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Squeac Report Tana River County- Kenya July 2013

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Squeac Report Tana River County- Kenya July 2013 SQUEAC REPORT TANA RIVER COUNTY- KENYA JULY 2013 Acknowledgement International Medical Corps would like to thank everyone who made it possible for successful completion of coverage assessment whose findings are hereby presented. IMC would like to extend its sincere gratitude and indebtedness to the following actors for their support; . UNICEF for their financial support . CHMT Tana River County for their active participation in data collection . Community leaders for their facilitation during the data collection Special thanks go to IMC Nutrition and M & E Departments and all SQUEAC experts who took their time to review this document and offer their valuable contribution and technical inputs when called upon during the coverage assessment Page 1 of 37 Acronyms CHW- Community Health Workers CU- Community Unit DHMT- District Health Management Team FFA- Food for Assets GFD- General Food Distribution HINI- High Impact nutrition Interventions IMAM- Integrated Management of Acute Malnutrition IMC- International Medical Corps KFSSG- Kenya Food Security Steering Group MAM- Moderate Acute Malnutrition MOH- Ministry of Health MUAC- Mid Upper Arm Circumference NDMA- National Drought Management Authority OTP- Out patient Therapeutic Program OJT- On Job Training RUTF- Ready to Use Therapeutic Food SAM- Severe Acute Malnutrition SFP- Supplementary Feeding Program SQUEAC- Semi Quantitative Evaluation of Access and Coverage TBAs- Traditional Birth Attendants THPs- Traditional Health Practitioners UNICEF- United Nations Children’s Fund URTI- Upper Respiratory Tract Infection Page 2 of 37 Table of Contents Acknowledgement ........................................................................................................................................ 0 Acronyms ...................................................................................................................................................... 2 List of Tables ................................................................................................................................................. 4 List of Figures ................................................................................................................................................ 4 Executive Summary ....................................................................................................................................... 5 1. Introduction .............................................................................................................................................. 6 1.1 Background ................................................................................................................................... 6 1.2 Survey Justification ....................................................................................................................... 7 1.3 Objectives of the survey............................................................................................................ 7 1.4 Assessment area and Timing ......................................................... Error! Bookmark not defined. 2. Methodology ............................................................................................................................................. 7 2.1 Stage 1: Identification of Areas of Low and High Coverage ................................................................ 7 2.1.1 Monthly admission....................................................................................................................... 8 2.1.2. Admission trend in relation to disease and seasons ................................................................... 8 2.1.3 MUAC Admissions ........................................................................................................................ 9 2.1.4 Exits ............................................................................................................................................ 10 2.1.5. Defaulting .................................................................................................................................. 11 2.1.6 Program Documentation ........................................................................................................... 12 2.2 Qualitative information..................................................................................................................... 13 2.3 Tana River OTP Concept map............................................................................................................ 14 2.3 Stage 2: Confirming of hypothesis for Areas of low and High Coverage .......................................... 15 2.3.1 Small Area Study ........................................................................................................................ 15 Stage 3: Prior Development .................................................................................................................... 16 2.3.2. Wide Area Survey .......................................................................................................................... 18 Discussion.................................................................................................................................................... 21 Recommendations ...................................................................................................................................... 26 Appendices .................................................................................................................................................. 30 Page 3 of 37 List of Tables TABLE 1: RESULTS OF SMALL AREA STUDY .................................................................................................................. 15 TABLE 2:SMALL AREA STUDY ANALYSIS ....................................................................................................................... 15 TABLE 3:WEIGHING BARRIERS AND BOOSTERS ........................................................................................................... 17 TABLE 4: FINDING OF WIDE AREA SURVEY .................................................................................................................. 20 TABLE 5: SUMMARY OF FINDINGS ............................................................................................................................... 22 TABLE 6: RECOMMENDATIONS ................................................................................................................................... 26 List of Figures FIGURE 1: TANA RIVER COUNTY ADMINISTRATIVE STRUCTURES AND LIVELIHOOD -------------------------------------------- 6 FIGURE 2: ADMISSION OVERTIME TRENDS ------------------------------------------------------------------------------------------------- 8 FIGURE 3: ADMISSION TRENDS IN RELATION TO DISEASE AND SEASONS---------------------------------------------------------- 9 FIGURE 4: ADMISSION MUAC ---------------------------------------------------------------------------------------------------------------- 10 FIGURE 5: OTP EXITS ---------------------------------------------------------------------------------------------------------------------------- 11 FIGURE 6: DEFAULTING ------------------------------------------------------------------------------------------------------------------------ 12 FIGURE 7: DEFAULTING AND SEASONS ---------------------------------------------------------------------------------------------------- 12 FIGURE 8: FULLY FILLED OTP REGISTER ---------------------------------------------------------------------------------------------------- 13 FIGURE 9: PARTLY FILLED OTP REGISTER -------------------------------------------------------------------------------------------------- 13 FIGURE 10: BBQ ANALYSIS -------------------------------------------------------------------------------------------------------------------- 14 FIGURE 11: THE CONCEPT MAP -------------------------------------------------------------------------------------------------------------- 14 FIGURE 12: THE PRIOR ------------------------------------------------------------------------------------------------------------------------- 18 FIGURE 13: COVERAGE ESTIMATE ---------------------------------------------------------------------------------------------------------- 20 Page 4 of 37 Executive Summary International Medical Corps in conjunction with Ministry of Health conducted the first coverage assessment for OTP program in Tana River County. The main objectives of the assessment was to determine the program coverage, establish barriers and boosters for the OTP program, capacity build the MOH and IMC staff on coverage assessment using SQUEAC methodology as well as providing recommendations for future programming. This assessment was carried out in the entire Tana River County between 9th and 28th July 2013. SQUEAC methodology was used. Overall point coverage of 47.5% (34.5%-60.8%) was unveiled by the assessment, which was slightly below the 50% SPHERE standard for coverage in rural set ups Some of the barriers identified to affect the program negatively included; distance (due to the vastness of the county). This coupled with few, inconsistent and un- integrated outreaches became a big challenge in the implementation of the program. Shortage of staff (leading to absenteeism) was also noted as a major barrier that lead to the program being handled by CHWs. This made the CHWs concentrate in facility work which affected the case finding in the community. Other barriers
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