South Sudan

Deployment 8

Name of sector: IYCF-E

Dates of deployment: 25 May – 21 July 2019

Reason for request:

Many aspects of infant and young child feeding are far from optimal, mainly Initiation of breastfeeding, continued breast feeding at one and two years as well as introduction of semi solid foods. Inappropriate infant and young child feeding practices are among the most serious obstacles to maintain adequate nutritional status and contribute to high levels of malnutrition in South Sudan. Majority of deaths during the first year of life are often associated with inappropriate feeding practices. To address this, and also support optimal mental development, UNICEF and MoH have developed MIYCN Strategy and Guideline documents to focus comprehensively on the preventative lessons and key areas of concerns including the components of essential nutrition services with the rollout of infant and young child feeding program to improve the feeding practices for children across all former 10 states of the country.

South Sudan MIYCN Strategy & Guideline is endorsed in 2017;
A set of strategic actions and interventions for government and partners to roll out in all states;
Annual investment of $11 million per year is planned to prevent undernutrition related deaths and illness of mothers and children in South Sudan;
Cluster required further guidance on how to implement recommended actions within humanitarian response;
Tech RRT fill the technical gap and provide practical and realistic plans for prioritised MIYCN actions.

Key achievements:

The MIYCN-E response and gap analysis tool- now incorporated in nutrition (including CMAM) response dashboard
A MIYCN-E program budget/costing tool developed- partners now able to incorporate MIYCN-E activities into proposals and master budget
An advocacy brief- reinforcing the importance of MIYCN interventions in South Sudan and call for action
The MIYCN-E integration action plan for South Sudan- focusing priority sectors like FSL, WASH, Health
BFHI guidance- the existing draft reviewed, shared feedbacks with WHO and agreed on steps for revision of the draft and finalization
10-steps action plan, with standards of implementation- shared with WHO for considering adoption
‘the Code’ implementation action plan- MIYCN TWG in South Sudan now able to take agreed steps to implement ‘the Code’
Facilitated the training sessions based on the deployment outputs, with nutrition and non-nutrition partners

Outputs:

Post deployment webinar: A post-deployment webinar took place on 18th December 2019. The recording can be found here and the slides can be found here.

Deployment 7

Name of the sector: Multi-sectoral

Dates of deployment: 19 – 23 November 2018

Reason for request:

The ICNWG identified limited capacities of humanitarian partners and clusters for multi-sectoral nutrition sensitive programming among the main barriers to effectively achieve nutrition outcomes in humanitarian settings.

To address this barrier a three-days training package “Integrated Inter-Cluster Training Package for Nutrition Outcomes” was developed to support in-country cluster coordinators and partners in applying integrated nutrition-sensitive approaches to achieve a better nutrition outcome across sectors, with specific focus on: nutrition, food security, health, WASH, education, and protection.

Key achievements:

A three day Integrated Inter-Cluster Workshop for nutrition outcomes in South Sudan was conducted. This workshop was supported by the Global Inter-Cluster Nutrition Working Group (ICNWG), a joint working group of the Global Food Security Cluster (gFSC), co-led by Food and Agriculture Organisation (FAO) and World Food Programme (WFP); and the Global Nutrition Cluster (GNC), led by UNICEF.

This three-day workshop conducted for partners in Juba aimed to build on the integration work already carried out in South Sudan

The specific objectives of the workshop were as follows

To build capacity for integrated programming for improved collective outcomes
To develop proposed action points for better integrated programming for improved nutrition outcomes in South Sudan.

A total of 27 participants attended the workshop. Participants were made up of a combination of coordination and operational programme staff, from education, FSL, health, nutrition, protection & WASH clusters.

The workshop was facilitated by Darana Souza (FAO), Michele Goergen (Technical Rapid Response Team) and Vivienne Forsythe (FAO Consultant).

Content of training

Day one was an introduction to integrated planning for better nutrition outcomes. Three main sessions were facilitated i) an introduction to basic nutrition concepts, ii) an overview of integrated planning for better collective outcomes, and what informs the selection of integrated planning; and iii) an introduction to nutrition sensitive interventions. These sessions were conducted in an interactive fashion, with buzz questions and plenary discussion of points through each of the presentations.

