UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Location (State/County/Payam/etc): Unity/Rubkona/Nhialdiu
Date of the Mission: 16-25 October 2014
1 Name & Title of Kibrom Tesfaselassie - Nutrition Specialist UNICEF Team Leader
2 Names & Titles (with 1. Elizabeth Mukheb, Child protection UNIDO – Tel No. 0927328405; [email protected] org/depart/section) 2. Hari Vinathan, Nutrition Consultant, UNICEF - Tel no. 0955492068; [email protected] of other members of 3. Luel Deng, Education officer, UNICEF - Tel no. 0955158685; [email protected] 4. Okwera Joseph Okot, Health consultant - Tel no. 0959001482; [email protected] the team 5. Paul Okullu, WASH officer, International Aids Services (IAS), Tel no. 0955963274
3 Sites visited Nhialdiu HQ, Nhialdiu payam, Rubkona County, Unity State GPS; virtually centre of Nhial-Diu:- Latitude : N 09001’19.91’’ Longitude : E 029040’45.44’’ Altitude : 428.4m Information and Data collected
4 General General information about the mission site Information Number of registered people: 40,000 based on WFP verification process for previously given registration card last July.
Number of households: over 14,000 including IDPs
Total number of children under five (if available): Not Applicable as there was no new registration.
Total number of children under 18 years (if available): NA
Humanitarian situation and needs (IDPs, last time they received support, who is in control of the area etc.): Nhialdiu is a Payam of Rubkona County consisting of 16 Bomas southwest of Bentiu town approximately 40 km away. As per WFP, this mission covers four/five Payams including IDPs, with a total of population above 40,000. Although the current security situation is relatively calm and the population seems relaxed, they are always taking precautions.
Basic social services such as health, education and others have not been operational since the crisis broke out in Nhialdiu town which is highly populated by the IDPs from Mayom, Pariang and Bentiu. Since the start of the crisis the PHCC and schools have been closed and there has been a lack of essential drugs/medical equipment and learning/teaching materials.
The community is fully dependant on livestock and traditional fishing to support their families. Generally, there are no service providers or any humanitarian interventions; that is why WFP/UNICEF organized a second mission to the same location and beneficiaries. The first RRM mission was conducted in July 2014 and over 37,000 beneficiaries were registered. However, the WFP mission was disrupted during
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
distribution.
Currently, the area is flooded and movement is greatly hampered by water especially for children who could not cross deep water to reach the verification site. Because of this, only 2,275 (out of above 7,000 target children 6-59 months) were able to come and benefit from UNICEF interventions.
Immediate Response Provided and Follow up Actions
5 Nutrition Provide a brief situation analysis and list down the critical humanitarian needs related to Nutrition
Situation Overview Nutrition services such as outpatient therapeutic programmes (OTPs), targeted supplementary feeding and Humanitarian programmes (TSFPs) and infant and young child feeding (IYCF) counselling have not been operating in needs: Nhialdiu. In the PHCC, there is a lack of nutrition supplies, anthropometric equipment, office furniture and stationery. However, the PHCC infrastructure and human capacity of local nutrition workers are in place. Non-appearance of nutrition partners in the ground has also negative impact to nutrition situation in the area.
Nhialdiu and other Payams’ community depend mainly on livestock and the nutrition situation is currently serious as per WHO classification thresholds for rates of global acute malnutrition (GAM). According to proxy indicator of MUAC measurement 78 (3.4 per cent) and 188 (8.3 per cent) severely and moderately children were identified respectively from a total of 2,275 children screened. See the table below. Moreover, the nutrition situation of pregnant and lactating mothers is critical with 20.8 per cent GAM which 5.7 per cent is severe based on the assessment conducted using MUAC measurement. This high level of under-nutrition can be justified that the inadequate household food resources are being prioritized to husband and elder children, while mothers eat less and young children are also being fed with breast milk for longer period without complementary foods.
Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: Response/Results during RRM: 1. MUAC screening for malnourished children and PLW
1.1 A total of 2,275 children 6 – 59 months were screened for malnutrition using MUAC tape; among these 78 children (3.4%) and 188 children (8.3%) were found with SAM and MAM respectively. All SAM children newly identified are admitted in OTP site revitalized within Nhialdiu PHCC. See table below for details of screening result:
Rate using MUAC M F Total MUAC only (%) Oedema (SAM) 0 0 0 <11.5cm (SAM) 45 33 78 SAM 3.4% >11.5 - <12.5cm (MAM) 95 93 188 MAM 8.3% >12.5 (Normal) 1038 971 2009 Total 1178 1097 2275
1.2 Total of 1,149 pregnant and breastfeeding mothers were screened using MUAC. See table below.
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Pregnant breastfeeding Rate by MUAC MUAC Mothers mothers Total (%) <21.0cm (SAM) 22 44 66 5.7% (SAM) >18.0 - <21.0cm (MAM) 84 90 174 15.1% (MAM) >21.0 (Normal) 251 658 909 Total 357 792 1,149
2. 2,188 children 6-59 months (1,131 male and 1057 female) were supplemented with Vitamin A. 3. 1,765 children 12-59 months (917 male and 848 female) received deworming tablets. 4. IYCF key messages were conveyed in the local language to the whole population focusing for above 2,188 pregnant, breastfeeding mothers and mothers with children under 5.
Data against the following indicators and mention the source of information in the end 2,275 # of children 6-59 months screened for acute malnutrition via the RRM 78 # of SAM cases detected 188 # of MAM cases detected 78 # of children 6-59 months admitted to a SAM management programme 0 # of MAM cases 6-59 months referred for treatment 1,458 # of PLW access IYCF messaging 2,188 # of children reached 6-59 months reached with Vitamin A 1,765 # of children 12-59 months reached with deworming medication Source of information: Tally Sheets
Follow up Actions What key actions are required and by whom? required: Provide necessary support to sustain the OTP, TSFP and IYCF projects in Nhialdiu PHCC run by Local Health Workers who are working volunteers. Periodic monitoring/supervising and supplying nutrition items (therapeutic food and equipment) when needed from UNICEF. Recommended follow up visit is three months later – Mid January 2015.
6 Health Provide a brief situation analysis and list down the critical humanitarian needs related to Health
Situation Overview Since the first RRM mission in July 2014, access and provision of health care services remained and Humanitarian hindered and the population in Nhialdiu have not been accessing health care services. Below are health needs: related needing to be addressed :- . Though masles vaccination was done during the July 2014 RRM mission, cases of measles are still been reported. . There were high numbers of cases of Malaria in the OPD attendance during the RRM OPD consultations. . Inadequate drugs and medical supplies in Nhialdiu health centre. . Medical equipment and furniture in Nhialdiu health centre were all looted in July. . Reproductive health and emergency obstetric cases remains challenging and need to be addressed. There were also no ANC services provided in Nhialdiu health centre. . Limit numbers of skilled and trained middle cadre health personnel in Nhialdiu Health centre to provide health care services.
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: CARE international in remote management has sent drugs supplies to Nhialdiu health centre, this made it possible to allow the Nhiladiu health centre to re-open since it closure in July. The County Health Department were supportive to mobilize the Nhalidiu facility health workers to resume work. UNICEF supplied the Nhalidiu health centre with PHCU kit.
OPD consultations made during RRM mission between 20 and 25 October 2014.
Under 5 year Consultations Male 119 Under 5 year Consultations Female 137 Over 5 year consultations Male 204 Over 5 year consultations Female 373 Total 833
The top three leading morbidity cases includes: Malaria, Pneumonia and Acute Watery Diarrhoea. However, Malaria remains the top leading morbidity. It was observed that Nhialdiu area is flooded, providing space for mosquitoes to bread. Some families are not consistently using/sleeping mosquito nets and this could be the possible reason making Malaria the leading cause of morbidity.
Vaccination was conducted during the July 2014 RRM mission but still cases of Measles have been reported. The county surveillance focal person continues to collect data though the data remains confined in the Nhalidiu health centre.
