MARCH BULLETIN 2017 Nutrition Situation and Response in Former State

In this issue:

1. Situation Overview 1. Situation Overview 2. Response The February 2017 IPC estimated that 4.9 million (41.7 a) Gap analysis and increasing geographical %) of the total population were estimated to be food in- coverage of responses secure (IPC 3, 4 and 5) between February and April with b) Types of nutrition being implemented and 100,000 people facing famine (IPC 5) in two counties of scaled up Leer and Mayandit. Two other counties-Kouch and Panyi- c) Emergency Nutrition response mecha- jar were classified as IPC 4 implying that were at the tip- nisms being implemented ping point to IPC 5 if responses won't be scaled up. The d) Emergency Nutrition response mecha- food insecurity situation was expected to worsen be- nisms being implemented tween May and July during which the food insecure pop- e) Funding status for implementation of re- ulation was estimated to increase to 5.5 million (46.7%) sponse in the four counties of the population. 3. Capacity building 4. Coordination Following the release of the IPC in February 2017 that 5. Challenges declared famine-IPC 5 in two counties, the nutrition clus- 6. Key Messages ter has been closely monitoring the evolving nutrition situation in those counties. The monitoring involved i) conducting SMART surveys in three counties (Panyijar, lected sites below. The decreasing admissions trend was Leer and Kouch) to provide benchmark information for associated with the combination of the on-going GFD, monitoring of the planned and on-going nutrition re- OTP and TSFP interventions implemented by partners. sponses and ii) Weekly reports of new SAM and MAM Despite the decrease in weekly admission in Panyijiar admissions were also initiated in the beginning of March during March, the overall number of admissions in 2017. March was higher than those reported in February; part- ly due to an increased number of operational sites.

The graph below depicts an increasing trend in MAM admission in an average of nine TSFP sites in three months. A SMART survey conducted (2 weeks after famine decla- ration) in Panyijar reported critical nutrition situation with GAM and SAM of 16.0 and 3.5 percent respectively. Crude and under-five mortality rates were normal com- pared to Sphere and international emergency thresh- olds. When compared with SMART survey results con- ducted during same period in April 2016, there was no significant difference in MUAC, GAM and SAM preva- lence, crude and under-five mortality levels. SMART survey in Kouch was being conducted by end of March whose results will be reported in the April bulletin. Leer survey was delayed due to access and security con- During the month of March, over all 2,926 SAM and 5460 cerns, however, it is expected to be conducted in the MAM children and were newly admitted in Unity state. 3rd week of April.

Weekly new SAM and MAM admissions in the four coun- ties during the month of March indicated a decreasing trend towards the end of the month. See graphs in se- Program Updates Response overview

In Leer county, SAM and MAM new admissions dropped b) Types of nutrition services being imple- during the 5th week of March. mented and scaled up: The nutrition cluster dis- cussed and agreed with partners to implement and strengthen the existing curative (SAM and MAM) and pre- ventive interventions. The preventive nutrition interven- tions included IYCF in mother to mother support groups, micronutrient supplementation, deworming and Blanket Supplementary feeding programme (BSFP). Following the famine declaration, WFP scaled up BSFP response to be implemented in the TSFP sites. The aim was to increase BSFP coverage and ensure continuity of BSFP responses in- between general food distributions (GFD) rounds in three counties of Leer, Mayandit and Panyijar. By the end of SAM and MAM caseload and targets revisions: March, Medair had started implementing BSFP in 6 of the 13 sites planned in Leer. This measure complements BSFP Following the release of the February IPC, SAM and MAM responses implemented along with GFD covering all the caseload and targets were revised. SAM and MAM targets counties in former Unity State. increased two to four folds in Leer and Panyijar counties. Apart from the deterioration of food security and nutrition Moreover, partners expressed commitment to implement situation, the increase was partly associated with use of integrated Community Case Management (iCCM) in their MUAC screening data in projecting revised caseload in- operational sites. Where it was not possible to implement stead of WHZ-score; since there was no such information the entire iCCM package, a minimum of screening and during the IPC process. Mayandit nutrition survey data was treatment of malaria among under-five children presenting recent (January 2017) and therefore there were no changes with SAM will be done. By the end of March, two partners in caseload and targets for both SAM and MAM. (Medair and IRC) were implementing iCCM in their opera- tional areas in Leer and Panyijar counties respectively.

