Reporting fiscal year FY 2020
Awardee Name and Host Country Nascent Solutions Inc.
Host/implementation country Cameroon
Award Number 72DFFP18FA00006
Activity Name Increasing food Security Amongst IDP In Ngoketunjia Division
Activity Start Date 10/01/2018
Activity End Date 03/31/2020
Submission Date 06/25/2020
List of ARR documents uploaded in FFP ARR Narrative and Indicator Table (to be PRT done in Oct 2020)
Awardee HQ Contact Name Beatrice Wamey
85 S. Bragg St., Suite 500, Alexandria, VA 22312
703-333-5822
Host Country Office Contact Name Henry Njakoi
+237 7759 6804
Bureau for Democracy, Conflict, and Humanitarian Assistance
International Food Relief Partnership Grant No.: 72DFFP18FA00006 Increasing food Security Amongst IDP In Ngoketunjia Division Implemented by Nascent Solutions
Final Report Submitted June 25, 2020
The International Food Relief Partnership is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Grant number 72DFFP18FA00006. The project was implemented by Nascent Solutions Inc.
DISCLAIMER: The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development of the United States Government.
Contents Executive Summary ...... 3 Activity Results ...... 3 Award Summary ...... 5 Results Framework ...... 6 Major Activities Implemented ...... 7 Challenges, Achievements, And Lessons Learned ...... 11 Outcome reporting ...... 13 Output reporting ...... 14
List of Acronyms
CHW Community Health Workers
HHS Household Hunger Survey
IDP Internally Displaced Person(s)
IFRP International Food Relief Partnership
UNOCHA United Nations Office for Coordination of Humanitarian Assistance
USAID United States Agency for International Development
WASH Water, Sanitation, And Hygiene
Title page photo caption: A group of beneficiaries in Babungo community of Ngoketunjia Division after receiving their food rations. Photo Credit: Nascent Solutions 2019.
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Executive Summary The USAID-funded IFRP Grant No. 72DFFP18FA00006 aimed to reduce the prevalence of malnutrition among children aged 6-36 months in Ngoketunjia Division of the North West Region of Cameroon. The project’s two objectives were:
1. Reduce household hunger amongst 9,500 IDP in 1,900 households, and 2. Increase knowledge of positive health practices amongst 1,900 household heads.
The project reached 1,970 direct beneficiaries and 10,225 indirect beneficiaries. 75MTof Harvest Lentil Pro was distributed to 1,970 households in 13 target communities in Ngoketunjia Division, exceeding the target of 1,900. Additionally, 1,196 persons were trained on positive health practices, particularly handwashing, disease prevention, safe food preparation, safe water treatment and positive dietary practices. Households experiencing moderate to severe hunger decreased by 7.9 and 19.7 percentage points, respectively. Activity Results # Performance Indicator Oct 2018 - March 2020 figures Notes 1 Percentage of households in each At final evaluation: 225 households household hunger score (HHS) 54.7% recalled food anxiety 10+ times in sampled during category outcome the past four weeks; baseline and final.
39.2% recalled food anxiety 3-10 times in the past four weeks;
6.1% recalled food anxiety <3 times in the past four weeks 2 Metric tonnage of Harvest Lentil 75 Pro received at Bamenda warehouse 3 Number of persons attending 13 stakeholders meeting (output) 4 Number of beneficiaries 1,995 All IDP. registered (output) 5 Number of people who received Harvest Lentil Pro (output) Direct 1,970 All IDP. Indirect 10,225 All IDP. 6 Quantity of Harvest Lentil Pro 75 (5,337 boxes) Total across 2 distributed distributions. 7 Number of people receiving 1,196 All IDP. training on safe food preparation and positive water and sanitation practices
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Cost-efficiency performance
Cost of commodities $222,341.27
Cost of transportation, distribution, $149,959.00 management, etc.
Total cost of project $372,300.27
Total number of beneficiaries 12,195
Average cost per beneficiary $30.53
Average cost per beneficiary per month (18- $1.70 month project)
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Award Summary Introduction
The United States Agency for International Development (USAID) funded an International Food Relief Partnership (IFRP) project in Ngoketunjia Division of the North West Region of Cameroon. Grant 72DFP18FA00006 was implemented by Nascent Solutions Inc. The project aimed to address food insecurity amongst 1,900 households in Ngoketunjia impacted by the socio-political unrest in the North West Region. These households are composed of internally displaced persons (IDP).
