ANNUAL REPORT 2014.

I. Contents II. ACRONYMS...... 1 III. EXECUTIVE SUMMARY ...... 2 IV. SWISSO Kalmo Operational Map ...... 4 V. GFATM...... 5 VI. REPRODUCTIVE HEALTH SERVICES ...... 11 VII. NUTRITION INTERVENTIONS ...... 14 VIII. PRIMARY HEALTH CARE PROGRAMS ...... 16 IX. LIVELIHOOD INTERVENTIONS ...... 18 X. FINANCIAL REPORTS 2014 ...... 21

II. ACRONYMS CHWs Community Health Worker

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MHWs Maternity waiting home CeMOC Comprehensive Maternanal and Obstetric Care BeMOC Basic Maternal and Obstetric Care GAM Global Acute Malnutrition MAM Moderate Acute Malnutrition SAM Severe Acute Malnutrition PLW Pregnant and Lactating women ANC Antenatal Care PNC Postinatal care OTP Outpatient Therapeutic Program TSFP Target Supplementary Feeding Program MUAC Middle Uperarm Circumference SGBV Sexual Gender Based Violence BNSP Basic Nutrition Service Package MMN Multiple micronutrient AWD Acute Watery Diarrhoea LLIN Longlasting impregnated Net RIS Residual Indoor Spray UNICEF United nations Childrens Fund ARI Acute Respiratory Infection WCBA Women of Chilbearing Age ER Emergency Rlief UNFPA United nations Fund for population activities WHO World Health Organization

III. EXECUTIVE SUMMARY

In 2014, Swisso Kalmo continued to implement life saving projects in Somalia. Working in the spirit of our mission of ‘Addressing emergencies and alleviating human suffering through provision of quality health care services, Water sanitation and Hygiene (WASH), Livelihood and strengthening institutions, systems and local capacities’. In 2014, A total of 6 Projects have been implemented in 7 districts across south and central Somalia. SWISSO Kalmo continues to take active role in Nutrition cluster activities both in Nairobi and field level while standing shoulder to shoulder with the Somali people and will help them look into the future with optimism in line with our vision of ‘A world that provides care to all people; alleviate poverty, responds immediately to save lives in times of emergencies and beyond’. Therefore the Organization will continue implementing essential and basic services to the people of Somalia. As the country continues to stabilize, we will venture into long term development projects and capacity building and make our mark in Somalia that has a bright future. Health care projects of reproductive health in nature were implemented in Merka, Afgoi, Madina majabto, Baidoa, Banadir, Guricel and Dhusamareb under the BeMONC and CeMONC projects supported by UNFPA. Together with the reproductive health projects, prevention of gender based violence (GBV) was also implemented in Afgoi and Merka. This was done to help address the maternal and infant mortality which is highest in the world. Maternal mortality rate of

