Day 4: Advanced analysis, integrated response and advocacy…

1The IPC Acute Malnutrition scale

The IPC AMN classifies areas into five phases, from “acceptable” to “extremely critical”, based on GAM prevalence and contributing factors (morbidity, diet, water, health, access). The analysis is carried out by a technical working group, with quality-controlled data, and produces projections for the coming months.

It is used to prioritise areas, size the response and advocate with donors. An NGO contributes its programme and screening data, but the analysis is consensus-based and validated by the national working group.

2An integrated response

The best results come from integrated packages around the child: screening, treatment, vaccination, safe water and hygiene, transfers or rations for the household, breastfeeding support, mothers' mental health. We speak of simplified approaches when the national protocol allows them: a single product for SAM and MAM, MUAC-based dosing, screening by mothers.

Designing an integrated response means targeting the same areas and the same households, sharing referral lists (while respecting data protection) and monitoring common indicators.

3Calculating requirements and managing supplies

Common formula for SAM: population aged 6-59 months × prevalence × incidence factor × target coverage, then multiplied by the quantity of RUTF per treatment (often around 150 sachets, depending on the protocol). A safety stock is added and supply lead times, often several months, are taken into account.

Stock monitoring is done every month, site by site, with stock-out alerts shared with the cluster. The pipeline is managed with UNICEF and WFP, which often supply RUTF and supplementary foods.

4Quality, accountability and advocacy

Quality is managed through performance indicators, coverage surveys, supportive supervision and community feedback (complaints mechanism, focus groups with mothers). Identified barriers (distance, hidden costs, reception) are addressed in an action plan.

Advocacy relies on data: prevalence, mortality, coverage gaps, supply stock-outs, cost of treatment per child cured. The cluster carries common messages to donors and authorities.

In-depth course

Detailed methods, a complete worked example, tools, common mistakes and interview questions.

5Taking part in an IPC Acute Malnutrition analysis, step by step

The IPC Acute Malnutrition analysis (IPC AMN) is conducted by a national or sub-national analysis team, under the auspices of the country's IPC Technical Working Group, often chaired by the government, with support from the Nutrition Cluster, UNICEF, WFP, FAO and NGOs. An NGO nutritionist takes part as an analyst: they bring data, defend them and accept the rule of evidence-based consensus.

Phases and reference thresholds

IPC AMN phase	Name	GAM by weight-for-height (6-59 months)	Response orientation
1	Acceptable	Less than 5%	Maintain services, build resilience
2	Alert	5 to 9.9%	Strengthen services and surveillance, act on contributing factors
3	Serious	10 to 14.9%	Urgent response to reduce acute malnutrition and prevent mortality
4	Critical	15 to 29.9%	Large-scale, multisectoral emergency response
5	Extremely critical	30% or more	Maximum and immediate response to avert widespread deaths

The IPC manual also provides MUAC-based thresholds for when weight-for-height data are missing, with more restrictive rules of use. The IPC classifies an area as Famine when three thresholds are reached simultaneously in the same area: at least 20% of households face extreme food gaps, GAM reaches at least 30% among children (or an equivalent MUAC threshold), and the crude death rate exceeds 2 deaths per 10,000 people per day. This classification falls under the Famine Review Committee and a specific verification process.

The process

Preparation (4 to 8 weeks before the workshop): inventory of available data by area (validated SMART surveys, surveillance data, programme data, data on contributing factors), assessment of their reliability, entry into the IPC analysis worksheets.
Analysis workshop (one to two weeks): in groups, analysts examine each area, the direct evidence (prevalence) and contributing factors: inadequate food intake (consumption, IYCF), disease (diarrhoea, malaria, measles, epidemics), underlying factors (food security, water, access to care, care practices).
Classification of the current period: phase of each area, with a level of confidence that depends on the quality and age of the data.
Projection: estimation of the phase for the coming period (often the lean season or the seasonal peak), based on seasonal trends, agricultural prospects, expected epidemics and planned and funded assistance.
Estimation of the expected number of cases: number of children aged 6 to 59 months and of pregnant and lactating women likely to suffer from acute malnutrition over the year.
Quality review and validation: where applicable, by the IPC Global Support Unit; publication of the report and maps.

