Modality 2: Life Saving intervention and stabilisation.
Somaliland Cyclone Emergency Response
1. Relevance, appropriateness and timeliness of the intervention The timeliness of the proposed intervention
Somaliland experienced the worst Cyclone named Sagar with heavy rains that has left devastating human death cases, injuries, distruction of houses, hospitals, Health Centers (HCs), schools, and loss of animals and farms. The Cyclone has seriously affected Awdal and Sahil regions of Somailand, especially Lugahaya, Gargaarab-bari, Baki and Zeila districts, where most of the communities who lived there lost everything they had before. This situation for the above mentioned districts calls for very urgent humanitarian responses to save human lives.
According to Somaliland authorities, the extent of the impact for the cyclone Sagar, shows the high level of destruction left by the storm in its wake. The Government estimates the number of people affected around 670,000, including hundreds of thousands of children. According to the local authorities, Lughaya district of Awdal, with a combined population of just over 100,000 people, is the most affected zone. Zaylac district, in the same region, with an estimated population of 77,000 people, was also seriously affected and, just like Lughaya, have been cut off from transport and communications by the cyclone. At least 52 people have been killed and over 1500 were injured.
The winds and floods had a severe impact on the livestock and farms, and also damaged key infrastructure, such as schools, ports, roads and airstrips, and washed away many shelters in IDP settlements. Supply stores and food markets have been damaged and in some cases washed away. The government estimates that at least 80 per cent of livestock in some of the most affected areas were killed and some 700 farms have been devastated.
Due to the heavy cyclone Sagar hit in Awdal/Selel region which lost human lives and wept out their properties has impacted some people who have developed post traumatic stress disorder. It was reported that some individuals in Gaargaara bari and Lughaya remain on the dead bodies of their animal while others are still searching to find their animals which was wept out by the heavy floods through the flood river to sea.
A rapid assessment done by the Ministry of Health indicated that MCH, health posts, health centers in Lughaye, Gargaarabari and zaylac were completely destroyed by the cyclone and need immediate rehabilitation. The facility based medical services stopped due to facility destruction and swept all NFI, drugs and nutrition by the heavy wind flowed in the cyclone. At the same time, several cases of AWD outbreaks have been report in Baki district and there is a fear of other affected areas in other districts affected by the cyclone.
In this regard, This proposed intervention has been selected due to the complex and multi dimensional nature of the humanitarian needs in Somaliland and the interlinks between the various needs which has been brought on by the cyclone crisis. Particularly, we will give focus on the prevention/treatment of the health related crised impacted by the cyclone inlcuding AWD, post
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traumatic stress disorder and other infections diseases through provision of outreach health services, counselling and awareness raising campiangs in Gargaara-bari, Lughaye and Zelylac. This communities resides hard to reach area and had an inadequate health intervention due to geographical locations but SHiFAT had an experience to implement a programme in hard to reach communities including Selel/Awdal peripheral district where there no any other health intervention. Currently, there are other NGOs implanting nutrition and livelihood programme in above communities which we have interlinked to integrate and provide mulitiple mobile medical services outreach programme among the communities.
Integrated Mobile Medical services to affected communities in lughaye, Gargaarabri and Zaylac in Awdal/selel region
1. Mobile medical services
To deliver mobile medical services to the communities. The general OPD clinic treats patients with basic ailments and refers those with more complicated problems to diagnostic centers and the government hospital. The patients will undergo follow ups to ensure that they complete their prescribed treatment. Additionally, mobile medical services deliver preventive health care and education to all communities including children, adults and youth.
2. Psychosocial support
To stabilise the target group beyond immediate needs and towards early recovery, we propose to deploy trained psychosocial agents to the cyclone affected area to provide basic counselling and other psychosocial support.
3. Community mobilization/Sensitization.
To establish Community mobilization to affected communities by sensitizing communities to prevents disease outbreak and hinder deterioration in hygiene and sanitation among the community.
Explain how you will start your activities in 7 days and finish within the duration of the proposed intervention.
