3.2.d.

Focus area 2:  Garissa District

Garissa, an arid and mainly pastoralist District in the North Eastern Province, was hit by both the

drought and floods during 1997/98.  Garissa town was the head quarters of the airlift operations at

the height of the flood emergency.  The main  focus of the study in Garissa was targeting by

nutritional criteria, particularly of Supplementary Feeding.

Supplementary feeding

 (SF) distributions of Unimix (a blended food of maize, beans and sugar

fortified with vitamins), resourced by UNICEF, were an important part of the relief operation for

both drought and flood victims in Garissa.

Supplementary Feeding is a demographic targeting method which selects nutritionally vulnerable

age groups   children under five years old and (usually) pregnant and lactating women   for a

special nutritionally balanced and fortified ration.  Perhaps the most important point about the

targeting of SF is that it can only be effective if the target households also have adequate access

to general rations (either through their normal sources or food aid distributions)   as stressed by

the definition of SF as   the provision of foods to specific vulnerable groups 

in addition to the

general ration

, with the aim of preventing or reducing excess mortality   [Jaspars & Young, ref.

152, p.136, italics added].  When general rations are not adequate or are poorly targeted, SF

rations are shared among household and community members and the program has no impact on

the nutritional status of the target group.

In 1992 95 UNICEF had organized a major blanket SF operation for all women and children under

5 in Garissa:   UNICEF's Resident Program Officer commented that this operation had been

difficult to phase out  because people had become  dependent on it.  In any case, in 1997

resources did not allow  a similar scale of assistance, so SF was targeted both at area level

(selection of areas with the highest prevalence of child malnutrition), and at beneficiary level (each

child was screened, and only those below 80% of the reference weight for height were fed).

Mikono, one of the NGOs implementing this UNICEF / MoH program in Garissa, added that when

they identified a malnourished child they also provided Unimix  for other children in the household,

because a single ration would have been shared among the siblings and thus would have had no

impact on the target child.   The feeding program was taken to the nomadic communities by mobile

health centers, dates and locations of which were announced in advance at public 

barazas

(meetings).

Area targeting according to the prevalence of malnutrition (i.e. the percentage of children in an

area below a cut off point of nutritional status) was used for WFP's general distribution program in

Garissa as well as for UNICEF's SF program.  This was somewhat problematic since nutritional

survey data from different agencies and different areas was not necessarily available at the same

time, and did not necessarily use the same methodology (so that the results were not strictly

comparable).  For example,  Mikono was funded by UNICEF to conduct a nutritional survey of the

southern Divisions in June 1998 (during the 2

nd

 phase of flood relief).  Based on the results, which

showed that 38.9% of children under five were acutely malnourished, WFP proposed to increase

rations for the Southern Divisions to 100% and reduce those for the North to 25%. CARE, which

was managing food distributions in both northern and southern Divisions, was concerned about the

possible effects of such a reduction in aid to the northern areas. They therefore conducted a rapid

nutritional survey with MSF Belgium, which found a global child malnutrition rate of 36% in the

northern communities surveyed (not significantly different from the southern rate).  However,

different methods were used both for sampling and for measuring the children (Mikono used WFH

while CARE/ MSF used MUAC).  The ration rates for the continuing distributions were eventually

fixed at 100% for the Southern Divisions and 50% for the Northern.  WFP's expert adviser on

these issues (see section 3.2.a. and refs 112 to 116) commented on the difficulties caused by lack

of standardization among the various nutritional assessments used for area prioritization, and this

report supports her

 RECOMMENDATION that national guidelines be established on standard

24

methodologies to be used for nutritional surveys in the context of relief needs

assessments,  and if funding allows, a core team of nutritionists should be established

A 45