I NTEGRATED DROUGHT RESPONSE IN ETHIOPIAN SOMALI R EGION FOR DROUGHT A FFECTED POPULATIONS

SEMI-ANNUAL REPORT (October, 2017 – March, 2018)

Reporting Organization Name: Mercy Corps Program Summary Award No : AID-OFDA-A- 16- 00053 Start Date : October, 2016 End Date : June 30, 2018 Report Date : October 1, 2017 to March 31, 2018

Integrated Emergency response for Drought Affected Populations in Ethiopian Semi Annual Program Report (October, 2017 to March 2018)

OVERVIEW OF THE PROGRAM 1. Program Overview Mercy Corps (MC) and Action Against Hunger Ethiopia (AAH) are working together in a joint effort, led by MC, to provide integrated emergency response for drought-affected pastoral communities of fifteen woredas in the Ethiopian Somali Regional State (SRS). The project focuses on implementation of Community Management of Acute Malnutrition (CMAM) with particular emphasis on treating acute malnutrition, behavior change on hygiene-promotion and in some districts, sanitation infrastructure. MC is the lead implementer in this program, with AAH as the sub-grantee. The program covers fifteen districts, eleven of which are covered by MC in Jarar, Shabelle, Siti and Fafan Zones, and the other five of which are covered by AAH in Shabelle, , Korahe and Nogob Zones. Woredas were selected based on the severity of drought in collaboration with the Regional Health Bureau. The 15 intervention woredas in the SRS include 10 woredas approved for implementation in the initial proposal, including - Birkot, , Ararso woredas; Shebelle Zone - East Imi, Denan, Adlade and woredas; - woreda; - Elweyn woreda; - West Imi woreda. Additionally, six woredas were approved in the cost extension as of October 2017 and include Jarar Zone - Bilibur, Deghamedo and woredas; - Tuliguled and Shabeley woredas; and Siti Zone - woreda.

Operational implementation commenced in December 2016 in ten woredas approved in the first proposal and in the additional six woredas in October 2017. In spite of delays upon start-up of the initial program, as a result of challenges with obtaining government approval, the team has worked to catch up with the initial implementation plan. Drought conditions still have not demonstrated much improvement throughout the year and in general are worsening. Factors including poor livestock productivity and displacement of people from neighboring region create an additional burden, which hampers the efforts of the CMAM nutrition intervention to reduce morbidity and mortality related to malnutrition. In most of the districts, malnutrition is increasing, with high SAM and MAM incidence rates, which leads to a shortage of supplies to address the increasing case load. Meanwhile, pastoralist communities have lost the majority of their livestock and the milk productivity of the remaining livestock has decreased, affecting the daily diet for children. As a result of continuing critical food shortages, the program’s effectiveness is challenged as sharing of TSFP supplies is observed by families who do not receive blanket supplementary food support.

Since the beginning of the program, MC and AAH have reached more than the initially planned target beneficiaries anticipated for the program, which were estimated based on the trends during the proposal development period. To meet the growing needs of malnourished beneficiaries in the fifteen districts, MC has flagged the issue of food shortage to WFP as early as possible and as a result, secured additional supplies from WFP. MC, in collaboration with WFP, has implemented blanket supplementary feeding in selected high priority woredas to minimize the effect of malnutrition on under five children and PLW. In spite of all these efforts, beneficiary numbers are drastically increasing every day and supply shortages continue to be a bottleneck to address all communities in need. Like many other regions and communities in Ethiopia, SRS faces ongoing challenges of deteriorated natural resources and the inability to grow sufficient and sufficiently diverse food. As a result, acute malnutrition threatens the livelihoods and stability of local communities.

2

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

Program Goal The program goal is to contribute to the reduction of mortality, morbidity and suffering associated with moderate and severe acute malnutrition in children under 5, and pregnant and lactating women living in the target woredas of ESRS.

