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NUTRITION A ND F OOD S ECURITY ASS IS TANCE TO CONFLICT -A FFECTED H OUSEHOLDS IN S OUT H S UDAN

Country/Region: , Koch County and Bentiu PoC, State, , Time Period Covered by the Report: Final Report: June 1, 2017 – May 31, 2018

Start Date: June 1, 2017

Dollar Amount Requested from USAID/OFDA $2,499,312 Dollar Amount from Other Sources $ 45,395 Total Dollar Amount of Program $2,544,707

Program Goal: TOTAL Total Number of People Affected in the Target Area 143,000 Total Number of People Targeted (Individuals) 89,500 Total Number of internally-displaced persons (IDP) 44,500 Targeted (Individuals) as subset of above

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1. Sector 1: Nutrition Overview of Activities: The Nutrition sector emphasizes Community Management of Acute Malnutrition (CMAM) through screening, referral, treatment and follow-up for malnourished children under five, pregnant and lactating women as well as tracking defaulters to programs by organizing home to home visits by CNVs. A community education component (MIYCN) focuses on behavior change for mothers and care takers on appropriate care giving practices for young children. For the capacity building, many training sessions were organized as well as on to the job trainings.

World Relief supported nutrition services in Unity and Jonglei states in South Sudan.

• In Koch county unity state, 4 Outpatient therapeutic programs (OTP) and Targeted supplementary Feeding program (TSFP) and 1 stabilization center (SC) in Koch PHCC were operational as of the end of the award period. At other times during the grant, up to 10 OTP/TSFP sites, but some were closed due to inability to access the sites or because the population had evacuated the area. • In Fangak County, Jonglei state World Relief operates 6 OTP/TSFP services during these period • In Bentiu (Rubkona County (PoC). World Relief operates 1OTP/TSFP in sector 2 and 1 OTP in sector 5 of POC.

Unexpected challenges: • Throughout June 2017 – May 2018, Insecurity continued to be experienced in Koch resulting to only 4 nutrition sites operational, 4 suspended and 2 remained closed due to no population in the area. • Inadequate logistical support in terms of cars to transport nutrition supplies from the UNICEF and WFP warehouse to the nutrition center. • Delay of nutrition supplies from WFP warehouses to the nutrition centers resulting to no distribution for TSFP in all nutrition sites. • Delay in delivery of OTP supplies by UNICEF.

Links to other programs or partners: • Integration of the nutrition activities with FSL e.g. Care takers of discharged children from TSFP been absorbed to FSL programme • FSL members are included in the Mother Support Groups • Integration of Nutrition to WASH ,WASH sector to dig pit latrine in nutrition centers • Integration of nutrition and GBV by conducting GBV awareness in nutrition centers • WRSS participates in various nutrition coordination meetings with SMOH, UNICEF, and WFP including Cluster meetings at the national and state levels and with other nutrition partners on weekly and monthly basis. WRSS also participates in various technical working groups with the nutrition cluster.

Indicators Table Indicator OFDA target Final Reporting June 2017 – May 2018 Sub-Sector 1.1: Infant and Young Child Feeding 1.1.1 # and % of infants 0< 6 mo. who are 50% Total: 1,169 exclusively breastfed Bentiu:407 Koch: 311 Fangak: 451 1.1.2 # and % of children 6- <24 mo. 50% Total: 1,343 receiving foods daily in 4 food groups Bentiu: 348 Koch: 513 Fangak: 482

