be managers for health sector;

- Develop the capacity of woreda and health center management to map, analyze and predict the situation such as movement of the community;

- Enhance results based management and motivation schemes;- Provide technical support;- Strengthen follow-up, monitoring and evaluation mechanism.

2. Service delivery- Organization of health service delivery level (contextualize the package);- Determine package and scope of services;- Diversify service delivery modality - Define HR, what services are needed and who should provide what and where;- Supply and logistics.

Under the health center (HC) there will be two teams (see chart below):- Health post: static (village and school health will be addressed under the health

post);- Mobile team: addressing the mobile community (multidisciplinary teams) will

serve temporary settlements and IDPs.

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Service delivery package and scope- Redefine service packages at health post and community;- Upgrade health post service package, scope and quality (to be able to address

needs of mothers that cannot access health centers due to infrastructure, distance…);

- Include key curative services including skill delivery neonatal care and treatment of common illness;

- Share some tasks from health centers and shift some tasks to community and school level.

Diversifying delivery modality:- Fixed: health center, health post, community village;- Outreach: short (1-2 days), extended (3-15 days), schools;- Mobile (current practice need transition (TA, supply and also offering caravan

services).

There are mobile health teams in Somali and Afar and consist of 4 team members both addressing preventive and curative services. We are planning to revise the arrangement due to costs etc. but it will continue as mobile team.

3. Human resourceStaffing health post: three options have been proposed- depending on the context of the area:

- 2-3 female health extension workers;- Mixed gender HEW (60-75% female and 25-40% male);- Assigning different categories include one nurse/midwife.

The Ministry wants to have all HEW female, but it is not feasible in all locations.At community level: we will include influential community leaders to support the health extension workers.

HC

HP

Villages School

Mobile (multi-disc. team)

Temporary settlements &IDPS

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Supply and logisticsHealth centers should be the central hub for supplies to provide the health post. Health posts are directly linked to health centers.

6. Community engagement - Explore available community platforms: since they have not been used enough in

the past;- Initiate modified Women Development Army (WDA) approach using locally

appropriate social networks such as clans and religious leaders, traditional birth attendants;

- Engage community level health workers;- Use schools for message dissemination;- Strengthen traditional communication systems: such as Dagu in Afar;- Use of mass media;- Improve health service quality.

Special support- Stratification of woredas in terms of the hardship and implementation status and

provide need-based support;- Material support (residential houses, water, etc.);- Technical support for low performing woredas: strengthen integration with other

sectors;- Psychosocial support.

5. Integration and coordination- Integration within the sector such as: primary health care should be integrated in

the public health emergency system, and also mobile and fixed services should be integrated;

- Schools can also contribute to dissemination of messages as key communication channel in these regions;

- Animal technicians meet community at water points and can collaborate on human health as well, using One Health approach;

- Opportunities for integration with schools, animal health technicians and PSNP taskforce (considering a One Health approach – given that pastoralists sometimes give more consideration to their animals than to their children, the One Health approach will help give more attention to their children).

6. Follow up/monitoring- Involve stakeholders starting at planning stage;- Provide reporting template, reporting periods;- Set periodic supportive supervision mechanisms quarterly or monthly;- Conduct periodic tri-party dialog and monitoring review meetings with

administration, health managers and community representatives;- Conduct operational research;- Recognize best performers;- Document and disseminate key lessons.

Current implementation status:- The Strategy is approved by the executive and JSC committees and endorsed by

the Deputy Prime Minister;- Implementation manual prepared;

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- Ready for launching at regional and woreda levels.

Questions

- Coordination with pastoral development strategy?o We are working together with Ministry of Federal and Pastoral Affairs: we

are ready to integrate this package to the new WB-IFAD funded Government programme in pastoral areas (which is a programme to implement the MoFPA strategy).

- Cross border collaboration?o Most of the pastoral areas are trans-border, both internal and to other

countries, which is considered in the strategy.

- Viability of mobile teams given that only a part of the population is mobile?o We are providing mobile services together with UNICEF: we have defined

already where these services are needed and there is a schedule to catch mobile population. They also have a defined service package.