Despite the above achievements made, the fighting in July greatly affected the Nhiladiu PHCC. Drugs, medical equipment and supplies were completely looted. This has led to closure of the facility from July to September 2014, though CARE and UNICEF have provided drugs to the Nhialdiu health centre. However, EPI and reproductive health services remain major concerns to be addressed as CARE International is in Rubkona there is need for CARE to scale up and extend its full operation in Nhialdiu.
The patient referral system is another concern to be addressed as there is no referral in place, therefore, due to poor linkage and distance between Koch and Leer county – the health facilities where most of the severe cases could be referred – are too far as Koch is two days walk and Leer about four to five days.
Provide data against the following indicators and mention the source of information in the end N/A # of children 6m-15 years vaccinated against measles N/A # of children under 15 vaccinated against polio 2160 # of households reached with at least 1 ITN 256 (119 M & 137 F) # of consultations for children under 5 *source of information: OPD register (<5 & >5 Registers) and LLTN distribution sheet. Follow up Actions What key actions are required and by whom? required: Drugs and medical supplies, preferably delivery of supplies to be done on monthly basis. EPI outreach to Nhialdiu since case of suspected measles been reported. Comprehensive facility assessment in Nhialdiu PHCC to identify the health situation and strengthen health system and quality health service
7 WASH Provide a brief situation analysis and list down the critical humanitarian needs related to WAHS
Situation Overview One latrine in the PHCC, no more latrines around. and Humanitarian Total of 25 broken boreholes Page 4 of 13
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Rapid Response Team Report
needs: 70% of people in Nhialdiu get water from boreholes while 30% get their water from the river. Women and girls feel safe with access to water from boreholes but those women who collect water direct from the river don’t feel safe because the water is untreated.
Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: A total of 3 boreholes were rehabilitated during the period of RRM. WASH supplies (Bucket/jerry cans, Water floc/disinfectant and Soap) distributed to severely and moderately malnourished children and pregnant/lactating mothers and mothers with children under five years old.
Provide data against the following indicators and mention the source of information in the end NA # of people reached with hygiene promotion messages to be shared with their community 1,500 # of people provided with sustained access to safe water supply (at least agreed emergency standards of 7.5L) 1,200 # of people provided with WASH supplies source of information: Distribution sheet Follow up What key actions are required and by whom? Actions required As spare parts and standard and special WASH tools were given by UNICEF to County WASH Coordinators, the remaining boreholes will be repaired by local exiting capacity under supervision of County WASH Coordinators. The implementation this maintenance will be followed up by International Aid Services (IAS) through telephone call (Thuraya).
8 Child Protection Provide a brief situation analysis and list down the critical humanitarian needs related to CP
Situation Overview Nhialdiu is a Payam in Rubkona county southwest of Bentiu town, approximately 45 km away. The and Humanitarian current security situation is relatively calm and population seem relaxed, though they always taking needs: precautions. The estimated population of host community and IDPs is 40,000. Generally, there are no service providers - either child protection or any other humanitarian interventions. The area is flooded and movement is greatly hampered by water especially children who could not cross deep water to reach the verification site.
The critical humanitarian needs related to child protection are as
i) Cases of missing children who needs to be traced from various places in South Sudan and Sudan ii) Separated and Unaccompanied children whose parents are to be traced for reunification iii) No recreational place or activities for children as well as youths iv) Girls at risk of early / forced marriages v) Gender Based Violence is common especially with intimate partners (held discussion with 6 individuals 3 female and 3 men differently). vi) Early and forced marriages are common, from the discussion; it was revealed that some of the children are not sent to school, especially girls who are normally married off at early ages. vii) Discussion with girls revealed that some of girls even before the crisis were not attending school, the crises only worsened the situation now that school were closed. There is need to create awareness on girl child education.
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Rapid Response Team Report
Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: Child protection managed to make interventions through i. Setting up of a child friendly space at the Nhialdiu primary school (volleyball and football pitch) with a high number of attendance ii. Identified 20 separated and unaccompanied children, 10 missing children (due to floods children could not make it to the verification sites) iii. One recreational kit and 10 ECD kits provided to the child friendly space under the care of one child protection volunteer iv. A total of 372 (213 boys and 159 girls) children reached with protection services through child friendly space and at the verification site where children were able to play while waiting for their parents to be attended to.
