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Aweil West, South Sudan April 2013 Lovely Amin

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Aweil West, South Sudan April 2013 Lovely Amin Aweil West, South Sudan April 2013 Lovely Amin ACKNOWLEDGEMENTS I would like to thank the team of Concern Worldwide of Aweil West, South Sudan for the support they have provided throughout the mission as well as their active participation in the SQUEAC assessment for Aweil West County. I would like to convey a very special thanks to Lucia Gwete, Coordinator Nutrition Programme Aweil for assisting me during the SQUEAC training and the survey. I am grateful to all participants of the SQUEAC training and the survey that includes the teams from Concern Aweil, Aweil County Health Office, staff from Ministry of Health for their active and lively participations throughout the entire exercise. My gratitude also goes out to the various members of the community: the mothers, Home Health Promoters (HHPs), and the Boma Chiefs, the TBAs and Traditional healers as well as the OTP and SC staff of the visited health centres. Lastly, but not the least CMN would like to thank it’s funders, ECHO and USAID for funding the CMN project which made possible to conduct this coverage assessment and trained some international health and nutritional professional as well as some national staff on SQUEAC method in Aweil West. 2 EXECUTIVE SUMMARY Introduction Northern Bahr el Ghazal (NBeG) is the poorest state in South Sudan with 75.6% of state population living below poverty line compared to national figure of 50.6%. Almost 83% of the population in the state reside in rural areas as agro-pastoralists, and over 9% of the population in NBeG are severely food insecure1. Recognising the vulnerability and poor service provision for the population of Northern Bahr el Ghazal, since 1998 Concern Worldwide has been implementing emergency and early recovery programmes. Aweil West County is among the five counties that constitute Northern Bahr el Ghazal State, an administrative division of South Sudan where Concern implement CMAM programme. This SQUEAC assessment was conducted from 16th April to 3rd of May 2013 in Aweil West. Methodology The Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) methodology was used to assess the coverage. Three stages investigation model was used: i) Stage 1, analyse the qualitative and quantitative data ii) Stage 2, develop and test the hypothesis; hypothesis one, ‘more community members in villages close by to OTP service delivery point are aware of the CMAM programme. Fewer community members living in villages far away to OTP service delivery points are aware of the CMAM program’. S Hypothesis two, ‘higher number of admissions to OTPs from the villages with presence of HHPs while low number of admission to OTPs from the villages without presence of HHPs’. iii) Stage 3, conducted a ‘Wide area survey’ to estimate the final programme coverage. Main Results Stage -1 The OTP admissions The programme admission data showed that in 2012, 2520 SAM children age between 6-59 months were admitted and 86% of them were successfully treated and cured. The OTP defaulters The defaulter rate was found within the SPHERE minimum standard 9%. Information of reasons for defaulting was however not captured through the OTP cards and registers. For example, how many weeks attended to OTP before defaulted and the reasons for defaulting etc. SQUEAC assessment includes assessing programme qualities therefore defaulter’s information is important indicators to see if the programme providing services that are need for the community and determine ways of improvements. 1 Annual Needs and Livelihoods Analysis 2011/2012, WFP/VAM 3 Screening at the communities Home Health Promoters (HHPs) serve the community by engaging themselves in health promotion messaging and other health and nutrition campaigns. In Aweil West HHPs are expected to conduct MUAC screening regularly. At the time of the assessment in sample villages nearly one third of the village were found without HHPs. This is due to that CWW had just initiated this concept and had not identified and trained HHPs in all villages in Aweil West. Villages where HHPs were present it was found that some of them were not active or very motivated due to poor incentive package. Therefore no regular screening has been carried out in all villages of Aweil West. Stage – 2 Hypothesis testing Hypothesis that was generated after stage 1 data collection and analysis, in stage 2 it was tested. Both hypotheses were confirmed based on field data. Communities nearby to OTP centre have better knowledge of the programme compared to communities far away from OTP centre. Village with HHPs have higher coverage than villages with no HHPs. Stage - 3 Coverage Estimation (results from wide area survey) The final coverage estimation was done after the ‘wide area survey’ ‘Point’ coverage is estimated at 50.7% ((CI 40.2- 61.2%). This estimation lies within SPHERE standard the rural area ≥50%. Main Barriers Findings from the assessment indicated that poor community perception on CMAM programme, inconsistent supply of RUTF and poor record keeping were the main determinants poor programme quality and coverage. Key Recommendation 1. The scheme and strategy of utilising the HHPs need to be reviewed and revised. 