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Coverage Survey Report of World Vision Nutrition Programs in Luuq and Dolow Districts in South Central, Somalia

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Coverage Survey Report of World Vision Nutrition Programs in Luuq and Dolow Districts in South Central, Somalia COVERAGE SURVEY REPORT OF WORLD VISION NUTRITION PROGRAMS IN LUUQ AND DOLOW DISTRICTS IN SOUTH CENTRAL, SOMALIA. October – December 2016 TABLE OF CONTENTS Acknowledgements ii Acronyms iii Executive summary v 1.0 Introduction 1 1.1 Luuq and Dolow nutrition programs 2 2.0 Specific objectives of the survey 3 3.0 Investigation process 4 4.0 Findings 6 4.1 Stage 1: Routine program and qualitative data analysis 6 4.2 Stage 2: Hypothesis testing 11 4.3 Stage 3: Estimation of overall coverage 12 4.4 Discussion 18 4.5 Recommendations 22 Annexes 26 List of figures Figure 1: TSFP program admissions 6 Figure 2: MUAC at admission 6 Figure 3: Program response to context 8 Figure 4: Histogram of beliefs – TSFP 13 Figure 5: Prior estimate BayesSQUEAC – TSFP 14 Figure 6: Reasons for coverage failure –TSFP 16 Figure 7: Reasons for coverage failure - Luuq BSFP 17 Figure 8: Reasons for coverage failure – Dolow BSFP 17 Figure 9: Point coverage BayesSQUEAC – TSFP 18 Figure 10: Single coverage BayesSQUEAC – TSFP 18 List of tables Table 1: Luuq program monitoring data January – September 2016 7 Table 2: Luuq and Dolow BSFP admissions 2016 8 Table 3: Booster, Barriers Sources and Methods 9 Table 4: Small area survey findings – TSFP 11 Table 5: Synthesis of boosters and barriers 12 Table 6: Information for computation of required villages 14 Table 7: Wide area survey findings 15 Table 8: Likelihood coverage survey estimates 16 Table 9: Overall headline coverage estimates (Posterior) 17 Table 10: Review of uptake of Dolow 2015 SQUEAC recommendations 22 Table 11: Luuq and Dolow 2016 SQUEAC recommendations 25 Coverage survey report of the WV Luuq and Dolow nutrition programs, South-Central Somalia, October – December 2016. ii ACKNOWLEDGEMENTS The consulting team take this opportunity to extend appreciation to all persons to who contributed to the success of the Luuq and Dolow coverage investigations: • WFP for funding the coverage evaluation • WVSO staff for supporting the coverage survey: § Martin Busingye–M & E Coordinator, WV-Somalia § Florence Obura – Health and Nutrition Coordinator § Edward Mulindwa– Senior Commodities Officer, WV-South Central § Abdi Fatah Ali Issack – Project Officer § Mohammed Ibrahim Abdi – Health and Nutrition Officer § Aden Ahmed Abdullai – health and nutrition assistant, Luuq district § Bureka Ali Sheikh – M&E assistant officer § The entire Dolow and Luuq team • Abdikafi Abdullahi – WFP • Seynab Hussein – Nutrition Officer WFP. • Abdullai Arab- MoH focal point • Ahmed Mohammed Adullai –SRDA project officer • Aden Ahmed-CEDA project officer • Asma Ibrahim-CEDA project officer • The coverage survey emumerators • Luuq and Dolow communities. • The data collection teams Coverage survey report of the WV Luuq and Dolow nutrition programs, South-Central Somalia, October – December 2016. iii ACRONYMS ARI Acute Respiratory Infections AWD Acute Watery Diarrhoea BBQ Boosters, Barriers and Questions BNSP Basic Nutrition Services Package BSFP Blanket Supplementary Feeding CEDA Community Empowerment Development Action CMAM Community Management of Acute Malnutrition CMN Coverage Monitoring Network CHW Community Health Worker CNW Community Nutrition Worker CSB Corn-Soya-Blend FGD Focus Group Discussion FSNAU Food Security and Nutrition Analysis Unit GAM Global Acute Malnutrition IDPs Internally Displaced Persons INGO International Non-Governmental Organization IPC Integrated Phase Classification IYCF Infant and Young Child Feeding KII Key Informant Interviews MAM Moderate Acute malnutrition MCH/N Maternal Child Health/Nutrition MOH Ministry of Health MUAC Mid Upper Arm Circumference OTP Outpatient Therapeutic Program PLW Pregnant and Lactating Women RUSF Ready to Use Supplementary Food RUTF Ready to use Therapeutic Food SAM Severe Acute Malnutrition SC Stabilization Centre SQUEAC Semi-Quantitative Evaluation of Access and Coverage SRCS Somaliland Red Crescent Society SRDA Somali Relief and Development Agency TBA Traditional Birth Attendant TSFP Targeted supplementary Feeding Program UNDP United Nations Development Program UNICEF United Nations Children’s’ Fund WASH Water Sanitation and Hygiene WFP World Food Program WV World Vision Coverage survey report of the WV Luuq and Dolow nutrition programs, South-Central Somalia, October – December 2016. iv EXECUTIVE SUMMARY Background WV Somalia has been implementing nutrition programming as a component of an overall food security and resilience program implemented by WFP in partnership with different organizations in South Central Somalia in Luuq, Dolow, Balet Hawa and Elwak districts in Gedo region and in Wajid and Baidoa in the Bay and Bakool