Nutrition and HFA

The objective of this topic is to present key aspects to be considered about nutrition when dealing with ECHO funded humanitarian food assistance interventions.

What do we call undernutrition?

Addressing undernutrition in external assistance, by Europaid, 2011.

Click on the image to maximise it.

Why is nutrition a problem in emergencies?

When emergency strikes:
– People have less access to food;
– Diet diversity worsens;
– Care practices are disrupted;
– Access to health, clean water and sanitation decreases.
These factors have a direct impact on the nutrition status of affected population, especially on children.

Find more on the adapted conceptual framework for Malnutrition and HFA by ECHO at this link.

Nutrition programming: Treatment of Acute Undernutrition 1/2

Nutrition programming: Treatment of Acute Undernutrition 2/2

The 1,000 days window opportunity

The video below summarizes well the challenges and potential met during this crucial period of life.

Infant and Young Child Feeding in Emergencies (IYCF-E)

It is necessary to protect good practices for the care and feeding practices of women and young children, and in emergencies, the specific needs of these groups must be taken into account in the assessment, design and implementation of all interventions.
In 2015, DG ECHO has adopted a specific guidance on Infant and Young Child Feeding in Emergencies (IYCF-E), to help develop IYCF sensitive programming, and maximize their impact on the nutrition status of young children. IYCF-E principles revolve around 2 main axes:

Protection and promotion of exclusive breastfeeding, or provision of safe and adequate alternative until the infant reach 6 months (that could translate, according to the needs identified, into activities such as mother support group, shelter, mother-friendly cash for work, provision of Breastmilk substitute).
Promotion and support of access to age appropriate diet of children until the age of 2 (with activities such as seasonal distribution of complementary foods or voucher, behavior change communication).

ECHO Guidance for Programming IYCF

Brief overview of ECHO’s Nutrition Policy “Addressing Undernutrition in Emergencies”

In 2011 the European Commission has adopted a reference document

This document highlights the Commission concern in regards to the importance of undernutrition and its consequences at individual, national and global levels provides practical guidance on how nutrition objective can be incorporated into different sectors, thematic areas and funding modalities.

In 2013, DG ECHO has adopted a Nutrition Policy that addresses more specifically undernutrition in Emergencies. The following video provides an overview of this policy:

The Commission’s objective is to reduce or avoid excess mortality and morbidity due to undernutrition in humanitarian situation, through the funding of interventions that meet the following strategic priorities:

– Treatment of Moderate and Severe Acute Undernutrition
– Prevention of the immediate causes of undernutrition (inadequate dietary intake and disease) through the nutrition and the health and food assistance sectors
– Prevention of underlying causes of undernutrition (food insecurity, inadequate care practices and inadequate access to healthcare and environmental health) through the nutrition, health, food assistance and WASH sectors
– Integration of nutrition interventions within an overall resilience strategy in coordination with development partners

In addition to the nutrition specific and sensitive programming, DG ECHO considers the following activities in the scope of tits interventions: Support to information systems, capacity building, integration into national systems, advocacy and research.
DG ECHO’s principles include, (but are not limited to):
– The systematic consideration of gender and age perspectives in the analysis and design of the nutrition response (cf. box)
– The Link between Relief, rehabilitation and Development (LRRD) for a maximization of the sustainability of interventions through development partners and national institutions
– The promotion of practices, tools and that are accepted globally as efficient and cost-effective

Entry and Exit criteria

DG ECHO may In considering whether and how to respond to a given crisis, the Commission pays close attention to the comparative advantage and disadvantages of the humanitarian instruments at its disposal nutrition operations when emergency rates of mortality (Under five mortality rate >2/10,000/day) and acute undernutrition (GAM> 15% or >10% with aggravating factors) have been reached or exceeded, or are anticipated.
The Commission may consider phasing out its humanitarian nutrition assistance when indicators of acute undernutrition and related mortality are stabilized below emergency levels, or are expected to stabilize there in a foreseeable future, independently of the Commission’s humanitarian support.

Operations funded by ECHO

DG ECHO is one of the major donor for the funding of programs of Nutrition in emergency situation.
In 2014, the European Commission provided €130 million in humanitarian funding to address undernutrition. Humanitarian projects funded include the following activities:

  • Treatment of acute undernutrition, following a community-based approach;
  • Providing free health services as disease and undernutrition;
  • Providing clean water and sanitation services in nutrition and health centres;
  • Providing water, sanitation and hygiene package in the nutrition programmes;
  • Food assistance (cash, vouchers, in-kind) to families who are particularly vulnerable to undernutrition.

Most of the nutrition interventions funded by the Commission in 2014 focused on the response to the Sahel crisis and continued support to the Horn of Africa, South Sudan and Yemen, regions that are particularly vulnerable to disasters.

Find more about fund allocation here.

Examples of nutrition research and innovation funded by DG ECHO

DG ECHO also funds Research and innovation projects to help improve the performance, coverage and cost efficiency of Nutrition specific and sensitive programming trough Enhanced Response Capacity funds.
Here is an overview of some of the projects supported by DG ECHO:

Optidiag: Biomedical Investigations for Optimized Diagnosis and Monitoring of Severe Acute Malnutrition

Optidiag is a package of research studies which objective is to optimize the diagnosis of Severe Acute Malnutrition (SAM) by generating new evidence on the morbidity and mortality risks associated with different diagnosis of undernutrition. Anthropometric measurements alone are not sensitive enough to account for all nutrition deficiencies linked to an increased mortality risk; field-friendly tools for the diagnosis of the physiological anomalies induced by undernutrition (i.e. micronutrients deficiencies, presence of molecules produced by the degradation of fat and muscle in the early stage of food deprivation) to will be tested in the frame of this project.