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1.1.3 # of people receiving behavior change 7,200 Total: 63,377 M: 2,481 F: 60,896 interventions, by sex and age M: 800 F: 6,400 Koch: 7,981 M: 250 F: 7,731 Bentiu: 47,596 M: 1,468 F: 46,128 Fangak: 7,800 M: 763 F: 7,037 Sub-Sector 1.2: Management of Moderate Acute Malnutrition 1.2.1 # of sites managing MAM 15 Total: 17 Koch: 10 Bentiu: 1 Bentiu: 1 Koch: 10 (June to April), 4 (May) Fangak: 4 Fangak: 6 1.2.2 # of people admitted to MAM services, 8,275 Total: 7,383 by sex and age M: 2,851 U5: 4,551 M: 2,175 F: 2,376 F: 5,424 PLW: 2,832 Koch: U5: 459 M: 237 F: 222 PLW: 352 Bentiu: U5: 1,817 M: 841 F: 976 PLW: 1,363 Fangak: U5: 2,275 M: 1,097 F: 1,178 PLW: 1,117 (L: 488 P: 629) 1.2.3 # of health care providers and volunteers 275 Total: 246 (M: 191; F: 55) trained in the prevention and management of M: 140 Koch: 46 (M: 42; F: 4) MAM, by sex F: 135 Bentiu: 74 (M: 59; F: 15) Fangak: 126 (M:90; F: 36) Sub-Sector 1.3: Management of Severe Acute Malnutrition 1.3.1 # of health care providers and volunteers 275 Total: 246 (M: 191; F: 55) trained in the prevention and management of M: 140 Koch: 46 (M: 42; F: 4) SAM, by sex and age F: 135 Bentiu: 74 (M: 59; F: 15) Fangak: 126 (M:90; F: 36) 1.3.2 # of sites established/rehabilitated for OTP/TSFP: 10 Total: 19 inpatient and outpatient care SC: 2 Koch: SC: 1 OTP/TSFP: 10 (June to April), 4 (May) Bentiu: OTP: 2 Fangak: OTP/TSFP: 6 1.3.3 # of people treated for SAM, by sex and 2,627 Total: 4,975 M: 2,409 F: 2,566 age M: 1,280 F: 1,347 Koch: 2,318 M: 1,113 F: 1,205 Bentiu: 1,957 M: 965, F: 992 Fangak: 700 M: 331 F:369

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1.3.4 Rates of admission, default, death, cure, Cure rate >75% Koch relapse, nonresponse-transfer, and length of Defaulter rate <15% Cure – 98.8% stay Death rate <10% Defaulter – 0.0% Non- response rate <15% Death rate – 0.0% Non respondent – 1.2% Medical transfer – 0.0%

Bentiu Cured: 94.3% Defaulter: 1.6% Death : 0.0% Non respondent : 1.7% Medical transfer: 0.7%

Fangak Cured – 90.8% Defaulter – 9.0% Death – 0.0% Non respondent – 0.2% Medical transfer – 0.1%

• Indicators 1.1.1 and 1.1.2: There was no KAP survey conducted under this grant; therefore, WRSS is unable to report on the percentages for these indicators. A KAP survey is being conducted under the new award which will be used to inform future programming. • Indicators 1.2.1 and 1.3.2: In Koch County Unity State, 4 Outpatient therapeutic programs (OTP) and Targeted supplementary Feeding program (TSFP) and 1 stabilization center (SC) in Koch PHCC were operational as of the end of the award period. At other times during the grant, up to 10 OTP/TSFP sites, but some were closed due to inability to access the sites or because the population had evacuated the area. • Indicators 1.2.2 and 1.3.3: The number of cases admitted for treatment to MAM were lower than the projected target, while the number of cases admitted for SAM were higher than the target, which is indicative of the increasing food insecurity in the region.

2. Sector 2: Health Overview of Activities: The Health sector supported a primary healthcare in Sector two of the Bentiu PoC. The PHCC offers basic integrated primary health care services including reproductive and child health, disease surveillance and prevention package.

Health activities include; antenatal care, deliveries, postnatal care; curative consultations for common conditions (Malaria, diarrhea, and acute respiratory infections (ARI)); routine EPI immunizations (with gift- in-kind from UNICEF); Key maternal and child health messages were disseminated by Home Health Promoters in the community as well at the health facilities. HHPs have been active in referrals from the community to the facilities thus the increase in maternal and child health service utilization. Additionally, WRSS procured essential medicines and supplies for sector 2 health facility and some formal and on to the job trainings were organized under OFDA grant.

