Moderate Wasting Initiative – Expression of Interest from Countries

The global CMAM 2021 conference highlighted a lack of infrastructure, supply chain, health worker capacity, and financing for addressing moderate wasting at scale^[1]. In addition, services for moderate wasting tend to lack innovation with a focus on a somewhat medicalized, one-size-fits-all approach mimicking services for severe wasting. However, there are a variety of opportunities that could signal a shift in the current approach. These include but are not limited to: the expansion of simplified approaches to improve care for wasted children^[2], the revision of the WHO guideline on wasting, the Global Action Plans on wasting with country-level road maps^[3], the expansion of the NIPP approach^[4], Advancing Nutrition’s work on using locally available products to manage moderate wasting^[5], as well as work being done on simplifying the methodology to understand the context-specific drivers of malnutrition.  

It is time to do things differently.  

The GNC Technical Alliance (the Alliance)^[6], established in 2020, is a humanitarian nutrition technical assistance platform that responds to technical requests, by leveraging and building on existing resources, capacities, initiatives, and coordination structures. The purpose of the Alliance is to improve the quality of nutrition preparedness, response and recovery, by enabling and providing coordinated, accessible and timely technical support through multiple channels where gaps exist. The Technical Support Team (TST) within the Alliance, combines various resources for nutrition in emergencies and technical assistance to meet the specific needs of practitioners in a timely, cost-effective, coordinated and sustainable manner. These include resources hosted by INGOs (AAH Canada and USA, Save the Children US and International Medical Corps), GNC Coordination Team and UNICEF as well as 20 TST Partners available, on-demand, to provide technical support when needed. The coordination of these resources is under the supervision of UNICEF and AAH Canada, in collaboration with a steering group of the INGO partners.

The Moderate Wasting Initiative is included within the TST’s Irish Aid current funding and is intended to support the mapping and design of context-specific solutions for the management of moderate wasting with multi-sectoral stakeholders.

This initiative aims to address the challenges that nutrition stakeholders have in accessing and utilizing feasible, effective and innovative solutions to respond to moderate wasting in children under five years old at scale. It will seek to support the development of programmatic solutions for managing moderate wasting at scale through a range of contextualized options, including the current standard of traditional SFP with the provision of specialized nutritious foods for those that require them. If relevant and feasible, the approach could include an assessment of risk and stratification of children into different streams based on their risks and needs. With the global focus on severe wasting due to its high risk of mortality, moderate wasting is frequently overlooked even though these children often outnumber severely wasted children 3:1, and have an increased risk of morbidity, mortality and the risk of their condition becoming severe. Improving response to moderate wasting is a critical part of the global effort to increase interventions focusing on the prevention of severe wasting, as highlighted in the UN GAP.  

The goal of the Moderate Wasting Initiative: Find feasible, replicable processes and solutions to bring moderate wasting management to scale  

Suggested process

A set of selection criteria are proposed below Countries (or sub-national governments and stakeholders) meeting those criteria can express an interest in partnering with the Alliance’s Technical Support Team (TST). Once the areas have been selected a co-creation process will consist of identifying the needs and risk factors for moderately malnourished children and designing a response to meet the needs. Critically, this process should be a consultative one and include various stakeholders such as government ministries, NGOs, UN agencies and others as appropriate. It is also important to note that the TST will not be able to fund the actual programmatic implementation costs, so the partners in the countries selected will need to either already have resources to dedicate to these activities or be willing to mobilize any resources necessary.

Country selection criteria

• The burden of moderate wasting known and above 10% and/or a high burden of moderate wasting (low prevalence but high population)
• Current understanding of the contextual drivers of wasting available via a LinkNCA or other method
• Context exhibits fragility in terms of seasonality, food security, service access, or other
• Countries with a political commitment to addressing moderate wasting and willing to innovate moderate wasting options^[7] , including available funds

Suggested roles and responsibilities for stakeholders

For the Moderate Wasting Initiative, the TST is looking to partner with Governments first and foremost. However, the various roles and responsibilities of the Initiative are intended to be:

• Steering Committee provide technical oversight and stewardship 
• TST will support the coordination and co-creation of the process in-country via technical resources and co-facilitation followed by the facilitation and dissemination of learning and advocacy for the process 
• Country governments will provide political and resource commitment, and technical oversight, and coordination and co-facilitation in-country 
• Other stakeholders such as the UN, NGOs, CBOs, SUN focal points and actors, donors and others can provide resources and technical input as appropriate, in addition to linking with the UNICEF-WHO operational advisory group   

Application process

To express interest or find out more information about the Moderate Wasting Initiative, please write to: Moderatewasting@actionagainsthunger.ca

^[1] https://admin.concern.net/sites/default/files/documents/2021-09/Management%20of%20Moderate%20Wasting_D2.pdf

^[2] https://www.simplifiedapproaches.org/what-are-simplified-approaches

^[3] https://www.childwasting.org/

^[4] https://www.goalglobal.org/impact-learning/nipp/

^[5] https://www.advancingnutrition.org/news/2022/01/18/global-survey-program-experiences-using-locally-available-foods-treat-moderate

^[6] https://ta.nutritioncluster.net

^[7] This includes having flexible Ministry of Health policies around treatment options for moderately wasted children.

© UNICEF/UN0494304/Nesbitt