National One health strategy – Meseret Bekele, Chairperson of National One Health Steering Committee

The One Health (OH) approach is known to be the mechanism that enhances collaboration among the human, animal and environment sectors to deliver optimal health for humans, animals and the environment.Ethiopia has made huge steps to strengthen the animal and human health services both in manpower and facilities. Cross-sectoral efforts to prevent, detect and respond to OH threats are still at infant stage. Cross-sectoral collaborations have been limited in their lifespan and specific in their scope and are disbanded once the threat is contained or reduced.

The National One Health Steering committee (NOHSC) is led by the Deputy Prime minister and was established in 2016.It is comprised of

- Ministry of Health/EPHI;- Ministry of Livestock and Fisheries;- Ministry of Culture and Tourism, represented by Ethiopian Wildlife conservation

authority;- Ministry of Environment, Forest and Climate Change;- Development partners.

The NOHSC is mandated to facilitate multi-sectoral coordination and collaboration among OH stakeholders at National and sub national levels and strive towards the establishment of a sustainable institutionalized OH platform in the country.

Technical Working Groups are envisaged to provide expert forums for tackling zoonotic diseases, enhance mutual accountability and collaboration among the sectors and promote greater efficiencies in the management of zoonotic diseases and other health threats using OH approach in the country. To accelerate the multi-sectoral coordination

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and collaboration and reduce the risks of health threats at the animal-environment-human interface in the country, OHSC has come together to design the One Health strategic plan (2018-202.2), which technically is approved, but now needs to be endorsed by the individual ministries..

The vision of the strategy is that there will be negligible risks and impacts of endemic, emerging and re-emerging health threats at the animal-environment-human interface. The mission is to establish a sustainable one health coordination mechanism at all levels for multi- disciplinary and multi-sectoral engagement in the prevention, detection and response to endemic, emerging and re-emerging health threats at the human, animal and environment interface.

Key pillars and strategic objectives of the strategy are:1. Coordination and collaboration;2. Preparedness and response;3. Surveillance reporting;4. Policy, advocacy and communication;5. Research and capacity building.

The following strategic objectives have been proposed for the different pillars:

1. Coordination and Collaboration To ensure effective and functional One Health coordination mechanism at all

levels by 2022; To mainstream One Health activities in all relevant Government sectors by 2020; Develop and implement monitoring and evaluation system for OH at national and

sub-national levels.

2.Preparedness and Response Establish and strengthen multi-sectoral and multidisciplinary capacities at all

levels for timely detection, and rapid response to emerging and re-emerging priority threats at the human-animal-environment interface by 2021;

Develop multi-sectoral prevention and control strategies for priority emerging and re-emerging zoonotic diseases;

Implement and promote multi-sectoral prevention and control strategies and preparedness and response plans for priority emerging and re-emerging zoonotic diseases using One Health approach.

3. Surveillance and Reporting Establish and strengthen integrated multi-sectoral surveillance systems by 2022; Operationalize regular sharing and use of surveillance data and information

across sectors by the year 2020.

4. Policy, Advocacy and Communication Improve enabling policy environment across all collaborating sectors for the

implementation of one health by year 2022; Secure high-level buy-in and support for one health across all sectors; Improve knowledge, attitude, behavior and practice of community on health

threats or risks at human, animal, and environment interface.

5. Research and Capacity Building

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Conduct joint research projects on prioritized zoonotic diseases and other health threats at the animal-human-environment interface by 2020;

Improve policy on disease prevention, detection and response using one health in line with research findings by 2022;

Improve human resource and infrastructure capacity for health research by 2022.

Questions/Comments:

- Cascading of the strategy down to regions?o So far we are strengthening the national level, but there is a plan as part

of the 5 year implementation plan to cascade the strategy down to all levels;

- The two strategies on One health and health pastoral extension programme could be working more closely together having very similar objectives.

Pastoral Areas policy context analysis– Tilahun Asmare, Mercy Corps

The Ministry of Federal and Pastoral Affairs has prepared a Pastoralists Development Policy and Strategy framework for which Mercy Corps has conducted a policy context analysis. This presentation includes the main findings of this analysis.

