NORTHWEST MULTISECTORAL NEEDS ASSESSMENT REPORT
ANKA, BUNGUDU, GUSAU, SHINKAFI, TALATA MAFARA ZAMFARA LGA
December | 2020
© MSF/Abayomi Akande TABLE OF CONTENTS 1. EXECUTIVE SUMMARY ...... 6 Health ...... 6 Nutrition ...... 6 Food Security and Livelihoods ...... 7 Protection ...... 7 Mental Health and Psychosocial Support ...... 7 2. Introduction ...... 8 Background ...... 8 Objectives of the Assessment ...... 11 Methodology ...... 13 2.3.1. Study Design ...... 13 2.3.2. Limitations ...... 15 3. ASSESSMENT FINDINGS ...... 16 Demography ...... 16 3.1.1. Survey Respondents Characteristics ...... 16 3.1.2. Household Characteristics ...... 17 Primary Health Care ...... 20 3.2.1. Health Services ...... 20 3.2.2. Health Manpower ...... 23 3.2.3. Supplies, Equipment, Infrastructure ...... 24 3.2.4. Finance ...... 24 Nutrition ...... 25 3.3.1. Treatment Seeking For Acute Malnutrition ...... 25 3.3.2. IYCF Knowledge And Practices ...... 26 Food Security and Livelihoods ...... 28 3.4.1. Food Security Indicators ...... 28 3.4.2. Food Availability ...... 30 3.4.3. Food Accessibility ...... 31 3.4.4. Population’s Perception of their Food Security and Livelihoods ...... 32 Protection ...... 34 3.5.1. Gender Based Violence (GBV) ...... 34 3.5.2. Coercion ...... 35 3.5.3. Deliberate Deprivation ...... 36 3.5.4. Unaccompanied and Separated Children (UASC) ...... 37 3.5.5. Other Protection Risks/Problems ...... 38 3.5.6. Existing Capacities to Cope or to Overcome Risks ...... 38 Mental Health and Psychosocial Support ...... 39 3.6.1. Impacts of the Current Crisis on Population & Psychosocial Reactions ...... 39 3.6.2. Coping Strategies ...... 40 3.6.3. Perception & Support to People in Psychosocial Distress ...... 41 3.6.4. Community’s Perception of People with Mental Health Issues ...... 42 3.6.5. Services Available for People with Mental Illnesses ...... 43 4. RECOMMENDATIONS ...... 44 Primary Health Care ...... 44
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4.1.1. Short-term solutions ...... 44 4.1.2. Mid-term solutions ...... 44 4.1.3. Long-term solutions ...... 44 Nutrition ...... 44 4.2.1. Short term solutions ...... 44 4.2.2. Mid-term solutions ...... 44 4.2.3. Long term solutions ...... 45 Food Security and Livelihoods ...... 45 4.3.1. Short term solutions ...... 45 4.3.2. Mid-term solutions ...... 45 4.3.3. Long term solutions ...... 45 Protection ...... 45 4.4.1. Short term solutions ...... 45 4.4.2. Mid-term solutions ...... 45 4.4.3. Long term-solutions ...... 46 Mental Health and Psychosocial Support ...... 46 4.5.1. Short-term solutions ...... 46 4.5.2. Mid-term solutions ...... 46 4.5.3. Long term solutions ...... 46 5. ANNEXES ...... 48 Annex 1: Category of staff in the assessed PHCCs ...... 48 Annex 2: Map of Assessed Locations ...... 49 Annex 3: List of Available Health Facilities in the Assessed Areas ...... 50 Annex 4: Number of Individuals Reported in Need ...... 51 Annex 5: Actor Mapping in Assessed Areas ...... 52 Annex 6: Assessments Conducted (November 2020 – December 2020) ...... 54 Annex 7: Random Walk Methodology ...... 56
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LIST OF TABLES Table 1: Specific objectives of the needs assessment ...... 11 Table 2: Assessed Health Facilities ...... 14 Table 3: Gender of household respondents per assessed location ...... 16 Table 4: Key informant role per assessed location ...... 16 Table 5: Average household members per location ...... 17 Table 6: Sources of income details per location ...... 19 Table 7: Drugs availability in the all (7) health facilities ...... 24 Table 8: Characteristics of wealth groups as defined by assessed communities ...... 33 Table 9: Average number of reported cases between November and December 2020 ...... 34 Table 10: What people do to feel better when there are mentally unwell or unhappy ...... 40 Table 11: Causes of mental illness according to household respondents ...... 42 Table 12: Services available for mentally ill individuals according to household respondents ...... 43 LIST OF FIGURES Figure 1: IDP Distribution by State and Site Type ...... 10 Figure 2: Education level of household respondents per location ...... 17 Figure 3: Gender and age breakdown within households ...... 18 Figure 4: Household status per assessed location ...... 19 Figure 5: Distribution of death cases per LGA ...... 20 Figure 6: Difficulties accessing the health facilities ...... 21 Figure 7: Estimated time to get to the nearest health facility by walking ...... 21 Figure 8: Common disease household members suffered from in the last six months ...... 22 Figure 9: Household knowledge about signs of malnutrition ...... 25 Figure 10: Early initiation to breastfeeding ...... 26 Figure 11: Household Hunger Score indicator ...... 28 Figure 12: Food Consumption Score per location ...... 29 Figure 13: Household Dietary Diversity Score per location ...... 29 Figure 14: Average Coping Strategy Index per location ...... 30 Figure 15: Category of Coping Strategy Index per location ...... 30 Figure 16: Causes of food insecurity in Zamfara state ...... 32 Figure 17: Perception of food availability during a normal year by surveyed households ..... 33 Figure 18: Sources of support for GBV survivors ...... 35 Figure 19: Targets of coercion acts ...... 36 Figure 20: Reported cases of coercion in some locations ...... 36 Figure 21: Source of support to UASC ...... 37 Figure 22: How often the respondents felt mentally unwell/unhappy ...... 39 Figure 23: Complaints from respondents when they feel unwell or unhappy ...... 40 Figure 24: Attitude of key informants toward mentally-ill individuals ...... 41 Figure 25: Relationship of mentality-ill with the community according to key informants ..... 43
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ACRONYMS AND ABBREVIATIONS Assessment Capacities Key Informant / Key ACAPS KI/KII OPD Outpatient Department Project Informant Interview Outpatient Therapeutic CHW Community Health Worker LGA Local Government Area OTP Program Community Nutrition CNM LLTN Long Lasting Treated Nets PHC Primary Health Care Mobilizer Moderate Acute Primary Health Care CSI Coping Strategy Index MAM PHCC Malnutrition Clinic/Center Displacement Tracking DTM MCG Mother-Care Group PSS Psychosocial Support Matrix Psychosocial Support FCS Food Consumption Score MDM Médecins du Monde PSS Service Post-Traumatic Stress FeFo Iron-Folic Acid Oral MH Mental Health PTSD Disorder Mental Health and Premiere Urgence FGD Focus Group Discussion MHPSS PUI Psychosocial Support Internationale Food Security and Maternal, Newborn and FSL MNCHW SAM Severe Acute Malnutrition Livelihoods Child Health week Sexual Assault Response GBV Gender Based Violence MNP Micro-nutrient Powder SARC Coordinator Médecins Sans Frontières / HC Host Community MSF SC Stabilization Center Doctors Without Borders Household Dietary Diversity MSF Medecin Sans Frontiere Sexual and Gender-Based HDDS SGBV Score OCA Holland Violence MSF Medecin sans Frontiere HH Household SI Solidarités International OCB Spain Multi Sectorial Need HHS Household Hunger Score MSNA SMoH State Ministry of Health Assessment Mid-Upper Arm Sexual and Reproductive HI Humanity and Inclusion MUAC SRH Circumference Health National Emergency HQ Headquarters NEMA TBA Traditional Birth Attendant Management Agency Information and Unaccompanied and ICT NFI Non-Food Items UASC Communication Technology Separated Children Joint United Nations Internally Displaced IDP NGA Nigeria UNAIDS Programme on HIV and Person/People AIDS International Non- United Nations High INGO NGN Nigerian Naira UNHCR Governmental Organization Commissioner for Refugees International Organization Non-Govermental Water, Sanitation and IOM NGO WASH for Migration Organization Hygiene Individual Protection National Security Affairs Women and Children IPA NSAG WCWC Assistance Group Welfare Clinic Islamic State West Africa ISWAP OAG Organized Armed Group WFP World Food Program Province In-patient Therapeutic Coordination of ITFC OCHA WHO World Health Organization Feeding Centre Humanitarian Affairs Infant and Young Child Orphan and Less Privileged Zamfara Emergency IYCF OLPC ZEMA Feeding Clinic Management Agency
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1. EXECUTIVE SUMMARY
Since April 2016, PUI has been present in Nigeria, contributing to address the needs of crisis- affected populations in Borno State. An integrated response is implementing in Maiduguri and Monguno.
Following recent reports on the multidimensional crisis in the North West region, PUI undertook a context analysis through literature review in Katsina, Sokoto and Zamfara states. The analysis highlighted the difficulties and vulnerabilities faced by both displaced and host community. Zamfara state appears to be the epicenter of this crisis and experienced regular, if not daily, security incidents. Due to this insecurity, significant displacement waves are reported within and outside the North West region. The population faces acute humanitarian needs related to food, livelihoods, protection, health care, water and sanitation. Thus, after carrying out a security assessment, PUI decided to conduct a multi-sectoral needs assessment in Zamfara state to identify and analyze the major concerns.
HEALTH Malaria measles and acute watery diarrhoea are the main health problems reported. Different types of health facilities are available for treatment, from Primary Health Care Clinics (PHCC) to Primary Health Care Centers (PHCC). However, several barriers prevent the population from accessing them. The first one is the cost, while the second is the distance/time of transport. The shortage of medicines and lack of skilled health workers are also cited and prevent the provision of quality health care. None of the health facilities assessed have doctors and nurses, and some have not received medicines for more than 3 months. As a result, 33% of the people interviewed said that they do not go to health facilities. Nevertheless, the data show that the majority of the population prefers to treat themselves or use traditional medicine. For instance, almost all women give birth at home. The lack of knowledge in sexual and reproductive health can be extended to the whole health sector. There is a real need for community sensitization on the prevention and management of different diseases.
NUTRITION Global acute malnutrition is the main cause of mortality among children in Zamfara state. According to Zamfara SMoH nutrition activity report in 2020, 7.2% children are SAM while 18.0% are MAM. Despite these acute needs, few malnutrition treatment facilities exist (only 10 OTP and 1 stabilization center). These centers generally lack medical supplies such as RUTF and MNP. Also, most communities do not have local nutritional screening activities. As a result, MAM children are not detected early enough and often have to walk for hours to reach a center in order to be treated for complicated SAM. Finally, there are huge gaps in knowledge about IYCF in the communities assessed.
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FOOD SECURITY AND LIVELIHOODS There is a need for urgent food assistance. Subsistence farming (crop production and livestock rearing) are the major source of food and livelihoods for majority of households. The reduction of food production at household, due mainly to insecurity, has negatively affected the availability of food for many households and caused them to rely more on the market. However, the majority of households has a weak purchasing power resulting from the loss of livelihoods, on one hand, and of increased food prices on the other hand. They cannot therefore afford accessing enough food to meet their daily requirement. Many households record days without eating at all – 88.1% with severe household hunger score (HHS). Up to 58% of assessed households had a “poor” Food Consumption Score (FCS) and 25% had a “borderline” FCS. These food security indicators appear to be worse in Anka LGA (especially Dan Galadima ward, 90% households with poor FCS) and Talata Mafara LGA (especially Madawakin Galadima ward, 80% households with poor FCS).
PROTECTION Both host and displaced communities face many protection risks. Children are at risk of abduction, separation from parents (either killed or abducted), forced labor and trafficking; while adult men are at risk of abduction and forced labor. On the other hand, women and girls are the most at risk of gender-based violence, kidnapping, rape, sexual assault, forced marriage. They are also target of stigmatization and isolation for those who had been released or escape, and it includes rejection from family or husband. In addition, cases of deliberate deprivation targeting IDPs, women, adolescent girls and adolescent boys have been reported. No protection actors were found in the assessed LGAs. GBV survivors and those in need of Psychosocial Support and Mental Health care have no place to go except few available hospitals which charge for their services. Finally, community beliefs and gender established norms are barriers to seek supports for those suffering from mental illness.
MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT The majority of respondents reported that they are mentally unwell or unhappy because of the impact of the crisis. The main stressors reported by participants are loss of property and family members. Respondents report suffering from high level of anxiety and depression symptoms. Community support is found by turning to family and friends, but also traditional leaders, religious leader, teachers. Participants mentioned several individual coping mechanisms such as doing something they like, talking to someone or crying. Community generally shows empathy for people with psychological distress and try to support them. Otherwise, respondents believe that mental-illness is caused by struggles or painful/serious event faced in life, hereditary or attributed to superstitious believes. The main barrier to mental health care was identified as the lack of services available.
