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STATEMENT OF COPYRIGHT

COPYRIGHT

© Action Against Hunger – February 2017

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ReseaRch stRategy 2016-2020

TAblE OF CONTENTSIntroduction

Research work streams to achieve a world without hunger

1. Prevention of undernutrition

2. Treatment of undernutrition

3. Effectiveness of emergency response

Research Uptake

Operationalising the strategy

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INTROduCTION

The main aim of research is to address critical gapsin the evidence base and contribute to tangible improvements in policy and practice

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INTROduCTIONFor over 35 years, Action Against Hunger has been at the forefront of the fight against hunger worldwide. Today, it is has an leading referent in nutrition security and nutrition in emergencies, with an established reputation as an evidence-based organisation, capable of providing high-quality technical and operational support in even the most challenging contexts and provides a leading example in the areas of nutrition security and nutrition in emergencies. Research and analysis are our primary means of assessing and improving the efficiency, effectiveness and sustainability of our interventions; of delivering quality results at-scale; of responding better responding to beneficiary needs and vulnerabilities, especially in times of crisis; and of boosting our evidence-based advocacy approaches. In short, research is critical to our work and continued success.

This document sets out the priority research areas and activities across Action Against Hunger Headquarters (HQ), to support a coordinated plan of action, highlight synergies and ensure a complementary approach. It aligns directly with the five goals of the Action Against Hunger International Strategic Plan 2016-2020, and should be read in tandem with Action Against Hunger’s research policy1 and research guidelines2. The strategy has been developed jointly by all HQs and incorporates feedback from the Action Against Hunger International Scientific Committee (ISC), as well as the recommendations from an external review of the achievements of the 2010-2015 research strategy3.

RESEARCH wORk STREAMS TO ACHIEvE A wORld wITHOuT HuNGERConflict, poverty, inequality, natural disasters, and political and social turmoil continue to have severe consequences for the world’s populations. Today, an estimated 50 million children under five years of age suffer from acute undernutrition, the most life-threatening form of hunger, and approximately 159 million children suffer from chronic undernutrition, which brings long-term consequences on a child’s ability to grow and thrive.

Over decades of responding to humanitarian crises, Action Against Hunger’s expertise has been refined and focused across a number of key thematic areas: Nutrition and Health; Mental Health and Care Practices; Water, Sanitation and Hygiene; Disaster Risk Reduction; and Food Security and Livelihoods. In light of its areas of expertise, Action Against Hunger’s research over the next five years will be prioritised and guided by the three primary work streams of the 2016-2020 Research Strategy:

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The following chapters elaborate on each of the three work streams. Specific research areas are also highlighted where Action Against Hunger’s expertise and capacity can be maximised to address critical gaps in the evidence base, and contribute to tangible improvements in policy and practice. The implementation of each work stream will be undertaken according to Action Against Hunger’s research guidelines,2 in order to ensure quality, coherence, continual learning and accountability.

1. Prevention of undernutrition: understanding and addressing the causes of hunger; 2. Treatment of undernutrition: managing and mitigating the consequences of undernutrition; 3. Effectiveness of humanitarian assistance: encouraging preparedness, improved reactivity and a higher quality of response.

PREvENTION OF uNdERNuTRITION

wORk STEAMS OF 2015-2020RESEARCJ STRATEGY

PREvENTION OF uNdERNuTRITION

uNdERTANdING ANd AddRESSING THE CAuSES OF

HuNGER;

TREATMENT OFuNdERNuTRITION

MANAGING ANd MITIGATING THE CONSEQuENCES OF

uNdERNuTRITION

EFFECTIvENESS OFHuMANITARIAN ASSISTANCE

ENCOuRAGING PREPAREdNESS, IMPROvEd REACTIvITY ANd A HIGHER

QIAlITY OF RESPONSSE

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PREvENTION OF uNdERNuTRITION:

uNdERSTANdING ANd AddRESSING THE CAuSES OF uNdERNuTRITION

Over the past 25 years, the global prevalence of chronic undernutrition has shown consistent decline, with the number of affected children under five dropping from 255 to 159 million. While this positive trend demonstrates that the absolute burden is decreasing, it is not decreasing fast enough - in 2014 one in four of all children under the age of five worldwide was stunted. In the same year, 50 million children were acutely undernourished, and nearly a third were severely wasted4. Furthermore, global prevalence of wasting has not declined as rapidly as stunting.

