Attachments
Executive Summary
The SNS Consortium with support from WFP, carried out a Nutrition Causal Analysis (NCA) study across six locations in South Central Zone (SCZ) Somalia, between March and November 2015. These included the following Livelihood Zones: Beletweyne riverine, Baidoa agropastoral and Dollow pastoral rural livelihood zones, as well as Mogadishu urban, plus Mogadishu and Dollow Internally Displaced Persons (IDP) settlements. This NCA Report includes a specific section on each of the six NCA studies undertaken. The aim of the study was to investigate key factors that contribute to acute malnutrition in particular contexts, and the relationship between these factors as experienced by the communities studied, to highlight recommendations for service providers in the interest of strengthening prevention and support initiatives. The Mogadishu urban community, which displays stronger nutritional status, was specifically included as a relatively positive case to highlight learning for key actors.
The study drew on the Link-NCA methodology developed by ACF, adapting and applying it in the six South Central Somalia study locations as feasible.
It should be noted that the SNS Consortium was established to work in particularly vulnerable, prolonged malnutrition “hotspots” in South Central Somalia which means that the study was undertaken in extremely challenging circumstances. Each of the six location NCA Study findings are to a degree context specific and caution should be taken when extrapolating the findings of a particular NCA study more widely. At the same time, many key findings are common across the locations and livelihood groups studied. Therefore the research can be seen to have wide relevance across many Somali contexts. Significant, extreme challenges have been faced throughout the process for many reasons and inevitably, the main challenges impacting on the study itself are those which continue to affect all humanitarian efforts and actors in South Central Somalia. Related challenges faced and learning are highlighted in the report’s final section. The research explicitly sought to develop more nuanced recommendations to inform related programming by key SCZ actors, in particular locations. In-depth Focus Group Discussions and Key Informant Interviews were the main methods used to gather qualitative data on the underlying drivers of acute malnutrition in select locations.
While many NCA findings are widely relevant across Somalia and serve to confirm existing knowledge, as anticipated, others provide more nuanced, contextspecific understandings of issues with particular local significance. In all NCA study locations the causes of acute malnutrition are multiple and complex. See the six Causal Pathways on pages 7 - 13 below which summarize the findings per NCA study. They include less known underlying drivers in need of urgent attention, as well as factors already typically addressed in nutrition-sensitive programming in South Central Somalia.
On the ground realities in many complex and highly insecure SNS SCZ locations where the NCA took place, combined with weak qualitative research capacity amongst local research teams able to access the NCA study locations, largely explain significant limitations in the NCA process and findings. Overall, NCA Advisory Group members remain disappointed with the limited depth apparent in much NCA data, which has inevitably impacted on the comprehensiveness of the findings which are not as nuanced as expected.
Notwithstanding these weaknesses, at the same time the findings do serve to highlight some critical underlying drivers of acute malnutrition in specific SCZ contexts and more generally, to raise important questions about appropriate nutrition sensitive programming and the limitations of dominant responses.
Unsurprisingly, the NCA research has confirmed that as well as insecurity, climatic and seasonal factors and notable poverty amongst some communities, dominant child care practices and select socio-cultural beliefs remain core drivers of malnutrition in SC Somalia, due to their negative impact on the lives, livelihoods and nutrition status of the communities studied. In all communities studied, weak infant and child feeding and care practices, combined with poor hygiene, the lack of basic health and WASH facilities and women’s excessive workloads, which commonly take mothers away from their very young children, are seen to have a major impact.
Dominant socio-cultural beliefs and related social norms including dietary taboos and, in some communities, extremely young marriage (from 13 years old) and childbearing ages for girls, Female Genital Mutilation and the growing phenomenon of female-headed households in many areas, widely impact adversely on the health, well-being and nutritional status of communities studied.
Dominant beliefs about the “inadequacy” of a mother’s breast milk to satisfy the needs of her new-born, continue to fuel diarrhoea and heightened vulnerability among infants. The lack of adequate basic health, nutrition, education, WASH and other services continues to negatively impact on nutrition status. So too do limited or non-existent income generation opportunities for more vulnerable community members. In farming and pastoral areas, many respondents noted with concern the lack of support to strengthen community skills (agricultural and livestock related) and their lack of access to resources like livestock specialists, basic farm equipment and quality seeds, which they perceive could help to increase local production, strengthen livelihoods and nutritional status.