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2. INTRODUCTION
BACKGROUND The North West region of Nigeria is divided in seven states which are Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto and Zamfara. The two main ethnic groups are the Hausa and Fulani and there are 33 million inhabitants estimated (2006 Census). The region has the highest poverty rate in the country, with 87% for Sokoto, 87% for Jigawa and 74% for Zamfara as top three states. Access to health care, clean water and food is not assured for all and many people are in extremely vulnerable situations. Regarding education, the North West has the highest number of out-of-school children in Nigeria1 and the literacy rate is estimated at 29,7%. The region suffers from three different but intertwined crisis.
From 2009 to 2011, existing tensions between Hausa sedentary farmers and Fulani roving herders in Zamfara State turned into armed clashes. This state is the epicenter of the conflict with a population of 5,307,154 inhabitants spread in 14 LGAs including Zurmi, Maradun, Talata Mafara, Gusau (state capital), Kaura Namoda, Bungudu, Chafe, Maru, Anka, Bukkuyum, Gummi, Bakura, Birin Magaji/Kiyaw and Shinkafi2. While the clashes over land property progressively became more militarized, the conflict spread from 2014 to neighboring states such as Kano, Kaduna, Katsina, Kenni and Sokoto.
The rise of OAGs for self-defense was coupled with an increased violence and banditry. Few criminal gangs organized large-scale cattle rustling, kidnapping for ransom, armed robbery, pillage, and attack of gold miners and traders. These groups do not hesitate to target the population directly, which significantly increases insecurity.
This volatile context has contributed to the spread of larger OAGs in the North West, such as Jama'atu Ansarul Muslimina Fi Biladis Sudan (JAMBS) and the Islamic State West Africa Province (ISWAP)3. OAGs are interested in the porous and close borders between Nigeria and Niger (Jibia in Katsina and Ilela in Sokoto) which facilitate illegal movements of people and
1 International Crisis Group. (2020, May 19). Violence in Nigeria’s North West: Rolling back the mayhem. Crisis Group. https://www.crisisgroup.org/africa/west-africa/nigeria/288-violence-nigerias-north-west-rolling-back-mayhem 2 Nigeria Investment Promotion Commission (NIPC), https://nipc.gov.ng/nigeria-states/zamfara-state/ 3 UNHCR Nigeria, & NCFRMI. (2020, September 9). Joint protection assessment mission to northwest Nigeria: 25 July - 4 August 2019 - Nigeria. ReliefWeb. https://reliefweb.int/report/nigeria/joint-protection-assessment-mission-northwest-nigeria-25-july-4-august-2019
December 2020 / Needs Assessment 8 Première Urgence Internationale goods across the two countries4. However, several reports indicate that ISWAP has not yet established a presence as consistent as in the North East5.
Government's security response appears to have been unsuccessful. Various joint security operations were mounted in the region, such as HARBIN KUNANA II in Katsina, HARBIN KUNANA III in Sokoto and SHARA DAGI in Zamfara6. In fact, clashes between government security forces and OAGs have increased overall insecurity over the years. This situation was aggravated by the failure of a peace agreement initiated in 2019 by the governors of Katsina and Zamfara states. Some powerful OAGs, such as Buharin Daji and Dogo Gyedi, did not participate in the peace negotiation. Moreover, the peace agreement was seen as privileging the Fulani and neglecting the Hausa, which led to a more violent division between both communities 7 . Thus, since 2016, almost daily attacks have been recorded in Zamfara, Katsina and Sokoto states.
This multidimensional crisis creates insecurity and has numerous impacts on the population. Human rights violations were reported with assaults on rural communities and violent reprisal attacks against the civilian population. Due to this violence, many people abandoned their farms and assets leading to significant displacement waves within and outside the North West region. Different sources estimate that the crisis has forced around 200,000 individuals to leave their homes and 60,000 people fled into neighboring country Niger8. They find refuge in urban towns or across the border to Niger, causing acute humanitarian needs in those regions. The distribution of IDPs by states is indicated in the figure below.
The general living conditions of the host community and IDPs are significantly impacted by the crisis. In May 2020, UNHCR reported that the priority needs were food, livelihoods, while protection risks were steadily increasing9. In parallel, ACAPS also reported health care, water and sanitation as main challenges in areas with high concentration of IDPs10. Consequences on children and family structures are notable as the government reported that over 16,000
4 ACAPS. (2020, July 25). Nigeria: Banditry violence and displacement in the northwest. https://www.acaps.org/special-report/nigeria-banditry-violence-and-displacement-northwest 5 Chitra Nagarajan. (2020, May 15). Analysis of violence and insecurity in northwest Nigeria. https://chitrasudhanagarajan.files.wordpress.com/2020/05/zamfara-analysis-of-violence-and-insecurity.pdf 6 UNHCR Nigeria, & NCFRMI. (September 9). Joint protection assessment mission to northwest Nigeria: 25 July - 4 August 2019 - Nigeria. ReliefWeb. https://reliefweb.int/report/nigeria/joint-protection-assessment-mission-northwest-nigeria-25-july-4-august-2019 7 ACAPS. (2020, July 25). Nigeria: Banditry violence and displacement in the northwest. https://www.acaps.org/special-report/nigeria-banditry-violence-and-displacement-northwest 8 UNHCR Nigeria. (2020, June). Nigeria: Protection monitoring dashboard - Katsina, Sokoto and Zamfara May 2020 - Nigeria. ReliefWeb. https://reliefweb.int/report/nigeria/nigeria-protection-monitoring-dashboard-katsina-sokoto-and-zamfara-may-2020 9 Ibid. 10 ACAPS. (2020, July 25). Nigeria: Banditry violence and displacement in the northwest. https://www.acaps.org/special-report/nigeria-banditry-violence-and-displacement-northwest
December 2020 / Needs Assessment 9 Première Urgence Internationale children had been orphaned because of violence; other sources estimate this number up to 44,000 children affected11.
Figure 1: IDP Distribution by State and Site Type12
To better understand the highly volatile environment of the North West region, PUI carried out a desk review and gathered secondary data. In light of the findings on the difficulties faced by the population, PUI decided to conduct a multi-sectoral needs assessment (MSNA) in Zamfara state between December 6th and 21st. Synergy group, set up both at headquarters and field level with HI, SI and MdM, was a driving force to develop a collaborative response and avoid duplication. This needs assessment report aims to provide an update on the humanitarian situation and needs in Zamfara state, North West Nigeria.
11 International Crisis Group. (2020, May 19). Violence in Nigeria’s North West: Rolling back the mayhem. Crisis Group. https://www.crisisgroup.org/africa/west-africa/nigeria/288-violence-nigerias-north-west-rolling-back-mayhem 12 IOM Nigeria. (2020, October). Nigeria - North central and north west zones displacement dashboard 4 (August 2020). Displacement Tracking Matrix | DTM. https://dtm.iom.int/reports/nigeria-%E2%80%94-north-central-and-north-west- zones-displacement-dashboard-4-august-2020
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OBJECTIVES OF THE ASSESSMENT The study overall objective is to assess the population needs resulting from the on-going crisis in six targeted LGAs of Zamfara state (Gusau, Bungudu, Anka, Bukkuyum, Talata Mafara and Shinkafi). The assessment focused on PUI core sectors of intervention as presented in the table below.
Table 1: Specific objectives of the needs assessment
Health and Nutrition Identify the main causes of Collect key health indicators highlighting the main causes of mortality mortality and morbidity and morbidity as well as the major health risks in the area Identify and analyze the determinants that could influence population Identify the determinants of health (e.g. geographical, environmental, demographic, political, health security regulatory, socio-economic and socio-cultural) Describe the health system organization and priorities according to the Describe and analyze the health six pillar model (e.g. health services; health manpower; health system information management system; supplies, equipment and infrastructure; finance; and governance) Describe the perception of the Collect the opinion of the population and health workers on the access population regarding health and functioning of the healthcare system Identify the key stakeholders (civil society, governments, NGOs, UN Identify stakeholders and agencies, donors) and classify them according to their area of potential partners intervention and mandate Prioritize the health needs by criteria (frequency, severity, Analyze and prioritize health consequences...) and list those on which PUI could intervene in needs accordance with the organization's health intervention framework. Propose recommendations for Provide answers to the identified needs/problems, mainly those where action PUI could intervene Identify constraints, limitations Describe security, institutional or logistical constraints as well as and opportunities on the field opportunities that may arise during a project implementation Food and Nutrition security and Livelihoods (FNSL) Assess the factors limiting Assess food production, food imports, markets functionality, sources of availability and access to food revenue, coping strategies when there is no money to access food Identify the political and institutional environment, context and Analyze the underlying causes of vulnerability (climate, geography, physical infrastructures and risks), food insecurity and threats facing capital of livelihood (access to capital, land usage habits and livelihood methods…) Identify the geographic region and Identify the most affected areas, vulnerable categories of population the population groups most (according to status, age, gender, professional category…), and define sensitive to food insecurity in vulnerability criteria that distinguish these groups regard to their livelihood Outline the population’s Collect testimonies from the population concerning their food security perception of FNSL and their perception of their own livelihood List the main stakeholders (civil society, authorities, NGOs, UN Identify stakeholders and agencies, donors) and specify their sector and geographic area of potential partners intervention
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Assess local priorities in terms of Identify and organize FSL priorities as well as available local resources needs and identify local capacity to respond to the identified needs and resources available Propose recommendations for an Identify relevant actions to tackle food insecurity and support livelihood appropriate response Identify constraints, limits and Describe security, institutional or logistical constraints as well as opportunities of the field opportunities that may arise during a project implementation Protection Identify different protection risks Identify what the main protection risks are and which populations are faced by the population most vulnerable Assess the main characteristics of the threats (type, frequency, Analyse different threats looming prevalence, location) and determine the responsible actors and the over the population main factors that define their behavior Describe the characteristics of the individuals and/or groups most Analyse individual/population’s vulnerable to the identified threats and determine the vulnerability impact/consequences of the threats Analyse individual/population’s Identify existing resources and strengths to address, mitigate and/or capacities overcome the various threats Calculate level and impact of the Risk calculation is carried out as follows: risks to anticipate mitigation RISK = THREATS X VULNERABILITIES measures CAPACITIES Identify constraints, limitations Describe security, institutional or logistical constraints as well as and opportunities on the field opportunities that may arise during a project implementation Mental Health and Psychosocial Support (MHPSS) Identify the population groups Identify the most affected areas, vulnerable categories of population most sensitive to the crisis in (according to status, age, gender, professional category…), and define terms of psychosocial well-being vulnerability criteria that distinguish these groups Outline the population’s Collect testimonies from the population concerning their perception of perception of mental illnesses mental illnesses Identify the key stakeholders (civil society, governments, NGOs, UN Identify stakeholders and agencies, donors) and classify them according to their area of potential partners intervention and mandate Assess local priorities in terms of Analyze MHPSS priorities by using participative approach within the needs and identify local capacity local communities and resources available Propose recommendations for an Identify relevant interventions and target groups endorsed to tackle appropriate response to tackle MHPSS needs the psychological problems Identify constraints, limits and Describe security, institutional or logistical constraints as well as opportunities of the field opportunities that may arise during a project implementation
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METHODOLOGY 2.3.1. Study Design The assessment used mixed methods for data collection, including household surveys, key informants' interviews (KII), focus group discussion, desk review and observation.
Physical accessibility, vulnerability reported from existing data and security assessment conducted were used to determine which Local Government Areas (LGAs) to assess. Given the limited information available from secondary data analysis, purposive sampling was used to select sites from Zamfara state. The assessment team prioritized informal settlements and host communities where local authorities reported more vulnerability and presence of IDPs.
Household Surveys
Household surveys provide information on the situation of households with respect to the assessment objectives. They also provide a valuable validation finding from the Focus Group Discussion via triangulation. The household survey was conducted using a random walk sampling13 to select respondents in target communities. Convenience sampling was used to determine the number of respondents assuming 450 households equally distributed in 5 LGAs (90 households per location) given the limited demographic information available during the preparation phase of the assessment.
Key Informants Interviews (KII)
Key informants were randomly identified and selected for the needs assessment. For health, government health managers, nurses and registrars (in health clinics) were targeted for the information collection. For food security and livelihood, community leaders, teachers and vendors were selected to participate in the assessment and provide information on FSL. Lastly, for protection, IDP representatives, person with disabilities, religious leaders and women leaders were identified to participate in the assessment. There were 9 key informants per LGA (3 health and nutrition, 3 food security and livelihoods, 3 for protection and PSS), for a total of 45 respondents.
Focus Group Discussion (FGD)
As a qualitative data collection method, focus group discussions were used to help understand the social norms of the affected and assessed communities or their subgroups, as well as the range of experiences, opinions, perceptions and attitudes that exist within those communities or their subgroups. Key elements such as gender, age, ethnicity or socio-
13 Systematic random walk: A type of non-probability sampling in which interviewers begin the interview process at some random but well-defined geographic point, and then follow a specified path of travel, systematically selecting households to be interviewed. (Gibson, R., & Ferguson, E. L., 1999)
December 2020 / Needs Assessment 13 Première Urgence Internationale economic status were used during focus group discussions and the facilitator guided the discussion by key questions for each sector.
