Prototype IPC Nutrition Phase Classification for Acute Situations

IPCThe Integrated Food Security Phase Classification

Prototype IPC Nutrition Phase Classification for Acute Situations

Why we need it & the development process

GNC Meeting, Rome

17 Sept. 2014


Prototype IPC Nutrition Phase Classification for Acute

Situations• What is IPC?• Why is a nutrition classification needed?• IPC Nutrition Classification - technical

development process

Presentation Outline


What is IPC?


THE IPC IS…..

A set of tools and procedures (protocols) for classifying the nature and severity of food security situations

A process for multiple stakeholders to share information and build technical consensus.


IPC FOUR CORE FUNCTIONS

(1) Building Technical Consensus (2) Classifying Severity and Driving

Factors(3) Communicating for Action (4) Quality Assurance

EACH HAS A SET OF SUPPORTING TOOLS and PROCEDURES


6

Understanding evidence with an integrated Analytical Framework

Referencing evidence against international standards

Transparently methodically & consensually analyzing evidence

Transform analyses into concise information for action

The 4 Functions of IPC

TWG MATRIXANALYTICAL FRAMEWORK

REFERENCE TABLESANALYSIS WORKSHEETS

COMMUNI-CATION TEMPLATE

Multi-agency stakeholders to do collaborative analysis

Assuring for quality

SELF ASS. PEER REVIEW

1. Building Consensus

2. Classifying Severity & Driving Factors

3. Communication

for Action

4. Quality Assurance

Fu

ncti

on

sTo

ols

Pro

ced

ure

s

for:


Why is nutrition classification

needed?


IPC Acute Food Security Phase Classification

Proven Applicability and Relevance - Globally Asia & Near East Africa Central America &

Caribbean North Africa & Near East Central Asia

Why an IPC Nutrition phase classification for Acute Situations - Background


Why do we need an IPC Nutrition Classification for Acute Situations?

Two Situations We Observe:1. Low severity of acute Food Insecurity

and High levels of acute Malnutrition– Why? Casual factors are not food

security related– A public health issue, related to social

and care environment and access to health services and health care environment


Example: FSNAU Nutrition & Food Security Situation in Somalia


2. High severity of acute Food Insecurity and Low levels of acute Malnutrition Why? 2 possible reasons

Lag effect o Body Tissue and muscle loss related to underlying

causes of food insecurity – depends on severity of food inadequacy

o Can take time before it manifests, some cases ‘’late indicator’’

Why do we need Both Classifications?


Why do we need Both Classifications?

Mitigating Factors o Coping strategies in household, e.g. prioritize

the children, until deplete their coping strategies. o Accessible and Effective Public Health

Services, that mitigate effects of acute malnutrition, though food insecurity still problem

IF there are social protection programme, strong coping capacity: nutrition indicators - lag effect or no manifestation


How is Nutrition Currently Integrated in IPC?


To date - IPC focused on the analysis and classification of food security situations and outcomes

Nutrition is integrated within the IPC FS analysis, – Not a full analysis of the Nutrition situation and

outcomes– Nutrition only in relation to Food Security – Malnutrition caused by non-food security are not

included, i.e. inadequate caring practices and disease

Identified Gap & Country Requests


UNICEF’s Conceptual Framework on the Causes of Malnutrition

Inadequate Food Intake

Disease

Household Food

Security

Social and Care

Environment

Access to Health Care

& the Health

Environment

Immediate Causes

Underlying Causes

Basic Causes

National Policies Formal and Informal Structure

Context and Potential Resources

Malnutrition & Death

Core outcomes


How is IPC FS linked with the Nutrition Classification?

Household Food

Security



IPC Acute Food Security informs the Analysis of Household Food Security


What is needed in IPC?