There are numbers of continental and regional policies that address pastoralists:

Continental and Regional Polices• Pan-African policy framework: Promoting pastoral mobility, securing land rights,

harmonizing policies, identifying the needs of pastoralists and empowering them;• Intergovernmental Authority on Development (IGAD): A Livestock Policy Initiative

to ensure that livestock potential is understood, articulated and strategically built into poverty reduction processes.

National Polices Making Process• The Ethiopian Constitution on pastoralists 1995Article 40: Ethiopian pastoralists have the right to free land for grazing as well as the

right not to be displaced from their own lands;Article 41: Pastoralists have the right to receive fair prices for their products.• 2003 rural development policyThe need to focus on livestock development, specifically recognizing the need to

develop livestock feed and water supply;market and marketing infrastructure challenges, market institutions, and the need for

improving livestock production that fulfills the demand of consumers.• Ministry of Federal affairs, 2008 draft policy: Reduce sole reliance on livestock

through human capital development and diversification of sources of income;• GTP II : Rangeland and pasture land management

Strengthening and expansion of animal health service;• Draft PAP policy and strategy framework of MoFPDA: based on Sectoral Policies

The Draft Pastoral Development Policy Framework:

• The MoFPDA reorganized during Oct 2015 with Missions of Ensuring Pastoral Equitable Development, Sustainable Peace and Building Consensus on Same Economic & Political Space in the Nation.

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• Drafted Pastoral Development Policy & Strategy Framework by reviewing and bringing together sector specific & fragmented pastoralist policies and strategies

• The policy document includes two pillars and13 major policy statements;• The core of the policy pillars is water centered sedentarisation and modernizing

agricultural sector in pastoral and agro-pastoral areas;• USAID/Mercy Corps supported to enrich and update the draft policy, • Conducted study and six consultative workshops to verify the findings and further

refine the information and conclusions gathered;• Discussions with regional and woreda officials, community representatives, and

stakeholders’ consultation workshops show that the core of the policy should be livestock, pastoralists and their way of life and should aim at reducing vulnerability and building resilience.

• The context analysis follows a systems perspective to understand the complex PAP way of life focusing on the following six major components:

1. Livelihood policy recommendations:

Animal health • Government facilitation and incentives to attract private animal health services• Policy to support improved disease related information flow • Strengthen community based animal health service

Livestock Feed• Improve livestock feeds (fodder production, forage cultivation, etc.)• Promote ecologically sound water point development and distribution that

considers temporal and spatial variability in the availability of forage

Livestock marketing • Policy to enable the expansion of ICT and communication services e.g. for

market information; access to finance; pasture availability; mobile banking • Livestock market policy which addresses blockages that benefits producers e.g.

market linkage; formalizing cross border trade • Policy to promote value-added livestock production and trade (e.g., fodder

production, improved breed (selection), meat processing, and local feedlots)

Rangeland • Need for a comprehensive land use policy: resource assessment, land use

planning and enforcement (which into consideration vision of pastoral livelihoods)• Expand communal range land management and certification• Policy to support range science education and research • Support implementation of national invasive species management policy • Policy to enhance the capacity of pastoralists in rangeland management skills

Diversification• Policies and strategies for diversification of adaptable and context specific

livelihoods: extension services- e.g. adaptable crop varieties, BDS and market linkages; benefit sharing

• Policy to enable pastoral drop outs to enter into urban life and to different livelihoods.

• Diversification/crop production should be supported by science and technology to be adaptive to changing and variable climate

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2. Disaster risk reduction policy recommendations

• Improved policy and planning for drought and response• Policy to focus on building resilience that focuses on wealth/asset and

opportunity creation • Need for a comprehensive natural resource management and land use policy• Commercial destocking needs to be incorporated into DRR system with lessons

learned from previous experiences.• Incentives for consistent livestock offtake, not just during periods of drought.