Unexpected challenges: • Shortage of essential drugs particularly Malaria RDT testing kits. This is addressed through collaboration with partners in Bentiu POC. Request to core pipe line partners (UNICEF & WHO) to supply us drugs/RDT testing kits with subsequent stock replenishment from WR Juba main store to avoid stock outs.

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Links to other programs or partners: • Health, Nutrition and ECD (Education) sectors managed to work in collaborative managers including referral of children in the OTP/TSFP with medical conditions for treatment, integrated health education messages, tracing both EPI and nutrition defaulters and their referrals to the respective health and nutrition sections. • Coordinated with health cluster Juba and Bentiu as well as SMOH, UNICEF, UNFPA, WHO, IRC, IOM and MSF to enhanced coordinated efforts during the implement phase of this project.

Indicators Indicator OFDA target Final Reporting June 2017 – May 2018 Sub-sector 2.1 Health Systems and Clinical Support 2.1.1 # of health care facilities supported and/or 1 PHCC 1 PHCC rehabilitated by type 2.1.2 # of health care providers trained by type, by sex Staff: 50 Total: 32 M: 25, F: 25 Clinical Officers: 5 Midwives: 3 Volunteers: 225 Nurses: 3 M: 115, F: 110 HHPs: 9 Clerk: 3 Vaccinators: 5 Laboratory Technicians: 2 Health Officer: 2 2.1.3 # and % of health facilities submitting weekly 1, (100%) 1 (100%) surveillance reports 2.1.4# of consultation by sex* and age per quarter <5:5600 <5 Total: 12,222 (M: 5,989; F: 6,233) 5+: 12,500 5+ Total: 42,631 (M:20,889; F: 21,742) Sub-Sector 2.2: Communicable Diseases 2.2.1 Incidence and prevalence of high morbidity rates by N/A Diarrhoea: 5% (2,973/54,853) type (e.g., diarrhea, ARI, measles, and other), by sex* ARI: 66% (36,201/54,853) and age Measles: 0% Malaria: 21% (11,602/54,853) 2.2.2 # and % of cases diagnosed and treated per <5: 22,400 <5 Total: 12,222 (22% of all standardized case management protocols such as IMCI, consultations) disaggregated by sex* and age (M: 5,989; F: 6,233) 2.2.3 Case fatality rates for diarrhea, ARI, measles, and 0 0 (No death case was registered in the other, by sex* and age clinic during this grant period) Sub-Sector 2.3: Reproductive Health 2.3.1 # and % of pregnant women who have attended at 600, 60% 61.3% (2,430/3,967) least two comprehensive antenatal clinics (ANC)

2.3.2 # and % of women and newborns that received 300, 30% 99.9% (704/705). postnatal care within three days after delivery 2.3.3 # and % of pregnant women who deliver assisted 300, 30% 99.9% (704/705). by a skilled (not traditional) birth attendant by type and location 2.3.4 # of cases of sexual violence treated 10 9 Sub-Sector 2.4: Medical Commodities including Pharmaceuticals

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2.4.1 Number of supplies distributed by type (e.g., UNICEF Kit: 50; 80 medical kits, equipment, consumables) WHO/ IEHK Kit: 4 5 UNFPA Kit: 400; 200 UNHCR Kit: 811 0 2.4.2 Number of people trained, by sex, in the use and 10 Total: 15 proper disposal of medical equipment and consumables (M: 13; F: 2) 2.4.3 Number and percentage of health facilities, 0 0 supported by USAID/ OFDA, out of stock of selected essential medicines and tracer products for more than one week

