CAFOD

EAST AFRICA DROUGHT RESPONSE PROGRAMME

EVALUATION REPORT

Daudi Ekuam

April, 2007

ABOUT THE AUTHOR

The consultant for this evaluation, Daudi Ekuam, has long experience of working in arid and semi arid (ASAL) parts of Kenya and Africa. Before becoming a consultant and technical advisor to civil society organisations in the region, he worked for over fourteen years as a Kenyan provincial administrator. During this time he served as District Commissioner in eight arid and semi arid districts, where key responsibilities included development planning, policy and implementation. Currently he is the Conflict and Peacebuilding Advisor to the Centre for Minority Rights Development (CEMIRIDE) and has also undertaken numerous consultancies for national and international NGO’s.

2 TABLE OF CONTENTS

ABBRIVIATIONS AND ACRONYMS...... 4

1.0 EXECUTIVE SUMMARY ...... 5

2.0 INTRODUCTION ...... 6

3. 0 METHODOLOGY ...... 7

4.0 CONTEXTUAL ANALYSIS...... 8

4.1 Background Information 8 4.1.1 Marsabit District ...... 8 4.1.2 Isiolo District ...... 9 4.1.3 Kitui and Mwingi Districts ...... 10 4.2 Programme Implementation 10 4.2.1 Planned Outputs...... 10 5. 0 MAIN FINDINGS...... 12

5.1 Relevance/Appropriateness ...... 12 5.2 Sustainability ...... 13 5.3 Efficiency...... 14 5.4 Effectiveness...... 15 5.5 Impact ...... 18 6.0 RECOMMENDATIONS...... 21

3 ABBRIVIATIONS AND ACRONYMS

AI Appreciative Inquiry ASAL Arid and Semi Arid Lands CAFOD Catholic Agency For Overseas Development CDI-CADEP Catholic Diocese of Isiolo Caritas Development Programme CI Community Interviews DAC Development Assistance Commission DDO Diocesan Development Office DDP District Development Plan DSG District Steering Group ECHO European Community Humanitarian Office EMOP Emergency Operations GAM Global Acute Malnutrition GoK Government of Kenya ITN Insecticide Treated Nets KI Key Informants MUAC Middle Upper Arm Circumference NGO Non-Governmental Organization OECD Organisation for Economic Cooperation and Development TOR Terms of Reference UNICEF United Nations WHO World Health Organisation WFH Weight For Height WFP World Food Programme

4 1.0 EXECUTIVE SUMMARY

CAFOD has been responding to the latest drought in Kenya and other countries in the region since March 2006. The Programme has been implemented through a number of partners mainly comprising of Diocesan Development Offices (DDO) in Kitui, Muranga, Isiolo, Samburu and Marsabit, but also including international NGOs. The primary focus of the programme has been to alleviate the effects of one of Kenya’s long-drawn droughts on the most vulnerable members of affected communities i.e. children under 5 years, pregnant and breast-feeding women and the elderly by giving them fortified supplementary foods, nutritional drug supplements and providing them with other essential drugs among other components.

Towards the close of the programme, CAFOD engaged an independent consultant to conduct an end of the programme evaluation, among other tasks. The evaluation was mainly required to draw lessons on the implementation of the project; the role of the communities in the project cycle; the programmes effectiveness and efficiency of implementation; sustainability; how relevant actors were involved in the various stages and its impact in general. The evaluation was conducted using the rapid Communities Interviews methodology (CI) conducted in 2 sites each in Marsabit, Kitui/Mwingi and Isiolo area. Face-to-face interviews, documents and report reviews, and telephone interviews were also used to get information on the programme. Results were analyzed based on the five criteria/standards set by OECD-DAC for evaluating humanitarian action.

The Programme began in March 2006 and ends in April 2007. Six partners delivered the programme in two phases in Kenya at a budget of close to £750,000. The funds were used primarily to provide supplementary food (locally known as Unimix), nutrition drug supplements, essential drugs, small scale water development, partner logistical and staff support costs and basic staff capacity-building on screening and supplementary feeding skills.

During the more substantial second phase of activities, in the supplementary feeding and drugs supplementation, although the Programme screened a total of 25,865 potential beneficiaries, it had only planned to cover a total of 11,974 people. As at now, a total of 12,321 people have benefited; 2% higher than planned. Kitui contributed to the high percentage of coverage due to the fact that they covered almost twice the number of people planned for. Despite the late commencement, Isiolo nearly met its target by recording an overall coverage of 84%. Main deviations from the programme planning were that by the mid-term of the programme Marsabit Diocese had only targeted 26% of beneficiaries against initial forecast and CAFOD has subsequently approved a proposed amendment by Marsabit to use part of the remaining funds for small scale water development and malaria control by providing ITNs. In Isiolo, one of the four programme components, the re-stocking and livestock health component was cancelled for reasons outlined later in the report. Although two water tanks have been completed in Isiolo, the intake weirs are yet to be completed.

Generally, going by the OECD-DAC criteria, the Programme has been well-implemented and is largely on the right track to achieve its stated goal.

A number of challenges were encountered. These included inaccurate forecasting, partly brought on by heavy rains that also affected transport and presented new challenges like Malaria in Isiolo and Marsabit, and floods in Isiolo. Procurement of goods and services were also noted as challenges. Partners did not consult beneficiary communities adequately to determine their needs. Partners were lacking in some appropriate personnel and institutional capacity. The sudden and unilateral decision by the Isiolo Bishop to suspend all staff engaged in the Programme for 3 months affected the implementation considerably.

5 Generally however, CAFOD should take pride of the fact that although supplementary feeding programmes have been undertaken in these areas before, this particular one was unique in that it was professionally delivered, strictly following the latest WHO screening and delivery standards. It was undoubtedly one of the first programmes to target a broader scope of the “most-vulnerable-of-the- vulnerable”, silently providing a rights angle to supplementary feeding. This was probably one of the reasons the programme has received wide acclaim from the communities, health officials and humanitarian practitioners.

