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human resources for health and nutrition integration and WASH

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Cornelia Wakhanu

Normal user

10 Oct 2013, 16:03

I find nutrition interventions working in a different way in humanitarian than in normal public health systems. Lack of integration of services within the same health and nutrition and also WASH on promotion/prevention issues. WASH need to only have hardware staff separate. These will avoid-health promoters under WASH, health promoters under nutrition and health promoters under health itself in one locality only to wait during exit with many being laid off, due to funding, or the other partners or public sector not able to motivate all financially. Humanitarian nutrition interventions are separately implemented and all staff employed you will see their roles specifying nutrition interventions. Rarely will you find a few urgencies integrating the job description with health tasks leading to many volunteers with different roles in one locality. You will find the staff even if she or he is a health staff for example nurse recruited in nutrition as a nutrition nurse, everything is nutrition related, and apart from WASH interventions will be added but only those issues related to nutrition like food preparation. Surprising enough, the community health worker at village level has to perform all the tasks for health and nutrition unlike those staffs above him or her, who's the tasks are divided- health staff or nutrition staff. Though in some areas or projects, there are communities for health and nutrition combined due to the donor supporting integrated activities and then there are community health workers for nutrition alone in the same communities based on what the donor is supporting. We really need to avoid duplication and instead expand to other areas less or unattended to Integration of services is an issue that still lucks in some areas. This at most times bring lack of interest in nutrition and the staffs at the health facilities, with the mind that the other staffs was recruited for nutrition and him or her for the other health interventions despite being same profession. The recruited staff will also only deal with issues related to nutrition- apart from those who love their profession as a mission sent from God will obviously deal plus the health but documentation might not be done as the M&E tools do not specify anything of the sort. And if it is recorded anywhere else and reported as part of the report submission, rarely will it be passed on to the relevant department otherwise, mostly it will be a paper discarded as refuse and cannot be traced. But the challenge faced is when the direct implementation is handed over to public sector, due to donor requirement or as a gradual exit strategy. The nurses recruited for the nutrition at this time is entitled to perform health and nutrition intervention as a public health policy. This leads to arguments by staff why this is the case when they are funded by the donor targeting nutrition alone and why them being different from the previous ones employed by the humanitarian NGOs (Some belonged to the previously NGOs' recruited staffs). My recommendations: On project /programme exit strategy, we need to include in the plan at the inception stage to facilitate smooth hand over to the others be it public or private or international actors as some have done that very well. This avoids challenges faced on tasks-mix in future. I am of the opinion that we delegate nutritionists as specialists /advisors at different management levels from community to office- as it is in the public systems. Nurses feed for patients in the hospital or any settings, but the nutritionist is a specialist. Just as the nurse/midwife does the work and the obstetrician/gynaecologists/paediatricians /special or general surgeons are there to make sure their specialty is there. Unless the government s ready to employ nutritionists in every ward the same numbers as to nurses at present which it cannot happen at the moment due to the available number of nutritionists and the nature of their roles too. It is better all of us to avoid many types of volunteers when one volunteer cadre can do all the tasks. This makes the public or other agencies taking over not able to retain most of them due to motivation. Duplication of information/data and sharing of beneficiaries especially cannot be ruled out. Sorry for the long post as my network might go unreliable at any time and not able to post in bits. Thanks, Cornelia Wakhanu

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