UNICEF Cameroon Situation Report 25 June, 2012

Highlights  The Sahel regions of Cameroon suffered three overlapping years of devastating drought and/or floods. UNICEF is responding to the nutrition and food emergency, but still has a 58% funding gap which must be filled with urgency to meet the most important needs of children and women.  Significant increase in severe acute malnutrition cumulative admittances in one month, (from 18,012 in April to 29,376 in May).  More than half of the 2012 target of 55,000 SAM children has been reached. About 53 % (29,376) of Children under 5 with Severe Acute Malnutrition have been admitted to Therapeutic Feeding programs, and 19.87% (8,195) have recovered in the North and Far North regions of Cameroon.  As of 05 June, 2012 UNICEF is ready with the distribution of therapeutic foods in the two regions, consisting of 414 cartons of F-75, 1,229 cartons of F-100, 16,176 cartons of Plumpy nut, and 102 cartons of RESOMAL.  New partnership agreement signed on 06 June between the Ministry of Public Health (MOH), the faculty of medicine at Yaoundé University and UNICEF to deploy sixteen medical Residents in sixteen priority health districts of the two regions to reinforce the capacity of nutrition therapeutic centres and hospitals in managing severe acute malnutrition.  UNICEF continues to lead Nutrition Cluster at national level and together with the government has held regional nutritional cluster meetings on 18 June in Far North region and 20 June in the North region.  Since January 2012, 9 cases of cholera with zero deaths were reported in the North and Far North regions, compared to 101 cases with 2 deaths reported nationally. With the arrival of the rainy season, the season for cholera epidemics has also begun. UNICEF is partnering with the MOH for an on-going national cholera awareness and prevention campaign  Successful measles campaign conducted during the 15 epidemiological weeks has helped reduce number of measles cases from an average of 444 cases per week down to 152 cases per week l in both regions.  Communication for Development (C4D) training of 20 trainers was performed in Far North

Red color on the MUAC band shows Samana suffering from severe acute malnourishment. Maroua, Far North region of Cameroon, © UNICEF/2012/Jorgensen

1. Situation Overview and Humanitarian Needs

Two regions out of ten in Cameroon, with more than 6 million people, are affected by the Sahel crisis. The beginning of the response to this crisis, supported by UNICEF and its partners, gives hope that thousands of lives of children and women may be saved.

Estimated Affected Population From the Nutritional Crisis Sources: UNICEF Humanitarian Action Update June 2012 OCHA Humanitarian snapshot June 2012 Cameroon General Census 2010 Cameroon PEV 2012 Ministry of Health March 2012 Total Male Female Total Population in affected regions 6,897,000 3,397,761 3,499,239 Population estimated to be at risk of food and 350,000 n/a n/a nutrition insecurity Children Under 18 in affected regions 2,868,177 1,412,988 1,455,189 Children Under Five in affected regions 1,148,000 565,555 582,445 Children 6 to 23 months in affected regions 459,200 286,938 295,508 Pregnant women in affected regions 344,850 n/a 344,850 Children Under Five with Severe Acute Malnutrition 55,119 27,154 27,965 (SAM) Children Under Five with SAM and medical 5,512 2,715 2,797 complications Children Under Five with Moderate Acute 105,009 51,732 53,277 Malnutrition (MAM)