• Indicator 2.1.4: Staff strikes beginning in February 2018 resulted in lower numbers of consultations. • Indicator 2.2.1: Limitations in reporting the prevalence or incidence are that the PHCC technically covers only Sector 2 of the PoC, not the entire camp. Moreover, in practice, the PHCC received patients from other sectors while some people residing in Sector 2 may similarly seek services in other sectors. The figures presented are more accurately disease-related morbidity. • Indicators 2.3.2 and 2.3.3: All deliveries in WR Sector 2 PHCC are attended by skilled midwives and all delivered mothers and their children receive immediate postnatal care/services within the first 24hours before their discharge to home. This ensured the 99.9% achievement in these two indictors. • Indicator 2.4.1: UNFPA kits also included dignity kits that UNHCR previously provided specifically for protection issues. During the reporting period we were provided these kits by UNFPA and didn’t request the same to UNHCR.

3. Sector 3: Agriculture and Food Security Overview of Activities: The Agriculture and Food Security (AFS) sector seeks to improve food security by providing inputs and basic agricultural training to conflict-affected people. The project is implemented in partnership with UNFAO. The following activities were implemented throughout the course of the project: • Trained fisheries groups in improved fish production • Captured and recorded number of kilograms of fish harvested per fisher in six-month period, by sex • Distributed fishing inputs to the household beneficiaries • Distributed agricultural inputs/seeds the household beneficiaries • Trained farmers groups on improved agricultural practices • Trained people in organic pesticides formulation

Unexpected challenges: Insecurity has continued to be the main challenge interrupting programming. Due to the fighting that erupted in some parts of Koch, program staffs had to be evacuated.

There was also a delay in delivery of inputs to the field locations. This was further complicated by the poor road terrain that worsens during the rainy season. Planting in June and July of 2017 was delayed in some parts of the project areas due to these delays. Parts of Fangak County experienced sub-normal rainfall during the growing 2017 main growing season. This led to retarded growth for some time.

Links to other programs or partners: The FSL project has coordinated well with other partners at different levels. Under partnership with FAO, the project was able to acquire the required inputs for distribution. In order to scale up operations especially in Koch County, the project partnered with the South Sudan Humanitarian Fund managed by the as well as World Vision to reach more beneficiaries with fisheries and vegetable kits.

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This project also coordinated well with other partners to avoid duplication of interventions. Such organizations in the area of operation include Polish Humanitarian Aid, Danish Refugee Council, Care International who also have Agriculture and Food Security interventions in Koch.

Indicators Indicator OFDA target Final Reporting June 2017 – May 2018 Sub-Sector 3.1: Fisheries 3.1.1 # of people trained in fisheries, by sex 1,101 1,177 F: 446 F: 461 M: 716 M: 655 3.1.2 # of people benefiting from fisheries activities, by sex 7,340 11,102 F: 3,009 F: 6,568 M: 4,534 M: 4,331 3.1.3 Average number of kilograms of fish harvested per F: 260Kg F: 1080.9Kg fisher in six-month period, by sex M: 1950 Kg M: 670.12Kg Sub-Sector 3.2: Improving Agricultural Production and Food Security 3.2.1 Projected increase in number of months of food self- 3 Months ≤1 Month (42.46%) sufficiency due to distributed seed systems/agricultural input 2-3 Months (49.61%) for beneficiary households ≥4 Months (7.935%) 3.2.2 # of people benefiting from seed systems/agricultural 8,580 14,572 input activities, by sex F: 5,105 F: 8,741 M: 5,831 M: 3,475 Sub-Sector 3.3: Pests and Pesticides 3.3.1 Number and percentage of people trained in pest control 1,020 1,491 (10.2%) practices, by sex F: 607 F: 924 (10.6%) M: 413 M: 567 (9.7%) 3.3.2 Number and percentage of people trained by USAID/ 816 763 (93.5%) OFDA partners practicing appropriate crop protection F: 486 F: 407 (44.0%) procedures, by sex M: 330 M: 356 (62.8%)

4. Vehicle Information Number of vehicles purchased or leased this reporting period 1 Number of non-U.S. vehicles purchased or leased this reporting period 1 Source of each purchased vehicle and nationality of supplier Doshi motors, Japanese

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Annex 1: Beneficiary Stories and Photos Nutrition Sector: Nyadeng’s experience and her role as lead of mother to mother support group (MSG)-Fangak Nyadeng, a mother to 4 children, including 3 boys and 1 girl, lives as an IPD living in Koatnyakoang Village where work WRSS runs an OTP/TSFP nutrition site. Nyadeng was displaced from her original village of Tonga in neighboring Panyikang County as a result of the arm conflict that took place in 15/4/2017 between the opposition and government forces.