Especially pastoral area traders – linked to larger facilities – fattening, abattoirs.• Policy to enhance innovative coping mechanisms: E.g. Species diversification;

Shifting to more drought resistant species and crops; and, Commercially sourcing feed/food

3. Basic services policy recommendations

Health• Policy that consider peculiarities of the ecology, social system, and geographical

locations• Investment framework to integrate road networks, mobile communication,

electricity and ambulance services

Education• Curriculum and methods of delivery need to consider the pastoral context and

mobility patterns• Context based and flexible academic calendar• Policy to promote school feeding programs ,• boarding schools, and competitive payment for highly motivated teachers • School construction and sustaining teachers need the provision of basic services

such as water, mobile network, and at least certain centers Water

• Strategies for sustainable water development that take into account NRM & sustainable livelihood options through community participation

• Policy and investment framework for improved operation & maintenance

4. Governance and capacity building recommendations

• Legitimize pastoralist governance of rangeland resources, improving governance capacity

• Recognition of communal land rights (communal certification and enforcement)• Clear mandate for coordination state and non state actors programs and also

accounting sectoral bureaus (e.g. Oromia Pastoral Commission)• Policy to focus on physical and human capacity building for Government

implementation agencies based on the gaps. • Policy needs to strengthen institutions that support the pastoralist way of life.• Land use/planning policy and implementation that recognizes the rights of

pastoralists and improves their production system• Value local knowledge and practices and guide complimenting scientific

knowledge to inform local decisions and development initiatives

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• Policy and strategies that show long term vision and goals of pastoralist livelihood taking into consideration – GENDER, HTP, HIV/AIDS, ENVIRONMENT

5. Conflict and peace recommendations

- Policy on conflict management must enhance the inter-regional and inter-governmental collaboration.

- It should strengthen customary conflict resolution and management mechanism.- It should support the traditional and indigenous practices for safer and legally

regulated and protected inter and intra-community mobility.

6. Policy dialogue and advocacy recommendations:

• Pastoralism and policy support for industrialization of the livestock sector should be the center of the policy, not to move pastoralists to become settled farmers (there is a thinking that pastoralists have to move to crop production before industrialization can take place)

• Commune system to be considered as a safety net primarily for pastoral drop outs, but to be open for others, not undermining the mobile production system

• Policy to enable co-existence (with benefit sharing) of mega projects with the pastoral way of life.

Inclusive and participatory planning and management of mega projects Policy to promote pastoralists (region) to be share holders of mega

projects; Policy to set aside some irrigated land from mega projects to fodder

production to meet the needs of pastoralistsSkill development and employment for pastoral drop outsBy products need to benefit pastoralists – policy to force this change

• Contextualize AU and IGAD policy frameworks that advocate for cross-border mobility and trade

• Policy to inform linkages between universities/ research institutions and sectoral ministries

Questions/Comments:

- This seems to be the second policy framework for pastoralists and looks very much like the IDDRISI strategy and the country paper (strategic document). There needs to be synergy within the government policies.

- Why does the policy have to support industrialization? o We should think of commercialization of livestock and there is some

literature supporting that. From Somali we know that there is a marketing challenge, which high transportation costs to get to center market. If markets are closer to pastoralists, it will help them. Also for milk processing companies there should be a market, which will add value to the products of livestock

Mobile teams, SAM-MAM management, TFP and TFP admissions, Orla O’Neill, Emergency Nutrition Coordination Unit ENCU

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The following charts show the burden of severe acute malnutrition in pastoral areas, nationally, in Afar and Somali Region 2017and 2018. The charts show the admission rate to Therapeutic Feeding Programmes (TFP) since 2010, which is when the massive scale up of the Community-based Management of Acute Malnutrition (CMAM) started, which obviously changed admissions. Overall national yearly admissions over the last years have never gone below 300,000. In bad years they reach up to 350,000 per year.

Average monthly admissions – national level

Average monthly admissions – Somali region

Average monthly admissions – Afar region

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What type of emergency nutrition services exist in the country?

