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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/

Zimbabwe Nutrition Cluster monthly meeting 08 May 2020, 10:00 to 12:00, Zoom Online Meeting

Meeting minutes Chair: Nutrition Cluster Coordinator, Agnes Kihamia, Nutrition Cluster Note taker: IMO, Nakai Munikwa, Nutrition Cluster

Agenda 1. Welcome and Introduction 5 mins by NCC 2. Review of the action points 10 mins by NCC 3. Cluster update, HRP performance and gap update 15 mins by IMO and NCC 4. Presentation on draft guidelines on Nutrition Support in Critically ill COVID-19 patients (DAZ) 25 mins by MoHCC 5. Update on AAP from partners and MoHCC provinces 30 mins 6. Key updates (achievement and challenges) from partners and MoHCC provinces 30 mins 7. AOB 5 mins.

Action points from previous meetings

Discussion point/cluster partner Action points Focal point/agency Status Comments Report has been reviewed by MoHCC. Further analysis has been done. Restructuring is also being done. Report on Pellagra to be shared by mid- Pellagra update; Availability of the Nicotinamide so far, April. Draft already available. the quantification was done for nicotinamide of about 6000 1 Mr. Nyadzayo in-progress supplements. A letter has been drafted

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 1

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

which is with the PS for the procurement that will need concurrency with UNICEF. The initial group that was working on pellagra to concentrate on developing the report. Comments on Pellagra report Committee on Pellagra to meet once the are expected from WHO, UNICEF and report is in a better state. All cluster MoH to share their comments with members to receive document for city. Mr. Nyadzayo in-progress comments Nicotinamide quantification. 6,000 supplements have been requested. Letter has been drafted and yet to be signed by PS. Request for procurement to be sent through UNICEF. Mr. Nyadzayo in-progress By 15 May 2020 Case definitions were developed by Case definition of pellagra still WHO and were shared with Mufaro. outstanding. Mufaro to provide an email to Zvanaka WHO in-progress to reshare the Case Definitions. Materials for health workers and Materials need to be adapted into community collected from Mozambique

Zimbabwe context. were shared by NCC that were Pellagra taskforce Pending translated into English. Seke district has a high number UNICEF in discussion with ADRA on 2 of SAM cases being realised. support of nutrition activities in Seke Thoko In-Progress SOPs on how we can continue Management of Wasting in the context working to be drafted and of COVID-19. MoHCC Nyadzayo 3 shared. and Agnes in-Progress

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 2

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

High defaulter rates are affecting MoHCC and Partners to propose the way Suggestions: the cure rate thus cure rates are forward/strategies on the IMAM MoHCC In-Progress Verification of data. lower than the Sphere standard. performance improvement. Defaulter case definition verification. Research/study on the factors associated with low cure rate. PPE for VHWs: Quantification has already been done, procurement plan now with Mr Nyadzayo to follow up on VHWs NCC and MoHCC In-Progress logistics pillar. This includes PPE protective clothing and give feedback. Budgeting has been done and it will be for health workers with direct submitted to accounts department. It is contact with patients. difficult to tell timelines. Mash East sensitising VHWs on Nyasha to send the Lack of VHW data collection tools should M-MUAC so they can join food request for printing be addressed. MOHCC to submit In-Progress distributions and collect data to MoHCC National requests of tools. and distribute MUAC tapes. Nutrition Office

Main Agenda Items Discussion point/cluster partner Focal Action points Timeline point/agency Cluster Update and IMAM performance Agnes to keep partners Agnes As posted on the funding for information the addendum. comes in. Nutrition cluster update 08_05_2020.pptx

Cluster is funded to the tune of 3.6 million which is 18% of the total funding requirements. The Nutrition cluster requires an additional 5.8 Million for COVID-19 response. Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 3

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

HRP achievements 50% of coordination meeting held 38% of target children screened 26% of target children with SAM admitted for treatment No data for children admitted with MAM 11% of children who were acutely malnourished were successfully treated. Data on caregivers reached with IYCF-E messages not yet available. 30% of targeted children received Micronutrient supplementation. No community dialogues have been conducted to date.

PiN in the COVID-19 addendum is still 1 million people. Target is 300 000 and requirement is 5.8 million dollars. 7 partners have participated and 9 projects have been submitted. Covid-19 HRP has been launched. Link to the HRP has been shared which has the HRP and Addendum together.

IMAM update Zimbabwe has not been able to meet sphere standards for Cure rate and defaulter rates. Partners to participate in All Partners Every Data is an issue it needs to be cleaned. Management at OTPs and SCs is also an issue since it leads to technical emergency Tuesday. these outcomes. meeting every Tuesday.