2.0 INTRODUCTION

From March 2006, CAFOD has been actively involved in responding to one of Kenya’s worst droughts since 1971. CAFOD contributed in a unique way to the humanitarian efforts of the Government of Kenya (GoK) along with the other humanitarian agencies including United Nations’ World Food Programme (WFP). CAFOD’s programme was implemented through its long-term partners, including Diocesan Development Offices, local and international NGO’s, coordinated by the Drought Response Manager at CAFOD’s regional office in Nairobi, with technical support from the Humanitarian Support Department in London.

Primarily, the Programme focused on malnourished children, pregnant and breastfeeding women, the elderly, the chronically sick and people living with HIV/AIDS through supplementary feeding activities. Apart from supplementary feeding, other Programme activities included the improvement of access to water and essential drugs for both human and livestock populations.

The programme has been implemented in two phases. Phase I, which was implemented between April 2006 through to October 2006, targeted beneficiaries from Marsabit District through the Diocesan Development Office; Isiolo District through the CDI-CADEP office; Kitui District and Mwingi District through the Kitui Diocese Development Office; Samburu District through Practical Action (an International NGO); and with Muranga Diocese covering 5 administrative divisions in Kirinyaga, Maragua, Muranga and Thika Districts. A small grant and ongoing partnership was also provided to Caritas Kenya to assist them with their national response to the drought. This Phase of the Programme involved total grants of approximately £250,000.

A further two projects were supported through NGO partners, Action For Development and Islamic Relief in the Borana Zone and Somali Regions respectively of Southern Ethiopia but these are outside of the scope of this evaluation.

Phase II, which was implemented between September 2006 and April 2007, working with the existing partners, and concentrated its activities on the worst affected areas of Isiolo, Marsabit, Kitui and Mwingi Districts. Phase II had a budget of £450,000 amongst three partners.

This evaluation report is part of a consultancy commissioned by CAFOD through the East Africa Drought Response Programme with the key objectives of providing technical advice and support to the development of CAFOD East Africa multi-year natural hazard risk reduction strategy and conducting an evaluation of the process for implementation of the CAFOD East Africa drought response programme.

The specific objectives of the evaluation process were to provide guidance which would result in the following:

1. Improved project management practices by ensuring that CAFOD and its partners implement their projects in conformity with key steps in the project cycle;

6 2. Increased involvement of client communities in the design, delivery and monitoring of the programme; 3. Enhanced appropriateness and transparency in the targeting mechanisms across the entire programme; 4. Improved engagement of communities in the coordination and management of nutrition programmes both at the district and local level; 5. Better financial and logistical arrangements management at all levels; 6. Effective project monitoring systems to enhance the delivery of the programmes and its outputs; 7. Improved gender sensitivity in both project planning and implementation

3. 0 METHODOLOGY

A number of investigative techniques were employed; a good number of them in combination. However, the two major general approaches that were adopted were interviews - specifically Community Interviews (CI) (Krishna Kumar, USAID, 1987), and Key Informants (KI) interviews. All interviews adopted an appreciative inquiry (AI) line based on the programme outcomes.

Specifically, among the methodologies employed were documentation/literature review – mostly targeting CAFOD organisational and drought programme documents; structured checklists – based on proposals made to CAFOD by partners and the TOR's there of; focus groups discussions – mainly based on Community Interviews; key informants interviews – targeting CAFOD and partner officials directly involved in project administration and implementation and key partner figures; case studies – depicting positive and negative experiences of beneficiaries; and personal observation.

Special attention was devoted to programme documentation, organizational as well as partners’ records and relevant documents. CAFOD’s line Manager, Matthew Wingate, provided a central resource/reference file containing all the relevant documents regarding the programme. Although attention was necessary for financial reports of the programme with a view to relating expenditure to activities undertaken, it ended up being not entirely practicable.

Quality time was spent with the top CAFOD management in the region and Programme Manager and other CAFOD staff to gain deeper knowledge of the programme and the organization as a whole. Invaluable input was gained through telephone interviews with London-based staff particularly Tim Aldridge and Helen Beesley. Information gained during this period served to not only crystallize an understanding of the Programme but also provide a window through which the evaluation exercises were structured and conducted. Basically, this period served as a preparatory phase.

Lessons to guide the evaluation were also drawn from a programme review workshop held in Naro Moru between from 31st January to 1st February 2007 involving all of CAFOD’s drought partners and a variety of other stakeholders involved in responding to drought in the Greater Horn of Africa in 2006.

The areas/partners visited were randomly selected through the assistance of the Drought Response Manager and the different partners. In doing so, the principle of fair representation and inclusivity was upheld.

Community Interviews were preferably employed because of their rapid and cost-effective information collection tendencies. They involved the use of direct probing techniques to gather information from several individuals in a group situation. They were preferred because they not only provided background information on the programme including its implementation but also helped to

7 generate ideas and hypotheses for future program design and provided feedback from beneficiaries to enable a thorough assessment of the response and recommended innovations.

Community meetings, comprised an average of 25 members of a programme village or locality were organized. Meetings were generally divided and included separate meetings with men, women, the elderly and other specially vulnerable groups, and youths. The venues were chosen by the communities themselves. In these interviews, the main interaction was between the consultant and the respondents. The Consultant posed the questions, raised issues, and sought responses from those in attendance.

Major questions to guide the discussions were listed in advance by the consultant in conjunction with the Drought Programme Manager. This was mostly meant to facilitate collection of comparable, systematic data from a series of community interviews; to keep the discussions focused; and to enable the consultant to pursue leads, recognize opportunities for questioning, and phrase questions so that all can comprehend them.

Summarily, the evaluation was carried out in a number of stages:

• A comprehensive briefing by senior members of staff who have been directly involved in the conceptualization, implementation and internal review of the Drought Programme; • Telephone interviews conducted with the CAFOD London officials who are directly involved with the Programme; • A review of key documents related to the Programme in the custody of CAFOD Nairobi office was conducted; • Community Interviews over a period of three weeks and face to face interviews with grassroots partners staff identified by CAFOD; • A preliminary evaluation report was shared with the Drought Programme Manager and later with CAFOD’s management. Their comments were incorporated in to a further draft. • A report detailing the main findings, conclusions and recommendations, both for evaluation and broader programme development, to the wider CAFOD and its partners was produced;

The information and data gained was analysed using both qualitative and quantitative methods.