Emergency Nutrition Services for hard-to-reach populations are provided through four modalities:

• Mobile Health and Nutrition Teams (MHNTs)/Temporary clinics- SAM MAM treatment is integrated, coverage is low (remote sites and IDPs only)

• NGOs providing supporting Government SAM treatment and monthly targeted supplementary feeding programme (TSFP) for MAM

• 35% of all relief beneficiaries receive CSB++ (Quasi Blanket supplementary feeding programme) (preventative, short term)

• Opportunity for expansion: Static health facilities- where SAM-MAM treatment is integrated, yet coverage is low (<50% in many woredas)

Mobile Health Nutrition Teams (MHNT)• Reach the most vulnerable, hard-to-reach pastoralist communities • Target areas where routine primary health care and nutrition services are limited• Respond quickly to communities in priority areas where occurrence of both

manmade & natural emergencies are frequent

What services do the MHNT provide?

• Basic curative / preventative services• Classification/diagnosis & management of common illnesses• ANC, Delivery (attend normal delivery)• Immunizations - Routine

• Nutrition services- Screening – U5s & PLW - Admission to outpatient treatment programme (OTP) for weekly SAM

treatment for U5– Uncomplicated to reach children before complications arise

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- TSFP for children under five and PLW with MAM• Health Education: Including nutrition /IYCF, hygiene promotion and health

counseling• WASH: Provide soap, water treatment chemicals• Disease surveillance • Referrals: Children with complicated SAM and maternal complications are

referred to health centre/hospital• Health System Capacity building: health workers in Somali have been rotating

from mobile and then put back into a struggling health post and will be returned into static system. This will build capacity of static as well as mobile teams

Integration of MAM

• Since mid-2016, Mobile Health and Nutrition Teams (MHNTs) have started to treat moderate acute malnutrition (MAM) through targeted supplementary feeding programmes to hard to reach communities.

• This integration promotes improved SAM–MAM continuum of care, preventing a child with MAM deteriorating into SAM and enabling any child cured from SAM to fully recover.

The chart below shows the evolution and scale of the mobile health and nutrition teams, which started in 2004 with UNICEF and regional health bureau, because of a measles outbreak. In 2007 the programme was scaled up by adding more child basic disease services. It was gradually scaled up in both Somali and Afar. Currently UNICEF is supporting the regional health bureaus and WFP 29 in Somali and Afar to 20 in 2015.

Over the course of this period, the structure and guidelines have improved (developed by UNICEF, also adopted in Oromiya for NGOs). UNICEF and WFP provide support to government mobile health teams: the government provides staff, sometimes they

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provide the vehicle and UN maintains it. The UN also provides per diem for the 4 th or 5th

staff. Technical support, training etc. is the cost that UNICEF provides.The NGO model that is being implemented in Oromiya is newly scaled up (in other regions such as Somali, Save the children and others have been doing it there as part of the response mechanism). In the NGO model in Oromiya, the same package and guidelines are being used as in Somali and Afar, but the government has asked NGOs to find the health workers themselves.

Challenges• Costly form of service delivery (up to $8,000 team/month, does not include

Government contribution for staff cost and some logistics)• Weekly service provision rather than routine, makes it difficult to address ad hoc

emergency health needs (e.g. severe malaria case, complicated delivery) • Issue of parallel system and sustainability: Regional Health Bureau (RHB) interest to

expand mobile services, possibly to the detriment of expansion of static/ routine services

• Ensuring quality of services: requires frequent monitoring and supervision by the Regional Health Bureau and UNICEF/ WFP

• Repurposing MHNTs in response to outbreaks could interrupt the full course of treatment for SAM and MAM

The mobile teams are however 100% lifesaving.

Outlook and Sustainability

There needs to be cost-effective mechanism to bridge the static and mobile model.

Three fold increase in static service access. So the static model needs to be expanded where possible, but there will always be a gap and a need for an alternative strategy such as for mobile teams. Advocacy is needed for Government funding for MHNTs and other mobile and outreach to ensure sustainability and coverage of primary health care services for remote and pastoralist communities.There also is ongoing joint WFP and UNICEF advocacy with FMoH to integrate MAM treatment into the health system (currently it is dealt as part of the Disaster response, which is under the Ministry of Agriculture), which obviously affects the continuum of care.

Woreda Led Sustainable Outreach Services (SOS)This innovative new platform is currently being piloted by UNICEF, which should be a bridge between the static and the costly mobile teams.

