Country: Nigeria Donor: Office of U.S. Foreign Disaster Assistance Award Number: 720FDA19GR00123 Reporting period: October 1, 2019 to March 31, 2020 Submitted by: International Medical Corps
Sustaining WASH, Nutrition and Protection Response for Conflict Affected People in Borno State, North East Nigeria
SEMI ANNUAL 2 REPORT
Acronyms
AAH Action Against Hunger CG Care Group CHEW Community Health Extension Worker CL Community Leaders CNV Community Nutrition Volunteers CMAM Community-based Management of Acute Malnutrition CV Community Volunteer CHV Community Health Volunteer DTM Displacement Tracking Matrix EBF Exclusive Breastfeeding F Female FGD Focus Group Discussion FRC Free Residual Chlorine GBV Gender Based Violence GBVIMS+ Gender Based Violence Information Management System + IDP Internally Displaced Person IMC International Medical Corps INGO International Non-Governmental Organization INSO International NGO Safety Organization IOM International Organization for Migration IPTT Indicator Performance Tracking Sheet IPV Intimate Partner Violence IYCF-E Infant and Young Child Feeding in Emergencies l Liters LGA Local Government Area LM Lead Mother M Male MAM Moderate Acute Malnutrition MdM Médecins du Monde MHM Menstrual Hygiene Management MMC Maiduguri Metropolitan Council MoWASD Ministry of Women Affairs and Social Development NA Not applicable NFI Non-Food Item NR Non-Recovered OAG Organized Armed Groups OFDA USAID Office of Foreign Disaster Assistance O&M Operation and Maintenance OTP Out-Patient Therapeutic Program PHCC Primary Health Care Center PLSO Partner Liaison Security Organization PLW Pregnant and Lactating Woman PMT Program Management Tool PSS Psychosocial support RUTF Ready-to-Use Therapeutic Food RUWASSA Rural Water Supply and Sanitation Agency SAM Severe Acute Malnutrition SBC Social and Behavior Change SC Stabilization Center SEMA State Emergency Management Agency SFP Supplementary Feeding Program SMoH State Ministry of Health SPHCDA State Primary Health Care Development Agency UN United Nations UNHAS United Nations Humanitarian Air Service UNICEF United Nations Children’s Fund UNOCHA United Nations Office for the Coordination of Humanitarian Affairs VTC Vocational Training Center WASH Water, Sanitation and Hygiene WFS Women Friendly Space WHO World Health Organization
Program Goal: To reduce morbidity and mortality associated with poor nutrition, WASH and protection conditions among conflict affected populations in North-East-Nigeria. Program Objectives: The IMC OFDA grant has three main objectives:
Objective 1: To improve nutrition status of children 0-59 months through the provision of CMAM and IYCF-E in North-East, Borno
Objective 2: To ensure that affected people have access to water, sanitation and hygiene promotion services
Objective 3: To increase protection for women and girls and provide critical response services for survivors of GBV
1. PROGRAM SUMMARY 1.1 AWARD LEVEL BENEFICIARIES Cumulative Targeted Total 282,571 IDP 58,175 (from Baseline) Reporting Period Total 393,498 IDP 88,160 Reached Cumulative Total 393,498 IDP 88,160 Reached
1.2 SECTOR LEVEL BENEFICIARIES
Reporting Period Cumulative Period Sector Cumulative Targeted Reached Reached Total IDP Total IDP Total IDP Nutrition 132,084 6,635 393,498 6,635 393,498 6,635 Protection 282,571 65,311 254,034 88,160 254,034 88,160 WASH 90,935 58,175 65,635 65,635 65,977 65,977
2. EXECUTIVE SUMMARY – PROGRESS TO DATE During the reporting period, from October 1, 2019 to March 30, 2020, major security challenges throughout Borno State impacted International Medical Corps’ activities and those of other international non-governmental organizations (INGO). These challenges included increased attacks by Armed Opposition Groups (OAG) and frequent vehicular movement restrictions imposed by the state authorities.
Humanitarian workers continued operating under intense pressure and scrutiny by the military and the state government during the reporting period. In September 2019, Action Against Hunger and Mercy Corps’ operations were suspended by the military with the ban temporarily lifted in October. The suspension of these agencies created a gap in WASH services in Damboa, especially provision of potable water for the camps, resulting in International Medical Corps’ immediate response to ensure that the needs of Mercy Corps’ beneficiaries were addressed within 24 hours of the ban.
In addition, with 135 confirmed cases with 2 deaths as of March 31st, the COVID-19 pandemic in Nigeria has created market instability and inflation, with high price volatility amid federal and state governments’ measures to lockdown cities and states including Lagos, Kano, and Abuja Federal Capital Territory, where most supplies are procured through local vendors. 1
On March 27, 2020, all commercial flights throughout the country were suspended, including those to Borno. On March 31st, Borno State declared a border closure to curb the spread of the disease, however humanitarian movements were still permitted. Apart from COVID-19, road movements from Maiduguri to International Medical Corps’ (IMC) field project site in Damboa remains a concern due to frequent attacks by insurgents and unpredictable actions from the military.
Despite these challenges, International Medical Corps has continued to implement its USAID/OFDA- funded emergency response intervention under the project to save lives and promote personal dignity for the conflict-affected people in four (4) Local Government Areas (LGA), including Jere, Konduga, Damboa and Maiduguri Metropolitan Council (MMC). The activities are contributing to the achievement of the project’s goal through the provision of quality lifesaving preventive and curative nutrition, water, sanitation, and hygiene (WASH), and protection/gender-based violence (GBV) prevention and response services.
The project activities under this grant initiated on July 1, 2019, and focused for the first two (2) months on protection/GBV and nutrition. WASH activities were launched in September 2019, following the completion of a no-cost extension (NCE) for International Medical Corps’ previous USAID/OFDA grant (720FDA18GR00236), which ended on August 31, 2019.
Project implementation is carried out in close collaboration with the communities and relevant government line ministries including the State Ministry of Health (SMoH), the Ministry of Water
1 https://covid19.ncdc.gov.ng/ Resources, the Rural Water Supply and Sanitation Agency (RUWASSA), and the Ministry of Women Affairs and Social Development (MoWASD). In addition to the collaboration with the government and communities, IMC remained active in the Nutrition, WASH and Protection sectors and Technical Working Groups at the national, state and LGA levels.
Key achievements during this period included:
- Nutrition: A total of 3,123 children aged 6-59 months were admitted to the 15 Outpatient Therapeutic Program (OTP) sites for treatment of severe acute malnutrition (SAM) without medical complications. The recovery rate was 81% (above the recommended Sphere standard of at least 75%). A total of 146 children aged 6-59 months were admitted for SAM with medical complications into the Damboa stabilization center (SC) supported under this grant, with an 80% recovery rate recorded (80% of the children were either referred back to OTP to continue treatment or continued treatment in SC until fully cured). Thirteen (13) infants aged 0-5 months were also admitted into the SC under the special protocols for these infants. In addition, a total of 98,049 people participated in social and behavior change (SBC) interventions.
- WASH: The WASH interventions have continued to support the basic needs of IDPs through the provision of potable water (34,589,645 liters (l) per month to 65,635 beneficiaries as shown in the table below.
Type Number of liters Water trucking 4,960,000 Jet wells 2,790,000 Solarized water systems 22,189,645 Hand pumps 4,650,000 Total 34,589,645
The provision of water was coupled with sanitation, health and hygiene promotion and solid waste management interventions. The beneficiaries were served in six (6) IDP camps in Maiduguri and Damboa, including Unity and Vocational Training Center (VTC) camps during the suspension of Mercy Corps with an additional 4,278,000 liters per month.
During the reporting period, International Medical Corps conducted major rehabilitation of 30 blocks of six (6) units of latrines and showers (4 latrines-2 showers), and minor rehabilitation to 34 blocks of six (6) latrines and showers in Damboa. In Bakassi IDP Camp, a total of 50 blocks of latrines and showers have undergone major rehabilitation. The sanitation activities have reached a total of 65,635 beneficiaries.
- Protection/GBV: Case management services, including psychosocial support (PSS) and referrals, were provided to survivors of 359 GBV incidents through the nine (9) established and supported Women Friendly Spaces (WFS). In addition, 100 service providers (M=47; F=53) received training on GBV concepts, guiding principles, referral pathways, psychological first aid, and use of the Gender- Based Violence Information Management System Plus (GBVIMS+). A total of 166,887 people were reached through prevention, outreach and mass awareness activities. A total of 2,520 women and adolescent girls participated in age-appropriate skills acquisition activities (embroidery, crocheting, pasta making, basic literacy and numeracy sessions).
3. PROGRAM ADMINISTRATION
A. SECURITY
The security situation in Borno State, as in the entire North East, has shown no sign of improvement during the past six (6) months. Attacks from OAG operatives continued to be reported daily throughout the North East, but especially in Borno State, including in the immediate environs of Maiduguri Metropolitan Council (MMC) and Damboa. Two (2) major direct attacks on Damboa town were reported in February 2020. As a result of one (1) attack, the Kauji Kura Primary Health Care (PHC), located 15 km from Damboa town and supported by IMC with nutrition activities, was burned and activities were disrupted for two (2) weeks. In order to help children with SAM and their caregivers from this community to avoid travelling to Damboa town to access nutrition services, the Bulama (head of the community) offered his compound as a site for the outreach OTP. In this way, the program was able to prevent treatment interruptions for the 48 children (28 girls, 20 boys) enrolled in CMAM affiliated with Kauji Kura PHC.
The humanitarian community continued to witness a rise in insecurity directly impacting humanitarian workers. On December 13, 2019, insurgents executed four (4) men among the six (6) aid workers abducted in July 2019. On December 22, 2019, three (3) aid workers were among a group of civilians abducted along the Monguno-Maiduguri road. This was a result of increased illegal vehicle checkpoints set-up by OAG operatives. On December 26, 2019, two (2) female aid workers were executed after they were forced to step out of a bus stopped at in illegal checkpoint on the Gwoza-Madagali road.
Continuous road closures and access restrictions to Damboa have resulted in vendors increasing the price of their services as they have to take alternate routes of longer distances to reach Damboa. The situation has been exacerbated by COVID-19 travel restrictions to prevent the disease spreading from Lagos and Abuja to places like Borno, which has reduced transport options from Abuja to Borno State.