4.0 CONTEXTUAL ANALYSIS

4.1 Background Information

A widespread assessment undertaken by the Kenyan Government, the World Food programme (WFP) and other humanitarian organizations late 2005 concluded that 3.5m people in Kenya were in need of immediate food aid in 25 Districts. The districts were mainly the arid pastoralist districts of northern Kenya and coastal region of the country. Kenya was part of a wider East and Horn of Africa region that was seriously affected by drought. As at then, roughly 395,000 metric tonnes of food aid was needed for an initial period of six months. CARITAS Kenya sent out an appeal (SOA) to the network for €1.0m including requesting CAFOD for specific support.

In both Phases of the Programme, CAFOD assistance was channelled through strategic Catholic Church and local and international NGO partners with considerable historical presence and involvement in their respective areas of operation. The programme was mainly targeting vulnerable communities in the least developed pastoralist communities in the Arid and Semi Arid Lands (ASAL). The contexts in which CAFOD partners operate are varied and unique, as shown below:

4.1.1 Marsabit District

8 The District is divided into 6 administrative divisions of Gadamoji, Laisamis, Loyangalani, Maikona and North Horr. The estimated population of the District is 140,739 with an approximate area of 66,000 km². This includes an area of 4,956 km² under the expansive Lake Turkana located west of the District.

Most of the District is extensive plain lying between 300-900 metres above sea level. The areas below 700 metres have low agricultural potential and cover 75% of the land surface – only suitable for wildlife and livestock rearing. The other 25% of the District’s land surface is made of highland, which has reasonable rainfall and agriculturally favourable soils.

Marsabit has 7 main ethnic groups, namely Borana, Gabra, Rendille, Samburu, Turkana, Dasnatch and Elmolo. This ethnic diversity has contributed to a variety of socio-economic issues including access to land, political voice and influence, and conflicts in the District.

The District is one of the poorest in Kenya. Access to social services, particularly education and health are quite limited and concentrated in the few urban setups. According to the current District Development Plan (DDP) (2002/2008), 87% of the population is food poor. Some of the key reasons for this pathetic situation are attributed to drought, inadequate water supply, low food production, poor governance, poor communication and transportation infrastructure, lack of markets for products, conflicts and widespread illiteracy. This has also created the seemingly high dependency rate on external food aid during times of drought.

The failure of two key rainfall seasons in 2005 greatly intensified drought in the District. A number of assessments on the food situation and the nutrition status of the communities instituted by various stakeholders including CAFOD painted a critical picture that required urgent intervention. It was established that 60% of the total number of shoats (Sheep and Goats), 40% of the cattle and approximately 15% of the camel population died between 2005 and 2006. According to GoK/WFP Emergency Food Operation Programme (EMOP) in March 2006, in humans, the malnutrition rates were as high as 30% Global Acute Malnutrition (GAM), indicating severe emergency situation.

4.1.2 Isiolo District

The District is divided into six administrative divisions comprising of Central, Garbatulla, Sericho, Merti, Oldonyiro and Kinna. It is further divided into twenty two locations and forty four sub- locations and covers approximately 25,605km². The district is characterized by flat low-lying plains, especially in the lower Ewaso Ng’iro basin, gently undulating landscapes, and some hills and minor escarpments. The altitudes range between 180 to 900 m above sea level. 65% of the District is classified as most arid.

According to statistics, as at 2002, the total population of Isiolo District was estimated at 112, 364 persons. Population projections place the current population of the District at 140,000 persons. The population density is approximately 4.4 persons per km². The single most worrying challenge to development in Isiolo is poverty, at 88%. The main ethnic groups that occupy Isiolo District include the Borana, Somali, Samburu, Turkana, and the Meru.

Between 2005 and 2006, Isiolo suffered a long dry spell which affected the majority of the population. The effects of the drought were even more pronounced among the vulnerable members of the society like children, women and the elderly. Large numbers of livestock were lost; crops failed leading to poor harvests.

To alleviate the situation, the programme settled on the two divisions of Central and Oldonyiro which were considered to be the most affected and were not covered by other agencies that were providing food assistance in the District e.g. CORDAID, Kenya Red Cross and Save the Children.

9 4.1.3 Kitui and Mwingi Districts

Due to the drought experienced in both Districts in 2005 and early 2006, a steady rise in malnutrition rates in children aged 0-59 months, pregnant and lactating mothers, people living with HIV/AIDS and the elderly was recorded over a period of nine months at the health facilities and hospitals under Kitui Diocese.

The Kitui District Hospital admitted a number of severely malnourished children between February and June 2006. The children showed signs of severe forms of malnutrition including Kwashiorkor, Marasmic Kwashiorkor and severe Anaemia. In addition, due to their weakened conditions, disease outbreaks like measles were reported.

During this period, Kitui District also experienced increased pressure on the health facilities in the Diocese due to increased morbidity and inability of patients to pay for their health care due to diminished income sources. There are altogether 19 Catholic Health facilities in the diocese, as well as 10 government facilities and numerous private clinics. All Catholic facilities reported an increase in the number of people with measles, acute respiratory infections, malaria, diarrhoea and intestinal worms. These are diseases that would easily have been eliminated with essential drugs.

4.2 Programme Implementation

The Programme was implemented in all the anticipated areas mainly by Diocesan Development offices as partners with the exception of one division in Marsabit District where the health facility administration at Laisamis declined to use the Weight for Height standards for screening beneficiaries. One component was also dropped; the livestock restocking and vaccination component in Isiolo. Some adjustments in the methodology of provision of both supplementary food and drugs were made in Mwingi where the implementing partner was closely collaborating with the Ministry of Health. Marsabit experienced a low implementation rate due to various unavoidable circumstances which will be dealt with later in this report. As a result, the project was extended to include other components, particularly water provision.

4.2.1 Planned Outputs

(i) Training/Programme Management Capacity Building

Prior to the commencement of the Programme, CAFOD facilitated a 3-day supplementary feeding and nutritional training at the beginning of Phase II at each of the programme sites, in Kitui in July followed by Isiolo and Marsabit in October. Participants were drawn from medical personnel, community health volunteers and personnel from the development offices of the respective dioceses. A total of 63 persons participated.

