United States Ambassador to Mozambique, Dean Pittman, and EFSP Manager, Dorance Cooper visiting WVM food distribution point in Bulawayo community, Moatize district, December 2017
U. S. Agency for International Development Bureau of Democracy, Conflict and Humanitarian Assistance Office of Food for Peace FY 2017 Annual Results Report/Final Report
July 26, 2016 – August 30, 2017
Submission Date: November 6, 2017
Awardee Name and Host Country World Vision, Inc. - Mozambique
Award Number AID-FFP-G-16-00093
Emergency Food Security Program - Activity Name Mozambique
Activity Start Date July 26, 2016
Activity End Date August 30, 2018
Submission Date November 6, 2017
Reporting Fiscal Year 2017
Awardee HQ Contact Name Seth Abu-Bonsrah
Awardee HQ Contact Address 300 I Street NE, Washington D.C. 20002
Awardee HQ Contact Telephone # 202-572-6435/202-629-7004
Awardee HQ Contact Email Address [email protected]
Graham Strong Host Country Office Contact Name National Director – World Vision Mozambique
Host Country Office Contact +258-843111332 Telephone Number
Host Country Office Contact Email [email protected] Address
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Table of Contents LIST OF ACRONYMS ...... 5 1. Introduction ...... 7 A. Award Summary ...... 7 B. Award Outputs ...... 8 C. Programing Performance ...... 13 Monthly Beneficiaries Caseload and Food Distribution (MT) ...... 19 Asset Creation ...... 19 Malnutrition Admission Trend Analysis of Therapeutic Feeding program (TFP) ...... 21 Therapeutic Feeding program performance Indictors ...... 23 Household Demographic Profile ...... 23 Time Taken at Food Distribution Points (FDPs) ...... 24 Food Consumption Scores (FCS) ...... 24 Household Dietary Diversity ...... 25 Coping Strategies Index ...... 26 Household Hunger Scale ...... 27 Complaints, Response and Humanitarian Accountability Mechanisms ...... 27 D. Market Analysis ...... 28 E. CROSS-CUTTING THEMES ...... 29 Gender ...... 29 Protection ...... 29 Environmental Protection ...... 29 F. CHALLENGES ...... 30 G. SUCCESSES ...... 30 H. LESSONS LEARNT ...... 31 I. VISITATION ...... 31 J. ANNEXES ...... 33
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
List of Figures Figure 1: Commodity Losses ...... 9 Figure 2: Quantity of Food Distributed ...... 16 Figure 3: Number of Children Screened ...... 17 Figure 4: Malnourished Children referred to health facilities ...... 17 Figure 5: Beneficiary Registration Time Line ...... 19 Figure 6:Trend of SAM in CU5 admitted to Therapeutic Feeding Program in Moatize district ...... 22 Figure 7: Trend of SAM in CU5 admitted to Therapeutic Feeding Program in Chiuta district ...... 22 Figure 8:Performance indicators of TFP in Tete province, Mozambique, June 2017 ...... 23 Figure 9:Household Demographic Data ...... 24 Figure 10:Food Consumption Scores (FCS) ...... 25 Figure 11:Price Trend for Commodities ...... 28
List of Tables Table 1: Commodities Received and Distributed ...... 9 Table 2: Program Indicators Plans and Achievements ...... 15 Table 3: Monthly Beneficiaries Caseload and Distribution ...... 19 Table 4: Assets Created ...... 20
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
LIST OF ACRONYMS ARR Annual Result Report
CHD Complaints Help Desk
CMAM Community Based Management of Acute Malnutrition
CU5 Children Under 5 CRM Complaints Response Mechanism CV Community Volunteer DIP Detailed Implementation Plan EFSP Emergency Food Security Program EIA Environmental Impact Assessment FCS Food Consumption Score FDP Food Distribution Point FEWSNET Food Security Early Warning Systems Network FFA Food For Asset FFP Food For Peace FH Food for the Hungry Association FMC Food Management Committee FPMG Food Programming Management Group FSC Food Security Cluster GAM Global Acute Malnutrition GoM Government of Mozambique IEC Information Education and Communication INGC National Institute of Disaster Management IPC Integrated Food Security Phase Classification HCT Humanitarian Country Team HDDS Household Dietary Diversity Score HEA Humanitarian Emergency Affairs
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
HF Health Facility HH Household LMMS Last Mile Mobile Solutions MAM Moderate Acute Malnutrition MIYCF Maternal Infant Young Child Feeding MoU Memeorandum of Understanding MT Metric Ton MUAC Mid Upper Arm Circumference NFI Non Food Item ODM Onsite Distribution Monitoring OTP Outpatience Therapeutic Feeding Program PDM Post Distribution Monitoring PLW Pregnant and Lactating Women RUTF Ready-to-Use Therapeutic Foods SAM Severe Acute Malnutrition SARO Southern Africa Regional Office SETSAN Technical Secretaruate for Food Secuirty and Nutrition SWALES Swaziland and Lesotho USAID United States Agency for International Development WASH Water, Sanitation & Hygiene WV World Vision WV Inc. World Vision United States WVM World Vision Mozambique
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
1. Introduction Mozambique is a country located in a region cyclically endangered by extreme natural events (floods, drought, tropical cyclones, earthquakes, and epidemics) which predominate in the months of October to March yearly. In 2016/17, the country faced one of the most devastating El Niño conditions in three decades, which affected an estimated 1.5 million people (SETSAN, March 2016). Through drought & intermittent floods, the El Niño caused food insecurity, increased food prices, livestock death and economic slow-down. There were also significant impacts on children, through food insecurity, heightened malnutrition and child protection concerns. The El-Niño induced drought during the 2015/2016 planting season had enormous repercussions in central and southern Mozambique. The Government of Mozambique (GoM) activated the institutional Red alert on 12th April 2016 to support national internal and external resource mobilization, this alert saw a scale-up in emergency WASH, agriculture and food assistance and nutrition interventions for affected communities in the Tete and Sofala amongst other provinces.