In July, Nyadeng was selected as one of the Lead Mothers for the Mothers’ Support Group (MSG) for Koatnyakoang. She was trained on the infant and young child feeding (IYCF) package, and Nyadeng has been a Nyadeng and mothers during a mother support group session charismatic and outstanding advocate in the promotion of IYCF practices. Before Nyadeng came to Koatnyakoang Village, she had spent eight weeks in one of WRSS OTP program caring for her malnourished child Nyawura at Kuemduok feeding center.

Nyadeng shared her story during an interview with WRSS’s Nutrition Officer, and when asked what she is doing differently now since she got in contact with WRSS Nutrition program, this is what she had to say: “I have gained a lot of useful information from the breastfeeding mobilization since I came to the center. Before this training, I gave birth to all my first six children in my village and we were told by our elders that children are not supposed to be given colostrum, and no breastfeeding be should initiated before giving herbs after giving birth, which I believed in and practiced during my days I was still living in Koatnyakoang village. After attending various IYCF sessions and the follow ups from the Nyadeng leading a demonstration during a mother support group mother support groups based in Koatnyakoang village, I session have benefitted and learnt a lot IYCF practices like, skin- to-skin contact during breastfeeding, giving colostrum to child at birth, children being exclusively breastfed for the first 6 months, and many other breastfeeding practices. This has changed my previous belief. My youngest child is very healthy compared to the previous kids, as they use to fall sick frequently almost every one month.”

Nyadeng continued, “I am a member of the Mothers’ Support Group at Koatnyakoang village, and I dedicate my free time to passing on breastfeeding information to the rest of the mothers that reside at the village and also to my members of the mothers’ support group. We mainly mobilize and give breastfeeding orientation to young mothers, pregnant and lactating ones by doing group discussion session at the centers for new mothers and explaining to them the advantages and some of the misconceptions about breastfeeding.”

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Nyadeng and Nutrition officer during a facilitation season in Koatnyakoang village

Health Sector: Elizabeth Nyaluak lives very far from the PoC in a small village called Nyathoar which is a 6 hours walk to the Sector 2 health facility. She didn’t attend any ANC visits before and had not delivered in a healthy facility before. In her past obstetric history, she delivered all the five children at home. When she gave birth to the fifth child, she experienced some bleeding after delivery at home, but luckily enough it was not very serious.

This time her longtime village friend, who came to visit from Juba, advised her to deliver in a health facility However, she didn’t see any need for her to go and deliver in a health facility after all she had been delivering at home all the past times.

Fortunately, Nyaluak came in to the PoC to see her elder sister who is married to one of Sector 2 facility Home health promoters (HHPs) by the name of Peter Jok. Early morning the following day she started to experience labor pains and quickly Mr. Peter and the wife rushed her to the Sector 2 health facility. After 45 minutes the membrane ruptured, and she delivered a bouncing baby boy with birth weight of 3.6kgs. Shortly after, when the placenta was delivered, she started bleeding heavily. The midwife on duty quickly placed Nyaluak on intra venous fluid infusion and continuously monitored her vital signs while accessing the bleeding. After 48 hours, Nyaluak recovered fully and she was discharged.

She was very grateful for the way she was given attention and handled during her labor time and she vowed to encourage pregnant mothers in Nyathoar village to come for delivery in Sector 2 health facility. Currently Elizabeth Nyaluak is like an ambassador of Sector 2 health facility to Nyathoar village as we continue to receive mothers coming from that far for ANC and delivery services.