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1,600 per 100,000 live births is indicative of high rates of morbidity, including obstetric fistula. Maternal health in Somalia is worse than in almost any other country in the world. Towards this Swisso-Kalmo has increased access to quality emergency obstetric and routine reproductive, maternal and newborn care services in Dhusamareb and Guriel in Galgadud region and Banadir Hospital in Banadir region. Another health intervention implemented by Swisso-Kalmo in 2014 was integrated primary health services which were Implemented in Baidoa, Merka, Afgoi supported by UNOCHA, under the title Provision of integrated primary health care services in Afgoye district of Lower Shabele. The activities were relocated to Baidoa hospital to serve the vulnerable communities in Bay region. Staff recruitment, orientation and capacity development and procurement and delivery of supplies (drugs and equipment) were done. In addition, the maternity wing was fully rehabilitated. Swisso-kalmo also worked in reduction of morbidity and mortality for vulnerable communities in Baidoa district through provision of PHC services, capacity building and community mobilization through a well-defined EPHS package. In order to address the food shortage problem in Somalia and the resultant malnutrition in children, pregnant/Lactating mothers and PLWs, Swisso-Kalmo has implemented nutrition project that was initially started in Bay and moved to Lower Shabelle regions after three (3) months as result of the rationalization exercise by the Nutrition cluster. Lower shabelle is the most populated area in Somalia with an estimated population of 850, 651 (UNOCHA 2012). Lower Shabelle has the largest concentration of IDPs with 496,000 people including 406,000 in Afgoye. These IDPs were originally displaced from Mogadishu by a multidimensional conflict since 2007 living in the Afgoye corridor. During the conflicts in February and May 2012 over 50,000 IDPs were displaced to Mogadishu and other parts of Lower Shabelle from the Afgoye corridor. In June 2012, AMISOM/Somali National Army(SNA) took over Afgoye town, ending more than four years of Al-Shabaab rule. In August 2012, Merka, previously under AS, was also taken by AMISOM and SNA. This has enabled Swisso Kalmo having previously been working with the community to successfully set up the nutrition projects in Afgoi and Merka and implemented it smoothly with 5 OTP centers operational as well 11 SFP centers. Staffs were recruited and trained including 15 Nutrition staff, 40 community health workers (CHWs). Equipments and supplies were provided that included plumpy nut, routine medications, MUAC and other equipment for weighing including supplementary plumpy , weighing machine, weight board, Scale(electronic, mother/child), Weighing trousers. In order to re-build the livelihood of IDP returnees, Swisso-Kalmo provided Livelihood Restoration and building the resilience for the most affected urban livelihood communities in Marka District of Lower Shabelle Region under the CHF with support of UNOCHA. This was done through food voucher to the vulnerable communities in Merka District of Lower Shabele region which was among the most affected regions in South Somalia. There has been high number ofIDPs in (Merka) where SWISSO-Kalmo implemented this project. There were high numbers of vulnerable people demanding food and we could not cover the all the communities in need. However, the project was integrated with other on-going projects such as OTP/TSFP which supports malnourished children who needs special treatment. The food aid was used to support the family of these malnourished children by providing food ration to them. This approach helped in better targeting as well as protecting malnourished children’s allocation of plumby nuts so as not to be shared among other family members. SWISSO-Kalmo has learned a crucial lesson from this project which will help us use this implementation approach of similar projects in the future.

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IV. SWISSO Kalmo Operational Map SWISSO KALMO OPERATIONAL MAP

Health Centre/MCH

TB Centre

Hospital

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V. GFATM

Malaria control

In Somalia the malaria prevalence vary from different regions. The Malaria parasite prevalence survey undertaken between 2004 and 2007 by FSNAU showed different prevalence in different regions in Somalia from low prevalence to high prevalence (from <5% PfPR to 39% PfPR). Malaria is unstable and epidemic character in Puntland and Somaliland; it is moderate transmission in Central regions; and it is high transmission in southern regions such as Jubbas, Bay, Bakol, Gedo and Shabellas. Although efforts has made in the previous years (from 2004) through Global funding, malaria still remains a public health problem whereby malaria models estimate that in 2009 there were 744,590 clinical malaria episodes and 7,460 malaria deaths.

SWISSO Kalmo operates in the most endemic and high transmission areas in Lower Shabelle and Bay regions where malaria is stable and where children (<5) and Pregnant mother are most at risk. SWISSO Kalmo has been working on malaria as direct implementing agency through malaria integration of primary health care services starting from 2010. The main objective of SWISSO Kalmo for malaria control was malaria case management (prompt malaria diagnosis and treatment) using malaria treatment guideline; upgrade human resource capacities; contribute to development of strategies, policies and guidelines. SWISSO Kalmo is active member of Malaria working group at Nairobi level as well as at the field level.

The overall goals of the global fund Malaria program are:

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i. By 2016, achieve near zero (Less than 1% parasite prevalence) malaria transmission within areas of historically low transmission (Somaliland, Puntland and Central parts of CSZ) ii. By 2016, achieve and sustain universal coverage resulting in 50% reduction of malaria transmission in malaria prone areas of the country (Southern parts of CSZ).