Given the resources available to conduct the assessment and the security analysis, 3 LGAs (Anka, Bungudu and Talata Mafara) were selected to host the gender-segregated focus groups for a total of 6 FGDs: 3 for women and 3 for men. The survey team insure to lead inclusive discussion by selecting participants with different roles and age in the community including young adults, pregnant and lactating women, petty traders, local leaders, elderly, teachers, IDPs and CBO representatives.
Desk Review
The literature review covered global publications, such as INGOs, local NGOs, WHO, WFP, UNHCR, IOM and UNAIDS documents, publications related to the target locations and different Analysis reports. Data on Health, Nutrition, PSS, Protection, Food Security and Livelihood were reviewed. Interpretive techniques (coding and recursive abstraction) were applied in the analysis of secondary data. Validity was addressed as a central challenge to ensure credibility of the review - reference checking, compliance and balance was observed as ways of establishing validity.
Observation
During the needs assessment, a total of 7 primary health care centers (PHCC) were selected and assessed using an observation/checklist methodology. Some PHCCs, such as PHC Mada in Gusau LGA, were assessed based on the recommendations of the administrative authorities who were interviewed as Key Informants. The table below provides further information for each PHCC assessed per location.
Table 2: Assessed Health Facilities
LGA Ward Name of Health Facilities Bungudu Bungudu Orphan & less privileged PHC Bungudu Bungudu WCWC PHC Talata Mafara Galadima Orphan & less privileged PHC Anka Anka PHC Galadanci Shinkafi Shanawa PHC Shanawa Shinkafi Galadi PHC Galadi Gusau Mada PHC Mada
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2.3.2. Limitations The security context in a few planned wards limited the data collection team’s access. Thus, these locations were skipped and not covered by the focus group discussions, KIIs and household surveys.
LGAs and ward demographics (i.e. sampling frame) were unavailable for prior planning. As a result, some wards had a higher proportionate sampling than others.
The sampling design contained a high degree of judgment (in order to cover the most vulnerable areas) and should be considered as purposive sampling. This limitation prevented the application of probabilistic formulas to calculate confidence intervals and extrapolate the data to represent population of the whole area. Instead of relying on probabilistic theory, this assessment used methodological triangulation based on household surveys, observations, desk reviews, focus groups and key informant interviews.
This report cannot tell the burden of malnutrition in the assessed location because it was not assessed, nor the weight for height assessment was done.
The random walk method is subject to bias and depends on good facilitation by the supervisor. As a quality control measure, the survey supervisor was required to verify the distribution of selected households on a daily basis for at least 10% of the households assessed per enumerator.
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3. ASSESSMENT FINDINGS
DEMOGRAPHY 3.1.1. Survey Respondents Characteristics Gender of Household Respondents
The household survey reached 454 respondents with the planned methodology. The table below provides further details for the number of households and gender of respondents.
Table 3: Gender of household respondents per assessed location
Locations Female Male Total Anka 44 45 89 Dan Galadima 20 10 30 Magaji 24 35 59 Bukkuyum 41 49 90 Nassarawa 41 49 90 Bungudu 35 56 91 Bungudu 35 56 91 Shinkafi 39 51 90 Shanawa 39 51 90 Talata Mafara 41 53 94 Galadima ward 11 9 20 Kayaye Matuzgi 24 40 64 Madawakin Galadima 6 4 10 Grand Total 200 254 454 Key Informants Role
The number of key informants reached was 43 instead of the planned 45, due to their availability during the assessment period. The table below shows the category of key informants. Most of them were men (81%), while women were mainly TBA or leaders.
Table 4: Key informant role per assessed location
-
Locations
repre
tatives
Birth
Total
Nurse
leader
Leader Leader
Vendor
Women
t Health
Teacher
disability
Manager
Registrar
Religious
IDP
Traditional
sent
Community
Attendance
Governmen
Person with Anka 1 1 1 1 1 1 1 7 Bukkuyum 2 1 1 1 1 1 1 1 9 Bungudu 1 1 1 1 1 1 1 1 1 9 Shinkafi 1 1 1 1 1 1 1 1 1 9 Talata Mafara 1 1 1 1 1 1 1 1 1 9 Grand Total 6 3 1 4 5 5 5 3 3 3 5 43
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Education Level of Household Respondents
The majority of respondents, which were 71.8%, mentioned that they attended Only Koranic Education, while 10.6% completed secondary school and only 7.3% completed primary school. The graph below provides further information per LGA.
Figure 2: Education level of household respondents per location
Madawakin Galadima 80.0% 20.0% Kayaye Matuzgi 54.7% 34.4% 3.1%
Galadima ward 25.0% 20.0% 20.0% 25.0% 5.0% Talata Mafara Talata
Shanawa 74.4% 5.6% 7.8% 8.9%
kafi Shin
Bungudu 72.5% 14.3% 5.5%
udu Bung
m Nassarawa 83.3% 14.4%
uyu Bukk Magaji 78.0% 3.4% 16.9%
Anka Dan Galadima 80.0% 10.0% 10.0% Only Koranic Education Secondary Completed Primary Completed No Formal Education Superior Completed Secondary Non-Completed
3.1.2. Household Characteristics Household Composition
The household survey conducted in the 5 LGAs of Zamfara showed that the overall average household size was 8.914, with the highest size recorded in Talata Mafara around 11.2 members per household. The table below provides further details per location.
Table 5: Average household members per location
LGA Ward Average of Household Members Anka Dan Galadima 8.2 Anka Magaji 10.4 Bukkuyum Nassarawa 8 Bungudu Bungudu 8.3 Shinkafi Shanawa 7.6 Talata Mafara Galadima ward 9.9 Talata Mafara Kayaye Matuzgi 11.8 Talata Mafara Madawakin Galadima 10 Overall Average 8.9
In Bungudu, FGDs indicated that the household structure is mostly a man with two (2) wives and children for a total average of 12 members, including two (2) working members. In Anka, FGDs reported that the average household size in the community is 10, with mostly two (2)
14 Median: 7; Standard deviation:6.3
December 2020 / Needs Assessment 17 Première Urgence Internationale wives and 2 working members. In Talata Mafara, it was stated that, the average household size is 12, with mostly three (3) wives, many children and three (3) to four (4) working members.
Gender and Age Composition of Household Members
The graph below shows the composition of the households surveyed in terms of age and gender. 32.1% of the household population surveyed was between the ages of 0 to 59 months, while 34.0% was between the ages of 5 to 17 years old, and 30.0% between 18 and 59 years old. Only 3.8% of the population were over 60 years of age.
Figure 3: Gender and age breakdown within households
60+ Years 1.6% 2.2%
18 to 59 Years 15.4% 14.6%
5 to 17 Years 16.0% 18.0%
24 to 59 Months 7.7% 8.9%
6 to 24 Months 4.3% 5.6%
0 to 5.9 Months 2.7% 2.9% Male Female Household Settlement Status
About 42.5% of the households surveyed were host community, while an overwhelming majority of 57.3% were IDPs. Only 0.2% of the assessed households were returnees in Bungudu. The graph below provides further details.
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Figure 4: Household status per assessed location
Madawakin Galadima 100.0%
Kayaye Matuzgi 54.7% 45.3%
Talata Mafara Talata Galadima ward 50.0% 50.0%
afi Shanawa 48.9% 51.1% Shink
Bungudu 81.3% 17.6% 1.1%
udu Bung
Nassarawa 21.1% 78.9%
Bukk uyum Magaji 1.7% 98.3%
Anka Dan Galadima 100.0% Host IDP Returnee Household Means of Livelihood
The survey showed that the majority of the surveyed households relay on casual labour with an average of 28.6%, followed by agriculture with an average of 18.4%. 22.2% of households mentioned that they have no income. They selected that option as the majority of them relayed on casual labor, agriculture or other types of income which are short term and not sustainable on the long term. The table below provides more details.
Table 6: Sources of income details per location
/
Keke
Trade
LGA Location /
Other
Salary
Delivery
Begging
Agriculture Assistance
No Income
Petty
Government
Remittances
Skilled Labour
Casual Labour
Driver
NGO Assistance Dan Anka 0% 17% 0% 0% 47% 3% 10% 23% 67% 67% 0% 3% Galadima Anka Magaji 3% 3% 0% 0% 17% 22% 5% 46% 68% 81% 12% 2% Bukkuyum Nassarawa 0% 16% 2% 1% 33% 10% 2% 54% 67% 72% 4% 7% Bungudu Bungudu 3% 15% 0% 2% 76% 12% 12% 24% 33% 73% 2% 3% Shanawa Shinkafi 1% 22% 0% 1% 47% 9% 2% 49% 58% 69% 2% 3%
Talata Galadima 0% 45% 0% 5% 50% 10% 30% 15% 5% 45% 0% 0% Mafara Talata Kayaye 6% 17% 0% 3% 42% 19% 3% 45% 58% 64% 2% 6% Mafara Matuzgi Talata Madawakin 10% 30% 0% 0% 40% 0% 0% 30% 90% 90% 0% 10% Mafara Galadima Average 2% 17% 0% 2% 45% 12% 6% 41% 55% 71% 4% 4%
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PRIMARY HEALTH CARE According to MSF-OCA, which operates in health facilities in Zamfara State, severe acute malnutrition and malaria were identified as the main mortality causes in 2020 and represented 60.4% of death cases (37.3% caused by malnutrition and 23.1% by malaria) in three facilities. Most of these cases (about 87.8%) are from Anka, Talata Mafara and Bukkuyum LGAs as indicated below. While health risks are critical, the health facilities need to be supported to provide quality care to a greater number of patients.
Figure 5: Distribution of death cases per LGA
27.10% Anka LGA Talata Mafara LGA 27.60% Bukkuyum LGA 33.10%
3.2.1. Health Services Availability
From various FGD conducted by PUI, the community mentions that 91% of the existing health facilities are Primary Health Care Centers) or clinics (PHCCs). The only clinics assessed are Galadima OLPC PHCC and Bungudu OLPC PHCC. The difference between these two kinds of health facilities is the level of services they provide. In addition to outpatient services, the clinics provide 20 hours a day, 7 days a week of BEmONC and hospital services. The PHCCs assessed usually operate 6-8 hours per day, 5 days per week and provide OPD consultations and sexual and reproductive health services (ANC, PNC, family planning). The most complicated cases are referred to other centers. Unlike in Bungudu and Talata Mafara LGAs, there are no deliveries in Anka LGA facilities. Nevertheless, MSF-OCA provides secondary health care services and pediatric surgery there, while PHCCs in Bungudu and Talata Mafara LGAs are not supported by any NGOs. Among the listed areas, Bungudu is the only LGA with a general hospital operating 24 hours a day.
Accessibility
Both the host community and the IDP population have access to health facilities. In total, the assessment reveals that 77% of the respondents households stated going to health facilities, while other see traditional healers (10,4%), self-medicate (8,6%), consult traditional birth attendants (3,6%) or spiritual healers (0,4%). Nevertheless, the analysis conducted by
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Pastoral Resolve, Search For Common Ground and Terre Des Hommes in 201915 mentions that even those who go to the health facilities still resort to traditional medical practices and sometimes self-medicate. Several constraints prevent the population from going there.
Information gathered from the FGDs indicate that medical cost is the first barrier to access health care, as shown in the figure below. In most health facilities, the services provided are not free of charge and patients have to pay for every medical service, including medicines, medical supplies or deliveries. Figure 6: Difficulties accessing the health facilities
Cost 25% Distance (far off)
Lack of supplies 46% 13% (medicines/equipment) Security 13% 4% Insufficient number of staff/qualified staff For 25% of the households surveyed, the second constraint is distance. Some communities have to walk about an hour to reach the closest health facility. The figure below shows that this is particularly the case in Talata Mafara LGA. For instance, in Madawakin Galadima, 90% of the population has to walk between 30 minutes and one hour to reach a health facility. This access issue is aggravated by insecurity or the weather conditions as roads are sometimes impassable such as during the rainy season.
Figure 7: Estimated time to get to the nearest health facility by walking
Average 21.0% 79.0% Madawakin Galadima 90.0% 10.0%
Kayaye Matuzgi 27.4% 72.6% Talata Mafara Galadima ward 47.4% 52.6%
fi Shanawa
Shi 8.2% 91.8% nka
u Bungudu 9.6% 90.4%
gud Bun
Nassarawa 36.3% 63.8%
um
kuy Buk Magaji1.7% 98.3%
Anka Dan Galadima 33.3% 66.7%
30 mins to 1 hours Less than 30 minutes
15 Pastoral Resolve, Search For Common Ground, Terre Des Hommes. (2019, October). Zamfara Conflict Analysis and Multisectoral Needs Assessment
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Finally, the poor quality of services due to inadequate skilled health staff and drug supplies is also a contributing factor. Many respondents underline the lack of medicines. The lack of medicines is a real issue as some health facilities are not supplied for several months. In addition, the health centers in remote areas lack qualified staff because they refuse to go there due to the insecurity.