International Medical Corps has continued to liaise with the International NGO Safety Organization (INSO), the USAID Partner Liaison Security Operations (PLSO), the United Nations Department for Safety and Security (UNDSS), Nigerian security forces (military and police), other partner organizations, and local civilians in order to obtain real-time, accurate security-related information in its areas of intervention for the safety and security of its staff and beneficiaries. Strong collaboration with the United Nations Humanitarian Air Services (UNHAS) has allowed IMC staff to conduct frequent field visits to Damboa with air transportation (helicopters) as road access remained a security challenge.
B. POPULATION MOVEMENT- BENEFICIARIES UPDATE
The IOM Displacement Tracking Matrix (DTM) round 30 released in December 2019, showed a slight increase of 1% in IDP numbers from 2,018,513 to 2,039,092 in Borno State compared to the DTM round 28 in IMC’s previous report. 2 The DTM Round 30 also shows a steady increase compared to the DTM Round 29 released in November 2019. The increased insecurity in some LGAs was noted as the primary cause of the increase. Maiduguri Metropolitan Council (MMC) remains the LGA that recorded the highest number of displaced persons.
The population at some camps will continue to fluctuate (internal movements) depending on the security situation. Borno State is preparing to relocate the IDPs living in government housing camps including Bakassi IDP Camp. The plan disclosed in March 2020, is to relocate IDPs to a location yet to be identified by the State. International Medical Corps will continue to coordinate with the State Emergency Management Agency (SEMA), IOM, the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), and appropriate sectoral clusters and actors on the ground, to closely track population movements, including projections and patterns. As of May 2020, there have been no further discussions or plans released regarding the relocation of these IDP populations.
C. COMMUNITY PARTICIPATION
During the reporting period, International Medical Corps organized monthly community dialogues. Regarding nutrition, participants in community dialogues were informed about the project’s objectives, activities and messages related to the support of Infant and Young and Child Feeding in Emergencies (IYCF-E). This included both nutrition-specific (exclusive breastfeeding for the first six (6) months, and age-appropriate, optimal complementary feeding) messages targeting hygiene and health. In addition, a total of ten (10) safety audits were carried out through community consultations to collect information and suggestions on how to better align the program’s approaches to beneficiaries’ needs. Results of the safety audits reflected the major concern of respondents as light, including security lighting, in the camps.
D. GOVERNMENT SUPPORT
All interventions have been conducted in coordination with the government of Nigeria at the state and LGA level. Coordination included working closely with the State Primary Health Care Development Agency (SPHCDA), as part of the State Ministry of Health (SMoH), for nutrition interventions; Rural Water Supply and Sanitation Agency (RUWASSA) for WASH interventions including the pre-positioning of supplies for a cholera outbreak; and the Ministry of Women Affairs
2 International Organization of Migration. https://reliefweb.int/sites/reliefweb.int/files/resources/DTM%20Nigeria%20Round%2030%20Report%20December%20 2019.pdf and Social Development (MoWASD) for protection/GBV-focused interventions. Close collaboration with SEMA also remained critical for the effective implementation of the program in IDP camps.
E. FIELD COORDINATION/COLLABORATION WITH OTHER ACTORS
In addition to coordinating project activities with government line ministries and agencies, International Medical Corps continued to closely coordinate and collaborate with UN and non- governmental organizations to ensure targeted interventions that support and complement, and not duplicate, the work of other actors.
A strong collaboration with UNICEF has allowed International Medical Corps to continue managing 15 outpatient therapeutic program (OTP) sites in the project area, and one (1) stabilization center (SC) in Damboa through their provision of RUTF, F-75 and F-100 therapeutic milks. Without support from WHO and UNICEF through the provision of SAM kits, SC medical consumables and pharmaceuticals, International Medical Corps would not have had the commodities needed to provide comprehensive life-saving services to children with SAM.
International Medical Corps remains an active member of the Nigeria International Non- Governmental Organization (INGO) Forum, the Nutrition and WASH sector leads for Damboa and Technical Working Groups, and the GBV sub-sector.
International Medical Corps has been leading the IYCF Technical Working Group since February 2019. The chairmanship for 2020 was renewed by the sector as a result of good leadership which included increasing the technical expertise of the working group and re-establishing the importance of IYCF in all comprehensive nutrition programs.
International Medical Corps is also an active member of the GBV sub-sector of the North East and continues to serve as the INGO representative of the National Multi-Stakeholders Leadership Task Team for the Call to Action. International Medical Corps is the lead GBV partner in Mohammed Goni Stadium Camp, Bakassi IDP Camp in MMC, and in all formal camps in Damboa.
In addition, IMC remains an active member of the WASH sector in the North East and is the leading WASH organization in Bakassi and Damboa. International Medical Corps has been working closely with partners and providing technical assistance as requested. Moreover, the WASH sector consolidated the “one (1) actor per LGA” strategy to deliver WASH support, to rationalize partner presence and optimize resources within the sector. Effective December 2019, IMC is fully responsible for Bakassi IDP Camp and five (5) camps in Damboa following the withdrawal of other partners. International Medical Corps is leading WASH coordination at Bakassi IDP Camp and interacts with key line agencies and actors in the camp to ensure effective coordination and delivery of all services.
F. HUMAN RESOURCES
During the period under review, the staffing rate for this grant was estimated at 90%. All technical positions have been filled in Maiduguri and Damboa through March 2020. Some support positions in Finance and Logistics are yet to be filled due to COVID-19 and the deployment of recruited staff has been put on hold because of travel bans, both domestic and international. Some technical sector leads (IMC’s Senior Nutrition Manager) were on leave in their home country and state when almost all African countries suddenly imposed flight bans, including Nigeria. As per IMC’s notification to OFDA on April 28, this staff member will be working remotely supporting their managers on the ground until they are able to return to Nigeria.
G. MONITORING AND EVALUATION
During the reporting period, International Medical Corps continued routine monitoring and supervision of activities to measure progress and provide timely corrective measures and solutions to identified challenges. The routine monitoring included weekly field visits by program staff of OTPs, WFS, and WASH activities including availability of water, and evolution of WASH constructions. Collection and review of monthly data by the M&E team and program staff continued to be conducted in order to take corrective measures. Supervisions were conducted every week by coordinators, managers and officers using supervision checklists. A WASH household survey was conducted in all IMC IDP camps. The survey’s key objective was to assess the population’s level of knowledge and use of WASH practices by measuring progress against target for WASH indicators collected as described in the M&E table. A total of 384 households were sampled from the IDP population. In March, the IMC MEAL team also began preparatory actions in the context of COVID-19 to adapt monitoring and evaluation approaches to reduce the risk posed to MEAL staff and beneficiaries. These included working with program staff to plan for remote supervision of staff and examining options for phone-based surveys and data verification in anticipation of the spread of the pandemic to Borno and a lockdown on movement.
4. ANALYSIS OF PROGRESS AGAINST INDICATORS
4.1. Sector 1: Nutrition
Sub-Sector 1: Infant and Young Child Feeding in Emergency/IYCF-E
Activity 1. Social and Behaviour Change (SBC) through Care Groups (CG) for Pregnant and Lactating Women (PLW)
A total of 700 Lead Mothers (LM) delivered IYCF-E messages and discussed prevailing health and nutrition topics and concerns using the Care Group model. Each LM conducted a total of 12 home visits to each of her assigned 10-15 neighbouring homes within the reporting period using SMoH/UNICEF approved counseling booklets. Topics covered during this reporting period included:
- Breastfeeding low birthweight babies - How to hand express breastmilk and cup feed - Breastfeeding and working mothers - Good hygiene practices - Start complementary feeding at 6 months - Complementary feeding from 6-9 months - Complementary feeding from 9-12 months - Complementary feeding from 12-24 months - Dietary diversity - Feeding the sick baby less than 6 months of age - Feeding the sick child more than 6 months of age - Monitor the growth of your baby regularly
In addition, Lead Mothers met every two (2) weeks at their respective OTPs for bi-weekly sessions facilitated by Community Health Promoters (CHP) who are directly supervised by CHP supervisors for a minimum of one (1) to two (2) hours per session. During these sessions, CHPs reviewed and discussed reports submitted by the Lead Mothers. In these same sessions, CHPs share the SBC discussion topics for subsequent sessions.
Lead Mothers session at Maisandari 2 conducted by an IMC supported Community Health Promoter, supervised by Community Health Promoter Supervisor and Nutrition Coordinator.
Activity 2. Community Mobilization International Medical Corps continued to work with 150 Community Nutrition Volunteers (CNV) who conducted community outreach activities, including screening for acute malnutrition during the reporting period. The CNVs received SPHCDA approved monthly transport stipends from IMC as well referral cards from SPHCDA.
In October 2019, a total of 285 Lead Mothers attended a five-day refresher training facilitated by IMC’s Nutrition Officer, Nutrition Manager and SPHCDA staff in Damboa. The average knowledge gained by participants was 12% as the training was a refresher training. Training topics included: early initiation of breastfeeding, exclusive breastfeeding for the first six (6) months after birth, complementary feeding, immunization schedule, how to complete the family MUAC tool and Lead Mother tally sheets, MUAC measurement, and edema assessment.
Community engagement activities continued through monthly community dialogues facilitated by CNVs, Nutrition Assistants and LMs. These participatory education sessions have been designed to promote optimal IYCF-E practices that include exclusive breastfeeding, complementary feeding, and handwashing during the five critical times in addition to addressing myths, misconceptions, and rumors surrounding feeding practices. An estimated 450 persons attended these dialogues (averaging 30 persons per location (all male); 15 locations), including key behavioural influencers (i.e. traditional healers, community leaders, Water Committee members, and other distinguished persons) in each community. The objective of the community dialogues was to mobilize, educate and change the community's perceptions and beliefs about infant and young child feeding practices.
Dialogue session at Aburi Camp in Damboa Activity 3: Cooking demonstrations for mothers/caregivers of sick children and LMs
Five (5) rounds of cooking demonstrations were conducted across the 15 OTPs in all LGAs during the third week of each month. Lead Mothers, Community Nutrition Volunteers and caregivers/mothers of OTP beneficiaries participated in these CHP-facilitated sessions. The aim of these cooking demonstrations is to enlighten mothers and caregivers on optimal IYCF-E practices, and to show the use of locally available, affordable and accepted foods to produce nutritious and well-balanced meals for their children.