A. Award Summary In response to the food security crisis, WV Mozambique and Food for the Hungry Association (sub-grantee) implemented a United States Agency for International Development (USAID) funded Emergency Food Security Program (EFSP) with the strategic objective of addresssing immediate lifesaving food needs in target communities in Sofala and Tete provinces and promote early recovery through productive asset creation. The project objectives were to enable vulnerable households have improved food security and create livelihood assets, increase Food Consumption Scores (FCS), Household Dietatary Diversity Scores (HDDS) and strengthen the nutrition screening and referal systems using local government structures. This report covers the achievements of the EFSP over a period of 13 months from July 26, 2016 to August 30, 2017
The project initiated startup workshops that involved all staff, government officials and key stakeholders in both provinces. The teams discussed the program strategy, detailed implementation plans and general objectives of the grant. This was cascaded down to district and community levels and subsequently greatly aided the acceptance of the project by all stakeholders and targeted communities.
Upon completion of inception meetings, the project commenced beneficiary registration processes based on the approved Humanitarian Country Team´s (HCT) selection criteria. This process was participatorily undertaken with committed involvement of community and district leadership, it was done communally although in some instances house to house verification were undertaken to minimize on inclusion and exclusion errors. Persons who qualified as
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
beneficiaries were then subsequently issued with Last Mile Mobile Solutions (LMMS) cards detailing their demographic information and ration entitlements. These LMMS cards also signified that one was now an eligible beneficiary and the cards were used to distribute, receive and account for food resources all through the food cycles and the project implementation period.
B. Award Outputs By end date , the EFSP, had provided food assistance support to 29,797 vulnerable households (totalling to 131,348 individuals).
The project commenced the first food distributions in November 2016 with a food basket containing 40Kgs of Cereals and 6Kgs of Pulses per household per cycle. This food basket was later adjusted with approval from the HCT aimed at aligning cash and non-cash assistance programming and the need to increase the calorific intake to 1900kcal/person/day. The new ration that became effective on 1st March 2017 comprised of 60Kgs of cereals and 9Kgs of Pulses per Houeshold per month.
In Tete, the project reached 16,233 direct beneficiaries (HHs) which represented 24.8% of the population classified as food insecure in the province (either IPC3 or IPC4) whereas the 13,564 direct households reached in Sofala, denoted 20.9% of the total provincial households categorized as chronically food insecure. Of the total 29,797 households targeted, the project registered 55% female and 45% male beneficiaries. Overall, 77% of total registered beneficiaries were between the ages of 15 and 59, and 23% were 60 years and above. The project utillized the following targeting criteria to select project beneficiaries, which was primarily informed by approval and recommendaiosn from the Mozambican HCT. Households prioritized for program participation had to meet at least two of the below criteria:
. HHs with chronically ill or disabled persons; . HHs without access to land or other income sources; . Female-headed and child-headed HHs . HHs engaged in negative coping mechanisms such as selling productive Child headed persons; . Pregnant and Lactating Women (PLW) . Sick family provider with inability to work . HHs Without assets such as livestock (excluding poultry) . Chronicaly ill or disabled persons . Elderly persons caring for children
The targeted beneficiaries were identified, selected and subsequently registered in collaboration with the community leaders and WV and FH field staff. A total of 29,797 households (F=16,352 – 55%, M=13,445 – 45%) were selected and registered according to compliance with the selection criteria approved by the humanitarian country team.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
By grant end date, a total 7,983 MT (Cereals = 6,917.47) and Pulses (Yellow Split Peas=529.75 and Pinto Beans=535.78) food commodities were distributed to the registered vulnerable households in the five districts of Tete and Sofala provinces.
Commodity Planned Excess Losses Actual Actual Type Tonnage (MT) (MT) Receipts Distributed (MT) (MT) (MT) Cereals 7,150 5.402 237.93 6917.47 6917.47 Pulses (Yellow 550 0.121 20.37 529.75 529.75 Split Peas) Pulses (Pinto 540 0.170 4.39 535.78 535.78 Beans) Total 8,240 5.69 262.69 7983.00 7983.00 Table 1: Commodities Received and Distributed
Commodity Loss Types 160 140 120
100 80 MT 60 40 20 0 Port EDP to Vessel Wareh Wareh Loss by Distrib FDP Loss by shortla ouse ouse Dispos ution Total Transit Theft nding Transit Losses al Losses Loss Losses MT 96.25 5.914 0.6 21.602 0.55 138.308 0
Figure 1: Commodity Losses A total of 162 community sensitization meetings were conducted across the 99 Food Distribution Points (FDPs) during the project implementation period. In these meetings, the participants were informed about the objective of the project, identity of donor, duration of the grant, beneficiary’s criteria selection, food basket and accountability mechanisms. A total of 99 Food Management Commmittees (FMCs) and 99 Complaints Handling Committees (CHDs) were created and, that included 47 for Tete province and 52 in Sofala, respectively. The food
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
management committees were charged with the responsibility of crowd control, setup of FDPs, spaces for pre-address, guided food distribution processes, offloadings and stacking of food commodities and oversaw beneficiaries orderliness during food sharing procedures. The accountability committees also supported the program in receipt of beneficiary´s complaints, record, resolution and provision of feedback. In Tete province, 6 cycles of food distributions were completed during the program implementing period. However, in Sofala only 5 cycles were completed due to logistical issues, localized insecurity that curtailed early beneficiary registration and late arrival of food to the main warehouse in the province. A total of 880 food distributions were carried out over the project implementation period across the two provinces.