2. Inter-agency cooperation  To avoid duplication UNICEF and its partners, WHO and WFP, have harmonized nutrition training tools and planning for community management of acute malnutrition.  Bi-weekly coordination meetings were held between the Central Emergency Response Fund (CERF) funding recipients (UNICEF, WFP, WHO, and FAO). The CERF funded agencies have created a joint bulletin that puts focus on the supporting of inter-agency partnerships and provides support to joint advocacy efforts on the nutritional crisis.  In cooperation with UNICEF, WFP is implementing general food distribution in three sub regions (Zina, Goulfey and Hilé Alifa) in the Logon and Chari Department until September 2012. WFP started a food security survey jointly with the FAO in the same region on 4 June.  In cooperation with UNICEF, WHO has ordered medical supplies (complementing supplies donated by UNICEF) to be distributed in the nutrition therapeutic centres of the Far North and North regions of the nutritional emergency.  Part of UNICEF supplies are stored in WFP and UNHCR warehouses in Garoua and Kousseri.  FAO plans to vaccinate all sheep and goats of WFP’s defined beneficiaries of the Far North.  In order to harmonise the activities the community workers trained by UNICEF’s partner OFSAD have been shared with all the agencies.  WHO and the UNICEF Emergency teams are collaborating on training for community management of acute malnutrition and the Integrated Management of Neonatal and Childhood Illness (IMNCI).

3. Emergency response

3.1 Emergency Response. Nutrition

UNICEF & operational partners Estimated coverage North & Far North regions UNICEF Cumulative % of Target Target results ( #) Achieved Children <5 with Severe Acute Malnutrition 29,376 55,000 53.42% admitted to Therapeutic Feeding programs (Jan to May) Children <5 in Therapeutic Feeding Programmes of 8,195 41,250 19.,87% who have recovered. (Jan to May) List of UNICEF Operational Partners: Government, WFP, OFSAD (Organization of Women for Food security and Development).

MMXI MMXII 60000

50000

40000

30000

20000

Numberofadmissions 10000

Month Figure 1: Cumulative admissions of children under five in the SAM programme in Cameroon. Comparison between 2011 and 2012

 Despite the incomplete nutrition data from the health districts for April 2012, the table above shows that admissions for 2012 are well above those of 2011. It shows that more than half of the 2012 target 55,000 SAM has been reached. This is likely explained by the increase of the number of nutrition community workers trained - 600 are operational today whereas 8,000 are needed.Assessment of facilities including warehouses, hospitals (CNTI) and health centres (CNA) was carried out in 7 districts of North and 2 districts of Far North Region. This included a review of equipment and educational tools for patients and how health personnel can maximise sensitization at the community level.

UNICEF and Partners programming:  The community management of children under five, and pregnant and lactating women suffering from severe and moderate acute malnutrition, in existing health structures through CNA and CNTI, is ongoing in both regions. This collaborative effort involves community volunteers, health personnel and members of the community.  UNICEF has continued the placement of Ready to Use Therapeutic Food - RUTF and RESOMAL consisting of 414 cartons of F-75, 1,229 cartons of F-100, 16,176 cartons of Plumpy nut, and 102 cartons of RESOMAL, in the regions, in readiness for distribution: In the Far North region (277 cartons of F-75, 822 cartons of F-100, 10,818 cartons of plumpy nut, and 68 cartons of RESOMAL): In the North region (137 cartons of F-75, 407 cartons of F-100, 5,358 cartons of plumpy nut, and 34 cartons of RESOMAL).

 This distribution plan of RUTF will allow the forty three health districts in both regions to continue managing severe malnutrition cases and avoid the nutrition therapeutic centres to be out of RUTF supplies. To date, 60% of UNICEF need of plumpy nut has been covered.  The rapid dispatch of the RUTF and equipment, along with the WASH kits began between the 14 and 16 of May. The replenishing of stock at the health districts level is on-going.  In collaboration with Regional Health delegation and UNICEF, two trainings of trainers were held by Plan International in Poli on May 22 - 25, 2012 and in Yagoua on May 28 - 31, 2012. For each training twenty five health personnel were trained on community management of acute malnutrition. Each of the trainees is getting ready to train 125 community workers.  Two MOH Officers and the UNICEF data manager have travelled to Dakar to participate in training on SMART survey methodology to be conducted in July 2012.  CNA, CNTI and warehousing facilities in North and Far North Regions were visited by the UNICEF Emergency Team based in Maroua:  Storage facilities were advised on correct storage and monitoring of inventory and facilities.  Health clinics (CNAs) were advised on therapeutic food distribution as well as on training mothers in food preparation and on prevention of malnutrition.  Hospital wards (Maroua CNTI 1) for children suffering from severe malnutrition with complications were monitored on admission and discharge policies and practices.

