ﺟﻤﮭـــــﻮرﯾـﺔ اﻟﺼـــــــﻮﻣــﺎل Jamhuuriyadda Federalka Soomaaliya اﻟﻔﯿــــــﺪراﻟﯿﺔ ﺣﻜﻮﻣﺔ إﻗﻠﯿﻢ ﺟﻠﻤﺪج Goboleedka Dowlad Wasaaradda Caafimaadka & Daryeelka Bulshada

وزارة اﻟﺼﺤـــــــــــﺔ ورﻋـــــــــ ﺎﯾﺔ Republic Federal Somali Galmudug State of

Ministry of Health & Human Services

Draft meeting minute for health, nutrition and Wash sectors quarterly coordination

MoH Galmudug /Held in Adaado 12-August 2017

Attended Organizations: Absence without apology:

1. MoH-GMS 1. WFP, 2. MoH FGS 2. IMC/Abudwak 3. UNICEF 3. SORDO 4. MoH and Aid Coordination-Gms Absence with apology: 5. IMC(), IRC, SK, SCI, TOUS, HDRO, SAF- UK, CPD, CISP, CESVI, ADESO, MERCY USA, 1. SRC SDRO, WCI, DEH,SORRDO 2. KAAH

Background

The meeting was organized by Ministry of health of Galmudug with close collaboration FMoH, and participated by Health, Nutrition WASH and Food security IPs operating in THE state as well as UNICEF, FMoH, Galmudug Ministry of Humanitarian and disaster management, then followed by introductory session leaded by Director General MoH Dr. Abdiwali Ahmed, he welcomed participants and invited them to introduce themselves, and proceeded with the next agendas.

The DG emphasized the objectives of meeting, which is current drought situation and scale up response interventions, identify key Gaps for integrated Health, Nutrition/food security and Wash, necessity of Registration and Signing MOU among IPs and State MoH, reviews the new

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

draft Galmudug Health Sector Strategic plan HSSP II for the the period of 2017-2021 and preliminary joint assessment of MoH-Galmudug and UNICE.

The Mister of health H.E Naima Mohamud opened the meeting and talk about the importance of such kind coordination meetings for sharing information, identify gaps, overlaps and progress existing in areas and painted deteriorate drought condition in state and its impact to health, nutrition , water and food security which needs scale up the response, also point out Galmudug MoH are responsible and accountable the health, Nutrition and WASH activities existing and upcoming in the areas and IPs are intend to implement the priority areas and locations in order to improve leadership and collaboration.

Followed by head of coordination and communication unite Minister of health federal government of Somalia and emphasis the important of coordination and filling the gaps in order to improve service delivery, he also mentioned the outcome of this meeting is to improve leadership of human resource of health of MoH Galmudug. Mohmaed Amin highlighted that this time IPs are intended to implement the priority areas and activities under HSSP, any implementation and activates with consultation to states and federal MoHs are not considered.

Brief update OCHA Inter-agency assessment : the assessment have been conducted in Galgadud region between 30 July and 4 August 2017, Two planning meetings were held in Cadaado and Dhusamareb towns in attendance of respective authorities in 29 and 31 July 2017 and carried out by 28 organizations with support and collaboration Local authorities of Cadaado, Dhusamareb, Cadaado, BalamBale, Abudwak, Guriel and Heraale as well as the Ministry of Health, Ministry of Education, Ministry Humanitarian Affairs, Aid Coordination Authority, and Ministry of Water Resources. The Draft report will be coming soon. The assessment objectives are:

• Identify and inform partners on needs and gaps for immediate response and additional resource mobilization. • Provide recommendations for response based on the findings.

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

• Estimate the number of people affected and displaced by the drought and conflict.

Preliminary finds UNICEF mission Galmudug : the assessment have been conducted by UNICEF national teams in 6-12 august 2017 with support for Galmudug state line Ministries and private sectors as well local authority in Dhusamareb, Guriel, Adaado and Galkacyo , the main gaps they observed during the mission is shortages food due to consequence of drought , limited WASH intervention offered in health facilities as well schools, increase number of IDP due to prolonged drought , deteriorating malnutrition situation existing in areas, the draft will be came up soon .

Health, Nutrition, WASH and foods security programmes updates, supplies and challenges

SAF-UK – Is implementing an integrated Health and Nutrition Program in Afbarwaqo, Dhinowda and FixedMCH/OPD in Buqda supported by UNICEF.

SWISSO – Kalmo : has been implementing health and nutrition projects for more than 4 years in Galgadud, and funded by UNICEF and SK running 2 RHC, 6HC,10 PHU and 2 mobile clinics, as well Sub-National cold chain Hub which supplied 42 Facilities and 16 mobile teams. The main challenges is due to Long drought which affects the well-being of the entire population especially the vulnerable women and men, Lack of WASH components in the health programs, Ever increasing number of new patients admitted at the OTP/SCs sites, Urgent need of BSFP and water trucking to the community, Disproportionate distribution of SHF funds to the state of Galmudug.