The nutritional status of children under 5 years of age were drastically affected by the food crisis and the level of acute malnutrition (GAM) rate was estimated more than 15% by SETSAN in April 2016 in drought affected provinces including Tete and Sofala. A deteriorated malnutrition situation was also predicted during the hunger season between November 2016 and March 2017. Hence, the project was implemented to save lives and avert complications of malnutrition through strengthening nutrition surveillance activities, provide technical and logistics support and build the capacity of district health offices to plan for emergency nutrition responses. Nutrition screening of children 6 to 59 months of age and PLWs were integrated with food distribution. Mothers and caretakers were counselled to bring their children along to food distribution points and the project team undertook screening using MUAC tapes. Afterwords, children identified as malnourished were stabilized by 10% sugar water at food distribution points and then immediately referred to health facility. Overall, a total of 24,820 (F = 12,563; M = 12,257) children under 5 years of age screened for acute malnutrition using MUAC tapes at food distribution points and house to house visits by community volunteers. A total of 1,559 (F = 795; M = 720) children were identified with different form of acute malnutrition in Tete and Sofala provinces. Three hundred seventy nine 379 (F = 198; M = 181) children had severe malnutrition and 1,170 (F = 597; M = 573) were moderately malnourished. The project inserted the screening the data into LMMS (Last Mile Mobile Solution) on monthly basis. Additionally, active nutrition surveillance activities of malnutrition cases were carried out at home to home visits by community volunteers who were trained on MUAC screening, odema identification and MIYCF counselling. The project also managed to screen a total of 4,494 Pregnant and Lactating Women (PLW) across the five districts. Of the total mothers screened 192 (4.3%) were identified with Moderate Acute Malnutrition. There were no SAM cases.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
The project also provided technical support for health facilities and mobile brigades. Mobile brigades were supported and trained to conduct MUAC screening and to identify, refer and follow up on malnutrition cases. Mobile brigades comprised a team of three to four nurses who were established by the district health offices to provide outreach services to far-to-reach communities. Additionally, the project supported a total of 26 health facilities with anthropometric equipment and basic outpatient and stabilization centers materials such as thermometer, plastic bucket, basin for washing clothes, bleach, file box and plastic envelope, measuring Jag (1000ml), plastic bucket 3 different color -red, blue & green and others.
Delivery of basic stabilization centers materials and anthropometric equipment in Kazula health facility, Chiuta district, Tete province
A total of 279 livelihoods assets were established, completed and handed over to communities for sustained management and utilization across the target districts and these included; 39 farm to market access roads, 210 farmland, 10 Mini dams, 2 Fish Ponds, 12 Water wells, 5 Water Pumps rehabilitated and 1 Apiary farm established. An assortment of 11,557 non food items (NFI) and construction kits for asset creation were procured and distributed to work team in all targeted communities. These tools included Hoes, Pangas, Machetes, Wheel barrows, Rakes and Spades.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Moatize District Administrator cutting tape during inaugauration of WVM staff visiting a farm group in Nhantumbe community, Chiuta district, the Maligoli water catchement in Maligoli community, Moatize Tete district, Tete
As part of the branding strategy, USAID banners were displayed at food distribution points, nutrition screening places and asset creation sites. These were appropriately worded and visible on plycards for communities benefiting from the project. Signposts were produced clearly indicating the identity of the donor, implementing agencies, communities´ name and the type of livelihood assets created. Information Education and Communication (IEC) materials such as banners, Vests, Caps, T-shirts, roll-ups, stickers (placed on motorcycles, laptops & bags) were also clearly marked with USAID logo. Commodity Warehouses, tools including workshop materials and IEC materials which beneficiaries receive were also adequately and correctly branded. The project secured a two month and a week No Cost Extension (NCE) that was largely attributed to the late in-country arrival of food commodities. As per the signed donor agreement, food commodities were slated to arrive by September for distributions to commence in October 2016 and run through to April 2017 (7 cycles). However, the first shipment of commodities arrived in late November, consequently delaying the start of distributions by two and a half and three and a half months for World Vision (WV) and Food for the Hungry (FH) respectively. This delay, coupled with the late grant start-up, environmental challenges and political conflicts in some areas especially in Sofala province justified the project´s request to extend the original grant agreement to August 31, 2017. Both organizations reviewed their budgets and concluded that cost savings would allow them to complete activities without necessitating additional funding from USAID. This extension enabled the project to complete and handover of livelihoods assets, achieve nutritional activities targets and fine-tune implementation of under-achieved targets that subsequently ensured the translation of intermediate results and outputs into tangible and sustainable outcomes.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
C. Programing Performance
The table below provides details of planned and actual achievements with following relevant narratives as per the performance indicators outlined for the project.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Indicators Participants Planned and Actual Achievements Unique Partici Oct Nov Dec Jan Feb Mar Apr May Jun Jul pants
