Nigeria has had multiple deployments. Two in CMAM and one in IYCF-E.
First CMAM Deployment
Reason for request:
Borno State has been a scene of violent conflict for the last few years, which has caused unprecedented movement of populations. The conflict has left a significant number of people with limited access to any form of humanitarian assistance including nutrition. This has resulted in “Extremely Critical” high rates of acute malnutrition which prompted the Government of Nigeria through the Ministry of Health to declare nutrition emergency in Borno state. The State the nutrition response sector includes CMAM with both facilities based and outreach OTPs, few inpatient care facilities which are extremely capacity is stretched and limited BSFP.
The main objective of the Technical RRT advisor was to:
- Support the Borno State department of Health, NGOs, and UN partners to strengthen and scale-up the emergency nutrition response through CMAM technical capacity building, response coordination and monitoring and evaluation of the program quality.
- Supported the State Public Health Care Development Agency (SPHCDA) in response coordination including to establish the CMAM technical working group, development of the first “4W” CMAM mapping and gap analysis and organization of joint monitoring and supervision activities.
- Conducted a 6-day CMAM/IYCF training for 39 health staff including 25 from the State department of health and 14 from NGOs (IMC, NRC & Mercy Corp).
- Supported the host agency International Medical Corps to strengthen their nutrition programming including on-job training in CMAM, mass MUAC screening and supported in establishing a Care Group model.
Reason for request:
The protracted conflict in North East Nigeria has increased population vulnerability to displacement, destruction & loss of livelihood, malnutrition, food insecurity, inadequate health services and poor sanitation since 2009. Since the advent of the conflict, 60 per cent of pre-existing health centers have been damaged or destroyed in Borno, resulting in significantly reduced access to health and nutrition services in both states, and increasing immense pressure on the existing services in the IDP camps and host communities (HRP, 2016).
According to Nigeria 2013 Demographic and Health Survey, the national rate of early initiation of breastfeeding (within 30 min according to Nigeria recommendation) is 33% and the rates of exclusive breastfeeding (EBF was 17%, 13%, 15% and 17% respectively in 2003, 2008, 2011 and 2013) showing no improvement for the last decade. The percentage of children aged 0 to 5 months who are breastfed and also consuming plain water is evaluated at 47%, and an estimated 5% consume infant formula or other milk in addition to breastmilk. Untargeted BMS distributions were not systematically monitored for but have been anecdotally reported.
The first half of 2016 the IYCF TWG concluded the development of strategic documents and tools developed with concrete implementation plans for the coming 5 years and other key achievements against yearly milestones. IYCF strategic document and 5yr operational plan to guide implementation at all levels as well as the National Social and Behavioural Change Communication (SBCC) for IYCF Strategy and plan were developed. However, low investment in IYCF-E by government and development partners resulting in implementation at very small scale with very low coverage.
The IYCF-E Technical Surge Adviser was responsible for strengthening the delivery of the IYCF-E response through the provision of senior leadership, technical support and capacity building during both in-country and remote support to Emergency Nutrition Sector Group and non-governmental organisations implementing IYCF-E in Borno State, Nigeria.
Outcome: Stated outcome of the deployment including statistics if applicable (i.e. number of people trained and on what, assessment results, and any other outputs/documents that were completed during the deployment)
- IYCF-E was not on anyone’s radar before the deployment and has been put on the agenda, government and partners have been made aware of the importance of IYCF-E through trainings and through a presentation at the nutrition sector meeting in Abuja.
- Rapid assessment tools for IYCF-E have been developed/adapted to the context and are ready to be used by government and partners.
- A list of key indicators has been developed.
- IYCF-E training as part of CMAM training completed for 43 participants (23 male and 20 female) in Borno. The majority of participants were government and IMC CMAM staff.
- IYCF-E training conducted for 26 partner (including UNICEF, Save the Children, IMC, NRC, and ACF) and government (including State Nutrition Officer and NAFDAC) nutrition staff (8 male and 18 female) in Borno.
- The first steps for the set-up of an IYCF-E TWG in Borno have been made.
- A reporting mechanism for BMS Code Violations has been developed in collaboration with NAFDAC (national responsible authority).
- Development of an IYCF-E Action Plan for Borno State
Second CMAM Deployment
Reason for Request
Borno State has been a scene of violent conflict for the last few years, which has caused unprecedented movement of populations. The conflict has left a significant number of people with limited access to food. The onset of the lean season has impacted the situation negatively leading to large increase of people in need of immediate food assistance. This has resulted in high rates of global acute malnutrition which prompted the Government of Nigeria through the Ministry of Health to declare nutrition emergency in Borno state. Critical levels of SAM have also been reported in some camps like Muna Garage and newly liberated areas. The host communities within Maiduguri have also reported high GAM rates up to above 6.4% based on surveillance survey (February- March 2017). As of March 2017, the Cadre Harmonise estimates 3.9 million people in Borno State are in severity levels 3-5 (Acute food crisis to Famine), with 38,000 of these in level 5 (famine/human catastrophe).
The SAM Inpatient Management Specialist will provide technical support, training, strategic advice, and operational support on for the implementation of inpatient management of SAM with medical complications.
In coordination with the State Ministry of Health, INGO and UN partners the SAM inpatient management specialist will contribute to strengthening the overall emergency nutrition response by ensuring there is capacity to manage SAM with medical complications including set up of inpatient management facility, monitoring, onsite coaching, review of existing services and making recommendations with action plan for improvement.
- Capacity Assessment was conducted in seven stabilization centers. Capacity assessment report and capacity building plan was developed and shared with partners.
- Twenty-two partners were trained in Borno and Yobe states on conducting on-the-job-coaching in Stabilization centers.
- A scale-up plan and framework for stabilization centers was developed and shared.
- Recommendations on how to improve the referral system were made and shared.