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Roadmap for Complementary Feeding in Emergencies, 2023

Roadmap for Complementary Feeding in
Emergencies
Emergency Nutrition Network, December 2023
A working document that identifies needs and priorities for providing practicaland sustainable guidance to countries to improve the planning, policies andimplementation of interventions regarding complementary feeding.

Roadmap for Complementary Feeding in Emergencies, 2023

Table of contents
Abbreviations and acronyms............................................................................................. 3
Acknowledgements .......................................................................................................... 3
Extending recognition ....................................................................................................... 4
Why a CFE roadmap?........................................................................................................ 4
Objectives ..................................................................................................................... 5
How has the CFE roadmap developed?.............................................................................. 5
Desk review: Identification of gaps and recommendations ............................................. 5
Consultation process: Identification of priorities ............................................................ 5
CFE literature review and findings ..................................................................................... 6
CFE gaps: From the literature ............................................................................................ 7
Advocacy, funding and prioritisation ............................................................................. 7
Policy ............................................................................................................................ 8
Capacity building........................................................................................................... 8
Preparedness, programming and interventions.............................................................. 9
Challenges in programme implementation.................................................................................................... 9
Health system challenges ............................................................................................................................... 9
Food assistance challenges .......................................................................................................................... 10
Supply chain and commodity challenges ..................................................................................................... 10
Social protection system challenges ............................................................................................................ 10
WASH system challenges ............................................................................................................................. 10

Coordination .............................................................................................................. 11
Assessment and data collection ................................................................................... 11
CFE recommendations: From the literature ..................................................................... 12
Advocacy, funding and prioritisation ........................................................................... 12
Policy .......................................................................................................................... 12
Capacity building......................................................................................................... 13
Preparedness, programming and interventions............................................................ 13
Coordination ............................................................................................................... 14
Data collection and assessment ................................................................................... 14
CFE priorities identified ................................................................................................... 15
Priority 1 ..................................................................................................................... 15
Actions ......................................................................................................................................................... 15

Priority 2 ..................................................................................................................... 16
Actions ......................................................................................................................................................... 16

References ...................................................................................................................... 182

Roadmap for Complementary Feeding in Emergencies, 2023

Abbreviations and acronyms
CF

Complementary Feeding

CFE

Complementary Feeding in Emergencies

ECD

Early Childhood Development

ENN

Emergency Nutrition Network

FAO

Food and Agriculture Organization

GNC

Global Nutrition Cluster

IFE-CG

Infant Feeding in Emergencies Core GroupIYCF

Infant and Young Child Feeding

IYCF-E

Infant and Young Child Feeding in Emergencies

MoH

Ministry of HealthNGO

Non-Governmental Organisation

SBC

Social and Behaviour Change

TAG

Technical Advisory Group

UNHCR

United Nations High Commissioner for Refugees

USAID

United States Agency for International Development

WASH

Water, Sanitation and Hygiene

WFP

World Food Programme

Acknowledgements
This work was made possible by the generous support of UNICEF. The ideas, opinions and comments
included are entirely the responsibility of the document’s authors and do not necessarily represent
or reflect the policies of the donor. For more information, contact the IFE Core Group Coordinator at
ife@ennonline.net.

https://doi.org/10.6084/m9.figshare.25460590

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Roadmap for Complementary Feeding in Emergencies, 2023

Extending recognition
This report was prepared by Elsie Abou Diwan and Caroline Abla, consultants for theEmergency Nutrition Network (ENN), as an action of the Infant Feeding in Emergencies CoreGroup (IFE-CG) workplan. This report is a working document that aims to identify needs andpriorities to provide practical and sustainable guidance so that countries can improve theplanning, policies and implementation of complementary feeding in emergencies (CFE)interventions.
We extend our sincere appreciation to the Technical Advisory Group (TAG), comprising of
esteemed experts and stakeholders and representing a diverse array of backgrounds in infant
and young child feeding in emergencies (IYCF-E) programming. Their invaluable contributions
have been instrumental in shaping the outcomes of this roadmap. We are deeply grateful forthe insights and expertise brought by Jen Burns from Helen Keller International/United States
Agency for International Development (USAID) Advancing Nutrition, Terry Njeri Theuri fromthe United Nations High Commissioner for Refugees (UNHCR), Sarah O’Flynn from Save theChildren USA, Linda Shaker-Berbari, Megan Gayford, and Najwa Al Dheeb from UNICEF,
Alessandro Iellamo from FHI 360 and Deborah Joy Wilson (an independent IFE-CG member),as well as Nicki Connell, Gwénola Desplats and Rachael Menezes from ENN. Their dedicatedinvolvement has significantly enriched the quality and depth of the findings.