Community Health Promoter explaining the Nutritional Content of Recipes for the cooking demonstration in General Hospital Camp OTP, Damboa (left) and Food preparation by Lead Mothers as supervised by the Community Health Promoter (CHP) (right)
Sub sector 1: Indicators
Indicator 1.1: Proportion of infants 0-5 months of age who are fed exclusively with breast milk
Proportion of infants 0-5 months of Baseline Target Reporting Cumulative age who are fed exclusively with Period Period Reached breast milk Reached Male 5.4% N/A N/A Female 5.4% N/A N/A Total 5.4%3 15% N/A N/A
This indicator will be measured at the end of the grant when an IYCF survey is planned. IMC will provide Personal Protective Equipment to staff during the survey in order to limit the spread of the COVID-19. In the event movement restrictions are imposed in the State because of the disease, IMC will conduct the survey remotely using mobile phones.
3 IMC OFDA Baseline report Indicator 1.2: Proportion of children 6-23m receiving foods from at least four (4) food groups every day
Proportion of children 6-23 Baseline Target Reporting Cumulative months of age who receive Period Period Reached foods from four (4) or more Reached food groups Male 40.9% N/A N/A Female 41.5% N/A N/A Total 41.8% 50% N/A N/A
This indicator will be measured at the end of the grant in an IYCF survey, as per the project’s M&E plan.
Indicator I.3: Number of people receiving in behavior change interventions to improve infant and young child feeding practices.
Number of people
receiving behavior Target Reporting Period Reached Cumulative Period change interventions Reached F M T F M T 51,672 9669 60164 55,172 13,461 68,043 TOTAL 13,000 51,672 9,669 60,164 55,172 13,461 68,043
A total of 60,164 people participated in SBC activities. Monthly community dialogues, house-to-house visits by the Lead Mothers, health and nutrition education sessions at the OTPs and one-on-one IYCF sessions in the SC were the forums used in SBC activities. The figures are likely overestimates of the number of people receiving behavior change interventions due to a possibility of double counting (people participating in more than one (1) session).
Sub- sector 2: Management of Acute Malnutrition
International Medical Corps is implementing three (3) components of CMAM: community mobilization, outpatient therapeutic programs for the treatment of SAM, and in-patient care at its stabilization center for the treatment of SAM with medical complications, using the approved Nigeria Ministry of Health guidelines and protocols.
During the reporting period, supervision visits were orgainzed every week by the Nutrition Coordinator, Nutrition Manager and Nutrition Officers using the supervision checklist. Supervision of Commmunty Health Promoters and their supervisors was also conducted by the Officers, thw Nutrition Manager, and Nutrition Coordinator using the Quality Improvement and Verification Checklist (QIVC).
Some of the challenges included: - Slow responders in the OTP. Upon investegation, it was deduced that this is due to the sharing of nutrition commodities at home (with healthy children and older family members). - Difficult defaulter tracing and follow up as a result of insecurity. - Referral of patients from the SC to secondary health facilities remained a key challenge as the same caregiver has responsibility to look after other children back home, and because of movement restrictions due to insecurity.
1. Community Mobilization
Activity 1.1 Community-based active case finding, referral and admission
A total of 150 CNVs and 700 Lead Mothers carried out active case finding at the community level. These cadres on LMs and CNVs are well equipped to use MUAC measurement and the detect bilateral pitting edema as criteria for referring a child to the OTP. A total of 180,972 children (89,307 boys and 91,665 girls), aged 6-59 months, were screened using MUAC tapes during the reporting period. A total of 60,407 (33.4%) were identified with MAM and 1,829 (1.0%) with SAM.
In December 2019, IMC conducted a mass MUAC screening in all accessible areas (wards) in Damboa, reaching 13,098 children aged 6-59 months (6,478 boys and 6,620 girls). Out of the 13,098 children screened: 154 children had a red MUAC, including 100 with edema, and 788 children had a yellow MUAC. A total of 71 children with red MUAC readings, and not currently enrolled in the program, were referred for SAM treatment at IMC nutrition sites. A total of 21 children were admitted for SAM treatment (19 in the OTPs and 2 in the SC) within a week of the mass MUAC screening exercise, and an additional 40 were admitted in the subsequent three (3) weeks, with total 61 children admitted in less the three (3) weeks. The Damboa population is usually very fluid, so the remaining ten (10) never returned for admission because the families might have moved.
As of March 2020, International Medical Corps has fully adopted the Nutrition Sector’s COVID-19 Response Strategy, which in its entirety, will adapt the various guidelines including the IASC guidelines, Nigeria’s national guidelines, Global Nutrition Cluster guidelines and other guidelines recommended by UN Nigeria for nutrition programming.
One of the major mitigation measures IMC has undertaken under the COVID-19 context is to reduce acute malnutrition screening and mobile outreach services and suspend mass MUAC in favor of house to house screening. All partners are therefore expected to scale up and promote the Family/Mother MUAC approach which will lead to an increase in referrals of SAM children, an action which IMC began in March 2020.
Graph 1: Mass MUAC screening findings, disaggregated by sex
MUAC by Sex
191 200 180 160 148 140 120 106 100 86 80 59 52
60 TOTAL SCREENED TOTAL 29 33 40 20 25 12 7 10 12 7 11 9 20 3 1 0 0 1 0 1 0
WARD
<115 mm 115-124 mm
Activity 1.2 Family MUAC approach The Family MUAC approach was rolled out in all accessible LGAs. This approach trains mothers/caregivers to identify early signs of acute malnutrition in their children with the simple-to- use MUAC tape without having to visit a health facility or OTP, and before screening by the CNV. This is not a replacement for screening by health professionals or trained volunteers, but an additional measure to ensure children are regularly screened, often timelier and as effectively by mothers (or other family members) as by CNVs. Family MUAC has the potential of ensuring that cases of acute malnutrition are detected earlier, leading to less delayed presentations in the program. This approach is already showing positive outcomes in terms of increased referrals and fewer late admissions. As of March 2020, 38% of the trained mothers had correctly used and read the MUAC tape when verified during the training, and 34% of self-referrals were confirmed as accurate by the trained OTP staff in the six-month period. Performance indicators for this approach remained relatively low because of two (2) major reasons: the concept is new in the target communities, and increased insecurity affecting refresher trainings.
In total during the reporting period: • 71,815 caregivers received refresher training in the Family MUAC approach in Damboa (68,005 females and 3,810 males) • 24 self-referrals presented at OTPs in Damboa • 61,624 caregivers received refresher training on the Family MUAC approach in Maiduguri (49,982 females and 11,642 males) • 780 self-referrals presented at OTPs in Maiduguri.
2. Outpatient Management of SAM
Activity 2.1 Outpatient Therapeutic Program (OTP) for uncomplicated SAM among children 6-59 months.
International Medical Corps supported 15 OTPs across four (4) LGAs including one (1) facility-based site (Tashan Bala, in Jere LGA) and 14 outreach sites (4 in Jere, 2 in MMC, 1 in Konduga and 7 in Damboa). IMC and State Ministry of Health staff run all sites jointly. The minimum and maximum length of stay for every child in the OTP is eight (8) and 12 weeks, respectively.
During the reporting period, a total of 3,123 children aged 6-59 months were admitted for SAM treatment in International Medical Corps’ 15 operational OTPs. During this reporting period, the minimum Sphere standards were met for all performance indicators (see below, page 18).
3. In-patient Management of SAM with Medical Complications
Activity 3.1 Stabilization Center services for treatment of SAM with medical complications for children 6-59 months.
International Medical Corps operates a stabilization center (SC) in Damboa LGA for the management of SAM with medical complications among children 6-59 months and infants under six (6) months with acute malnutrition. It is the only SC in the LGA. A team of qualified IMC doctors (3) and nurses (10) provide 24-hour inpatient care to children under five referred to the facility. IMC recently added another cadre of staff, six (6) Community Health Extension Workers (CHEW), to assist the medical team on duty with general nursing activities and overall patient care under strict supervision/monitoring of the nurses on duty. UNICEF provides all essential therapeutic foods/milks and the majority of medical supplies, including pharmaceuticals through the grant from USAID/OFDA.
To ensure that the caregivers commit and are able to stay at the SC for the period needed, and to minimize the burden to their families, International Medical Corps continued to support a feeding subsidy program for one (1) caregiver per child admitted at the SC. A stipend of NGN600 (approx. USD 1.67) per day was provided for the period the child was admitted. This initiative fosters caregivers’ adherence to admission timeliness without having to worry about the impact on their family at home. This allows the children to complete their treatment as scheduled.
Grandmother wet nursing her grandchild at Damboa SC
4. Support referral services between SC and OTP
International Medical Corps works in collaboration with nutrition partners in Jere, MMC and Konduga LGAs, and refers all SAM cases with medical complications to nutrition partners operating SCs in these areas. IMC also receives referrals from nutrition partners operating SCs to provide follow-up for stabilized SAM cases that reside in communities within IMC OTP catchment areas. A similar synergy exists in Damboa between International Medical Corps and Médecins du Monde (MDM), ICRC, and UNICEF who provides passive screening and refers SAM cases without complications to IMC’s fifteen OTPs and SAM cases with medical complications to the SC. To avoid disruptions in referrals, coordination meetings took place in March and advocacy was conducted with the authorities to ensure nutrition activities including OTPs and SC are considered critical and would not be suspended during a possible lockdown on movement.
Sub sector 2: Indicators
Indicator 2.1: Number of health care staff trained in the prevention and management of acute malnutrition, by sex Number of health Baseline Target Reporting Cumulative Period Reached care staff trained in Period the prevention and Reached management of acute malnutrition Male 0 0 39 Female 0 285 395 Total N/A 200 285 434 (217%)
A total of 285 health care staff (lead mothers) (M= 0; F= 285) were trained during the reporting period.
Indicator 2.2: Number of Supported Sites Managing Acute Malnutrition, by type of facility (OTP, SFP, SC)
Number of supported sites managing acute Baseline Target Reporting Cumulative malnutrition Period Period Reached Reached Stabilization Center (SC) 1 1 1 1 Supplementary Feeding Program (SFP) 0 0 0 0 Outpatient Therapeutic Care (OTP) 15 15 15 15 Total 16 16 16 16 (100%)
All International Medical Corps supported sites were operational during the reporting period.