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Provide data against the following indicators and mention the source of information in the end Est. 20,000 # of people reached with lifesaving information/awareness sessions 20 Separated / # of registered UASC receiving FTR services and family-based care/appropriate Unaccompanied alternative care services children 10 missing children 213 boys and 159 girls # of children reached with critical child protection services source of information: UNIDO/UNICEF RRM Follow up Actions What key actions are required and by whom? required: Family tracing and reunification for separated / unaccompanied and missing children There is a need to strengthen community networks to protect children - UNICEF / UNIDO There in need to provide first aid psychosocial support to distressed children who have lived in crisis through establishing of child friendly spaces – UNICEF / UNIDO Awareness with lifesaving messages to be disseminated in the community to protect their children GBV interventions very much required by UNICEF / UNIDO
9 Education A brief situation analysis and list down the critical humanitarian needs related to Education
Situation Overview The purpose of the mission was to reactivate the education network, community mobilization, carrying and Humanitarian an education needs assessment, distribution of education emergency supplies and to start launching needs: education emergency activities.
Situation Analysis and critical humanitarian needs: : Nhialdiu is the headquarters of Nhialdiu payam in the southern part of Rubkona County inhabited by Nuer and hosting thousands of Dinka IDPs displaced from Pariang County. Since December 13, Nhialdiu has been a contested/disputed area and seriously affected by the crisis including the current flooding. It comprised of 16 bomas according to local authority. This remote part of the Ccunty is highly populated by the IDPs from Bentiu, Pariang and Mayom.
The current crisis has affected the education system in Rubkona County. All primary schools in Nhialdiu payam have been closed since December 2013 due to the fighting and lack of learning and teaching materials. Most of the schools materials were destroyed and looted including school furniture. It has also
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report been noted or observed that 98% of regular teachers are present in the Payam.
During the rapid education needs assessment, the following were the critical education/humanitarian needs:
Basic needs (food, water, health, shelter and education) Teaching and learning materials including textbooks Teachers’ support including trainings to support children affected by the crisis Temporary Learning Spaces to accommodate 2, 000 affected children Adolescent life skills training and peer education in three hub centres Establish coordination system and Community base mobilization for reopening of all affected primary schools
Field Mission Objective
To advocate for reopening of primary schools including ECD Assess education needs and ensure protective and safe learning centers established linked with WASH facilities. Deliver and distribute education in emergency supplies to affected and registered children Mobilize and register existing teachers and conduct teacher orientations/refresher training on EiE, teacher code of code, Professional Standard for teachers, Distribution plan, and Content of EiE kits. Establish active PTAs and conduct refresher training on their roles and responsibilities. Mobilize 2013 primary eight candidates
Main findings:
12 primary schools in Nhaildiu payam were closed since Dec 13. A total of 4, 077 (1, 023 girls & 3, 054 boys) school age children have missed the two terms (Feb – May & June – September) for new academic year 2014 (source of data: County Education Department) The situation facing children and women continues to be very challenging due to the crisis and flooding. Education system is in place and functional headed by Chairperson for General Education and Director General for all SPLA IO control areas with their headquarters based in Nhialdiu. Education materials were looted including school furniture (desks and benches). Children are sitting on floor. Nhialdiu primary school is a permanent school with 8 classrooms, 5 offices and 1 store. The school needs renovation including old permanent latrines. 2 blocksof temporary latrines collapsed. No latrines for children in the schools Schools have boreholes. Children are drinking safe and clean water No schools occupation was reported or observed during rapid education needs assessment. No Education Cluster partner on ground to support education emergency activities. Most of teachers are scattered Community leaders including County Commissioner are willing to support education activities including social mobilization and reopening of schools
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: Community based mobilization, meetings, education needs assessment and enrolment Three meetings with local authorities and education officials were held. Community mobilization was energized upon the discussions and information gleaned from education planning meetings with local authority and education department. Meeting with parents, community leaders and chiefs were very helpful to start children mobilization and reopening of primary schools Six (6) out of 12 existing primary schools were mobilized, assessed and reopened in Nhaildiu payam on 20/10/2014
ECD (3-6yrs)children in class with intensive children teaching centred method building up corns 2, 520 (718 girls & 1, 802 boys) children mobilized and enrolled in six (6) primary schools.