Objectives • Objective 1: Reduce mortality and morbidity associated with moderate and severe malnutrition of children under 5 and pregnant and lactating women living in the targeted areas. • Objective 2: Reduce mortality and morbidity associated with poor sanitation and water quality, amongst moderate and severe malnutrition of children under 5 and pregnant and lactating women living in the targeted areas. • Objective 3: Reduce mortality and morbidity associated with primary health care service inaccessibility

These objectives are further delineated as follows: • Improve awareness of the community through health education so they can practice appropriate maternal, infant and young child feeding and recommended hygiene practices. • Improve the capacity of health care providers so they can manage acute malnutrition independently at facility level. • Strengthen the government health system by providing technical and logistical support. • Improve health facility sanitation infrastructure through construction of Ventilated Improved Pit Latrines (VIPL). • Provide timely distribution of Corn Soya Blend Plus (CSB++) for U5 and PLW with Moderate Acute Malnutrition (MAM) to minimize the number of severe acute malnutrition cases. • Distribute water treatment chemicals to prevent water born disease. • Distributing NFIs for nutrition beneficiaries to properly treat and store the water they used for their daily consumption. • Providing Medical consultation for sick individuals who have no access to health facility and supporting immunization services to reduce the prevalence of vaccine preventable diseases.

Planned Activities The activities listed below were planned with the following target figures: • Community mobilization for improved infant and young child feeding: o Distribute IEC/BCC materials for all health facilities, schools and beneficiaries to use them as teaching aids to change the behavior of the community. o Provide education to mothers to practice exclusive breast-feeding and maternal, infant and young child feeding practices to 15,666 mothers. • Management of MAM cases: o Screen and admit 64,121 beneficiaries into Targeted Supplementary Feeding (TSFP), including OTP discharged Beneficiaries. • Management of Severe Acute Malnutrition (SAM) cases: o Establish or rehabilitate 158 OTP and 20 SC sites. 3

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

o Establish 119 sites for mobile health and nutrition teams. o Treat 5,134 children in inpatient and outpatient therapeutic programs. • Hygiene promotion services: o Provide hygiene promotion to 99,299 people. o Provide soap for hygiene promotion to 64,121 nutrition beneficiaries. o Conduct 50 hygiene promotion campaigns. o Provide Non-Food Items (NFIs), including water treatment chemicals, Jerricans and buckets for point of use water treatment chemicals (POUWTC) to 64,121 people. • Sanitation infrastructure: o Construct 21 VIPLs for health facilities. o Establish 45 hand-washing points for health facilities. • Capacity building for improved CMAM and WASH services: o Provide training to 419 health care providers on SAM management and WASH services. o Train 1,970 community volunteers on community mobilization. o Train 419 health workers care providers on MIYCN.

SECTOR 1: Nutrition As planned, MC provided the full complement of nutrition activities community mobilization, Targeted Supplementary Feeding Program for MAM Beneficiaries, Outpatient and Inpatient Therapeutic Program for SAM beneficiaries with and without medical complications

1.1 Community Mobilization (Planned target for the whole project life = 99,299)

MC teams in each woreda have been conducting routine nutrition education and nutrition campaigns using different entertainment methods to encourage people to change their nutrition practices and behavior. Health education and awareness creation were components of all service delivery, including food distribution days, Outpatient Therapeutic Program (OTP) days and any occasions for community gathering. Awareness creation campaigns were conducted in three woredas, covering 12 kebeles, and focused on nutrition and hygiene promotion, particularly on Maternal, Infant and Young Child Nutrition (MIYCN) and Acute Watery Diarrhea (AWD) prevention through key handwashing times. Messaging was delivered during these campaigns through circus dramas, games, other dramas and local public entertainment, which included messages on exclusive breast-feeding for the child’s first six months and proper complementary feeding after six months. In total, 7,770 (M= 4,208 and F= 3,562) beneficiaries have been educated through these campaigns. IEC/BCC materials including IYCF counseling cards, mother action cards, breast-feeding posters, WASH reminder cards, and leaflets for water treatment chemical instruction, were re-produced for a second time in the reporting period and were used to educate people. The Mobile Health and Nutrition Teams (MHNT) also provided routine health education with particular emphasis maternal and child nutrition covering the first 1000 days of the children’s life. Through routine health education in fifteen woredas, the project reached 99,811 (M= 13,362 and F=86,449) beneficiaries.

