DRC

Deployment 4

Name of sector: CMAM Simplified approaches

Dates of deployment:  8 June – 3 August 2020, remote support

Reason for request:

To respond to the spread of the COVID-19 epidemic, the Ministry of Health through the national nutrition program (PRONAUT) in collaboration with the Nutrition Cluster has developed and disseminated throughout the country a guidance manual providing recommendations for adjustments that could be made in routine nutrition programs that were already underway before COVID-19. This manual gives practical guidelines to minimize the risk of nutrition programmes becoming sources of
transmission for COVID-19.
This guidance manual recommends that programs for the integrated management of acute malnutrition (IMAM) continue to use the national protocol but can integrate several possible adjustments to programmes including using a different MUAC tape for each child, reduced frequency of visits, training CHWs and family members to use MUAC and behaviour change communication for IYCF-E. The guidance manual also includes several other infection prevention and control measures.

Given the lack of expertise in the country for the implementation on simplified approaches for the management of acute malnutrition, the Ministry of Health has requested that Nutrition Cluster engage the Tech RRT to support the process of designing the specific simplified approach and support partners in implementing the chosen approach.

Key achievements:  

• Consultation facilitated with partners, on the pros and cons of different simplified approaches available.
• Review of routine programme and available survey data, from five selected health zones, to analyse the potential impact of different simplified approaches.
• Training package on simplified approaches developed.
• Remotely delivered training sessions and capacity building to key nutrition partners (3 days remote training).
• Developed a package of job aids and quick reference materials on the selected simplified approaches to assist partner staff with implementation.
• Developed an on-going coaching plan to support partners during implementation.
• Supported the Nutrition Cluster team to develop a robust Monitoring and Evaluation system.
• Supported Nutrition cluster team to conduct data review in order to inform quick decision making to adjust the simplified approach and/or identify challenges.
• Documented learning on good and bad practices and lessons learned related to uptake, quality and efficiency of implementing the simplified approaches selected.

 

 

Deployment 3

Name of sector: IYCF-E in Ebola context

Dates of deployment: 10 February – 22 March 2020 in country and 30 March – 26 April 2020 remote support

Reason for request: 

The Democratic Republic of Congo (DRC) has been facing an Ebola Virus Disease (EVD) epidemic since August 2018. At the end of August 2019, the country had recorded 2,997 cases with 1,998 deaths; a mortality rate of 67%. Currently three provinces including North Kivu, Ituri and South Kivu are affected, and children and pregnant and lactating women represent a significant number of cases.

In North Kivu and Ituri provinces, the rate of exclusive breastfeeding is 83.7% and 65.2%, respectively, while the proportion of children (6 to 23 months) with access to an acceptable minimum diet is 20.6% and 14.3% according to the last national survey report (MICS 2018).Before the EVD epidemic, there was limited capacity to cope with aspects of infant and young child feeding in emergencies (IYCF-E) and so the health system was unable to cope with the additional challenges that EVD presented. There were no normative documents to adapt the IYCF-E strategy to the additional challenges posed by the EVD context.

To cope with this situation the Nutrition Cluster, and partners, with UNICEF have set up a nutritional component of EVD epidemic response. This nutrition component covers IYCF-E in the context of Ebola and nutritional care for people suffering from EVD and admitted in EVD treatment centers. At the end of September 2019, the IYCF-E component had monitored 714 children aged 0 to 23 months and 2744 pregnant and lactating women in the different structures and in the community. However, the implementation of the IYCF-E component still faces some weakness that need to be addressed.

The DRC Nutrition Cluster, and partners, therefore, requested technical support from Tech RRT to support the following three areas of work:

Key achievements:  

Name of sector: IYCF-E

Dates of deployment: 16 April – 25 May 2018

Reason for request: 

Violence and instability in the Greater Kasai region of the Democratic Republic of Congo (DRC) began in August 2016 and has further deteriorated in 2017. The Kasai conflict affects 9 of the 26 provinces in the country and is unfolding in one of the poorest regions of DRC. The crisis is having a devastating impact on children under five years old who are quickly cut-off from food and basic health services, leading many into an acutely undernourished condition and at a heightened risk of mortality. Before the start of violence, the nutritional status of children in Kasai was already worrisome with more than 1.2 million children stunted and up to 3% severely acutely undernourished, the emergency thresholds is 2%. The ongoing conflict has further worsened conditions for families who were already vulnerable. Children affected by severe acute malnutrition (SAM) arrive for treatment – available in limited locations – at very late stages. Altogether, the five provinces have a population of almost 18 million people; 700,000 children under 5 are acutely malnourished and at high risk of dying. Children in Kasai represent almost one quarter (23%) of all children affected by severe acute malnutrition in DRC. Furthermore, 62 percent of households did not cultivate as per displacement and lack of purchasing power and the food security situation has deteriorated as per the recent Inter Phase Classification results released in June 2017, revealing that 2,750,446 people are food insecure (IPC 3- crises and 4- emergency) in the five provinces and 980,711 alone in an emergency situation (IPC4 emergency). Four million people have been forced out of their homes.  There has been limited scale up of IYCF-E in affected areas and more support is needed for mothers and caregivers to receive the appropriate support. There are ongoing IYCF community based activities implemented by partners at health facility and community level linked to awareness on key messages. Activities remain awareness based and there is need to increase coverage as well as to strengthen counselling capacity of health workers and community volunteers especially for key aspects of IYCF-E.