The nutrition security of households must be a priority, to maximise child growth and development, as well as to minimise child suffering. But the international community is still struggling to find the most effective interventions to ensure nutrition security and prevent child undernutrition. One of the greatest challenges in preventing childhood undernutrition is that little is known about the unique causes of acute and chronic undernutrition. There is little understanding of how and why these conditions evolve, individually or in conjunction with others, from conception through the critical years of child growth and development. Moreover, there is little evidence on how best to design and target interventions to address the potential overlap of these manifestations.5,6 Challenges remain in understanding what the best method is for preventing undernutrition, which may vary between people and contexts.

The current evidence on prevention is limited on the impact of sectoral interventions,7–9 and calls for adopting a Nutrition Security approach.10 This approach recognises the need for integrated, complementary and multi-sectoral interventions (e.g. food security, hygiene, sanitation, behaviour changes, care practices, health) over the entire continuum of care, in order to have simultaneous impacts upon the complex and interconnected drivers of undernutrition. An understanding of context-specific factors like cultural beliefs, gender roles, education levels, poverty, inequality, and socio-political stability plays a pivotal role in the ultimate success of preventative actions. More evidence is needed to better understand the effects of these base causes on nutritional status, and what intervention packages might address the diverse factors in an effective and comprehensive way.

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TREATMENT OF uNdERNuTRITION

An understanding of context-specifi c factors plays an essenti al role in the eventual success of the preventati ve undernutriti on acti ons

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PREvENTION wORk STREAM RESEARCH PRIORITIES. In the next fi ve years we will focus on:

− Understanding the multi -sectorial nature of the causes of undernutriti on in our areas of interventi ons; − Identi fying context-specifi c vulnerabiliti es and enabling factors at individual, household and community levels, based on the knowledge and experience of Acti on Against Hunger’s partners, stakeholders, benefi ciaries and communiti es where we work.

− Building evidence on key relati onships between acute and chronic undernutriti on; severe and moderate acute undernutriti on; maternal health (pre- and post-natal) and child nutriti onal status; and seasonality, shocks and peaks in the burden of undernutriti on.

− Demonstrati ng the impact and cost-eff ecti veness of multi -sectoral, nutriti on-sensiti ve interventi ons (e.g. social protecti on, cash transfers, WASH-in-Nut, behaviour change, women’s empowerment, agro-ecology) to improve nutriti onal security in the short and longer terms.

− Demonstrati ng the effi cacy of integrated interventi ons along the conti nuum of care, which improve both maternal and child health in all Acti on Against Hunger’s sectors.

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TREATMENT OF uNdERNuTRITION:

MANAGING ANd MITIGATING THE CONSEQuENCES OF uNdERNuTRITION

Each year, over 5 million children die before their fifth birthday11. While the main drivers of mortality remain acute respiratory infections, malaria and diarrhoea12, almost half of all child deaths can be attributed to undernutrition13. Severely acutely undernourished children are 11 times more likely to die as compared to well-nourished children, and severely chronically undernourished children are 5.5 times more likely. Furthermore, children with multiple nutrition deficits have the highest hazard of death.14 The use of Ready-to-Use-Therapeutic-Foods within community-based treatment programmes is considered a cost-effective way to treat severe acute malnutrition (SAM). Yet in 2012, less than 15% of children suffering from SAM had access to adequate treatment.15 The close link between SAM and child mortality makes SAM treatment at-scale an essential part of global efforts to reduce the prevalence and incidence of undernutrition, as well as to achieve Sustainable Development Goal child survival targets.

Practitioners working on the integration of SAM treatment into national health systems are constantly exploring new ideas and approaches to address bottlenecks associated with the supply, demand and quality of SAM treatment services. However, the application of a “one-size-fits-all” approach for the integration of SAM treatment within health systems is often prioritised. Efforts should focus instead on identifying how the SAM treatment component should be adapted to reflect the context-specific opportunities and challenges of each health system.