Achievement The specific objective of the Malaria program was to increase access to effective prompt diagnosis and treatment to at least 80% of patients at the public health facilities in Lower shabelle and Bay regions. In addition to that, the project has reached 90% of the target population through distribution of LLINs or IRS. To increase the number of people in the malaria prone areas who understand malaria prevention and treatment through behaviour change and community outreach in 2 regions (Bay and Lower Shabelle). During year 2014, SWISSO Kalmo was supporting 12 health facilities (MCHs and HPs) which have been receiving regular malaria supplies; 35 MCH clinical staffs were trained for malaria case management; 12 CHWs were trained for integrated fever management including malaria; 37 HP staffs were also trained for malaria case management; and 198 community educators were recruited and trained for proper distribution and maintenance of LLINs. During the reporting period, 6,061 suspected malaria cases were investigated with RDT in all SWISSO Kalmo health facilities. Of which 579 were malaria positive and were treated with ACT drugs.

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TUBERCULOSIS CONTROL

Merka TB hospital

TB is a public health emergency in Somalia. The estimated incidence is extremely high at 160/100,000 for sputum smears positive TB cases in Somalia, while the prevalence is estimated at 290/100,000 (WHO Global TB Report 2009). The HIV/AIDS epidemic is worsening and is likely on the verge of generalized epidemic stage. The TB/HIV co-infection is therefore is real challenge in Somalia. The long-standing complex emergency with natural disasters has negatively affected the TB epidemiology.

The goal of the Program is to decrease the burden of TB in Somalia with emphasis on accessibility, affordability, quality, equity, sustainability and patient satisfaction in line with the Millennium Development Goals and the global Stop TB Partnership targets. The Program targets people suffering from TB (including multi drug resistant TB (MDR TB) patients); their healthy contacts, including families, neighbours and health staff; and internally displaced persons, refugees, prisoners and military personnel

Swisso-Kalmo plays a leading role in the TB control program in Somalia supported by the Global fund through World vision as the principle recipient. With about 70 centers across in Somalia, Swisso-Kalmo is supporting 9 centers in 4 regions in SCZ namely Biadoa, Burhakaba, Buale, Merka-swisso, Qorioley, Barawe, Merka Hospital, Dhusamareb and Dharkenley.

During the year 2014, SK has signed the GFTB phase 2 as the continuation of TB project, all TB staffs signed a new contract starting January 2014; as recommended by Global Fund/World Vision, a new salary scale were adopted (see below table). However, the new salary scale is much lower than the one agreed by MOH with UNICEF for EPHS project. To motivate the staff and to standardize the salary of all SK staff, SK adds top up incentives. 7

Monthly salary in USD Category Global Fund SWISSO Kalmo Doctor 600 1200 Head Nurse/Nurse 275 400 Nurse 250 400 Lab technician 250 400 Auxillxries 161 200 Support staff (Cleaners, Cook, Security) 100 150

ACHIEVEMENTS

Table 1. Admissions to the TB program 12 to 10 9 to 7 6 to 4 3 to 1 month months months month before before before before supervision supervision supervision supervision Quarter being supervised: Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total New smear positive PTB (category I) 118 129 168 214 629 Smear positive PTB retreatment (category II) 4 2 2 6 14 (Smear +ve PTB relapses) 0 0 0 0 0 Smear negative PTB 8 3 18 20 49 EPTB 13 11 20 37 81 Total PTB cases 130 134 188 240 692 TOTAL TB cases 143 145 208 277 773 Cases bacteriologically confirmed 122 131 170 220 643 Cases NOT batteriologically confirmed 21 14 38 57 130 Patients transferred in 0

Total number of patients in the program 143 145 208 277 773

Indicators (patients transferred-in are excluded): Percentage of smear +ve among PTB cases 94% 98% 90% 92% 93% Percentage of smear +ve among all TB cases 85% 90% 82% 79% 83% Percentage of re-treatment cases 2.8% 1.4% 1.0% 2.2% 1.8%

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Chart 1. TB cases by category

Chart 2. Trend of admissions into the TB program

Table 2. TB cases by sex and age groups Male TB Female TB Total cases cases TB cases below 15 years 39 29 68 TB cases 15 years and above 282 423 705 Total 321 452 773

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Chart 3. TB cases by sex Chart 4. TB cases by age groups

Table 3. Case detection rates

Total number of new TB smear +ve cases 629 Total number of new TB cases 759 Estimated population in the TB centre catchment area 900,000 Expected number of TB smear +ve cases (100/100.000) 900 Total number of expected TB cases (224/100.000) 2016