Indicator 2.3: Number of people admitted, rates of recovery, defaulters, deaths, relapses, and average length of stay for people admitted to CMAM sites, by sex; age: children 0<6 months, children 6<24 months, children ≥5 years, PLWs (10-14, 15-19, 20-49, 50+ years)
Table A: Number of people admitted to CMAM sites by sex and age Number of people admitted to CMAM Reporting Period Cumulative Period sites by sex and age Target Reached Reached F M Total F M Total 0-6 month 6 7 13 6 7 13 6-24 months 1180 852 1860 2269 1792 4061 24-59 months 710 339 1091 1279 849 2128 6202 Total 5,037 1896 1386 3282 3554 2648 (123%) Source: CMAM Monthly Report
A total of 3,282 children aged 6-59 months and 13 infants 0-5 months were admitted for SAM treatment in IMC’s 15 OTPs and SC. The figure includes 3123 new admissions in the OTP and roll over from the previous quarter.
Table B: OTP rates of recovery, defaulters, deaths, relapses, and average length of stay for people admitted to Management of Acute Malnutrition sites
Target Reporting Period Reached
Average Average Nutrition # of Recove Default Death Relapse length Recovery Default Death Relapse length of Program exit ry rate er rate rate rate of stay rate er rate rate rate stay 10 9.4 OTP 4,180 >75% <15% <10% 0% weeks 81% 8% 1% 2% weeks
A total of 4180 children were discharged from the fifteen OTPs during the reporting period.
• 3,394 (81%) discharged cured • 354 (8%) defaulted • 25 (1%) died because of anemia and late admission • 220 (5%) were non-responsive to treatment • 202 (5%) were transferred out either to the SC or hospital. The primary reasons for transfers included: severe respiratory distress needing a resuscitating machine and a need for transfusion.
Analysis by geographic areas
Maiduguri OTPs: MMC, Konduga and Jere (October 2019 to March 2020) • The performance indicators significantly improved in comparison to the last reporting period. • Recovery rates improved by 15% from 64% to 79% • Deaths rates remained at 0% • Defaulter rates improved from 15% to 13% (this is primarily attributable to extensive community outreach facilitated by IMC’s community network including CNVs and LMs conducting defaulter tracing, SBC and support provided during Care Group meetings and LMs’ house-to-house visits. • Non-Recovery (NR) rates decreased by 13% from 21% to 8% (this improvement may be attributed to a good treatment process and thorough follow up and home visits by Community Nutrition Volunteers as well as the positive effects of the Care Group Model). • Transferred remained unchanged at 0% • Average length of stay in the OTPs is currently eight (8) weeks
Damboa OTPs (October 2019 to March 2020) • All performance indicators are within acceptable Sphere standards • Recovery rates improved by 7% from 77% to 84% • Death rates remained at 1% • Defaulter rates improved from 6% to 3% • Non-Recovered rates remained unchanged at 2% • Transfers decreased from 14% to 10% (transfers out were mostly complicated cases that needed further observation in an inpatient facility or cases referred to other OTPs closer to the family’s home) • Average length of stay in Damboa OTPs is currently 10.2 weeks
Indicators for the stabilization center
Table C: SC rates of recovery, defaulter, death, relapse, and average length of stay for people admitted to CMAM sites, by sex; age: children 0<6 months, children 6<24 months, children ≥5 years,
Target Cumulative Period Reached
Nutrition Recovery Default Death Relapse Recovery Defaulter Death Relapse program # of exits rate rate rate rate rate rate rate rate
SC Total 162 >75% <15% <10% 0% 80.24% 3.1% 4.3% 0%
A total of 162 children exited the program during the reporting period; • 130 (80.24%) were stabilized and referred to the OTPs for continuation of treatment of SAM • 5 children (3.1%) defaulted • 7 children (4.3%) died while admitted at the stabilization center, mainly due to anemia and late admission into the program • 20 children (12.3%) were transferred to either another SC or hospital (Non Recovery). The main reasons for these transfers were severe anemia and patients in need of blood transfusion, a service not available in Damboa local government area.
Indicator 2.4: Number of people screened for acute malnutrition by community outreach workers, by sex; age: children ≤5 years, PLWs (10-14, 15-19, 20-49, 50+ years)
Number of people screened for malnutrition by Baseline Reporting Period Reached Cumulative Period Reached community outreach workers Female Male Total Female Male Total Female Male Total <5years 62,121 71,580 133,701 91,665 89,298 180,972 200,526 192,972 393,498 Total 62,121 71,580 133,701 91,665 89,298 180,972 200,526 192,972 393,498
A total of 180,972 children aged 6 to 59 months were screened for acute malnutrition during the reporting period. This number included screening by CNVs in the OTPs and at the community level. There is a significant probability of double counting as community screening is conducted monthly in the same locations. On top of these screenings by CNVs, 804 (24 in Damboa and 780 in Maiduguri) screenings were done under the Family MUAC approach mentioned previously, in addition to the total mentioned for this indicator.
Indicator 2.5: Number of Management of Acute Malnutrition sites rehabilitated
Number of Management of Baseline Target Reporting Cumulative Period Acute Malnutrition sites Period Reached rehabilitated Reached Total 0 1 0 0
During the reporting period, supervision visits conducted at the SC showed the facility needed some improvement to provide quality and safe treatment to children. A rapid needs assessment was conducted and needs were identified, which including the improvement of water supply, renovation of the solar panels, and renovation of the milk room. A Bill of Quantity (BoQ) was developed and discussions were held with OFDA field team. The renovations were later included in the cost modification.
IV II. Sector 2: Water, Sanitation, and Hygiene
Sector 1: Environmental Health
Activity 1: Collection and Disposal of Solid waste within the IDP camps
During the reporting period, International Medical Corps mobilized the community to conduct a total of 144 general environmental clean-up campaigns. During the clean-up campaigns, WASH Committees and Community Health Volunteers (CHVs) mobilized and distributed the cleaning materials to the targeted communities. Solid waste was collected into communal litterbins. A total of 100, 200-liter waste bins were installed at Bakassi IDP camps to increase the coverage of the communal waste collection points under the previous grant. Two (2) additional waste disposal sites were constructed at Bakassi IDP camp. Solid waste was collected at the temporary waste transition points before finally being disposed of at the local government designated safe dumping sites outside the camps. In Damboa, waste generated within all the camps (Hausari, Abori, Central and General Hospital) were dumped outside the camp at a government designated waste disposing site in Damboa.
Activity 2: Drainage system management in IDP camps
In Bakassi the 500-meter-long existing drainages were safely maintained every week to remove any obstructing material to permit the free flow of the water connected from water fetching point, and to prevent mosquito breeding near the water collection points. A total of 100 rakes were distributed to support the drainage management. In Damboa, seven (7) soak pits drainage channels were repaired with one (1) in each of the following camps, Central, Hausari and Abori, and four (4) are in General hospital IDP Camp.
Solid waste management at Bakassi IDP Camp
Sub sector 1: Indicators
Indicator 1.1: Number of people receiving improved service quality from solid waste management, drainage, or vector control activities (without double-counting)
Number of people Target Reached (This reporting Reached (Cumulative) receiving improved period) service quality from solid waste management, drainage, or vector control activities (without double-counting) Females 31,996 35,019 35,019 Males 26,179 30,616 30,616 Total 58,175 65,635 65,635(113%)
A total of 65,635 beneficiaries were reached by waste management and drainage activities in six (6) camps (1 in Maiduguri (Bakassi) and 5 in Damboa (Hausari, Central, Abori, General hospital and VTC (Low cost Camp)). During the course of the project, influxes of IDPs were recorded in the camps by SEMA, thus increasing the number of beneficiaries served.
Indicator 1.2: Average number of community cleanup/debris removal activities conducted per community targeted by the environmental health program
Average number of Baseline Target Reporting Cumulative Period community cleanup/debris Period Reached removal activities Reached conducted per community targeted by the environmental health program Total 240 144 164 (68%)
International Medical Corps mobilized the targeted communities and conducted on average, 24 community clean-up campaigns in multiple locations per month. IMC plans the continuation of the clean-up campaigns throughout the life of the project.
Indicator 1.3: Average number of communal solid waste disposal sites created and in use per community targeted by the environmental health program
Average number of Baseline Target Reporting Cumulative communal solid waste Period Period Reached disposal sites created and Reached in use per community targeted by the environmental health program 2 2 2 (100%)
Two (2) waste disposal sites were created at Bakassi Camp this reporting period for proper dumping of waste generated within the camp before safe disposal at government allocated sites outside the camp.
Indicator 1.4: Average number of persistent standing water sites eliminated via drainage interventions per community targeted by the environmental health program
Average number of persistent Baseline Target Reporting Cumulative Period standing water sites Period Reached eliminated via drainage Reached interventions per community targeted by the environmental health program 85 27 38 (45%)
A total of 27 standing water sites were eliminated during the reporting period, bringing the total number of sites to 38.
Indicator 1.5: Average number of vector control activities conducted per community targeted by the environmental health program
Average number of vector Baseline Target Reporting Cumulative control activities conducted Period Period Reached per community targeted by Reached the environmental health program 85 27 38 (45%)
A total of 27 stagnant water sites were filled with broken rubbles and broken construction materials (blocks) for leveling to level ground. This practice of filling water-logged locations in Bakassi and Damboa has reduced the presence of rodents and vector breeding.
Sub-Sector 2: Hygiene Promotion
International Medical Corps’ WASH teams in MMC and Damboa worked in collaboration with trained CHVs in five (5) camps (Bakassi, General Hospital, Central Primary School, Hausari and Abori) to mobilize targeted communities to promote health-supporting hygiene practices and mitigate the risks of water and sanitation-related diseases. The CHVs were selected during the previous grant based on community acceptance, commitment and willingness to serve the community as volunteers.
Activity 1: Hygiene promotion and sensitization: Hygiene campaigns
International Medical Corps continued community mobilization on hygiene promotion at Bakassi IDP Camp in Maiduguri, and five (5) IDP camps in Damboa. The volunteer workforce consists of 70 CHV (M=31; F=39) with 40 based in Damboa and 30 in Bakassi. These volunteers are supervised by 12 supervisors (M=9; F=3) with five (5) in Bakassi and seven (7) in Damboa. Hygiene promotion sessions were conducted for a minimum period of three (3) hours per day, five (5) days per week. Each CHV Supervisor remains responsible for at least six (6) CHVs to ensure community mobilization activities are delivered.
International Medical Corps’ hygiene promotion strategy is key to behavior change through improved hygiene practices and places an emphasis on hand washing at critical times due to disease outbreaks like Lassa Fever, cholera, diarrheal diseases and now, COVID-19. The community volunteers regularly visited the assigned households and conducted the risk communication and hygiene promotion activities to raise awareness on key hygiene related themes. In March 2020, hygiene promotion was expanded to include NCDC and WHO approved messages on COVID-19 prevention.
