|Guidelines for Selective Feeding Programmes in Emergency Situations (UNHCR, 1999, 25 p.)|
3. In emergency situations, WFP and UNHCR try to ensure that the food needs of the population are met through the provision of an adequate general ration. However, in certain situations there may be a need to provide additional food for a period of time, to specific groups who are already malnourished and/or are at risk of becoming malnourished.
4. These interventions have to be seen in the context of a general ration being distributed. The impact of Selective Feeding Programmes aimed at compensating for inadequate general rations has proven very limited and not cost-effective. Thus to be effective, the extra ration must be additional to, and not a substitute for, the general ration.
5. Many factors influence nutritional status (as shown in Figure 1). It should therefore be kept in mind that interventions must be multi-sectoral and cover food, health, hygiene, sanitation and care. A properly designed nutrition survey and complementary analysis of the causes of malnutrition can help to guide the need to implement Selective Feeding Programmes.
6. National health authorities and NGOs have an important role to play in nutritional interventions. In emergency situations NGOs usually organise and implement Selective Feeding Programmes. They form an integral part of the efforts to prevent and treat malnutrition among young children, women and other at-risk groups.
7. Selective Feeding Programmes should have clear objectives and criteria, defined from the beginning, for opening, admission, discharge and closure. In order to be effective, Selective Feeding Programmes need to be integrated into Community Health Programmes, which offer health and nutrition services like Safe Motherhood, immunisations, nutrition and health education and growth monitoring. Integration facilitates referrals between services and the phasing out of Selective Feeding Programmes.
8. In addition to nutritional and medical treatment, care is an essential part of rehabilitation. Care in nutrition refers to the practices of the care givers in the household which translates food security and health care into rehabilitation, growth and development. These practices include care for women, breast-feeding, infant feeding, psycho-social care, sanitation and hygiene practices, food processing and preparation, and home health practices (1). These issues can be addressed through Selective Feeding Programmes in the form of education, individual counselling, social activities and involvement of caretakers in the programme.
*Source: UNICEF, 1997.
9. The community must be consulted to the extent possible during programme design and women must take part in the decision making from the outset (2).
10. Proximity of feeding centres to the population and availability of trained health staff are a prerequisite when Selective Feeding Programmes are being considered.
11. The policy of UNHCR and WFP concerning safe and appropriate infant and child feeding, in particular the protection, promotion and support of breast feeding must be respected (3).
12. When planning the food needs of Selective Feeding Programmes the energy density as well as the fat, protein and micronutrient content of food commodities must be considered. In addition, micronutrient supplements (especially vitamin A, iron and folic acid) should be given.
13. It must be kept in mind, that adolescents, adults and elderly persons may also be malnourished and should be included in Selective Feeding Programmes.
14. The effectiveness of Selective Feeding Programmes, and their impact on mortality and morbidity of affected populations, should be monitored regularly.
15. The need to set up Selective Feeding Programmes after the initial stage of an emergency often represents a serious warning that the assistance as a whole is insufficient.
16. For interpretation of nutrition surveys, results are presented both in weight-for-height Z-scores and percentage of the median. However, during admission and discharge to feeding programmes, percentage of the median is often being used. At present, no consensus has yet been reached on the use of Z-score in feeding programmes.
17. The standards mentioned in these guidelines meet the set of minimum standards in disaster response as mentioned in the Sphere Project (4).