Indicators: Estimated case detection rate (for smear +ve TB cases) 70% Estimated case detection rate (for all TB cases) 38%

Swisso-Kalmo supported centers enrolled a total of 773 patients into the National TB program in the year 2014. Sputum smear positive cases were 629 while smear negative TB cases were 48. Extra pulmonary TB cases diagnosed were 81 in total. An impressive case detection rate of 70% for smear positive TB cases was achieved. 83% of all the cases treated were sputum smear positive. This is very encouraging considering pulmonary smear positive cases of TB are the most infectious and therefore a public health risk. The program had 58% of its patients being male while children under the age of 15 years were 9% of the patient population registered.

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VI. REPRODUCTIVE HEALTH SERVICES

CeMOC service: delivery with CS

Somalia has one of the highest maternal and infant mortality and morbidity rates due to limited accessibility to antenatal, postnatal and neonatal care and inadequate of emergency obstetric care. This has led to number of pregnant mothers who remain to be at highest risk of pre-pregnancy and post-pregnant stages. Poor professionalism of the practitioners and the untrained midwives and nurses are also a contributing factor to the matter. There is a poor existence of national health system in place. Hence, there is no strong institution or system of controlling the quality of the work done by the national practitioners. Among the most alarming but least addressed healthcare need is the right of women to access safe motherhood services. Somali people have been suffering from poverty, underdevelopment, conflict, natural disasters and internal displacements for decades. The health system has suffered considerably and, of all areas of health, reproductive health is uniquely dependant on overall health system adequacy and functioning to progress. The Somali health system is characterized by insufficient, inequitable, fragmented and highly privatized services, with low levels of central governance or management. Consequently, a large segment of the population is without access to basic health services and with complete absence of some higher level services in many regions. Gender-based violence (GBV) and in particular sexual violence is a serious, life-threatening issue primarily affecting women and children and it requires adequate, appropriate, and comprehensive prevention and response and the most vulnerable to violence and exploitation are the women, girls and the minority communities in the IDPs, simply because of their gender, age, and status in society.

During the reporting period (in 2014), Swisso-Kalmo had implemented and successfully completed two Comprehensive Emergency Maternal and Obstetric Care (CEMONC) centres (Dusamareb and Banadir hospital). In addition to that, SK has also implemented 5 Basic Emergency Maternal and Obstetric Care (BeMOC) in the following locations (i.e. Merka, Afgoye, Baidoa, Guriel and Majabto); also 2 SGBV stop centres were implemented integrating in two of the BeMOC centres (Merka and Afgoi).

Main Objectives of the project: To increase access to quality emergency obstetric and routine reproductive, maternal and newborn care services in Dhusamareb and Guriel in Galgadud region and Banadir Hospital in Banadir region and Merka, Qoryoley and Afgoi of 11

Lower Shabele region. Increase capacity to prevent gender-based violence and harmful particles and enable the delivery of multispectral services in Afgoye and Merka in Lower Shabele region. Achievements At the beginning of the project, local community was mobilized and informed the benefits of the project; stakeholders (including community members, local authorities and IDP leaders) were met and informed about the project implementation; community awareness campaigns were conducted reaching 2300 persons; During the year of the project, staffs were recruited both national and international staff; trained on CMR, basic counselling, basic psycho- social support, safe delivery including community volunteers and counsellors; Stop centres were rehabilitated and fully equipped with medical devices, beds and furniture; provided with medical supplies; Dhusamareb CeMOC and Guriel BeMOC centres were fully rehabilitated and equipped. During this year, a total number of 300 victims of SGBV were registered and attended to including supporting them with dignity kits alongside the medical and psychological support given. All of those victims were women, age between 13 years to 55 years. Achievement Description of indicators # reached ANC Consultations 13900 PMTCT Service provision 724 T.T Vaccine usage 8568 VDRL testing 2596 VDRL positivity 100 Delivery by skilled birth attendants 6788 Instrumental deliveries 152 Delivery through caesarean section 1012 Life births 7808 Underweight babies 524 Post natal consultations 5824 FP Consultations 4388 Maternal deaths 44 Neonatal deaths 144 Obstetric complications 1432

