Institutional development in Ethiopia: supporting an improved emergency response
By Jean Gladwin
Dr Jean Gladwin is an independent consultant and researcher. She was seconded from the World Food Programme as a technical adviser to the Ethiopian government department responsible for co-ordinating emergency response, prevention and preparedness.
Planned institutional development can be fraught with difficulties and diverted by internal and external political agendas. Therefore, it was with excitement and trepidation that I accepted the challenge of contributing to the development of the Emergency Nutrition Coordination Unit (ENCU) within the Disaster Prevention and Preparedness Commission (DPPC). This government department, as its name implies, coordinates the prevention, preparedness and response to emergencies in Ethiopia.
Throughout the last century the people of Ethiopia have experienced many food crises as wars, natural disasters, political instability and poor infrastructure have taken their toll. Most recently, in 2000 a drought crisis affected over 10 million people, resulting in widespread deterioration in nutritional status, primarily amongst women and children (DPPC 2000).
The Early Warning Department (EWD) at the DPPC had, for several years, sought to improve the government and its partners' response to nutritional emergencies in Ethiopia. A Nutrition Unit had existed within the EWD, but had limited resources and a different mandate. With this in mind, a detailed funding proposal (DPPC 2000) was developed with WFP and UNICEF support and, through the January 2000 government appeal, the DPPC successfully won donor support to establish the ENCU at federal and regional level. This unit had a broader mandate and consequently greater resources than the original nutrition unit. In November of that year I was recruited to begin the set up of the ENCU.
The DPPC envisaged that the creation of the unit would initially go through three phases, each being roughly one year in length. In the first year the ENCU would be established at federal level and in regional offices whose needs were considered greatest. In the second phase regional units would be developed with extra support being given to the most severely affected zones. Further strengthening of the federal level ENCU and existing regional units would also take place. The third Phase would include further regional and zonal expansion and strengthening of existing units.
The need to develop objectives
Ploughing irrigated field in Kalu Worreda
The new unit was a highly ambitious plan and as a newcomer I considered it an important challenge to develop detailed objectives and activities for the ENCU.
The DPPC is supported by many partners. These include other government departments (e.g. Health, Agriculture, Water) at both regional and federal level. The main UN agencies involved are WFP, UNICEF, UNHCR, OCHA and UNEUE. In addition many local and international non-government organisations provide services, technical advice, funds and other resources. Finally, donors from many countries fund relief efforts in Ethiopia, and in some cases provide technical assistance.
At the time of my arrival there was a degree of distrust and misunderstanding amongst some of these stakeholders, which appeared to be affecting the ongoing relief effort. Some improvements in these relationships therefore needed to be realised if the ENCU was to become an efficient unit. In addition major funders felt they had not fully discussed and agreed the objectives and activities of the ENCU and that greater transparency regarding objectives and activities was needed.
There was also a complex funding arrangement and even though funds and resources had been informally pledged, in addition to those from the DPPC itself, none had been officially committed for various reasons. This left the DPPC unable to plan ahead even in the short term. Major donor stakeholders wanted to influence the objectives and priorities of the ENCU, and although they were not fully satisfied with the objectives given in the funding document they had informally agreed to give funding and leave the discussion of those objectives and priorities until the ENCU was established.
Finally, the lack of technical input when drafting the original project proposal had limited the vision of the unit and not taken the organisational context sufficiently into consideration.
Developing the objectives in consultation with stakeholders
With these issues in mind I began to develop the objectives and detail the associated activities. At this stage there was no attempt to prioritise the activities given their complexity and the need to first develop a greater understanding of the situation.
Various documents were reviewed including those from government, UN, donors and non-government organisations. These included policy documents, funding proposals, field reports and assessments. Consultation with individuals proved most time consuming with discussions held on a one-to-one basis, both in small and large groups.
As the discussions progressed it became possible to develop the ideas and the detail with groups of people who had many different perspectives. This eventually resulted in a version of the objectives and activities, which was acceptable to the government and the major stakeholders.
Drawing upon personal experiences of working at district and regional level during the recent food crisis in Somali Region in Ethiopia, in feeding centres and previous experience in other countries, greatly facilitated this task.
The objectives of the ENCU
The over-arching objective of the ENCU was to 'Facilitate the use of good quality nutrition and nutrition-related information to enable the rational use of food aid and other resources in emergencyaffected areas'. This was translated into several subobjectives including:
- Initiate the ENCU within the DPPC with an emphasis on sustainability and flexibility;
- Establish and build the ENCU at regional and zonal levels in stages;
- Build the technical capacity of staff at federal, regional and zonal levels to collect, review and use nutrition and nutrition-related information in their evidenced-based practice;
- Contribute to the improvement of nutrition surveys/surveillance, in drought affected areas of the country;
- Contribute to the improvement of nutrition interventions in drought affected areas of the country;
- Assist in the identification of geographic areas and vulnerable groups in need of nutrition and nutritionrelated interventions;
- Contribute to the co-ordination of nutrition and nutrition-related responses of various organisations in drought affected areas;
- Provide nutrition and nutrition-related information to needs assessment for general food assistance and other resources;
- Strengthen and add technical justification for emergency food aid targeting;
- Facilitate targeting and monitoring of appropriate supplementary food assistance to selected groups;
- Assess the effectiveness of relief operations in meeting the nutritional needs of the affected population;
- Develop management and strategic planning capability within the DPPC Early Warning Department.
