Nutrition Resilience could be described as being achieved when a person, population or system has the capacity to mitigate, adapt and transform in response to shocks and stresses without long term impact on their nutritional status.

1. WHAT WORKS?

2. Measuring
Resilience
 Nutrition status indicators good for resilience
indicators because
Undernutrition is an unambiguous marker of
poverty and deprivation (causal framework),
Livelihood programmes often tend to target
better off households so changes in livelihoods
based resilience indictors may not show the
impact of the programme on the most deprived,
Undernutrition is a good indicator to bring
gender issues into focus. A women’s livelihood
status is one of the most important influences
on a child's nutritional status.
Undernutrition

3. Measuring
Resilience
Chronic undernutrition is standard Nutrition
Development Indicator.
Used in many Resilience programmes as an
impact indicator.
Chronic malnutrition improves ~1pp/year if good
integrated programme implemented.
Age and height difficult to get quality measures.
Stunting most appropriate for end programme
monitoring of Resilience programmes.
Acute and chronic undernutrition different
manifestations of same causal factors.
Acute undernutrition trends can also be used for
monitoring more regularly.
Chronic and Acute
Undernutrition

4. Desired 5 year Goal.
PRESENT SITUATION DESIRED SITUATION.
Continued reduction in maximum
GAM Prevalence by 1.5% a year
from 21% in 2014 to 13.5% in
2019.
Continued reduction in maximum
SAM Prevalence by 0.5% a year
from 4% in 2014 to 1.5% in 2019.
0
5
10
15
20
25
30
35
2009
2010
2011
2012
2012b
2013
2014
Prevalence%
2009-2014
Yearly Max. GAM and SAM Prevalence
GAM. SAM. Linear (GAM.) Linear (SAM.)

5. What is special about the Nutrition
situation in Karamoja?
CHANGEABLE SITUATION FOR GAM
AND SAM
EXAMPLE
Acute Undernutrition improving 2009
– 2014
6 year average is 23.3% GAM and
4.6% SAM
Very changeable
18 % difference between highest and
lowest GAM and 8.4% for SAM.
Up to 16.7% GAM and 6.3% SAM
difference between years.
N=22
0
5
10
15
20
25
30
35
2009
2010
2011
2012
2012b
2013
2014
Prevalence%
2009-2014
Yearly Max. GAM and SAM Prevalence
GAM. SAM. Linear (GAM.) Linear (SAM.)

6. Change and Resilience
CHANGES’ IMPACT ON RESILIENCE
Shocks are inherent to Karamoja
nutrition system – cause negative
changes in facility, community,
household and for an individual.
Negative changes in Karamoja
nutrition system are caused by many
small shocks , a few medium shocks
and rare big shocks.
Each shock challenges the nutrition
systems capacity to cope.
Many shocks to the nutrition system
synergistically combine also combine
with stresses to challenge
development progress.
PROPOSED DEFINITION FOR
NUTRITION RESILIENCE IN KARAMOJA
Nutrition Resilience could be
described as being achieved when
a person, population or system
has the capacity to mitigate,
adapt and transform in response
to shocks and stresses without
long term impact on their
nutritional status.

7. Measuring
Resilience
Change for nutrition can also be measured by
looking at anthropometric indicators.
GAM and SAM are most changeable and easily
measured so can also be used for yearly
monitoring of progress.
Example goals:
Reduce 5 year variability of GAM and SAM from
18% and 8% by half to 9% and 4% respectively.
Reduce average annual variability in GAM and SAM
from x% and X% by half to x% and x% respectively.
Measuring
Change

8. Development Pathways, Shocks, Stresses.
Population in Karamoja experiences
constant stresses (chronic) on their
development pathway.
Also experience regular shocks (acute)
e.g. drought.
Long term trends in either indicator
indicate long term trends in nutrition
system represented by the causal
framework.
Therefore, trends in chronic and acute
undernutrition can be used to
measure longer term impact of
resilience programming.

9. Nutrition
Resilience
Programming
Combination of three types of programming at
district, facility and community levels:
Chronic Nutrition Insecurity – Positive
development pathway. (reduction of impact of
stresses)
◦ Nutrition system strengthening, community based
nutrition, facility based nutrition services, Nutrition
Sensitive and Specific programming. = good
programming.
Acute Nutrition Insecurity – Reduce negative
impacts of shocks on development pathway.
Emergency – Respond to large extra-ordinary
shocks to save lives.
◦ General Food Distribution, Cash transfers, emergency
OTPs and SFPs, mass screening.
SO WHAT ARE NUTRITION RESILIENCE
INTERVENTIONS?

10. Acute
Nutrition
Insecurity
Models
Facility Based Surge Models.
Small and medium shocks happen at a local level
affecting one or a group of Health Facilities offering
Nutrition services. (idiosyncratic)
A shock on the facility causes challenges to the
facilities nutrition services to cope. Usually this
involves an increase in numbers attending the
service producing challenges to:
 Human resources availability and capacity
 Supply Resources
 Space
The challenges result in reduced quality and
coverage of the service.
The facility surge model uses data and thresholds
on admissions and capacity to monitor a shocks
effect on the system and to predefine the response
of the health facility and the DHT and external
stakeholders.
Facility Based
Surge Models.

11. Facility Based Nutrition Surge
Model in Karamoja.

12. Acute
Nutrition
Insecurity
Models
Community based nutrition
programme:
Integrated (specific and sensitive)
Prevention + Promotion,
Referral and follow up.
In process of being defined in Karamoja.
Work in progress.
Capacities and vulnerabilities, barriers and
promoters etc. Formative research.
Methodologies
Linkages
To adapt for Acute Nutrition Resilience
Risk Informed
Context specific
Capacity based
E.g. Diarrhoea
COMMUNITY BASED
MODELS

13. THANK YOU