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The results summarized in the bar graph above shows that the ANC attendees, T.T usage, delivery at health facility and by skilled birth attendants, life births and post natal consultations and delivery through caesarean section had a remarkable achievements while PMTCT services, VDRL testing, instrumental deliveries and FP services are picking up. 13900 pregnant women were consulted for ANC; 724 pregnant women counselled and tested for HIV (PMTCT); 8568 pregnant women received tetanus toxoid vaccine during ANC; 2596 pregnant woman counselled tested for VDRL; 100 pregnant woman testing VDRL+VE ;7952 of Deliveries were performed by skilled birth attendant in HC; 5824 Post-natal consultations; 4388 of family planning/Birth spacing consultations were done; 524 underweight babies(<2.5kg)were delivered; 7808 life Birth were delivered; there were 44 maternal deaths; There were 144 neonatal deaths and 1432 obstetric complications. Deliveries carried out by skilled birth attendants stood at 6788. Despite there being 1432 obstetric complications, there were only 44 deaths. This translated to 0.6% maternal deaths as compared to the national average of about 1.6%. The national maternal mortality is estimated at 1,600 for every 100,000 (WHO). About 68 lives were therefore saved. Challenges Somalia is high on the list of developing countries combating high rates of poverty and disease. There are still many factors affecting Somali’s ability to overcome many health-related problems including child and maternal mortality. Some of the common reasons why maternal and child mortality remains high include: lack of health centers in the rural areas, poverty, inadequate number of health personnel, and lack of equipments at the health facilities; logistic obstacles such as long distances and lack of transport to health service providers for the rural and nomadic populations; Low level of capacity of skilled staff, incoherent running of services and break in supplies further aggravates the situation. Rural communities are difficult to reach by health experts because of bad road conditions. The roads become even worse during the rainy season and are inaccessible. Care for pregnancy and children are mostly in the hands of unskilled TBA. Unfortunately, most TBAs cannot read and write and therefore have no access to information and knowledge for a safe pregnancy and child care; lack of maternal audit, Illiteracy and ignorance are playing a major part.

Istarlin Istarlin Ahmed Shukri a mother of 9 children who has had 11 pregnancies is happy to be alive. She was delivered through caesarian section and received blood transfusion at Banadir hospital under the CemONC project for free after being referred by another hospital within the city due to her delicate condition. Istarlin is a house wife and her husband is small scale trader who can only afford to put some food on the table. She says they cannot afford health care and that she is grateful, ‘she has heard that she was in coma, most women died in such circumstances but her life has been saved’. 13

VII. NUTRITION INTERVENTIONS

In this reporting period, SK has been implementing nutrition projects including OTPS, TSFPs, SCs and IYCF in Lower Shabelle region. SK has been managing 6 OTPs/MCHs (Merka, Jilib Merka, Afgoi, Ceel Ahmed, Gendershe & majabto), 2 SCs in Afgoi and Shalambood, 12 TSFP sites, It has also been running and IYCF to caregivers in all these facilities. The target groups are children U5 and PLW who are the most Vulnerable. The project was integrated with other projects such as health and WASH for better reach and acceptance. All nutrition sites also provide health care services, so malnourished children receive treatment of other diseases as well as immunizations. Stabilization center was rehabilitated and water system provided, in addition hand washing facilities and electricity were provided. Gender dimension based on understanding of women, girls, boys and men's different needs, roles, responsibilities, capacities and risks has also been integrated in the consultation, decision making and capacity development and the intervention ensured equity in selection of male and female.

Achievement Communities were mobilized and specifically women group were targeted on nutrition related activities through BNSP activities and IYCF promotion sessions were held with each session having an average of 80 community members. Community members were sensitized by participating in IYCF activities through workshops. During the reporting period, a total of 48 IYCF promotion sessions were conducted. Multiple Micro nutrient supplementations, de-worming tablets and treatment of common illnesses were provided to under 5 children and pregnant and lactating women; a total of 51,014 acutely malnourished children received nutrition and 3821 caregivers reached with IYCF messages. Total children admitted to TSFP 40,477; OTP 279. In this reporting period, 71,251 beneficiaries were screened and total caregivers reached with IYCF messages were 3,840.