Food distributions are used to attract IDP and their household members to health clinics, where they receive Harvest Lentil Pro and training on food preparation and positive water and sanitation (WASH) practices. For simple reasons of proximity, food distribution at a clinic site is likely to increase uptake of health services. As such, this project indirectly assisted in improving the overall health of IDP households.
The Challenge in Ngoketunjia Division
The socio-political crisis in Cameroon began in late 2016, and so far, more than 400,000 people in the English-speaking regions have been displaced by violence, food insecurity and their inability to maintain their livelihoods in their communities of origin. Many internally displaced persons currently stay in Ngoketunjia Division, temporarily sheltered by benevolent families. As of February 2018, UNOCHA estimated there were 42,000 IDP in Ngoketunjia Division. Evidence suggests that IDP children disproportionately suffer poor health outcomes compared to non-displaced children, largely due to food insecurity. A majority of IDP - largely women and children - are poor and food insecure.
Project Objectives
The project has two immediate objectives:
1. Reduce household hunger amongst 9,500 IDP in 1,900 households; 2. Increase knowledge of positive health practices amongst 1,900 household heads.
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Results Framework
Objective 2: Increase Objective 1: Reduce Goal: Increase food household hunger knowledge of positive security amongst 9,500 amongst 9,500 IDP health practices amongst IDP from 1,900 households. 1,900 heads of families
Activities: Activities 1.1 – Ship and transport 2.1- Train 1,900 IDP commodities heads of household on 1.2 - Organize food preparation and stakeholder meetings nutrition practices 1.3 – Registration 2.2-Train 1,900 IDP of beneficiaries heads of households on 1.4 - Distribute and positive water,
monitor the use of sanitation, and hygiene Harvest Lentil Pro practices
Key:
Items for which Nascent is directly and fully responsible
Items for which Nascent is not directly or fully responsible; various entities will be working toward these outcomes
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Major Activities Implemented Stakeholder meeting
Nascent Solutions organized a stakeholder meeting on 21 June 2019 as part of its commitment to working with local stakeholders in Ngoketunjia Division. Stakeholders represented in this meeting were community health workers (CHW) and the representative of the district medical officer. Due to the socio-political crisis, traditional rulers and some government administrators were unavoidably absent. Nascent brought in 13 participants from the 13 communities of Ngoketunjia Division to receive a briefing on the project and its activities. The meeting fully met its objectives, as the participants understood the project content, and accepted the responsibility to commence work thereafter.
Stakeholders and CHW at the stakeholder meeting in Ndop
Registration of beneficiaries
Due to the insecurity prevailing in the division during this period, registration of beneficiaries and the baseline survey were carried out simultaneously in July 2019. These two activities were limited to safe communities at the time. A total of 1,995 beneficiaries were registered from the 13 communities in the division, exceeding the target of 1,900. When registration began, some communities abstained due to fear and threats from various armed groups. Gradually, all 13 communities participated in registration due to Nascent’s outreach efforts through trusted community leaders.
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Beneficiaries registered
# Community # registered % registered
1 Bamunka 405 20%
2 Bamali 50 3%
3 Bambalang 210 11%
4 Bamessing 308 15%
5 Baba 1 252 13%
6 Babungo 120 6%
7 Babessi 133 7%
8 Bangolan 79 4%
9 Balikumbat 259 13%
10 Bafanji 98 5%
11 Balifashu 35 2%
12 Baligansen 25 1%
13 Bamunkumbit 21 1%
Total 1,995 100%
Baseline Survey
The survey measured the experiences of target beneficiaries on specific food insecurity outcomes such as food anxiety, food preference, food availability, food quality, meal sizes and food consumption. The Household Hunger Scale (HHS) tool was administered to 225 respondents in June 2019.
Food Anxiety: Results revealed that 72.9% of households experience food anxiety; with 25.3% and 46.7% recalling food uncertainty for 10+ times and 3-10 times respectively in the past four weeks. Only 27.1% of households had minimal food anxiety. Average scores were 2.6, with a median of 3.0.
Food preference: Only 10.7% of households were able to consume preferred food. Since most of the respondents have minimal educational attainment (78.8% have less than a secondary qualification), the inability to eat preferred food was common. Within this social class, 95.5% of the respondents acknowledged that they do not have the ability to eat the kind of food they prefer due to lack of resources.
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Fumigation of warehouse and reception of commodities
For security reasons, Nascent chose a warehouse in Bamenda, 50km from the project site. Fumigation was conducted by the phyto-sanitary staff of the Ministry of Agriculture and Rural Development. Nascent received a total of 75 tons of Harvest Lentil Pro in August 2019 and December 2019.
