Past support to Ethiopia
Requester:
UNICEF
Background:
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. Many parts of Ethiopia faced critical food shortages and an 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 the treatment of Severe Acute Malnutrition (SAM) in 2016. The Somali region was one of the regions seriously hit by the drought. The poor functioning health system in the region also worsens the situation demanding additional support.
The request:
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. UNICEF requested Tech RRT support to help in strengthening the CMAM program in Ethiopia in terms of service scale-up, case finding, program monitoring and reporting.
Key achievements:
- Delivered one Training of Trainers (ToT) at regional level for scaling up OTP/TFU services.
- Created a reporting system with support from CMAM monitors to continuously track the activities and achievements of the monitors.
- Conducted one capacity assessment.
- Strengthened CMAM technical working group among the cluster members (RHB & NGOs).
- Trained partners in the use of databases, monitoring tools and interpretation of results for improvements and quality programming.
- Conducted a Joint field visit involving RHB, ENCU, NGOs and CMAM monitors conducted including set of actionable recommendations. (RHB and partners).
- Developed packages of integrated messages in collaboration with other sectors.
- Conducted one debriefing meeting with the MoH and donors at the end of the assignment.
- Developed End of Mission report, for dissemination to UNICEF and partners.
Resources:
Requester:
UNICEF
Background:
Ethiopia is experiencing its worst drought in thirty years, threatening over 30 million people across the affected area. At the time of technical support, the evaluation of the number of Severely Acute Malnourished (SAM) children in the country was at 425,000 and the main nutrition response was 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 was at 96% and 82% respectively before the crisis. Other pre-crisis Infant and Young Child Feeding (IYCF) indicators demonstrated several gaps regarding the quality of breastfeeding (51.5% of mothers-initiated breastfeeding within one hour of birth and only 52% of mothers exclusively breastfed). There was a National strategy on Adolescent, maternal, infant and young child nutrition and several programs on IYCF, but no changes were made to adapt those programs to the current emergency.
The request:
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 the Federal Ministry of Health (FMOH), Department of Prevention and Preparedness Bureau (DPPB), UNICEF and Nutrition Cluster partners’ staff.
Key achievements:
- Conducted a workshop with FMOH, Multi Agency Nutrition Task Force and UNICEF members to create awareness of IYCF-E, generate discussion on the 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)
You can find out more about IYCF-E on our website or submit any questions or technical queries you may have through our request page.
Requester:
UNICEF
Background:
Ethiopia 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. In 2017 the Somali region alone shared 26% of total Severe Acute Malnutrition (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 NGOs supported 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 the turnover of skilled staff.
The request:
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.
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.
- Conducted training of 18 staff (including 3 supervisors) for the survey and 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.
Resources:
Requester:
Concern Worldwide
Background:
Somali region in Ethiopia faced 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, and the severe acute malnutrition (SAM) caseload already double the region’s projected estimate in the January 2017 Humanitarian Requirements. For the nutrition response, especially regarding Community-based Management of Acute Malnutrition (CMAM), UNICEF and partners have highlighted multiple nutrition challenges including a lack of sufficiently trained staff, low coverage of CMAM programs, hard to reach remote and Internally Displace People (IDP)communities, NGO staffing restraints, poorly skilled staff, surge staff that lack experience in CMAM. Concern Worldwide has started an intervention in one Zone in Somali and together with partners, Concern worldwide started to map out additional contribution to improve capacity and quality response to CMAM.
The request:
The Tech RRT CMAM advisor was requested in three phases:
Phase 1
- 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.
Phase 2
- To provide technical support and capacity building in Coaching and Mentoring capacity through both in-country and remote support to Concern Worldwide, Ethiopia.
Phase 3
- Following the coaching skills assessment that was carried out in February 2020, 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 incorporate 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 the 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.
- Conducted training and developed a training report following each visit with key issues identified and recommendations.
- Developed final deployment report.
Phase 3
- Shared and discussed coaching assessment results, and experience sharing with the team.
- Conducted a refresher training (in Addis) for supervisors and nutrition managers on the coaching skills approach with a focus on aspects identified during the assessment that require particular improvement.