regions. WV through local partners has been implementing TSFP and BSFP with OTP, SC and MCHN implemented by other partners. WV in partnership with WFP conducted a SQUEAC coverage survey in Dolow district in November 2015. To continue assessing the performance of the nutrition component in South Central, WV in 2016 sought to undertake a coverage investigation of the Luuq program. Objectives of the coverage investigation • Identify barriers and promoters of access to: • Targeted Supplementary Feeding Program (TSFP) [Luuq district] • Blanket Supplementary feeding (BSFP)[Luuq and Dolow districts] • Establish and document Point and Single coverage of the programs (where applicable). • Identify and refer severely and moderately malnourished children not covered by the current interventions. • Review uptake of the 2015 Dolow Coverage Survey recommendations. • Generate practical recommendations that would lead to better access and coverage of the nutrition program. • Build the capacity of WV staff, MoH and Partners in conducting coverage surveys using Semi Quantitative Evaluation of Access and Coverage. Methodology The coverage investigation utilized the SQUEAC methodology and covered the period January to September 2016. Data collection to include training, was conducted from 3rd to 15th November 2016. FINDINGS Boosters and Barriers Boosters Barriers Community mobilization Sharing of rations Community appreciation of the nutrition Double registration interventions Community program ownership Busy mothers Consistent supplies Specific to TSFP Specific to TSFP Newly settled families Active case finding Distance Varied sources of referral Lack of adequate knowledge on malnutrition Good referral system Presence of stigma Coverage survey report of the WV Luuq and Dolow nutrition programs, South-Central Somalia, October – December 2016. v Enhanced monitoring of screening activities Use of alternative treatment/inadequate inclusion of potential key field sources of referral Lack of/minimal defaulters Malnourished children in BSFP Waiting time in program efficiency Inadequate numbers of CNWs in IDP camps Appropriate health seeking behavior Lack of payment for CNWs and tools Specific to BSFP Previous program rejection Source of extra food Specific to BSFP Community program ownership Lack of continuous admissions and discharges Consistent supplies Overcrowding during distributions TSFP and BSFP coverage estimates The TSFP has achieved coverage above the recommended 50% as per SPHERE standards for rural set- ups. Estimator TSFP Luuq BSFP Dolow BSFP Point coverage 64.3% (54.9% - 72.4%) 75.8% 86.8% Single coverage 73.8% (67.5% - 79.2%) - - Recommendations To continue improving program coverage there is need to enhance various aspects in regard to; program design, program implementation, community mobilization and sensitization, monitoring and evaluation, capacity building and coordination. Coverage survey report of the WV Luuq and Dolow nutrition programs, South-Central Somalia, October – December 2016. vi 1.0 INTRODUCTION Luuq and Dolow districts are located in the Gedo region of Southern Somalia in Jubaland state one of the administrative states of Southern Somalia. Gedo region comprises of six districts namely, Baardheere, Balet Hawa, Dolow, El Wak, Garbahaarreey and Luuq with the regional capital being Garbahaarrey. Gedo is bordered by the Ogaden in Ethiopia, the North Eastern province in Kenya and the Somali regions of Bakool, Bay, Jubbada Dhexe in Middle Juba and Jubbada Hoose in Lower Juba. The region is the second largest in Somalia and the only one with two international borders and two major rivers; the Dawa and the Jubba. Luuq district is situated in the Southwestern part of Gedo province and is one of the older settlements in the region. Luuq town the capital of the district is located on a bend of the Jubba River with the river having great influence on the city and its surrounding areas. Dolow is one of the smallest districts in Gedo and is located on the Northwestern part of Gedo bordering Luuq district to the East and South, the Somali region in Ethiopia to the North and Beled Xaaro district and Mandera district in Kenya to the West. Dolow city the capital of Dolow districts sits on the Jubba River approximately 70 km North of Luuq. The Jubba River starts from Dolow, then flows through the middle Juba region, until the river empties into the Indian Ocean. Luuq has a hot semi-arid Koppean climate and has long, extremely hot summers and short, very hot winters as well as little rainfall. Averages high temperatures exceed 40 °C in March, the hottest month of the year and remain above 33 °C during July and August, the least hot months of the year. Luuq is one of the hottest places year-round on earth as the annual daily mean temperature exceeds 30 °C. Dolow has average high temperatures between 31°C and 35°C with March being the hottest month. Both Luuq and
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