The full list of education topics includes: • The advantage of proper feeding during the first 1,000 days (from conception to second birthday) and other issues related to Maternal Infant and Young Child Nutrition (MIYCN).

4

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

• Prevention of acute watery diarrhea and other communicable diseases. • Importance of scheduled immunizations. • Personal hygiene particularly focusing on the five key handwashing times. • Other major health- and nutrition- related gaps identified by the team and government health care providers.

1.2 Targeted supplementary feeding for MAM Children and PLW (planned target for the whole project life = 64,121)

During the reporting period, MC has received 98 MT of food from FFP and 351.42 MT of food from WFP to reach in total 35,381 MAM beneficiaries (15,986 U5, 18,888 PLW and 507 OTP discharged children). Of those admitted, 36,965 MAM beneficiaries were cured and discharged from the program with a cured rate of 99.53%, 140 beneficiaries defaulted from the program with defaulter rate of 0.38% and 33 were non-respondents after attending four consecutive months with NR = 0.09%. The 507 children discharged from OTP received a two-month OTP discharge ration according to national protocol. While the total project target was 64,122, beneficiaries including MAM plus SAM, calculated based on malnutrition prevalence trends during the time of proposal development, the actual number of beneficiaries reached within the project life is 103,432; this is 161.3% of the planned target and indicates the severity of the drought.

Distributions for MAM beneficiaries were not implemented monthly as per the program plan because of pipeline breaks faced by WFP and FFP. MC team did not provide food in October 2017 and AAH did not distribute food in December 2017 and February 2018 due to supply shortages and delays of food delivery from WFP. Therefore, the beneficiary figures do not demonstrate the real trends of MAM incidence during the reporting period.

Table 1. Targeted supplementary feeding program from October 2017 to March 2018

Woredas Admission Discharge Total in U5 Preg. Transferre Total Cured Defaulte Non Total program childre and d in from new d responde discharg at the end n Lactatin OTP Admissio nt e of March. admitte g n d women Ararso 2239 2086 124 4967 0 0 1,740 Aware 1329 1371 0 4190 0 0 956 Birkot 2043 1362 0 5788 0 0 479 Denan 1523 2769 156 2952 35 3 3,059 East Imi 2852 4533 227 2457 90 4 9,850 Gode 2368 2643 0 4974 0 5 384 1279 1542 0 5106 0 5 269 West 2039 2036 0 4805 8 12 1,711 Imi Elwyene 97 191 0 895 0 0 490 Marsin 217 355 0 831 7 4 1,127

5

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

Total 15,986 18,888 507 36,96 140 33 20,065 5

Table 2. Current Stock balance of CSB++ and distributed food for the last six months, including WFP food.

Woreda Commodity Carry over at Total Total Damage Balance Remark the beginning Received Distributed or Loss end of of the year (MT) Oct. (MT) Oct. Mar. (MT) to Mar. to Mar. 2018 2018. 2018 All ten CSB++ From 98 0 98 0 FFP food woredas FFP finished in Nov. All ten CSB++ 0 351.42 289.5 61.93 Received is from woredas From WFP WFP Total 98 351.42 387.5 61.93

1.2.1 BSFP implementation for four consecutive months in three woredas of Jarar Zone (planned target = 18,652)

The regional government in collaboration with WFP and other implementing partners decided to implement Blanket Supplementary Feeding Program (BSFP) to minimize the burden of malnutrition in 43 selected priory woredas where the situation was the worst; three of these woredas were supported by OFDA. BSFP requires that all under five children and PLW (pregnant and lactating women) receive rations as all are highly vulnerable; therefore, in three woredas, all under five children, pregnant mothers with visible/ confirmed pregnancy and lactating mothers with children not more than six months were admitted in the program. Within the implementation period, Mercy Corps reached 29,398 people (19,040 U5 and 10,358 PLW) and all were subsequently discharged from the program.