Why a CFE roadmap?
Complementary feeding (CF) refers to the introduction of complementary foods, including
solid, semi-solid and soft foods (both locally prepared and commercially manufactured), tochildren between the ages of 6 and 23 months to complement breastmilk, which is advised to
be provided until at least two years of age. CF is an essential transition that provides additional
nutrients, energy and texture through feeding to support an infant's growth and development.
A well-rounded approach to infant and young child feeding (IYCF) acknowledges theinterconnectedness of breastfeeding and CF, recognising that both are crucial for a child's
overall health and development. Effective programming in IYCF should focus on CF and work
to maintain and scale up breastfeeding practices worldwide.
In emergency situations like conflicts, natural disasters and displacement, providing support
to breastfeeding and adequate and appropriate CF becomes paramount to prevent
malnutrition and promote the health and optimal growth of children, especially those aged 6
to 23 months. There is a growing recognition of the importance of IYCF-E, including bothbreastfeeding and CFE, and several organisations – including USAID, UNICEF, the World HealthOrganization, the World Food Programme, the Food and Agriculture Organization (FAO), theIFE-CG and ENN – have taken the lead in scaling up efforts to address CFE globally.
To further enhance the response to CFE, action has been taken to document theimplementation of CF programmes and interventions in various emergency contexts. The
primary goal of this documentation is to collect evidence, share best practices and identify
gaps, needs and enablers that can be addressed to improve the overall effectiveness of CFE.
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Roadmap for Complementary Feeding in Emergencies, 2023

By addressing these gaps and needs, the quality and impact of these programmes can be
improved, leading to the prevention of malnutrition and a reduction in malnutrition rates, aswell as better health and developmental outcomes for infants and young children affected byemergencies.
The aim of developing this roadmap is to consolidate findings and construct an overview ofthe progress made over the past years in CFE programming and documentation. The primary
goal is to identify, outline and prioritise specific gaps in CFE policy, leadership, programmingand documentation. This will constitute the foundation for informed decision-making and will
guide forthcoming actions aimed at determining next steps for CFE programming. The
intention is that this roadmap will be picked up by all key agencies working on CFE, including
UNICEF, WFP, UNHCR and the Global Nutrition Cluster (GNC) amongst others, to contribute toa global action plan on CFE. As such, the objectives of this roadmap are as follows.

Objectives
1. Conduct a mapping of CFE needs and recommendations to identify priority areas
for CFE actions.
2. Develop a CFE roadmap to facilitate the scaling up of effective CFE actions at the
global level.

How has the CFE roadmap developed?
The methodology employed to develop the CFE roadmap was a comprehensive and iterative
process that included two main stages: a desk review, and a consultative process with subject
matter experts.

Desk review: Identification of gaps and recommendations
A thorough review of the literature was conducted, including reports, guidelines, lessons
learnt articles, case studies and publications related to CFE practices in different countries.
This initial step helped identify key gaps and challenges in the existing approaches to CFE.
In addition, various stakeholders, including non-governmental organisations (NGOs),
humanitarian agencies and local organisations, have actively documented their experiences
and lessons learnt from implementing CFE. These documentation efforts have resulted innumerous field reports that provide valuable insights into the strategies, innovations andchallenges faced during the implementation of such programmes.1

Consultation process: Identification of priorities
The subsequent stage was to identify further priorities, for which a TAG was set up, comprisingof members from the IFE-CG and prominent nutrition key informants. The support of the TAG

1

Reviewed documents can be found at the end of this report in the reference section.

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Roadmap for Complementary Feeding in Emergencies, 2023

was instrumental in eliciting feedback from nutrition experts, contributing to the roadmap's
refinement and enrichment.
A Terms of Reference for the TAG was defined, outlining roles and responsibilities and aschedule of meetings. The TAG held three meetings between June and July 2023.
✓ Meeting 1 – Presentation of identified CFE gaps and recommendations from theliterature review: TAG members explored additional gaps and recommendations nothighlighted in the literature review.
✓ Meeting 2: The initial prioritisation of CFE gaps was discussed.
✓ Meeting 3: In preparation for this meeting, a draft roadmap document was shared for
the TAG’s feedback. At the meeting, a revised document was shared, discussed andagreed to.
The result was a comprehensive narrative report (the CFE roadmap). This methodical
approach ensured that the roadmap's development was inclusive, well-informed andrepresentative of the expertise and insights of the TAG.