Nutrition Cluster  The national nutrition cluster meeting was conducted on 31 May in Yaoundé. The cluster meeting discussed key nutritional points and updated the mapping table to clarify who is doing what, where and with whom.  Regional nutritional cluster meeting has been held in Maroua in the Far North on the 18 June and in Garoua in the North on the 20 June by UNICEF. In order to improve the nutrition data collection and avoid monthly missing data, the cluster suggested organizing the first joint supervision mission in the regions of Far North and North next month.

Training of local partners and training of trainers

Training dates / Place Trainees / how Training objectives Output many 2 TOT sessions planned 89 participants Provide trainers who Participants will train  Maroua (Far North) on consisting of will train community community volunteers 23 to 26 July heads of health volunteers on the in the management of districts and their community acute malnutrition in  Garoua (North) on 18 to assistants management of acute children below five, as 21 July (60 Far North and malnutrition. well as in pregnant and 29 North) lactating women. 43 training sessions (3 days 780 Community Training on community Work towards the each) in each health district volunteers (480 management of acute achievement of of North and Far North Far North and malnutrition national community regions will begin on 25 July 300 North region) management of acute and continue until 10 August. malnutrition targets. 4 training sessions planned; 220 health agents Management of acute Increased identification  2 in Mokolo (Far North) representing 43 malnutrition (Ministry and management of on 2 to 5 July and 6 to 9 health districts of Health, DSP , acute malnutrition in July (135 Far North DRSP, with UNICEF the community and 85 North). support)  2 in Garoua (North) on 25 to 28 June and 2 to 5 July.

2 training sessions planned 90 community Training on Essential Increased awareness for Maroua (Far North) and volunteers and Nutrition Actions. of Essential Nutrition

Garoua (North) for 25 to 29 health agents Actions. June. (47 in Far North and 43 in North) Yaoundé on 9 to 13 July 2 MoH officers SMART survey The next SMART and the UNICEF survey is proposed for YCS data the end of June / July manager

3.2. Emergency Response WASH UNICEF assisted the Ministry of Water Resources & Energy in completing the WASH Emergency Preparedness and Response System, Protocols and Tools, which are now ready for implementation prior to the annual cholera cycle in all 10 regions of Cameroon.

Distribution of WASH KITS A total of 9,000 WASH Kits have been delivered by UNICEF partners in the following Health districts as of 5 June. A WASH Kit contains; 1 bucket with lid, 1 cup 500ml, 1 cup 200ml, 5 pieces soap, 1 plastic kettle , Packet (2) of Aqua-tabs, Water testers (2 per district), Chlorine (45kg sack per district).

 North Region: A total of 3,728 WASH Kits are now being delivered at district level at Bibemi (435), Golombe (278), Guider (850), Figuil (330), Rey Bouba (380), Tcholliré (435), Poli (275) and Touboro (745). The WASH kits have been completely distributed. There is an urgent need of replenishment.

 Far North region: A total of 4,872 WASH Kits are now being delivered at district level at Kousseri (795), Goulfey (270), Mada (485), Makary (587), Guere (435), Kaele (485), Kar-Hay (485), Yagoua (950), Vele (190) and Maga (190). The WASH kits have been completely distributed. There is an urgent need of replenishment

 WASH Kits at the household level: A total of 1,654 WASH Kits have now beendelivered at household level at Kaele (282), Vele (154), Mada (133), Kousseri (43),Goulfey (98), Makary (361) and Maga (165).

Prepositioning of cholera supplies:

All the 18 targeted health districts in the North and Far North region received Chlorine HTH (45kg per health district), chlorine pool testing (2 per health district), and hand washing facilities (2 per health district) and communication tools as part of national cholera awareness and prevention campaign.