Anchored at woreda administration following country 3 tiered decentralized health delivery system, which gives more ownership and capacity to the woreda

In addition to current MHNTs in Somali to demonstrate an alternative outreach modality – SOS

Now Implemented in 15 woredas (29 Health Centers) in Somali since Sept 2017 Inclusion criteria of the woreda:

with difficult geographic, communication access but with adequate human resources to deliver the outreach services.

representing different livelihood zones .i.e. pure pastoralist Agro-pastoralist and riverine.

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With limited number of health facilities (HPs) to provide outreach services within the health center as catchment.

Outreach schedules: 3x /per week or 12 days per month within the HC catchment area

Logistics: drugs, transport and team allowance In Afar this approach should also be piloted and 5 woredas were identified to

start this year

The SOS approach will include the following: Staffing: 2 Nurses, 1 Midwife, 1 HEW, 1 social mobilizer from the local villages Service Package: Maternal Child Health & Nutrition, EPI, Health Promotion,

Referrals, HH water Treatment (WTC) Baseline HF profiling including social mapping, Orientation, Monitoring,

Supervision, HMIS, Community mobilization and linkages Advocacy, Coordination, alignment with national policies

Questions:

- Is there a difference in mobile teams in Afar or Somali?o The MHNT model of MoH that UN supports is the same in Afar and

Somali: in Afar they have 4 health workers, and Somali has 2 HEW that rotate back into the static system (so in Afar you might have more qualified staff but in Somali you have the advantage of the rotation). Staff turnover is a challenge in both though. What Somali had to deal with was more a more difficult situation, floods etc. The performance changes depending on difficulties they are facing. 15-20% of all SAM are reached by Government mobile teams, UN and NGO reach more.

- Are these mobile teams cost-effective? Could there not be alternative cheaper, static services?

o Not having the mobile service will not only mean lower admission but higher death rate. Everything you can do to develop the resilience to stop the spikes in malnutrition, such as prevention is obviously key, but there is little development/infrastructure funding going to the pastoral areas. If you map the development funding in the country, it is all focused on the highlands. If more could be done on infrastructure, resiliency in the health system, more cost effectiveness to do outreach, it would help prevent the repeated spikes in malnutrition. We need to work on prevention (such as nutrition sensitive agriculture) in pastoral areas, and effective IYCF, which is part of the nutrition development package that the Government, donors, NGOs are supporting. There will always be spikes but we can handle them better with the right prevention, which will also reduce mortality rates.

o The number of people you may reach with mobile teams is very small, but you need to consider the cost of saving lives.

o It is also difficult to assess the cost-effectiveness of interventions in the pastoral areas. In highlands you have 5000 people in a kebele, but in lowlands you don't have that structure, which makes it difficult to do calculations.

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o For 49 (20 Afar, 29 Somali) health mobile teams, there were an estimated annual 500,000 consultations (UNICEF Health team would have these numbers)

- Development/humanitarian nexus: Isn’t offering those nutrition services perpetuating dependence on assistance and increasing admissions?

o Offering life-saving services is not a demand-supply system. Obviously admission will go up when you put these services in place, but people would be dying if these services where not in place.

o The Humanitarian Requirements Document (HRD) is also looking at health systems strengthening and mitigation (see the pillars of HRD), and works actively to strengthen the development-humanitarian nexus

Discussion on how to mainstream nutrition

- Policy cohesion: There should be scope for more cohesion among the strategies within the Government as well as within partners. If the Government has accepted to support the mobility, then partners should also support such decisions.

- Dependency on goods and food aid needs to be addressed. There is a need for a more market-based approach. PRIME has had very good experience in using market-based approaches, introducing credit system, vaccination services offered by private sector (which were more effective and cheaper than government ones).

- Coordination platforms: there are many platforms talking about pastoralists and nutrition: How to introduce nutrition into RED-FS? There might be an opportunity to set up a technical committee on nutrition under RED-FS, which also could address pastoral issues.