2. Response In order to increase coverage and ensure that all SAM and a) Gap analysis and increasing geographical MAM children are immediately enrolled in the selective coverage of responses: Before the nutrition respons- feeding programme, mass screening was agreed on as es were scaled up, a coverage gap analysis was conduct- initial response strategy. In view of this, house to house ed. The gap analysis focused i) on the number of sites that mass screening was planned to be conducted once per were operational before the famine was declared ii) sites month involving all under-five children in each partner’s that would open as part of scale up and iii) timeline for respective areas. By the end of March partners reported to opening of sites. As of 22-25th February when the gap have conducted mass screening in their respective sites. analysis was conducted for the first time, 37 OTP, one Sta- bilization Centre SC) and 41 TSFP sites were operational in Project monitoring frequency increased by partners from the four counties. More than half of those sites were in Pa- monthly during pre-famine period to weekly basis in order nyijar County. As a result of scale up in the four counties, to improve quality of nutrition services. This will be as- by the end of March, the number of operational OTP sites sessed in April as to what extent has it been implemented. increased from 37 to 52 sites; SC increased from 1 to 3 and TSFP sites increased from 41 to 46. In terms of capacity, partners scaled up their respective human resources capacities in the four counties in different However, a considerable gap of 23, 24 and 5 OTP, TSFP ways. These included: relocating staff to Unity from other and SC sites respectively still existed partly due to insecu- locations, surge capacity, seconding technical and recruit- rity and access particularly in Leer, Mayandit and Kouch. ment of additional staff. These measures were taken to Important to note is that there was still no SC services in cope with the increased number of operational sites to be Leer and Mayandit counties due the reasons explained opened and high demand for quality improvement in all above. SCI had agreed to support Nile Hope in establish- nutrition sites. ing at least one SC in Leer County. A mission involving Concern, Nile Hope and SCI was conducted in Leer to esti- mate the SAM beneficiaries that would be enrolled in the c) Supplies: By end the of March there was no report- SC and identify locations. A decision was expected to be ed supply shortage for SAM and MAM management in for- made mid-April. Population movement and opening of new mer unity state particularly in the most affected four coun- sites while maintaining the vacated sites also explain the ties. Sporadic site level shortage were reported in Panyijar reasons why the gap still exists despite the increase in County for RUTF and RUSF due to delayed submission of number of new sites that have resumed nutrition services supply replenishment requests. In order to prevent or opened up.

Program Updates Response overview

interruption of nutrition services associated with late deliv- 17,501 pregnant and lactating women received key IYCF ery of nutrition supplies, the ICWG and logistic cluster pri- messages. All pregnant and lactating mothers and vulnera- oritized delivery of nutrition, health, WASH and FSL sup- ble households, i.e. households containing children and/or plies. women with low nutritional status, benefitted from distribu- tion of NFI kits. However, the stock status of supplies at nutrition site level was not easy to establish. In view of this, the nutrition clus- With respect to the routine program the total of 2926 SAM ter in consultation with WFP and UNICEF and all partners and 5460 MAM children were newly admitted in selective introduced a monthly site level stock status tracking tool. feeding programs(OTP,TSFP). Due to the significant differ- The RUTF and RUSF supplies tracking tool will be complet- ence in numbers of OTP and TSFP sites reporting, compari- ed by partners and submitted to the cluster latest on 15th son of total admissions can only be made between Febru- of subsequent months. The report will be summarized and ary and March that had relatively similar numbers of re- reported to all partners once per month. porting sites. Based on this we can conclude that OTP and TSFP admissions in Unity increased by 14.3% and 25% re- Due to the increased SAM and MAM caseload and targets spectively. mentioned earlier, supply requirements for Unity in par- ticular in two of the four counties increased two to four times between January and February 2017. In order to fill the gaps, additional supplies were to be procured by UNICEF and WFP by traditional donors (DFID, FFP/OFDA, ECHO). Additional supplies were funded by CERF to re- plenish supplies allocated to ICWG-RRM coordinated by OCHA. Other donors (FFP, DFID, and ECHO) have also in- creased its support in filling the supply and funding gap. d) Emergency Nutrition response mechanisms being implemented: A number of responses mechanisms is used in emergency The survival kits response mechanism that has been inte- interventions in . These are i) Static/ grated with the ICRM were not implemented in March due outreaches, ii) UNICEF/WFP Rapid Response Mechanisms to security and access challenges in the proposed loca- (RRMs), iii) ERT/MET, iv) survival kits and v) Inter-cluster tions. The ICRM/survival kits response were expected to Rapid Response Mechanisms- ICRM-RRM). The ICRM was be implemented from first/second week of April. devised by the ICWG under the coordination of OCHA to complement the WFP/UNICEF RRMs given that there were a number of sites that needed RRM response mechanisms e) Funding status for implementation of response in by then. the four counties: By the end of March 2017, most of the OTP and TSFP sites in were being supported through static/ The nutrition cluster compiled the funding status (available outreaches. In Leer and Kouch it was a mix of static/ resources and funding gaps) of partners operational in for- outreaches and UNICEF/WFP RRMs. In Mayandit county mer Unity State during the first and second week of March. only UNICEF/WFP RRMs were implemented due to access Out of the 11 partners, only one was adequately funded to and security challenges. implement planned scale up of nutrition services. Partners’ frontline funding status in the four counties (Mayandit, During the first quarter 2017 (Jan – Mar), 12 UNICEF/WFP Kouch, Leer and Panyijar) was 47.5% with a gap of US$ 7.5 RRM missions were conducted in Unity State (Nyal, Kol, million excluding WFP supplies. For the entire former Uni- Mayom in Panyja County; Koch town, Buaw DinDin, Bouh, ty State, the funding status dropped to 29.5 % with a fund- Bieh in Koch County; Leer, Pedeah in Leer Couny and ing gap of US$ 9.6 million. Rubkai in Mayendit County). Most partners were having bilateral discussions with vari- Overall, a total of 22,532 children were screened during ous donors including OFDA, RRM, ECHO and DFID to fill the 12 missions and 497 (2.2%) identified as SAM and 1,619 the funding gaps. The Unity partners funding status will be (7.2%) MAM. Similarly, MUAC screening of pregnant and updated in April. However, most of the nutrition cluster lactating women revealed that 1,088 (16.0%) women partners operational in former Unity State were prioritized screened were at nutritional risk with MUAC <23cm from a to access SSHF first standard allocation in 2017 in March. total of 6,782 pregnant and lactating women screened. Be- However, three partners (SP, Concern and Medair) did not sides, a total of 10,271 children of age group 6-59 months apply. The SSHF funding injection in March 2017 age were supplemented with Vitamin A and 7,607 children of age group 12-59 months age were dewormed. A total of Program Updates