The data an NGO must prepare

Data	Expected format	Point to watch
SMART surveys conducted by the NGO	Validated report, database, plausibility report	A survey that has not been validated will not be accepted as direct evidence
Admission trends	Monthly series over at least three years, by site, with geographical coverage	An increase in admissions may reflect an increase in coverage rather than in malnutrition
Exhaustive MUAC screenings	Proportions by band, method, period	Usable as indirect evidence, not as prevalence
Morbidity and IYCF data	Surveys, health facility data	Specify representativeness
Qualitative information	Supervision reports, alert reports, community feedback	Useful for projections

The golden rule of the IPC analyst: separate what the data say from what you would like them to say. An NGO that pushes for a more severe classification without evidence loses its credibility within the group, and the country may lose the credibility of its analysis with donors.

6Full example: calculating supply requirements and the budget for Nara-Est district

Fictional context: Nara-Est district has 54,000 children aged 6 to 59 months. The IPC AMN analysis classifies it in Phase 4 for the projection period, with a peak expected from July to October. The most recent SMART survey gives SAM of 2.8% and MAM of 9.4%. The cluster asks each partner to cost its requirements for the coming year. Your NGO supports all 14 health centres in the district.

Step 1: the expected SAM caseload

Prevalence measures the cases present at a given point in time; over the course of a year, new cases appear. Prevalence is therefore multiplied by an incidence correction factor. The default factor long used is 2.6 for SAM; Global Nutrition Cluster guidance encourages replacing it with a locally estimated factor (based on admission and coverage data, or on the average duration of an episode) whenever possible. Here, the technical working group keeps 2.6.

Parameter	Value	Calculation	Result
Prevalent SAM cases	2.8%	54,000 × 0.028	1,512
Expected annual caseload	Factor 2.6	1,512 × 2.6	3,931
Target coverage	70%	3,931 × 0.70	2,752 children to be treated
Of which stabilisation	About 10% (according to the district's historical data)	2,752 × 0.10	275 children

Step 2: RUTF

The usual benchmark is about one carton of 150 sachets per child treated (about 13.8 kg), which corresponds to an average treatment of 6 to 8 weeks. A margin is added for losses, forecasting errors and children who stay longer.

Item	Calculation	Result
Cartons required	2,752 × 1	2,752 cartons
10% margin	2,752 × 1.10	3,027 cartons
Tonnage	3,027 × 13.8 kg	about 41.8 tonnes
Indicative cost (assumption for this example: USD 45 per carton, plus 25% for transport, storage and distribution)	3,027 × 45 × 1.25	about USD 170,300

Step 3: the TSFP

For MAM, the technical working group uses in this example a local incidence factor of 1.5 and a target coverage of 60%, with an average treatment duration of 60 days and one sachet of RUSF per day.

Item	Calculation	Result
Annual MAM caseload	54,000 × 0.094 × 1.5	7,614
Children to be treated	7,614 × 0.60	4,568
RUSF sachets	4,568 × 60	274,080 sachets
Tonnage (92 g per sachet)	274,080 × 0.092 kg	about 25.2 tonnes

Step 4: the monthly profile and the supply plan

Admissions are not evenly distributed. Data from the last three years show that 50% of OTP admissions occur from July to October. The average monthly RUTF requirement is 3,027 / 12 ≈ 252 cartons, but it reaches about 3,027 × 0.50 / 4 ≈ 378 cartons per month during the peak.

Stock parameter	Rule adopted	Value for the peak
Supply lead time (from order to delivery to the district)	4 months based on history	-
Safety stock at district level	2 months of peak consumption	756 cartons
Maximum stock at a health centre	1 month of consumption, monthly resupply	Depends on the centre
Alert threshold to the cluster	Less than 6 weeks of projected stock across the whole district	about 570 cartons
Order date for the peak	Full delivery before the end of June, so order no later than the end of February	-

Step 5: other supplies and resources

Routine treatment drugs (amoxicillin, antimalarials, deworming tablets), calculated from the number of children and the protocol regimens, with the same margin.
F-75 and F-100 therapeutic milks, ReSoMal and stabilisation drugs for 275 children.
Anthropometric equipment (MUAC tapes for community volunteers and mothers, scales, height boards), forms, registers and cards.
Human resources: number of OTP days and outreach sites, community volunteers, supervisors.