Main health issues
Key informants (KIIs) stated that safety and security needs (7%), livelihood and education opportunities (29% each) and access to water (36%) were their concerns, while food (86%) and health care (100%) were the most urgent needs for the community.
As indicated in the figure below, most FGD respondents reported that main health concerns are malaria 41.9%, measles 18.4% and acute watery diarrhoea 18.3%. Other diseases such as skin spots/rashes, high blood pressure and cell cancers were also mentioned.
Figure 8: Common disease household members suffered from in the last six months
Overall 41.9% 18.3% 18.4% 10.1% Madawakin Galadima 25.6% 7.7% 25.6% 20.5% Kayaye Matuzgi 48.1% 20.2% 19.4%
Galadima ward 40.8% 24.5% 20.4% Talata Mafara Talata
Shanawa 43.3%
kafi 16.7% 19.7% 11.8% Shin
u Bungudu 38.2% 22.7% 6.0% 18.0% 10.7%
gud Bun
m Nassarawa 44.1% 14.2% 16.2% 10.3%
uyu Bukk Magaji 48.7% 19.3% 16.8% 10.1%
Anka Dan Galadima 32.6% 16.3% 7.6% 17.4% 13.0% 7.6%
Malaria Diarrhoea ARI Measles Pregnancy Related Wound/Injuries Skin Diseases Others (Specify) None I don't know Sexual and Reproductive Health (SRH)
According to the Maternal, Newborn, and Child Health Programme (MNCH2)16, in Zamfara State, the maternal mortality ratio is 1,100 deaths per 100,000 live births (compare to 211 deaths per 100,000 live births globally according to 2017 UNICEF data) and infant mortality is 104 per 1,000 live births (compare to 52 per 1000 live births in 2018 in WHO African Region). These figures highlight the importance of conducting assisted deliveries in health facilities. However, key informants reveal that most deliveries are conducted at home (as per 71% of key informants) mainly because of the cost (57%), the lack of SRH awareness (36%)
16 Maternal, Newborn, and Child Health Programme. (2016). MIC Survey 2011-2016. https://www.mnch2.com/zamfara-state/
December 2020 / Needs Assessment 22 Première Urgence Internationale and safety/security on the road to reach the facility (21%). These assertions are confirmed by PUI's observation, as only three of the seven PHCCs assessed handled deliveries in November 2020: 23 in Galadi PHCC, 21 in Bungudu WCWC PHCC and 6 in Galadima OLPC PHCC.
Of all SRH consultations conducted in the seven PHCCs in November 2020, 40% concerned antenatal care, which is preventive care to monitor the health of the mother and the fetus during the whole pregnancy and to detect any complication as soon as possible. In contrast, only 2% were postnatal care consultations. This can be explained by the FGD, to the question "after delivery, when do the mother and baby go to the hospital/clinic?", 45.4% of the communities replied “if the mother and/or child has a problem” and 13.2 % said there is no need to go to a health center.
Thus, SRH services appeared to be unknown and/or misunderstood. This explains why the majority of those concerned by SRH care do not benefit from it.
Health Promotion
Community education and awareness of common diseases, including their preventive measures, is insufficient in Zamfara State. The frequency of message receipt is unsatisfactory, with only 24% of the respondents receiving messages often. The awareness is limited to handwashing (29%), vaccination (28%), use of insecticide-treated nets (19%) and open defecation (6%). Most of them are communicated in health facilities (40%), on the radio (21%) and through CHWs (11%). However, a few respondents showed some knowledge by stating that mosquitoes, which are often present because of stagnant water, cause malaria.
3.2.2. Health Manpower The quality of patient care depends on the availability of efficient and qualified health personnel. This staff must be sufficient in number and equitably deployed. However, in the health facilities assessed in Zamfara State, the distribution of health care workers is highly unequitable in terms of numbers but also of specific skilled personnel. For instance, Bungudu WCWC PHCC in Bungudu LGA has 2.8 times more staff than Galadima OLPC PHCC even though it covers half its population.
The only health facility with sufficient staff is Bungudu WCWC PHCC with 23 workers. The other six PHCCs assessed have, on average, 8 health care staff at their disposal (see Annex 1), while the NPHCDA guidelines state that each PHCC should have at least 21 health workers. Thus, these health facilities need 2.8 times more health care workers to receive and provide adequate care to patients. These data underline the unsustainability of the situation and the need to recruit additional staff to ensure quality care. None of the seven PHCCs have doctors or nurses.
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3.2.3. Supplies, Equipment, Infrastructure The lack of available medicines is one of the main reasons cited by the community for not accessing health care. In most facilities, the supply is provided by the Ministry of Health through the revolving fund system implemented in January 2020. Most patients cannot afford to pay for medical services in health facilities, so this is a recurring issue. If patients cannot afford to buy the drugs, health facilities will not be able to pay for the drugs at the state pharmacy, which prevents facilities from replenishing their stocks. That is why some health facilities prefer to be supplied by a faith-based organisation (Zakkat), such as in Galadima OLPC PHCC and Bungudu OLPC PHCC, or INGOs, such as MSF-OCB in Shanawa PHCC. Usually the supply takes between 1 to 4 months. While Shanawa PHCC received its last drugs in November 2020, one month before the assessment, Galadima OLPC PHCC had not received any for 6 months. The table below shows the availability of drugs in each PHCC. Galadima OLPC PHCC, Bundugu PHCC and Mada PHCC are the most vulnerable health facilities. The lack of antibiotics, among other drugs, affects the quality of care provided.
Table 7: Drugs availability in the all (7) health facilities
PHC Values
PHC PHC PHC PHC
OLPC
WCWC WCWC
Bungudu Bungudu Bungudu
Shanawa
Galadima Galadima
OLPC OLPC PHC
PHC Mada PHC
Galadi
Galadanchi Antibiotics Yes Yes No Yes No Yes No ORS No Yes No Yes No Yes No Anti-Malaria Yes Yes No Yes Yes Yes No Antipyretic Yes Yes No Yes No Yes Yes Contraception Yes Yes Yes Yes Yes Yes Yes Dressing materials Yes Yes Yes No Yes Yes No Tetanus toxoid Yes Yes Yes Yes Yes Yes Yes Measles Yes Yes Yes Yes Yes Yes Yes DPT Yes Yes Yes Yes Yes Yes Yes Polio Yes Yes Yes Yes Yes Yes Yes BCG Yes Yes Yes Yes Yes Yes Yes Functional cold chain Yes Yes Yes Yes Yes Yes Yes
3.2.4. Finance At the federal budget level, the percentage allocated to health care has decreased from 7.23% in 2014 to 4.38% in 2020. These percentages are far below the WHO recommendations of allocating 15% of the national budget to health care. In Zamfara State, priority has been given to security rather than health, which explains why the health facilities are drastically under- resourced, whether for equipment, drugs or for health staff. To remedy this lack of funding, some health facilities benefit from external support such as MSF for Shanawa PHCC, WHO’s
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Global Change Program for Mada PHCC, and a faith-based organization (Zakkat) for Galadima OLPC PHCC and Bungudu OLPC PHCC. Despite this, needs are still acute.
NUTRITION Zamfara SMoH nutrition activity report in 2020 17 revealed that, out of 10,937 children screened with MUAC, 18.0% children were MAM while 7.2% children were SAM. Compared to the National Nutrition and Health Survey (NNHS) 2018, in which MUAC report shows GAM 10%, MAM 8.5% and SAM 1.8%, the nutrition situation in Zamfara state warrants urgent attention.
3.3.1. Treatment Seeking For Acute Malnutrition All respondents agreed that malnutrition is a major health problem in their community. PUI has assessed the community knowledge about malnutrition, its causes and its signs. The signs identified by respondents are lack of a balanced diet, body shrinking, sliming/bulging, lack of growth and vomiting. Most of them also mentioned weight loss, frequent illnesses, and loss of appetite as signs to recognize a malnourished child. These data are presented in the following figure.
Figure 9: Household knowledge about signs of malnutrition
Overall 38.4% 21.9% 34.2% 5.5% Madawakin Galadima 50.0% 50.0%
Kayaye Matuzgi 39.7% 20.7% 36.2% 3.4% Talata Mafara Galadima ward 34.7% 28.6% 30.6% 6.1%
Shanawa 32.9% 25.0% 34.8% 7.3%
kafi Shin
u Bungudu 41.9% 19.8% 32.0% 6.4%
gud Bun Nassarawa 38.4% 22.7% 32.0%
um 7.0%
kuy Buk Magaji 37.3% 22.0% 38.1% 2.5%
Anka Dan Galadima 42.9% 20.6% 31.7% 4.8%
Less of weight (skinny) Swollen feet/body Not eating Others
Families behave differently when their children are malnourished, depending on where they live. In Bungudu LGA, FGD respondents usually give rice or soya porridge, while in Talata Mafara LGA they reported giving medicines and in Anka LGA they usually give traditional ones. If there is no improvement, most of the respondents take the child to the health facility or hospital.
17 Médecins Sans Frontières. (2020). Nutritional Overview Zamfara and Sokoto States
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In the KIIs conducted in Anka, Bungudu and Talata Mafara LGAs, 11 out of 14 people indicated that there were nutrition treatment facilities in their communities in outpatient therapeutic feeding centers (ATFC), also known as outpatient therapeutic program (OTP). However, there is no nutritional screening in the communities of the three LGAs.
For the management of complicated SAM cases, the FGDs reveal that there are few inpatient therapeutic feeding centers (ITFC) available, also known as stabilization centers (SC). In Bungudu LGA, SAM treatment services are available at Bungudu General Hospital. While some people need a 5-10 minute walk to reach the facility, others may spend 1-2 hours walking. In Anka LGA, outpatient treatment services are available at the stabilization center supported by MSF OCA and at Genunu General Hospital. Most residents need 15 minutes to get to these facilities. Finally, there is no existing stabilization center in Talata Magara LGA. The inhabitants are forced to go to the nearby town of Anka LGA to seek treatment at the MSF-OCA supported facility, which takes them about 2-3 hours to walk. Nevertheless, MSF-OCA reports that their stabilization center is overcrowded even before the peak season and that there is a need to open one in Talata Mafara LGA.
3.3.2. IYCF Knowledge And Practices Since the security crisis started, the community has noticed some difficulties with child feeding, such as lactating failure, low capacity to provide the right food, insufficient nutrition treatment facility and lack of information on nutrition.
From various FGD conducted on the length of breastfeeding, the majority of the surveyed population, 76.9% said a child should be breastfed for 24 months, while 11% stated 12 months and 1.1% less than 6 months, 1.3% said “no breastfeeding” and the last 9.5% didn’t know. Regarding the knowledge about IYCF, 70.7%, mentioned that breast milk alone is the best food to give to the baby after delivery. In comparison, 26.2% stated it is breast milk and water, and the remaining 3.1% responses were a combination of those who recommended water alone and others who did not know the answer. Figure 10: Early initiation to breastfeeding
Overall 70.7% 26.2% Madawakin Galadima 100.0% 0.0%
Kayaye Matuzgi 65.6% 34.4% Talata Mafara Galadima ward 85.0% 10.0%
fi Shanawa
Shi 72.2% 23.3% nka
u Bungudu 68.1% 28.6%
gud Bun
Nassarawa 62.2% 32.2%
um
kuy Buk Magaji 67.8% 32.2%
Anka Dan Galadima 96.7% 0.0%
Breast milk alone Breast milk and water I don't know Others (Specify) Water alone
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Nevertheless, most FGD respondents are not fully aware regarding the length of exclusive breastfeeding. While some define exclusive breastfeeding as only breastmilk for 6 months, others say for only 2 months. In all the locations assessed, there are few or no community- based nutrition activities, including IYCF services.
In Anka, respondents stated that MSF-OCA distributes micro-nutrient powder (MNP) in the nutrition facility to children diagnosed as malnourished. Although some of them indicated that they were aware of exclusive breastfeeding, many said that they did not practice it.
In Bungudu, the respondent stated that lactating women do not have enough breast milk, which is due to insufficient food intake (hunger). Although the insufficient food intake, leading to malnutrition, may have a long-term effect on breast milk after deteriorating the mothers' own health, the body will always prioritize milk production over any other function. Such a belief highlights the lack of knowledge about how the body produces breast milk and how breastfeeding can be maintained. They reported that Save the Children used to distribute formula, but that they no longer operate there.
In Talata Mafara, they indicated that there is not even enough food in the community to feed the children, unlike in other LGAs, nobody distributes formula for the children.
The above information highlight the fact that needs of nutrition assistance remain high in the assessed location. Especially for malnutrition case management as well as sensitization on complementary feeding initiation (6-8 months) and child feeding practices (9-23 months).
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FOOD SECURITY AND LIVELIHOODS 3.4.1. Food Security Indicators Food is the number one priority need quoted by all the key informants (100%), followed by health services (87%) and shelter (73%). The severe food insecurity observed in Zamfara is a direct consequence of insufficient food availability and accessibility which have been adversely affected by insecurity in the state. Insecurity reduced food production, decreased the purchasing power and contributed to the increase of prices of food commodities. Four food security indicators were assessed as following.