What is needed to complement the IPC Acute Food Insecurity Phase

Classification?Malnutrition

& Death

The Prototype IPC Nutrition Classification for Acute Situations

- elaborates and measures the non-food factors and drivers of malnutrition

Disease

Social and Care

Environment


& the Health

Environment


UNICEF’s Conceptual Framework on the Causes of Malnutrition



Disease

Household Food

Security

Social and Care

Environment


& the Health

Environment

IPC Nutrition Classification

for Acute Situations

IPC Acute Food Security Classification


• IPC Acute Food Security Classification – provides the full analysis of acute food security, and food security factor analysis for the IPC Nutrition Classification for Acute Situations

• IPC Nutrition Phase Classification for Acute Situations – provides the full analysis of acute malnutrition outcomes, nonfood factors and food factor analysis. Where food factors analysis is provided by the IPC Acute Food Security (Inter-locking)

Complementary Inter-linking Phase Classifications– IPC Acute Food Security Phase Classification & IPC Nutrition Phase

Classification for Acute Situations are to be complementary & inter-locking– Together provide the full analysis of acute food and nutrition security

situation

Prototype IPC Nutrition Classification for Acute Situations


Development Process: Nutrition Phase

Classification for Acute Situations


IPC Global Steering Committee Endorsement

In 2013 - the IPC Global Steering Committee endorsed resolution to develop IPC Nutrition Phase Classification for Acute Situations

The SC endorsed the use of Food Security and Nutrition Analysis Unit (FSNAU) Acute Nutrition Classification Tool as a base– Developed & Implemented along side the IPC Food

Security Phase Classification, since 2007 in Somalia

Formation of IPC Nutrition Working Group of the IPC Global Technical Advisory Group (TAG) – to lead technical development & piloting– Technical Experts from both the global food security

and nutrition community


Based on the Acute Nutrition Classification Tool , an IPC Nutrition Classification for Acute Situations prototype has been developed.

Prototype is the refined version of the FSNAU Nutrition Classification Tool– Analytical Framework

IPC Analytical Framework UNICEF & Lancet Conceptual Framework

– Reference Tables for Nutrition Classification– Mapping Protocol



Prototype IPC Nutrition Phase Classification for Acute Situations– Focused on analysis of Acute Malnutrition– Classification of the Severity of Acute

Malnutrition & identification of contributory factors

Pilot test and revise by the global IPC NWG for universal applicability



Share same IPC Protocols and Four Core Functions

(1) Building Technical Consensus (2) Classifying Severity and Contributory

Factors(3) Communicating for Action (4) Quality Assurance



IPC Prototype Nutrition Classification for Acute Situations

Reference Table – Outcome IndicatorsIndicator Acceptable Alert Serious Critical Very critical

GAM among children 6-59 months (%)

<5 5-9.9 10-14.9 15-29.9 ≥30

MUAC <125 mm among children 6-59 months (%)

<2.0% 2.1-5.5% with increase from

seasonal trends

5.6-8.0%

8.1-19.9 %, or where there is

significant increase from seasonal

trends

≥20.0%, Or where there is significant

increase from seasonal trends

Sentinel Site Data Very low

(<5%) and stable levels

Low levels (5 to <10%)and one round indicating increase, seasonally adjusted

Low (5 to < 10%) & increasing or moderate (10 to <15%) levels based on two rounds (seasonally adjusted)

High levels (> 15%) of malnourished children and stable (seasonally adjusted)

High levels (> 15%) and increasing with increasing trend (seasonally adjusted)

HMIS Data V. low (<5%) proportion in the preceding 3mths relative to >2yr seasonal trends

Low proportion (5 to <10%) and stable trend in the preceding 3mths relative to >2yr seasonal trends

Moderate (10 to <15%) and stable or low (5 to <10%) but increasing proportion in the preceding 3mths relative to >2yr seasonal trends

High (> 15%) and stable proportion in the preceding 3mths relative to >2yr seasonal trends

High (> 15%) and increasing proportion in the preceding 3mths relative to >2yr seasonal trends

Programme Data TBD TBD TBD TBD TBD

Screening (purposive) (%) <1.0 <1.0 1.0-2.0 2.1-3.0 3.1-5.5



Reference Table – Contributory Factors (1/3)

