Type of Deployment: Assessment

Date of Deployment: Feb 22, 2018 – May 5, 2018

Reason for request:

Ethiopia has suffered two of the worst drought waves in decades; these have resulted in severe food and nutrition insecurity across the country, with Somali Region among the most affected. During 2017 the Somali region alone shared 26% of total SAM admissions in the country, a radical increase from 5% in normal years and this number is likely to increase in 2018. The proportion of children admitted to stabilization centers (SC’s) also rose from 4% of all SAM admissions in 2016 to 8% in 2017. In response to the growing needs, UNICEF and thirteen NGO’s are supporting the Somali Region Bureau to expand therapeutic feeding programme (TFP) sites to 1,296 health facilities including 1,151 Outpatient and 143 SC’s that continue to provide treatment for SAM cases across the Somali region. In addition, 210 Outreach sites managed by 35 mobile health and nutrition teams (MHNT) assist hard to reach Woredas and the population in IDP locations.

In the Somali region, SMART survey(s) have not been conducted since 2016.  As a result, there has been a loss of experience conducting SMART surveys due to turnover of skilled staff. There is currently a need to build survey capacity of all stakeholders to ensure standard nutrition assessments of high quality are reinstated in the region. To better understand the magnitude of the nutrition situation of the Somali region, the UNICEF Jijiga Regional Office in consultation with Regional Health Bureau (RHB) and Disaster Prevention & Preparedness Bureau (DPPB) requested the support from the Tech RRT to build survey capacity in the Somali region so that surveys can be conducted in 2018 in 4 Woredas (Kelafo, Charati, Dolo Ado, and Gunagado for IDP’s) selected by consultation with DPPB, RHB, and UNICEF.  The Tech RRT advisor trained 18 staff and led one survey, Kelafo, while in-country and the remaining surveys will be conducted in the second half of 2018. The Tech RRT advisor worked with UNICEF, Regional Disaster Preparedness and Prevention Bureau (RDPPB), Emergency Nutrition Coordination Unit (ENCU), Regional Health Bureau (RHB) and respective NGOs to conduct the SMART survey.

Key Outputs: 

  1. Led all phases of a Nutrition and Retrospective Mortality survey in Kelafo, Somali Region, Ethiopia from protocol development to final results presentations and report.
  2. In addition to training 18 staff (including 3 supervisors) for the survey, I also facilitated a 3.5 day Supervisor/Survey Manager training for the 3 supervisors which included elements of the SMART survey manager level training that will be applied when planning and implementing future surveys.
  3. Created two documents including; Key Activities template for SMART surveys in Somali Region and Pastoral Sampling in Kelafo Woreda to also be used for planning and implementing future surveys.

 

Type of Deployment: IYCF-E

Dates: 05/01/2016-29/01/2016

Reason for request:

Ethiopia is experiencing its worst drought in thirty years, threatening over 30 million people across the affected area. At the time of deployment, the evaluation of the number of Severely Acute Malnourished (SAM) children in country was at 425,000 and the main nutrition response is based on the expansion of Community Management of Acute Malnutrition (CMAM) programs. Breastfeeding is widely practiced in Ethiopia as continued breastfeeding at one and two-years-old were at 96% and 82% respectively before the crisis[1]. However, other pre-crisis Infant and Young Child Feeding (IYCF) indicators demonstrated several gaps regarding the quality of the breastfeeding (51.5% of mothers initiated breastfeeding within one hour of birth and only 52% of mothers exclusively breastfed). There is a National strategy on Adolescent, maternal, infant and young child nutrition and several programs on IYCF, but no changes have been done to adapt those programs to the current emergency.

As a nutrition cluster lead, UNICEF is committed to scale up its response and support the government of Ethiopia to address vulnerable children with lifesaving and quality treatment of severe malnutrition.