CFE literature review and findings
The evolution of the CFE research and documentation has been a dynamic process marked by
key milestones over the past years. It included a special section Field Exchange on CFE (1), an
updated section on CFE in the IYCF-E Operational Guidance (2) and a comprehensive review
of CFE (3), which uncovered significant gaps in CFE programming. The identification of thesegaps triggered the need for more comprehensive exploration, leading to the development offour case studies (4, 5, 6, 7) that meticulously documented CFE programming approaches
across diverse contexts. These case studies provided invaluable insights into the challenges,
successes and lessons learnt in the field in relation to CFE.
Around the same period, USAID conducted a comprehensive review of the tools and resources
available for CF education (8) and found a pressing need for improved resources that alignedwith the latest evidence and best practices. This led to a concerted effort to enhance the tools
available, ensuring that frontline workers and caregivers received accurate and up-to-date
information on CFE.
The publication of a special section on CFE in Field Exchange 68(1) provided a significant
platform for disseminating research findings and practical experiences. This publication
became a crucial resource for policymakers, practitioners and researchers facilitating theexchange of knowledge and promoting evidence-based decision-making in CFE.
Moving forward, building on the foundation laid by USAID’s recent CFE brief (9), identifying
concrete steps for integrating CFE actions at each stage of the humanitarian programme cycle,
is a key step in advancing CFE programming. Leveraging the insights and recommendations
from the CFE brief, strategies can be refined and interventions and approaches adopted todifferent contexts.

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CFE gaps: From the literature
The gap mapping exercise provides an overview of the current state of CFE, focusing on efforts
made to identify gaps and address recommendations from the literature review.
The analysis categorises the identified gaps into six themes: 1) advocacy, funding andprioritisation; 2) policy; 3) capacity building; 4) preparedness, programming and interventions;5) coordination; and 6) assessments and data collection. These themes were selected because
they emerged from the desk review and received consensus within the TAG.
These themes are aligned with the ‘four systems’ approach categorised by the UNICEF
programming guidance on improving young children’s diets during the CF period (10) – health,food, social protection and water, sanitation and hygiene (WASH) systems, covering thestrategy, institution, community and household levels.

Advocacy, funding and prioritisation
IYCF-E interventions are life-saving activities focused on a very vulnerable group, yet there areoften difficulties in advocating for and securing an optimal coordination mechanism that could
prioritise IYCF-E, as well as the necessary resources and funding, during emergency situations.
Advocacy for CFE is a major gap. The lack of effective and timely advocacy affects coordination,
funding, and prioritizing of CFE. Evidence from the literature review shows that the activationof a coordination mechanism for nutrition has taken time (2), either because nutrition has notbeen considered a life-saving sector/intervention by decision-makers or, if emergency
thresholds are not met for acute malnutrition, it is often concluded there is no need for
nutrition coordination or leadership at all. In addition, the limited emphasis on comprehensive
nutrition indicators within the humanitarian response plan, coupled with the delayed
activation of coordination mechanisms for nutrition-focused activities, point to the necessityof enhancing planning strategies (2).
The minimal global funding allocated for CFE and the insufficient inclusion of a robust CFE
component in United Nations and NGO emergency nutrition proposals and response plans
underscore the financial challenges encountered in addressing CFE needs (2). One donor has
estimated that 25% of the nutrition funding it has provided for IYCF-E; of this, only 20% is for
CFE (2).
Across various systems, from the reviewed documents, it became apparent that there is a lackof prioritisation and recognition of the importance of CFE by donors. This is highlighted by theabsence of a multi-sector policy for CFE and inadequate funding within humanitarian
strategies (6, 7). The absence of multi-sector actions and limited consideration of innovative
activities for CFE in response plans weaken the integration and effectiveness of CFEinterventions (6, 7). Additionally, insufficient promotion and advocacy within the donor
community regarding the significance of CFE programming in preventing malnutrition,
coupled with limited awareness about its principles and effectiveness, compound thechallenges faced (3).