Table 3, Summary of Blanket Supplementary Feeding Per Woreda, December 2017 to March 2018

Admission Discharge Total in Preg. program U5 Transferred Woredas and Total new Non Total at the children in from Cured Defaulted Lactating Admission respondent discharge end of admitted OTP women March. Gunagado 8038 4926 0 12964 12964 0 0 0 0 Degahamedo 7770 3768 0 11538 11538 0 0 0 0 Bilibur 3232 1664 0 4896 4896 0 0 0 0 Total 19,040 10,358 0 29,398 29,398 0 0 0 0

6

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

Table 4. BSFP stock balance

Woreda Commodity Carry over at Total Total Damage Balance Remark the beginning Received Distributed or Loss end of of the year (MT) Oct. (MT) Oct. to Mar. 2018. (MT) to Mar. Mar. 2018 2018 Gunagado CSB++ 0 236.325 234.912 0 1.413

Deghamedo CSB++ 0 197.391 196.986 0.403 0

Billibur 0 74.482 74.478 0 0.00352

Total 0 508.199 506.376 0.403 1.42

1.3 Outpatient therapeutic program (OTP) from October 2017 to March 2018 (Planned target for the whole project life =5,134)

MC and AAH have been providing OTP services in 109 static OTP sites and 47 outreach sites; this figure includes the 32 static OTP sites and 24 outreach sites established during the October scale-up. From all sites in total, 5,785 under five children were admitted in the program from October 2017 to March 2018. Of these, 5747 were admitted by MUAC, 33 children by Edema and 5 children were in the program before and came back to the program as a relapse. For the static service, MC supported the existing government health facility to provide better services for the community through capacity building in terms of logistics support, supply chain management and improving capacity of the government staffs.

Table 5: OTP admission by category, October 2017 to March 2018

MUAC Total < transfer beginning 110mm Readmission in from Total Month Edema Relapse of the or after default other admissions month W/H< TFP 70% October 1384 809 1 1 0 0 811 November 1499 1168 6 1 0 0 1175 December 1718 1544 10 1 0 0 1555 January 1629 962 10 2 0 0 974

7

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

February 1281 820 0 0 0 0 820 March 1248 444 6 0 0 0 450 Total 5747 33 5 0 0 5785

In total, of those who were admitted to the OTP program, 4664 under five children were cured at a rate of 97.3%, 104 (2.2%) defaulted, 6 (0.16%) were non-respondent, and one child died (0.02% death rate) within the reporting period. All outcome indicators are within acceptable sphere standards. MC-covered interventions in Aware, Ararso, Birkod, Denan and East Imi phased out at the end of December 2017 and AAH-covered intervention in Gode, Adadle, West Imi, Marsin and Elweyn phased out on February 28, 2018. Only the six new woredas added in the cost extension will continue after February through June 30, 2018. As a result of this fluctuation in service coverage due to grant end, it is quite difficult to show the trend of admission from October to March per woreda. Although the total OTP admission appears to be decreasing, this trend is a result of the phase-out of programming; however, the actual admission has increased when assessing the figures per woreda, in each woreda.

