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Humanitarian Support to Vulnerable Populations in Pakistan

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Humanitarian Support to Vulnerable Populations in Pakistan INDEPENDENT FINAL EVALUATION SEPTEMBER 2015 Humanitarian Support to Vulnerable Populations in Pakistan Funded by ECHO By Saeed Ullah Khan This report was commissioned by Action Against Hunger | ACF International. The comments contained herein reflect the opinions of the Evaluators only. An ACF beneficiary in Tando Muhammad Khan, Sindh, expressing his joy as his son got better after receiving nutrition support from ACF /ECHO. * Cover Picture 1: Female Focus Group Discussions in Kohat ** Cover Picture 2: People's Primary Healthcare Initiative (PPHI) official explaining different aspect of coordination to the evaluation team member in Bannu. i | P a g e Preface The evaluation team would like to thank everyone who participated in and supported the undertaking of this evaluation. This includes the communities the team visited as well as the management and field staff of ACF. Special thanks go to Ms. Hannah Wichterich, Mr. Shahzad Ajmal Paracha and Mr. Tariq Rahim from ACF for their coordination and support enabling a successful conclusion to the evaluation exercise. Author Mr. Saeed Ullah Khan and Mr. Zaki Ullah: For information/clarification on the report please email at [email protected] Evaluation Team Mr. Saeed Ullah Khan (Lead Consultant) Mr. Zaki Ullah (Co-Consultant) Ms. Saima Inayat (Female Facilitator-Khyber Pakhtunkhwa) Mr. Said Jehan (Field Facilitator – Khyber Pakhtunkhwa) Ms. Faiza (Female Facilitator – Sindh) Mr. Muhammad Ismail (Household Data Analyst) Mr. Muhammad Haroon (Map Designer) ii | P a g e Contents Preface .................................................................................................................................................... ii Author ..................................................................................................................................................... ii Evaluation Team ..................................................................................................................................... ii List of Acronyms .....................................................................................................................................iv List of Figures .......................................................................................................................................... v List of Tables ........................................................................................................................................... v Executive Summary ................................................................................................................................vi a. Background Information ................................................................................................................ 1 b. Evaluation objective and methodology ......................................................................................... 3 c. Findings ........................................................................................................................................... 8 d. Conclusions ................................................................................................................................... 24 e. Good Practices .............................................................................................................................. 28 f. Lesson Learnt ................................................................................................................................ 30 g. Recommendations ....................................................................................................................... 32 Annex 1 – Good Practice ....................................................................................................................... 34 Annex 2 - Evaluation Matrix .................................................................................................................. 36 Other Annexes ...................................................................................................................................... 37 iii | P a g e List of Acronyms ACF Action Contre la Faim ACTED Agence d'Aide a la Coopération Technique et au Développent BHU Basic Health Unit BISP Benazir Income Support Programme CCG Conditional Cash Grant CfW Cash for Work CLTS Community-Led Total Sanitation CMAM Community-based Management of Acute Malnutrition DAC Development Assistance Committee (DAC) DoH Department of Health DRR Disaster Risk Reduction ECHO European Commission Humanitarian Aid Office EU European Union FCM Feedback and Complaint Mechanism FGD Focus Group Discussion FSL Food Security Livelihoods GAM Global Acute Malnutrition HH Household IDPs Internally Displaced Persons INP Integrated Nutrition Programme IYCF Infant Young Child feeding KAP Knowledge, Attitude and Practices KII Key Informant Interviews KP Khyber Pakhtunkhwa LHW Lady Health Worker MAM Moderately Acute Malnutrition NNS 2011 National Nutrition Survey 2011 NTU Nephelometric Turbidity Unit NWA North Waziristan Agency ODF Open Defecation Free OTP Out-Patient Therapeutic Programme ORS Oral Rehydration Solution PC1 Planning Commission 1 PCRWR Pakistan Council of Research in Water Resources PEFSA Pakistan Emergency Food Security Alliance PHED Public Health and Engineering Department PKR Pakistani Rupee PLW Pregnant and lactating women PPHI People's Primary Healthcare Initiative PQA Program Quality and Accountability SAM Severally Acute Malnutrition SMART Specific. Measurable. Attainable. Realistic and relevant SEK Swedish Krona SIDA Swedish International Development Cooperation Agency SFP Supplementary Feeding Program SUN Scaling Up Nutrition TB Tuberculosis TMA Taluka Municipal Administration TMK Tando Muhammad Khan ToR Terms of Reference UC Union Council UNICEF United Nations Children's Fund WASH Water, Sanitation and Hygiene WFP World Food Programme WINS Women and Children/Infant Improved Nutrition in Sindh WMC Water Management Committee iv | P a g e List of Figures Figure 1: Alisa Khan in Shereen Village, Bannu, a nutrition beneficiary ................................................. 6 Figure 2: Discussions in CCG beneficiary in Barakzai, Bannu .................................................................. 6 Figure 3: ACF Hygiene Related Messages ............................................................................................. 10 Figure 4: ACF Feedback and Complaint Mechanism ............................................................................. 11 Figure 5: Beneficiary Data on Usefulness of Action .............................................................................. 12 Figure 6: Chulli Filter in Use (L). Water cooler is used for storing filtered drinking water (R). ............. 12 Figure 7: Hygiene Messages Displaced in Sindh / A well maintained toilet in Sindh ........................... 15 Figure 8: CfW beneficiaries in front of the road they rehabilitated ..................................................... 16 Figure 9: People Perception about Timeliness of ACF Support ............................................................ 18 Figure 10: Effectiveness of Hygiene Messages ..................................................................................... 20 Figure 11: People Perception about Effectiveness of ACF Nutrition and WASH Activities .................. 21 Figure 12: Effectiveness of Water Interventions. ................................................................................. 22 Figure 13: A latrine not in used in Sindh. .............................................................................................. 23 Figure 14: Recording keeping by community for nutrition activities ................................................... 26 Figure 15: Discussions with Vulnerable IDPs to Know About Selection Process for CCG. .................... 29 Figure 16: Discussions with ACF beneficiaries in KP and Sindh ............................................................ 31 Figure 17: KII in KP with DoH and in Sindh with Nutrition team .......................................................... 33 List of Tables Table 1: Planned Activities per Result ..................................................................................................... 1 Table 2: Planned vs Actual Villages Covered for the Exercise................................................................. 4 Table 3: Type of Focus Group Discussions .............................................................................................. 5 Table 4: Number of Participants in Focus Group Discussions ................................................................ 5 Table 5: Household Questionnaire Disaggregated Data ......................................................................... 6 Table 6: List of Visited Villages in All the Household Questionnaire Disaggregated Data ...................... 7 v | P a g e Executive Summary Background to the Project and Evaluation: Pakistan is facing a nutrition emergency with Sindh being the worst affected area of the country (National Nutrition Survey 2011). The nutrition situation has become a crisis after the unrelenting cycle of disasters hit Sindh since 2010. Floods and draughts have taken the already fragile state of the population into a state of nutrition emergency. After the influx of over a million Internally Displaced Persons (IDPs) for North Waziristan Agency (NWA) with a deteriorating nutrition status affecting women and children, ACF extended its nutrition project to cater
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