Nigeria

Deployment 5

Name of sector: Assessment

Dates of deployment: 25 March – 27 April 2019

Reason for request:

The Boko Haram insurgency has caused mass population displacement throughout Northeast Nigeria since 2012, when the government declared a state of emergency secondary to the conflict. According to the International Organization of Migration’s (IOM) Displacement Tracking Matrix (DTM) round XXV (October 2018) report, there are 2,026,602 internal displaced persons (IDPs) spread across Borno, Adamawa and Yobe states. This represent 6.6% increase compared to the IDPs population identified in Round XXIV (August 2018). The impact on freedom of movement, livelihoods, markets, and humanitarian access have resulted in a severe food security and nutrition emergency in North East Nigeria, Niger, Chad and Northern Cameroon.

Given the emergency situation as well as increases in access to newly accessible areas since the emergency declaration, a series of repeated surveys were organized with the primary objective of providing representative estimates for prevalence of acute malnutrition among children (by both weight-for-height and MUAC), as well as mortality rate in Northeast Nigeria to inform the ongoing emergency response. Information on nutritional status of women, prevalence of common child health morbidities, access to health services and health status among children, and infant feeding is also gathered.

The first survey round was conducted in October – November 2016, the second in February – March 2017, the third in July – August 2017, the fourth in November-December, 2017, the fifth in March-April 2018 and the sixth in October 2018. Data from these surveys suggest that GAM trends were fluctuating based on seasonal variations as well as due to the volatility of the conflict.

The humanitarian crisis in North-East Nigeria has become protracted, with local population still bearing the brunt of the conflict that has resulted in widespread displacement, destroyed infrastructure and collapsed basic social services. Threats of attacks by non-state armed groups and restrictions in movements continue to have negative impacts on trade, livelihoods and markets, leaving a substantial proportion of the civilian population relying on humanitarian assistance. To date, over 2 million people are still displaced in the three most affected states – Adamawa, Borno and Yobe States – with about 70 percent of the displaced population being women and children.

The Tech RRT Assessment Adviser was deployed in Nigeria to build the capacity of response stakeholders in the design, implementation, analysis and reporting of nutrition assessments with special emphasis on the validation process of any type of assessment that will be conducted by partners.

Key achievements:

An updated IMTWG ToR shared and agreed with Nutrition Sector members.
A set of rationalised assessment and data collection tools specific to Northeast Nigeria with a protocol explaining the purpose of each and how they should be used.
Members of the IMTWG trained on the implementation of the standard assessment and survey protocol.
A process protocol on the validation of assessments and surveys
Members of the IMTWG trained on the assessment and survey protocols and the validation process protocol.
Report on the assessment and survey capacity and gaps of IMTWG members and recommendations on further capacity building exercises. This should also include identified assessment needs that require remote or additional support.
End of mission report with overall recommendations on strengthening the IMTWG functions.

Deployment 4

Name of sector: CMAM

Dates of deployment: 23 June – 27 July 2017

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.

Key achievements:

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.

Post deployment webinar: A post-deployment webinar took place on 28th September 2017. The recording can be found here.

Deployment 3

Name of sector: IYCF-E

Dates of deployment: 4 October – 3 December 2016

Reason for request:

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 are currently not systematically monitored for but have been anecdotally reported. Based on 2014 National Health and Nutrition Surveys (NHNS), which uses a different methodology, the rate of EBF increased up to 25%. Apart from the non-optimal breastfeeding practices, complementary feeding is also of concern in Nigeria. The percentage of children aged 6 to 23 months who consumed the minimum dietary diversity was 37% and this percentage drops to 15.8 % for the age group 6-11 months. Accessibility to a minimum acceptable diet has been identified as one of the bottlenecks to adequate complementary feeding with only 17.5% and 12.5 % of children 6-23 and 6-11 months respectively having access to a minimum dietary diversity and a minimum meal frequency. The northern part is the most vulnerable and most affected.

The first half of 2016 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. Reporting has been cited as a constraint but the IYCF- TWG has finalized the development of reporting tools aimed at improving the reporting rate on IYCF activities. By end of May nutrition sector partners have reached a total of 95,644 beneficiaries on IYCF out of the 375,845 HRP target representing 25%.

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.

Key achievements:

Desk review (report) of existent national and agency strategies, policies and legislation on IYCF and IYCF-E.
Top line summary on country and state level capacity to respond to emergency.
Set of rapid assessment tools and key indicators.
Workshop / Training Report.
Brief recommendations on BMS Management.
IYCF-E Response Plan for Borno State.
Framework for action: capacity-building activities for response to acute/rapid onset emergencies, protracted emergencies and acute emergency ‘spikes’ within protracted emergencies.

Deployment 2

Name of sector: IYCF-E

Dates of deployment: 8 August – 9 September 2016

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).

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.

Key achievements:

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.

Deployment 1

Name of sector: CMAM

Dates of deployment: 3 August – 9 September 2016

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 Tech RRT CMAM 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.

Key achievements:

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.

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Mission Reports