In addition, IMC trained five (5) groups of ten (10) WASHCOMMS each for a total of 50 persons in Maiduguri and ten (10) groups with 100 persons in Damboa camps. To ensure gender equality and mainstreaming, a ratio of 50:50 male to female was targeted during WASHCOMM selection.
The 70 members of supported school WASH clubs in Bakassi and the 50 active members across the camps in Damboa, also continued to receive training on improving basic hygiene behaviors and skills to reach out to peer groups. Support of these WASH clubs continues to focus on the “catching them young” principal of behavioral change among young age groups and their parents. From informal feedback received from the WASH club members, IMC has learned that WASH club members are cascading information learned to their peers and parents related to safe water transport and storage, and handwashing at critical times.
School WASH Club hygiene promotion session in Bakassi IDP camp
Hygiene promotion campaign at Bakassi IDP Camp
Activity 3: Cholera emergency preparedness and response plan
During the reporting period, IMC continued preparing for an outbreak of cholera. No cases of cholera were reported in the camps supported by IMC with a population of over 60,000. Community mobilization continued, and was conducted by 70 Community Health Volunteers (CHV). Other activities carried out by the volunteers included: communal hygiene promotion and house-to-house sensitization around cholera prevention, hygiene awareness campaigns, cholera kit distribution, latrine and household disinfection, water quality testing and water point chlorination. Additional cholera response materials were procured and prepositioned in camps including knapsack sprayers, gum Boots, plastic protective clothing, masks, eye protection goggles, heavy duty gloves, and pool testers for Free Residual Chlorine (FRC) checks. All CHVs and water monitors were given on-the- job refresher training on cholera response including topics such as community mobilization, awareness campaigns, case identification and prevention as well as early referral pathways.
Sub sector I1: Indicators
Indicator 2.1: Number of people receiving direct hygiene promotion (excluding mass media campaigns and without double-counting)
Number of people receiving Baseline Target Reporting Cumulative direct hygiene promotion Period Period Reached Reached (excluding mass media campaigns and without double-counting) Females 30,957 31,481 36,287 Males 24,957 29,915 26,690 55,935 58,175 61,396 65,977 (113%)
A total of 61,396 people received direct hygiene promotion. The number of beneficiaries continues to exceed the target because after the start of the project, some camps, including Bakassi, experienced a rise in IDP population.
Indicator 2.2: Percent of people targeted by the hygiene promotion program who know at least three (3) of the five (5) critical times to wash hands
Percent of people Baseline Target Reporting Cumulative Period targeted by the hygiene Period Reached Reached promotion program who know at least three (3) of the five (5) critical times to wash hands Females 93.2% Males 74.7% 90.5% 80%4 90% 90% (125%)
Based on the semi-annual WASH survey, 90% of beneficiaries have knowledge of at least three (3) of the five critical times to wash hands. The sustained percentage of people with good knowledge of the critical times for handwashing is due to the weekly hygiene promotion conducted throughout the life of the project.
Indicator 2.3: Percent of households targeted by the hygiene promotion program who store their drinking water safely in clean containers
Percent of Baseline Target Reporting Cumulative households targeted Period Period by the hygiene Reached promotion program Reached who store their drinking water safely in clean containers 81.1% 65% 69% 69% (106%)
A recently conducted WASH HH survey has shown 69% of beneficiaries store their water in safe and clean containers. This can be attributed to the weekly jerry can cleaning campaigns monitored by CHVs across all camps. The baseline was conducted after a distribution of jerry cans, which led
4 IMC set this target for the ‘Percent of people targeted by the hygiene promotion program who know at least three (3) of the five (5) critical times to wash hands’ and ‘Percent of households targeted by the hygiene promotion program who store their drinking water safely in clean containers’ prior to the completion of the initial baseline survey, and based on the first WASH household survey, will seek to revise the targets for these indicators in the next reporting period. to the high percentage of persons storing their drinking water safely. IMC intends to provide new jerry cans to beneficiaries during the next reporting period, and will continue conducting cleaning campaigns as well as sensitization on the importance of keeping containers clean. In order to take into account baseline values and the most recent WASH HH survey, IMC will aim to revise the to 85% in the next reporting period.
Sub-Sector 3: Sanitation
Activity 1: Rehabilitate emergency temporary sanitary facilities (latrines and showers)
Since December 2019, International Medical Corps has been fully in charge of WASH services in Bakassi IDP Camp, and four (4) camps in Damboa due to the “single partner per camp rationalization” strategy recommended by the WASH sector. During this period, International Medical Corps conducted major rehabilitation of 30 blocks of six (6) units of latrines and showers, and minor rehabilitation of 34 blocks of six (6) latrines and showers in Damboa. In Bakassi IDP Camp, a total of 50 blocks of latrines and showers underwent major rehabilitation during the reporting period. With these rehabilitations, IMC has achieved a ratio of latrines per person of 1:36 in Bakassi and 1:24 in Damboa against the 1:20 target according to the Sphere standards. International Medical Corps plans to further rehabilitate 114 blocks of WASH facilities including 64 in Bakassi and 50 in Damboa IDP camps in a proposed cost modification to further improve the latrine ratio.
For all rehabilitation work, International Medical Corps used a monitoring and WASH supervision team to monitor WASH construction work and repairs to ensure completion based on IMC and Sphere standards. The team was comprised of WASH technicians who were assisted by camp-based WASH volunteers. IMC was fortunate to complete all major rehabilitations prior to the COVID-19 pandemic and lockdown in Borno State and faced no significant issues with daily workers hired to complete the work.
Routine operation and maintenance (O&M) activities for existing sanitary facilities continued and included: minor repairs and routine cleaning by community groups set-up in all locations (Damboa and Bakassi). Four (4) (all male) artisans, including carpenters and plumbers, are responsible for routine repairs on sanitary and water systems in all the camps where IMC is operational.
Activity 2: Improve usage, cleaning and maintenance of sanitary facilities (Latrines and Showers
After taking full responsibility of the camps as mentioned above, International Medical Corps is now supporting a total of 109 latrine cleaners in Bakassi and 76 in Damboa who received latrine cleaning kits for regular daily latrine cleaning. Each group will continue to receive sanitary equipment kits, including hand gloves, face google, gum boots and masks. Additional cleaning materials provided weekly included detergent powder, disinfectant liquid, brooms, steel buckets, scooping devices, and soap for hand washing.
Sub sector III: Indicators
Indicator 3.1: Number of people directly utilizing improved sanitation services provided with OFDA funding
Number of people directly Baseline Target reporting Cumulative utilizing improved sanitation period Period Reached services provided with OFDA reached funding Females 34,130 36,287 Males 31,505 26,690 56,670 58,175 65,635 65,977 (113%)
A total of 65,635 direct beneficiaries received services rendered by improved sanitation facilities. The number of beneficiaries exceeded the target because of additional beneficiaries in Bakassi and the addition of Low Cost IDP Camp as a project site in Damboa.
Indicator 3.2: Percent of latrines/defecation sites in the target population with hand washing facilities that are functional and in use
Percent of latrines/defecation sites in Baseline Target Reporting Cumulative the target population with hand period Period Reached washing facilities that are functional reached and in use 41.8%* 50% 30% 30% (60%)
Based on the recent WASH household survey report, only 30% of latrines have functional hand washing stands as most of the households prefer to use local plastic kettles for this purpose. Based on the recommendation from a visit from the USAID Global WASH Advisor in 2018, hand-washing facilities were replaced with the distribution of plastic kettles to each household. This was primarily due to the destruction of hand washing facilities that were put in place and to ensure the appropriateness and cultural acceptance of kettles for the pouring of water for hand washing at a variety of locations. IMC program and MEAL team will discuss a better and realistic way to capture this indicator in the context of IPD camps in Borno State.
Indicator 3.3: Number of people per safe bathing facility completed in target population
Number of people per safe Baseline Target Reached Cumulative Period bathing facility completed (This Reached in target population reporting period) N/A 50 43 43 (86%)
Following the recently completed rehabilitation and construction of an additional 10 shower blocks of 5 compartments, the project has attained the ratio of 43 persons per shower, reaching the Sphere standard of less than 50 people per shower.
Rehabilitation of shower blocks at Bakassi IDP camp
Indicator 3.4: Percent of excreta disposal facilities built or rehabilitated in health facilities that are clean and functional
Percent of excreta disposal Baseline Target Reached Cumulative facilities built or rehabilitated in (This Period Reached health facilities that are clean and reporting functional period) N/A 80% TBD TBD
The construction and rehabilitation of latrines were completed at the end of the last period. The facilities will be assessed after three (3) months of use as per the performance indicator reference sheet. Data for this indicator will be provided during the next reporting period.
Sub-sector 4: Water Supply
International Medical Corps continued trucking approximately 220m3/day of water to supplement water supplied to camps from jet wells, which supplies 60,000 liter daily to Abori camp, solarized boreholes at Hausari IDP Camp, which produces 40,000 liters per day, and four (4) hand pumps with a daily production of 7,000 liters. Six (6) new jetting pumps have been procured to boost water supply in Abori and Central IDP camps in Damboa. International Medical Corps also operates and maintains nine (9) boreholes at Bakassi IDP Camp. The boreholes were installed with automatic chlorine e-dosing pumps during previous grants. The average water supply per person per day was 21 liters following the increase in WASH facilities rehabilitated and the installment of new solar panels (31 pieces of 220 watts) which replaced damaged and non-functional ones in Bakassi Camp. International Medical Corps also continued to monitor the water supplied to camps in Damboa and Bakassi IDP Camp in Maiduguri. FRC levels are monitored daily at randomly selected households and at water distribution points. The water quality, in terms of physicochemical and microbiological testing, are monitored weekly. A total of six (6) hand pumps in Bakassi, and 14 in Damboa are maintained by the pumps operators who perform minor repairs like connecting rod replacement, fixing chains, raising pipes or replacing cylinders.
New Solar panels replacing damaged ones for optimal water supply in Bakassi Activity 1: Rehabilitate and upgrade water sources and distribution systems During the reporting period, three (3) additional boreholes were upgraded with solar power (solar panels) and 5,000 Liters water storage water tanks for improved water supply. They were installed with automated chlorine dozing pumps for constant water treatment (chlorination). Reticulation of new lines mounted with six tap heads were completed in Bakassi to seven (7) new locations, and five (5) locations in Damboa. A total of 14 steel tank stands were also installed in Damboa to replace sandbags as mounts for overhead water storage tanks. Activity 2: Improve water quality, water testing and monitoring.