The calculation is only worth something if its assumptions are written down. A requirements table without an explicit source prevalence, incidence factor, target coverage and margin can neither be verified by the cluster nor defended before a donor.

7Designing an integrated response around the child and the household

Recent guidance, including the Global Action Plan on Child Wasting promoted by several United Nations agencies (2020) and the Joint Intersectoral Analysis Framework used for humanitarian needs overviews, encourages designing responses around the child and their household rather than sector by sector. In concrete terms, an integrated response means: the same areas, the same households, functional referrals and shared indicators.

The integration matrix

Entry point	Nutrition service	Linked service	Concrete mechanism
Child admitted to the OTP	Treatment of SAM	WASH kit (soap, water container, water treatment products) and hygiene session	Kit handed over at admission; WASH volunteers trained in follow-up
Child admitted to the OTP or TSFP	Treatment	Cash transfer to the household during treatment	Referral list sent to the food security partner under a data-sharing protocol
Antenatal care	MUAC screening, IYCF counselling	Iron and folic acid, malaria prevention, TSFP if needed	Single card for the pregnant woman
Vaccination campaign	MUAC screening, vitamin A	Measles vaccination	Joint teams, shared data
General distribution	MUAC screening of children present	Ration or transfer	Screening station at the distribution site
Child-friendly space or protection service	Identification of malnourished children who are unaccompanied or neglected	Case management	Written referral procedure

Design steps

Start from the causal analysis and the IPC: which contributing factors dominate in each area?
Map the actors of each sector present in the same areas (cluster 4W matrices).
Define a common minimum package and shared targeting criteria.
Draft the referral procedures: who refers, with which form, within what timeframe, who confirms that the service has been provided.
Sign a data-sharing protocol between organisations.
Set common indicators (for example the proportion of children admitted to the OTP whose household received a WASH kit and a transfer within two weeks).
Plan a quarterly joint review.

The case of cash transfers

Cash transfers improve household access to food and reduce the sharing of therapeutic products, but their effect on acute malnutrition depends on their amount, regularity, duration and accompanying measures. A good design calculates the amount on the basis of the cost of a nutritious food basket, targets households at the time of maximum risk (lean season, ongoing treatment), and combines IYCF and hygiene messages. Markets must be able to respond: a prior market analysis is essential.

Integration rarely fails on principle and almost always on the details: lists not transmitted, incompatible criteria, misaligned funding timelines. The practical test is to follow ten children admitted to the OTP and check how many actually received the linked services that were promised.

8Managing the quality and accountability of a nutrition programme

The Core Humanitarian Standard on Quality and Accountability (CHS), in its updated 2024 version, sets out nine commitments to affected people. Applied to a nutrition programme, they become very concrete requirements, which evaluators and certification auditors check.

The commitments translated into nutrition practice

CHS commitment theme	Translation into a nutrition programme	Expected evidence
Appropriate and relevant response	Programme based on a validated survey, the IPC and a causal analysis	Needs analysis cited in the proposal
Timely access and coverage	Measured coverage, decentralised sites, no supply stock-outs	Coverage assessment, stock-out monitoring
No negative effects, strengthening of local capacities	Integration into the health system, respect for the Code, no substitution for Ministry staff without a plan	Transition plan, training of public staff
Communication, participation and feedback	Understandable messages, consultation of mothers, accessible complaints mechanism (including for women who cannot read)	Register of complaints and responses
Handling of complaints	Confidential channel, in particular for sexual exploitation and abuse	Written procedure, response times
Coordination and complementarity	Active participation in the cluster and in intersectoral referrals	Monthly reports submitted
Learning and improvement	Quarterly reviews, death reviews, action plans followed up	Minutes and action tracking
Competent and well-managed staff	Training on the national protocol, supportive supervision, signed code of conduct	Training plans, supervision reports
Responsible management of resources	Traceability of supplies, prevention of fraud and diversion	Stock reconciliations, audits