Gender Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual Planned Actual # of abled bodied people 5,15 5,1 9,53 9,53 13,9 13,95 14,1 14,14 14,74 14,74 M 0 0 0 0 0 0 0 0 0 0 registered by the end of the 7 57 4 4 56 6 48 8 9 9 project 6,12 6,1 10,8 10,8 14,1 14,11 14,4 14,47 15,04 15,04 F 0 0 0 0 0 0 0 0 0 0 5 25 23 23 14 4 74 4 8 8 # of direct beneficiaries 3,17 3,17 36,8 36,85 58,9 58,93 34,04 34,04 33,70 33,70 46,00 46,00 49,92 49,92 M 0 0 0 0 received food rations monthly 5 5 57 7 36 6 2 2 9 9 2 2 4 4 3,64 3,64 36,1 36,18 34,1 34,10 32,19 32,19 36,32 36,32 48,96 48,96 54,53 54,53 F 0 0 0 0 1 1 82 2 04 4 8 8 1 1 7 7 5 5 # of children screened for acute malnutrition M 0 0 930 0 930 150 930 632 930 1,208 930 1,776 930 1,801 930 2611 930 2,825 930 1,254
100 100 100 F 0 0 0 1007 0 562 1007 1,423 1007 1,639 1007 1,980 1007 2,753 1007 2,939 1,267 7 7 7 # of malnourished children 6-59 M 0 0 19 0 19 0 19 39 47 78 47 55 47 133 82 236 82 115 82 64 months referred to Health Facilities (HF) for treatment F 0 0 21 0 21 0 21 42 50 89 50 73 50 154 89 242 89 111 89 84 # of moderate malnourished M 0 0 0 0 3 13 17 40 65 29 14 (SAM) children identified F 0 0 0 0 4 11 17 43 77 27 19 # of Severe malnourished M 0 0 0 0 36 65 38 93 171 103 67 (MAM) children identified F 0 0 0 0 38 78 56 111 165 84 65 # of Pregnant and Lactating F 0 0 200 0 200 0 200 213 215 212 215 348 215 1,191 230 860 230 969 230 701 Women (PLW) screened # of PLW identified F 0 0 35 0 35 0 35 16 24 11 24 18 24 38 13 34 13 51 13 24 malnourished and referred # of community Volunteers M 0 0 29 0 29 42 29 15 30 0 30 0 30 60 0 0 0 0 0 0 trained on Maternal Infant and Young Child Feeding (MIYCF) F 0 0 31 0 31 27 31 28 33 0 33 0 33 59 0 0 0 0 0 0 and nutrition screening # of PLW referred to HF for F 0 0 35 0 35 0 35 16 65 11 65 18 65 38 95 34 95 51 95 24 technical counseling on MIYCF # of PLW and caregivers receiving nutrition counseling by F 0 213 200 213 200 0 200 0 215 212 215 348 215 1043 230 4599 230 749 230 353 community volunteers # of children 6-59 months, PLW F 0 0 21 0 21 0 21 5 112 58 112 77 112 128 155 115 155 137 155 61 referred to HF admitted to nutrition support within 48 M 0 0 19 0 19 0 19 6 104 39 104 62 104 98 143 136 143 102 143 44 hours # of children 6-59 months who F 0 0 21 0 21 0 21 5 80 58 80 77 80 128 103 101 103 119 103 58 are prescribed treatment received 1 home visit by a community volunteer within 1 M 0 0 19 0 19 0 19 6 74 39 74 62 74 98 95 128 95 94 95 36 week of starting treatment # of MT of food distributed at the 80.7 80.7 657. 657.9 1,37 1,317. 718.3 718.3 1.120. 718.3 2.055. 1.623. 1629. 1850. 545. 545.28 0 0 0 0 end of the project 20 20 990 90 8.01 14 90 90 077 90 993 483 696 449 288 8 # of of assets were built by the end ------170 136 50 68 56 67 08 08 - - - of the project
Table 2: Program Indicators Plans and Achievements
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Overall the project managed to enable 29,797 households access food assistance across the two provinces. A total of 131,348 beneficiaries were reached with food assistance (Men=23,313, Women=31,056, Girls=37,057 and Boys=39,922).
Quantity of Food Commodities (MT) Distributed Monthly
1,200.00 1,000.00 800.00
600.00 MT 400.00 200.00 - Nov, Dec, Jan, Feb, Mar, Apr, May, Jun, 2016 2016 2017 2017 2017 2017 2017 2017 Tete 80.72 527.7 841.1 718.3 868.4 1,088 665.9 63.88 Sofala - 130.2 357.9 - 158.1 577.6 1,184 348.7
Figure 2: Quantity of Food Distributed
Overall, a total of 24,820 (F = 12,563; M = 12,257) children under 5 years of age were screened for acute malnutrition using MUAC tapes at food distribution points and house to house visits by community volunteers. In Tete province, 19,828 (F = 10,002; M = 9,826) children were screened by World Vision. Likewise, in Sofala province 4,992 (F = 2,561; M = 2,431) children were screened by FH. Number of children under 5 years of age screened for acute malnutrition from October 2016 to June 2017 in Tete and in Sofala provinces, Mozambique 8000
6000 WV
4000 FH Aggregate 2000
Number of children of children Number Target 0 Oct Nov Dec Jan Feb Mar Apr May Jun
Figure 3: Number of Children Screened
In line with the number of children screened, acute malnutrition case identification has been enormously increased between November and April and peak of acute malnutrition cases occurred in April. Then, it was progressively ascending in May and June. The prevalence of acute malnutrition during this period was in agreement with the findings of food security and nutrition assessment report that showed acute food insecurity situation and acute malnutrition was critical in majority of the surveyed provinces in the period of March and April 2017. This was therefore typical of Mozambique where food is scarce between October and April every year.
Number of acutely malnourished children under 5 years of age detected and referred to health facility from October 2016 to June 2017 in Tete and Sofala province, Mozambique, 2017
600 500 400 MAM 300 SAM 200 Total 100
Number of of children Number 0 Oct Nov Dec Jan Feb Mar Apr May Jun
Figure 4: Malnourished Children referred to health facilities
A total of 1,515 (F = 795; M = 720) malnourished children were identified with different forms of acute malnutrition in Tete and Sofala provinces. Three hundred and seventy nine (F = 198; M = 181) children were having severe forms of malnutrition and 1170 (F = 597; M = 573) with moderate malnutrition. In Tete province, 1063 (SAM = 255; MAM = 808) malnourished
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
children had been identified and referred to health facilities by WV. Similarly, in Sofala, 452 (SAM = 124; MAM = 328) malnourished cases identified and referred by FH.
Out of the total of 1,515 cases referred, 70.5% (1068) of children were admitted to health facilities for nutritional treatment within 48 hours. Additionally, 90.5% (1009) of children who were prescribed treatment received at least 1 home visit by a community volunteer within 1 week of starting treatment. Hence, this has generally been a great achievement comparing with the first and second quarters that cases were able to be followed strictly at health facility level and home visits.
Likewise, in both provinces, pregnant and lactating women (PLWs) were also screened for acute malnutrition at food distribution points and house to house visits by community volunteers. By grant end, a total of 4,494 PLWs were screened using MUAC tapes. Out of these, 192 moderately malnourished PLWs; 150 in Tete and 42 in Sofala province were identified. Accordingly, all of them had been referred to health facilities for nutrition support as well as for infant and young child feeding counseling.