The IYCF-E Adviser was requested to strengthen the delivery of the IYCF-E response through the provision of senior leadership, technical support and capacity building to government and local as well as international non-governmental organizations.  This would be done in two fold – on the one hand training a core group of trainers on delivery of counselling and on the other hand, assessing food and nutritional supplement distribution platforms to recommend a package of awareness on IYCF-E that can be integrated to such activities.

Key achievements:  

1. A one-day workshop in the province of Kasai Central with 19 participants from all five provinces to develop the minimum IYCF-E response package in a collaborative manner. The workshop included definitions of the goal and objective of the response, identification of target groups, key contact points and priority interventions at several levels of service delivery. It also included the development of a monitoring and evaluation framework and an action plan.
2. A minimum response package on IYCF-E for the Grand Kasai region and action plan developed in collaboration with relevant stakeholders. The response package included a simple monitoring and evaluation framework with suggested key output and outcome indicators for the response.
3. A suggested package of integrated IYCF-E activities into several platforms, such as CMAM, food/cash distribution, blanket feeding, etc. and a set of key messages that can be used in awareness activities at these points of contact.
4. A pool of 21 certified trained trainers from all five provinces on IYCF counselling, in addition to 3 participants who attended the training of trainers but weren’t certified.
5. Two field level trainings for health workers and community workers conducted by trained trainers and observed by the Tech RRT advisor, where a total of 34 health workers and community workers were trained.

Post deployment webinar: A post-deployment webinar took place on 12th June 2018. The recording can be found here.

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Deployment 1

Name of sector: CMAM

Dates of deployment: 13 February – 27 March 2018

Reason for request:

Violence and instability in the Greater Kasai region of the Democratic Republic of Congo (DRC) began in August 2016 and has further deteriorated in 2017. The Kasai conflict affects 9 of the 26 provinces in the country and is unfolding in one of the poorest regions of DRC. The crisis is having a devastating impact on children under five years old who are quickly cut-off from food and basic health services, leading many into an acutely undernourished condition and at a heightened risk of mortality. Before the start of violence, the nutritional status of children in Kasai was already worrisome with more than 1.2 million children stunted and up to 3% severely acutely undernourished, the emergency threshold is 2%. Ensuring basic health and nutrition services is a right for every child and must be prioritized.

The ongoing conflict has further worsened conditions for families who were already vulnerable. Women and children displaced by violence have had to move to isolated locations, often deep in the forest, to find safety and have been completely detached from basic goods and services. This lack of access has led to increased morbidity and child mortality. Children affected by severe acute malnutrition (SAM) arrive for treatment – available in limited locations – at very late stages. Altogether, the five provinces have a population of almost 18 million people; 350,000 children under 5 are severely malnourished and at high risk of dying. Children in Kasai represent almost one quarter (23%) of all children affected by severe acute malnutrition in DRC. Furthermore, 62 percent of households did not cultivate due to displacement and lack of purchasing power and the food security situation has deteriorated as per the recent Inter Phase Classification results released in June 2017, revealing that 2,750,446 people are food insecure (IPC 3- crises and 4- emergency) in the five provinces and 980,711 alone in an emergency situation (IPC4 emergency). Four million people have been forced out of their homes.

The Tech RRT advisor was deployed to support the development of a quality assurance framework for CMAM services including technical capacity building of SC services.

Key achievements: 

1. CMAM site Assessment: A CMAM assessment was conducted by interviewing key partners, reviewing existing tools, reports and materials and conducting field visits.  A total of 11 CMAM sites were visited (5 UNTI and 6 UNTA) and NGO partners, Head of Health Zones and PRONANUT were interviewed. A report with the assessment results was completed and submitted.
2. Results of the CMAM assessment were presented in Mbuji Mayi, Kananga and Kinshasa. A workshop was held in Kananga with key stakeholders (PRONANUT, some MCZ, NGO partners) to develop the framework and implementation plan. The framework and narrative detailing the implementation plan was submitted.
3. In coordination with PRONANUT (the coordinator in Kananga and a Doctor from Kananga) an SC training was facilitated for MCZ, Nutritionists at zonal level from PRONANUT and NGO partners who conduct supervision visits regularly. The goal was to address gaps identified in the SC assessment and to improve coaching techniques to be used during supervision visits. The training was well received, and a practice session was held at a UNTI.

Post deployment webinar: A post-deployment webinar took place on 12th June 2018. The recording can be found here.