Monthly admission trend for SAM/MAM

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The peak admission was in January and November which coincides with the hunger period in this region and in the whole of Somalia.

Overall performance indicators for the OTP/SC/TSFP

All the indicators met the SPHERE standards of SAM/MAM programming and a clear indication of quality programming in addressing SAM. The 92% cure rate is attributed to reduction in defaulter rate as a result of beneficiary follow up through community nutrition workers. The CNWs also sensitized the communities on proper infant and young child feeding and food hygiene practices thus reducing malnutrition rates.

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VIII. PRIMARY HEALTH CARE PROGRAMS Provision of primary and secondary emergency health care services to vulnerable communities in Bay region

ANC clinic

Vaccination

In Baidoa district, SK was implementing Primary and secondary health care services in Baidoa district through the support of Baidoa hospital and 3 MCH/Health centers (i.e. Baidoa Berdale, Awdiinle and Goofgadudow Shabellow). The health activities that have been undertaken during the reporting period in 2014 include Staff recruitment, capacity development and procurement and delivery of supplies (drugs and equipment); Management of common ailments, immunizations of the 8 common preventable diseases (TB, Whooping cough, Deftheria, Measles, Tetanus, polio, Hemophelus influenza type b and Hepatitis B) among the under five year old children and Women of Child Bearing Age including pregnant women; provision of medical supplies to both the hospital and PCH facilities (i.e. MCHs). Training of 35 health care workers on clinical management of childhood illnesses and on prevention and control of epidemic diseases; provision of life saving medical and surgical treatment to patients through establishment of the triage in the emergency unit; strengthening the linkages between the primary health facilities and Baidoa regional hospital through provision of an ambulance and creation of public awareness about the existence of the service.

ACHIEVEMENTS A total number of 97,003 patients were registered in all health facilities of which 70,238 were children under 5 years of age, 12,811 were pregnant and lactating mothers, 3542 were women of children of child bearing age. In this period, 12,310 under 5 years old children were immunized against 8 diseases, while 13,421 women of child bearing age were immunized against Tetanus (TT).At the end of the project, 30 health care workers (18 female, 12 male) were trained on clinical management of childhood illnesses using IMCNI guideline; SWISSO -Kalmo also trained 15 other health workers (9 female and 6 Male) on the prevention, epidemic preparedness and control, surveillance and treatment of communicable diseases.

12,310 under 5 years old children were immunized against 8 diseases (measles, whooping cough, Tetanus, TB and Diphtheria, pertussis, Hepatitis B, Meningitis) while 13,421 women of Child Bearing Age were immunized through routine immunization exercise.

Adequate medical supplies both the outpatient and the inpatient department was provided to Baidoa hospital. 3,554 Kg of essential drugs and medical materials; 20 hospital beds with mattresses and bed covers ; 1 operation table, diathermy machine, oxygen concentrator, surgical equipment and OT light among others, couches,glucometer, for the emergency department and basic laboratory reagents including hb machine and strips, blood group reagents, blood bags among other life saving equipment.

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30 health care workers (18 female, 12 male) were trained on clinical management of childhood illnesses using IMCNI guideline.

SWISSO-KALMO improved access to high quality emergency life saving surgical and medical health care service for vulnerable community living in Bay by providing adequate supplies at the casualty department and in addition trained health care workers on life saving skills hence strengthening their capacity. SWISSO-KALMO established the triage emergency unit in Baidoa hospital and improved provision of quality life saving emergency medical and surgical treatment to 6795 patients of which 1556 received surgical intervention and 5242 received emergency medical intervention.

SWISSO-KALMO established the triage emergency unit of Baidoa hospital and this improved provision of quality life saving emergency medical and surgical treatment to 6795 patients which included: 1556 surgical cases and 5242 medical cases. The surgical emergency cases included: 1. 121 gunshot cases, 2. Road traffic accident-21, 3. Bomblast-10, 4. Burns-52, 5. Abscess-640, 6. Other surgical procedures traumas-579, 7. Fractures setting-50, 8. Hernia repair-40, 9. Knife wound-43.

