Extremely poor people, Concern believes, have few assets or achieve little return on the assets they own. They cannot escape extreme poverty because of structural inequalities and because of risks and vulnerabilities. Inverting these problems or obstacles allows us to envision desired outcomes: asset building and maintenance, equality, and resilience–which is a necessary precondition for helping people exit extreme poverty and hunger.

Learning from Tahoua Region, Niger

In Niger, where Concern has been working for over a decade, more than 300,000 children are treated for malnutrition and between 1 million and 3 million people suffer from food insecurity on average each year. The livelihoods of the poorest are under enormous pressure from constant environmental degradation, advanced desertification, regular pest invasions and inadequate response to shorter recurrent drought cycles. Repetitive shocks have impoverished rural households. Chronic malnutrition is endemic and has increased over the last 20 years. One in three harvests is generally poor. Farmers and agro-pastoralists are the most affected as they often cannot meet their food needs for the five-month hunger period between May and September.

Between April 2010 and September 2012, Concern responded to several nutrition crises in this region while conducting three research projects over the course of three hunger seasons: April–December 2010 (Aker et al. 2011), May–December 2011 (Aker and Nene 2012), and July–September 2012 (Bliss 2012). These interventions and research studies focused on the impact of cash transfers on both nutritional and wider poverty outcomes. A deeper inquiry into the link between cash transfers and nutritional outcomes led to these insights from Niger:

1. Cash transfers seem to improve nutritional outcomes in the short term because they lead to more frequent meals for children and more legume consumption. A large portion of cash transfers are spent on household food. Clearly, food expenditures depend on the availability of food. Therefore, whether food or cash is needed depends on local conditions.
2. If the goal of a program is to improve or maintain nutritional status, cash transfers should be integrated with other interventions that address the causes of malnutrition and food insecurity.
3. Nutrition and food security indicators such as the number of hunger days, dietary diversity scores, or the global acute malnutrition rate should be developed and monitored to track cash transfers’ many uses and to measure the success of the program.

These insights in turn led to the realization that both cash transfers and nutrition treatment programs that focused on seasonal hunger needs were not enough to create resilience to periodic hunger crises and that longer-term development interventions focused on building absorptive and adaptive coping strategies would be required. This learning continues to inform our programming and practice in Niger and beyond.

Learning from Wollo and Wolayta, Ethiopia

In the Dessie Zuria woreda, or district, South Wollo Zone, Amhara Region, the stunting rate is 54 percent, higher than the national average of 44 percent. The woreda is chronically food insecure, with approximately 40 percent of the population dependent on social safety nets. Between 2000 and 2010, annual surveys show the prevalence of global acute malnutrition dropped only once to less than 10 percent.

Rural livelihoods, especially of the extreme poor, are often vulnerable to risks and shocks. Climate variability, human and livestock diseases, pests, flooding and landslides present risks and limit livelihoods. In 2011, 86,359 rural households in Wolayta Zone, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), faced critical food shortages for more than six months, and many depended on the government’s Productive Safety Net Program (PSNP). These vulnerable communities’ major coping mechanisms included PSNP, begging, eating unpalatable wild fruits, and daily labor.

Concern has managed interventions across the relief-development spectrum for many years in Ethiopia, ranging from emergency response to health-system strengthening projects. Over time, Concern staff in Ethiopia have come to understand the need to create resilient communities through multisectoral interventions that align with the Ethiopian government’s strategies. This integrated approach has helped strengthen vulnerable communities’ adaptive capacity to manage both short-term shocks and stresses that lead to short-term food and nutrition insecurity and long-term trends and changes, such as environmental degradation that result in chronic hunger and malnutrition.

Many important lessons have emerged from our work in Ethiopia:

• Use a multisectoral approach to maximize linkages between nutrition and other sectors such as agriculture, health, gender, and water and sanitation.

• Use existing institutional coordination and administrative arrangements to help promote sustainability and a sense of ownership among all key stakeholders.

• Map resilience outcomes in real time to create evidence for new and better programming, and develop research and innovations that can be shared and used to influence policy change.

• Promote resilient livelihoods by addressing the environmental drivers of risk and using disaster risk reduction technologies and practices for sustainable food production.

• Address gender issues that are critical to achieving resilience. Take into account women’s greater vulnerability to disasters (Neumeyer and Plümper 2007), as well as their different roles in fostering a culture of disaster resilience.