Day two focussed on technical aspects of integration for better nutrition outcomes. Sessions were held on Integration of nutrition with food security and livelihoods, with health, WASH, protection; and with education and early childhood development. During each session definitions and conceptual issues were presented, and participants then explored the experience of integration in South Sudan, as well as opportunities for greater integration; through plenary discussion and group work.

Through the participant engagement in days one and two, it was apparent that there is quite a lot of operational experience of varying levels of integrated programming in South Sudan, within and between agencies, and across clusters.

Day three focussed on developing proposed priority actions to move the integration agenda forward in South Sudan, through group work, presentation and plenary discussion.

At the end of the training:

Each sector outlined some proposed points of action identified by the workshop participants to improve integration. This included, national, state and county level priority actions to facilitate integrated programming for better nutrition outcomes were put forward.

The education, food security, health, nutrition, protection and WASH clusters each identified proposed actions, for their respective clusters, that could be undertaken at operational level to improve integration

Deployment 6

Name of sector: IYCF-E

Dates of deployment: 17 February – 12 March 2018

Reason for request:

The current population of South Sudan stands at 11, 261, 51. More than 3.9 million South Sudanese have been forced to flee their homes, and 1.9 million internally displaced persons and over 2 million refugees have been hosted by the Central African Republic, the Democratic Republic of the Congo, Ethiopia, Kenya, the Sudan and Uganda.

Between 1990 and 2010, there has been success in curbing maternal and child mortality. Maternal mortality decreased from 1,730 to 789 (/100,000 live births) during this period. A similar trend has been recorded for child mortality, in which under five mortality rates decreased from 253 to 99 (/1000 livebirths), infant and neonatal mortality decreased from 150 to 64 and 65 to 39 respectively (/1000 livebirths).[1] The same survey shows that less than 20% of pregnant women were able to have at least one Antenatal Care Visits (ANC) by a skilled attendant and just around 11% delivered in health facilities. At the same time, Mother to child transmission of HIV reached worrisome levels and lacked appropriate interventions to support the nutritional status of the mother and the child. No data on anaemia and other micronutrient deficiencies is available, posing some limitations in the effectiveness of the programming.

Both acute and chronic malnutrition were serious with stunting above 30% and wasting above 20%.¹ Poor Infant and Young Child Feeding practices are one of the key causes of child malnutrition.

Needs are substantial and it is apparent that there is an absence of even the most basic services in many parts of the country. The protracted conflict further exacerbated the rates of acute malnutrition due to the reduced ability of children under five, chronically ill persons, and pregnant and lactating women to meet their nutritional needs because of displacement and increased morbidity caused by disease outbreaks, lack of access to clean water, sanitation facilities and basic health services[2]. The estimated number of children suffering from severe acute malnutrition rose from a pre-crisis estimate of 108,000 to 229,000 in 2015 to 362,000 in 2016 and 276,000 in 2017 due to deteriorating food insecurity, displacement and the destruction of health, water and sanitation facilities along with underlying causes of suboptimal infant and young child feeding practices.

In line with the above considerations and the ongoing efforts of the Ministry of Health with the support of the Nutrition Cluster to improve both CMAM and the Maternal Infant and Young Child Nutrition situation in the country, the Tech RRT specialized assistance was requested to:

Roll out the implementation of key interventions as indicated in the MIYCN strategy in selected areas
Provide inputs for the finalization of the MIYCN training package based on the learning from the two (2) trainings
Document inputs and agreements with the MIYCN TWG on key actions that will need to be sustained and supported based on the initial experience of the roll out activities
Participate in the MIYCN TWG and provide feedback on a) the trainings conducted b) the results and findings of the follow up, and c) facilitate agreements on supporting the roll out of the training and coaching activities

Key achievements:

Finalized MIYCN Training Packages (Master, ToT, Health Workers, Community Health Workers and Lead mothers), updated and revised based on the inputs and feedback from three MIYCN ToT trainings (Eastern Equatoria State (EES), Central Equatoria State (CES) and Jonglei State). The Adviser supported two of the three (3) listed MIYCN ToT, specifically in CES and Jonglei.
Updated and finalized MIYCN recording and reporting tools
Finalized with the consensus of the MIYCN TWG the MIYCN indicators to be included in the Nutrition Information System of the Nutrition Cluster
Handover Note from the MIYCN ToT Follow Up of the Unity State, conducted in November 2017
Key agreements with the MIYCN TWG on how to support and sustain the remaining roll out of the MIYCN Trainings
Training of Trainers was also conducted by the MIYCN team (the adviser was the course director) from Feb 20 to 24 in CES and from Feb 27 to March 3 in Bor, Jonglei. A total of 19 participants from 8 partner agencies plus state level ministry of health attended in CES and a total of 19 participants from 9 partner agencies and state and county ministry of health attended in Jonglei. The Adviser prepared and coached the facilitator’s team prior to the departure.