SWISSO-KALMO strengthened the referral system between Baidoa Regional Hospital and the other primary health facilities by providing an ambulance and creating public awareness about the existence of the services including the existence of the ambulance that was on the move to facilitate transportation of ill and the injured individuals within the region to the hospital for management. 569 casualties who received prompt emergency treatment

The pediatric and the emergency department of the hospital were fully renovated.

15 health workers (9 female and 6 Male) were trained on the prevention, epidemic preparedness and control, surveillance and treatment of communicable diseases.

Integrated disease surveillance and response was established and working at the hospital and among its core functions is to report on disease of public health concern including Acute Flaccid Paralysis (AFP).

Patients with communicable diseases were treated at the hospital both as outpatient and as inpatient depending on the condition of the patients. 23,400 patients were treated. In this particular period there was no any outbreaks reported in the region.

The health activities that have been undertaken during the course of the project (from November 2013 to August 2014) included: Access to life saving reproductive health care (BeMONC and CeMONC); improve maternal and child health through provision of quality ante natal, post natal and delivery by skilled birth attendant in Baidoa regional hospital; provide routine and campaign immunization to children under 5 and pregnant mothers; continues strengthening the referral system; maintain linkages between the out-patient and the in-patient 17

departments and mothers with obstetric complications access secondary interventions such as caesarian section, Management of common ailments, immunizations of children under five against the 8 common preventable diseases.

IX. LIVELIHOOD INTERVENTIONS Livelihood Restoration and building the resilience for the most affected urban livelihood communities in Marka District of Lower Shabelle Region

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Somalia has been facing chronic emergencies for more than two decades due to ongoing conflicts, coupled with recurrent droughts, floods, shrinking humanitarian assistance and access, increasing malnutrition, and increased acute food insecurity. Somalia’s extremely fragile humanitarian situation is at risk of sliding back into crisis if urgent action is not taken to address deterioration in the humanitarian situation across different livelihood zones and IDP populations. 6 % increases in GAM caseload in the last 12 months. Today, 21,800 children under five in Somalia are suffering from acute malnutrition. More than 71% of the people do not have access to safe drinking water; while 77% do not have access to safe means of waste disposal. Somalia’s population, remain on the margin of food insecurity and may struggle to meet their minimal food requirement. Children in Lower Shabelle region are at increased risk of acute malnutrition 6 % increases in GAM caseload in last 12 months. Lower Shabele has a GAM rate of 17.2 which is considered as critical and a SAM of 5.5 (critical). In 2014, SK implemented a Lifesaving humanitarian assistance and livelihood support in the communities living in Merka town and surrounding villages.

Lower Shabelle region was one of the most affected regions in South Somalia. There has been high number of IDPs. The area (Merka) that SWISSO has implemented this project is alongside the coastal area. During the implementation of this project, there were high number of vulnerable people demanding food and we could not cover all the communities in need. However, the project was integrated other ongoing projects such as therapeutic feeding program which supports malnourished children who needs special treatment, while the food aid supports the whole family by providing food ration. SWISSO Kalmo has learned crucial lessons from this project which will help us use the implementation of similar projects in the future.

The proposed project objective was to provide Livelihood Restoration and building the resilience for the most affected urban livelihood communities in Marka District of Lower Shabelle Region through food voucher to the vulnerable communities in Merka District of Lower Shabele region. SWISSO Kalmo has put in place all necessary efforts to implement this project. Project staffs were recruited (15 staffs) and trained (orientation); community were mobilized by community mobilizers (volunteers).The beneficiaries i.e malnourished pregnant/lactating women, boys, girls and aged women and men at nutrition sites in Marka town were first identified and the food requirement established based on the cost of the minimum food basket; The Food Vendors were identified according to specified criteria. Agreements were prepared for those vendors who fulfilled the set criteria; Beneficiaries were issued with vouchers indicating the amount of food rations they need to sustain them for one month; The beneficiary were then taking the voucher to the food vendor for food provision; SWISSO-Kalmo Supervisors and Data Manager recorded the amount of food provided on a monthly basis; Monitoring it regularly . A total of 500 households were selected according to the selection criteria as proposed in the project. The project has targeted those families who are poor and the ones who had malnourished children who are registered at Merka therapeutic feeding in Lower Shabelle. Each family has received a family ration (50 Kg of rice, 5 litres of oil, 15 kg of sugar and 10kg of pulses) in each months for six months (August, September, October, November, December 2013 and January 2014)The effect/benefits of the family ration to the beneficiaries has been 19

