Somalia 2018 Appealing Agency Project Title Project Code Sector/Cluster Refugee project Objectives HEALTH POVERTY ACTION (HPA) Emergency Nutrition Interventions for IDPs in Somaliland 2018 (NutriSom) SOM-18/N/121295 Nutrition No The overall objective of the project is to contribute to the reduction of maternal and child morbidity and mortality in the drought affected districts of Berbera, Sheikh and Burco. This will be achieved though the enhancement of equitable access to and utilization of quality, high impact nutrition interventions for internally displaced pregnant and lactating mothers and children under 5 that will result in a reduction of acute malnutrition and help contribute to the reduction in maternal and child mortality and morbidity. Beneficiaries Implementing Partners More specifically the objectives of the project are (1) to strengthen lifesaving preventive nutrition services for vulnerable populations focusing on appropriate infant and child feeding practices in emergency, micronutrient interventions and optimal maternal nutrition, (2) Improve equitable access to quality lifesaving curative nutrition services through systematic identification, referral and treatment of acutely malnourished cases. This project will specifically be targeting internally displaced people and vulnerable communities who have been dislocated because of the drought. Communities have left low land areas for regions with more available water and pasture, this project will work to address the challenges IDPs face in their current locations. Total: 24,606 Children Under 5 and Pregnant and Lactating Women Female: 17,745 Male: 6,861 Children (under 18): 14,002 Adult (18-59): 10,604 IDPs: 24,606 Somaliland Ministry of Health Project Duration Jan 2018 - Dec 2018 Current Funds Requested $797,230 Location Priority / Category Gender Marker Code Contact Details North West A - High 2a - The project is designed to contribute significantly to gender equality Morgan Kindberg, m.kindberg@healthpovertyaction.org, +44 20 78403763 Cash transfer programming Is any part of this project cash based intervention (including vouchers)? Conditionality: Restrictions: No Estimated percentage of project requirements to be used for cash/vouchers: 0 Needs Page 1 of 5
Somalia has one of the highest prevalence s of malnutrition in the world, with an average of 17.42% Global Acute Malnutrition (GAM) rate among children under 5 years old. Despite large scale ongoing humanitarian assistance in the country, the Food Security and Nutrition Assessment Unit Somalia (FSNAU) post Gu assessment found that a critical nutrition situation prevails in many rural livelihoods and IDP settlements throughout the country, with poor livestock performance accompanying this. The continued drought has had a particularly detrimental impact in the North West where we will focus our work. It is expected that high levels of acute food insecurity and malnutrition will persist through the end of the year and there is a risk of famine. The persistent droughts (Gu 2016, Deyr 2016 and Gu 2017) have resulted in mass livestock losses and poor livestock health in the pastoral livelihood zones that we are seeking to target. Data from the ICPAC/IGAD suggest that this is expected to continue throughout most pastoral and agro pastoral zones until to the end of the year and beyond. The outlook suggests that most areas of Somalia will experience warmer than normal temperatures, which will lead to faster depletion of pasture and water sources. Additional recent data from FSNAU has indicated below average Deyr rainfall are expected between now December, thus leading to even further reduction of pasture and water which is desperately needed. This project will target Berbera, Sheikh and Burco districts in Somaliland. The Berbera district, is classified under the North West Agro Pastoral Livelihood zone; and Burco and Sheikh are classified as West Golis and Guban Livelihood zones respectively. All of these zones have been affected by poor rainfall since January 2017. The FSNAU s post Gu August 2017 report found that the Guban livelihood zone has a GAM rate at 18.8% and the SAM rate of 3.1%. In Berbera the GAM rate is 13% with SAM rates of 3.2%, with Burco at a 10.4% GAM rate and 3.0% SAM rate. Morbidity rates throughout all districts remain high, (Guban pastoralist at 20.1%, West Golis at 19.8%, North West Agro Pastoral populations at 7%). With pasture, water conditions and livestock conditions expected to deteriorate further between now and January the situation is expected to worsen with all areas expected to be in the Emergency/Crisis phase throughout December 2017. With few livelihood assets and opportunities, IDPs across Somalia are some of the most vulnerable. IDP settlements in Burco show an Alert nutrition situation with GAM prevalence of 9.2% and SAM prevalence at 1.5%. A GAM prevalence of 18.7% and SAM prevalence of 4.3% has been recorded among IDPs in Berbera, reflecting a critical nutrition situation. This can be attributed to poor food consumption among 51% of households; very high vulnerability to food insecurity and asset poverty. High temperatures combined with increased morbidity, particularly AWD, further aggravated the nutrition situation. Furthermore, the drought has resulted in an increase in IDPs, people have moved from areas such as Sool and Sanaag to the Sahil and Togdheer. This project will target these IDPs who have settled outside of villages in temporary shelters. As it currently stands, no improvements are expected in the coming months in IDP communities unless significant interventions are implemented FSNAU has suggested that among others, Berbera IDPs are most in need these humanitarian interventions. The overall food security and nutrition situation throughout North West Somalia has continued to deteriorate in recent months when compared to Deyr 2016, predominantly due to reduced crop and livestock production, income sources and modest humanitarian intervention. That FSNAU classified all livelihood zones in the North of Somalia as in Crisis or Emergency in July, suggests the desperate need for significant and targeted humanitarian intervention throughout all of these zones. Activities or outputs Page 2 of 5