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PolicyAcross all systems, the lack of cohesive and integrated national policies stands out as a major
concern, as highlighted in the Fed to Fail report by UNICEF (11). The absence of strong
government leadership in CFE programming, either because the government is overwhelmedby an emergency or is otherwise unwilling to take on that leadership role (3), further hinders
the development and implementation of effective policies at the country level.
At the level of the health system, the existence of an outdated national nutrition strategy incountry poses a disabling challenge for nutrition actors looking to initiate action on improving
the quality of CFE interventions (12).
In terms of strategy within the food system, the absence of legislation for implementing theInternational Code of Marketing of Breastmilk Substitutes, subsequent relevant World Health
Assembly resolutions, and the inflated price of products that can support diversified children's
diets, pose significant barriers to optimising CF practices (4). In areas characterised by armed
conflict and insecurity, the prioritisation of other humanitarian priorities like emergency aid
and acute malnutrition treatment often relegates CF to a secondary role (6).
The absence of legislation to restrict the marketing of processed complementary foods raises
concerns about appropriate and safe options for infants and young children (12). Additionally,
the lack of a formal national food security strategy tailored to the unique needs of migrants
and refugees further underscores the importance of addressing policy gaps in CFEinterventions (13).

Capacity building
Across all systems, there is an unclear understanding and utilisation of the approaches to, andtools for, CFE programming among frontline workers, indicating a need for improved
knowledge dissemination and training opportunities (3). Agencies operating in sectors that
impact CF often lack sufficient CFE training and knowledge, hindering their ability to effectively
contribute to CFE interventions (5).
Moreover, international donors focussing more on capacity building of local partners andcommunities and less on NGOs strengthening government systems poses an additional
challenge in building sustainable CFE programmes (7). Sectors that can contribute to CF, suchas education, early childhood development (ECD), social protection and agriculture, often lackclear guidance on minimum actions and indicators, highlighting the need for comprehensive
sector integration and guidance (3).
At the level of the health system, several factors highlight the need for improved capacity
building: first, the limited dissemination of CF knowledge and tools to frontline workers (3);second, the fact the IYCF-E Operational Guidance lacks detailed operational andimplementation guidance on CFE; and third, the limited training and knowledge of CFE among
Ministry of Health (MoH) and local NGO staff. In addition, insufficient programmatic
knowledge, limited competency of Nutrition Cluster Coordinators and the lack of simplified
tools and guidance at the agency level further hinder the implementation of effective andefficient CFE programmes (3). Inadequate preparedness regarding IYCF-E at the country level;
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lack of information, education and communication materials; and poor retention of
information among caregivers following awareness sessions are additional challenges toaddress (14).
Within the food system, limited capacity building for volunteers involved in food security
interventions, as well as a lack of expertise and knowledge among agencies working on foodsecurity regarding their critical role in CFE, pose barriers to developing CFE-friendly
programmes (7). The absence of standardised guidance regarding food baskets, appropriate
food items and determining quantities in food assistance packages also hampers optimal CFEinterventions (15).
At the community and household levels, the main challenge resides in the inadequate trainingof community health workers, consequently causing barriers to delivering appropriate CFE
counselling (14).

Preparedness, programming and interventions
Preparedness is a major gap, and its absence is a barrier to effective and efficient CFE response(3). When preparedness plans did exist, they were for IYCF in general, more focused onbreastfeeding and breastmilk substitutes issues, and at a high level, with limited specificdetails for children aged 6 to 23 months old. Based on gaps presented in the literature and asdebated by the CFE TAG members, there is also a critical need for comprehensive operational
guidance on CFE programming to address the nutritional requirements of infants and young
children aged 6 to 23 months.

Challenges in programme implementation
Programme plans and emergency responses are often driven by funding and timeliness rather
than a thorough understanding of barriers and needs identified through assessments (3).
Short durations and discontinuity of CFE programmes incorporating multiple systems
approaches result in minimal impact on stunting despite improvements in a child’s diet (16).
In addition, the inaccessibility of certain community groups in remote areas; political andarmed conflicts hindering intervention delivery; poverty; movement restrictions for women;
and limited access to financial services contribute to the adoption of poor CF practices (4).

Health system challenges
Until recently, the lack of global and country-level leadership in CFE, in addition to the absenceof CFE monitoring and support interventions at the level of the national nutrition working
group, posed significant challenges within the health system (3). As a result, preparedness
plans often lack specific guidance on CF, primary healthcare facilities are understaffed andhealthcare workers are overstretched, and therefore unable to provide IYCF counselling for
pregnant and lactating women – particularly on CFE, which is a major gap in health andnutrition programming, especially at health facilities (14).
Looking at home fortification programmes, there has been weak integration of multiple
micronutrient powder programmes into IYCF-E interventions (17). Awareness-raisinginterventions lack participatory and practical approaches to induce behaviour change (12).
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Poor access to health services, limited attendance at healthcare centres, increased nutrition
vulnerability and lack of trust in services further impact CFE at the community and household
levels (12).