monitored and the effect clearly shows that the level of nutrition among the beneficiary families have improved and if maintained or extended to other families/households we expect the level of malnutrition to go down in the region

ACHIEVMENTS

The project achieved a high success rate despite the challenges of insecurity while operating in newly liberated area that is highly unstable. The main constrains was insecurity of the area that was not 100% secure; community mobilization through the media was not possible; The project's small number of beneficiaries (only 500HHs) created demands from those who did not receive the food. During the implementation of this project, there were high number of vulnerable people demanding food and we could not cover all the communities in need. Despite such challenges the following are the main accomplishments of the project.

Food accessibility to 500 Households were improved. (60% female and 40% male) of urban in Livelihood crisis in Marka District of Lower Shabelle Region. The selection of beneficiaries women headed household was 60%. SWISSO -Kalmo is running a nutrition center (OTP/TSFP). The project selected the beneficiaries through screening of the malnourished children and their families/Households. Each family received a per-calculated family ration (15KG of Sugar, 5lts of Oil, 50kgs of rice and 10 pulses) through food voucher for six months (August, September, October, November, December 2013 and January 2014).

This is the breakdown of the beneficiaries. 1170 were men while 1830 were Women. This is 40% men and 60% women. The total number of men and women was therefore 3000. 250 boys and and 350 girls were also reached. The total number of boys and girls were 600. The overall number was 3600.

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X. FINANCIAL REPORTS 2014 Consolidated Statement of Financial Activities

A. INCOME SOURCES:

Cash ( Currency USD ) FUNDING Total Income Contributions Comments

Income From Donors:

GLOBAL FUND- TB 441,808.00 441,808.00 GLOBAL FUND – MALARIA 107,743.00 107,743.00 UNOCHA (CHF 528, CHF 454, CHF505 413,593.00 413,593.00 UNFPA 1,054,468.00 1,054,468.00

TOTAL 2,017,612.00 2,017,612.00

B. EXPENDITURE:

Description Budget Expenditures Variance SUPPLIES :

Medical Supplies 157,045.57 157,045.57 0.00 Food Voucher Distribution 241,250.00 241,250.00 0.00 Rehabilitation & Renovation 68,232.50 68,232.50 0.00 Personnel:

Personnel Costs 555,582.00 555,582.00 0.00

Contracts (with implementing partners) 788,145.00 788,145.00 0.00

Monitoring & Supervision 13,900.00 13,900.00 0.00 Transport & storage :

Transport & Vehicle costs 220,410.00 220,410.00 0.00 Storage costs 19,200.00 19,200.00 0.00 Workshops & Training:

Training Costs 100,619.00 100,619.00 0.00 Logistics $ Maintenance: 44,000.00 44,000.00 0.00 Capital Expenditure:

furniture & equipment 28,200.00 28,200.00 0.00 Other Direct Costs:

Stationery 24,583.00 24,583.00 0.00 Rents 28,800.00 28,800.00 0.00 Communications 22,832.00 22,832.00 0.00 Utilities 9,300.00 9,300.00 0.00 Bank Transfer Costs 52,383.73 52,383.73 0.00 Travel 22,202.80 22,202.80 0.00

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General Expenditure: 0.00

Offices Costs 26,345.00 26,345.00 0.00 Consultants& Professional fees 54,400.00 54,400.00 0.00 Other general Costs 13,870.00 13,870.00 0.00

Total 2,491,300.60 2,491,300.60 0.00

Balance Of Funds:

Total Opening Balance (C ) 473,688.60 473,688.60 Income (A) 2,017,612 2,017,612 Expenditure (B) 2,491,300.60 2,491,300.60 Closing Balance (C+A-B) 0 0

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