More evidence is needed on the supply-side in terms of identifying the effectiveness and cost-effectiveness of treatment options to increase coverage (e.g. the use of a single protocol for both SAM and moderate acute malnutrition (MAM) children, or protocols with optimised treatment doses) and strengthen service delivery models (e.g. the integration of SAM treatment into community case management). On the demand side, more evidence is needed on how to improve awareness about SAM and SAM services, as well as to empower caregivers to seek treatment. Finally, reliable and accurate estimations of SAM caseloads is a fundamental component of successfully planning SAM treatment. This requires methods that reliably estimate incidence, taking contextual factors – such as the severity and type of undernutrition, the prevalence of infectious illness, access to health services, treatment delivery models and the age structure of the population – into account.

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TREATMENT wORk STREAM RESEARCH PRIORITIES. In the next fi ve years we will focus on:

− Increasing the eff ecti veness of treatment through:

a. Building the evidence on MAM and SAM diagnosis and treatment as a conti nuum to improve treatment access and coverage;

b. Identi fying and assessing the eff ecti veness and scalability of health service delivery methods, especially in low-resource and emergency environments, through existi ng and innovati ve methods in terms of actors and approaches;

c. Strengthening the integrati on of nutriti on-specifi c interventi ons into the health system;

d. Investi gati ng the impact and the cost-eff ecti veness of multi sectoral, integrated treatment packages on the prevalence of acute and chronic undernutriti on (e.g. WASH-in-Nut; psychosocial care & nutriti on);

e. Finding non-product-based sustainable soluti ons to ensure more equitable access to care and reduce costs, in order to maintain eff ecti veness;

f. Improving esti mates of context-specifi c incidence rates and caseloads.

TREATMENT OF uNdERNuTRITION

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Practitioners are constantly exploring new ideas and approaches to address bottlenecks associated with the supply, demand and quality of treatment services

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EFFECTIvENESS OF EMERGENCY RESPONSE

EFFECTIvENESS OF EMERGENCY RESPONSE:

ENCOuRAGING PREPAREdNESS ANd IMPROvEd SPEEd ANd QuAlITY OF RESPONSE

In 2014 alone, an estimated 107.3 million people were affected by natural disasters,16 and conflict and persecution pushed the numbers of displaced and refugee populations to the highest level ever recorded, at a total of over 65.3 million.17 More people than ever before are in need, and for longer, straining the capacity of the humanitarian system to efficiently respond, both in terms of timeliness and quality of response. In these contexts, acute-onset and protracted crises often overlap, as do people’s immediate and chronic needs and vulnerabilities.

Providing emergency humanitarian assistance to populations in need amid conflict or natural disaster is dangerous and difficult. Response can only be as good as key stakeholders’ levels of preparedness, of which community resilience and coordination in planning and resourcing are of the utmost importance. Access to populations may be limited by political considerations, physical impediments related to weather or infrastructure, diversion of aid, or security constraints related to active fighting and attacks on humanitarian personnel. Such field constraints mean that reaching affected populations requires adapted assistance delivery modalities and strategies. Furthermore, increasing urbanisation linked to population growth poses new challenges in disaster response in terms of numbers of affected, their identification, understanding of local vulnerabilities, and capacities and strategies to respond.

Emergency response remains limited by key evidence gaps. Improving the quality of risk assessment and early warning systems to trigger early action remains a challenge, and evidence is lacking on what works in improving preparedness mechanisms at the local level. Linked to this is the limited understanding of local self-recovery processes and local perceptions of vulnerabilities, both of which play a guiding role in emergency response. As more and more acute emergencies occur within fragile, chronically insecure settings, strengthening the linkages between emergency response and medium- to longer-term activities could improve preparedness and therefore enhance response. Evidence on how to accomplish this is, however, limited. Finally, the effectiveness of aid approaches (cash, in-kind, health system strengthening, livelihood support, behaviour change, etc.) to increase community resilience is likely to be context specific: evidence on the most appropriate approaches and enabling factors is limited.