The supportive supervision checklist for an OTP site

Area	Points checked	Method
Anthropometry	MUAC technique, scale calibration, oedema check	Observation of 5 measurements, re-measurement of 5 children
Admission and referral	Compliance with criteria, appetite test, referral of complicated cases	Review of 10 admission cards
Treatment	Complete routine treatment, RUTF dosage according to weight	Card review and observation of the distribution
Follow-up	Tracing of absentees, transfer criteria applied	Comparison of the register with the volunteers' list
Discharge	Discharge criteria respected, referral to the TSFP	Review of 10 discharge cards
Stocks	Consistency between stock card and physical stock, expiry dates, storage conditions	Physical inventory
Data	Consistency between the register, the monthly report and the cluster report	Recount of one month
Reception and accountability	Waiting time, respect, information given to mothers, posting of the complaints mechanism	Exit interviews with 5 mothers

Each visit ends with immediate feedback to the team, a dated action plan and, at the next visit, verification of the agreed actions. Supportive supervision aims at improvement, not sanction: a team that fears supervision hides its problems.

Protection from sexual exploitation and abuse

Nutrition programmes bring staff who control access to high-value goods (therapeutic products, rations) into daily contact with women and children in situations of great vulnerability. The risk of exploitation is real. The IASC Six Core Principles relating to Sexual Exploitation and Abuse apply: signed code of conduct, training, safe and accessible reporting mechanisms, presence of female staff at sites, informing communities that services are entirely free of charge.

9Building evidence-based advocacy: example of a note to donors

Effective nutrition advocacy relies neither on images of children nor on adjectives, but on a precise problem, validated figures, demonstrated consequences and a clear ask. It is preferably carried collectively by the cluster, with the NGO contributing its data.

The standard structure of a one-page advocacy note

The key message in two sentences: the situation and the ask.
The facts: three to five validated and sourced figures.
The consequences of inaction: quantified, with a timeframe.
The proposed response and its cost.
The specific asks: to whom, what, when.

Example note for Nara-Est district

Section	Content
Key message	Nara-Est district is projected in IPC AMN Phase 4 (Critical) for the July to October period. Without funding before the end of February, an RUTF stock-out will interrupt the treatment of nearly 1,400 children during the seasonal peak.
Facts	GAM 12.2% and SAM 2.8% (SMART survey validated by the technical working group); expected annual caseload of 3,931 children with SAM; current coverage estimated at 41%; available stock covering needs only until the end of June; supply lead time of four months.
Consequences	Children with untreated SAM have a risk of death several times higher than that of well-nourished children; a stock-out during the peak would lead to the suspension of admissions, an increase in defaulting and a loss of community trust that takes a long time to rebuild.
Proposed response	Treatment of 2,752 children with SAM (target coverage 70%), including 275 in stabilisation; TSFP for 4,568 children; decentralisation to four outreach sites; WASH integration and cash transfers with two partners.
Cost	RUTF and distribution: about USD 170,000; full treatment package, including staff and supervision: to be detailed in the attached budget, with the cost per child treated.
Asks	To donors: funding for RUTF before the end of February so that the order can be placed. To the Ministry: authorisation of the outreach sites. To the cluster: prioritisation of the district in the next pooled fund allocation.

Advocacy targets

Humanitarian donors (ECHO, BHA, FCDO, pooled funds, CERF): they expect explicit links with the IPC, the humanitarian needs overview and cluster priorities, realistic unit costs and an analysis of stock-out risks. ECHO has published a thematic policy on nutrition in humanitarian aid that emphasises integration and prevention; BHA sets out its requirements and indicators in its application guidelines.
National authorities: inclusion of therapeutic products in the essential medicines list, national budget lines, adoption of updated protocols.
Development actors: social protection, health systems, multi-year funding in line with the humanitarian-development-peace nexus.

The credibility of advocacy is earned over time. The figures must be exactly those of the cluster and the IPC, confidence intervals must not be hidden, and promised results must remain measurable. An NGO caught exaggerating once is listened to less for a long time.

