Deployment 2
Name of sector: Assessment
Dates of deployment: 24 November – 20 December 2019
Reason for request:
A persistent nutrition crisis caused by cyclic drought and flooding had affected the southern provinces of Angola in recent years. Notably, the 2018-19 rainy season received the lowest seasonal rainfall since the early 1980s. Delayed and erratic rains resulted in reduced crop cultivation and loss of livestock as well as diminishing the availability of water for human consumption. According to the Integrated Food Security Phase Classification (IPC) conducted in July 2019 in the provinces of Cuando Cubango, Cunene, and Huila, it was estimated that 421,127 families were acutely food insecure. The most recent Demographic and Health Survey (DHS) in 2015-2016 reported the highest prevalence of GAM per WHZ in Cunene Province (10.5%) while somewhat lower in Huila Province (4.6%).
In order to generate more evidence and mobilize resources for increased investment in response to the impacts of drought, up-to-date and reliable data on the prevalence of acute and chronic malnutrition in the most affected provinces were needed. Given the lack of existing expertise to implement SMART surveys in-country, UNICEF Angola requested the Tech RRT consortium to support in the implementation of two SMART surveys in the drought-affected Provinces of Huila and Cunene. On 24 November 2019, the Tech RRT Assessment Advisor was deployed to Luanda, Angola.
Key achievements:
- Contributed to the Angola SMART survey protocol.
- Refined and adapted survey tools for data collection, including electronic questionnaire for mobile data collection.
- Led the SMART enumerator training with a total of 44 participants.
- Led the implementation of two SMART surveys in Cunene and Huila Provinces.
- Analyzed collected data and disseminated preliminary results.
- Completed the final Angola SMART report.
Deployment 1
Name of sector: CMAM
Dates of deployment: 27 October – 8 December 2019
Reason for request:
Angola is currently (2019) implementing a national programme for the integrated management of acute malnutrition (IMAM). The IMAM program has had a history of challenges affecting the quality of service delivery leading to poor program performance. The challenges include:
- Limited community mobilization system,
- Uncoordinated and ineffective supply chain management,
- Sub-optimal quality of IMAM services offered,
- Limited volunteer engagement and support for outreach services,
- Lack of proper follow up system of patients,
- Dual but not consistent monitoring and evaluation systems through the DHIS2,
- Insufficient funding allocated to IMAM,
- A weak enabling environment for IMAM implementation.
Furthermore, there is no systematic way of identifying, prioritizing and addressing bottlenecks to access, coverage and quality of care of the IMAM program.
Due to these challenges, UNICEF commissioned Professor Mike Golden and Dr Yvonne Grellety to conduct a 2-week mission in April 2019. The mission involved an evaluation of several health facilities that deliver care for severely malnourished children in Luanda. The assessment found the current protocol was not being applied properly and the reasons for its provisions are not understood by many of the staff.
In addition, in May 2019, an initial bottleneck analysis (BNA) of the national SAM programme was conducted. Data was collected in 18 provinces during a 2-month period. Although the BNA has the potential to provide evidence-based indication as to where the SAM programme requires reform, the analysis was not finalized due to the limited time. Therefore the identification of the root causes and relevant solutions was not performed. Despite this, supply chain challenges were identified as a critical inhibiting factor for the SAM programme.
The focus of the Tech RRT Deployment was to finalize the May 2019 BNA analysis and to directly support the scale up of quality CMAM services at national level with a strong focus in the drought affected areas, to be delivered through the health system in order to meet the increasing needs of the affected populations.
Key achievements:
- Bottle Neck Analysis training report and SAM Programme Bottle Neck Analysis report for Cunene.
- SMART protocols for Huila and Cunene with an implementation strategy.
- Report on recommendations for improving the quality of CMAM program in Angola that can direct future work on a scale up plan for CMAM in country once the surge team member arrives.