2. Increase sensitisation of the community on CMAM programme needs strengthening to a greater extent. 3. Improving communities knowledge on malnutrition and its consequence 4. Improve supply and monitoring of RUTF regarding regular, correct supply and correct utilization in OTPs; 5. Health and nutrition education for the community on malnutrition, child care and hygiene to prevent diseases and malnutrition 6. Improve record keeping in OTP and SC 7. Improve collaboration with other partners in the county 8. Conduct another SQUEAC survey after one year to assess if the situation has changed 4 CONTENTS EXECUTIVE SUMMARY-------------------------------------------------------------------------------------------------------------3 ABBREVIATIONS ---------------------------------------------------------------------------------------------------------------------6 1. INTRODUCTION------------------------------------------------------------------------------------------------------------------7 1.1 CONTEXT OF AWEIL WEST------------------------------------------------------------------------------------------------7 2. PURPOSE ------------------------------------------------------------------------------------------------------------------------11 2.1 SPECIFIC OBJECTIVES ----------------------------------------------------------------------------------------------------11 2.2 EXPECTED OUTPUTS -----------------------------------------------------------------------------------------------------11 2.3 DURATION OF THE ASSESSMENT -------------------------------------------------------------------------------------11 2.4 PARTICIPANTS -------------------------------------------------------------------------------------------------------------11 3. METHODOLOGY ---------------------------------------------------------------------------------------------------------------12 3.1 STAGE 1 --------------------------------------------------------------------------------------------------------------------12 3.2 STAGE 2 ---------------------------------------------------------------------------------------------------------------------12 3.3 STAGE 3 ---------------------------------------------------------------------------------------------------------------------15 4. RESULTS -------------------------------------------------------------------------------------------------------------------------16 4.1 STAGE 1----------------------------------------------------------------------------------------------------------------------20 4.1.1 PROGRAMME ROUTINE DATA ANALYSIS -------------------------------------------------------------------------20 4.1.2 QUALITATIVE DATA COLLECTION AND FINDINGS --------------------------------------------------------------25 4.2 STAGE 2 SMALL AREA SURVEY-----------------------------------------------------------------------------------------28 4.2.1 FINDINGS OF SMALL AREA SURVEYS ------------------------------------------------------------------------------28 4.3 STAGE 3 WIDE AREA SURVEY-------------------------------------------------------------------------------------------30 4.3.1 FINDINGS OF WIDE AREA SURVEY ---------------------------------------------------------------------------------30 4.3.2 COVERAGE ESTIMATION ---------------------------------------------------------------------------------------------31 4.3.3 THE BARRIERS AFFECTING THE COVERAGE ---------------------------------------------------------------------33 5. DISCUSSION -------------------------------------------------------------------------------------------------------------------35 5.1 PROGRAMME ROUTINE DATA ----------------------------------------------------------------------------------------35 5.2 PROGRAMME CONTEXTUAL DATA------------------------------------------------------------------------------------36 5.3 WIDE AREA SURVEY------------------------------------------------------------------------------------------------------37 6. CONCLUSION-------------------------------------------------------------------------------------------------------------------38 7. RECOMMENDATIONS--------------------------------------------------------------------------------------------------------39 7.1 SPECIFIC RECOMMENDATIONS ---------------------------------------------------------------------------------------39 7.2 ACTION PLAN--------------------------------------------------------------------------------------------------------------41
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