Food assistance challenges
Numerous financial constraints and challenges are evident, ranging from insufficient cash
allocations for nutritional support (limiting the household's ability to afford a diversified diet),lack of access to cash transfers, and discrepancies in target groups and indicators between thefood security and nutrition sectors (16). Additional limitations arise when attempting toemploy food vouchers for mobile displaced populations, further underscoring thecomplexities inherent in addressing the nutritional needs of vulnerable communities during
emergencies (3).

Supply chain and commodity challenges
In emergency situations, there are several challenges in procuring, importing and distributing
commodities in general, including CFE commodities. These include importation delays,
coupled with government regulations on products (including CF products), unavailability of
appropriate commodities and difficulties (security, poor roads, system inefficiencies, etc.) in
distributing CFE commodities (3). At the level of locally available CFE commodities, challenges
encompass selecting locally made suitable foods for food assistance baskets – especially iffunding is not available for local purchases, there is uncertainty regarding the quality of local
products, or there is a reliance on commercial complementary foods (3). The limited
availability and affordability of diversified foods, extensive marketing of unhealthy processed
foods (11), a high reliance on food assistance, inadequate nutritional content of family foods
cooked at home and limited access to cooking facilities and health centres (12) makes CFE
programming very challenging.
Moreover, there are factors affecting CFE programming at the community and household
levels, including the lack of local food suppliers (13) and seasonal fluctuations influencing local
food availability (17).

Social protection system challenges
Within the social protection system, challenges include the lack of integration andcoordination of social protection interventions, with a lack of effective social and behaviourchange (SBC) for CF, weak endorsement of national policies and strategies and insufficient
cash transfer values to promote positive nutritional practices (16).

WASH system challenges
In the WASH system, the lack of availability and affordability of clean potable water for
drinking and food preparation impacts CFE practices at the community and household levels
(18).

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Coordination
Across all systems, there is a lack of inter-sector coordination in relation to CF education at
the country level, particularly between the WASH, food security, social protection and healthsectors (3). Other sectors also often lack an understanding of their critical role in CFE.
At the institutional level, poor communication and coordination between different
departments within the same organisations, specifically at the level of food assistance,
nutrition and health services, pose challenges and showcase a major communication gap (3).
There is also a notable lack of, or limited coordination between, nutrition teams and theircounterparts in food security and logistics within the same agency, which hampers theintegration of efforts to address CFE (3).
Within the community and household levels, education and awareness-raising on CFE
primarily rely on the health system and lack a multi-systems approach (11).
Within the health system, the absence of effective coordination and leadership on CF at thecountry level by the government or by any United Nations agency is a significant concern (3).

Assessment and data collection
Across all systems, the absence of inter-sector digital registration platforms for data collection
and information management systems hinders coordination and poses challenges to effective
implementation (16). The lack of a unified system for data collection and management limits
the ability to track and analyse CFE interventions. Within the food system, the Ministry of
Public Health lacks governance over the data collected from CFE interventions, relying heavily
on the national nutrition sector for data management (5).
During the initial stages of emergency response, limited time and funding are available for
conducting comprehensive assessments on IYCF-E practices, which hampers theunderstanding of the specific needs and gaps in CFE interventions (3).
At the implementing organisation’s institutional level, the absence of baseline and endline
assessments presents a challenge in tracking nutrition outcomes in short-term humanitarian
programmes (6). The short-term nature of most programmes contributes to limited
availability of information on programme outcomes related to CF. Existing data fromStandardised Monitoring and Assessment of Relief and Transitions (SMART) surveys is
occasionally, and unsystematically, utilised to advocate for interventions related to IYCF-E (3).
Furthermore, there is often a lack of emphasis and interest among agencies in assessing
food availability and affordability in the local market as part of nutrition assessments for CF(3).
In the food system, the absence of impact evaluation surveys or studies on CF interventions is
a significant gap (4). The lack of overlapping indicators and differing targeting and objectives
between the food security and the nutrition sector also hinder comprehensive CFE datacollection and analysis (3).