The expected outcomes of these studies are 1) globally accepted data that can be used to improve the targeting of treatment protocols at global policy level 2) an increased understanding in the physiologic impact of undernutrition to inform on the nutritional and medical needs of SAM cases.
Partners: ACF-F (lead), Institute of Tropical Medicine of Antwerp, AgroParisTech University, Duke University Medical Center.

Treatfood: Effectiveness of improved diets for children with moderate acute malnutrition

Following the development of the WHO guidance for the composition of supplementary food used for the treatment of Moderate Acute malnutrition (MAM), several organizations have been developing/ improving and testing various products, including fortified blended foods and lipid based nutrient supplements. But to date there is no consensus on the most suitable product to manage children suffering from MAM. In this research project, twelve investigational food supplements will be developed.

This trial aims at assessing the acceptability and effectiveness of these newly developed products for the management of MAM children 6-23 months old. Effectiveness will be assessed by determining their effects on accrual of weight gain (measuring both the fat and muscles mass gain), linear growth, physical activity, motor milestones, morbidity, as well as few other physiological indicators.
Some results have already been published:
Partners: ALIMA (lead), Médecins sans Frontières Denmark, Department of Human Nutrition, University of Copenhagen.

The Coverage Monitoring Network (CMN) aims at improving nutrition programmes through the promotion of quality coverage assessment tools, capacity building and information sharing. The CMN website gathers a database of the coverage assessments carried out over the world and their results, toolkit of the existing methodologies, advocacy and research documents:

REFANI: Research on Food Assistance for Nutrition Impact

The objective of the REFANI is to generate evidence on the type, duration and amount of food assistance transfer modalities that translates into the better impact on nutrition at Household level. The research also proposes to document how the impact is generated, by investigating the allocation decision process within the household. Its results are expected to be used to inform stakeholders for the development of future policies, at global level.
Partners: Concern, ACF-US, UCL, ENN, University of Texas

WASH in Nut operational guidance

The concept of a minimum package for WASH in Nutrition projects has been initiated in West Africa, and rolled out in a number of countries with various level of success. While the impact of adequate WASH conditions on the recovery patterns of Severe Acute Malnutrition cases has been documented, access to drinkable water and basic hygiene are not systematically provided to children under treatment, which undermines the very process of their recovery. This guideline is a field manual on the WASH in Nut Minimum package that will support the actual implementation and provide cost considerations for planning purpose.
Partner: ACF-F

CMAM Forum

The CMAM Forum is a web based platform which objective is to provide sustainable, robust information and knowledge-management mechanism to a diverse audience including practitioners, academics and policy-makers, in order to expand the knowledge base, address gaps to improve practice and position acute malnutrition as a major health and nutrition priority worldwide. The information available on the site is gathered from partners but also generated by the CMAM Forum nutrition experts (technical briefs, training material).

Global Nutrition Cluster

It was established in 2006 as part of the Humanitarian Reform process, which aimed to improve the effectiveness of humanitarian response programmes by ensuring greater predictability, accountability and partnership. The vision of the GNC is to safeguard and improve the nutritional status of emergency affected populations by ensuring an appropriate response that is predictable, timely and effective and at scale. DG ECHO has been supporting a major contributor to the GNC workplan.

Maximising the nutritional impact of Humanitarian Food Assistance – January 2016

In 2014 DG ECHO commissioned a study to map existing documents and tools relevant to maximising the nutrition component and outcomes of humanitarian food assistance (HFA). The study reviewed policy, guidelines and case studies available online and provided by humanitarian agencies, donors and academic bodies. The findings show that a limited number of documents take nutrition-sensitive criteria into account in HFA programming and identify significant gaps in the policy and operational resources reviewed. Practical recommendations are given to humanitarian agencies and donors to bridge these gaps. These include identifying key principles for nutrition in HFA programming, adopting basic rules / standards relating to Maternal and Child Nutrition and HFA and increasing engagement and participation of the nutrition sector in HFA programming, particularly cash-based programming.
The full review with its annexes and a power point presentation are available at this link.

Additional resources and source of material

Forum on Nutrition in Emergencies
CMAM Forum
ENN Forum
Global Nutrition Cluster
Scaling-Up Nutrition (SUN)
Nutrition programming indicators
WASH and Nutrition
Examples of existing eLearning materials on nutrition
UNICEF eLearning
FAO eLearning
London school of Hygiene and Tropical Medicine
Tool boxes and training materials
– Save the Children toolkit on YICF
SMART survey
Link NCA
Coverage Monitoring Network
1,000 Days initiative
– World Vision video about the 1000 days
Videos used
– The 1,000 Day Window of Opportunity video
– IMC Coverage Monitoring Network Project video

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HFA overview


HFA toolbox




Gender and HFA






Food utilisation




Market Assesment


HFA Indicators