A total of 231 community volunteers (180 in Tete; 51 in Sofala) were trained in screening, odema identification, Maternal infant young child feeding and counseling and community mobilization techniques and deployed to their local community by WV and FH. Additionally, a total of 8 bicycles had been given to 8 community promoters in geographically dispersed and far-to-reach communities to fasten and facilitate the screening and counseling processes. As a result of this, a remarkable achievement was recorded by community volunteers. In addition to screening of children and PLWs, community volunteers were able to counsel an aggregate of 7,517 PLWs and caregivers of malnourished children - 1,709 in Sofala by FH and 5,808 in Tete by World Vision.
During the project period, 92% (213) of community volunteers submitted complete monthly MIYCF and MUAC data for all their target households. During the handing-over of the nutrition activities to district health offices, the project team emphasized the need to maintain the momentum of community volunteers´ activities and their complete lists had been given to districts for regular supportive supervision to ensure sustainability. The project provided a two days training for 21 health workers on management of acute malnutrition. Colleen Emary, Senior Emergency Nutrition Advisor from the Global Nutrition Excellence Center visited the project and delivered a three-day training for nutrition staff on CMAM database.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Monthly Beneficiaries Caseload and Food Distribution (MT) Beneficiary Caseload Food Distribution (MT) Month/yea Gender Planned Achieved % Commodit Planned Achieved % r y Nov-16 Male 22,480 3,175 14% Cereals 649.320 80.720 12.4% Female 32,349 3,641 11% Pulses N/A N/A N/A Dec-16 Male 22,480 36,857 164% Cereals 649.320 657.990 101.3% Female 32,349 36,182 112% Pulses N/A N/A N/A Jan-17 Male 56,687 58,936 104% Cereals 1,108.88 986.800 88.9% Female 81,574 64,104 79% Pulses 269.13 212,286 78.8% Feb-17 Male 27,668 34,042 123% Cereals 649.32 637.360 98.1% Female 39,815 32,198 81% Pulses 97.398 82.030 84.2% Mar-17 Male 23,953 33,439 140% Cereals 973.980 1,163.020 119.4% Female 34,469 36,322 105% Pulses 146.097 113.421 77.6% Apr-17 Male 51,440 46,002 89% Cereals 1,787.82 1,353.286 75.6% Female 74,023 48,967 66% Pulses 268.173 270.197 100.7% May-17 Male 37,407 49,924 133% Cereals 1,417.62 1,623.084 114.5% Female 53,829 54,535 101% Pulses 212.076 250.732 118.2% Jun-17 Male 28,469 28,469 100% Cereals 407.416 407.416 100% Female 32,287 32,287 100% Pulses 137.872 137.872 100% Table 3: Monthly Beneficiaries Caseload and Distribution
Beneficiary Registration Timelines 35,000 30,000
25,000 20,000 15,000 10,000 # HHs HHs Registered # 5,000 - Nov,16 Dec,16 Jan,17 Feb,17 Mar,17 HHs Registered Planned 29,797 18,515 9,440 1,727 1,175 HHs Registered Actual 11,282 9,075 7,713 552 1,175
Figure 5: Beneficiary Registration Time Line
Asset Creation The project partnered with district technical teams and effected environmental impact assessments (EIA) for all livelihood assets. This process ensured that all potential negative impacts associated with creation of intended assets were ascertained and mitigation measures outlined before start of any activity. Planned assets that did not meet the requirements of
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
environmental conservation were not implemented. This approach was greatly appreciated by the provincial leadership, district teams and beneficiaries greatly aided active participation in the initiation, implementation, construction, completion and eventual ownership and sustainability of created assets. Memorandum of Understanding (MoUs) were signed with targeted communities and Work norms created and jointly consented to by beneficiaries. Work register books were provided to all asset sites and beneficiaries participating in weekly asset creation were tracked and accordingly used to inform eligibility for monthly and subsequent food distribution.
Month Type of Asset # Planned Actual % Completion Completed March, 2017 Market Access Road 20 10 50% Farmland 150 126 84% April, 2017 Farmland 40 63 157.5% Water Wells 10 5 50% May, 2017 Market Access Road 19 29 152% Farmland 20 21 105% Mini dams 7 7 100% Fish Ponds 2 1 50% Water Wells 7 7 100% Apiary (Bee Keeping) 1 1 100% June, 2017 Mini dams 3 3 100% Water Pumps Rehab 5 5 100% Table 4: Assets Created
FFP Officer and EFSP Response Director during the visits to food distribution center and the activities in Maligoli community, Moatize district
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
A completed mini dam in Maligoli community in Moatize district
Malnutrition Admission Trend Analysis of Therapeutic Feeding program (TFP)
A total of 26 health facilities were supervised by the project team. The whole processes of therapeutic feeding services were routinely monitored using standardized quality monitoring checklist. A detailed trend analysis of health records in these health facilities unfolded interesting findings. In Moatize district, it was observed that severely malnourished children (SAM) admissions to therapeutic feeding programs (TFP) enormously increased by 192 % (98 in November as compared to 286 in December) and showed a decreasing trend by 65% (100 in Jan and 286 in Dec) in January 2017 and then increased 58% (158 in Feb vs 100 in Jan) in February. Then, for the next four consecutive months, it exhibited a stable admission. On the other hand, in Chiuta district, the trend followed a different admission fashion during the first four months where, SAM admission massively increased by more than 300% in Feb (405 in Feb vs 101 in Jan) and then showed a declining trend in March by 11% (361 in March vs 405 in Feb). Then it showed a relatively stable admission tendency in the next three consecutive months which was similar to what has been observed in Moatize district. See figure 3 and 4.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Admissions, Exits and number registered in SAM programme, Moatize district, Mozambique , 2017 400
300
200
100
Number of of Number 0 11 12 1 2 3 4 5 6 Month
ChildrenAdmissions Exits & ChildrenAdmissions Total Admissions Total Exits
Figure 6:Trend of SAM in CU5 admitted to Therapeutic Feeding Program in Moatize district
Admissions, Exits and number registered in SAM programme, Chiuta district, Mozambique, 2017 500
400
300
200
100
Number of of Number 0 12 1 2 3 4 5 6 Month Total Admissions Total Exits ChildrenAdmissions Exits & ChildrenAdmissions Figure 7: Trend of SAM in CU5 admitted to Therapeutic Feeding Program in Chiuta district
From these TFP admission trend analyses, the project inferred that active case finding, referral and community mobilization activities, despite its irregular pattern, were performed intensively. As a result a substantial number of severely malnourished children were identified, referred and admitted to health facilities. Hence, it was implicit that significant number of children were reached and brought to the services and hence complications and deaths from malnutrition were able to be averted during the first phase of the project implementation.