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RESEARCH STRATEGY 2016-2020

EFFICIENCY wORk STREAM RESEARCH PRIORITIES. In the next fi ve years we will focus on:

− Understanding the implicati ons (in terms of cost, resourcing, level of eff ort, etc.) of early versus later acti on, including how and when decision-making can best be infl uenced to improve response;

− Investi gati ng the eff ecti veness and appropriateness of assistance approaches to increase resilience;

− Appraising the contributi on of new technologies in circumventi ng fi eld constraints.

RESEARCH uPTAkE Despite the breadth and depth of knowledge that exists globally, “the right systems and incenti ves are not in place to ensure that evidence is available and used to inform decision-making”.18 Transforming evidence into acti on and policy change is one of our responsibiliti es as an NGO conducti ng research. The ulti mate goal of research uptake acti viti es is to ensure that the evidence generated by Acti on Against Hunger’s research projects is used to improve the effi ciency and eff ecti veness of undernutriti on programmes globally. As indicated in Acti on Against Hunger’s research guidelines, a high level of engagement with the target audience is criti cal for successful research uptake. This engagement can vary from research disseminati on (where informati on on research is distributed to a presumably interested audience) to research communicati on (where informati on is shared through an iterati ve and multi directi onal process involving targeted stakeholders). Ulti mately, research uptake acti viti es entail strategic engagement with stakeholders throughout the enti re project period.

Research uptakei is an integral part of every stage of the Acti on Against Hunger research cycleii and is part of the organisati onal approach to Monitoring, Evaluati on, Accountability and Learning (MEAL), and to Knowledge and Informati on Management (KIM). Uptake reinforces skills, creates effi ciencies in project delivery, and drives progress by ensuring that learning taken from a project informs the design and implementati on of future work. Uptake acti viti es demonstrate not only that Acti on Against Hunger not only produces relevant and ti mely evidence, but also that the organsati on is able to use evidence to infl uence key decisions in policy and practi ce (thereby

i Research uptake includes all those acti viti es that facilitate and contribute to the use of research evidence by policy-makers, practi ti oners and other development actors (DFID 2013).ii More details can be found in Acti on Against Hunger research guidelines (Acti on Against Hunger 2016).iii Acti on Against Hunger Research Guidelines provide further details on how to create and integrate a research uptake strategy (Acti on Against Hunger 2016).

EFFECTIvENESS OF EMERGENCY RESPONSE

improving not only our own actions, but also those of the communities of practice within which we operate).

To this end, as part of the 2020 Research Strategy, Action Against Hunger will focus its efforts on ensuring that the evidence produced by current and future research projects is taken up by its staff, partners, and external stakeholders. Each research project will include a Research Uptake Strategy (RUS).iii While the scope of each RUS will vary according to the size, focus and resources of the project, strategies will include stakeholder engagement, capacity building, communication, and Monitoring and Evaluation throughout the research project cycle.19 Finally, continuing to discuss the challenges and opportunities associated with designing and implementing each RUS in practice will contribute to creative thinking about which uptake activities create the most impact (and why, when and how they positively influence change).

OPERATIONAlISING THE STRATEGYGOvERNANCE

• Increase efficiency of Action Against Hunger research governance and define the role of the ISC.

• Define priority projects and encourage collaboration across HQs in project implementation to increase the return on investment of methodological development and of evidence production around the impact of a given intervention in different contexts.

• Provide guidance on the common principles across all Action Against Hunger research projects to encourage best practice and support broader uptake of research and findings within the organisation and beyond.

RESOuRCES

• Develop human resources in Monitoring and Evaluation, data management, research skills, translation of scientific findings into operational language, and capitalisation on past programmes at both mission and head quarter level.

• Strengthen the linkages with the broader MEAL approach by increasing the utilisation of monitoring data to explore trends and patterns, and to understand the contexts where we work. PARTNERSHIP

• Strengthen anchoring at national and regional level by fostering collaboration with national and international academic partners, as well as private, public and civil society actors.

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• Promote the integration of PhD candidates within research projects.

• Participate in global networks aiming to develop southern capacities and to ensure the relevance of evidence produced.

FINANCING

• Define a donor strategy with the aim of increasing donors’ awareness on major research and research gaps to mobilise funding.

• Create an internal fund to respond to research questions when external donor funds cannot be secured.

• Engage in joint fundraising with academic partners.