There were many activities associated with these subobjectives. These included:
- focusing on assessing the organisational set-up, available capacity and constraints to the establishment of the unit at national level
- analysing the organisational structure to discover if there are impediments to the use of nutrition and nutrition-related information to inform decisions concerning allocation of food and other resources
- facilitating organisational change in order to utilise nutrition and nutrition-related information to inform management decisions
- developing a nutrition information management system at national and sub-national levels that focuses on collection, analysis, and dissemination of nutrition and food data and other information. This, in turn, will have a direct influence on decentralised management decisions concerning the targeting and monitoring of supplementary food assistance
- developing links with other national/sub-national information systems and an ENCU management information system to assist in the targeting of food assistance including general food rations
Need to understand the decision-making structures
An original aim of the ENCU was to 'trigger nutritional interventions'. However, I felt that this was an unrealistic aim as at best the unit would only be able to provide information to other people to help them take such actions.
Input from all stakeholders
Given the wide range of stakeholders interested in the activities of the ENCU it was important to consider views of all interested parties.
Adaptability of methods and tools
I had expected to be able to use the Soft Systems Methodology, as originally developed by Checkland (1981) to develop an in-depth understanding when problems are not well defined. However, as the level of transparency and willingness to reach consensus through discussion was not what I had envisaged I used a different approach. Instead of bringing most stakeholders together I often discussed their needs in separate situations.
Although it took several weeks to develop the new objectives and associated activities this was a relatively short time for this process. There are a number of reasons for this shorter time-frame. First, since the DPPC was the main instigator of the ENCU, i.e. it was not a donor-imposed unit, there was an immediate willingness to progress. The technical advisor had a background in information management and organisational change and resources were pledged from the outset. Finally there was a commitment from UN organisations, local and international NGOs and stakeholders to participate in the discussion process.
Importance of highlighting essential policy and frameworks
There are several basic policy approaches and theoretical frameworks that have to be considered in this type of process. For example, the EWD and its funding partners did not appear to recommend a broad based approach to malnutrition. I therefore placed emphasis on an integrated approach that took into consideration many factors (food security situation, quality and quantity of water, sanitation, health services, care and feeding practices, knowledge, attitude and practice of preventative health issues) when developing the unit. This approach was, in turn, reflected in the objectives and activities of the unit. In addition, it was important to decide whether nutrition status was perceived as an early or late indicator of food crisis, as this would affect interpretation of data and recommendations for support.
Need to consider an informational approach to management
As I had expertise in information management, this allowed ENCU to facilitate nutrition and nutrition-related information gathering and to consequently become a management tool for the DPPC, DPPB and other managers taking management decisions regarding resources. This informational approach to management may become a new approach, that is distinct from centralised or 'convenience' decision-making. Moving to this management style is not an easy transition to make and recent research (Gladwin 1999) indicates that organisations often have to undertake specific changes in order to do this. The ENCU objectives and activities needed to reflect this, since it was important to identify and support the necessary changes, e.g. identification of impediments to decision-making and development of additional management and other skills.
Danger of inappropriate indicators driving data collection and processing
There was much discussion on how the ENCU data and information could be used by non-service providers. For example, there was a demand from international donors to use the data to evaluate their own contributions to the emergency. Some donors wanted to be able to use outcome indicators, that is levels of malnutrition and mortality, to suggest that their contribution (food aid) had had a positive benefit to those in need. However, such indicators are unlikely to be useful for that purpose due to the multi-causal nature of malnutrition. Therefore it would be more useful to use process indicators, for example, those which show where food went to and if these communities had been identified as in need in an earlier assessment. External pressures should not dictate the data collection and processing that routinely occurs within the government system.
This case study and the lessons learnt point to the following recommendations when developing or changing a department which aims to provide information support to decision-makers:
- understand the organisational structure and where the decisionmakers are, as the objectives need to be appropriate to the level of decision-making;
- focus on the need for organisational analysis and change;
- have someone with an information management background who understands the need for organisational change as well as a nutritionist to develop a unit such as the ENCU as this will save time;
- assess the organisational ability to use information as this could be inhibited by a lack of training, management expertise and inappropriate management procedures and tools;
- identify who the stakeholders are at an early stage and realise that there will be more than one stakeholder in each organisation;
- be aware of a variety of methods to achieve your goal and be willing to adapt;
- ensure the most powerful stakeholders are 'on board' in order to make progress;
- take into consideration fundamental policy approaches and frameworks at a very early stage;
- take a long term view;
- educate donors in the complexity of factors affecting malnutrition and resist pressure to use levels of malnutrition and mortality as the indicators of programme success when it is not warranted.
Although the stakeholders have accepted the objectives and associated activities of the ENCU in Ethiopia, it does not necessarily mean these will be adhered to. It will be important to assess needs at different organisational levels and not use a top-down approach when developing sub-national units and support. A participatory approach is most likely to work, even though this will take longer.
Finally, the ENCU produces a regular Progress Report on its activities, and will soon have other information outputs including updates of nutrition assessments on various parts of the country. Anyone interested in receiving these should contact the ENCU Information Manager Amir Siraj by email at Amir.Siraj@wfp.org
For more information contact Jean Gladwin at: email@example.com
Checkland, P. (1981) Systems Thinking, Systems Practice, Chichester: John Wiley and Sons. DPPC (2000) Project Proposal to strengthen the nutrition unit within DPPC and establish similar units at regional level, Addis Ababa, July 2000. Gladwin, J. (1999) An informational approach to health management in lowincome countries, PhD thesis, University of Sheffield, Sheffield, UK.
Taken from Field Exchange Issue 15, April 2002