Estimated coverage UNICEF & operational partners North and Far North UNICEF Cumulative results ( #) % of Target Achieved regions Target Emergency affected population provided with 16,000 1,654 10.3 access to safe water Emergency affected population provided key 16,000 1,654 10.3 hygienic supplies Emergency affected population provided with 5000 2417 48.3 access to appropriately designed toilets List of UNICEF Operational Partners: Ministry of Public Health, Ministry of Water, CARE, Cameroonian Red Cross (CRC), International Medical Corps (IMC), Plan International.

Training of local partners and trainers  Far North Region: WASH training has been conducted with 11 local partners. Training has been completed in 12 health districts (Mokolo, Mogodé, Gueré, Kaelé, Maga, Velé, Kousseri, Goulfey, Makary, Mada, Yagoua and Kar-Hay).The 143 WASH local partners (64 health providers, 7 water technicians and 72 community workers) have been trained on the prevention of diarrheal diseases, cholera and malnutrition, use of WASH kits, water purification and monitoring of the WASH response at Community level. During the implementation of their activities, WASH local partners have mobilized and briefed 241 other community workers (64 in Vele, 100 in Kaele, 64 in Maga,13 in Yagoua) in charge of door to door education on WASH good practices .  North Region: 77 local partners trained from 28 May to 1 June targeting the 7 districts of Guider, Golombe Figuil Poli, Bibemi, Tchollire and Rey Bouba.

3.3 Emergency Response Health 3.3.1. Routine vaccination coverage (Expanded Programme of Immunization) From January to May 2012, the following rate of children aged 0-11 months was vaccinated:

Immunization North Far North

(DPT) diphtheria, tetanus and whooping cough 71,13% 83,94%

Poliomyelitis 73,19% 84,18%

Measles 75,45% 83,58%

3.3.2. Epidemiological surveillance  Measles cases have reduced after the measles campaign was conducted during the 15th epidemiological week in both the regions. From an average of 444 cases per week the number has come down to 152 per week. North region showed decrease from 247 cases to 42 cases and Far North reported reduction from 198 cases to 109 cases on average per week.  Both of the two Northern regions maintain high alert levels toward rise in epidemics. Epidemiological surveillance data for 23rd epidemiological week reported 01 case of bacterial meningitis in the health district of Guider and 03 cases of measles (all the three cases occurred among children who were not vaccinated during the immunization campaign)

3.3.3. Other activities:  Medical supplies: A consignment of 1200 bottles of 125 mg/5ml amoxicillin syrup, 57600 Rapid diagnostic tests (RDT) for malaria and 58,300 Artemisinine-based combination therapy treatments are being supplied to Health facilities of the two regions.  A training session of 49 new community volunteers on the integrated community care of current diseases among children (Malaria, Acute respiratory infections, diarrhea) and management of malnutrition, was held from 11 to 21 June in the health district of Pitoa, raising the number of trained community volunteers to 122 in the health districts of Lagdo and Pitoa, North region.

3.4 Emergency Response Education  Education cluster has been activated and a 6 months matrix of intervention of partners’ responses is being developed.  A rapid-assessment took place to evaluate WASH situation in 41 (Primary and Pre-Primary) schools in 8 nutrition priority districts in North and Extreme North Regions. A protocol for school data collection has been put into place at regional level to construct a system that monitors school attendance monthly, starting in September 2012.

 A complementary mission, to the rapid situational analysis performed in April, took place to prepare the implementation of two summer curricula: o Accelerated curriculum for re-entry of children who dropped out from Primary school o Accelerated preparatory curriculum for children who will enter Primary school without pre- primary experience).  Parental education and community discussions have been held in these critical areas to ensure high enrolment in these summer programs and to strengthen impact of it nutrition and health components.

4. Communications for Development (C4D) The first C4D Training of Trainers for the Far North Region successfully took place in Maroua 4 to 7 June. Taking part were 20 participants from local NGO and Government partners. These participants now form a pool of C4D trainers who will implement and train at the regional level. This program is to be expanded to the North Region in coming months.