- Opportunities for advocacy: RED-FS is also preparing policy fiches, one will be on pastoralism, which is being prepared by USAID. This fiches would be an opportunity to also include nutrition advocacy points.

- Involvement of private sector: there is a disconnect between emergency and humanitarian aid, which is where the private sector could play an important role to bridge them. It is also important to consider private sector involvement with caution when it comes to nutrition. Some of the private sector investments take land and resources away from pastoralists, which affects their nutrition situation. So whenever private sector involvement is considered, it should be done with a nutrition lens. At the same time there might be limited understanding by the Government on how these investment in megaprojects could affect the pastoralist livelihood.

- Practical models for what works in nutrition and pastoral areas are needed: while it is important to have policy coherence, there need to be tangible, practical solutions on the ground.

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- How to modernize pastoralism? Innovative models for mobile teams and market based approaches together with other initiatives can help modernizing pastoralism. At the same time it will be important to listen to pastoralists and understand what their vision is. How do they see modernization? Where do they want to be in 10, 20 years. We cannot decide this for them without hearing their voices.

- Industrial parks in pastoral areas need to be designed for livestock commercialization.

Next steps

- A small group led by Maya Hage’Ali (FAO/EU officer) will work on the action fiche for RED-FS to integrate nutrition advocacy points

- Next workshop to take place in October- Steering Committee to take place in June, where potential topics, speakers for

next workshop will be discussed.

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Annex 1 - Agenda of the workshop

9-9.30 Welcome and introduction of participants

9.30-9.45 Objectives of the meeting

9.45-11.00 Presentations

FMoH Extension strategy in pastoralist areas – Hentsa Haddush, FMoH National One health strategy – Meseret Bekele, Chair of National One Health

Steering Committee Review of MoALR Pastoral Strategy – Tilahun Asmare, Mercy Corps Nutrition situation, mobile health and nutrition teams in pastoral areas, Orla

O’Neill, ENCU

11.00-11.30 Coffee break

11.30-12.30 Discussion on potential nutrition mainstreaming in the presented strategies

12.30-13.0.1 Next steps and closing

13.00 Lunch

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Annex 2 – List of participants

ACF Jogie Abucejo Agbogan nhta@et.missions-acf.orgBioversity International Mestawet Gebru mestigbr@gmail.comCARE Meseret Demissie Meseret.Demissie@care.orgComitato Collaborazione Medica (CCM) Andualem Assefa healthadvisor.eth@ccm-italia.orgComitato Collaborazione Medica (CCM) Ms Fatimata Rogomssore Ghione Ouedraogo fatimata-rogomssore.ghione@u-bordeaux.frConcern Worldwide Nicky Dent Nicky.Dent@concern.netEU Berhanu Taye Berhanu.TAYE@eeas.europa.euEU Pierre-Luc Vanhaeverbeke Pierre-Luc.VANHAEVERBEKE@eeas.europa.euEU Ursula Truebswasser utruebswasser@gmail.comFAO Maya Hageali Maya.HageAli@fao.orgFAO Florence Tonnoir Florence.tonnoir@fao.orgFMoH Hentsa Haddush hentsa5@gmail.comGAIN Hana Yemane Wodajo hywodajo@gainhealth.orgGIZ Dr. Elisabeth van den Akker Elisabeth.Akker-van@giz.deIFAD Ulac Demirag u.demirag@ifad.orgIFAD Samir Rayess Calvo s.rayesscalvo@ifad.orgItalian Agency for Development Cooperation Andrea Ghione a.ghione@itacaddis.itItalian Agency for Development Cooperation Faben Getachew faben.getachew@gmail.comMercy Corps Berissa Abdella babdella@mercycorps.orgMercy Corps Tilahun Asmare tasmare@mercycorps.orgUNICEF O Neill Mary Orla oorla@unicef.orgUNICEF Richard Machokolo rmachokolo@unicef.orgUSAID Larissa Mori lmori@usaid.govUSAID Darsema Gulima Darsema_Gulima@dai.comVSF Suisse Zuleka Ismail zuleka.ismail@vsf-suisse.orgOne Health Steering committee Meseret Bekele yohanan14sm@gmail.com