Both the Governor and Regional Health/Medical Officer are on board and have been consulted in the preparation of application for this fund. Casual interviews have been conducted with some of the community members present in region (seeking medical care). The list below highlights some of the other activities and initiatives that will have to be achieved by the partnership (Guryasamo & SHiFAT) within the 3 months: 1- Within 7 days: Staff, volunteers and local stakeholder’s induction training and responsibility allocation. Procurement processes for Mobile Clinic, Medication and ER equipment. Co-ordination meetings commence with local stakeholders. Actual locations of the target
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group(s) within the target region are identified Vulnerability assessment in consultation with the targeted groups and relevant stakeholders.
END OF OF THE FIRST HALF FOR THE 3 MONTHS [PHASE ONE]. Please note that the ER equipment and Mobile clinic should arrive at the start of phase one
1- Once the mobile clinic arrives the healthcare services can expand and have more coverage. ER set up at lughaya, Gargaarabari and Zaylac with relevant training commences. 2- Coordination meetings with local and international cyclone committees will act as a yard stick and KPIs can be reviewed. 3- Mobile services continue. 4- Post traumatic stress disorder counseling and referring to public hospital where the programme will cover their basic health revovery costs. 5- The Monitoring trips at the beginning and ending of each month by Guryasamo representatives and regional stakeholders. 6- Health awareness campaigne throughout the community and step by step guidance to prevent disease outbreak and other deterioration.
END OF THE SECOND HALF OF THE 3 MONTHS [PHASE TWO].
1- 80% of lughaye, Gargaarabari and zaylac communites screen all types of diseases recording presumptive register book. 2- 90% of community will be sensitized publicly and individualy to prevent outbreak disease, will also list contact tracing register book. a. Post traumatic stress disorder counselling and referring to pschysocial center in Borama. b. Hygiene and sanitation awareness to prevent disease outbreak. c. Benefits of clinic attendance and number of diseases. A physican will treat and prevent. d. Comprehensive service available in mobile clinic in awdal/Selel region. e. Monthly statistical reporting indicating all above mentioned objectives. f. Quarter statistical and Narrative report reflecting programme performance. 3. Final activities/draw down phase, final reporting, Monitoring Evaluation and Learning (MEAL), stakeholder communications.
How are you co-ordinating, and with whom? Kindly include a reflection on how this contributes towards ensuring that the target group will receive coordinated and complementary assistance
We will coordinate with the Ministry of Health and the health sector focal point at a national level; we will also co-ordinate at regional level with the Somaliland ministry of health’s regional branches and the Regional Medical Officer (RMO). As already mentioned with our key stakeholders in order to make sure that we get a proper overview of the situation.
We will also take part in the Office of coordination of humanitarian Affairs (OCHA) meetings in Hargeisa, to understand where and how fellow NGO’s/INGO’s are delivering services including the Humanitarian Response Plan (HRP). As well make sure we communicate our work and implementation plans to make sure other organisations are aware.
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These activities will help in making sure that services to our target group will not overlap or duplicate other interventions. It will also help our target group receive varied complimentary humanitarian assistance which means a bigger and better impact in saving lives. What will success look like, and in what time frame?
Using indicators success will be the achievement of the strategy of the intervention and its objectives within a period of 3 months.
The following indicators will be used to assess the success of the project # 10800 clients will be screened and a report wil be conducted in the end of 3 months. # 17800 displaced people will be provided with health education in the end of the 3 month. # 30 patients affected by post traumatic stress disorder will get proper referral and counselling. Mobile clinic will conduct outreach 6 working days and will work 24 days monthly, the project duration 3 months = 72 days and prompt services within the target group villages/towns. Emergency mitigation through medical screening and refer any complicated cases to Borama hospital. The patients will be in the programme until the patients will fully resume and recover. ER services are saving lives (target minimum 7200 people/month) Monthly meetings and quarterly M&E initiatives are conducted and findings reported. Corrective action to return to project design and plan will be taken if necessary. Challenges resolved.