• Put a contingency plan in place and define surge capacity to help respond to small-scale disasters or provide an initial response to large-scale disasters. Support local governments with early warning systems, and communicate during even small disasters to ensure that food security is not threatened by the cumulative effects of lesser shocks or stressors.

The above learning from the programs in South Wollo and Wolayta will help to ensure even better outcomes for the people and communities with whom Concern works in Ethiopia in partnership with the government and other stakeholders.

Learning from Moyale, Kenya

Concern has implemented an integrated set of initiatives designed to enhance resilience among the pastoralist communities in Moyale District in northern Kenya since 2006. Past droughts, including those in 2006 and 2009, eroded household assets such as livestock and health and left the pastoralist residents of Moyale with fewer coping options. However, the evaluation of Concern's program revealed that Moyale’s severe acute malnutrition rates fell by 50 percent in early 2011, when those in neighboring areas rose more than threefold (Table 4.2 below) (Erasmus, Mpoke, and Yishak 2012). In addition, its global acute malnutrition rate increased by a far smaller amount than nearby districts’.

Several factors helped reduce Moyale District’s rate of severe acute malnutrition between 2010 and 2011:

1. The strengthening of resilience at the community level over time through contextually appropriate, multisectoral interventions. These included introduction of dryland farming (alongside pastoralism) to grow kale, onions, tomatoes, and fruits; improved irrigation systems; diversification of livestock; rangeland management; mitigation of conflict over pasture access; and improved access to water.
2. The strengthening of government capacity to respond to nutritional crises. This included technical training for the District Health Management Team staff; the creation of technical protocols and quality-of-care oversight systems; adoption of interventions with the highest impact on mortality; improved budgeting; adoption of thresholds, strategies, and protocols for scale up and scale down; and monitoring for signs of scale-up triggers.
3. Early scaling up of high-impact nutrition interventions when warnings were triggered.
4. Coordinating among Concern, the local Kenyan government services, the World Food Programme, and World Vision (which provided an important protective ration of food targeted at malnourished children).

Designing for Community Resilience in Chad

There is much interest in creating systems to build resilience at the community level. Unfortunately rigorous data on the best intervention packages is scarce. To address the evidence gap, Concern is partnering with the Feinstein International Center at Tufts University to rigorously evaluate its Community Resilience to Acute Malnutrition program in eastern Chad and generate evidence to contribute to international discussions on the concept of resilience.

Based on knowledge gained from other programs, in early 2012, Concern designed a three-year program involving water, nutrition, disaster risk reduction, livelihoods, and inequality interventions. The program was developed to improve the overall health, nutrition, and livelihood security of the rural population of Dar Sila in eastern Chad while improving their resilience to shocks.

Between 2005 and 2010, many people in the Dar Sila region were displaced due to conflict on both sides of the Chad-Sudan border. While insecurity has decreased, the region remains vulnerable to food insecurity for many reasons, including unpredictable rainfall patterns, market price hikes, limited community and household assets, and limited alternative livelihood options. The population is susceptible to shocks, having experienced poor harvests in 2009, pockets of flooding in 2010, and significantly below-average harvests again in 2011, due in part to pest attacks and erratic rainfall. These events have depleted stocks and led to food shortages, leaving households vulnerable to future disasters.

Taking an integrated approach, Concern aims to deliver a range of projects addressing multiple needs, coordinating across sectors to achieve common goals. Success will be measured in terms of household wealth via proxies such as livestock ownership and household assets. In turn, greater wealth is expected to lead to increased dietary diversity, less reliance on negative coping strategies, and increased food security. Improvements in health and nutrition will be measured through improved practices related to child health and behavior, while improvements in water and sanitation will be measured through increased access to potable water and latrines. The impact of the program will be reflected in improvements in the nutritional status of children and maternal health.