COMMuNICATION

• Make information available on the intranet and on the Action Against Hunger public website about research expertise, activities and achievements in all relevant languages.

• Encourage the development of Research Uptake Strategies for all Action Against Hunger research to plan strategic engagement with external stakeholders and the communication of project updates and findings.

The evidence produced by research projects should be taken up by its staff, partners, and external stakeholders

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EFFECTIvENESS OF EMERGENCY RESPONSE

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Uptake drives progress by ensuring that learning from one project informs the design and implementation of future work

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ACTIONS CRITICA MOMENT

1. Knowledge production

- Number of peer-reviewed papers made available (preferably) in open access format;

- Number of projects with scientific partners, scientific protocol, trial registry, approval from International Review Boards;

- Number of effectiveness studies embedded within programmes.

2. Evidence dissemination and uptake

- Number of policy briefs, manuals, press releases, social media, memos, videos, photo-series, blogs, etc;

- Contribution to policy debates: citation, downloads, media mentions, demand for future work to be conducted;

- Number of conferences and seminars, national policy forums, restitution workshops, cluster working groups;

3. Partnership - Number of Memoranda of Understanding / collaboration agreements signed with partners;

4. Financing- % of annual operational volume dedicated to research and development; - % of annual operational volume dedicated to MEAL.

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REFERENCES

REFERENCES1. Action Contre la Faim International. Research Policy ACF-IN. Paris; 2008. doi:10.1016/j.respol.2010.01.009.

2. Action Contre la Faim International. Designing and Managing Research Projects: A Practical Guide for Fieldworkers.; 2016.

3. Lachat C, Kolsteren P. Evaluation of the ACF International 2010-2015 Research Strategy Achievements: Final Report. Internal Document; Paris; 2016.

4. UNICEF, WHO, World Bank. Levels and trends in child malnutrition - UNICEF-WHO-WB joint child malnutrition estimates. http://www.who.int/nutgrowthdb/estimates2014/en/. Published 2015. Accessed February 6, 2016.

5. Menon P, Stoltzfus RJ. Building convergence in science, programs, and policy actions on child undernutrition: symposium rationale and overview. Adv Nutr. 2012;3(2):224-226. doi:10.3945/an.111.001115.

6. Khara T, Dolan C. The Relationship between Wasting and Stunting, Policy, Programming and Research Implications.; 2014.

7. Bhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. June 2013. doi:10.1016/S0140-6736(13)60996-4.

8. Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536-551. doi:10.1016/S0140-6736(13)60843-0.

9. Blanchet K, Sistenich V, Ramesh A, et al. An Evidence Review of Research on Health Interventions in Humanitarian Crises.; 2013. http://www.elrha.org/r2hc/evidence-review.

10. ACF International. Nutrition Security Policy.; 2014.

11. UN Interagency Group for child mortality estimation. Levels and Trends in Child Mortality.; 2015.

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12. GDB 2013 Mortality and Cause of Death Collaborators. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;385(9963):117-171. doi:10.1016/S0140-6736(14)61682-2.

13. Black R, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-451. doi:10.1016/S0140-6736(13)60937-X.

14. McDonald CM, Olofin I, Flaxman S, et al. The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr. 2013;97(4):896-901. doi:10.3945/ajcn.112.047639.

15. UNICEF / Coverage Monitoring Network / ACF International. The State of Global SAM Management Coverage 2012. New York and London; 2012.

16. Guha-Sapir D, Below R, Hoyois P. EM-DAT: International Disaster Database. Université catholique de Louvain. www.emdat.be.

17. United Nations High Commissioner for Refugees. Global Trends: Forced Displacement in 2015. Geneva; 2015.

18. DFID. Promoting Innovation and Evidence-Based Approaches to Building Resilience and Responding to Humanitarian Crises : A DFID Strategy Paper.; 2012.

19. UKAID. Research Uptake: A Guide for DFID-Funded Research Programmes. London; 2016.

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FOR FOOd. FOR wATER. FOR HEAlTH.FOR NuTRITION. FOR kNOwlEdGE.FOR CHIldREN. FOR COMMuNITIES.FOR EvERYONE. FOR GOOd.FOR ACTION. AGAINST HuNGER.