Graph 1: Total OTP Admissions Total OTP admissions 1800 1600 1400 1200 1000 800 600 400 200 0 October November December January February March

Table 6: OTP discharges by Category from Ten Woredas October 2017 to March 2018 Non Unknow Defaul Medical Transfer Total Month Cure responde Death n t transfer out to SC discharges r October 700 0 7 1 0 0 3 711 Nov. 926 4 24 1 0 0 1 956 December 951 1 15 1 0 0 3 971 January 935 0 15 1 1 0 0 952 February 709 0 21 0 0 0 1 731 March 443 3 22 2 0 0 2 472 Total 4664 8 104 6 1 0 10 4793

8

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

(97.3%) (2.2%) (0.16%) (0.02%)

1.4 Management of Complicated severe acute malnutrition at stabilization centers (SC) planned target for the whole project life = 513)

Mercy Corps established 26 Stabilization Centers, of which 12 were established as part of the initial proposal and 14 as part of the costed scale-up. Mercy Corps fulfilled the required SC materials in two rounds based on need and now a majority of the health centers are providing adequate services for complicated SAM cases. In addition, Mercy Corps provided caretaker food for all caretakers whose children were admitted in the SCs. Furthermore, the MC team conducted regular follow up and support for government staff and provided on-the-job training based on the identified gaps.

Table 7: SC Admissions from October 2017 to March 2018 from 26-stabilization center Month Total at New Admission Discharge Total the MUA Ede Readmissi Transfer cured default death NR Medical end of beginni C ma on after in from er transfer the ng of <11c default other month the m TFP month October 13 35 0 0 0 32 0 0 0 2 14 Novembe 14 46 0 0 0 37 0 0 0 2 21 r December 21 49 0 1 0 56 0 1 0 2 12 January 12 50 0 0 0 47 1 1 0 0 13 February 13 32 0 0 0 30 1 1 0 0 13 March 13 29 0 2 0 30 0 0 0 0 14 Total 241 0 3 0 232 2(0.82 3(1.23 0 6 (95.47%) %) %)

The statistics above show that 244 children were admitted to SCs to manage their medical complications. Most of the admitted children (232 = 95.47%) were successfully cured and discharged from the program and were connected to OTP’s to continue treatment at the outpatient level, ensuring the continuum of care in the CMAM program. Three children died (1.23% death rate) while they were in the program due to their medical complications and two others defaulted from the program with a defaulter rate of 0.82% because of family problems, namely, that mothers were not convinced to remain in the SC with their children when other children required care at home.

1.5 Capacity Building for health workers and the existing system to function properly (Target = 419 health care provider and 1970 CHWs)

Capacity building is important to ensure the sustainability of services and the existing government systems take over the responsibility after recovering from crisis. Accordingly, 151 static OTP sites and 26 SCs have been well equipped and government staff trained on SAM and MAM management, MIYCN and WASH. Before the reporting period, 61 health workers and 227 HEWs plus 639

9

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

community volunteers were trained. In addition, in the cost extension period, Mercy Corps trained 188 (M=95, F=93) health extension workers and 85 (M=62 and F=23) health workers on SAM management, 209 (M=123, F=86) HEWs plus 93 (M=60 & F=33) HWs on MIYCN, 183 (M=100 & F=83) HEWS on WASH. Moreover, a one-day orientation has been given for 1300 (M=718 & F=582) Community Volunteers on CMAM focusing on screening, defaulter tracing and community mobilization. MIYCN and WASH orientation for community volunteers and WASH training for health workers will be conducted in April.

Table 8. Health care providers and volunteers attended SAM, MIYCN and WASH training Male Female Total Type of training trainees trainees participant Remark SAM management training for HEWs 95 93 188 SAM management training for health workers (HWs) 62 23 85 CMAM orientation for CHWs 718 582 1300 MIYCN training for HEWs 123 86 209 MIYCN training for HWs 60 33 93 WASH Training for HEWs 100 83 183 Total 1158 900 2058

SECTOR 2: WASH

2.1 Sanitation infrastructure (Target = 21 VIPL)

Mercy Corps Planned to construct 21 Ventilated Improved Pit Latrines (VIPL) for selected health posts and health centers. Construction and hand-over was successfully completed during the reporting period. The community started to use the VIPL in mid-2017 and Mercy Corps teams formed committees including HEWs to properly manage the VIPL. According to the contractual agreement MC made with the contractor, MC technical team checked the viability of all VIPLs after three months of completing the construction and minor defects were corrected.