Additionally, the trend analysis also indirectly indicted the resultant effect of community volunteers. Hence, once they had been trained and deployed to their local community, SAM admissions trend went stable due to a smooth active case finding, referral and community mobilization.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Moreover, the admissions exhibited a shrinking tendency in the last three months from April to June 2017. This was attributed to the onset of harvest season in majority of the districts when food availability had greatly improved.
Therapeutic Feeding program performance Indictors
Similarly, performance indicators were entered in to CMAM database for further analysis to monitor quality of nutrition services. The standardized program monitoring chart were generated from the database had showed that the quality of treatment had tremendously improved. The cure rate oscillated between 80% and 100% within an acceptable range. Likewise, death of malnourished children were also considerably averted and greatly decreased from three deaths (7%) in February to only one death (4%) in June 2017. On the other hand, number of children defaulting from the program slightly increased from 2% in March to 4% in June 2017. This was attributed to the fact that mothers or caretakers of malnourished children might have been busy to bring their children to treatment centers following the onset of the crop harvest seasons. See figure 8 below.
Standard Programme Monitoring Chart, TFP, Tete province, Mozambique, 2017 100
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Figure 8:Performance indicators of TFP in Tete province, Mozambique, June 2017 The project also provided a transport and logistical support of 339 cartons of nutrition supplies (F-75, F-100 and RUTF) to different health units within the target districts.
Household Demographic Profile The data collected during the last Post Distribution Monitoring (PDM) in May indicated that 62% of the respondents were females and 38% were males. The average age of the household head was 23.4 years. A total of (77.2%) of the household head are adults aged between 18 to 59 years old, 0.1% were young and 22.3% are elderly (+60).
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Figure 9:Household Demographic Data
Time Taken at Food Distribution Points (FDPs) PDM findings showed that sixty four percent (64%) of the respondents travelled for about 1 hour or less from their home to reach the FDPs. 20% took between 1 to 2 hours, 5% took between 2 to 3 hours, and 8% could not precisely recollect the time taken to reach FDPs.
Food Consumption Scores (FCS) The average FCS was 38 indicated by 55% of the beneficiaries interviewed. The FCS varied across the different districts: Dondo was the district with the highest acceptable FCS, followed by Chifunde, Chiuta and Moatize, which were also with an acceptable, while Caia the district with worst FCS. This can be justified by the fact that Caia district recorded a great effect of prolonged drought that affected farming opportunities and exposed families to extended hunger at alarming levels, compared to the other districts. NB: For detailed results see annex 4
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Figure 10: Food Consumption Scores (FCS)
Household Dietary Diversity The most consumed food items over the past 7 days were cereals (92%), pulses (86%), vegetables (83%) and milk was the least consumed food item (5%). The majority of the respondents reported that the main source of food was through food aid from World Vison/ Food for Hungry (41%), while own production (30%), and market purchasing (29%). Most of the food items were food aid with pulses most received (51%) from respondents, and cereals (47%). On the contrary, majority, 83% of the households obtained vegetables from own farm production and tubers at 43% from own production. Meat, milk group, sugar, salt and oil were the food most purchased at local markets. The figure below shows the percentage of households’ consumption for each food:
Figure 11: Food items most consumed in the households
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
From all food items consumed in the past 7 days, analysis indicated that 41% of that food was from food aid. This shows an increase from 39.7% on the food aid consumption on the households when contrasted with the situation at program inception. On the contrary, majority, 83% of the households obtained vegetables from own farm production and tubers at 43% from own production. Meat, milk group, sugar, salt and oil were the food most purchased at local markets. To 72% of the respondents, they took 0-1 hour from home to the market, while to 24% took 1-3 hours, and 4% (4-5 hours).
Coping Strategies Index The Coping Strategies Index is used to monitor food insecurity early warning. It measures the frequency and severity of household strategies of dealing with food insecurity. The negative coping strategies presented included limiting portion sizes at meal, reduction of meal portions and frequency, borrowing, gathering, consumption of less preferred food commodities, having food related debts, harvesting immature crops, sending members to relatives, begging and reliance on casual labor. Respondents were asked about the days in the past one (1) month where used any of the coping strategies listed above. The mean coping strategy index Score was recorded at 34.6, which indicates low level of food insecurity amongst interviewed households. According to the findings, there were remarkable decline in the food insecurity score when comparing the months of January/ February to April/May, as indicated by the decline in CSI index from 82.9 to 34.6 accordingly. The table below shows the most common coping strategies and percentage of households practicing each coping strategy.
Strategy % of Household Limited portion sizes at meal times 18 Reduced the number of meals per day 15 Skipped food consumption for an entire day 22 Borrowed food or rely on help from a friend or relative 39 Relied on less expensive or less preferred foods 36 Purchased food on credit 19 Gathered unusual types / amounts of wild food or hunt 25 Consumed immature crops 37 Restricted consumption of adults to allow more for children 32 Begged or engaged in degrading jobs 20 Relied on casual work 45 Sent household members to eat elsewhere 34
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Withdrew children from school 34 Reduce health care 46 Reduce agricultural and livestock inputs 45 Table 5: Percent of households using each coping strategy
Due to the improvement in the food security status of households, minimum negative coping strategies were initiated by households to address the problem of food unavailability. This trend is substantiated by the increment in food aid basket and trickling in of crop harvests from farmers own farms that augmented the supply obtained from WVM and FH subsequently enabling target households to improve their coping strategies.