Household Hunger Score (HHS)
The Household Hunger Scale (HHS) gives indication on the household food deprivation. Results of the household's survey indicated that about 89% of interviewed households had a HHS above 4 which is indicative of “severe hunger”, characterized by large food consumption gaps in the short term18.
Figure 11: Household Hunger Score indicator Madawakin Galadima 40.0% 60.0%
Kayaye Matuzgi 4.7% 95.3% Talata Mafara Galadima ward 30.0% 70.0%
Shanawa 12.2% 87.8%
kafi Shin
u Bungudu 7.7% 92.3%
gud Bun Nassarawa 4.4%
um 95.6%
kuy Buk Magaji 18.6% 81.4%
Anka Dan Galadima 16.7% 83.3% Moderate hunger Severe hunger Food Consumption Score (FCS)
The Food Consumption Score (FCS) informs on the quantity and quality of household food consumption (caloric intake) based on food groups consumed. FCS was “poor” for 57.9% of respondents and “borderline” for 20.3% of respondents. This indicates that 78.2% of the households are severely food insecure and have an insufficient caloric intake. The average FCS was 24.919 with the lowest score recorded in Anka followed by Talata Mafara with respectively 17.9 and 25.4. The top three locations with the highest “poor” food consumption
18 Vaitla, Bapu; Coates, Jennifer; and Maxwell, Daniel. 2015. Comparing Household Food Consumption Indicators to Inform Acute Food Insecurity Phase Classification. Washington, DC: FHI 360/Food and Nutrition Technical Assistance III Project (FANTA). 19 Median: 19; standard deviation: 17.7
December 2020 / Needs Assessment 28 Première Urgence Internationale score were Dan Galadima, Madawakin Galadima, Magaji with a score of 90.0%, 80.0%, and 67.8%, respectfully. The graph below provides further details per location.
Figure 12: Food Consumption Score per location
Acceptable Borderline
54.4% 49.5% 48.4% 67.8% 56.7% 60.0% 90.0% 80.0% 25.0% 20.0% 24.2% 21.1% 20.3% 40.0% 25.6% 26.4% 26.6% 10.0% 11.9% 22.2% 20.0% 0.0%Dan Magaji Nassarawa Bungudu Shanawa Galadima Kayaye Madawakin0.0% Galadima ward Matuzgi Galadima Anka Bukkuyum Bungudu Shinkafi Talata Mafara Household Dietary Diversity Score (HDDS)
The Household Diet Diversity Score (HDDS) informs on the quantity of food intake (caloric intake) at household level based on food groups consumed. The HDDS average was equal to 420 confirming that the diet of respondents is globally inadequate in terms of calorie and diversity. With the three lowest HDDS recorded in Dan Galadima, Madawakin Galadima and Magaji with respectfully 1.8, 3.0, and 3.8. Two of them being in Anka LGA. The graph below provides further details on the HDDS per location.
Figure 13: Household Dietary Diversity Score per location HDDS Avg HDDS
4.0
4.7 3.8 4.0 4.2 4.1 4.1 3.0 1.8
Dan Magaji Nassarawa Bungudu Shanawa Galadima Kayaye Madawakin Galadima ward Matuzgi Galadima Anka Bukkuyum Bungudu Shinkafi Talata Mafara
Coping Strategy Index (CSI)
The Coping Strategy Index (CSI) informs on the behaviors taken by a household to mitigate or react to shortfalls in food supply21. The average CSI is 26.722 with the worse value in Anka
20 Median: 4, standard deviation: 2.1 21 Vaitla, Bapu; Coates, Jennifer; and Maxwell, Daniel. 2015. Comparing Household Food Consumption Indicators to Inform Acute Food Insecurity Phase Classification. Washington, DC: FHI 360/Food and Nutrition Technical Assistance III Project (FANTA). 22 Median: 22, Standard deviation: 20
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(CSI: 31.1) followed by Talata Mafara (CSI: 28.6). Up to 19% of respondents had a CSI above 43, indicating that they might adopt high coping strategies when they lack the means to buy food. Such high coping strategies may include asset depleting coping strategies such as the sale of productive assets. Most of interviewed households (61%) had a CSI between 11 and 42 which indicates that they adopt food based coping strategies such as reducing the size of ration or skip meals in order to cope with food shortage.
Figure 14: Average Coping Strategy Index per location
34.526.7 33.0 29.9 27.4 25.6 25.5 22.5 21.6
Dan Magaji Nassarawa Bungudu Shanawa Galadima Kayaye Madawakin Galadima ward Matuzgi Galadima Anka Bukkuyum Bungudu Shinkafi Talata Mafara The most affected areas are Magaji with 22.0% CSI above 43, and 76.3% CSI between 11 and 42. Followed by Madawakin Galadima with 20.0% CSI above 43, and 80.0% CSI between 11 and 42. And lastly, Dan Galadima with 26.7% CSI above 43 and 56.7% CSI between 11 and 42. The graph below provides further details on the CSI calculations per locations.
Figure 15: Category of Coping Strategy Index per location
CSI >43 CSI 11 - 42 CSI <=10 8.9% 26.7% 22.0% 24.4% 19.8% 20.0% 18.8% 20.0%
49.5% 68.9% 55.6% 55.0% 60.9% 56.7% 76.3% 80.0% 30.8% 22.2% 25.0% 16.7% 20.0% 20.3% Dan Magaji1.7% Nassarawa Bungudu Shanawa Galadima Kayaye Madawakin0.0% Galadima ward Matuzgi Galadima Anka Bukkuyum Bungudu Shinkafi Talata Mafara 3.4.2. Food Availability Since a decade, the extreme violence has caused many displacement of farmers from their area of origin. The fear of being kidnapped or killed while they are working in their farmland has led to a significant reduction of the cultivated area and hence of food production at the household level. It is estimated that 13,000 Ha of farmland have been either destroyed or rendered inaccessible due to insecurity and more than 140,000 cattle and 215,000 sheep
December 2020 / Needs Assessment 30 Première Urgence Internationale were rustled in Zamfara state from 2011 to 2019.23 The household survey indicated that 58% of respondent do not have access to farmland while among those who have access to their land, 64% cultivated part of the whole of their land. The average size of farmland among the assessed households is 1.8 Ha, but 1.4 Ha was the average currently under cultivation. Insecurity was the main reason invoked by the large majority (85%) of the respondent for not cultivating the entire owned arable land. The other reasons were lack of inputs and capital (10%) and lack of labor.
Besides insecurity, land degradation and the occurrence of flash floods and droughts are aggravating factors that also contribute to reducing food production at the household level. As a consequence of desertification, land degradation in North-West Nigeria is characterized by a reduction of soil fertility and loss of water resources.24 It causes a decrease in crop yield and animal production. Floods occur almost every year in Zamfara state around September (July-October) and cause significant harvest loss of food and cash crops.
As subsistence farming was the main source of food and the major livelihood of the population in Zamfara state before the surge of insecurity, the loss of access to farmed land and livestock caused households to rely increasingly on the market to meet their food needs.
3.4.3. Food Accessibility Local markets remained relatively well supplied, and food commodities are available in the markets. Therefore, it can be assumed that imports from other states and other countries still cover the food gap left by the reduced local production. The available food items are however inaccessible for most of the surveyed households due to their weak purchasing power. About 21% of respondents said that they have no income and solely depend on solidarity (mainly remittances and state government assistance) and/or begging. Results showed also that the majority of households (75%) relies on irregular and unstable sources of income such as casual labor and petty trade; their weekly earnings range between 500 and 3000 NGN which, calculated per capita and per day, are below the 224 NGN food poverty line for Nigeria25. The assessment indicated in addition that a household in Zamfara spends in average 6000 NGN per week on food. There is a consensus in all the assessed wards that households’ earnings do not cover households’ basic needs; expenses were estimated to be at least 1.5 to 2 times higher than the earnings. Most of households therefore constantly buy food on credit and/or consume less than the daily required caloric intake.
23 International Crisis Group. (2020, May 19). Violence in Nigeria’s North West: Rolling back the mayhem. Crisis Group. https://www.crisisgroup.org/africa/west-africa/nigeria/288-violence-nigerias-north-west-rolling-back-mayhem 24 Umana Kubiat. (2018, September 15). Major effects of desertification in Nigeria. Research Cyber. https://researchcyber.com/major-effects-of-desertification-in-nigeria-2/ 25 National Bureau of Statistics. (2020, May). 2019 Poverty and Inequality in NIGERIA: Executive summary. https://nigerianstat.gov.ng/download/1092
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While households' incomes have decreased, prices of food commodities continue to increase, thus reducing further the access to food for many households. A year-on-year price comparison indicates that food prices have increased globally by 17% in Zamfara, from November 2019 to November 2020 26 . This price increase is probably explained by an increased contribution of imported food in the food sold in local markets (to compensate the loss of local production) and increased transportation costs. Indeed, imported agriculture goods have increased in value by around 110%27. As for transport costs, Zamfara had the highest within-city bus transport fare in Nigeria at the time of the assessment28 probably due to the high risk taken by transporters of being kidnapped or harassed by the OAGs operating in the state.
3.4.4. Population’s Perception of their Food Security and Livelihoods Figure below is a simplified description of the interrelations between the main causes of food insecurity in Zamfara state.
Figure 16: Causes of food insecurity in Zamfara state
26 Nigeria Bureau of Statistics, December 2020: Food price watch (November 2020) 27 Nigeria Bureau of Statistics, December 2020b: Foreign trade in goods. Statistics (Q3 2020), December 2020 28 Nigeria Bureau of Statistics: Transport fare watch (September 2020). October 2020.
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Farming and livestock rearing remain the main source of food and actually the main livelihood in Zamfara. Farmers grow a variety of food and cash crops including maize, millet, sorghum, rice, beans, groundnut, sugar cane, vegetables (tomatoes, pepper), watermelon, etc. Pastoralists rear cattle, sheep and goat. In a typical year, food availability is aligned to the agriculture calendar. Food is mostly available around November (October-December as shown in Figure below) coinciding with the harvest period while the hunger gap period is around June (May-August). In time of good availability, households usually eat 2-3 meals a day whereas during the period of food scarcity, most households eat 1-2 meals a day.
Figure 17: Perception of food availability during a normal year by surveyed households
80
60
40
20
Number Number of respondent respondent who have enough food 0 Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Households who do not own farmland can rent a plot of land for an agricultural season. However, as more and more farmers are displaced due to insecurity, many households are engaged in petty trade or various small Income Generating Activities. Respondents identified three wealth groups within the assessed communities, namely “very poor”, “poor” and “average” households. Respondents in IDP camps however said that in the IDP camps only the first two groups can be found. The table below shows the characteristics of each group.
Table 8: Characteristics of wealth groups as defined by assessed communities
Parameter Very poor household Poor household Average household Size of own No land < 1 Ha 1-2 Ha farmland Type and size of Few (2-3) chicken which 1-3 sheep Up to 10 sheep own livestock are not fed but stray in the Few chicken in cage 1-2 cattle (zero grazing) neighborhood for feed Sources of Casual labour Farming Farming (and rent out income Selling firewood Petty trade farmland if unable to Begging Casual labour cultivate whole owned land) Retailing business Type of housing Tent Mud house with zinc roof House with brick walls Squatting and zinc or tiles roof
Community leaders estimated that 46,294 individuals are vulnerable persons and in need of food aid and livelihoods support. A table summarizing the number of individuals for each location is under Annex 4.
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PROTECTION Ongoing violence in Northwest Nigeria has increased and created different types of protection concerns. According to a study conducted by Terre des Hommes29, “Men, women and children are affected differently. Men are mostly killed or kidnapped. Women suffer physical and psychological trauma from rape, or miscarriages in the course of fleeing from their communities/homes. They are also responsible for providing for their families when their husbands (the primary bread winners) are killed or kidnapped, despite their own loss of livelihoods. The youth, especially males (a major target) are also kidnapped or killed, while children are orphaned and are impoverished as a result of the loss of one or both of their parents/guardians. In some communities, there has been mass displacement of community members, with most houses and other personal properties burnt”. This statement raised many concerns and align with the identified risks in this assessment.
3.5.1. Gender Based Violence (GBV) According to 81% of the key informants, GBV cases are frequent in the communities and the perpetrators are mainly OAGs. The most frequent types of GBV are sexual assault and rape, of which 38 cases were recorded in the last two months of 2020, as shown in the table below. Key informants reported that GBV mainly targets women and girls (71%) followed by boys (29%) and IDPs (21%). It is important to note that GBV is largely under-reported, as this can lead to stigmatization and even rejection of victims (by their family or community).