- Reviewed 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.
- Developed an approach to continuously monitor and improve the implementation of the coaching approach.
Resources:
Requester:
Concern Worldwide
Background:
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)was 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.
The request:
In order to implement quality surveys, technical capacity strengthening was needed. CWW Ethiopia requested the Tech RRT 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).
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
Requester:
WFP
Background:
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 Infant and Young Child Feeding 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. 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 request:
The Tech RRT Remote Support was two-fold and happened in two different phases.
Phase 1
- to support the coordination of Maternal, Infant and Young Child Feeding in Emergencies (MIYCN-E) and
Phase 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 an inventory of resources reviewed (nationally and internationally)
- Developed MIYCN-E Capacity Assessment Report
- Developed recommendations for MIYCN coordination platform
- Developed MIYCN-E Recommendations Coordination documents which look at programmatic readjustments (nutrition specific and sensitive)
- Developed a 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
- Developed presentation slides on a 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 the importance of IYCF-E approach and demonstrating potential impact (2-3 pages) (Audience: government, partners and donors)
Resources:
Requester:
GOAL Ethiopia
Background:
A May 2018 multi-sector assessment highlighted significant humanitarian need, particularly in environmental health, hygiene and sanitation in Deder woreda which has a population of 314,935. The nutrition situation in the area is exacerbated by overcrowding and internal displacement on the Somali-Oromia border. The under-five population is estimated at 16.4%, with a birth rate of 3.4%. The prevalence of malnutrition for infant under 6 months is not known. However, a survey conducted for children under 5 years in October 2009 and October 2013 showed Global Acute Malnutrition (GAM) fluctuating between 5.2% and 10%. In March 2017 screening showed a GAM of 3.8% in children 6-59 months. Since that time there has been civil unrest affecting access to health facilities in many rural communities. Given the persistent vulnerability of the woreda area in terms of food insecurity, high birth rate, limited focus on maternal nutrition and Infant and Young Child Feeding (IYCF), lack of preventative nutrition interventions and instability, it was needed for management of malnutrition for under 6 months using MAMI approach.
The request:
Despite a dedicated Management of at-risk Mothers and Infants (MAMI) Advisor at GOAL Ethiopia, the position was new with little experience in MAMI. Therefore, GOAL Ethiopia requested technical support from Tech RRT MAMI Advisor to support and transfer knowledge to GOAL’s MAMI Advisor and to develop high-quality training materials for use in the RCT.
Key achievements:
- Developed 3 MAMI modules for the MAMI training package for MAMI RISE RCT.
- Developed MAMI orientation package.
Requester:
AAH
Background:
The humanitarian situation in the Tigray Region was a deep concern for refugees. The ongoing conflict displaced more than 21 million people and left more than 5.2 million people in need of food and other humanitarian assistance. Malnutrition among young children and breastfeeding women was a major concern despite that humanitarian response is facing increasing threats and security risks. The ongoing conflict on the other hand, has hindered timely collection of nutrition data to inform response programs as well as advocacy. Humanitarian workers were moved to safer places, worsening data collection such that there were no nutrition assessments conducted in the Northern part of Ethiopia. The little fainted nutrition data gathered indicates that 76,363 children in Tigray Region were screened with proxy Global Acute Malnutrition (GAM) and Severe Acute (SAM) Malnutrition prevalence of 25.7% and 2.7% respectively. However, the data lacked credibility because it was not gathered by experts.
The request:
Due to the increase in humanitarian nutrition partners and more financial resources allocated in response to Tigray there was a need to assess the nutrition situation. The TST advisor was requested to support nutrition data collection to understand the severity of the nutrition situation.
Key achievements:
- Conducted capacity mapping assessment exercise targeting 31 participants from 12 organisations.
- Developed a capacity assessment report
- Developed a guidance note for the implementation of Nutrition Assessments in Northern Ethiopia
- Developed a draft NIS action Plan for Tigray
- Developed a survey proposal which was approved by FHI360, AAH and SCI
Resources:
Revised guidance note for implementation of nutrition assessment