Output 1: Strengthen and improve access of nutrition services for vulnerable communities Activities: 1. Provide 10 mobile teams with fuel, vehicles, and supplies to provide nutrition services in hard to reach areas. Five mobile teams will be based in the Sahil Region and five will be based in Toghdheer. Each team will hold mobile clinics for 21 days each month and visit an average of 84 (40 Sahil and 44 Burco) villages each month. 2. Screen children under five and Pregnant and Lactating Women (PLW) for acute malnutrition and provide them with or refer them to Stabilization Centers and Outpatient Treatment Programs. 3. Train and support Community Mobilizers to identify children who are malnourished and ensure they attend the mobile clinics and follow up with children recovering from MAM and SAM. A training will be carried out to train the Community Mobilizers on their role, particularly on how to identify and support children with disabilities, female headed households and unaccompanied children, to ensure they are included in case findings and follow ups. The training will take place in January 2018 over 3 days. There will be a total of 50 community mobilizers covering the 84 villages, who will be provided with a $40 incentive each month. 4. Support Targeted Supplementary Feeding Program (TSFP) services to treat children with MAM and PLWs. Children between the age of 6 and 59 months and PLW with MAM will be enrolled in TSFP run through the mobile clinics. Please note that children with SAM will be referred to existing Outpatient Therapeutic feeding Programs (OTPs) in the three districts and likewise SAM cases with complications will be referred to stabilization centers in Burco and Berbera hospitals. Ambulances will be available to transport the complicated SAM cases if needed. 5. Provide multiple micronutrients to all PLW attending the mobile teams and provide vitamin A and deworming tablets to all children between 6 and 59 months and 12 and 59 months respectively, admitted into the TSFP programme. Treat children with diarrheal diseases with ORS and zinc at the mobile clinics and refer severe cases to health facilities. Ambulances will be available to transport the severe cases if needed. 6. Collect beneficiary feedback and address community concerns. Community meetings and visits will be held by Community Health Committees to collect feedback from beneficiaries. Score cards with indicators identified by the communities will be used to collect feedback. Output 2: Improve monitoring by and build the capacity of the Regional Health Offices (RHO) and Ministry of Health (MOH) workers Activities: 1. Hold a training and orientation on Basic Nutrition Service Package, IMAM and reporting requirements for 40 health workers. 2. Carry out monthly supportive supervision visits of the mobile teams with RHO and MOH Nutrition Officers to review and improve quality of care being provided. 3. Review nutrition data submitted on a weekly and monthly basis by mobile teams, to help ensure quality of data. 4. Participate in monthly nutrition review meetings with the RHOs and other NGOs working in the regions to improve coordination and reduce duplication of activities. 5. Present analysis of nutrition data at quarterly nutrition cluster meetings and other national coordination platforms such as drought emergency coordination meetings to update on changing situations, coverage of beneficiaries and new challenges and required additional supports. 6. Coordinate with food security, livelihood, health, WASH and other sectors and partners for a multisectoral response on shelter, food (cash), health, water and sanitation supports and other nutrition sensitive services for IDPs in the project locations. This will be done by attending relevant meetings on a monthly basis. Indicators and targets Page 3 of 5
Output 1: Indicator 1.1: Number and percentage of children under 5 (U5) screened for malnutrition (Target: 30,880 children (49% girls and 51% boys) U5, 50% of children U5 in IDP settlements) Indicator 1.2: Number and percentage of PLW screened for malnutrition (Target: 23,408, about 70% of PLWs in IDP settlements) Indicator 1.3: Number of boys and girls between 6 and 59 months with Moderate Acute Malnutrition (MAM) treated (Target: 14,002 children U5, 30% estimated l MAM caseload in in the target population) Indicator 1.4: Number of PLW with moderate malnutrition treated (Target: 10,604 PLWs) Indicator 1.5: Number of boys and girls (6 23 months) who receive micronutrient powder (MNPs ) (Target: 5,600 children between 6 23 months) Indicator 1.6: Number of boys and girls (6 59 months) who receive deworming tablets (Target: 8,400 children under 5) Indicator 1.7: Number of PLW who receive micronutrients including iron folate (Target: 10,604 PLW) Indicator 1.8: Percentage of direct beneficiaries or their caregivers whose feedback is collected (Target: 10% of direct beneficiaries) Output 2: Indicator 2.1: Improved capacity of MoH health and nutrition staff to deliver Basic Nutrition Service Package (BSNP components) (40 health workers 30 female and 10 male) Indicator 2.2: Development of coherent strategy on targeting and selection of affected women, children, old people, people (children) with disabilities and other vulnerable populations (Target: 10 Mobile teams using project produced targeting guidelines) Indicator 2.3: Mobilization of Health, Water, Sanitation, Hygiene and other supports to integrate into nutrition emergency response in for targeted IDPs (Target: 18 ) Indicator 2.4: Supportive supervision recommendations implemented to improve population coverage and the quality of care (Target: 12 supportive supervision recommendations implemented) Indicator Project target Page 4 of 5
Health Poverty Action(HPA) Original BUDGET items $ Personnel Costs 75,390 Office Running Costs 16,680 Mobile clinics and ambulance support (vehicle rent, health workers' per diems, community mobilsers s 610,356 Training Costs (venue hire, facilitators fees, transportation, stationary, per diems, refreshments) 25,349 Supportive supervision visits and monitoring activities 16,500 Meetings with MoH, RHO, and nutrition cluster members (refreshments and stationary) 800 Indirect Costs (7%) 52,155 Total 797,230 Health Poverty Action(HPA) Current BUDGET items Personnel Costs 75,390 Office Running Costs 16,680 Mobile clinics and ambulance support (vehicle rent, health workers' per diems, community mobilsers s Training Costs (venue hire, facilitators fees, transportation, stationary, per diems, refreshments) $ 610,356 25,349 Supportive supervision visits and monitoring activities 16,500 Meetings with MoH, RHO, and nutrition cluster members (refreshments and stationary) 800 Indirect Costs (7%) 52,155 Total 797,230 Page 5 of 5