10Common mistakes, contextual variations, interview questions and references

Common mistakes

Calculating requirements on prevalence alone, without an incidence factor: annual requirements are then underestimated by more than half, and the stock-out arrives at the peak.
Ordering too late: forgetting that the time between ordering and delivery to the district is counted in months.
Interpreting an increase in admissions as a deterioration without checking changes in coverage or the opening of new sites.
Building "integration" on paper without referral procedures or effective data sharing.
Measuring quality only through cure rates, without coverage, without accountability, without analysis of deaths.
Advocating alone with figures that differ from those of the cluster.

Variations by context

Sudden-onset crisis: no IPC available for several weeks; estimation of requirements from screenings and cautious assumptions, revised as soon as validated data arrive; supply loans between partners and prepositioning.
Protracted crisis: regular IPC cycles, multi-year funding, integration into the health system, local or regional procurement of RUTF where certified producers exist.
Camp: known population, more precise calculation of requirements, easier integration with UNHCR and WFP services.
Urban area: high mobility, uncertain denominators, need to cross-check several population sources.
Limited access or remote management: higher stocks at site level to compensate for access interruptions, third-party monitoring, remote monitoring data, increased risk of diversion to be documented in the risk analysis.
Local partner with low capacity: simplified quantification tool, support with stock management, progressive direct funding in line with the Grand Bargain localisation commitments.

Interview questions

1. "Calculate the annual RUTF requirements for 30,000 children aged 6 to 59 months, SAM of 2%, target coverage of 60%."

Expected answer: 30,000 × 0.02 = 600 prevalent cases; × 2.6 (default factor, to be replaced by a local factor if available) = 1,560 expected cases; × 0.60 = 936 children to be treated; about 936 cartons, or about 1,030 with a 10% margin. The candidate explains their assumptions and mentions seasonality and supply lead time.

2. "What is the difference between prevalence and incidence, and why does it matter for a nutrition programme?"

Prevalence measures the cases present at a given time, incidence the new cases over a period. A programme treats the annual caseload, which far exceeds point prevalence; confusing the two leads to stock-outs.

3. "You are taking part in the IPC workshop and a colleague wants to classify an area in Phase 4 without recent data. What do you do?"

The answer recalls the evidence reliability rules, proposes classifying with the appropriate level of confidence or flagging the area as lacking data, and recommends a survey or a rapid screening. It stays factual and favours evidence-based consensus.

4. "How do you check that an integrated response really works?"

Follow-up of cohorts of referred children, common indicators, joint reviews, feedback from mothers, and analysis of the time between referral and service received.

5. "How do you apply the CHS to a nutrition programme?"

The candidate gives concrete examples: a complaints mechanism adapted to mothers, measured coverage, death reviews, respect for the Code, traceability of supplies, strengthening of Ministry staff.

6. "A donor asks why your cost per child treated is higher than that of another partner."

The answer compares the scope (whether or not stabilisation, the TSFP, UNICEF-supplied commodities, community screening and hard-to-reach access are included), presents the coverage and quality achieved, and agrees to examine the budget lines where savings are possible.

Key references

IPC Technical Manual, current version, including the Acute Malnutrition protocol and the Famine procedures: IPC Global Partnership.
Global Nutrition Cluster guidance on caseload estimation and the calculation of people in need, and on supply pipeline monitoring.
Global Action Plan on Child Wasting (2020): FAO, UNHCR, UNICEF, WFP and WHO.
Core Humanitarian Standard on Quality and Accountability (CHS), 2024 version: CHS Alliance, Sphere and Groupe URD.
Six Core Principles relating to Sexual Exploitation and Abuse: IASC.
Thematic policy on nutrition in humanitarian aid: ECHO, European Commission.
Emergency Application Guidelines and indicator handbook: BHA.
Joint Intersectoral Analysis Framework (JIAF): partners in the humanitarian needs overview process, OCHA.
Grand Bargain commitments (2016) and follow-up documents on localisation.

Advanced analysis, integrated response and advocacy in nutrition