Link NCA Case Study 1

1. Case Study 1: The Golden Fields Region of Essos
Context
Essos is situated in Southeast Asia. Described as a democratic sovereign kingdom, it has
a population of over 15 million people and a land size similar to England. Almost 25
years ago it suffered from a violent conflict with its neighbouring country, Dothraki, and
approximately 500,000 were killed. Since then, with the support of development partners,
the country has seen significant progress and stability and the country has witnessed
substantial economic growth, averaging 8% growth per year. Poverty has also been
steadily declining from 35% of the population to 30% in 2013. However, the country
also suffers from widespread corruption and land-grabbing, and ranks 138th
on the
human development index. Despite the decrease in poverty, there is a growing inequality
between wealthy and poor among an urban/rural divide. In 2014, the GDP per capita is
now $2000 (adjusted for PPP). However, most of the wealth is concentrated in the
capital, Volantis. More than 80% of the population live in rural areas and are employed
in the agricultural sector. Essos also has a growing youth population with over half of the
population under 20 years of age.
The country is relatively homogenous. Over 85% of the people are of Essos origin and
speak the local language ‘Valyrian’. Approximately 90% of the population are Buddhists
and 10% are Muslims. The Muslim population are typically employed in the fishing
industry and often face discrimination in terms of access to services.
The Golden Fields province is one of Essos’s central provinces, situated approximately
50km from the capital. The province is subdivided into 8 districts. The majority of the
population in the province are rice farmers. However, a substantial proportion of the
women are also employed in the countries booming textile industry, working 10-12 hours
a day in factories outside the capital.
Ar Noy district and Ny Sar district within the Golden Fields province have particularly
high rates of undernutrition, reflected in high admission rates for acute malnutrition.
These districts are situation along the Rhoyne river, a notorious flooding plane. The
community there is made up of predominantly Muslim fishing communities.
The organisation does not currently work in Essos, but are applying to open a 5 year
programme within the two districts of Ar Noy and Ny Sar in the Golden Fields region to
reduce child undernutrition.
Nutrition Situation
Maternal and child undernutrition continue to be major public health problems in Essos,
reflected in high maternal and under-5 mortality rates. Nationally, almost half (40%) of
children under 5 are stunted and 14% are severely stunted, 11% of children under 5 are
wasted and 3% are severely wasted, and over a quarter (28%) of children under 5 are
underweight, with 7% severely underweight. Furthermore, iron deficiency anaemia and
vitamin A deficiency continue to be major public health problems. According to data
from the 2010 demographic and health survey (DHS) 20% of women of reproductive
age are underweight and over half of women of reproductive age are anaemic, putting
them at increased risk of poor birth outcomes such as premature deliveries, low infant
birth weights and haemorrhaging in mothers that can lead to death.
Rates of undernutrition in Golden Fields province are among the highest in the country,

2. despite being one of the more developed provinces in terms of other socio-economic
indicators, though the causes of malnutrition in the area remain largely unknown. Within
the province, 48% of children stunted, 18% of children wasted and 30% of children
underweight according to the DHS data from 2010. No data exists for the two districts
on levels of wasting and stunting. However, rates are believed to be as high as provincial
levels with high levels of admissions to health facilities particularly high during the rainy
season.
Food Security Situation
Essos produces enough food to be a net food exporter, and nationally is a food-secure
country, producing enough calories to meet the requirements of the whole population.
Rice is a fundamental part of the diet of Essos families and the culture of the country.
However, many small-scale farmers practice agriculture at subsistence level, using
traditional methods that are low in productivity. Two thirds of the country's rural
households face seasonal food shortages each year. Rice alone accounts for as much as
30% of household expenditures.
The country has two seasons, the dry season from November – May, and the rainy
season from June – October. Flooding during the rainy season is common.
Health Situation
Essos continues to make steady progress in the improvement of the overall health of
children. Nonetheless, childhood mortality in Essos remains one of the highest in the
region. Diarrhea and ARI remain among the leading causes of childhood morbidity and
mortality in the country. A recent study in the province found that 20% and 28% of
children have diarrhea or a fever in the two weeks preceding the survey respectively. Of
those children, only 35 and 40 % of parents sought attention from a health facility.
Barriers to health services include fees, service hours, cost of transportation and attitude
of health staff.
Environmental Situation
In 2010, only 40% of households have access to an improved water source and only 30%
of households have their own latrine. Flooding during the rainy season compounds
access to water issues. In a recent evaluation of an NGO’s WASH programme in the
area, found knowledge of diarrhea determinants was low at just 20% of mothers aware of
causes of diarrhea.
Situation of Women
According to data from the last DHS in 2013, the national birth rate is 2.8 children per
woman and the contraceptive prevalence rate is estimated at 40%.
In recent years, the growing economy in Essos has led to an increase in factory work for
women. A significant proportion of young women in the Golden Fields area work in the
country’s booming textile industry. Women typically work 10-12 hours a day, 6 days a
week, earning $100 a month, a lifeline for such poor rural farming communities.
Anecdotally, women typically return to work 3 months after giving birth.
While the situation for women has improved in recent years, gender inequalities still
persist in Essos. According to traditional beliefs, women are considered to be of lower
social status to men and are disproportionately poor and under-educated. Unequal access
to education and health services persist and women often have less access to and control
of assets. 65% of women compared to 82% of men are literate.

3. Infant and Young Child Feeding Practices
According to DHS data from 2010 for the province 35% of children receive breastmilk
within first hour of birth and 60% are exclusively breastfeeding. Pre-lacteal feeding
common with 55% of all children being given something other than breast milk during
the first 3 days of life. The median duration of breastfeeding was found to be 5 months.
In addition, breast milk substitutes are increasingly popular, and marketing of condensed
milk products in the country side is heavily directed at children.
A 2009 study in the Golden Fields area found that dietary diversity is very low, with most
children in the study receiving foods from only 1 or 2 food groups. The common diet for
young children is plain rice porridge. Furthermore, a qualitative study conducted in 2008
found that many myths exist around feeding practices, such as the belief that vegetables
cause diarrhea and that children’s stomachs are not strong enough to digest meat and
fish.
Group exercise
After reviewing the case study information, identify if a Link NCA might be relevant in
the area and justify:
- Identify the potential information gap
- Why conduct (or not) a Link NCA? Is there any other method more suitable for
this context?
- Objectives?
- Set up of the study?
 What is the objective of the study? Which kind of response are you planning to
do (refer to the 3-triers approach)?