The first part of the program aims to provide an integrated package to build long-term community resilience. It focuses on four key intervention areas (Figure 4.2) with social and behavior change as a critical ingredient of all four. Resilience-building components of the program include the following:

1. Improving agricultural production and diversifying livelihoods and assets (promoting conservation agriculture and homestead gardening, improving soil fertility, supporting extension and community animal health workers, and promoting links between farmers and markets).
2. Improving access to health services through community health outreach, community case management and care groups, effective management of moderate acute malnutrition, and stronger management of the formal health system.
3. Increasing access to safe water and promoting improved sanitation and sanitary practices at the community level.
4. Working with community groups at all levels, including establishing overall apex bodies such as Village Development Committees for better governance, to enhance their capacities and to ensure that women participate fully. This will involve working closely with community leaders and trying to change their attitudes and behaviors. One output will be a disaster management plan.
5. Promoting social and behavior change among those Concern works with, across all parts of the program. This includes changing child feeding practices, encouraging better hand-washing techniques, and changing how farmers plant their crops using conservation agriculture techniques.

The second part of the program includes a comprehensive community-based early warning system that identifies thresholds for key indicators that signal the need for an emergency response. In the first instance, the community will activate its own disaster management plans. After that, the program will initiate a response, strengthening capacities for conducting market analysis and nutrition surveys, getting systems in place to scale up cash aid, creating a system for immediate distribution of emergency supplies, creating village maps that identify the most vulnerable to shock, and formulating a strategy to scale up staff capacity. The early warning system links primary data from the household level and local and regional markets with rainfall and vegetation data from the Famine Early Warning Systems Network, a provider of information on food security. Data will include the Rainfall Estimation and Normalized Difference Vegetation Index (FEWS NET 2013), which is updated every 10 days. Existing health facility data, such as case incidence and admission rates, will also be used.

Primary data will be collected on key food crop prices from a selection of markets and from a Coping Strategies Index that will be calculated on the basis of a sample of households. This will be based on four kinds of locally relevant coping strategies (Maxwell and Caldwell 2008): (1) dietary change; (2) short-term measures to increase household food availability; (3) short-term measures, such as fostering arrangements or sending children to relatives, to decrease the number of people a household must feed; and (4) rationing, or managing the shortfall.

This program will be implemented in 53 of the 88 villages of Kimiti. Thirty-five of these will receive the same package of services and will be rigorously monitored to test the success of the program. Eighteen will receive various elements of the program, in some instances as part of a pilot for new interventions. The remaining 35 villages will receive the benefits of the strengthened government health system in the area and will be included in the early warning system. They will also be surveyed to demonstrate that the intervention has worked. If these villages pass the emergency response threshold, Concern will intervene.

When early warning indicator values, which include rainfall and vegetation measures, exceed a threshold level, an emergency response is triggered. The goal of Concern’s resilience-building package is to minimize the impact of the shock by reducing the number of hunger days, reducing the number of people with global acute malnutrition, and speeding up recovery time. The provision of an integrated package should have a positive impact on child and maternal nutrition in a “normal” year but also in those years when the region experiences comprehensive weather-related shocks. This happens about once every three years.

Figure 4.3 shows the expected impact of this program. The red line represents the values for one of Concern’s early warning indicators in a normal year. This indicator fluctuates on a seasonal basis and may come close to the intervention threshold, represented by the dashed line. Once this threshold is exceeded (probably about once every three years), an emergency intervention is considered. The value of the indicator may spike in the control area (orange line), but Concern’s resilience-building package should reduce the magnitude and duration of the spike in the treatment area (green line).

Conclusion

Community resilience is an outcome. It is about a community’s ability or capacity to anticipate, respond to, cope with, and recover from the effects of shocks and stresses without resorting to behaviors that negatively affect well-being or compromise its long-term prospects of moving out of poverty and hunger. Preventing local food and nutrition crises requires communities to analyze the crises’ underlying causes and to be involved in the design and implementation of initiatives to address those problems (Box 4.2).

Recognizing more recent initiatives across both regions, including Supporting the Horn of Africa’s Resilience (SHARE) and the Global Alliance for Resilience Initiative (AGIR), the current approach to chronic food crises in the Sahel and the Horn of Africa remains fragmented, dysfunctional, and ineffective. In countries like Haiti, shattered by regular natural disasters, the framework is only just becoming part of the conversation. To date, such crises have not been analyzed sufficiently with a resilience lens.

By encouraging systems-based thinking, the concept of resilience may radically transform the compartmentalized ways in which humanitarian and development actors work. Building resilience requires an integrated approach across issues, sectors, and disciplines. Such a collaborative multisectoral approach, and the creation of environments that promote such thinking and practices, are important steps toward improving our collective impact on undernutrition in the most difficult contexts.