Food security

Indicator Acceptable Alert Serious Critical Very critical

Food Consumption Score (FCS)

Acceptable consumption

Acceptable consumption (but deteriorating)

Borderline consumption

Poor consumption

[below] poor consumption

Coping Strategies Index (CSI)

Reference, stable

Reference, but unstable

Reference and increasing

Significantly > reference

Far > reference

Household Hunger Score (HHS)

None (0) Slight (1) Moderate (2-3)

Severe (4-6) Severe (6)

Household Economy Approach (HEA)

No livelihood protection deficit

Small or moderate livelihood protection deficit

Substantial livelihood protection deficit or small survival deficit of <20%

Survival deficit >20% but <50% with reversible coping considered

Survival deficit >50% with reversible coping considered

Consolidated Approach for Scoring Indicators of Food Security (CARI)

See attached table




Social and care environment

Indicator Acceptable Alert Serious Critical Very critical

Breastfeeding (BF) Practicesi) Exclusive BF for 6mthsii) Continued BF at 1 yeariii) Continued BF at 2year reference

>90%>90% >90%

50-89%50-89%50-89%

12-49%12-49%12-49%

0-11%0-11%0-11%

Complementary feeding in addition to breastfeedingi) Introduction of complementary food at 6 months of age: %introducedii) Meeting minimum recommended feeding frequency

≥95%≥95%

80-94%80-94%

60-79%80-94%

0-59%0-59%

0-59%0-59%

Maternal Wellbeing Index TBD

Caregiver workload




Access to Health Care & Health EnvironmentDiseases/nutritional deficienciesIndicator Acceptable Alert Serious Critical Very criticalDiarrhoea Normal

levels, & seasonal trends,

Review data in relevant context

-AWD 1 case-Suspected cholera 1 case-Suspected measles 1 case-Suspected malaria–doubling of cases in 2 weeks in hyper endemic areas–using RDT (WHO); OR increasing weekly trend (UNICEF)

Outbreak not contained and/or in non-endemic area – limited access to treatment:

CFR for AWD >2% ruralCFR for AWD >1% urban

AWD – duration exceed >6 wks

CholeraARIMeaslesMalaria

Micronutrient deficiency outbreaksAnaemia Severe ≥ 40

Moderate 20 – 39.9Mild 5 – 19.9Severe ≤ 4.9

Indicator Acceptable Alert Critical Very criticalAvailability of iodised salt at the HH level TBD TBD TBD TBDVaccination coverage (Measles and vitamin A) >95%

>95%80-94.9%80-94.9%

ANC Coverage TBD TBD TBD TBDLow Birth Weight TBD TBD TBD TBDCoverage of outreach programmes TBD TBD TBD TBDAccess to safe WASHIndicator Acceptable Alert Serious Critical Very criticalPopulation have access i) to a sufficient quantity of water for drinking, cooking, personal & domestic hygiene–min 15lts pp/ day ii) sanitation facilities

100%

100%

TBC

TBC

TBC

TBC

TBC

TBC

TBC

TBC


Map IPC Pilot Nutrition Classification, Kenya Map IPC Pilot Nutrition Classification, South Sudan

Communication for action


Two Year - Piloting and development period (2014-2015)– 2014-15 development of IPC Prototype based on FSNAU tool, Pilot

and Refine/Revise– 2016 Expected Roll-out of V.1.0 IPC Nutrition Classification

Process – Technical Consultations & Deliberations combined with Country Pilots & Learning for Refinement of tool

2014 Timeline & Work Plan– Launch of IPC Global Nutrition Working Group, March 25, 2014 – First IPC NWG Meeting: June 23-25– Development of Tools and First Round of Pilots: July – Aug 2014 (Kenya

and South Sudan)– Second IPC NWG Meeting: Sept 2014– Second Round of Pilots: Oct – Nov 2014 (Bangladesh, Haiti, and Niger)– Third IPC NWG Meeting and planning for 2015, Dec 2014

Timeline & Work Plan


Thank you

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Prototype IPC Nutrition Phase Classification for Acute Situations