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Elizabeth Nyaluak holding her new born baby few minutes before discharge.

AFS Sector: The Practical Man: Dak Chatiem Gai (Update from last report) Dak is part of the World relief South Sudan’s AFS project, funded by the OFDA, through which he has been trained in vegetable growing and preservation, organic fertilizers and pesticides, nutrition and food preparation and utilization.

He is 38 year old, is married with six children, and a few months ago, he was named the best farmer in Old Fangak County in Jonglei State in South Sudan. “[I won] for producing many vegetable varieties such as onions, eggplants, tomatoes. I would get up to touch it to be sure it was real,” said an exuberant Dak. “I could not believe my dream had come true after a long struggle since I left from Khartoum. My wife, she takes care of the children and grazing of the cattle, and I have to do the cultivation of the Onion harvest garden on my own. He took keen interest in learning how to do agro-forestry (mango trees and guava trees), which is one of the diversified agricultural practices for environmental conservation. He said they have found what to cook and what to eat and his wife can prepare three meals in the one day because of the presence of the vegetable in the garden, compared to the time his family was entirely relying on cow’s milk. This has improved

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reliance on only milk and sorghum than it was before. I can now sell vegetables in the nearby market throughout the year and meet some of my basic needs,” said Dak.

He is an excellent example to other farmers that hard work does pay off, with the win motivating other farmers to get involved in project activities to help change their lives. He shared, “I am very happy with the World Relief South Sudan for giving me knowledge and I wish them a long life in Fangak County because this is the first thing of its kind Interview in Dak’s home that has ever happened here in the village. I am getting a lot of appreciation from people for winning prize of being best lead farmers in this village, especially from fellow farmers who ask me how I won the prize of being the best farmers.”

The Fangak agricultural Lead Farmers and member farmers group, whose theme was Diversity in farming is the key for sustainable agriculture and economic growth, enabled farmers to share experiences and learn new technologies from their peers, as well as from the government.

Building resilience in South Sudan: a female farmer’s success story Nyadien Chan 37 year old, is a lead farmer of Matar demonstration farmers’ group in Koch County, and was one of supported beneficiaries by World Relief South Sudan organization funded project by OFDA. Nyadien Chan and her 20 member group live in Kuachlual payam in the village called Matar in Koch County former Unity State. Unity is one of the state in South Sudan in food insecurity classification Phase 4, or Crisis, and many people can not find enough to eat. Nyadien Chan is one of the most active lead farmers with the group members in Matar demonstration farmers’ group.

During our interview with Nyadien Chan and her group members, they were able to tell us exactly the number of children and family members that they are feeding with this Okra harvest project. In 2016, her family suffered severe food insecurity, after she suffered the loss of her livelihood during the crises of 2013 and 2015 that affected her social and economic life. She said “It was not easy for my family to find anything to eat,” but because previously her family usually depend entirely on cattle milk and meat, but after the crises, they lost all the cattle and agricultural activities. In 2016, life for Nyadien became very hard because she could not get what to eat for the family in really sense she cannot support the family more, and she has seven dependent children.

Today, Nyadien Chan and her group member have realized some livelihood recovery after they were identified and grouped together to be supported through the project funded by OFDA. “We express our gratitude to World Relief south Sudan organization, as Matar demonstration group members, because of what WR has done up to date. It is unforgettable, and we were even able to sell vegetables, especially okra and eggplants, to the local market and to organization compounds including World Relief, PAH and UNIDO.” From there vegetable production, Nyadien and her group members were harvesting about a 25kgs of okra in periods of three days, which earned them about 1500SSP (approximately $10) after Sale of okra and eggplants

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every three dividing the cash among themselves as a group members.

Nyadien said after dividing the money among themselves that, “She used her money for buying cloth for her dependent children during festival season and for buying additional food for the family.

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