International Medical Corps has procured H2H bacteriological test vials for water quality testing at the household level and sets of pool testers for FRC monitoring and reporting by water monitors and quality monitoring. Three (3) sets of turbidity meters were also used during the reporting period for turbidity checks of all hand pumps and trucked water.
Sub sector 1V: Indicators
Indicator 4.1: Number of people directly utilizing improved water services provided with OFDA funding
Number of people Baseline Target Reached (This Cumulative directly utilizing improved reporting period) Period water services provided Reached with OFDA funding
56,670 58,175 65,635 69,977 (113%)
The figure represents the number of people in IDPs camps served by IMC.
Indicator 4.2: Average liters/person/day collected from all sources for drinking, cooking, and hygiene
Average liters/person/day Baseline Target Reached (This Cumulative collected from all sources reporting Period Reached for drinking, cooking, and period) hygiene 20 15 21 21 (140%)
The average number of liters provided on a daily basis is estimated at 21 liters/person/per day. The figure is significantly above the Sphere standard of 15 liters/per person/day.
Indicator 4.3: Percent of households targeted by WASH program that are collecting all water for drinking, cooking, and hygiene from improved water sources
Percent of households Baseline Target Reporting Cumulative Period targeted by WASH Period Reached Reached program that are collecting all water for drinking, cooking, and hygiene from improved water sources 97.6% 70%5 100% 100%
All households in IMC-supported camps collect water from improved water sources.
Indicator 4.4: Percent of households whose drinking water supplies have a free residual chlorine (FRC) > 0.2 mg/L
Percent of Baseline Target Cumulative Reached (Cumulative) households whose Period Reached drinking water supplies have a free residual chlorine (FRC) > 0.2 mg/L 48% 80% 90% 90% (112%)
Ninety percent (90%) of households have drinking water with FRC> 0.2mg/L. Aqua tabs are provided as a stop gap measure for households whose FRC levels is <0.2 mg/l especially those utilizing hand pumps, which are not chlorinated at the source. Households with FRC<.2mg/L are mainly those who are non-compliant with aquatab treatment at hand-pump locations, and IMC continues to increase its monitoring and sensitization through CHVs to improve aquatab usage.
5 The target for this indicator was set prior to the baseline survey, and IMC will seek to revise the target to 100% in the next reporting period.
Indicator 4.5: Percent of water points developed, repaired, or rehabilitated with 0 fecal coliforms per 100 ml sample
Percent of water Baseline Target Cumulative Reached (Cumulative) points developed, Period Reached repaired, or rehabilitated with 0 fecal coliforms per 100 ml sample 53% 80% 100% 100% (125%)
All rehabilitated water sources are chlorinated and water samples are analyzed by the use of DelAqua kits for bacteriological checks before use by the community. FRC free residual chlorine is monitored every day for all boreholes, a turbidity test is conducted one-time once rehabilitation work is completed, and where hand pumps are used for drinking water supply, H2S test vials are used to check for water contamination at selected households.
Indicator 4.6: Percent of water user committees created and/or trained by the WASH program that are active for at least three (3) months after training
Percent of water user Baseline Target Reached Cumulative committees created and/or (This Period Reached trained by the WASH program reporting that are active for at least three period) (3) months after training 100% 80% 100% 100% (100%)
All WASHCOMMs created are active in the camps supported by IMC and have for at least three (3) months after training. Based on the level of performance, IMC will seek to revise the target for this indicator to 100% in the next reporting period.
Sub-sector 5: WASH Non-Food Items (NFI)
No distribution of NFIs was conducted during the reporting period. Distributions of NFIs will take place during the next reporting period.
Sub sector V: Indicators
Indicator 5.1: Total number of people receiving WASH NFIs assistance through all modalities (without double-counting)
Total number of people receiving Baseline Target Reached Cumulative WASH NFIs assistance through (This Period Reached all modalities (without double- reporting counting) period) N/A 39,216 0 0
No WASH NFIs were distributed during the reporting period. Distributions of NFIs will take place during the next reporting period.
Indicator 5.2: Percent of households reporting satisfaction with the contents of the WASH NFIs received through direct distribution (i.e. kits) or vouchers
Percent of households reporting Baseline Target Reached Cumulative satisfaction with the contents of (This Period Reached the WASH NFIs received reporting through direct distribution (i.e. period) kits) or vouchers N/A 80% N/A N/A
No WASH NFIs were distributed during the reporting period. Distributions will take place in the next quarter.
Indicator 5.3: Percent of households reporting satisfaction with the quantity of WASH NFIs received through direct distribution
Percent of households reporting Baseline Target Reached Cumulative satisfaction with the quantity of (This Period Reached WASH NFIs received through reporting direct distribution period) N/A 80% N/A N/A
No WASH NFIs were distributed during the reporting period. Distributions will take place in the next quarter.
IV.3. Sector 3: Protection
Sub-sector: Prevention and Response to Gender Based Violence
Protection/GBV activities under this grant continued to contribute specifically to the GBV sub-sector strategy in Borno through comprehensive response services and prevention activities. In all project implementation sites, IMC worked in close collaboration and coordination with UN agencies and INGOs including UNHCR, UNFPA, UNICEF, Médecins Du Monde (MdM), International Rescue Committee (IRC), Mèdecins sans Frontieres (MSF) and local partners including the Borno State Ministry of Health (SMoH) to provide emergency services. These services included: GBV case management, individual and group psychosocial support services, and referral to other response services including legal and medical services. International Medical Corps uses a comprehensive survivor-centered approach in case management services to promote resilience and empowerment among GBV survivors. In addition, through community prevention activities, including direct outreach, small group discussions, and advocacy with political, traditional and religious leaders, targeted campaigns, and awareness events, the team helped to mobilize communities to address root causes of GBV as well as to mitigate risks. The team also shared information on available services and promoted support for survivors.
International Medical Corps continues to be the lead for inter-agency GBV coordination in Mohammed Goni Stadium and Bakassi IDP camps, and Shehuri North community, in MMC LGA, and in Damboa LGA. During this reporting period, IMC’s Protection team organized 19 GBV working group meetings. A total of six (6) were held in Damboa, six (6) in Mohammed Goni Camp, six (6) in Bakassi IDP Camp, and two (2) in Shehuri North community of MMC. The main topics discussed during these meetings included: service mapping to inform referral pathway development and/or revisions, coordination of dignity kit distribution and capacity building of service providers to fulfill their roles and responsibilities, safety audits, and coordination of community education activities (especially in Mohamed Goni). In March 2020, through coordination meetings, partners agreed to increase the frequency of referral pathway revisions to ensure details of service providers are accurately updated.
1. Focused Response Services for Survivors of GBV
Activity 1.1. Case management services
In the reporting period, survivors of a total of 359 GBV incidents received case management and psychosocial support services from trained Case Workers at nine (9) IMC Women Friendly Spaces (WFS) in Maiduguri (5) and Damboa (4). Incidents reported included: 148 (41%) cases of denial of resources, services and opportunities, 107 (30%) cases of physical assault, 54 (15%) cases of psychological and emotional abuse, 25 (7%) cases of rape, 16 (4%) cases of forced marriage and 9 (3%) cases of sexual assault.
Regarding incident location, the vast majority of the incidents reported between October 2019 and March 2020, were perpetrated in the survivor’s residence (74%), while at the perpetrator’s residence in (15%) and other locations (11%.) Other locations include: unoccupied/abandoned buildings, and street/pathways, among others. These results reflect the high percentage of perpetrators as intimate or former partners.
One hundred percent (100%) of the survivors were female, and 87% (311) were adult survivors while 13% (48) were children at the time the incident occurred. Based on survivors’ specific needs, and with their consent, they were referred to other providers for appropriate services. These services ranged from facilitating survivors to access medical care, child protection, safety/security, legal and shelter as appropriate. Two (2) of the 359 survivors were referred for Mental Health and Psychological Support (MHPSS) services following initial assessment and case management.
Referrals to medical services were not universally accepted with a total of 78 referrals rejected out of 127 where medical services were deemed relevant. It must be noted that survivors’ refusal for medical services is primarily because the majority of incidents are perpetrated by intimate partners, and cultural beliefs and societal pressures prevent them from reporting their spouses. A total of 14 survivors who endured rape out of 25 (56%) reported to our services within 72 hours and all were referred appropriately and within the time window to be provided with PEP and HIV treatments. Five (5) reported within 120 hours and only two (2) of them accepted emergency contraception to prevent unwanted pregnancies; the remaining three (3) declined referral because the alleged perpetrators were intimate partners. Five (5) other rape survivors reported within two (2) weeks and received treatment for sexually transmitted infections (STI), and one (1) reported after a month of the incident but declined referrals.
With reference to referrals to security/police, a total of 48 survivors out of 50 (96%), where services were deemed relevant, declined referrals expressing intimate partner violence should be settled by family and that reporting to police may result in divorce which is not acceptable by their culture and tradition.
Livelihood services were deemed relevant for 162 survivors, but were not available to 139 (86%) due to lack of livelihood programs in most areas of implementation. Where services are available, twenty- three (23) declined this referral, and ten (10) survivors accepted referrals to livelihood services. IMC will continue to advocate for protection-focused livelihood services through the GBV sub-sector to improve the referral of those in need of livelihood support.
Figure 1: Types of GBV Incidents Reported from 1st October 2019 to 31st October 2020 (n=359)
3% Denial of Resources, Opportunities 7% or Services 4% Psychological / Emotional Abuse
41% Physical Assault
Forced Marriage 30%
Rape
Sexual Assault 15%
Activity 1.2. Outreach for case management
Ninety-two (92) community outreach volunteers conducted awareness raising sessions on the types, causes and consequences of GBV, service availability and the importance of timely reporting of incidents. Following community-based activities, survivors, especially women and adolescent girls, felt more confident to reach out to outreach workers for information on how to access services at the WFS. These interactions between volunteers and the community through awareness raising sessions serve as the major entry point for case management services, and during this reporting period, approximately 35% of survivors received at Women Friendly Spaces were referred by community volunteers.
2. Safe Spaces to Promote Psychosocial Support and Empowerment for Women and Girls
Activity 2.1. Women’s Friendly Spaces (WFS):
During the reporting period, construction of two (2) semi-permanent WFSs was completed in Damboa (Unity Camp), and Maiduguri (Mohammed Goni IDP Camp) to accommodate the growing number and needs of women and adolescent girls in the camps. The nine (9) WFSs continue to serve as a refuge for women and adolescent girls in the community.