Table 9: Average number of reported cases between November and December 2020
Anka Bukkuyum Bungudu Shinkafi Talata Mafara
Options
Dan
ward
Magaji
Kayaye
Grand Total
Matuzgi
Bungudu
Shanawa
Galadima Galadima Galadima
Nassarawa
Madawakin
Physical Assault 0 10 3 3 8 1 7 0 32 Sexual Assault 0 10 4 5 9 1 9 0 38 Psychological/Emotional Abuse 0 9 3 2 4 0 3 0 21 Rape 0 10 4 5 8 2 9 0 38 Denial of resources and 0 8 3 0 8 0 3 0 22 opportunities Forced/Early marriage 0 0 0 1 0 2 2 0 5
Survival sex has been mentioned as a widespread coping mechanism observed in both IDPs camps and host communities. Precarious living conditions and lack of opportunities make
29 Pastoral Resolve, Search For Common Ground and Terre Des Hommes. (2019, October). Zamfara Conflict Analysis and Multisectoral Needs Assessment
December 2020 / Needs Assessment 34 Première Urgence Internationale majority of adolescent girls and single women more vulnerable. Most of the time, these adolescent girls and single women are out of selection criteria of most of the humanitarian actors targeting well-structured households. Analysis of violence and insecurity in Zamfara state conducted in February 202030 came to the following conclusion, which is corroborated by PUI assessment: “There are high levels of sexual exploitation and abuse as well as survival sex (in all locations). Civil society representatives and civil servants said that women and girls often had no other choice to feed themselves and their families as homes continue to be unsafe and they have no other income sources.”
The support provided to GBV survivors depends on each location, as indicated in the figure below. In Galadima ward 100% of household respondents confirmed that survivors get support (especially psychosocial support and other in-kind support like food, cooking fuel, soap) from other community members. In other locations, respondents either did not know or indicated that GBV survivors get support from NGOs.
Figure 18: Sources of support for GBV survivors
Kayaye Matuzgi 50.0% 7.1% 28.6% 14.3%
Talata Galadima ward Mafara 0.0% 100.0%
Shanawa 22.2% 33.3% 44.4%
kafi Shin
u Bungudu 37.5% 25.0% 37.5%
gud Bun Nassarawa 25.0%
um 50.0% 25.0%
kuy Buk
a Magaji 50.0% 40.0% 10.0% Ank I do not know To health centers To NGOs To other community members
3.5.2. Coercion Coercion of individuals or groups forced to act against their will is common. This can take the form of sexual exploitation, sexual slavery, forced marriage, forced and compulsory labor, and illegal taxation. In Anka, in most cases, OAGs have sex with women and force men to provide them with food or water. 64% of the key informants confirmed that 89% of the cases of coercion are perpetrated by OAG members. The targets depend on the location, with the most vulnerable being adolescent girls, boys, IDPs and men as shown in the graph below.
30 Chitra Nagarajan. (2020, May 15). Analysis of violence and insecurity in northwest Nigeria. https://chitrasudhanagarajan.files.wordpress.com/2020/05/zamfara-analysis-of-violence-and-insecurity.pdf
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Figure 19: Targets of coercion acts
Kayaye Matuzgi 37.5% 37.5% 6.3% 18.8% Talata Mafara Galadima ward 50.0% 50.0%
afi Shanawa 50.0% 50.0% Shink
Bungudu 16.7% 50.0% 16.7% 16.7%
udu Bung
m Nassarawa0.0% 100.0%
uyu Bukk
Magaji0.0% 50.0% 30.0% 10.0% 10.0% Anka
Adolescent girls Boys IDPs Men People from different ethnic group Women
It should be noted that cases of coercion are common in all locations and 13% of coercion cases reported happened one week before this assessment. The figure below shows coercion acts in each assessed location.
Figure 20: Reported cases of coercion in some locations
Kayaye Matuzgi 37.5% 18.8% 12.5% 31.3% Talata Mafara Galadima ward0.0% 50.0% 50.0%
afi Shanawa0.0% 100.0% Shink
Bungudu 16.7% 33.3% 16.7% 33.3%
udu Bung
Nassarawa0.0% 100.0%
yum Bukku
Magaji0.0% 10.0% 90.0% Anka Have sexual relationship/give sexual favours Others (specify) To get married To join armed forces/groups To move from their homes/land
3.5.3. Deliberate Deprivation FGD respondents stated that some individuals have difficulty accessing food assistance, WASH and NFI services, or other support provided by international and or local organizations because they are prevented by community representatives, either in host communities or in IDPs’ camps. Disabled persons, IDPs, persons from a different ethnic and/or minority groups are the target of deliberate deprivation. Even though they are prevented from accessing available services, these vulnerable people still know their right of accessing services. Cases of deliberate deprivation were reported last November 2020 by few of FGD participants in both IDPs camp and host communities.
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At household survey level, 20% of respondents recognized that cases of deliberate deprivation are occurring, targeting IDPs (14%), women (24%), adolescent girls (13%) and adolescent boys (14%). Respondents stated that perpetrators are men and boys from the community (82%), OAGs (7%), members of government forces (6%) and to a little extent member of NGOs (5%). According to 77% of households’ respondent, most of the vulnerable deprived do not access services, 21% of respondents said that deprived persons give money to access service and 2% of respondents confirmed that deprived girls give sexual favors to access services.
3.5.4. Unaccompanied and Separated Children (UASC) The increasing number of UASC and other vulnerable children in North West and their precarious living conditions are worrying. According to 86% of the key informants, there are many children not living with their parents or legal/primary caregivers. The reason of separation being that parents/legal caregivers have been attacked and killed by OAGs members, as stated by 92% of respondents. Many children are begging and/or subjected to forced labor. As stated by household respondents, the type of labor/exploitation vary from sexual exploitation (9%), to farming (34%), mining (22%), potter (7%) and hawking (18%).
Regarding support, 67% of key informants recognized that these unaccompanied and separated children are getting support from community members (especially community leaders and religious representatives). The support given to the UASC is in terms of hosting them and providing for their basic needs (foods). Nevertheless, most of FGD respondents (48%) do not know if these UASC are getting support, while 51% of respondents confirmed that these UASC are not getting support at all. Only 4% of household respondents in Magaji recognized that these UASC are getting support from INGOs. This because there are very few INGOs intervening in this area. The graph below shows where UASC are getting support from according to household respondents in all locations.
Figure 21: Source of support to UASC
Madawakin Galadima 50.0% 50.0% Kayaye Matuzgi 41.7% 58.3%
Galadima ward Talata Mafara Talata 100.0%
afi Shanawa 25.0% 75.0% Shink
Bungudu 64.3% 35.7%
udu Bung
m Nassarawa 20.0% 80.0%
uyu Bukk
Magaji 56.5% 4.3% 39.1% Anka I do not know INGOS They are not getting support
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3.5.5. Other Protection Risks/Problems At household level, respondents stated that individuals are facing other protection risks such as abduction and trafficking (according to 37% of respondents), murder and assassination (35%), violation of property (15%) obstacle to access justice for victims of rights violation (4%) and incident related to mine, explosive remnants of war, improvised device of war (2%). Perpetrators are OAGs members (according to 78% of respondents), man and boys from community (according to 12% of respondents) and members from government forces (according to 1% of respondents). These perceived protection risks can target everyone in the community.
3.5.6. Existing Capacities to Cope or to Overcome Risks At the level of household survey, it should be noted that people in all locations have different capacities and strength to cope with, mitigate or overcome protection risks they face. These capacities range from ability to demand the government to protect them (reported by 46% of respondents), ability to move in search for safer location (reported by 24%), capacity to take weapon to fight against perpetrators (reported by 12% of respondents), to existing community organizations to support each other and awareness of their rights as affected population (reported by 36% of respondents). Only 8% of respondents mentioned seeking support from available services for any harmful event, due to only few service providers available in each location.
FGDs respondents confirmed these statements by explaining that people usually protect themselves by praying, not sleeping in their own town, hiding in the bush or in the woods. The key informants complete adding that there are community structures giving warning and awareness to individuals and populations groups regarding existing threats.
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MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT Mental health is an important component of emergency and crisis interventions and encompasses many forms such as acute stress, anxiety, depression or post-traumatic stress. In Zamfara state, most respondents stated that the current crisis affected the people and their mental wellbeing.
3.6.1. Impacts of the Current Crisis on Population & Psychosocial Reactions The overwhelming majority of respondents (91.9%, n=417) reported that they are mentally unwell or unhappy because of the impact of the crisis on their life. The highest incidence was recorded in Bungundu, followed by Talata Mafara, Anka, Bukkuyum and lastly Shinkafi, with the respective proportions of 97.8%, 94.7%, 94.4%, 88.9% and 83.3%. In Bungudu, Talata Mafara and Anka, most of complaints are related to loss of house, loss of property, loss of family members, loss of children, lack of access to farm land and loss of animals (cows, sheep, rams and goat). As shown in the figure below, it was further asked about the frequency of their feeling of unhappiness. Around 12.9% said there are always unhappy, while 9.8% indicated being often unhappy. However, the majority (76%, n=317) said that their feelings were affected only “sometimes”.
Figure 22: How often the respondents felt mentally unwell/unhappy
Madawakin Galadima 100.0% Kayaye Matuzgi 8.3% 85.0%
Galadima ward 52.6% 5.3% 15.8% 26.3% Talata Mafara Talata
Shanawa 17.3% 8.0% 74.7%
kafi Shin
u Bungudu 11.2% 4.5% 82.0%
gud Bun
m Nassarawa 11.3% 15.0% 73.8%
uyu Bukk Magaji 7.4% 90.7%
Anka Dan Galadima 26.7% 3.3% 23.3% 46.7%
All the time Not often Often Sometimes
The top five complaints reported by people mentally unwell or unhappy in response to the current crises, as shown in the graph below. The main complaints are body pain (headache, muscle pain, etc.) for 85.6% of respondents, sleeping problems (insomnia, nocturnal or early awakenings, etc.) for 42.9%, anxiety and stress (39.1%), sad mood (34.1%) and eating problems (30%).
December 2020 / Needs Assessment 39 Première Urgence Internationale
Figure 23: Complaints from respondents when they feel unwell or unhappy
Body pain. 85.6% Sleeping problems. 42.9% Anxiety/Stress. 39.1% Sad mood. 34.1% Eating problems. 30.0% Lack of concentration. 19.2% Aggressiveness. 9.6% Constant worry. 9.4% Flashbacks. 8.2% Loss of interest. 6.0% Social isolation. 1.9% Constant painful memories. 1.4% Irritability/Anger. 0.7% Other. 0.5%
In addition, FGD respondents reported that the crisis affected community ties to the extent that there is no longer trust between neighbouring villages.
3.6.2. Coping Strategies FGD respondents stated that they usually seek support or help from neighboring family, traditional leaders, religious leader, teachers, close friends or gather in groups (“Majalisa”). They sometimes go to the capital city hospital for help. In the assessed communities, people have set of actions they usually do to feel better, as shown in the table below. The top three actions are doing something they like (32.3%), talking to someone (26.1%) or crying (13.5%).
Table 10: What people do to feel better when there are mentally unwell or unhappy
Bukku Bung Shin Anka Talata Mafara yum udu kafi
Options
Overall
Dan
ward
Magaji
Kayaye
Matuzgi
Bungudu
Shanawa
Galadima Galadima
Madawaki
Nassarawa
n Galadima
Do something I like. 43.5% 29.9% 32.1% 28.2% 33.8% 35.7% 32.0% 37.0% 32.3% Get some air/exercise. 21.7% 7.7% 9.0% 12.3% 6.9% 0.0% 7.8% 37.0% 10.3% Have a balanced and healthy diet. 0.0% 3.4% 5.8% 4.3% 3.1% 3.6% 1.0% 0.0% 3.4% Have an unhealthy diet. 0.0% 2.6% 1.9% 0.6% 1.9% 0.0% 0.0% 0.0% 1.3% Cry. 15.2% 18.8% 17.9% 10.4% 10.6% 10.7% 13.6% 0.0% 13.5% Talk to someone. 10.9% 26.5% 18.6% 30.1% 30.6% 32.1% 29.1% 25.9% 26.1% Use substances or self-medicate. 0.0% 0.0% 1.9% 1.8% 1.9% 0.0% 7.8% 0.0% 2.1% Beat up my spouse/children/family member 0.0% 2.6% 1.3% 1.8% 1.9% 0.0% 1.0% 0.0% 1.5% Don’t know. 8.7% 0.0% 9.0% 4.9% 4.4% 17.9% 3.9% 0.0% 5.3% Other. 0.0% 8.5% 2.6% 5.5% 5.0% 0.0% 3.9% 0.0% 4.4%
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3.6.3. Perception & Support to People in Psychosocial Distress In Zamfara state, key informants stated that they identify people with mental disorders by their physical appearance (94%), such as wearing dirty and torn clothes, 31% identify them by their expressions, such as 94% incoherent speech or mutism, and 25% identify them by the expression of Identify mentally-ill emotions such as anger and aggressive behavior, laughing without by appearance reason, unprovoked shouting, etc. The figure below gives more details on the distribution of responses according to location.
FGD respondents stated that, whenever they find people in such situation, they reckon that the person is in great pain and needs help. They view people with mental disorders as part of the community and always treat them with respect. They consider them as the responsibility of the community, which is why participants said that they usually take them to Malam or Iman for prayer and sometimes to traditional healers or hospital for medication.