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CFE recommendations: From the literature
Advocacy, funding and prioritisation
Advocacy for IYCF-E (especially CFE) is needed to increase awareness of CFE, as well as to raise
funds for, and prioritise, it as a life-saving intervention in emergencies. The recommendations
from the literature review on this issue include the following.
✓ Ensure greater understanding among donors and decision-makers regarding theimportance of nutritious diets for children aged 6 to 23 months (6).
✓ Advocate and seek funding to incorporate all components of IYCF-E, including CFE, inemergency programmes, including changes to in-kind donations for CFE (3).
✓ Integrate CFE activities with other sectors such as health, education, social protection
and WASH, and into humanitarian response plans. Ensure strong CFE leadership by thenutrition sector (3, 18, 19, 20).
✓ Explore alternative solutions for food fortification in emergencies, ensuring the quality
and safety of locally available fortified foods (3).
✓ Incorporate monitoring of the marketing of processed complementary foods inprogramming (3).

PolicyWhen focusing on the strategic level, adopting a multi-system approach is strongly
recommended for planning efficient CFE interventions. These are suggestions from theliterature review that address policy gaps.
✓ Prioritise and develop an integrated CFE programme policy with MoH leadership
across all sectors and national programmes (3, 4, 21).
✓ Assume, where necessary, a leadership role for CFE at country level (partners or United
Nations agencies), ensuring the establishment of the IYCF-E working group andnutrition sector/cluster and coordinating with partners and other sectors on CFE (5,22).
✓ Ensure that an IYCF-E policy or guidance is readily available in-country and during
emergencies for a timely and effective response (4, 5).
✓ Address policies within the food system pertaining to food production, processing,
distribution and marketing to ensure a supportive environment for CFE (21, 23).
✓ Ensure that policies are in place to regulate the marketing of processed
complementary foods, particularly those in violation of the International Code ofMarketing of Breastmilk Substitutes (3).
Implementing these policy recommendations will contribute to a comprehensive andcoordinated approach to CFE interventions. The emphasis on government ownership, multisector collaboration, the integration of CFE in national policies and the regulation of marketing
practices will facilitate effective implementation and scale-up of CFE interventions, ultimately
ensuring the wellbeing and nutritional health of infants and young children in emergency
situations.
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Capacity building
Strategically, capacity building of government, partners and implementers at field level, andcaregivers in CFE is needed. Here are specific suggestions from the literature review that
address capacity building.
✓ Revise and update the CFE guidance outlined in the IYCF-E Operational Guidance anddevelop a concise ‘how-to’ plan to develop and implement integrated CFE
programmes (3).
✓ Adapt/improve existing CFE tools and create new resources as needed, disseminatingthem to governments and field implementers (3).
✓ Establish community-level support groups for both fathers and mothers and organise
large-scale SBC campaigns. These initiatives aim to increase awareness and engage
parents and caregivers in adopting appropriate CF practices (4, 24, 25).
✓ Enhance the capacity of local suppliers to provide quality complementary foods thatmeet minimum standards (3).
By implementing these capacity building recommendations, the knowledge and skills of
individuals and institutions engaged in CFE programming will be strengthened. This enhanced
capacity will lead to a more consistent understanding and application of CFE principles andpractices, resulting in more effective and impactful interventions across all levels. By
bolstering capacity, agencies and partners will be better equipped to address the uniquechallenges and complexities of CFE.

Preparedness, programming and interventions
The recommendations concerning preparedness, programming and interventions in thecontext of CF underscore the significance of comprehensive planning, coordination andimplementation efforts across all systems and institutions. Here are specific suggestions fromthe literature review that address preparedness, programming and interventions.
✓ Establish an emergency preparedness plan that incorporates IYCF-E, including CFE, ina coordinated effort across different sectors (3).
✓ Design programmes that integrate IYCF-E, specifically CFE, into primary healthcare (4)through antenatal and postnatal services, nutrition counselling for mothers andfathers (6), multiple micronutrient powder distributions (18), food fortification
programmes and home gardening programmes, all coupled with behaviour change
communication (4).
✓ Develop a joint programmatic standard operating procedure with other sectors (4) andincorporate monitoring of the marketing of processed complementary foods into
programmes (6).
✓ Prioritise local suppliers and markets for CF foods post-crisis, promote local foodsystems and support the local economy (3, 7).
✓ Ensure that cash programming allocates adequate amounts of cash to purchase locallyavailable foods appropriate for children aged 6 to 23 months (7), alongside nutrition
counselling (18).
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Implementing these recommendations related to preparedness, programming andinterventions will lead to the establishment of well-coordinated, evidence-based andcomprehensive approaches that address the nutritional needs of infants and young children
in emergency contexts. The evidence outlined above highlights the importance of integrating
CF into preparedness plans, fostering multi-sector collaboration and implementing targetedinterventions to support appropriate CF practices and enhance the overall nutritional
outcomes of young children.