The most five (5) common coping strategies across all districts were: reducing agricultural and livestock inputs, relying on casual work, borrowing food from friends or relatives and consuming immature crops. In contrast, reducing the number of meals per day, limiting portion size of meal, purchasing food on credit, begging or engaging in degrading jobs, and skipping food consumption for an entire day were the five (5) least practiced coping strategies. The percentage of households sampled mentioned they restricted food consumption by adults (both male and female) so that children can eat more reduced from 50% in January to 32% in May.
Household Hunger Scale In relation to the household hunger scale, 15% of the household reported that a household member go to sleep at night hungry because there was not enough food in the household, and 22% of household were a member go a whole day and night without aeting anything at all. The percentage of households sampled mentioned they restricted food consumption by adults (both male and female) so that children can eat more reduced from 50% in January to 32 in May. With this percents, the household are categorized as little to no hunger in the household (0-1), in contrary to the previous monitoring in which the household hunger was categorized as severe hunger in household (4-6).
Complaints, Response and Humanitarian Accountability Mechanisms The project established 99 Complaint Help Desks (CHDs) to increase the involvement of communities in the project and to ensure humanitarian accountability throughout the implementation period. The CHD numbered ten (10) persons per FDP with 60% female representation. The CRM was implemented in all districts covered by the program and considerably broadened beneficiaries perception of channels of submission and receipts of compliments, complaints and suggestions.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
D. Market Analysis The project conducted two market based food security and price monitoring surveys. The initial market assessment was conducted in Jnauary 2017 at the start of the first distribution cycle and the final assessment was undertaken in the month of May towards the final food distribution. The survey covered fourteen (14) regular food markets and these incuded; Luia and Chifunde Sede in Chifunde district, Mavudzi Ponte and Kaunda, in Chiuta, Cateme and Kambulatsitsi in Moatize, Chinamacondo Sede, Savane Sede and Milha 26 in Dondo. Other markets assessed were Caia central market, Beira bus station market, Sena rural market, Nhambalo market; Baixa market and Murraça Mission market in Caia district. During the final assessment, there was a general decline in prices of food commodities when contrasted with the prices in January, 2017 for Chifunde and Chiuta districts, Moatize recorded stabilization in the prices for most food commodities, while Caia and Dondo districts showed increments. Details are as indicated in the sampled districts of Caia and Moatize that are generally considered as buffer zones that normally influence and replenish stocks in neighbouring districts.
Price Trends Analysis for Common Commodities between January and May, 2017 250
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Figure 12:Price Trend for Commodities The general decline in prices across assessed markets was attributed to onset of the harvest season which resulted in relatively stable availability of the food products in the markets that World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
facilitated their access to nearby communities. With the current relative abundance of agricultural products in the markets, prices are forecasted to remain comparatively stable for next three months till end of September 2017, when stocks start to decline. However difficulties remain in transportation of commodities and products due to poor road network and weak infrastructure continually limits efficient distribution of crops harvests to areas that realized poor harvests resultantly contributing to high commodity prices in some selected markets and communities. NB: See detailed in attached Market and prices assessment reports
E. CROSS-CUTTING THEMES
Gender World Vision implemented and utilized inclusive community-based participatory planning approaches that ensured that women’s livelihood patterns were understood, and worked with the women in asset identification and creation. Food distributions were held at times and places that considered women’s household responsibilities and protection needs (e.g. not early in the morning when women are working on their farms but not too late that they will be required to travel after dark). WV promoted women’s participation in all aspects of the project, such as receiving food on behalf of their households. The community mobilization and gender sensitization sessions provided for distribution of food rations to women, even in cases where the male members of the household had worked on the assets project. The project also ensured that 60% of the Complaints Handling Committees and the Food Management Committes were women.
Protection The project ensured that the most vulnerable and needy beneficiaries received assistance. Safety of beneficiaries and staff was a focus by ensuring that timing and place of food distribution points are safe. The final PDM findings indicated that sixty four percent (64%) of the respondents travelled for about 1 hour or less from their home to reach the FDPs. 20% took between 1 to 2 hours, 5% took between 2 to 3 hours, and 8% could not precisely recollect the time taken to reach FDPs. This ensured that beneficiaries could travel safe, arrive in time, collect food and return to their homes safe.
Environmental Protection The project in partnership with district leadership conducted environmental impact assessments (EIA) and feasibility studies for all livelihood assets. This exercise ensured that all potential negative impacts associated with asset creation were identified and mitigation measures drafted well in advance before start of the activities. Sites that did not meet the minimum requirements and seem detrimental to aspects of environmental conservation were not implemented. This approach was greatly appreciated by the provincial leadership, district
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
teams and beneficiaries greatly aided active participation the initiation, implementation, construction, completion and eventual ownership and sustainability of created assets.
