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MANDERA CENTRAL SUB COUNTY, KENYA Th Th 6 to 17 October 2013

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MANDERA CENTRAL SUB COUNTY, KENYA Th Th 6 to 17 October 2013 MANDERA CENTRAL SUB COUNTY, KENYA th th 6 to 17 October 2013 Caroline Njeri KIMERE ACKNOWLEDGEMENTS Special thanks are expressed to; • European Commission Humanitarian Office (ECHO) and Department For International Development (DFID) for the continued financial support to Save the Children Nutrition program and for funding this survey. • Save the Children National office and the teams in Wajir East and South (Health, nutrition and Monitoring and evaluation) especially the nutrition coordinator Caroline Kawira and nutrition officer Dorcas Wanjiru for their technical and moral support. • The Ministry of Health (MoH) for their support and commitment especially the Sub County Nutrition Officer (Patrick M. Kamundi and all the health workers who participated in the survey • The Survey team (enumerators and drivers) for their tireless efforts to ensure that the survey was conducted professionally and on time. • Community members who willingly participated in the survey and provided the information needed. • This study would not have been possible without the hard work and commitment of everyone involved. 2 EXECUTIVE SUMMARY Mandera central sub county is one of the five sub counties in the larger Mandera County in North Eastern region of Kenya. Save the Children International (SCI) has been implementing nutrition programmes in the Sub-County since 2007 through direct implementation. The strategy however changed in August 2012 with the role of partners changing to supporting the Ministry of Health (MOH) to implement High Impact Nutrition Interventions (HINI). The aim of the program is to contribute integrated response and support to the management and treatment of malnutrition in Kenya, while building community resilience and preparedness in the 5 divisions of Mandera central(Kotulo, Elwak, Wargadud, Shimbir Fatuma, and Qalanqalesa) from August 2012 to December 2013. The funding for the program is by ECHO and DFID and the implementation is done by the Ministry of Health with support provided by SCI through seconding of 5 nurses, providing monthly incentive and training for 74 Community Health Workers who provide treatment for Severe Acute Malnutrition (SAM) in providing through HiNi services in the 5 divisions. Additionally logistical support is provided during outreaches ad to transport plumpynut monthly to health facilities from the district hospital. The HiNi services are provided in the 7 seven static health facilities (with one stabilization centre) and the 14 nutrition and health outreach sites across the divisions. The Global Acute Malnutrition rates have reduced from 27.5% (23.2-32.2 95% CI) April 2011 to 20.6% (16.2-25.8 95% CI) April 2013. Resume of coverage assessment The coverage assessment was conducted to evaluate access and coverage of the Community based Management of Acute Malnutrition programme for children ages 6 to 59 months with SAM. It conducted between September 6th to 17thOctober 2013 and it was the third Coverage survey to be conducted in Mandera Central. It was conducted at the beginning of the rainy season. SQUEAC 2010 2011 2012 2013 Coverage Point Point Point point Outreach 47.1% 54.9% 50.4% 56.3% (40.5% - 71.0%) CI: (23.3% - CI: (38.7% – 70.1%) (95% IC: 37.4% - 63.0%) OTP Health facility 71.7%) 59.0% (43.0% - 73.4%) The Semi-quantitative evaluation of access and coverage (SQUEAC) methodology used consisted of 3 stages, applying the principles of triangulation (by source and method) and sampling to redundancy. The coverage investigation conducted in Mandera Central district: point coverage is 50.4% (95% IC: 37.4% - 63.0%) 3 The table below presents the main barriers on which the program must act to improve coverage as well as specific recommendations how to do so: Barriers Boosters 1. Lack of Human Resources (in the sub 1. Awareness of the OTP program by the county there are only 3 trained nurses) community and caretakers 2. Community not aware of the admission criteria and when their children are not 2. Appreciation of the program admitted they view this as rejection and they never come back. 3. Lack of varied sources of referral (TBA and Traditional healers not conversant 3. Free under-fives services provided at with causes of malnutrition and the health facilities and outreach sites) therefore when malnutrition cases come to them they do not refer them 4. Poor perception of nutrition products 4. Appreciation of the community health i.e. RUTF causes disease and has virus workers by the community and caretakers 5. Pastoralism and migration 5. Good relationship between the health worker and the community members Recommendations • Advocate for recruitment of health workers and CHWs. • Strengthen routine health Education • Capacity building of the TBAs, CHWs, CHEWs and local leaders • Community mobilization • Consistent mass screening done quarterly • Number of outreach sites to be increased • Proper planning for outreach team • Organise for community nutrition days 4 CONTENTS 1. INTRODUCTION ......................................................................................................................................................... 8 1.1 CONTEXT ......................................................................................................................................................... 8 1.1.1. Overview of the area ................................................................................................................................. 8 1.1.2. Nutritional situation .................................................................................................................................. 9 1.1.3. Health access in Mandera central Sub County ....................................................................................... 10 1.1.4. Nutrition services .................................................................................................................................... 10 1.2 Save the Children in district ...................................................................................................................... 12 1.3 Results of previous SQUEACs in Mandera Central ................................................................................ 12 2. OBJECTIVES ............................................................................................................................................................. 14 Main objective .......................................................................................................................................................... 14 Specific objectives ................................................................................................................................................... 14 3. METHODOLOGY ...................................................................................................................................................... 15 3.1. GENERAL OVERVIEW .................................................................................................................................. 15 3.2. STAGES .......................................................................................................................................................... 16 3.3. ORGANIZATION OF THE EVALUATION .................................................................................................... 21 3.4. LIMITATIONS ................................................................................................................................................ 22 4. RESULTS ................................................................................................................................................................... 23 4.1. STAGE 1 ......................................................................................................................................................... 23 4.1.1. Recommendations follow up of SQUEAC December 2011 ..................................................................... 23 4.1.2. Quantitative data analysis ....................................................................................................................... 25 4.1.3. Qualitative data analysis ......................................................................................................................... 29 4.2. STAGE 2 ......................................................................................................................................................... 31 4.3. STAGE 3 ......................................................................................................................................................... 32 1 The prior ................................................................................................................................................... 32 2 The likelihood .......................................................................................................................................... 33 3 The posterior ........................................................................................................................................... 34 5. DISCUSSION ............................................................................................................................................................. 35 6. RECOMMENDATIONS .............................................................................................................................................. 37 Annex 1: Survey questionnaire for current SAM children NOT in the program ....................................................
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