Warehouse containing Harvest Lentil Pro in Bamenda Training on positive health practices
Nascent and Ndop district health authorities led a training to build the capacity of CHW on handwashing and its importance in disease prevention, safe food preparation and positive dietary practices, and safe water treatment. Training materials from previous Nascent projects in the same region of Cameroon were utilized.
CHW then replicated these trainings among beneficiaries during commodity distributions and other select periods.
Number of Participants Trained
Community # Participants trained % Participants trained Bamunka 428 36% Bambalang 34 3% Bamessing 71 6% Bamali 15 1% Babessi 138 12% Baba 1 135 11% Babungo 80 7% Bangolan 52 4% Balikumbat 53 4% Bafanji 100 8% Balikumbat 35 3% Baligashu 40 3% Baligansen 15 1% Total 1,196 100%
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Theoretical and Practical Demonstration on Hand washing in Bamunka, Ndop
Local transportation of commodities
Nascent contracted a local transporter - God is Great Transportation Company - to move commodities from the warehouse in Bamenda to the distribution sites in Ngoketunjia Division. The prevailing insecurity in Ngoketunjia required Nascent to obtain a special authorization from the governor of the region. If roads were inaccessible, Nascent field agents used motorcycles to move commodities, as they are more mobile and less of a target for banditry.
Offloading commodities upon arrival in Bamunka, Ndop. Distribution of Harvest Lentil Pro
The first distribution began in August 2019 among the nine communities that had completed beneficiary registration. Two months’ ration was given to each family head according to their respective family sizes. The distribution took place at community health centers. In a community like Balikumba where the health center had been taken over by the military, a safer location (often the home of the CHW) was chosen. Due to security concerns, Nascent’s distribution was done behind closed doors for fear of harassment and attack by armed groups. Beneficiaries arrived in small groups and were served gradually to avoid pulling large crowds that could attract armed groups. Trained CHW discreetly led the distribution exercise, remotely supported by Nascent Solutions staff (Nascent could not travel to communities for fear of kidnapping). See “Output reporting” for details on direct and indirect beneficiaries reached.
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Beneficiaries pose after receiving food in Balikumbat
Challenges, Achievements, And Lessons Learned Challenges of the context
Nascent implemented this project in an extremely difficult context, including ongoing socio-political unrest and occasional violence. Specifically:
• Registration of beneficiaries was impeded by threats from armed groups. • Some communities were not receptive to humanitarian activities; registration of beneficiaries in these communities started late. • Transportation of commodities to some communities was difficult as roads were blocked by armed groups, so the transporter had to use motorcycles. • Beneficiaries were harassed in some villages and food seized by armed men. • Harassment and demand for bribes from police and armed groups during food movement. • Constant lockdowns, “ghost towns”, and election-related threats suspended activities in February 2020, just after food was distributed. • Distribution was done without any publicity for fear of intimidation by armed groups. Since beneficiaries were already identified and registered, CHW were able to inform them via SMS, word of mouth, or through village associations. • Some CHW were arrested by leaders of the armed groups who queried the source of the commodities. Nascent’s project coordinator talked to the armed groups to secure the release of our CHW. • Some CHW evacuated their assigned zones of implementation for fear of violence between the armed groups. • The project team could not access remote communities for fear of being kidnapped. The CHW were empowered to do the distribution. Achievements by Nascent
• Nascent registered 1,995 beneficiaries, exceeding the 1,900 target. • Baseline survey was carried out with 225 respondents, meeting the target. • 75MT of Harvest Lentil Pro was successfully transported from Douala and stacked at the Bamenda warehouse. It was all distributed. • Nascent reached1,970 direct beneficiaries and 10,225 indirect beneficiaries.
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• Nascent delivered training to 1,196 persons on positive health practices. Lessons Learned for the future
• Nascent must be proactive and anticipate threats when working in insecure contexts. • Neutrality is important when working in a politically charged environment. It is important for frontline humanitarian workers to professionally frame negotiations and ensure open communication while dealing with armed groups. Information shared during the humanitarian cluster meetings guided planning of field activities. • Health centers are generally safe locations. The health officials loaned halls for meetings and provided information from the cluster meetings. • It was very useful to have the governor provide a permit to allow transportation of commodities from the Bamenda warehouse to the communities in Ngoketunjia for distribution. The permit greatly curbed police harassment during transit.