IMAM data tells us a story. Defaulter rate is way high. The high defaulter rates might be a result of wrong classification. High levels of defaulters, could also be caused by stockouts of RUTF. There is need to improve on our supplies. Work to be put in finding the correlation between stock-outs and high defaulter rate and factors associated with low cure rates.

Efforts were put in 2019 to look into IMAM performance. There is already data from last year which might assist in attending to some issues being realised. Provinces need to look at their data. Follow ups were done last year to the health facility level. Results showed that a few health facilities in a district contribute to the high defaulter rates. Mentorship visits need to be planned for specific health facilities that have high defaulter rates. Most cases were misclassification or data entry error.

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 4

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

The mentors would then do on-job training to assist the health facility and to avoid repetition of the mistakes and they would further go on to do data cleaning in DHIS2.

Presentation on draft guidelines on Nutrition Support in Critically ill COVID-19 patients (DAZ) 25 mins by MoHCC

DAZ came up with practical guidelines on how to manage inpatient malnutrition patients in the Context Practical guideline to be Mr. By 15 May of Covid-19 shared with partners Nyadzayo Nutrition Assessment: malnutrition universal screening tool will be used to identify malnutrition instead and DAZ of BMI. Nutrition assessment for patients with Covid-19 being done by frontline workers and dieticians will receive the results and recommend course of action. Those that are unable to feed orally will feed via the tube. A hypercaloric feed is preferred. It will be imitated slowly until full feeding is reached in 5 days. Special considerations for patients with diabetes, food allergies, severely malnourished. These will be referred to dietician. Guidance of all the nutrition materials that are required at every COVID-19 management centre was given.

NNU and DAZ are creating a training module for training frontline facility healthcare workers on the Training module to be NNU-Mr. By 19 May clinical management of malnourished COVID-19 patients. A budget for the trainings has been shared with partners for Nadzayo and developed. 1,000 health workers are set to be trained. Orientation will be done for management level comments DAZ colleagues. Trainings will target Covid-19 facilities. Printing of 10,000 copies of the guidelines will also be done plus other additional tools. There is a plan to procure supplies for the critically ill. MoHCC also plans to purchase food supplies for Budget to be circulated Mr. By 13 May those who are not critically ill. Nyadzayo Update on AAP from partners and MoHCC provinces Partners to improve on SCI- has a toll freeline that they are using as a feedback mechanism. The number is being distributed to AAP using ways that are All partners On going VHWs and communities. friendly

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 5

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

WFP- they have a hotline which has been well distributed. they also have suggestion boxes at food distribution points. Of the partners only 2 partners have already initiated AAP. Updates from partners and Provinces

Harare city: Will be training health promoters on IYCF starting the following week so they can deliver IYCF messages as they do door to door visits. The province is out of stock of Vit A. Vitamin A capsules being distributed my MoH at the moment and Harare city to take advantage.

OPHID: has just returned to the Districts after doing IPC trainings for staff members. Planning with the DHE in the districts they are working in, on how they can go ahead with implementation of activities. Working in 5 districts in Manicaland and 2 in . Follow-ups to be done on Mat North: Mother led MUAC is ongoing. RapidPro reports are being done. Working on updating VHWs reporting tools. contact lists to optimise RapidPro reporting. On AAP Suggestion boxes are at all health facilities in the Mat-North to send their districts, currently planning to sensitize community to use them. Stockouts of 100000 vitamin A. It has requests to national level. alertly been requested though. Lack of VHWs reporting tools.

GOAL: Supported Sensitisation of health workers on nutrition emergency response in Manicaland. In the context of Covid, the sensitisations are being done at health facility level. They are also orienting health facilities and VHWs on the RapidPro system. Anticipating better reporting. GOAL sharing toll- freeline during sensitisation meetings for AAP. Plans to give refresher trainings for village health workers on IYCF. Sensitisation of community leaders of the programme is also part of the plans. Lack of MUAC tapes is one of the challenges since requests from districts are not being met at provincial level.

Plan International: Prevention of stunting programme in in 43 Health centres and a distributing CSB++ with each child receiving 6kgs. Some of the SOPs they are following are social distancing, handwashing, maintaining less than 50 people per FDP. Also sharing IYCF-e messages during their public addresses. No new children are being registered. Registrations will be done separately to

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 6

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

prevent crowds. Help desk and suggestion box available for AAP. Plan International also using WFP toll free number.