2. Partnership
Describe the contributions, roles and areas of responsibility of all partners of the proposed intervention including each partner’s implementation responsibility. (maximum 5 bullet points)
Providing project framework as well as timely transfer of funds (Guryasamo) Needs assessments, Project design planning (SHiFAT and Guryasamo) and implementation (SHiFAT). Ongoing monthly/mid- term progress and situational reports of further needs/changing circumstances including access and security report (SHiFAT & Guryasamo) M & E activities with lessons learnt dissemination and information sharing (SHiFAT and Guryasamo) External auditing (Guryasamo)
3. Target groups
Planned target population:
Femal Male Children Total Services Type of Activity e (by age) Basic OPD Medical 5400 10800 services people 1800 3600 people people Clinical consultations Psychosocial 5 15 20 Refer and admistion to support counselling people people 0 people public hospitals
40 50 0 90 Counseling on their peopl people people location
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Health awareness 1. Health education sensatization 300 Provide heath, hygiene and mobilization to workshop and sanitation workshop the communities 2. Hygeine and sanitation workshop
Taskes Gargaarabari Lughaye Zaylac Total beneficiary General OPD 3600 3600 3600 10800 services
Pschosocial 7 8 5 20 support counselling Health education, 100 100 100 300 hygiene and sanitation workshop
Additional information: Somali families are quiet large and are composed of an average of 7 people 10800 people will be assisted during the above activities.
Which vulnerable groups are you specifically targeting (Note that you can include budget for additional vulnerability assessments as relevant in the application to DERF)? Please explain
The cyclone affected whole community and many of them need medical intervention but we targeted margenalized groups and the vulnerable groups.
We are targeting the following vulnerable groups;
Pregnant women Children under 5 House Holds (HHs) headed by children HHs headed by elderly and the incapacitated or people with long term illnesses such as mental illness HHs headed by single women Internally displaced HHs headed by women, children, elderly, incapacitated and people with long term illnesses such as mental illness
Additional Comments:
It will be wise to carry out further vulnerability assessments to better target those groups.
Explain how the target population has been and will be involved in your proposed intervention (maximum 5 bullet points)
Initial needs assessments consultations with our target group including vulnerable, marginalised members and hard to reach communities will be involved to align their needs with the project objectives. Monthly/Quarterly M&E initiatives to gauge progress, tackle challenges through conducting surveys Monthly community feedback and complaints reports Adhoc meetings to address complaints, as an when needed
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Explain how you plan to be able to identify and respond to potential complaints from the target population in regards to the implementation of the proposed intervention and / or the conduct of implementing organisations / personnel. (maximum 5 bullet points)
Guryasamo and the cyclone committee will be involved in field visits to locations of target groups without the presence of the implementing NGO partner Anonymous sample field survey questionnaires Supply prepaid mobile phones to the representative committee Established complaint response mechanism (hotline number) where the complaints can be channelled by the beneficiaires. Explain how you plan to source your goods (please tick all boxes that apply) Internationally Regionally / neighbouring country In country / locally Cash based programming
Please explain your answer in 2 bullet points: Assess and evaluate major local medical and equipment wholesalers Assess and evaluate drugs and equipment quality.
Source: table adopted from Start Fund Handbook 2014
4. Sector specific information: What sectors WASH will the Health proposed Shelter intervention’s Nutrition activities most Camp Management relate to Education (please tick ALL Protection that apply)? Emergency FSL Other (specify)
5. Strategy and expected results of the intervention
Describe objective(s), activities, expected outputs and indicators to be applied
Objectives:
To establish and Ensure provision of urgent basic medical service, health education and sychosocial support to cyclone affected communities in awdal/Selel Region.
Activities To deliver integrated mobile medical care serves to the communiteis. 1- Deliver mobile medical services to the communities. The general OPD clinic treats patient with basic ailments refers those with more complicated problem to diagnostic centers and the government hospital. The patient will be followed up on to ensure that they complete
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their prescribed treatment. Additionally, mobile medical services deliver preventive health care and education to all communities including children, adults and youth. 2- Deployment of trained psychosocial agents to the cyclone affected area to provide basic counselling and other psychosocial support. 3- Conduct sensitisation and awareness raising campaings to affected communities in order to prevent outbreak of diseases and promote hygiene and sanitation status among the community.
Expected outputs
1- Health care services delivery to planned target population (10800 people) through outreach using by the mobile clinic. 2- Inpatient emergency services by referral to Borama General/Mental hospital for further recovery status. 3- Refere and Admit to public hospital the severe cases by assessing, transporting and caring assigned health professional by the programme. 4- Pschosocial couseling for those post traumatic stress disorder(PTSD) and advancedly refere if in case severe patient. 5- The hygiene and sanitation condiction for 17800 people affected by the cyclone have been improved.