significantly alleviated the funding gaps by 25 to 100 per- up and risk of looting and theft of supplies in insecure are- cent of six Unity State partners’ frontline costs; excluding as. Lastly, timely scale up and implementation of integrat- WFP supplies funding gap. ed responses in some of nutrition sites was still lagging behind due to organizational and delayed funding chal- 3. Capacity building: lenges among some of the partners.

Given the scale up that is associated with relocation and 6. Key messages: recruitment of additional staff, capacity building of staff was critical. In view of this, the nutrition cluster coordina- Insecurity/access be sorted out urgently for timely scale tion team requested the CMAM TWG technical team up of responses in Leer, Mayandit and Kouch counties to (MOH, UNICEF, WFP, SCI and HFP) to prioritize conduct- increase coverage and fill response gaps that still exist ing CMAM training of former Unity State partners using the new guideline. The request was accepted. The train- Integration of nutrition of health/WASH/FSL is key in treat- ing was scheduled to be conducted mid-April. UNICEF ment of acute malnutrition. All these sectors need to be confirmed to the cluster that technical support on IYCF is adequately funded. also needed. SMART training for survey managers to be implemented by ACF-regional office in Nairobi was Implementation of BSFP in TSFP sites is a step in ensuring scheduled in May 2017 that will also include the rest of continued access to BSFP services that will lead to overall partners in the country. reduction in acute malnutrition in those counties.

4. Coordination: Prioritized delivery of nutrition responses supplies and human resources was very critical for timely implementa- Following the famine declaration, Unity partners coordi- tion and avoidance of service interruption. nation meetings are held on weekly basis. The Unity part- ners coordination meeting are held in Juba due to insecu- Coordinated responses and assessments by the nutrition rity, access and geographical challenges in partners op- cluster has prevented overlap and competitions, given erational areas. increased number of partners that were interested to im- plement nutrition responses in former Unity State coun- The meetings are coordinated by the nutrition cluster ties. coordination team at national level. The unity partners weekly coordination forum is tasked to review the ongo- ing responses, update the gap analysis and mobilize re- sources and advocate for adequate funding. Other roles include ensuring quality services are implemented in all sites and sharing experience and best practices on the implementation of nutrition responses. For example, im- Cluster Coordinator plementation of the iCCM in Panyijar and Leer by IRC and Isaack Manyama Medair respectively, keeping in loop the state level clus- Contacts ssnutritioncluster.coordinator ter focal points. @gmail.com Cell No: +211-956-105815 In order to strengthen coordination, improve monitoring and provide technical support to partners implementing Cluster Co-Coordinator Cluster Deputy Coordinator response in the famine affected counties, UNICEF was in Rachel TAPERA Hussein Hassan Mahad the process of recruiting a roving nutrition cluster coordi- nutcluster.ssd@acf- [email protected] nator to be based in (Bentiu PoC) for a period of six international.org Cell No: +211 -956-557838 months. Cell No: +211 -915-653-570

5. Key challenges: Information Manager Qutab Alam Some of the key challenges to scaling up nutrition re- [email protected] Cell No: +211 -955-265484 sponses include: Access and insecurity (Leer, Mayandit, Kouch) affecting resumption of responses (staff and deliv- ery of supplies); occupation of some nutrition sites by armed groups; Movement of beneficiaries from one loca- tion to another and therefore presenting challenges in monitoring; storage space for supplies for planned scale