The training which was led by CAFOD nutritionist, Esther Busquet, covered all aspects of the nutrition programme ranging from identification of malnourished persons to differences in types of malnutrition and treatment of moderate malnutrition.

The Drought Manager at CAFOD worked closely with Isiolo and Marsabit Dioceses Emergency Coordinators during the initial stages of the project implementation to strengthen their capacities on specific project management activities, including collection of data and general reportage. A 2-day humanitarian accountability workshop, in conformity with Humanitarian Accountability Partnership standards, was held in Naro Moru between 2nd and 3rd February 2007 involving participants from all partner organizations. A programme learning review workshop for all partner organizations took place between 31st January and 1st February 2007.

10 (ii) Baseline Screening

Baseline screening was undertaken in all health facilities at programme sites except Laisamis in Marsabit District. This was done between September and November – immediately after the nutritional training. Those screened were children under five years, pregnant and breastfeeding women and the elderly men and women. Whereas Weight-for-Height (WFH) was used to determine which children under five years should be admitted to the programme, Middle Upper Arm Circumference (MUAC) was used for adults. In some instances, both WFH and MUAC were used for children.

(iii) Supplementary Food and Drug Supplements

The distributions, though initiated at different intervals in the various programme sites, have occurred according to planned methodologies through all but one (Laisamis) of the 28 target health facilities across the 3 dioceses. In Marsabit and Isiolo Dioceses, 6 extra outstations were visited in each of them to extend the outreach of the programme. Distributions of food supplements – Unimix (fortified and chemically-tested food supplement) in all the areas were made on a fortnightly basis. Marsabit and Isiolo pre-mixed the Unimix with oil and sugar to ensure that all the ingredients are used for the intended purpose. Kitui staff felt that there was no need for pre-mixing and adopted awareness education on the necessity of the various food ingredients supplied through the programme.

(iv) Provision of Essential Medicines

Essential medicine was provided to health facilities in both Kitui and Isiolo Dioceses. Adjustments were made to the number of health facilities and the combination of drugs according to the advice of the local Ministry of Health personnel and prevailing conditions in the respective districts. Most emphasis was on the treatment of Malaria, Diarrhoeal diseases and worms. Treatment was for all beneficiaries based on the existing health services provision policies of the respective institutions, with the overriding assurance that nobody would miss treatment due to non-payment.

(v) Improved Domestic and Livestock Water Systems

This activity was slated for the Isiolo Diocese only. Four sites for improved access to water were targeted in Central Division. It was mainly aimed at meeting the needs of drought prone, vulnerable farming communities. The first activity was to construct two water intake systems complete with piping system covering the intake area in Maili Tano. The sites were identified with the assistance of the District water Engineer and duly approved by the District Steering Group (DSG). Work is in progress.

A further two water activities involve construction of 2x50,000lts water storage tanks for 2 further communities of Olla and Kiwanjani in Central Division. The project is intended to serve approximately 1,800 people. Work on the completion of the construction of the tanks is almost through.

(vi) Livestock Vaccination and Restocking

This component, which was geared to serve 1,000 pastoralists adversely affected by drought in order to improve their livelihoods had to be dropped due to administrative issues at the Diocese of Isiolo, when the office was officially closed for almost three months. The complexity of good quality restocking programmes require adequate capacity, which was lacking as a result of the suspension of some programme staff. At the point of cancellation now commitments had been made to the communities who it was hoped would be involved.

11 5. 0 MAIN FINDINGS

5.1 Relevance/Appropriateness

Following successive droughts and seasons of poor rainfall in the arid and semi-arid areas of northern Kenya, life support systems seriously deteriorated to life-threatening levels. As result, the Government of Kenya declared drought a national disaster, triggering intervention from several agencies including the UN World Food Programme. Together with the Government, WFP mounted the Emergency Operation Programme – EMOP – targeting 28 Districts in Kenya, most of which were in the arid and semi-arid parts of the country.

Moyale, Marsabit, Samburu, Kitui and Mwingi were among the ten most affected Districts. Recommendations by UNICEF’s Short Rains Food Assessment report identified an urgent need to monitor the nutritional status of vulnerable populations residing in these districts.

An integrated health and nutrition survey conducted in March 2006 by UNICEF concluded that there was a serious food shortage in the area that required immediate attention. The Global Acute Malnutrition (GAM) levels were way below WHO cut-off point of 15% for the U5’s. Most pregnant mothers lactating mothers were showing clear signs of malnutrition. The report called for immediate intervention on….“Supplementary Feeding Programs targeting risk groups (children, pregnant and lactating mothers) should be established at community level. The program should include additional components such as deworming, Vitamin A and Iron/folic acid supplementation, immunization and distribution of ITNs.”

Carcasses of both small and large stock that died as a result of the 2004/2005 drought in Marsabit District

Whereas this was the case, the joint GoK/WFP programme aimed at mitigating the general nutritional status of vulnerable households. Few partners, sought to target the most vulnerable individuals who were threatened with death. CAFOD’s Supplementary Feeding Programme served to fill in a gap by supplementing the normal diet of the most vulnerable individuals within the households.

Beneficiary communities were satisfied that the supplementary food came at the right time especially when households had lost over 70% of their livestock and given that the few remaining stock could not produce adequate milk to supplement the maize rations provided by the Government and WFP, especially with regard to children and the elderly. Communities also underscored the fact that elders in most pastoralist communities are usually neglected in favour of the economically active members of the community during times of scarcity of food. The SFP therefore came in handy for this category of people. Testimonies were heard about elderly people who were on the verge of death having recovered fully and are currently engaged in gainful activities.

12 However, although no evidence can directly be adduced over bias in selection of beneficiary communities and localities by the respective partners, care should be taken by partners to ensure that the selection criteria of beneficiary communities especially in areas inhabited by various ethnic groups is purely informed by need and professionalism. Secondly, there are areas which were targeted without adequate consultations with the respective people in charge of these areas e.g. Laisamis in Marsabit. Prior commitment by all concerned including parish priests and nurses in- charge should be sought in future before including an area into the programme.