The key informants further reiterated that 88% of them sympathize with people with mental disorders by feeling sorry for them and their families, 25% support them and one key informant stated that he advises them to seek support from family, friends, community, religious leader, traditional healer. The distribution of opinion across location can be seen in the figure below. Figure 24: Attitude of key informants toward mentally-ill individuals
20% 100% 100% 33% 40% 20% 67% 60% 60%
New Emir's palace IDP Bungudu Mada Shanawa Gwaram camp Anka Bungudu Gusau Shinkafi Talata Mafara Advise to seek for support from family, friends, community, religious leader, traditional healer Offer your support Sympathise with them
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3.6.4. Community’s Perception of People with Mental Health Issues It was reported during the key informant interview, that mental health issues are caused by struggles or painful/serious event faced in life (100% of the respondents), 19% of them perceived it as hereditary and 16% attributed to superstitious believes.
However, the responses from FGD and household survey gave
different perception to the causes of mental illness. During the FGD discussions, most participants stated that mental health issues are 77.3% attributed to superstitious believes where individual is possessed by Reported that mental devil spirits. This belief is confirmed by 77.3% of household illness is caused by superstitious believes respondents, while 16.7% of them mentioned that it is caused by struggles or painful/serious events faced in one’s life. The table below provides further details per location.
Table 11: Causes of mental illness according to household respondents
Bukku Bungu Shink Anka Talata Mafara yum du afi
Options
Overall
Dan
ward
Magaji
Kayaye
Matuzgi
Bungudu
Shanawa
Galadima Galadima Galadima
Nassarawa
Madawakin
Possessed by devil spirits 100.0% 62.7% 81.1% 73.6% 83.3% 90.0% 64.1% 100.0% 77.3% Caused by struggles or painful/serious events faced 0.0% 32.2% 13.3% 12.1% 13.3% 5.0% 32.8% 0.0% 16.7% in life Inherited 0.0% 5.1% 2.2% 3.3% 1.1% 5.0% 3.1% 0.0% 2.6% Smoking weed 0.0% 0.0% 0.0% 1.1% 0.0% 0.0% 0.0% 0.0% 0.2% Don't know 0.0% 0.0% 3.3% 9.9% 2.2% 0.0% 0.0% 0.0% 3.1%
However, all respondents reaffirmed the community's sympathy towards the mentally-ill individuals. When asked how they treat them, key informants gave a range of responses and the most common attitude was to try to help them (69%), while 63% said they tried to support them with material help (money, food, clothes, etc.). This was confirmed by the household level survey, as the majority of the respondents 48.7% mentioned that the community members support the mentally ill individuals with materials, and 30.2% said that they community members respect the individuals with mental illness.
December 2020 / Needs Assessment 42 Première Urgence Internationale
Figure 25: Relationship of mentality-ill with the community according to key informants
ta Gwaram0% 40% 60%
ara
Maf Tala
Shanawa0% 75% 25%
kafi Shin
au Mada0% 75% 25% Gus
u Bungudu 25% 25% 50%
gud Bun
a New Emir's palace IDP camp0% 50% 50% Ank
Respectful Disrespectful Try helping them Support them with material assistance
3.6.5. Services Available for People with Mental Illnesses Finally, the household respondents mentioned few services available for the mentally ill. 33.0% indicated health facilities availability, while other 33.3% mentioned the traditional healer as the first choice for the majority of the locations assessed. Only 11.0% cited NGOs, which is explained by the small number of actors operating in the region. The table below provides further details by site.
Table 12: Services available for mentally ill individuals according to household respondents
Anka Bukkuyum Bungudu Shinkafi Talata Mafara
Options
Overall
Dan
ward
Magaji
Kayaye
Matuzgi
Bungudu
Shanawa
Galadima Galadima Galadima
Nassarawa
Madawakin
Traditional healer 23.3% 1.7% 27.8% 45.1% 45.6% 50.0% 39.1% 10.0% 33.3% Health facility 33.3% 49.2% 40.0% 18.7% 31.1% 5.0% 31.3% 90.0% 33.0% NGOs 10.0% 33.9% 6.7% 7.7% 5.6% 0.0% 14.1% 0.0% 11.0% Don't know 33.3% 13.6% 25.6% 28.6% 17.8% 45.0% 15.6% 0.0% 22.5% Others, please specify 0.0% 1.7% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.2%
December 2020 / Needs Assessment 43 Première Urgence Internationale
4. RECOMMENDATIONS
PRIMARY HEALTH CARE 4.1.1. Short-term solutions The most pressing needs are the recruitment of skilled health workers as well as the provision of essential drugs and medical equipment to health facilities. Negotiations should be conducted with the Ministry of Health to remove the revolving fund from the facilities supported by NGOs. However, NGOs should plan mechanisms to ensure that the drug supplier is included in the exit package. The referral system should also be strengthened through the provision of ambulances and coverage of treatment costs at referral sites. Finally, community health awareness should be reinforced by recruiting and training CHWs.
4.1.2. Mid-term solutions Partnerships between health facilities and communities should be developed to improve communication, avoid misinformation and detect emerging health problems early. Also, training of health facility staff should be provided in collaboration with the Ministry of Health. Finally, NGOs should support public hospitals in LGAs, such as the public hospital in Bugundu.
4.1.3. Long-term solutions Training of CHWs should be pursued and they should be linked to the Ministry of Health for continuation of their services (CHIPS). Furthermore, facilities should be equipped with secondary health care, including BEmONC, CEmONC, pediatric and SC nutrition services.
NUTRITION 4.2.1. Short term solutions Integrated nutrition treatment services (OTP) should be provided in PHCCs. For existing services, capacity has to be increased by training nutrition staff on the prevention and treatment of malnutrition. Also, the supply chain of nutrition products should be stabilized with UNICEF. Regarding prevention, community-based nutrition screening should be developed in the communities and a community information and education mechanism set put through community mobilizers for nutrition (CNM) and IYCF activities.
4.2.2. Mid-term solutions A SMART survey should be conducted to determine the burden of malnutrition in these locations as baseline information. In addition, the supply of nutrition products should be regularized through the Ministry of Health.
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4.2.3. Long term solutions A framework should be set up for the regular conduct of SMART survey to inform the nutrition decision-making process for the LGA or Zamfara state as a whole. Integration of nutrition treatment services in all PHCCs should also be ensured.
FOOD SECURITY AND LIVELIHOODS 4.3.1. Short term solutions Multi-purpose cash should be provided to vulnerable households so that they can pay for nutritious food, access health services and get a better shelter.
4.3.2. Mid-term solutions Livelihoods strategies for farmers and pastoralists have to be rebuilt and strengthened by providing tools and inputs (seeds, pesticides, fertilizers) to farmers and veterinary inputs and services to pastoralist. Vocational training (i.e. skill development) should be planned and capital has to be given to those who want to start an income generating activity.
4.3.3. Long term solutions Long-term solutions would include stopping desertification, improving arable land, pasture and water resources. The resolution of community conflicts over access to natural resources would restore security. Finally, employment opportunities (agro-industry, post-harvest processing of agri-products) will have to be created so that no one is left behind.
PROTECTION 4.4.1. Short term solutions Awareness and sensitization sessions should be conducted on protection risks, available services and way to access them, as well as on human rights (women's rights, children's rights) for all population groups. The creation and training of community committees would strengthen local communities' protection mechanisms. Existing capacities and structures should be strengthened, whether through local authorities, police and judicial service providers, local health service providers or educational service providers. Finally, a gender study should be conducted to deepen PUI knowledge and guide further programming decisions.
4.4.2. Mid-term solutions Life skills training and possibility to start income generating activities should be provided. Moreover, the provision of required services to GBV survivors has to be ensured including clinical management of rape. Also, child protection case management should be provided
December 2020 / Needs Assessment 45 Première Urgence Internationale including family tracing and reunification. Finally, victims of human rights violation should have access to justice. Finally, specific trainings have to be organized to duty bearers (government authorities, police, government forces...) in order to reinforce their willingness to honor their obligation to respect and protect the rights of vulnerable.
4.4.3. Long term-solutions The main long-term solutions would be the restoration of security and state authority in conflict-affected areas.
MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT 4.5.1. Short-term solutions Psychosocial services should be systematically integrated into health services as most respondents indicate that they would recommend a person in need of psychosocial support to seek medical attention. For instance, a psychosocial component should be integrated into health services for hypertension (as stress is recognized as an important factor affecting blood pressure) and into sexual and reproductive health services (to prevent postpartum depression and to foster the mother's bond with her child). In order to allow patients to choose the gender of their doctor, it will be necessary to ensure the presence of at least one woman and one man in all services. In addition, awareness-raising messages on well-being, mental health and psychological distress should be created. Finally, referral of mentally ill patients should be ensured, whether to other humanitarian sectors or to MHPSS services.
4.5.2. Mid-term solutions Appropriate care should be provided to people diagnosed with a mental illness and/or with severe symptoms of psychological distress. Sustainable access to MHPSS services should be developed through intensive capacity building of relevant staff and regular clinical supervision. Finally, case management and referral tools should be created and integrated into the main job aid tool used by PHC providers through HIS and mapping.
4.5.3. Long term solutions MHPSS activities should be implemented within the health facilities and skilled personnel should be available at all times for the beneficiaries. Beneficiaries should be supported in their resilience process by promoting healthy coping strategies. This will require longer-term psychological follow-up. Finally, a sustainable training and supervision program on the 3 levels of care (community, psychosocial and psychological) should be set up.