[1] Ministry of Health, South Sudan. Household and Health Survey, 2010

[2] UNICE/WFP 2015 scale up report

Deployment 5

Name of sector: CMAM

Dates of deployment: 14 January – 4 March 2018

Reason for request:

In South Sudan, the 2013 civil war has resulted in widespread insecurity and instability. Conflict and insecurity across South Sudan has resulted in a breakdown in community structures, food insecurity, poverty, poor health and nutrition status. According to the Integrated Food Security Phase Classification, a famine was declared in Unity State from February till June 2017. Although the famine has been denounced, currently an estimated 1.7 million people are likely to be facing a food security emergency (IPC Phase 4) – one step below famine on the IPC scale. Currently it is estimated that six million people (50 per cent of the population) are expected to be severely food insecure. Acute malnutrition remains a major public health emergency in several parts of South Sudan. Over 1.1 million children are estimated to be acutely malnourished. A total of 22 SMART surveys were conducted between January and June 2017 by numerous organizations. Twenty of the surveys showed global acute malnutrition prevalence above the emergency threshold of 15%.

To ensure the quality of nutrition activities is high, all nutrition partners are expected to monitor and supervise their programs and report their findings bi-annually to the nutrition cluster. Efforts to improve the quality of nutrition programs should be made throughout the year by all partners to ensure all nutrition programs in South Sudan meet or exceed the minimum standards. However, it can be challenging for NGO’s to objectively monitor their nutrition activities.

The Tech RRT Advisor was deployed to South Sudan to support the nutrition cluster to conduct an independent review of routine nutrition activities and provide recommendations and corrective actions to strengthen the nutrition activities. Monitoring focuses on all routine nutrition activities implemented, specifically CMAM and IYCF activities, by all partners (both international and national organizations) in selected areas and uses the existing monitoring and supervision tools from South Sudan.

Key achievements:

Final report outlining methodology used, strong points, gaps and recommendations for way forward in nutrition programming.
Final power point presentation for all nutrition partners on the results and recommendations for nutrition programs.

Deployment 4

Name of sector: IYCF-E

Dates of deployment: 7 October – 25 November 2017

Reason for request:

Key achievements:

Deployment 3

Name of sector: Assessment

Dates of deployment: 27 March – 13 May 2016

Reason for request:

The violence that erupted in South Sudan mid-December 2013 has led to a humanitarian crisis involving a massive displacement of over 1.5 million people nationwide. The conflict, and associated displacement, has had a significant impact on food security and, consequentially, the prevalence of malnutrition. While famine was averted in South Sudan in 2014, the July 2014 Integrated Food Security Phase Classification (IPC) correctly projected that food security would deteriorate for displaced populations and host communities in 2015.

While famine was averted in South Sudan in 2014, the December, 2015 Integrated Food Security Phase Classification (IPC), forecast that for the period of January to March, 2016 Guit County will be under Emergency classification. Moreover, the same IPC projection states that 40.000 individual would be under Catastrophe classification in Unity state (Guit included) for March, 2016 (IPC, 2015).

The 2015 conflict in Unity state, and associated displacement, had also impacted Guit county, having a significant effect on food security and, consequentially, the prevalence of malnutrition. At the moment, INGO’s do not have bases in Guit county, though an Inter-Sector Rapid Need Assessment/Response (IRNA/R) Mission was conducted from February 20th to 24th by UNICEF, World relief, Nonviolent Peace Force, Norwegian People Aid and Concern World Wide. During the response associated to the assessment, interventions in WASH, FSL and health were carried out.

However, no SMART survey had been conducted in all of Guit County (access permitting) since 2013.

Therefore, given the background situation which set Emergency IPC levels of GAM for Guit County for the period January to March, 2016, there was a need to provide the NIWG with an up to date estimate of under nutrition prevalence for programming purposes.