Some of the beneficiaries of supplementary feeding and essential drugs programmes from Marsabit and Isiolo Districts of Kenya

In terms of relevance and appropriateness, the programme succeeded in keeping within the communities’ local needs and priorities as well as keeping within the policy and mandate of CAFOD as an organization. There was considerable community ownership of the programme although there’s little evidence of community involvement during conceptualization. Although this is understandable in an emergency intervention, CAFOD and its partners should strive to consult communities adequately in future programmes.

5.2 Sustainability

In all humanitarian action like this particular one, sustainability may be difficult to achieve. But the fact that CAFOD is already working on a programme to create a connection between humanitarian action, recovery and development to support long-term drought management goals, is consolation enough. There’s also a sound exit strategy indicating timelines and handover modalities.

Marsabit and Isiolo have adequate funds to cover some long-term interventions like potable water provision, water for crop irrigation etc. Kitui and Mwingi had adequate harvests as a result of good rains and as way of mitigating future nutritional problems for the vulnerable groups among them; they are willing to formulate their own food supplements using locally available ingredients. The nutrition and supplementary feeding training provided to the health personnel and partner organizations staff is invaluable for future interventions and early identification of needy cases.

The sustainability of this effort is greatly enhanced by the nature of partners that CAFOD worked with. The church organizations have a longstanding experience in working with the respective communities and are very close to them, almost on a day-to-day basis. These partners have other on- going development programmes that dovetail into humanitarian work.

13 In most of the project locations, the Ministry of Health nutrition officials were full of praise for the novel, efficient and effective manner in which the programme was executed. This portends a good guarantee that they will be able adopt the system in their future governmental interventions. In order to consolidate the gains so far achieved, CAFOD needs to move fast and institute a proper recovery and drought preparedness programme with clear strategies that dovetail it into the any future humanitarian intervention in the area.

5.3 Efficiency

Undoubtedly, emergency interventions operate on the principle of urgent action. Due to capacity gaps in some of the partners, there was a delay in the formulation of requisite proposals to CAFOD, prompting CAFOD programme staff to intervene in providing the necessary technical support. Unlike Phase I where there was some delay from CAFOD’s end, the approval for proposals and subsequent release of funds in Phase II was prompt, sometimes as fast as within one week e.g. Marsabit. This particular aspect, which contributed positively to the efficiency of implementation, seems to have been as a result of lessons learnt in Phase I.

However, considerable procurement hitches were observed in Marsabit and Isiolo projects, especially regarding the procurement of Unimix. Instead of raising competitive tender bids through a medium with a wider coverage e.g. national print media, the two partners opted for quotations to a few known manufacturers. Although within the organisations’ own and CAFOD procurement policies, this approach ran the danger of being over-charged for the services. This had also the effect of delaying the supply of Unimix.

Another hitch involved hire of transport to get the Unimix to the health facilities in Marsabit. Coincidentally, at the same time as the Diocese of Marsabit was soliciting for trucks from local businessmen, the Kenya Red Cross Society, which was the lead agency for distribution of relief food, were offering better prices for transport, not to mention the limited number of trucks available in the District. Marsabit would have also done better if they had thought of a well-negotiated use of the parishes’ transport which later proved helpful. Isiolo mobile team complained of poor means of transport which continuously broke down whenever out in the field – considerably slowing down progress.

In future, it may be conceivably efficient to pool transport with the lead agency that distributes general relief food, especially in places like Marsabit – instead of hiring a whole truck to only transport a few bags of Unimix to incredible distances.

Although adequate assurances were received from the Acting Diocesan Coordinator, Isiolo, there’s likelihood that contractor hired to do the intake weirs at Maili Tano may not finish the job in good time; worse still, he may not do good quality work. Diocesan staff should therefore be alert to this possibility and ensure they retain strong relations with the District Water Office, as they have been doing. A full final inspection and approval of the work by the Ministry of Water is essential before any final payments are made.

The sudden suspension for three months of all project staff in Isiolo through a unilateral action by the new Bishop was probably one of the biggest blows to the delivery of the project in that district. CAFOD were not involved in this decision and were immediately after the office closure by the Bishop and suspended staff. Given the critical timing of this decision and the humanitarian needs at the time in Isiolo, CAFOD worked with the Bishop to re-instigate a skeleton staff of project officers and nurses soon after the decision was taken, but this was not enough to mitigate all of the effects of this period of closure. Although the project has lately managed to gather good tempo, the stoppage slowed down the project considerably.

14 Commendably, all the partner projects’ indirect costs were kept below the acceptable upper limit of 20% with some spending as low as 13% on personnel, administration and M&E costs. Isiolo however needs to step up its financial records keeping systems as a matter of critical concern although it was noted during the evaluation that this was in the process of being undertaken.

CAFOD needs to re-evaluate its role in regard to partners’ proposal formulation process lest it is seen to be “spoon-feeding” its partners in this aspect. As much as it is important to raise quality proposals that conform to CAFOD standards, it’s also important that partners are adequately trained and empowered to be able to make sustainable high quality proposals without being assisted every time that they need to write proposals. With the very lengthy- in some cases over 25 years- association with CAFOD, it was noted during the evaluation that some of the partners had over time become reliant on CAFOD staff to make proposals. This should be further re-examined lest a dependency syndrome is nurtured in this area.

5.4 Effectiveness

Nutritional Training and Programme Management Capacity Building

A 3-day supplementary feeding and nutritional training was facilitated by CAFOD through Esther Busquet, in Isiolo and then Marsabit in October 2006. A total of 38 persons drawn from nurses in the beneficiary health facilities, community health volunteers and at least 3 members of staff from each development office were trained.

The Kitui staff also benefited from the same training programme between the first and the second phases of the programme through a separate training programme mounted in August 2006 and a refresher one organized in November 2006. A total of 26 field and development office staff participated.

The training covered all aspects of a nutritional programme, ranging from identification criteria for malnourished persons; different types of malnutrition; treatment of moderate forms of malnutrition; internationally accepted standards of measurement of malnutrition and reporting systems.

In all the areas visited, staff who attended the training were full of praise for the wide and specialized knowledge they gained during the training. They were also quite impressed by the manner in which the trainer – Esther Busquet - delivered the training and wished that she continues to update them on new development in the field of supplementary feeding. The nurses were particularly thankful because the training had provided them with lifetime skills which they didn’t have before – even with their nursing training background. They will be able to employ the knowledge in their day to day work beyond the CAFOD Supplementary Feeding Programme. Some suggested that the training period should have been longer than the allotted 3 days.