The Tech RRT IYCF-E Specialist was deployed to promote and support the IYCF component of the current Ethiopia Nutrition response through technical input including capacity building of Federal Ministry of Health (FMOH), Department of Prevention and Preparedness Bureau (DPPB), UNICEF and Nutrition Cluster partners’ staff.

Outcome:

  • Workshop with FMOH, Multi Agency Nutrition Task Force and UNICEF members to create awareness of IYCF-E, generate discussion on implementation of an action plan including setting up an IYCF-E working group
  • Development of a curricula for an IYCF-E orientation for health workers on how to adapt IYCF to the current emergency context
  • Developed guidance for Mother to Mother Support groups, breastfeeding safe spaces and proposed actions for monitoring of breast milk substitute donations and use
  • Provided recommendations on IYCF-E friendly activities to be integrated by other clusters (Health, WASH, Food Security, Education and Protection)

[1] EDHS 2011

CMAM Deployment 

Name of Sector CMAM

Date of Deployment: October 22, 2018-November 9, 2018 and November 27, 2018-December 21, 2018

Reason for request:

Somali region in Ethiopia faces an acute food and nutrition security crisis, with its third year of poor rains; with 83 out of 93 woredas classified as Priority 1 (P1), with the remaining 10 at P2,[1] and the severe acute malnutrition (SAM) caseload already double the region’s projected estimate in the January 2017 Humanitarian Requirements.[2]

For the nutrition response, especially regarding Community-based Management of Acute Malnutrition (CMAM), UNICEF and partners have highlighted multiple nutrition challenge including: lack of sufficiently trained staff, low coverage of CMAM programs, hard to reach remote and IDP communities, NGO staffing restraints, poorly skilled staff, surge staff that lack experience in CMAM.

UNICEF scaled up Mobile Health and Nutrition Team (MHNT) support to standardised services provided. Though a key gap is the skills of agency nutrition officers and counterparts (Healthworkers /Health Extension Workers) to manage the treatment as per the national protocol, to set up systems for reporting using standard formats, to adhere to the supply management guidance and system as needed (forecasting, reporting, managing simple stock balance and driving to Health facility level); trend analysis and utilisation of data – at woreda level and zonal level and the management of SC – clinical skills and quality of care are very limited.

Concern Worldwide has started an intervention itself in one Zone in Somali and, on request from OCHA, has started to scope out with multiple actors active in Somali, what additional contribution to improve capacity and quality response might be possible. Meetings have been held with ENCU (both in Jijiga and at the federal level), UNICEF (regional and federal), Regional Health Bureau Somali, DPPC and key international NGOs engaged in response including GOAL, ACF and Save the Children International.  Their role is to facilitate an inter-agency approach with the goal of jointly strengthening the quality of CMAM interventions in selected parts of Somali region through an improved zonal capacity to interpret and respond to gaps in service delivery at the woreda level.

The Tech RRT was requested to provide technical assistance in the response and kick start the capacity strengthening process through a capacity assessment, workshops to identification of key barriers and development of a framework and coaching package that can then be replicated by other NGOs.

 Key Outputs: 

  1. A capacity assessment was conducted at multiple levels. Key Stakeholder meetings were held at Federal and Regional level to discuss gaps. A capacity assessment was conducted at health center/post level in 2 zones which included interviewing zonal nutrition focal points, health extension workers and community members. Results were compiled in a final report and presented at both federal and regional level. A workshop was held at regional level to determine the way forward and a framework for action was developed by all stakeholders in Jijiga and shared.
  2. A coaching tool kit was developed as well as a coaching facilitators guide. Fifteen master trainers were trained during a week-long training. A cascade training is scheduled to train all zonal and woreda nutrition focal points and was approved by regional level and the RENCU. A coaching toolkit including a list of master trainers was developed. The workshop report from the training was shared.

[1] Ethiopia: Hotspot Priority Woredas, OCHA, June 2017

[2] Media ‘If Asked:’ Is there famine in Ethiopia’s Somali region? OCHA, July 2017.