Coordination
The recommendations related to coordination emphasise the need for improved collaborationand communication across sectors, particularly those with interventions that have a direct
influence on CFE outcomes. Here are specific suggestions from the literature review that
address coordination.
✓ Address inter-sector knowledge barriers related to CFE (6) and promote a better
understanding of the important roles that other sectors play in CF (3, 6).
✓ Ensure coordination between United Nations and NGO departments involved in CFEspecific or CFE-sensitive interventions. This involves addressing all levels of CFE,
including the assessment, proposal development and implementation phases (3).
✓ Establish a dedicated CFE coordination body either under the GNC, intersectoralcollaboration help desk which links Nutrition, WASH, and Health clusters, or as a Global
CFE Collective that will need to link to all relevant CFE clusters. This coordination bodycan facilitate collaboration, information sharing and joint decision-making among
stakeholders involved in CFE interventions (3).
Effective inter-sector coordination ensures that all facets of CF are addressed, involving
multiple actors and stakeholders and implementing comprehensive activities that allcontribute to appropriate feeding practices for infants and young children.

Data collection and assessment
The recommendations related to data collection and assessment highlight the importance ofinvesting in impact evaluation assessments (5), aligning indicators and objectives among
sectors and collecting comprehensive data to support CF interventions.
✓ Invest (donors to provide funding and mandate evaluation; partners to include
comprehensive CFE data collection in all their proposals) in rigorous evaluation of CFEinterventions to determine their effectiveness and impact on improving CF practices
and child health and nutrition outcomes (3, 5).
✓ Align indicators and objectives and harmonise/coordinate data collection efforts
across different sectors involved in CFE interventions (3, 4, 26–28). By aligning
indicators, data can be collected consistently and comparably, enabling better
monitoring and evaluation of the effectiveness of interventions.
✓ Integrate nutrition vulnerability criteria into social assessments and cash assistanceprogrammes (4). This ensures that caregivers of malnourished children receive
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targeted support, including cash assistance, based on their specific needs andvulnerabilities related to nutrition.
As discussed by CFE TAG members, the primary recommendation for CFE data collection andassessment involves incorporating one or two indicators for each sector to effectively monitor
and assess the comprehensive implementation of CFE programmes. Choosing indicators thatalign with the specific goals and activities of each sector will allow for a more holistic anddetailed understanding of the overall impact and effectiveness of CFE programming. Overall,these recommendations highlight the importance of robust data collection and assessments
to inform decision-making, monitor progress and advocate for funding and support for CF
interventions. By collecting comprehensive and standardised data, stakeholders can better
understand the effectiveness of interventions and make evidence-based decisions to improve
the nutritional outcomes of infants and young children.

CFE priorities identified
After conducting the literature review and holding consultative meetings with the TAG, andbased on various continued discussions and analysis, two CFE priorities were identified. For
each priority, a set of corresponding actions and sub-actions were suggested. The priorities
are outlined below.

Priority 1
Advocating for and elevating/positioning CFE, as part of IYCF-E, as a priority in global,
regional and national policy agendas and strategies.

Actions
1. Establish clarity and agreement among UN agencies, including UNICEF, WHO, WFP,UNHCR and FAO, on their role in advocating for and elevating/positioning CFE and how
these entities will work together to address this holistically. Once there is clarity andagreement on who does what and how, communicate this information to
governments, donors, and other partners, and ensure ownership of the following
action points.
2. Develop and disseminate an advocacy document that will support governments at thehighest level (cabinet/prime minister level), donors, country humanitarian teams andinternational organisations to include integrated CFE in key policy and strategy
documents and plans at global, regional and national levels.
3. Develop fundraising information materials such as brochures, fact sheets andpresentations to be used in advocacy campaigns by utilising various communication
channels, including social media platforms, websites and traditional media, to raiseawareness about the importance of CFE programming with donors, governments andpartners.