Indicators Process or key performance indicators KPIs M&E
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Logical framework of the project
Performance Means of Outcome(s) Timeline Targets Indicators verification
Outcome 1: % of the . Monthly/Quarterly September 10800 The health community reports 2018 beneficiareis will service in the members who . Case Success be targeted. cyclone affectived accessed health story treatememtn areas is restored . Ministry of Health maximized. and affected statistics communities % decreased in recovered from AWD and other the negative communcal impact of cyclone diseases reported sagar. in the last 3 months.
Means of Results Results indicator Targets verification Result 1: Number of . Monthly reports Urgent. . The Improved access community . Case Success proportion to health members who story Expecting patient services/Hygiene admitted in diagnose at . Quarterly reports start date sanitation for treatment support. the OPD . End of project July 2018 communities clinic should affected by the Number of report. be 90% cyclone in people/household . Narrative Report recover. Lughaye, received . Refer all Gargaarabari, and awareness severe cases zaylac. messages and to public adopted to good hospitals and hygiene and continue sanitation supporting to practices. cover costs per patient.
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Number of post- . Monthly reports Urgent. . All traumatic stress . Quarterly reports Household disorder cases . End of project Expecting members will reporting and report start date refereeing to participate Result 2: . Success case July 2018 Improved and public hospitals counselling. story report treating post- . Those traumatic stress Number of acute . Narrative report people disorder patient PTSD cases developed by referring public referred by mobile PTSD will clinic team and hospital and particularly supporting their number referred provide recovery cost per to hospital patients settings. . regular counseling and preventive mechanism.
Describe how and with which methods the proposed intervention is to be carried increasing the likelihood that it may lead to the objectives defined and avoid potential negative effects on the target group
The partnership will be consulting national, regional and target committees. Including all stakeholders and working on a grassroots level will establish ownership. During the project all items (with the exception of ER equipment and the Mobile Clinic) will be purchased locally. Also pschosocial counselling and health education compaign will be conducted employing at the village level. This will boast the economic standing of the target group alongside the proposed interventions. Complaints will be addressed through local committee arbitration and corrective measures will be prompt and decisive.
Describe how the proposed intervention strengthens local ownership and capacities
This proposed intervention strengthens local ownership through; prioritising local stakeholder needs, including recipients and local committees in project design and implementation
Upgrading and supporting local organisational capacity to design and efficiently deliver the intervention by understanding
Describe the risks to a successful intervention, and how you are managing them. Note that you can include budget for risk and safety management as relevant in the application to DERF
There are various risks levels to a successful intervention. They can be wide ranging and complex from one region to the other, but broadly speaking they are the following;
Contextual risk (state failure and eruption conflict, development failure etc...) Programmatic risk ( risk to achieving programme aims and objectives and/or causing harm through our intervention) Institutional risk ( this risk is faced by INGO’s and LNGO’s with regards to security, financial
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fraud, loss of legitimacy or reputation etc These can be managed by making sure that our organisational risk management policy is up to date and is robust whilst making sure we have efficient decision making processes are in place. We also make sure we have experience/information sharing within the organisation as well as reach out to other cluster members and humanitarian actors. Describe the monitoring for documentation of achievement of results and lessons learnt accountability and learning systems that you will employ. This should include participation in DERF peer review and experience sharing mechanisms (obligatory for all grant-holders) and planned external evaluations (obligatory for interventions above DKK 2 million)
Monitoring Evaluation and Learning will be conducted both on monthly and quarterly basis. Discussions with stakeholders will follow every MEAL initiative. The indicators selected (illustrated earlier) will be the sign of progress and aid the partnership in determining whether the programme/initiative has achieved its objectives and goals. Learning will help steer the programme back to project design. Establishing best practice is the ultimate goal of all humanitarian efforts.
Finally as suggested the partnership will participate in DERF peer reviews and experience sharing mechanisms. We welcome all external evaluation and the input a fresh view will bring to the project.
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