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REFERENCES ACAPS. (2020, July 25). Nigeria: Banditry violence and displacement in the northwest. https://www.acaps.org/special-report/nigeria-banditry-violence-and-displacement- northwest Azeez Olaniyan, & Aliyu Yahaya. (2016, December 1). Cows, bandits, and violent conflicts: Understanding cattle rustling in Northern Nigeria - Azeez Olaniyan, Aliyu Yahaya, 2016. SAGE Journals. https://journals.sagepub.com/doi/full/10.1177/000203971605100305 Chitra Nagarajan. (2020, May 15). Analysis of violence and insecurity in northwest Nigeria. https://chitrasudhanagarajan.files.wordpress.com/2020/05/zamfara-analysis-of-violence- and-insecurity.pdf International Crisis Group. (2020, May 19). Violence in Nigeria’s North West: Rolling back the mayhem. Crisis Group. https://www.crisisgroup.org/africa/west-africa/nigeria/288-violence-nigerias-north- west-rolling-back-mayhem IOM Nigeria. (2020, October). Nigeria - North central and north west zones displacement dashboard 4 (August 2020). Displacement Tracking Matrix | DTM. https://dtm.iom.int/reports/nigeria- %E2%80%94-north-central-and-north-west-zones-displacement-dashboard-4-august-2020 IOM Nigeria. (2020, October 25). Nigeria - North Central and North West zones displacement dashboard 4 (August 2020). Displacement Tracking Matrix | DTM. https://dtm.iom.int/reports/nigeria- %E2%80%94-north-central-and-north-west-zones-displacement-dashboard-4-august-2020 John Campbell. (2021, January 25). Nigeria security tracker weekly update: January 16–22. Council on Foreign Relations. https://www.cfr.org/blog/nigeria-security-tracker-weekly-update-january-16-22-0 National Bureau of Statistics. (2020, May). 2019 Poverty and Inequality in NIGERIA: Executive summary. https://nigerianstat.gov.ng/download/1092 OCHA Nigeria. (2019, January 28). Nigeria humanitarian response strategy 2019-2021 (January 2019 - December 2021) (December 2018). ReliefWeb. https://reliefweb.int/report/nigeria/nigeria- humanitarian-response-strategy-2019-2021-january-2019-december-2021-december Pastoral Resolve, Search For Common Ground, Terre Des Hommes. (2019, October). Zamfara Conflict Analysis and Multisectoral Needs Assessment Umana Kubiat. (2018, September 15). Major effects of desertification in Nigeria. Research Cyber. https://researchcyber.com/major-effects-of-desertification-in-nigeria-2/ UNHCR Nigeria, & NCFRMI. (September 9). Joint protection assessment mission to northwest Nigeria: 25 July - 4 August 2019 - Nigeria. ReliefWeb. https://reliefweb.int/report/nigeria/joint-protection- assessment-mission-northwest-nigeria-25-july-4-august-2019 UNHCR Nigeria. (2020, June). Nigeria: Protection monitoring dashboard - Katsina, Sokoto and Zamfara May 2020 - Nigeria. ReliefWeb. https://reliefweb.int/report/nigeria/nigeria-protection-monitoring- dashboard-katsina-sokoto-and-zamfara-may-2020 WFP Nigeria, NBS, & NPFS. (2019, September 18). Rapid food security and nutrition assessment among internally displaced households in Katsina, Sokoto and Zamfara states of Nigeria (September 2019) - WFP, NBS and PCU-FMARD | Food security cluster. Food Security Cluster. https://fscluster.org/nigeria/document/rapid-food-security-and-nutrition
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5. ANNEXES
ANNEX 1: CATEGORY OF STAFF IN THE ASSESSED PHCCS
Categories
PHC
OLPC
of staff in of staff
Bungudu Bungudu Bungudu
Galadima Galadima
OLPC OLPC PHC
PHC Mada PHC
Galadi PHC
Galadanchi
WCWC PHC WCWC
# of staff in # of staff in # of staff in # of staff in # of staff # in # of staff in # of staff
Shanawa PHC Shanawa HEALTH CARE STAFF AVAILABLE Medical doctor 0 0 0 0 0 0 0 Nurse 0 0 0 0 0 0 0 Community Health Officer (CHO) 0 0 0 1 1 0 0 Community Health extension 2 1 2 6 3 4 1 workers (CHEWs/JCHEWs) Midwife 1 1 2 0 0 0 0 Lab technician 1 1 3 3 1 2 1 Public health officer 1 1 0 0 2 0 1 Public health technician 0 0 1 0 0 0 0 Dental technician 1 0 0 0 1 0 0 Food hygiene 1 0 0 0 0 0 0 Environmental technician 0 0 0 0 0 0 1 Environmental health Officer 0 0 0 3 2 0 0 Environmental health Assistant 0 0 0 2 0 0 0 Community midwife 0 0 0 2 0 0 0 Health Information Officer 0 0 0 0 1 0 1 Drugs dispenser 0 0 0 0 0 1 0 Registrars 0 0 0 6 0 0 0 Health attendant 0 0 0 0 0 4 0 Total 7 4 8 23 11 11 5 NUTRITION CARE STAFF
AVAILABLE Nutrition doctor 0 0 0 0 0 0 0 Nutrition nurse 0 0 0 0 0 0 0 Nutrition screener (MUAC, W/H 0 1 5 4 3 1 1 z-score) Nutrition food dispenser 2 1 5 1 0 1 1 Nutrition community mobilizers 0 1 12 0 0 0 5 (CNMs) Triage/mobilizers and weight 3 1 0 0 0 0 0 Total 5 4 22 5 3 2 7
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ANNEX 2: MAP OF ASSESSED LOCATIONS Zamfara State
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ANNEX 3: LIST OF AVAILABLE HEALTH FACILITIES IN THE ASSESSED AREAS Local Government Ward Health facility Facility level Area (LGA) Anka Galadima Ward Galadanci PHC Primary Anka Galadima Ward Health Clinic Inwala Primary Anka Galadima Ward Kadaddaba Dispensary Primary Anka Magaji Ward Abare Dispensary Primary Anka Magaji Ward Anka General Hospital Secondary Anka Orphans and Less Previlaged Anka Magaji Ward Primary Clinic Anka Magaji Ward Dareta Dispensary Primary Anka Magaji Ward Primary Health Care Anka Primary Bukkuyum Nasarawa Ward (Burkullu) Gana Dispensary Primary Bukkuyum Nasarawa Ward (Burkullu) Gurusu Dispensary Primary Bukkuyum Nasarawa Ward (Burkullu) Kamaru/Tungar Rogo Dispensary Primary Bukkuyum Nasarawa Ward (Burkullu) Nasarawa Primary Health Centre Primary Bungudu Bungudu Ward Birnin Malam Health Clinic (MDGs) Primary Bungudu Bungudu Ward Bungudu General Hospital Secondary Bungudu Orphan and Less Privilege Bungudu Bungudu Ward Primary Clinic Bungudu Women and Children Welfare Bungudu Bungudu Ward Primary Clinic (WCWC) Bungudu Bungudu Ward Gidan Dangwari Dispensary Primary Bungudu Bungudu Ward Saye Community Dispensary Primary Bungudu Bungudu Ward Yartukunya Dispensary Primary Gusau Mada Ward Dr Mustapha Private Clinic Secondary Gusau Mada Ward Duddugel Clinic Primary Gusau Mada Ward Mada General Hospital Secondary Gusau Mada Ward Mada Primary Health Centre Primary Sauki Medical Clinic and Maternity Gusau Mada Ward Secondary Mada Gusau Mada Ward Shemori Primary Health Clinic Primary Shinkafi Galadi Ward Batamna Dispensary Primary Shinkafi Galadi Ward Bula Dispensary(Skf) Primary Shinkafi Galadi Ward Galadi Primary Health Centre Primary Shinkafi Galadi Ward Gidan Rijiya Community Dispensary Primary Shinkafi Shanawa Ward Ajiyawa Dispensary Primary Shinkafi Shanawa Ward Shanawa Primary Health Centre Primary Talata Mafara Galadima Ward Government Girls College Health Clinic Primary Talata Mafara Galadima Ward Nasarawa Colony Dispensary Primary Talata Mafara Galadima Ward Talata Mafara General Hospital Secondary Talata Mafara Orphans and Less Talata Mafara Galadima Ward Primary Privilage Clinic Source: Federal Ministry of Health (2019) - NIGERIA Health Facility Registry (HFR)
December 2020 / Needs Assessment 50 Première Urgence Internationale
ANNEX 4: NUMBER OF INDIVIDUALS REPORTED IN NEED
GPS Coordinates Population #People in Needs
Source of
Sub-ward Ward LGA information Latitude Longitude
#Host Community #IDP Food Assistance Livelihoods Protection + PSS Health Nutrition
Community Shiyar Nasarawa Bukkuyum 12.050288 5.737329 9,500 950 5,200 3,100 200 7,600 3,150 Leaders Magaji
Community Sabon Gari Nasarawa Bukkuyum 12.041739 5.742318 11,000 1,450 6,100 4,600 320 9,200 4,800 Leaders
Community Tabalaya Nasarawa Bukkuyum 12.046632 5.7468645 10,500 1,700 5,900 3,800 300 8,500 4,500 Leaders
NGO GRA Magaji Anka N 12' 6'25" E 5' 56' 7" N/A 3,698 3,698 3,698 3,698 3,698 3,698
Sabon NGO Magaji Anka N 12' 6' 41" E 5' 56' 20" N/A 1,499 1,499 1,499 1,499 1,499 1,499 Birni
Shiyar NGO Dangaladima Anka N 12' 6' 48" E 5' 55' 22" N/A 397 397 397 397 397 397 Tudu
Community Kasharuwa Bungudu Bungudu 12.264796 6.569119 N/A 5,000 5,000 N/A 1,000 5,000 2,500 Leaders Area
Community Talata Gwaram Gwaram 12.2436841 6.1410899 20,000 5,000 10,000 N/A 4,000 10,000 N/A Leaders Mafara
Community Kayaye Kayaye Talata 12.5672426 6.0704914 N/A N/A N/A N/A N/A N/A N/A Leaders Matusgi Matusgi Mafara
Community Shanawa Shanawa Shinkafi 12.613473 6.590185 10,824 2,500 3,500 1300 1,500 3,300 2,700 Leaders area ward
Community Mada Mada Gusau 12.139709 6.932922 N/A 5,000 5,000 N/A 4,000 5,000 2,000 Leaders Note: Data in the table was based on the declaration of the various key informants and does not necessary reflect the results of a census
December 2020 / Needs Assessment 51 Première Urgence Internationale
ANNEX 5: ACTOR MAPPING IN ASSESSED AREAS Local Government Sector ORGANIZATION Activities Area (LGA) Bungudu Health, Health Standard Concern Health education and support activities in health facilities: Nutrition Organization (HESCO) o HIV testing and counselling and awareness o creating HIV support groups o Malaria Awareness campaign o LLIN distribution Health facilities supported: General Hospital Bungudu, Bungudu WCWC PHC, Nahuche PHC, Furfuri PHC, Fantaru PHC, Gada PHC Bungudu Livelihoods Fulani Initiative Not available Bungudu Livelihoods Community Initiative For Women Empowerment Project (Distributions of goat to vulnerable women of Awareness And Bungudu LGAs) Development Anka Health, Advocacy Nigeria Community Health Awareness Nutrition Anka Health, MSF OCA Paediatric care services including SC Nutrition 14 running facilities, Health facilities located in the informal IDP camp within the host community Secondary health care services Bungudu Health, Advocacy Nigeria Community Health Awareness Nutrition Gusau Health, Advocacy Nigeria Community Health Awareness Nutrition Bukkuyum Health, Community Health Support activities in Nasarawa PHC Nutrition Awareness and o Nutrition OTP Development o Routine Immunization Organization (CHADO) Shinkafi Health, Center for Community Community-based and facility-based nutrition and health education Nutrition Excellence Health facilities supported: Katuru PHC, Kware PHC, Kanwuri WCWC PHC Shinkafi WASH Center for Community Sensitization on water-borne diseases, mobilizations Excellence Referrals linkages to UNICEF of WASH activities such as latrine constructions, water provision December 2020 / Needs Assessment 52 Première Urgence Internationale
Local Government Sector ORGANIZATION Activities Area (LGA) Shinkafi Protection Center for Community Support to SGBV (medical and psychosocial support) Excellence Child protection Shinkafi Health, Center for Community Community-based and facility-based nutrition and health education Nutrition Excellence Health facilities supported: General Hospital, Jangeba PHC, Morai PHC, Garbadu PHC Shinkafi WASH Center for Community Sensitization on water-borne diseases, mobilizations Excellence Referrals linkages to UNICEF of WASH activities such as latrine constructions, water provision Shinkafi Health MSC-OCBA Support nutrition and primary health care activities in PHCCs and General Nutrition hospital: ITFC: Shinkafi General Hospital OTP: Shanawa PHC, Birnin Yero PHC, Katuru PHC, Badarawa PHC, Jangeru PHC Shinkafi Health, UNICEF Support nutrition activities in health facilities: Katuru PHC, Kurya PHC, Kware Nutrition PHC, Shinkafi OLPC PHC
December 2020 / Needs Assessment 53 Première Urgence Internationale
ANNEX 6: ASSESSMENTS CONDUCTED (NOVEMBER 2020 – DECEMBER 2020)
STATE LGA PARTNER
NFI
PSS
PHC GBV
SRH
WASH
HEALTH
MENTAL
SHELTER
FOOD ASS.
NUTRITION
PROTECTION ZAMFARA ANKA Humanity inclusion (HI) x x x x x x x x ZAMFARA ANKA Medecins Du Monde (MDM) x x x x x x ZAMFARA ANKA Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA ANKA REACH x x x x x x ZAMFARA ANKA Solidarite Internationale (SI) x x x ZAMFARA BAKURA REACH x x x x x x ZAMFARA BIRNIN MAGAJI REACH x x x x x x ZAMFARA BUKKUYUM Medecins Du Monde (MDM) x x x x x x ZAMFARA BUKKUYUM Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA BUKKUYUM REACH x x x x x x ZAMFARA BUNGUDU Medecins Du Monde (MDM) x x x x x x ZAMFARA BUNGUDU Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA BUNGUDU REACH x x x x x x ZAMFARA GUNMI REACH x x x x x x ZAMFARA GUSAU Medecins Du Monde (MDM) x x x x x x ZAMFARA GUSAU Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA GUSAU Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA GUSAU REACH x x x x x x ZAMFARA KAURA NAMODA Humanity inclusion (HI) x x x x x x x x ZAMFARA MARADUN REACH x x x x x x ZAMFARA MARU REACH x x x x x x ZAMFARA SHINKAFI Humanity inclusion (HI) x x x x x x x x ZAMFARA SHINKAFI Solidarite Internationale (SI) x x x x December 2020 / Needs Assessment 54 Première Urgence Internationale
STATE LGA PARTNER
NFI
PSS
PHC GBV
SRH
WASH
HEALTH
MENTAL
SHELTER
FOOD ASS.
NUTRITION
PROTECTION ZAMFARA SHINKAFI Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA SHINKAFI REACH x x x x x x ZAMFARA TALATA MAFARA Humanity inclusion (HI) x x x x x x x x ZAMFARA TALATA MAFARA Medecins Du Monde (MDM) x x x x x x ZAMFARA TALATA MAFARA Premiere Urgence Internationale (PUI) x x x x x x x ZAMFARA TALATA MAFARA REACH x x x x x x ZAMFARA TALATA MAFARA Solidarite Internationale (SI) x x x x ZAMFARA TSAFE REACH x x x x x x ZAMFARA ZURMI Humanity inclusion (HI) x x x x x x x x ZAMFARA ZURMI REACH x x x x x x ZAMFARA ZURMI Solidarite Internationale (SI) x
December 2020 / Needs Assessment 55 Première Urgence Internationale
ANNEX 7: RANDOM WALK METHODOLOGY A simple map with village boundaries is drawn to the ground, in consultation with community members, including important features like main roads, main watercourse, buildings, etc.
4-5 easy to locate spots are marked around the ward boundary, plus 1-2 at the same time easy to locate a point in the center of the ward.
The points are numbered 1, 2, 3, 4, 5, etc. on pieces of paper and one is selected at random for each enumerator. It provides locations to start the random walk.
At the starting location for each enumerator, the household closest to the starting point is the first household to be surveyed.
After interviewing the first household, spin a pen to determine the direction to walk in the next household’s next interview along the direction you are taking by applying the “survey interval” of 10 households.
Interviewers should be careful to check the paths that lead to the main road - if these are short paths for households that are set back from the main road, these households should be counted when applying the “survey interval”.
Note: If the procedure results in a census taker go to a household that has already been interviewed, it is legitimate to ignore that house and restart the “survey interval” at the next household.
December 2020 / Needs Assessment 56 Première Urgence Internationale