The first opening day since Dec 13. Pupils at parade and attending lesson on 20/10/2014 the first day of their school in Nhialdiu primary school
31 (4 girls & 24 boys) 2013 primary eight (8) candidates were mobilized and registered. Revision class commenced on 22nd Oct 14.
Education Officials, Teachers, PTAs and refresher trainings 66 (2 Females & 64 Males) primary school teachers including 15 male volunteers were mobilized and attended a refresher training course on 22 October 2014 on how to support EiE activities, lifesaving messages, professional standards for teachers, teacher code of conduct, content of EiE supplies, and distribution plan. The capacity building for teachers are required in order to improve their ability of teaching and handling pupils during the emergencies. The teachers’ code of conduct handout were distribute to six primary schools.
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Rapid Response Team Report
Teachers fresher training on teachers’ code of conduct, psychosocial support, and EiEs including supply distribution plan in Nhialdiu Primary School on 22/10/2014
66 (42 females & 22 males) active PTAs in five primary schools (Nhialdiu, Nyewal, Waak, Bieel, Bormalual and Rubnyagai) were mobilized and attended refresher training on their roles and responsibilities to support teachers on the management of existing schools. Parent Teacher Associations (PTAs) were involved in day to day schools activities so as to monitor progress of their children during the emergency.
Picture of PTAs after attending refresher training on their roles and responsibilities in Nhialdiu primary school
Distribution of EiE supplies 216 (83 girls & 133 boys) school age children benefited from education emergency supplies in Nhaildiu Primary School including ECD (3-6 year old) children. The education emergency supplies distributed to end-users included 3 school-in-a box, 6 recreation kits, 1 blackboard (5 pieces) and 2 rolls of tarpaulins.
Adolescent and youths engagement in sport in the school As a part of integrated response with child protection, over 100 youths including young children have been engaged in the school with different sport activities.
Youths and young children playing after the school.
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UNICEF SOUTH SUDAN COUNTRY OFFICE
Rapid Response Team Report
Challenges and Observations Lack of teaching and learning materials (textbooks): 2, 304 (635 girls & 1, 669 boys) including ECD children have not received education emergency supplies. Teachers’ support to deliver quality education including trainings Lack of school feeding for pupils Lack of learning spaces as the number displaced children are increasing No school furniture in the school including no chairs for teachers No latrines in the schools. Existing latrines collapsed 2013 primary eight candidates did not sit there exams Number of young children are not able to come to school due to flooding. Number of children are traumatized and need to be supported Education system is in place need to be supported and strengthened.
Provide data against the following indicators and mention the source of information in the end 368 (112 girls & 256 boys) # of pre-school children (aged 3-6) with access to play and early learning, including supplies 2, 152 (606 girls & 1, 546 # of school-aged children including adolescents (aged 7-18) with access to boys) Education in Emergencies, including supplies 66 (2 females & 64 males) # of teachers trained to provide Education in Emergencies 66 (42 females & 22 # of other education personnel and Parent-Teacher Association members trained to Males) support Education in Emergencies 0 # of classrooms established/rehabilitated source of information: County Education Department Follow up Actions What key actions are required and by whom? required County Education Department (Director) will provide weekly or monthly report to UNICEF using Thuraya UNICEF will follow up with County Education Director for distribution of 10 school in a box to five primary schools support 400 children. Follow up with P8 examination for 31 candidates in Nhialdiu UNICEF will follow up with County Education department for social mobilization for reopening of six primary schools
Additional Information collected from the mission
10 Limitations of the Flooding has severely hampered flow of population particularly children under 5 to UNICEF mission intervention site. Hence, only about 30 per-cent of children arrived to the site from target number of children under 5
Absence of partners in the ground compromised the sustainability of the projects and quality services provision.
It was very difficult to reach some of affected primary schools due to fear and flooding. County education authority was seriously engaged and tasked to reach and assess the nearby schools and mobilize teachers and community for reopening of the schools. No education partner on ground to support the local authority for assessing and reopening of other remaining primary schools. This has an impact on education activities in the area.