WVI started supporting IMAM trainings in the districts and active screening trainings at the facilities. Active screening trainings were coupled with RapidPro trainings and distribution of MUAC tapes. On AAP, planning to have community dialogs.

Mash East: OTP trainings in Mudzi by WVI. Sensitisations to be done in Seke. VHWs had problems in moving from one place to another and lack of PPE. MUAC tapes to be redistributed. ZAPS distribution was done so most facilities do not have stockouts.

Mash Central: Sensitisations have started with support from WVI. Provincial nutritionist to visit to roll out the emergency response.

WFP: Winding up distribution of preventive ration for lean season assistance cycle. Continuing with maternity waiting homes programme. Numbers of mothers at waiting homes decreasing because of COVID-19. Stunting prevention rations still being distributed. Working with UN network and FNC on REACH funds to reprogrammed towards COVID-19 activities. Toll free in place for use.

SCI: Resumed activities under UNICEF CERF Project. Trained Health workers in IYCF. VHWs have been trained on RapidPro and MUAC screening. And IYCF. 80 Health workers and 20 VHWs trained in Binga. 90 VHWs and 45 HWs trained in district. was supported by training 125 HWs. Trainings in Hurungwe to start the oncoming week. Accountability mechanisms being implemented include the toll-free number and plans are in place to have community feedback meetings taking note of IPC in the context of COVID-19. Trainings are now taking long time since people are trained in small batches.

ADRA: In Seke, sensitisations on the programme have been done. Nurses have been sensitised on Rapid-Pro. Umguza, HWs have been sensitised on M-MUAC and Rapid-Pro. Meetings are being postponed since they cannot gather meetings thus delaying progress. A toll-free number being used for AAP and also a suggestion box.

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 7

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

NAZ: Started trainings for NAZ on IPF. OTP trainings for health workers. Facing challenges on PPE. Active screening trainings to start on Monday. Active screening and care group trainings starting in Chiredzi and Mwenezi.

UNICEF: continues to be on the look out for areas that have stock-outs of commodities. Partners to support distribution of emergency rations of nutrition commodities. Harare Has MUAC tapes and Colleagues can liaise with Mr. Makanganise.

Participants

Organisation Name of participant Email address Phone number 1 ADRA Josphat Kutyauripo [email protected] 0779000949 2 CCBICA Rodrick Dick [email protected] 0772911439 3 Goal Muchadei Mubiwa [email protected] 0772863001 4 Harare Central Hospital Molifia 5 Harare City Valeria Nkungwa [email protected] 0774220335 6 MoHCC Tasiyana K. Nyadzayo [email protected] 0773186484 7 MoHCC Nutritionist Manicaland Liberty Vhumisai [email protected] 0775213146 8 MoHCC Nutritionist Masvingo Zanele Moyo [email protected] 0774662717 9 MoHCC Nutritionist Mat North Elizabeth Katuluza [email protected] 0779071868 10 MoHCC Nutritionist Mat South Innocent Mazarura [email protected] 0772600800 11 NAZ Tapiwa Magaisa [email protected] 0773258165/0718459670 12 Nutrition Cluster Coordinator Agnes Kihamia [email protected] 0775920472 13 Nutrition Cluster IMO Nakai Munikwa [email protected] 0772257337 14 OPHID Diana Patel [email protected] 0772412795/242700607,252772 15 Parirenyatwa Nyasha Musingiwini 16 Plan Caroline Chingore [email protected] 17 Plan International Maxwel Mhlanga 18 SCI Sorofa Lovemore [email protected] Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 8

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Zimbabwe Nutrition Cluster https://www.humanitarianresponse.info/en/operations/Zimbabwe

19 UNFPA Rose Katumba [email protected] 072412154 / 776690851 20 UNICEF Mufaro Chiriga [email protected] 0773530598 21 UNICEF Caroline Chipinduro [email protected] 0772459706 22 UNICEF Thokozile Ncube [email protected] 0774587146 23 UNICEF Bridget Katsandegwaze [email protected] 0776793966 24 UNICEF Vengai Taremba [email protected] 0773194098 25 United Bulawayo Hospitals Rumbidzai 26 WFP Faith Dube [email protected] 0772366787 27 WHO Zvanaka Sithole [email protected] 0774109423 28 WHO Dr Bekeke Hana [email protected] 0772216914 29 WV Zimbabwe Ruramai Sibiya [email protected] 0772 818535

Cluster Coordinator Zimbabwe Nutrition Cluster monthly meeting, Agnes Kihamia 27 March 2020, Meeting minutes [email protected] , +263775920472 Page 9