Key achievements:

Attended the IPC Meetings which were held in Juba between April 19-24 and worked with nutrition colleagues to identify priority counties and completed IPC specific worksheets that are used throughout the IPC classification process
Provided feedback and contributed to the validating process of multiple surveys while attending Nutrition Information Working Group (NIWG) meetings.
Presented to the NIWG the importance of translating questionnaires (English to Nuer) and provided the NIWG the 4 translated questionnaires (Anthropometry and health, Mortality, FSL, WASH) created for the Bentiu POC survey that can be adapted for other surveys.

Provided support to both SET Survey Managers for the Guit County and Bentiu POC surveys. Support was provided remotely from Juba as well as one field visit for each survey.
Worked with Survey Managers to analyze the Guit survey data, write preliminary report (included final data set), and presented to NIWG (validated).
Worked with Survey Manager to write and present Bentiu POC protocol, analyze data, write preliminary report and present to NIWG for validation, followed by final report submission to NIW

Deployment 2

Name of sector: Social Behaviour Change (SBC)

Dates of deployment: 21 March – 29 April 2016

Reason for request:

Bentiu Protection of Civilians (POC) site in Unity State is currently the largest IDP camp in South Sudan. It was established in early 2014 in response to the large influx of displaced people as a result of fighting in the wider area of Unity State commencing in late 2013. In mid-2015, a new purpose-built camp was established on an organised grid with better drainage and planning. Due to the ongoing influx of new arrivals however, even this new site remains extremely cramped and the risk of illness and malnutrition is high. A SMART survey undertaken in August 2015 revealed an extremely high level of GAM 34.1 % C.I (31.1 – 37.2) according to WHZ <-2 and/or oedema) and SAM 10.5% C.I (8.5 – 12.9) according to WHZ <-3 and/or oedema). Both are clearly above international thresholds for a serious emergency. The same survey revealed low levels of diet diversity and exclusive breastfeeding and a KAP and WASH survey conducted in April suggests open defecation is still widely practiced while hygiene knowledge and practice remain suboptimal. In addition, as the situation in the wider area shows signs of stabilising and populations return to the area, humanitarian organisations are beginning to look at expanding services outside of the PoC, particularly in Bentiu Town. At the time of writing, there are approximately 20,000 residents in Bentiu Town.

The Tech RRT SBC Advisor was deployed to develop a practical strategy and action plan for promoting priority health, hygiene and nutritional practices that will have the quickest positive impact on the prevention and treatment of malnutrition and illness in children and pregnant women that encompasses both the POC and the evolving settlements in Bentiu town.

Key achievements:

A simple work plan for the assignment, including outline of the methodology for Barrier Analyses, FGDs and interviews to be undertaken in and outside the PoC, in collaboration with Concern.
Training of key partner staff in Barrier Analysis and other methods.
Documentation of the key assessments, including a very brief summary report for each BA undertaken and led by the consultant.
A detailed SBC final strategy and action plan for both the camp and outside the camp including milestones to monitor and evaluate the success of the plan.
A brief report outlining activities undertaken during the mission.
A presentation to stakeholders in Bentiu, and, as relevant in Juba.

Deployment 1

Name of sector: Assessment

Dates of deployment: 3 – 30 January 2016

Reason for request:

The SET team led by ACF but representing the Nutrition Cluster and Nutrition Information Working Group has a mandate to conduct emergency nutrition SMART surveys in the most vulnerable areas identified by the NIWG. In the current project, three surveys are to be conducted by July 2016 and will likely take place in Unity State, security permitting. There was a significant need to help provide assistance to the SET team with finalizing the data analysis, report writing etc. of the December 2015 Panyijar SMART survey, writing the survey protocol and planning the Leer County SMART survey, as well as to increase validation technical capacity within the NIWG pertaining to survey validation. As a result, a request was made to the Tech-RRT Consortium for assistance. On Jan 3rd the Tech-RRT Nutrition Assessment Advisor (NAA) was deployed to Juba, South Sudan.

Key achievements:

Provided feedback and contributed to the validating process of multiple surveys while attending Nutrition Information Working Group (NIWG) meetings.
Created a preliminary report template and final report template modeled after SMART templates but tailored to South Sudan context to be used by NIWG organizations.
At an NIWG meeting presented validation of data process using ENA for SMART software with sample data sets.
Developed Leer survey protocol with Survey Manager and presented to NIWG
Worked with Survey Manager to analyze Panjjar SMART data, write preliminary report and present to NIWG for validation, followed by final report submission to NIWG

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