Ethiopia

Deployment 7

Name of sector: IYCF-E

Dates of deployment: 16 February – 22 February 2020 in country and 6 April – 29 May 2020 remote support

Reason for request:

Natural, man-made disasters and public health emergencies are quite common in Ethiopia due to drought, flood, earthquake, epidemics of communicable diseases, dry and wet mass movement, and conflict.

The 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) shows that 37% of children under 5 are stunted and 12% are severely stunted. Additionally, there is a high percentage of wasted children with as much as 32% in some regions. With regards to IYCF, 59% of infants under six months are exclusively breastfed and 6% of infants under 6 months are not breastfed at all, a dangerous and life-threatening practice. The danger at which infants are placed in an emergency is impacted by whether the child is breastfed or non-breastfed and dependent on infant formula. Infants who are dependent on infant formula are extremely vulnerable especially in an emergency setting.

Infants have very specific food and fluid requirements, an immature immune system, are vulnerable to dehydration and illness, and are dependent on others for their care and needs. These characteristics coupled with conditions associated with emergencies such as poor sanitation, food and water shortage, power outages, overcrowding, and restricted access to health care create a situation where infants are at heightened risk.

Maternal nutrition is important not only for the health of the mother but also for the child. One quarter of women of reproductive age are undernourished, leaving their children predisposed to low birth weight, short stature, lower resistance to infections, and higher risk of disease and death. Among women with a live birth in the past 5 years, 60% took iron folic acid (IFA) tablets during pregnancy, and 11% took them for the recommended period of 90 or more days.

The Tech RRT Remote Support was two-fold and happened in two different phases. 1) to support the coordination of Maternal, Infant and Young Child Feeding in Emergencies (MIYCN-E) and 2) to support nutrition sensitive integration of MIYCN-E in WFP programming amongst partners.

Key achievements:

PHASE 1:

National Level MIYCN-E Policy Review Report and including and inventory of resources reviewed (nationally and internationally)
MIYCN-E Capacity Assessment Report
Recommendations for MIYCN coordination platform
MIYCN-E Recommendations to Coordination documents which look at programmatic readjustments (nutrition specific and sensitive)
Draft concept note for WFP MIYCN-E integration plan (2-3 pages) (Audience: donors)

PHASE 2:

Field Report detailing technical support provided to WFP and partners and
recommendations for action plans
Presentation slides on mission to debrief partners
Finalized costed concept note for WFP MIYCN-E integration plan (2-3 pages) (Audience: donors)
Draft Policy brief (2 pages) for WFP outlining importance of IYCF-E approach and demonstrating potential impact (2-3 pages) (Audience: government, partners and donors)

Deployment 6

Name of sector: Assessment

Dates of deployment: 25 August – 16 September 2019

Reason for request:

Concern worldwide (CWW) began working in Ethiopia in 1973 with an emergency response, which later evolved long-term development and resilience building programs targeting selected woredas (districts) in eight of the nine kililoch (regions) of the country. Within current programs CWW works to address issues of sustainability and to embrace a more holistic approach to programming by addressing multiple underlying causes of poverty and implementing integrated multisectoral projects. For many of the health and nutrition projects a Standardized Monitoring and Assessment of Relief and Transitions (SMART) is part of the assessment. CWW previously had a large survey unit in Ethiopia and lead surveys throughout the country. However, due to restructuring this unit was lost which led the organization to contract out to local consultants who often produced surveys of questionable quality.

In order to implement surveys of quality, technical capacity strengthening was needed. CWW Ethiopia requested the Tech RRT consortium to support in strengthening the overall emergency nutrition response by building the capacity of response stakeholders in the implementation, analysis and reporting of emergency nutrition assessments on behalf of CWW and the Ethiopian Nutrition Coordinator Unit (ENCU). On 25 August 2019 the Assessment Tech RRT Advisor was deployed to Jijiga, Ethiopia.

Key achievements:

Provided technical support for the development of SMART survey protocols for Filtu and Salahad Woredas
Refined and adapted survey tools for data collection
Led the Salahad SMART surveyor training with 18 participants
Led the implementation of the Salahad SMART survey
Provided remote support to the survey manager of the Filtu SMART survey

Deployment 5

Name of sector: CMAM Coaching

Dates of deployment: phase 1 from 9 to 14 June 2019, phase 2 from 15 September to 4 October 2019 and phase 3 from 15 March to 8 May 2020

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 challenges 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 key gaps are 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), to analyse trends and to properly use data. At woreda and zonal levels, clinical skills and quality of care are very limited for the management of the Stabilisation Center.