5. Supply and Logistics

Total Value of Supplies in USD by Sector

Delivered to Delivered to Total Amount Total Amount In UNICEF Partners – Sector In pipeline* Partners -- Committed supply order Warehouse** Since Last Cumulative Report

Nutrition 2,223,262.13 435,000.80 0.00 1,230,899.48 992,362.65 836,375.71 Health 168,329.22 0.00 30,132.22 138,197.00 99,797.00 WASH 161,764.78 18,223.65 55,087.71 88,453.42 0.00 Cross- 8,472.00 8,472.00 Sectoral * In Pipeline defined as supply order raised, not yet in UNICEF Warehouse **Current inventory in Warehouse made up of previous SitRep figure (including pre-positioned stock) + new receipts in reporting period

6 Emergency Response Human Resources

The initial plan was to have two teams with a base in Maroua and Garoua, and each composed of specialists in Nutrition, WASH and Health. Due to the scarcity of human resources and insufficient funds, UNICEF has revised its strategy to only one office in Maroua, serving both regions. Currently, the team consists of eight professionals. Five of them are already in place in Maroua. However, four professionals of the team came as standby partners. Unfortunately, the duration of their assignment is short (between 4 and 6 months). Therefore, UNICEF will start looking for other professionals for their replacement.

UNICEF Humanitarian Staff positions Total Sectors Mobilized and in country 7 Emergency WASH Specialist (3) Emergency Nutrition Specialist (2) NOB Nutrition Data manager (1) C4D Specialist (1) Communication Specialist (1)

Not yet funded 6 Emergency Nutrition Specialist (1) Health Specialist (NOC) Supply Logistics Specialist Drivers (2), KAP survey L2 (Canceled) Locally Mobilized (In negotiations with 16 Agreement with Yaoundé university for local university) medical residents to support ongoing emergency response

7 Emergency Response Funding

Country Nutrition crisis Total needs for Funds received Funding gap, Funding gap, % 2012 (HAU) USD Cameroon 13, 183, 970 5, 506, 026 7, 677, 944 58%

UNICEF wishes to express its deep gratitude to all public and private sector donors for the contributions and pledges received, which have made the current response possible. UNICEF would especially like to thank National Committees and donors who have contributed ‘unearmarked’ funding, which comprised 14 per cent of the funds contributed. ‘Unearmarked’ funding gives UNICEF essential flexibility to direct resources and ensure the delivery of life-saving supplies and interventions to where they are needed most – especially in the form of longer-term and predictable funding and in strengthening preparedness and resilience building. Continued donor support is critical to continue scaling up the response.

Across Sahel, UNICEF received financial and material contributions from: Andorra, Australia, Canada, CERF, Denmark, Estonia, European Commission/EC, Finland, Japan, Netherlands, Norway, Republic of Korea, Spain, Sweden, United Kingdom, United States of America; and the Danish Committee for UNICEF, Finnish Committee for UNICEF, French Committee for UNICEF, German Committee for UNICEF, Hong Kong Committee for UNICEF, Iceland National Committee for UNICEF, Japan Committee for UNICEF, Netherlands Committee for UNICEF, New Zealand Committee for UNICEF, UNICEF Bulgaria, UNICEF-Chile, United Kingdom Committee for UNICEF, United States Fund for UNICEF.

Date of next SitRep : 23 July 2012

For further information, please contact Name: Ora Musu Clemens Hope Name: Zakari Adam Name: Laure Bassek Representative Deputy Representative Communication Officer Country Office: Yaoundé CountryOffice: Yaounde Country Office: Yaounde Country: Cameroon Country: Cameroon Country: Cameroon Telephone:+23722223182 Telephone:+23722223182 Telephone: +23722223182 Facsimile: +23722231653 Or +23779523052 Or +23775296971 Email:[email protected] Facsimile: +23722231653 Facsimile: +23722231653 E-mail: [email protected] E-mail: [email protected]