The lesson for CAFOD, its partners and other supplementary feeding providers here is that capacity building for programme implementers is critical and should be an integral part of any intervention of this nature and should therefore be in-built in the programme planning.

(a) Project Management Training

The Drought Manager CAFOD has worked closely with the Emergency Coordinators of both Isiolo and Marsabit to strengthen their capacities on specific project management techniques, including data collection and reporting. There still remains a lot to be achieved in this area. In almost all the partners except Kitui, the programme management is lacking in some capacity. This is evident from the quality of reporting, projects records keeping, and lack of basic project management and proposal formulation skills – although the enthusiasm to learn and do a good job is there.

15

Financial management skills were also noted to present gaps in some of the programme areas – particularly Isiolo and Kitui (in fact Isiolo does not currently have a financial officer). Kitui have an adequate financial system but the fact that project funds management was not separated from other normal diocesan funds presented a problem in some of the parishes – especially in staff allowances.

The lesson for CAFOD and its partners here is that prudent project management skills even in an emergency programme of this nature are of essence. The reasoning behind the support that CAFOD extends to project management staff and the financial officer is to get the best from them in terms of prudence. Although there’s normally not much time in disaster response programmes of this nature, CAFOD should always insist on a clear, systematic, experienced and accountable management structure before approval/remission of funds. Where capacity lacks and a genuine need is seen, CAFOD would be justified to invest in training as it has done- although again such an investment should be weighed against the cost of hiring qualified personnel.

(c) Humanitarian Accountability Training and Programme Learning Review

Like the training on supplementary feeding and nutrition, the Humanitarian Accountability training based on the Humanitarian Accountability Partnership (HAP) standards was very well received by all the partners. Although most of them have been involved in humanitarian work for years, it was the first time that they were being exposed to some internationally acceptable way of administering humanitarian assistance. The learning review from 31st Jan to 1st February was also an eye-opener to most of them. Staff in the partner organizations are much more ‘at home’ with CAFOD as a partner and humanitarian work in general, especially drought emergency intervention work as a result of the workshop.

Baseline screening and the establishment of on-going nutritional monitoring system

Baseline screening was undertaken in all health facilities at programme sites except Laisamis in Marsabit District. This was done between September and November- immediately after the nutritional training. Those screened were children under five years, pregnant and breastfeeding women and the elderly men and women. Whereas Weight-for-Height (WFH) was used to determine which children under five years should be admitted to the programme, Middle Upper Arm Circumference (MUAC) was used for adults. In some instances, both WFH and MUAC were used for children.

Most health personnel and community health workers, though accepting the merits of the Weight for Height and MUAC screening for children, generally thought it was quite cumbersome- at least initially. Although the performance of Isiolo and Kitui was good in terms of coverage, there was a huge difference between the number of forecast beneficiaries and the actual number of cases that had benefited in Marsabit by the mid-point of the programme as the table below shows.

Area Forecast No. Screened No. Benefited % Coverage Marsabit 4,487 5,445 1,204 26% Isiolo 3,000 6,420 2,542 84% Kitui 4,487 14,000 8,522 189% Total 11,974 25,865 12,321 102%

The interim report and Marsabit staff advanced several reasons for the low coverage; the delay in the commencement of the programme found a considerable number of the beneficiaries already improving (those clinically malnourished had reduced), at least partly as a result of the consistent and widespread rains that fell throughout the district in November. The programme only admitted moderate cases of malnutrition, with severe cases referred for therapeutic feeding. The forecasted

16 figures appear to have included cases requiring therapeutic attention. Transport hitches due to heavy rains and other factors in both Isiolo and Marsabit also slightly affected coverage in these areas. The suspension of staff in Isiolo for three months reduced the number of beneficiaries because a good number of the cases earlier screened had improved.

Kitui exceeded the targeted figure by far. The explanation was that after screening, a large number of people were discovered to be requiring assistance. Faced with this, the Diocesan Administrator decided to commit another Ksh.800,000 to support the CAFOD funds and help alleviate the situation. But this was definitely a case of underestimation of the extent of the problem. Although the difference does not augur well in terms of planning and resource allocation, the consolation is that supplementary feeding programmes all over the world operates on fast-changing and highly dynamic context. In future however, CAFOD and its partners should strive to be a little more accurate in forecasting beneficiaries of such a programme.

Provision of Food and Drug Supplements

Distributions in all the areas that participated in the programme occurred according to planned methodologies although Marsabit and Isiolo were late by a month and one-and-half months respectively. The distributions were made fortnightly involving Unimix and drug supplements. For Marsabit and Isiolo, the ingredients – sugar, Unimix and oil – were pre-mixed to ensure that the beneficiaries received a fully fortified meal. Kitui opted to educate the recipients on the value of the different food ingredients, although health education was also part of each distribution exercise in Isiolo and Marsabit.

Apart from logistical and administrative hold-ups, this was probably one of the best executed components of the programme in all the areas. Most beneficiaries expressed appreciation in the way the distribution was handled. Whatever hitches that were experienced are within CAFOD’s ability to address.

However, the element of cost-sharing for drugs in the dioceses’ and GoK health institutions for patients receiving supplementary feeding needs to be re-looked at. Although the administration of the diocese in most cases commit themselves to not charging the patients receiving supplementary feeding for essential drugs, not all staff at the health institutions heed this for the simple reason that their remuneration comes from cost-sharing funds. A suggestion would be to incorporate the monthly allowance/salary of the staffer(s) in the indirect costs of the funded budget. It is also necessary that partners negotiate comprehensively with the local Ministry of Health officials to and District Health Management Board to see if the cost-sharing policy could be waived in times of stress such as during drought or disaster.

The reason why Kitui opted not to premix the supplementary food is not clear. The wisdom behind premixing is replicable in most poverty ravaged Kenyan societies. The argument on health education was not convincing since Marsabit and Isiolo who were pre-mixing the supplements also conducted health education before distribution. Moreover, the elderly in Kitui were unanimous during the evaluation on the demand that they should have been provided with Unimix and not maize and beans which they received during the latter part of the programme. It appears programme officers at Kitui falsely assumed that the elderly would prefer such a ration, but the evaluation highlighted that to them, maize and beans required elaborate preparation procedures and a lot of fuel energy to cook unlike Unimix which took less time and energy to prepare, and served to have more dramatic health improvement impacts.