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Roadmap for Complementary Feeding in Emergencies, 2023

Priority 2
Supporting
CFE
programming
throughthedevelopment
operational/implementation programming tools and guidance.

ofnecessary

Actions
1. Establish clarity and agreement among UN agencies, including UNICEF, WHO, WFP, UNHCR
and FAO, on their role in CFE as it relates to operational/implementation programming
tools and guidance, and establish how these entities will work together to address CFE
holistically. Once there is clarity and agreement on who does what and how, communicate
this information to relevant partners, including implementation agencies, and ensure
ownership of the following action points.
2. Develop CFE operational guidance that details the ‘how to’ for planning, implementation,and monitoring integrated CFE programs. Since this CFE Roadmap was started, thedevelopment of the WHO/UNICEF CF Implementation Guidance has been initiated andcould contribute to meeting this need through the emergency chapter. In addition, in lightof the newly formed Global CF Collective, it will be critical to work with them to ensure anadequate focus on CF in emergencies specifically. As these two initiatives proceed, it willbe essential to continually evaluate whether additional efforts are required to ensure
development and availability of sufficient CFE operational guidance.
3. Integrate IYCF-E, specifically CFE, in other sector proposals, budgets and indicators. Other
sectors include health, food security, ECD, WASH and protection.
✓ Develop a detailed multi-sector proposal prototype based on existing multi-sector
resources, such as UNHCR’s IYCF Framework (29), outlining the importance of CFE
programming and the contributions of each sector. This should include a detailed log
frame for specific activities, particularly addressing SBC and ECD (two approaches
experiencing significant resource mobilisation and funding), indicators specific to eachsector, and a detailed integrated budget for CFE assessments, implementation,
evaluation and research.
✓ Develop an online learning course on integrated IYCF-E, including CFE.
4. Ensure (GNC) that the in-country IYCF-E working groups established during an emergency
focus holistically on IYCF-E including CFE.
5. Ensure that all key partners, including those from other sectors, are trained on integrated
CFE programming using developed online and other training materials, through defining
inter-sector approaches, providing a ‘how-to’ plan, and implementing and monitoring CFE
programmes based on the suggested proposal prototype mentioned above.
6. Develop an infographic focused on CFE and disseminate this widely, including to othersectors who have a role to play in CFE.
7. Review and update existing tools for initial rapid assessment of CFE in the initial stages of
emergency response to help design a needs-based approach, with assessment questions
that address the availability of complementary foods, their affordability and their access,and which can be integrated into multi-sector assessments within sectors relevant to CFE.
✓ Design and roll out basic monitoring and evaluation training on CFE reporting tools to
be used by organisations working with governments on enhancing data collection andmonitoring.
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Roadmap for Complementary Feeding in Emergencies, 2023

✓ Develop a data collection brief highlighting the major successes from countries on
effective CFE data collection using digital platforms.
8. Conduct impact and process evaluation surveys (baseline/endline) to generate evidence
on the importance of CFE programming in selected countries that are implementing CFE
programmes.
✓ Develop guidelines on the types of research study needed to evaluate the impact of
CFE programmes through research specialists, and the steps needed – along withstaffing and budgets – to support countries to secure funding for the researchcomponent of CFE, by building on the evidence presented in the IYCF-E repository.
✓ Partner with international academic institutions to evaluate and publish researchstudies on CFE.
9. Enhance CFE programme documentation by reaching out to countries working on CFE to
document more case studies and lessons learnt.
✓ Establish periodic CFE lessons learnt workshops as a platform to share experiences
and success stories between CFE implementers.
✓ Create a user-friendly lessons learnt documentation tool designed to assist countries
in documenting their achievements, particularly in cases where they may have limited
capacity.
✓ Establish a CFE sub-working group to bring implementers, researchers, policymakers
and decision-makers together to ensure lessons learnt on CFE are shared and peer-topeer learning on CFE is facilitated.

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Roadmap for Complementary Feeding in Emergencies, 2023

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strengthening approach: Experiences from Egypt. Field Exchange, 68, November, 50.
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www.ennonline.net/fex/68/uniceflatinamericaandthecaribbean
25. Birungi A & Desie S (2022) A peer-to-peer model to improve maternal, infant and young childfeeding in Rwanda. Field Exchange, 68, November. www.ennonline.net/fex/68/cferwanda
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November. www.ennonline.net/fex/68/unicefeuropeandcentralasia
27. Jouda A, Abuwarda F, Awad R, Zarrelli A & Qadi K (2022) State of Palestine: Investing inassessment positively impacted programming for complementary feeding. Field Exchange,
68, November. www.ennonline.net/fex/68/cfepalastine
28. ENN (2022) Conducting situation analysis as a first step to improve young children’s diets:
Examples from Ethiopia, Tanzania, and Zimbabwe. Field Exchange, 68, November.
www.ennonline.net/fex/68/unicefsitanalysisethiopiatanzaniazimbabwe
29. UNHCR (2018) Infant and Young Child Feeding in Refugee Situation – A Multi-Sectoral
Framework for Action. https://www.unhcr.org/media/infant-and-young-child-feedingrefugee-situations-multi-sectoral-framework-action

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