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Outcome reporting The project evaluation consisted of a baseline and final project evaluation. Nascent worked with Community Health Workers (CHWs) representing 13 communities in Ngoketunjia division to collect data. A simple random sampling technique was used, with a focus on household hunger outcomes. The HHS measurement tool was used for and administered to 225 respondents in each evaluation.
The study explored the experiences of the target beneficiaries on specific food insecurity outcomes, such as food anxiety, food preference, food availability, food quality, food quantities, meal sizes and food consumption. Key results of the evaluation are presented in the table below.
Baseline Final HHS raw HHS Evaluation Evaluation Difference Baseline Final Category score (June 2019) (March 2020) Median 3.0 1.0 Little to 27.1% 54.7% +27.6 percentage no points hunger Average 2.6 1.5
Moderate 47.1% 39.2% -7.9 percentage hunger points
Severe 25.8% 6.1% -19.7 percentage hunger points
The final evaluation shows a substantial positive change in the HHS from baseline for the households interviewed. On average, the average HHS score moved from 2.6 at the baseline to 1.5 at the final evaluation, while the median HHS score moved from 3.0 to 1.0. This shift signals that respondents are experiencing hunger less frequently than at baseline. If respondents are categorized by hunger level, the percentage of respondents experiencing little to no hunger doubled from baseline to final evaluation. Households experiencing moderate to severe hunger decreased by 7.9 and 19.7 percentage points, respectively.
Though it appears that Nascent’s project is associated with an improvement in the percentage of households experiencing hunger, the evaluation design – notably, the lack of a comparison group due to a lack of resources - does not allow for the isolation of the contribution of the project to this change.
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Output reporting
First distribution direct beneficiaries (Aug 2019)
Community Total Males Females <18 19-34 35+ Boxes Distributed
Bamunka 325 117 208 35 207 83 392
Bambalang 86 32 54 7 21 58 120
Bamessing 220 74 146 32 103 85 301
Bamali 50 17 33 8 42 35
Babessi 78 21 57 12 25 41 109
Babungo 102 19 83 4 34 64 105
Baba1 231 37 194 29 78 124 291
Balikumbat 292 82 210 140 90 62 275
Bafanji 101 7 94 40 61 87
TOTAL 1,485 406 1,079 259 606 620 1,715
First distribution indirect beneficiaries (Aug 2019)
Community Total Male Females <18 19-34 35+
Bamunka 1,705 631 1,074 724 738 243
Bamessing 1,250 525 725 255 557 438
Bambalang 284 178 106 132 74 78
Bamali 197 93 104 91 49 57
Babessi 279 116 163 115 78 86
Babungo 410 151 259 209 175 26
Baba 1 1,319 389 930 722 425 172
Balikumbat 1,385 500 885 784 421 180
Bafanji 394 112 282 160 117 117
TOTAL 7,223 2,695 4,528 3,192 2,634 1,397
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Second distribution direct beneficiaries (Feb 2020)
Community Total Male Female 0-18 19-34 35+ Boxes distributed
Bamunka 539 141 398 6 153 380 800
Bamali 49 13 36 0 12 37 102
Bambalang 220 63 157 16 53 151 363
Bamessing 219 56 163 10 44 165 500
Babessi 108 23 85 8 38 62 250
Bangolar 87 20 67 5 35 47 155
Baba 1 259 51 208 2 52 205 450
Babungo 145 26 119 19 36 90 250
Balikumbat 132 44 88 0 37 95 410
Bafangi 125 25 100 0 43 82 194
Bamunkumbit 24 10 14 0 2 22 40
Baligashu 39 14 25 1 11 27 63
Baligansen 24 10 14 0 9 15 45
Total 1,970 496 1,474 67 525 1,378 3,622
Second distribution indirect beneficiaries (Feb 2020)
Community Total Male Female 0-18 19-34 35+
Bamunka 2,860 1,487 1,373 1,570 981 309
Bamali 277 130 147 99 79 99
Bambalang 1,126 533 593 716 288 122
Bamessing 1,425 749 676 700 514 211
Babessi 587 197 390 355 128 104
Babungo 566 286 280 304 194 68
Baba 1 1,426 780 646 666 383 377
Bangolar 347 168 179 203 90 54
Balikumtal 684 335 349 462 174 48
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Bafangi 506 214 292 247 181 78
Bamunkumbat 151 83 68 83 46 22
Baligashu 164 85 79 38 108 18
Baligansen 106 41 65 43 45 18
Total 10,225 5,088 5,137 5,486 3,211 1,528
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