The lesson for CAFOD and its partners here is that implementing partners need to constantly interact to share experiences and good practices during the course implementation of a programme of this nature.

17 Provision of Essential Medicines in Isiolo and Kitui

This activity, which commenced between January and February, was in response to feedback from Ministry of Health personnel and communities who requested an additional drugs caseload during the high stress periods of drought followed by floods. The composition of the requisitioned drugs kept on changing as a result of the changing climatic conditions and subsequent increases in water-borne diseases.

This was also one of the most appreciated components in the program. The comments above regarding drug supplements apply for this component in all the areas that it was provided.

Isiolo Diocese Mobile Clinic Nurse Pauline Ewoi and a local community health worker dispensing essential drugs during their fortnightly visits to communities at Chumvi Area of Isiolo District

Cooperation with CARITAS Kenya

CAFOD has had a strong relationship with CARITAS (K) in emergency drought response. According to the Executive Director of CARITAS (K), among all the CARITAS family members in Kenya, CAFOD has probably been the most consistent and steadfast supporter of CARITAS activities and initiatives in the region. CAFOD has also been instrumental in bringing together and maintaining the bond between the members.

CAFOD has assisted CARITAS mainly in capacity building, administrative support and organizational drought preparedness and intervention capacity. The role of CAFOD could however be further enhanced in:

• Supporting further development of staff capacity in management and drought preparedness and intervention • Organizational (CARITAS) capacity to deal with emergency disaster preparedness and response

5.5 Impact It is difficult to be able to determine the full impact of humanitarian action of this nature immediately after its implementation. But the fact that significant numbers of beneficiaries (number to be confirmed from partners) were discharged from the supplementary feeding (e.g. 27 in Chumvi area of Isiolo alone, 40 in Karare area of Marsabit alone at last report), specific beneficiaries testimonies, and the general appreciation shown by the communities indicates the high impact of the programme.

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During community interviews, a fraction of non-beneficiaries were also included as a control group. They gave a good account of how they witnessed people they though would die due to their nutritional status but have since improved drastically. The case studies presented below give a clear indication of the positive impact of the programme.

From this evaluation, and other discussions held with various actors, it is recommended that CAFOD should enhance or complement its traditional circle of church-based partners with other secular and neutrally perceived partners for greater impact. Although the current partners have tried their best to make sure that the programme is not seen as a church affair, perceptions to the contrary sometimes abound. Also, the church’s decision-making and hierarchical tendencies based on the clergy wielding more authority, present practical difficulties to the implementation and project management process. The clergy in most cases feel that as managers of their respective parishes and dioceses, they have to make all decisions on matters that affect their jurisdictions. This has set some of them on a collision course with programme staff, sometimes seriously affecting the outputs of the programme, as in the case of Isiolo, Laisamis etc. As spiritual heads, the clergy are revered by Diocesan staff, including the Coordinators who are mostly drawn from their flock. This has had the effect of monopolizing decision-making sometimes to the extent of being autocratic.

Comparing Phase I to Phase II

Although Phase I was also generally successful, its impact was noticeably less than that of Phase II. Phase I suffered initial delays between the time of making the proposal and the time of approval. Partners were generally inexperienced in targeted supplementary feeding and this slowed the rate of implementation. Ultimately, the programme was appreciated by beneficiaries but delivered largely as a general feeding programme for vulnerable groups rather than a supplementary feeding programme according to international standards.

Phase II benefited greatly from lessons learnt in Phase I, with a much scaled-up intervention in three locations; more focused targeting especially after the implementers were given supplementary feeding, screening and nutritional training by CAFOD and more resources for additional field staff and volunteers and for transport which allowed for important outreach to vulnerable mobile communities in Marsabit and Isiolo. Procurement and transportation of the required items was much more streamlined and smooth in Phase II. There was closer collaboration between CAFOD Programme staff and the partner staff at all stages- leading to prompt decisions and action on the part of CAFOD on any hitches that arose during implementation.

In both Programmes, CAFOD Management undertook its roles diligently and with due professionalism. As recommended elsewhere in this report however, CAFOD partners should be provided with the necessary capacity to be able to originate their own quality proposals without being over-dependent on CAFOD staff to do so.

19 Okotu Boru, 86, North Horr Division, Marsabit District

Okotu Boru, 86, lives on the outskirts of North Horr settlement in Ori Gudha village, one of the most arid parts of northern Kenya. Her wrinkled face does not betray her joy as she joins other elderly people from the village in welcoming and talking to us about CAFOD’s supplementary feeding programme run by the local Catholic Diocese.

Okotu was born in Malabot fora (a Gabra word for far-off rangelands or grazing areas) and was married at the age 15. Her husband, who paid the mandatory 3 camels as dowry, was aged 30 then and has since passed on. He was a wealthy man with over 400 camels, 600 head of cattle and several thousands goats and sheep. Her father was even wealthier with over 800 camels, 1,000 head of cattle and several thousand goats and sheep.

Out of her seven sisters and one brother, only two of the siblings are alive today. One sister lives with her and is also a beneficiary of the supplementary feeding programme. Her brother lives in similar conditions of poverty in Kalacha, some 100km away. All that is left for Okotu and her sister are two female camels which they look after within North Horr centre.

During her youth, life was worth living with plenty to eat and drink. Milk and meat were plenty in every home. Nobody lacked food as those without livestock were assisted and people shared food freely. Grazing and browse for livestock was plenty and water was easily accessible to both livestock and humans. The Gabra co- existed peacefully with their neighbours the Borana and Rendille. The only conflicts that were occasionally experienced were between the Gabra and the Galaba (Dasnatch) and sometimes the Turkana. Traditional celebrations accompanied by song and dance were common place in Gabraland especially after a good fill of camel milk and meat.

Things have since changed. Gabra are progressively being decimated by drought. The household stock holdings have dwindled to pathetic numbers which can no longer support family units. People no longer share the little they have like in the olden days. Even the younger people are suffering. Conflicts, occasioned by political greed and narrow individualistic agenda have become the order of the day. Many people continue to lose life in these conflicts and there seems to be no end in sight. Droughts have become part of us and no longer “delay” as used to happen.