Concern Worldwide has started an intervention 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. These key partners’ role is to facilitate an inter-agency approach to strengthen jointly the quality of CMAM interventions in selected parts of Somali region. This will take place through an improved zonal capacity to interpret and respond to gaps in service delivery at the woreda level.

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

In a second phase, the Tech RRT CMAM advisor was requested to provide technical support and capacity building in Coaching and Mentoring capacity through both in-country and remote support to Concern Worldwide, Ethiopia. This will strengthen the HSS approach that is an integral part of Concern’s support to the government to provide high quality essential service delivery, especially in the nutrition sector related to the management of acute malnutrition and infant and young child services.

In a third phase and following the coaching skills assessment that was carried out in February 2020, it was recommended to have an internal experience sharing discussion and use of the rest of the deployment time to work with the team to harmonize the existing tools and incorporating coaching skills checks and reminders in the tools.

Key achievements:

Phase 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.
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.

Phase 2:

Practical and interactive trainings provided for 20-30 staff members (including training cascades), including role play and site visits where possible.
Training package with tools provided.
Training and training report following each visit with key issues identified and recommendations.
Final deployment report.

Phase 3:

Sharing and discussion of coaching assessment results, and experience sharing with the team.
Refresher training (in Addis) for supervisors and nutrition managers on the coaching skills approach with focus on aspects identified during the assessment that require particular improvement.
Review and incorporation of coaching approach into the existing supervision tools. This would include SC, OTP, TSFP, BSFP and IMNCI tools adapted to the Gambella context.
Development of an approch to continuously monitor and improve implementation of the coaching approach.

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

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

Deployment 4

Name of sector: Assessment

Dates of deployment: 22 February – 5 May 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 achievements:

Led all phases of a Nutrition and Retrospective Mortality survey in Kelafo, Somali Region, Ethiopia from protocol development to final results presentations and report.
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.
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.

Deployment 3

Name of sector: CMAM

Dates of deployment: 22 October – 21 December 2017

Reason for request:

Key achievements:

Deployment 2

Name of sector: IYCF-E

Dates of deployment: 5 – 29 January 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.

Key achievements:

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

Deployment 1

Name of sector: CMAM

Dates of deployment: 29 December 2015 – 6 February 2016

Reason for request:

The Government of Ethiopia is implementing the Community-based Management of Acute Malnutrition (CMAM) approach through establishing health facilities at the kebele-level (the smallest administrative unit). The CMAM approach includes four components: Community Mobilization, Outpatient Therapeutic Program (OTP), Stabilization center (SC) and Targeted Supplementary Feeding Program (TSFP). This program uses a community-based approach in managing acute malnutrition among children and other vulnerable groups. UNICEF provides support to the government for the management of severely malnourished cases in OTPs and SCs while TSFP is supported by WFP. This program is part of the regular health program and the support to it is scaled up at times of emergencies.

Currently many parts of Ethiopia are facing critical food shortages and increased number of malnourished children following the failed two consecutive seasonal rains. According to the revised 2015 Humanitarian Requirement Document (HRD) for Ethiopia (October 2015), an estimated 350,000 children are expected to be affected by severe malnutrition in 2015. Another 400,000 children are also forecasted to be admitted to the program for treatment of Sever Acute Malnutrition (SAM) in 2016.

The Bi-annual survey results supported by UNICEF and conducted in May 2015 also revealed concerning situation in different parts of the country. According to the survey results, the nutrition situation was reported to be normal in four of the Woredas while it was serious and poor in nine and four of the Woredas, respectively. The other one Woreda in Afar region was reported to have critical situation.

Somali region is one of the regions seriously hit by the drought. The poor functioning health system in the region also worsen the situation demanding for additional support. As the drought situation is also expected to worsen over the coming months, the CMAM program requires maximum support in strengthening the system in terms of service scale up, case finding, program monitoring and reporting. This will be beyond the capacity of the existing staff there and additional support is needed to continue the response.

Key achievements:

One (1) ToT delivered at regional level for scaling up OTP/TFU services by RHB and NGO partners.
Support by the CMAM monitors strengthened and a reporting system created to continuously track the activities and achievements of the monitors.
One (1) capacity assessment done.
CMAM technical working group among the cluster members (RHB & NGOs) strenghtened.
Partners trained in use of database, monitoring tools and interpretation of results for improvements and quality programming.
Joint field visits involving RHB, ENCU, NGOs and CMAM monitors conducted including set of actionable recommendations. (RHB and partners).
Package of integrated messages developed in close collaboration with other sectors.
One debriefing meeting with the MoH and donors done at the end of the assignment.
End of Mission report, for dissemination to UNICEF and partners.

Where We Work

Mission Reports