2.2 Hygiene promotion ( Target = 99,299)

MC conducted hygiene promotion activities to prevent common communicable diseases which frequently occur in the region. MC delivered these promotion activities through routine health education at nutrition service delivery points. MC also conducted WASH campaigns using different entertainment approaches to reach more people, especially younger and healthier community members. Within the reporting period, MC reached 107,581 beneficiaries (M=17,570 and F=90,011) in about 1084 different sessions. The most common topics that MC focused on include the five key handwashing times, prevention of malaria, personal hygiene and environmental sanitation etc.

Table 9: Beneficiaries Reached by Routine Health Education

10

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

Months Number Male Female Total of sessions October 151 2351 13959 16310 November 208 2815 22707 25522 December 217 3507 20970 24713 January 129 1170 2973 4143 February 140 1132 3432 4564 March 138 1023 13524 14547

Table 10. Beneficiaries Reached through Nutrition and WASH Campaigns ZONE WOREDA KEBELE where TOTAL NUMBER campaign BENEFICIARIES conducted F M Total Sitti Dembel Qoranle 310 290 600 Arrabi 504 346 850 Agarwayne 440 360 800 Dembel 594 506 1100 Fafan Shabeeley Hadaw 240 260 500

Amadhle 207 193 400 Lafta galoolka 190 140 330 Shabeeley 387 313 700 Tuli guleed Tuli 560 440 1000 Ffeedhaad 107 123 230 Ceel mal 188 172 360 Gabagabo 481 419 900 Total 4208 3562 7770

NB. Nutrition and WASH campaign will be conducted in Bilibur, Deghamedo and Gunagado in April 2018.

In addition to sanitation infrastructure and hygiene promotion, MC also provided water treatment chemicals and NFIs including like Jerricans and buckets, for treating the water used at household, and soap, to promote handwashing practices. MC provided these supplies for all nutrition beneficiaries admitted in OTP, TSFP and SC services.

3. Additional Support with in Nutrition

MC, in collaboration with UNICEF, WHO and the Regional Health Bureau, provided mobile health and nutrition services for community members who have no access to primary health care services.

3.1 Medical consultation

11

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

UNICEF and World Health Organization (WHO) provided emergency drug kits (EDK) to MC to deliver medical consultation and treatment for sick people at IDP sites and for people who could not access health facilities. Accordingly, MC consulted individuals with medical complaints, treated common infectious disease, and gave referral services for those who should be treated at facility level. The most common diseases affecting people in were gastrointestinal infection, respiratory tract infection, skin infection, malaria and other communicable diseases. In total 16,879 beneficiaries received medical treatment.

Table 10. Beneficiaries receiving medical consultation under Month Adult Total Five October 993 650 1643 November 1635 1982 3617 December 2249 2635 4884 January 649 1865 2514 February 671 1153 1824 March 997 1400 2397 Total 7194 9685 16,879

3.2 Immunization for children

MC, in collaboration with woreda health offices, provided immunization services for children to prevent common vaccine-preventable diseases. Mercy Corps is supporting the efforts of the government to minimize child mortality and meet the sustainable development goals. As shown in the table below, 420 children received BCG vaccines, 375 children received penta 1 and 2, 931 children received Rota 1 and 2, despite shortages of vaccines which limited overall achievement.