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Rapid Response Team Report
11 Recommendations Health (specific) A comprehensive health facility assessment to be conducted in Nhalidiu PHCC to identify the health situation and strengthen the health system and quality health service provision.
Education Provision of teaching and learning materials include textbooks to support 2, 304 children enrolled in the schools.
Additional TLSs to support and accommodate 2, 000 host and displaced children from Mayom, Pariang and Bentiu.
Incentives for teachers.
Provision of sanitary kits for upper class girls.
Provision of school furniture (During dry season when security is stable)
WASH in the schools – building latrines and carrying hygiene and sanitation in the schools,
WTI to launch GESS program to support upper class girls in Nhialdiu
12 Lessons Learned The local capacity in all progamme cluster is available and all County progamme coordinators are also committed to sustain the progammre as long as they are supported and equipped with necessary and adequate supplies.
Currently, no partner present in the areas to provide technical support, guidance and follow up are needed to ensure quality education in the TLSs and timely completion of the Sybille’s.
Education Emergency Supplies were very limited.
Local authority and community are very supportive and willing to see that their children are in school despite difficulties of the crisis and flooding,
Teachers are willing to teach despite lack of pay 13 Suggested follow-up In one month – November 2014. mission: date
Supplies distributed:
Total # MT supplied by air: 7.34
Item Quantity Consignee/Beneficiary Remarks
Education and CP Supplies distributed ECD kit 10 boxes Education Director General Unity The supplies reached to the end State/school children users - children in the CFSs. Page 12 of 13
School in a Box 3 boxes Education Director General Unity The supplies reached to the end State/school children users - school children. Recreational kits 6 boxes Education Director General Unity The supplies reached to the end State/school children users - school children. Black board 1 set (5 each) Education Director General Unity The supplies reached to the end State/school children users - school children. Tarpaulins (plastic sheets) 2 rolls Education Director General Unity The supplies reached to the end State/school children users - school children. Health supplies distributed PHCU kit One kit Nhialdiu Payam Health Delivered in good condition to end supervisor/children U5 beneficiaries Mosquito net 2160 pcs Nhialdiu Payam Health Delivered in good condition to end supervisor/children U5 beneficiaries Plastic chair 5 pcs Nhialdiu Payam Health supervisor Delivered in good condition to end beneficiaries Plastic table 2 pcs Nhialdiu Payam Health supervisor Delivered in good condition to end beneficiaries WASH supplies distributed Soap (800 gm) 40 cartons WASH coordinator County Delivered in good condition to Rubkona. mothers with SAM and MAM children and PLW. Water Floc/disinfectant 440 cartons WASH coordinator County Delivered in good condition to Rubkona. mothers with SAM and MAM children and PLW. Buckets of 20 litres 600 each WASH coordinator County Delivered in good condition to Rubkona. mothers with SAM and MAM children and PLW. Collapsible Jerry-cans 120 pcs WASH coordinator County Delivered in good condition to Rubkona. mothers with SAM and MAM children and PLW. Hand-pump MKII spare part 25 set WASH coordinator County Delivered in good condition to Rubkona. WASH coordinator. Hand-pump tool kit 1 kit WASH coordinator County Delivered in good condition to Rubkona. WASH coordinator. Hand pump special tool kit 1 kit WASH coordinator County Delivered in good condition to Rubkona. WASH coordinator. Nutrition Supplies distributed RUTF (therapeutic food) 200 cartons Nhialdiu Payam Health Delivered in good condition to supervisor/children U5 SAM children. F-75 1 carton Nhialdiu Payam Health Delivered in good condition and supervisor/children U5 will be used when SC is established or when needed. Amoxicillin syrup 300 bottles Nhialdiu Payam Health Delivered in good condition to supervisor/children U5 SAM children. Height measuring board for child 1 set (2 pcs) Nhialdiu Payam Health Delivered in good condition and supervisor/children U5 used by Nutrition Officer in Nhialdiu.. *Remarks on the quality, package, visibility, and any other comment
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