A total of 2,520 women (1,524) and adolescent girls (926) visited a WFS during this reporting period. Of the 2530 participants, 38% (1008) were regular attendees while the remaining 62% (1512) visited the centers as intermittent users. The women and adolescent girls participated in activities including group education sessions on GBV topics and recreational sessions (henna decorations, traditional dances, art, games, etc.). The WFS is a place where women meet with other women and share their thoughts and experiences on a variety of issues they are facing, from the violence and humanitarian crisis to their personal lives and, with the help of others, reshape their lives and build resilience. Women and adolescent girls also take advantage of the safe space to be relieved of other tasks at the household level including family care. Adolescent girls use this space to discuss issues that affect them as youth transitioning to adulthood with their peers while building support systems to help them overcome the issues they face every day or may face in the future. In consultation with WFS beneficiaries, IMC developed a contingency plan in preparation for COVID-19 response to mitigate potential risk of the virus at WFS and the community level. Key recommendations have been followed which included increased frequency of activities and reducing the number of women and girls to 15 members per session, implementing physical distancing, increase hand washing stands from one (1) to two (2) at WFS, positioning of hygiene supplies (hand sanitizers, face masks) within each WFS. Furthermore, in April 2020, the team will organize consultation meetings with women and girls to collect their inputs on the effect of COVID-19 and recommendations for response.
Activity 2.2. Learning activities:
A total of 2,520 women and adolescent girls participated in age-appropriate skills acquisition activities (embroidery/hat crafting, crocheting, pasta making, basic literacy and numeracy sessions). In preparation for COVID-19 prevention and response from the 23rd to 31st March 2020, the WFS activity calendar was revised. For example, in the revised calendar, each day in a week has been allocated to one activity with 15-20 women per session to respect physical distancing. Women and adolescent girls are learning from one another while receiving material support from International Medical Corps. The time devoted to these activities provide women with a forum to enhance their social networks as they learn. Many of the women have stated that these activities are not only therapeutic but the end product gives them a sense of self-worth and accomplishment.
3. Risk Mitigation and community prevention
Activity 3.1. Capacity Building for service providers and other Implementation partners:
During the period under review, a total of 100 service providers (M=47; F=53) participated in three -day trainings with topics including GBV concepts, guiding principles, referral pathways, psychological first aid, and the Gender-Based Violence Information Management System Plus (GBVIMS+). Pre and post-tests showed an average knowledge gained of 65%.
Trainings conducted by IMC from October 2019 to March 2020:
Target Location group Topics Male Female Total
Protection 2-day training on core GBV basic 15 08 23 actors concepts, PSEA and referral pathways Damboa Sub total 15 08 23 IMC’s Two 2-day refresher training on GBV Community basic concepts, referral pathways, guiding 20 32 52 Outreach principles and PSEA Volunteers Maiduguri Service 2-day trainings on GBV guiding providers 12 13 25 principles, and referral pathways Training Sub total 32 45 77 Total 47 53 100
Activity 3.2. Community Sensitization:
A total of 166,887 people were reached through prevention, outreach and mass awareness activities during this period. The team covered a number of topics including:
- Rape: its consequences and the importance of reporting within 72 hours - Physical assault - Denial of opportunities and services - Emotional abuse - The effects of forced marriage on the girl child, and the importance of timely reporting of GBV incidents
These awareness sessions were conducted through house-to-house visits, group sessions in market places and water collection points, by use of public address systems and megaphones, and on international events. Continuous and consistent awareness messages have left the community members with a better understanding of rape, its consequences and impact, and where survivors can access services. As one example, from the information gathered from 359 survivors of GBV who received services from IMC, when asked about their source(s) of information on available services, they indicated that they were referred by community leaders, youth leaders, outreach volunteers, and family members/friends.
In November 2019, International Medical Corps finalized a plan for monthly radio talk shows in consultation with key stakeholders to plan shows aimed at reaching the wider community audience with Protection/GBV messages. In implementing this plan, ten (10) radio discussion were organized from November 2019 to March 2020, on topics ranging from the concepts, causes and forms of GBV, benefits of women’s empowerment, WFS activities, to GBV referral pathways. The frequency of radio shows increased in November 2019, and March 2020, due to the 16 Days of Activism campaign (November to December), and during International Women’s Day (IWD) in March 2020. All radio sessions were live with phone-in calls to allow listeners to contribute to the topic. For example, during a radio program in March, some general concerns raised by listeners were the lack of humanitarian presence in some communities and GBV intervention for men The radio discussion plan will be reviewed in April 2020, to include education session on COVID-19 prevention measures.
2020 International Women’s Day Celebration, MMC LGA
Furthermore, the GBV team worked closely with local authorities, key government organizations and other implementing partners to plan and implement the commemoration/celebration of special days including the 16 Days of Activism against GBV and IWD. During 2020, IWD celebrations, IMC organized an exhibition to spotlight the skills, creativity, and resilience of women and girls from 13 WFSs (including four (4) WFSs supported by the Government of the Netherlands (GoN) from Mafa, MMC and Jere LGAs). These events resulted in a high turnout of participants in prevention and risk mitigation efforts.
Activity 3.3. Engagement of men and adolescent boys:
During the reporting period, International Medical Corps collaborated with local leaders and initiated male engagement activities. To date, three (3) sports clubs have formed in IDP camps and host communities to expand the process of targeting men and gaining male involvement and support in GBV prevention and response. For example, during the 16 Days of Activism campaign in December 2019, four (4) sporting events were organized to increase men and boys’ participation in GBV prevention activities. Throughout the matches, the team displayed slogans and chanted GBV messages to stimulate discussion on GBV causes, contributing factors, etc. A total of 1,436 (M=1,051; F=385) audience members benefited from these events.
Male community dialogue session
In December 2019, IMC worked closely with Translators Without Borders (TWD), to translate the community dialogue guide into local languages (Kanuri and Hausa) to ensure that target audiences who are literate in these languages have access to GBV information and are able to disseminate to other community members. The guide contains GBV topics, consequences, and service availability, etc. These topics were carefully selected in consultation with women and adolescent girls to ensure their voices and concerns are discussed with men and boys. The English version of the guide has been printed and is currently used for community dialogue sessions with groups of men and adolescent boys.
Activity 3.4. Conduct quarterly safety audits:
In this reporting period, International Medical Corps engaged women (106) and adolescent girls (53) in discussions about protection risks through ten (10) meetings carried out in five (5) different sites. An average number of 11 beneficiaries were targeted at each site to discuss identified risks and potential mitigation strategies. Focus group discussions (FGD) were held with the selected beneficiaries where they had the opportunity to elaborate more on their concerns, risks, and challenges and faced at the sites, as well as suggest possible recommendations. The team also used observation and a safety audit checklist to collect quantitative data. Through these engagements, women recommended the installation of additional solar lights in strategic locations in some camps (Muhammed Goni and Bakassi). IMC has shared this recommendation with IOM, who is in charge of camp coordination and management in these locations. Progress on this will updated in the next reporting period.
Activity 3.5. Distribution of appropriate risk mitigation support materials to vulnerable women and adolescent girls:
No risk mitigation supplies were procured during this reporting period. Distribution of dignity kits will take place under the next reporting period.
Activity 3.6. GBV trainings for community leaders:
In January 2020, a two-day training on the basic concept of GBV, consequences, PSEA and the roles and responsibilities of leaders in GBV of response to GBV was organized in Maiduguri. Twenty-four (24) leaders (M=14; F=10) participated in the training. Two (2) planned trainings for community leaders have been postponed to May/June due to COVID-19.
Sub-sector I: Indicators
Indicator 1: Number of individuals accessing GBV response services
Number of individuals Target Reached for the reporting period accessing GBV response Cumulative Period Reached services Female Male Total Female Male Total Under 5 years 0 0 0 2 0 2 5-9 years 0 0 0 0 0 0 10-14 years 13 0 13 19 0 19 15-19years 36 0 36 61 0 61 20-49 years 296 0 296 503 0 503 50+ years 14 0 14 21 0 21 TOTAL 700 359 0 359 606 0 606
Indicator 2: Number of dollars allocated for GBV programming, USD amount
Number of dollars Baseline Target Reporting Cumulative allocated for GBV Period Period Reached programming, USD Reached amount $ 735,268.65 $ 735,268.65 $303,741.21 $463,143.13
Indicator 3: Number of individuals accessing GBV risk mitigation activities
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Number of individuals Cumulative Period Reached accessing GBV risk mitigation Target Reporting Period Reached activities Female Male Total Female Male Total Under 5 years 0 0 0 0 0 0 5-9 years 3,534 3,570 7,104 6,200 5,910 12,110 10-14 years 15,934 14,986 30,920 22,725 20,749 43,474 15-18years 17,763 17,811 35,574 29,011 27,527 56,538 19-49 years 44,011 20,889 64,900 65,013 32,110 97,123 50+ years 13,119 15,270 28,389 21,618 23,171 44,789 TOTAL 150,000 94,361 72,526 166,887 144,567 109,467 254,034
Custom indictor 1: Percentage of rape survivors who report within 72 hours of incidents and are referred for appropriate clinical care
CUSTOM INDICATOR 1: Target Reporting Cumulative Percentage of rape survivors Period Period Reached who report within 72 hours of Reached incidents and are referred for appropriate clinical care 80% 100% 100%
Of the 25 survivors who reported rape, 14 reported within 72 hours and all 14 were referred in a timely manner to appropriate clinical care.
Custom indicator 2: Number of vulnerable women and girls participating in PSS and empowerment activities in the WFS, age: <5, 5-9, 10-14, 15-19, 20-49, 50+
CUSTOM INDICATOR 2: Cumulative Period Number of vulnerable women Reporting Period Target Reached and girls participating in PSS and Reached empowerment activities in WFS
Female Total Female Total Under 5 years 0 0 0 0 5-9 years 120 120 120 120 10-14 years 693 693 965 965 15-19 years 579 579 960 960 20-49 years 1,089 1,089 1,749 1,749 50+ years 466 466 875 875 TOTAL 1000 2,947 2,947 4,679 4,679
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This figure (2,947) represents women and adolescent girls who participated in PSS and empowerment activities in Women Friendly Spaces during the reporting period.