Table 11. Children receiving vaccination BCG OPV OPV OPV, OPV, OPV, & & & Penta Penta Penta Rota Rota Month IPV Measles Vit.A OPV Penta Penta & & & 1 2 0 1 2 Pcv 1 Pcv 1 Pcv 2

October 55 0 0 173 138 114 161 152 159 173 159 November 102 358 211 181 322 208 181 346 206 261 134 December 229 275 164 170 389 191 170 405 193 413 490 January 22 0 0 0 169 124 2 169 124 216 326 February 12 0 0 0 181 115 37 181 115 176 193 March 0 0 0 0 234 103 60 234 134 99 107 Total 420 633 375 524 1433 855 611 1487 931 1338 1409

12

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

In addition, pregnant and lactating mothers received tetanus vaccines as shown in the following table:

Table 12. Pregnant and Lactating mothers receiving Tetanus vaccination Months pregnant women Non pregnant women TT1 TT2 TT3 TT4 Total TT1 TT2 TT3 TT4 Total October 95 57 4 0 156 0 0 0 0 0 November 197 125 70 19 411 17 4 1 0 22 December 305 211 139 0 592 116 11 0 0 160 January 100 66 0 0 166 79 54 0 0 134 February 87 65 5 0 157 101 54 2 0 157 March 90 81 16 0 187 97 93 4 0 194 Total 874 605 234 19 1669 410 216 7 0 667

Furthermore, MC provided referral services for mothers to deliver at health facilities, and postnatal care services.

4. Coordination

MC participated in federal, regional, zonal and woreda level coordination meetings, with particular attention to the frequent coordination meetings conducted at the regional level. The project also supported the government on the prevention of AWD in Jarar, Shabelle and Fafan zones by providing water treatment chemicals, hand washing soap, jerricans and buckets for affected households. Mercy Corps is an active partner in the region and cooperating with other partners to respond to humanitarian crises in the region, keeping in compliance with the proposed plan of the project.

Challenges and Lessons Learned

The program has overcome a number of challenges since its inception and MC has been able to manage most of the challenges in collaboration with the government and other partners in the region. Most of the challenges were related to a supply shortage of supplementary food, medical supplies and therapeutic food. The shortage was largely due to the number of actual beneficiaries admitted in the program, which was much higher than anticipated. Water shortage was also a critical barrier to providing appropriate nutrition services and towards maintaining the health and hygiene of the community. Poor sanitation and hygiene in turn exposed people to different disease outbreaks such as AWD which has been aggravating malnutrition in the community.

Challenges are summarized as follows: • Challenge: Supply shortage for MAM treatment after FFP food ran out. • Action taken: MC worked with WFP to provide food for MAM beneficiaries. As a result, MC received 859.62 MT of additional CSB++ (351.42 MT for TSFP and 508.2 MT for BSFP) from WFP. • Challenge: Government staff turnover o Action taken: MC trained new staff to continue providing services.

13

Integrated Emergency response for Drought Affected Populations in Ethiopian Somali Region Semi Annual Program Report (October, 2017 to March 2018)

• Challenge: Shortage of water at health facilities to provide nutrition services and demonstrate appropriate hygiene practice. o Action taken: MC advocated with other partner organizations to support the health facilities with water provisions.

5. Monitoring and Evaluation

MC has conducted joint quarterly supervision visits with regional, zonal and woreda government officers in each intervention woreda to assess the progress. Important feedback has been provided for better coordination of the government’s and the project’s efforts to improve synergies and improvement of service provision. Internally, the team conducted weekly monitoring and mentoring visits at each facility to ensure the quality of the service provided by HEWs, and feedback was provided to correct any deviations from national protocol.

6. Planned Activities for the Upcoming three month cost extension period

The following activities are planned for the upcoming three months.

• Conduct MIYCN and WASH training to health care providers in all woredas added in the cost extension period. • Continue routine activities provided by MHNTs and government health staff. • Continue community mobilization to minimize the effect of malnutrition and prevent water born disease, particularly AWD outbreak. • Strengthen the supply provision system.

The outlook for the situation in Somali Region remains bleak, including for the woredas covered by the OFDA grant, which remain mostly Priority 1. MC requests support for continuing these much- needed, life-saving interventions.

7. Budget Narrative

The budget is attached separately.

14