F. CHALLENGES • Late arrival of commodity in country lead to a delay in starting asset creation • Limited staff capacity in food programming at the start of the grant • Key gaps in the proposal design made it challenging in accomplishing some objectives (FFA vs FFW, no inputs like seeds, no nutrition supplement in the approved food basket) • Challenges in duty clearing processes and port clearances led to incurring large demurrage costs • Food for the Hungry faced delays in staff recruitment, along with cost sharing of PM with DFID grant, which impacted program start up • Insecurity in some parts of Sofala affected the pre-implementation assessment for program startup, such as operation space, availability of warehouses, commodity transporters • There was some resistance and non-acceptance by government officials leading to a delay in approving FFA activities • Delayed procurement of equipment like motorbikes affected smooth project registration and validation • Nutrition supplies shortages at health facilities, which lead the referral cases to not completing their actual visits for recovery of their malnourished children
G. SUCCESSES The Project implemented a conditional food for asset programming which enabled the provision of food assistance to alleviate immediate food needs while concurrently utilizsing the same food resources to build assets that aimed at strengthening long term resilience and self-dependency of target communities. This approach was greatly appreciated by the provincial leadership, district teams as well by beneficiaries and received great support and active participation in appropriate type of asset to be created after participatory completion of environmental impact assessment with proactive involvement of respective district local government technical teams. District agriculture technical supervisors actively engaged in supervision and backstopping all projects through the construction stages of the assets, benefitting communities contributed locally available materials and in some instances the local government provided items like seeds and trainings for establishment of vegetable gardens and farmlands. A case of this achievement is as contained in the attached successs story in the annex.
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
H. LESSONS LEARNT
• The program design lacked clear pathway of change under the nutrition component which led to uncomprehensive service provision to beneficiaries. • The bulk consignment received at the port presented immense handling challenges which led to delays, increased costs and losses. Poor port handling conditions further increased the costs of commodities transit to various warehouses. • Limited transportation services for mobile brigades to regularly visit communities affected provision of nutritional support leading to limited nutrition service delivery. (Mobile brigades were in design required to support referrals and follow up of malnourished CU5 and PLW). • Weak coordination with district authorities during design phase resulted into delayed onset of program implementation especially the beneficiary registration processes. • Specific key activities were under-budgeted which led to periodic budget re- alignment resultantly affecting smooth implementation of activities previously well budgeted for. • Challenges in processing and obtaining work and residency permits for international staff led to increased expenditure, lowered staff morale and affected smooth program implementation due to regular in and out of country movement by staff for VISA processing. • Unclear communication, coordination and reporting structure between the partners (WV & FH) created operational difficulties throughout the life of the program, slowed implementation and adversity in rolling out approved program approach and methodology.
I. VISITATION Visitor Details Month & Date (s) Purpose of Visit Mr. Dan Rurenza, Regional Commodities October 16, 2016 Technical visit and backstopping to FH Manager – FH implementing team in Sofala province. He was accompanied by WV EFSP Program Manager Mr. James Bedell, WVI Southern Africa November 15 – 29, 2016 Staff capacity building and mentorship on Regional Office, Senior Advisor – Food food programming and compliance. Greatly Programming Operations supported in receipt of first shipment of food commodities. Mr. Dean Pittman, US Ambassador to December 7, 2016 Visited Bulawayo FDP in Moatize district, Mozambique Tete province. On program acquaintance visit and interacted with beneficiaries, district and provincial level authorities
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Regional Food Security Technical Specialist – 12th January, 2017 Routine and visit and provided technical Food for the Hungry Association support to staff in areas of livelihood asset creation, he also visited food distribution sites and interacted with beneficiaries Regional Director – Food for the Hungry January, 2017 Routine and visit and also visited food Association distribution points and asset creation sites and interacted with beneficiaries Mr. Stephen Ongom Odur, WVI West February 13 – 27, 2017 Supporetd staff in training and capacity African Regional Food Programming Advisor building. Trained staff in livelihood asset creation, program review, compliance and effective reporting Ms. Precious Mubanga, Program February 7 – 9, 2017 Regular program review and implementation Management Officer World Vision Inc. visit. Compliance checks, she also visited field sites and food distribution points in Tete and Sofala provinces Mr. James Bedell, WVI Southern Africa March 06 – 12, 2017 Routine FPMG compliance visit, staff Regional Office, Senior Advisor – Food capacity building and mentorship on food Programming Operations programming and compliance. Greatly supported in receipt of first shipment of food commodities. WVI Regional Audit Teams March, 2017 Review of compliance and internal controls, undertook analytical review, physical inventory of finance, HR, food commodities, Asset creation and entire operation Mr. Dan Rurenza, Regional Commodities March 16, 2017 Regular Technical visit and backstopping to Manager – FH FH implementing team in Sofala province. He was accompanied by WV Emergency Response Director, Mr. Ventura Mazula Ms. Kaya Adams, FFP Officer, Southern March 16, 2017 Regular Technical support visit and African Region backstopping to project. She was accompanied by WV Mozqmbique ND Mr. Graham Strong and the WV Mozambiaue Emergency Response Director, Mr. Ventura Mazula. She visited food distribution sites and asset creation activities. WV Global Center, Senior HEA Directors April 27, 2017 Progress and site visits, the team lead by WV SARO regional HEA Director visited minindams construction site in Chiritse, Moatize district – Tete province Ms. Patience Kombani, FFP Officer, April 26, 2017 Monitor project progress and provided Southern African Region technical advise on livelihood asset creation initiatives. Mr. Dean Pittman, US Ambassador to May 16 – 18, 2017 Visited food distribution sites in Sofala and Mozambique inaugurated a completed water pump in Milha 12 community, in Dondo district. He was accompanied by WV Mozambique ND, Mr. Graham Strong
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017
Ms. Kaya Adams, FFP Officer, Southern June 27 – 28, 2017 Check on project close out processes, African Region interacted with staff and participated in incineration of damaged food commodities in Moatize district, Tete province Ms. Bagezile Dube, WV SWALES Quality June 12 – 16, 2017 Facilitated the final Lessons Learnt Event for Assurance Director and Ms. Josephine the EFSP project Mwale – WV Somalia DM&E Specialist
J. ANNEXES
EFSP Final_Market WV Mozambique LLE Survey May 2017.pdfMain Report_30th Jul
WV Moz EFSP DIP.xls WV Moz EFSP Logframe.docx
Video documentary Youtube Link https://drive.google.com/open?id=0B3yeTppzouIJY2RjRkJkRms 4VTg
World Vision Inc – Mozambique EFSP – FFP-G-16-00093 Date of Submission: November 6, 2017