According to her, during times of disaster and calamities brought about by drought, the local leadership led by the Yaa chieftaincy stepped and provided leadership. Today’s leadership is generally self-centred and cannot provide the necessary direction. They no longer keep in touch with the people to know their problems. Instead, they are hell-bent on causing trouble and fanning ethnic conflicts instead of promoting peace. The youth have lacked role models.

People used to love another and were generous to their kinsmen. Those in trouble were assisted to overcome their predicament. Today, every person has withdrawn to himself/herself. People are becoming greedy and selfish. This probably explains why many problems are bedevilling the Gabra community today.

CAFOD through the church in North Horr has helped in mobilizing food rations to mitigate the effects of drought. Apart from providing food to the general affected population, the church has targeted the abandoned lot like the children and the elderly under the current feeding programme. “We feel indebted to the church over this assistance. Otherwise some of us would have been dead by now. My teeth are weak and cannot chew anything hard solid foods. And so are most of the people of my age. I find the Unimix appropriate for me because it’s highly nutritious and easy to swallow when made into porridge.”

Regarding long-term solutions to drought hazards, Okotu is categorical: “We are dependant on our livestock for survival. It is the only thing we know. If you help with our livestock, you will have helped us.” Okotu also believes that more food should be provided to other community members that have not benefited. She also believes that assistance should be given to schools and health centres to make medical services available to all including herself who has a slight hearing impairment. 20

Robert Mulwa Mbuli, 67

“I come from Kaimu village, Muthale Location of Kitui District. I don’t know my real age but I can estimate it at 67 years. My wife left me some time ago because I could not provide for her in terms of food and other important material needs. My six children are all grown up and married in far away lands. I live alone. In 2005, due to a long drought that had hit us, I went for many days (I can’t remember how many) without food. Suddenly one day, I became sick with fever and my whole body became swollen. A neighbour who knew the existence of the programme approached church officials and pleaded with them to come to my rescue. Initially, she gave me part of her ration of Unimix which helped me to get better. In the meantime, I presented myself to the catholic nurses who after taking measurements of my arm admitted me to the programme. They provided me with fortnightly ration Unimix and later maize and beans together with drugs. I am fully recovered man now and I can even work in my small shamba now; a thing that was almost impossible a year ago. I thank those who brought the food and drugs for saving my life.”

Abei Erupe, 1½ years

Abei Erupe, who is 1½ years is seen here being brought by her grandmother for treatment with essential drugs supplied by CAFOD at Chumvi area of Isiolo District, Kenya. Abei was weaned by the mother at 6 months because she got pregnant with another child. Two months later, the child became very sick with chronic diarrhoea which went on for 2 months. Fearing that the child may eventually die, the mother abandoned it with the grandmother (mother to the husband) who took it to the Catholic-run mobile clinics under the Supplementary Feeding and essential drugs supply Programme funded by CAFOD for treatment and supplementary food. Apart from a few rashes on the body, the child is on the way to full recovery and has gained weight dramatically.

Generally, the Programme managed to achieve its objective of alleviating the affects of the long- drawn drought on vulnerable members of the community. All in all the vulnerable groups in these areas have benefited greatly and there’s a likelihood now that the rains have fallen again that most of them will cross over the next dry spell without much problems.

The programme has also managed to focus the attention of key agencies on the plight of women, children and the aged – who often receive less attention in these communities. A number of partner organization staff talked of henceforth incorporating the rights of children and the aged in the planning of their programmes.

6.0 RECOMMENDATIONS

21 1. The regional CAFOD office undertook adequate consultations with the various actors before making recommendations to the London office. Although most of the partners had adequate time in which to consult the various grassroots stakeholders including the beneficiaries, little consultation seems to have taken place laterally. Although this is understandable in an emergency situation, the partners should in future adequately consult communities, local government agencies, institutions and other local organizations when implementing such an important programme. CAFOD should help build the capacity of partners in community involved assessments.

2. For emergency programmes to achieve the greatest impact possible, preparedness is critical. In effect, preparedness should dovetail into an emergency approach and should enable lessons from earlier responses to be built into and refine disaster responses. Although all the partners have been working with the communities for more than a quarter a century, their level of drought or disaster preparedness both at the organizational and intervention levels is minimal. Their responses to drought and disaster generally have been reactive, representing the crisis management approach. This has meant the long term impact has been less than it could have been. To enable them to play a more effective role in disaster management and response, CAFOD needs to strengthen the capacity of these organizations to adequately plan for drought as an ongoing process, continuously evaluating communities’ changing vulnerabilities and how they, together with the communities, can work in partnership to lessen risk and dovetail risk management into development processes.

3. The CAFOD Drought Response Programme has contributed greatly to partner’s understanding of best practices in humanitarian efforts. Its decision not to go “operational” and instead work through local organisations, although presenting its own important challenges, including lack of the necessary expertise and capacity to always respond to maximum effect, has the potential of enhancing local ownership and capacity building- hence sustainability. CAFOD is therefore encouraged to remain on this course. In this regard, it should consider complementing current partners with some more secular organizations.

4. Early warning systems contribute significantly to preparedness as does good monitoring of key indicators, rapid communication of needs and effective media management. There must be a clear understanding of emergency procedures and their application. If possible, there should be a standard Emergency Response Manual1 that is well understood by all stakeholders. Partners should be encouraged to harness and develop traditional drought early warning mechanisms.

5. Appropriate institutional mechanisms need to be put in place both at CAFOD level and partners’ level. As a way forward, CAFOD should immediately develop a coherent regional disaster risk reduction strategy and encourage its partners to also develop the same. This should ensure that capacity and systems are matched with the need; that strong continuous leadership, institutional memory and an experienced team are in the right balance; that the organization’s systems’ scaling do not oscillate between disasters; that resource-sourcing systems are in place; and that a structured framework for staff recruitment and management and devolution of responsibility is in place.

1 The Caritas Emergency Toolkit is a useful tool, but requires much more dissemination and training for CAFOD partners in order for it to become effectively used at the operational level. 22