5. SUCCESS STORIES
SYNERGY BETWEEN IMC’s NUTRITION, WASH AND GBV INTERVENTIONS: Damboa
Introduction The UNICEF conceptual framework for nutrition has been very influential in the design and implementation of nutrition strategies for the last three decades. It provides the conceptual base to expand courses of action focused on improving children’s nutrition beyond the conventional set of nutrition-specific interventions. The framework classifies drivers affecting nutrition into a plethora of connected facets (food security, health services and child care) therefore arguing in favor of investments on a broader mix of early child development, schooling, healthcare, social protection, agriculture, and food security interventions. Consequently, policies that ameliorate food security alone cannot reduce undernutrition, if for instance, the community lacks appropriate levels of safe water and sanitation or prenatal health services. In fact, community level coverage of toilets has convincingly proven to matter more in malnutrition reduction than household level coverage in multiple contexts6.
With the ongoing conflict and frequent displacement, the vulnerability of women and girls has only increased in an already patriarchal society. International Medical Corps’ (IMC) interventions principally support the immediate and urgent needs of children aged 6-59 months, women and adolescent girls and reduce their isolation and help them to build relationships and links to services. IMC’s Nutrition team engages and sensitizes communities on the organization’s WASH and GBV programs and the importance of gender equality. Additionally the team targets male figures using community dialogues for attitudinal change to promote good IYCF practices, proper hygiene and sanitation as well as enhancing women’s safety and equal opportunities within the community.
Through community based structures like Lead Mothers, Community Nutrition Volunteers (CNVs) and Women Friendly Spaces, IMC continues its drive to strengthen gender balance in bodies that represent the interests of IDPs and host communities. This ‘modus operandi’ assures that women’s voices and concerns are at the forefront of community involvement throughout service provision. IMC also identified and trained CNVs, 60% of which are men. This idea of male involvement in hygiene promotion activities and community forums counters the notion that hygiene or childcare is exclusively a female issue.
The joint implementation of these vital programs (Nutrition, WASH and GBV) by IMC in Damboa Local Government Area (LGA) is an enormous achievement and major landmark in the humanitarian
6 Jose Cuesta & Laura Maratou-Kolias (2019). WASH and Nutrition Synergies: The Case of Tunisia. The Journal of Development Studies, 55(9), 2024-2045.
46 International Medical Corps-Nigeria 720FDA19GR00123 Semi-annual report context. The joint effects of these components brings about a complete package of functional humanitarian response implementation to ensure the sustenance of life.
Damboa Story A typical case, was that of a Nursing Mother*, who had been serially emotionally and physically assaulted by her husband from whom she requested money to buy food for her children. This mother of nine resides in one room, with poor access to good toilet facilities and clean water. To add more misery to her already very dire situation, her youngest child was passing diarrhea of several episodes and vomiting.
As the emotional and physical abuse continued unabated, a victim’s close friend took it upon herself to intervene and referred her to the nearest IMC Women Friendly Space in Damboa where she met with an IMC Case worker. During consultative engagement with the mother, the IMC GBV Case worker also made two striking observations; the victim looked malnourished (thin), tired and dirty and upon further probing, uncovered that she hadn’t had a proper meal for about a day prior to her presentation at the GBV center. Furthermore, this mother was nursing a visibly ill ten month old baby passing copious watery stool, vomiting and unable to breastfeed, obviously needing urgent medical care and nutritional rehabilitation.
The mother and her child were immediately referred to the IMC Nutrition Stabilization Centre, where children presenting with Severe Acute Malnutrition (SAM) with medical complications are treated. The mother was fed rice and meat stew whilst resident IMC Medical Doctors and Nurses treated her baby using intravenous medications and therapeutic milk (F75 and F100) free of charge. The mother was also given a daily feeding allowance of 600 Naira during her stay in the Stabilization Centre. She also benefitted from the daily counseling, health education and sensitization done jointly by the WASH team and Community Health Extension Workers (CHEWs) attached to the Stabilization Centre. Topics covered were mainly around personal and environmental hygiene, after which the WASH team gave her bathing and washing soaps to take home upon discharge from the SC. IMC’s WASH program plays an invaluable role in addressing the underlying causes of malnutrition in the target communities. In an endeavor to find solutions to some of these household level challenges exposed during their engagement with this lady, they supported her community (VTC Camp) by conducting an evaluation of water sources after which IMC rehabilitated and upgraded water supplies (through maintenance of hand pumps) ensuring an adequate supply of clean water.
After one week in the Stabilization Centre (four days in the stabilization phase and an additional two days in the transition phase) the child was free of diarrhea and vomiting and able to eat, then discharged to the IMC Outpatient Therapeutic Program (OTP) in Gumsuri where she was fully rehabilitated. The woman occasionally brings the child to IMC OTP for follow up and expresses her profound gratitude to the entire IMC team.
The mother revisited the Women Friendly Space where she received psychosocial support as well as gained skills improve her livelihood, like bead and cap making to generate money for herself and provide food for her family.
This woman’s story gives an insight into the real-life synchronism between IMC’s three (Nutrition, GBV and WASH) humanitarian response components in Damboa. *Consent to publish name and picture not granted. 47 International Medical Corps-Nigeria 720FDA19GR00123 Semi-annual report
6. PLANNED ACTIVITIES FOR NEXT REPORTING PERIOD – BY SECTOR*
Apr-20 May-20 Jun-20 Sector 1: Nutrition Sub-sector 1: IYCF-E
SBC through Care Group/CG for PLWs Support Family MUAC Approach through CGs & LMs IYCF CG sessions with LM/month House visits for IYCF counselling by LM Community dialogue Conduct monthly dialogue sessions with small group of people Cooking demonstrations for caregivers Provide materials for cooking demonstration Organize cooking demonstration during OTP days demonstration Monitoring and Evaluation Quarterly M&E Supportive Supervision Subsector 2: Community Management of Acute Malnutrition (CMAM) Active case finding, referral and admission CNV to conduct daily active case finding for acute malnutrition Conduct defaulter tracing Outpatient Therapeutic Program (OTP) for uncomplicated SAM amongst children 6-59 months. Preposition monthly RUTF and other supplies for the management of SAM Provide essential stationary, registers Stabilization Center services for treatment of SAM with medical complications Preposition monthly F-75, F-100 and other supplies for the management of SAM at SC Provide supplies and materials for SC-Infection and Prevention control, materials for Phase 3, stationery, job aids Support referral services to SC and OTP. Distribute referral forms to CNVs Facilitate referral and transportation of the child and caregivers to SC Provide food subsidy for caregivers at the SC
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Sector 2: WASH Sub-sector 1: Environmental health Activity 1: Collection and Disposal of Solid waste Provide appropriate PPE and locally made cleaning materials organize weekly community cleaning Excavation of waste collection pits
Activity 2: Drainage system management
Provide basic tools for routine maintenance Maintenance of 500m long drainage Ground levelling using marram/brown soil monthly environmental cleaning. Activity 3: Cholera Emergency Preparedness & Response Plan Monitor AWD epidemiological trends from the EWARNS data. WASH quality management targeting areas with high AWD incidence Coordination Sub-Sector 2; Hygiene Promotion Activity 1: Hygiene promotion and sensitization Maintain & train network of community selected WASH volunteers Reproduce and distribute targeted IEC materials & pictorial HP flip charts Hygiene promotion sessions-OD, Handwashing, MHM, AWD & Cholera Sub-Sector 3: Sanitation Activity 1: Construct and rehabilitate latrines and showers Disludge 1592 latrine stances at the IDP camps, OTPs and SC Activity 2: Improve usage, cleaning & maintain sanitary facilities Community dialogue with LGA & formation of community group Community group mobilize for weekly latrine & shower cleaning Provide with latrine cleaning materials Sub-Sector 4: Water Supply Activity 1: Rehabilitate and upgrade water sources & distribution system Provide O&M services for the 16 existing water supply system Maintenance of 7 handpumps as backups at Bakassi camp Provide 240m3 of water will be trucked to the IDPs at Damboa Activity 2: Improve water quality testing and monitoring 49 International Medical Corps-Nigeria 720FDA19GR00123 Semi-annual report install and maintain the 17 chlorine dozer pumps CHV trained on conducting sanitary inspection of water points. Water testing and treatment using pool testers at HH level Testing for fecal coliform at HH level using H2S vials/strips. Ensure access to clean and safe water at the OTPs/SC. Sub-Sector 5: WASH Non – Food Items Activity 1: Distribution of hygiene kits Beneficiaries sensitization on PSEA and the prevention of extortion Issue secure unique kit coupon to beneficiaries (registration) Development kit information leaflet for hygiene kits Establish complaint desk for distribution Targeted distribution of laundry and bathing soap in OTPs Site Target distribution of Dignity Kits Distribution of chlorine tab based on FRC test results at water points Monitoring and Evaluation Post Distribution Monitoring Sector 3: Gender Based Violence (GBV) Sub-sector: Prevention and Response to Gender Based Violence Focused response services for survivors of GBV Individual case management Outreach for Case Management: Conduct case management supervision meetings (internal) Organize conference meetings (external) Establish/Review GBV referral pathways Training for service providers on GBV concept, guiding principles + referral pathways
Safe Spaces to Promote Psychosocial Support and Empowerment for Women and Girls Organize group psychosocial activities Conduct skill building activities Conduct information session on GBV concepts and referral pathways Risk Mitigation and Community Prevention Adapt community sensitization guide Organize a half- day workshop with key stakeholders to plan radio program Organize monthly Radio discussions
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Commemorate key international events (16 Days, IWD, FMG and girls day) Conduct quarterly safety audits Organize GBV concept trainings for community leaders Organize GBV concept trainings for community IMC's GBV Community volunteers
Distribute dignity kits to vulnerable women and girls
*Activities planned for the next reporting period, April – June 2020, will be impacted by the COVID- 19 pandemic in Nigeria. During the period of this report, IMC began to take preliminary steps to mitigate the risk of COVID-19 on its staff and beneficiaries in coordination with sector leadership and the COVID-19 task force in Nigeria. These steps included integrating WHO/NCDC approved COVID-19 messages into routine sensitization, developing an action plan and consulting with GBV survivors in preparation for potential remote case management, restocking hibernation kits at IMC offices and guesthouses, reinforcing handwashing measures at offices, and field sites, renegotiating agreements with vehicle contractors to ensure access and flexibility with project vehicles, and other actions. A detailed list of mitigation measures which have been, and will be implemented in the upcoming reporting period based on the COVID-19 pandemic in Nigeria and associated restrictions on movement, have been included in the attached annex (Annex 2), originally submitted to OFDA on May 7 under its cost modification.
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