IRC: support Galkacyo South, Dhusamareb, and Guriel hospitals and partners with MDO and Swiss kalmo.

In Galkacyo south IRC provide referral services for identified severe morbidities, high risk and complicated pregnancy cases, provide medical supplies and pharmaceuticals for general morbidities targeting all diseases received within the supported service departments. Provide outpatient consultations targeting immunization of children below the age of five years. Conduct formal and informal training, targeting health care providers and beneficiaries at the facility and community level.

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

Implement GBV screening services, Through DFID funding as well responding to drought emergency in Galkacyo south, Through ECHO funding IRC is supporting health including RH services in GSH and partner with MDO at GSH and other partners.

IRC support Hanaan Hospital and Guriel Hospital partnership with Swiss-kalmo and supports the cost of health care, including staff salaries, essential equipment, clinical supplies and consumables, laboratory supplies and medical pharmaceuticals, including drugs, trainings to staff of HH/GH, through DFID funding supports nutrition activities in Guriel and Hannan hospitals as well OFDA funding which is supporting health activities in Hanaan hospital.

TUOS: implementing Nutrition project in Dhusamareb and Guriel district and partner with UNICEF with PCA star 13 March 2017and 29 February 2019 and running 3 Mobile OTP and 1 Fixed OTP centre, however the main is challenges is delay for Supply of EPI as well NHHP supply delivery and lack of integration Health Mobile team with nutrition OTP.

SCI: are implementing emergency and developmental projects, in emergency SCI implementing Emergency AWD/CHOLERA response (Integrated Wash/Health), Project Target locations is 4 ORPs rural village,1 (CTC), 4 IDP settlements and 15 rural villages, with 2,700 of beneficiaries for average of 30 cases per day over a 90-day period. On developmental projects SCI provide Durable solution for IDPs and returnees in Somalia (DRIS)the projects targeting five integration and social cohesion sectors which is Health, WASH, Education, Child Protection, GBV and Livelihood, the target beneficiaries is 90,000 persons (12,000 households - HHs) -72,000 from IDP settlements. The Target locations is 2 IDP settlements as well 4Host communities.

SCI also hopes the upcoming SOM-SIDA local health project which is Not fully approved and covers 1RHC Partially functional ,2 HC Partially functional and planed7 PHU as well 2 mobile /outreach unite, the project internal kick of meeting will be held when it is fully approved and implemented through MOH-Galmudug.

IMC: IMC currently running Galkacyo hospital through ECHO Supports for Health and Nutrition, the projects cover Medical and Surgical curative and treatment for adults, Medical and Surgical curative and treatment for paediatrics supported by ICU unit, Stabilization center for under five malnourished children with medical complications.the project duration is from 1st Feb 2017 to 31st November 2017. SAM children aged 6-59 months without medical complications

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

through weekly distribution of RUTF and routine medications, Inpatient and outpatient diagnostics and treatment of TB cases.

OFDA: support Provision of one full health Center supported with 24 hrs. BEmNOC services and 10 subsidiary primary health units. Two mobile health clinics integrated with OTPs services that support the 10 PHUs. The projects during is from 1st July 2017 to 30th June 2018. Complementary support from World Vision/Global Fund TB Program and UNICEF in-kind Support of Nutrition supplies for SC & OTP.

IFRP: Prevention of acute malnutrition among children aged 6-36 months and follow-up of children aged 6-59 months who recovered from SAM in Galkacyo South, Somalia through distribution of a Medium Quantity Lipid-based Nutrition Supplement (MQ-LNS) through a blanket supplementary feeding program (BSFP) for a period of six months in 2017 to specifically cover the most critical lean period. The project will run from 1st April 2017 to 31st November 2017. The main challenges are Geographical border lines for districts is not clear and existences of different many conflicting information available in the internet, Lack of realistic population estimates in most of the towns and villages.

CESVI: Cesvi implementing health nutrition, WASH Food security in both Mudug and Galgadud regions, for health CESVI runs 4HC ,3 PHU, in nutrition CESVI implementing3 mobile OTP Galkacyo IDPs, 4 fixed OTP and SC rural villages. Challenges are nutrition Supplies especially newly Plumpynut made in which cause Diarrhea in severe acute malnutrition.

SDRO: SDRO implementing health, Nutrition, WASH and food security, for Nutrition SDRO running 5OTP in Galkacyo & , 12 TSFP in Galkacyo in 3 BSFP sites Galkacyo District In health SDRO was running 2 HC Galkacyo & Bandiradley until 15July, 2017,SDRO also was implemented Water trucking 31 Villages and Distribution Hygiene kit 5,217 HH in and Jariban & Hobyo districts 5 weeks May – June 2017 and Rehabilitated of 9 Boreholes.

Challenges, shortages fund gaps Galkacyo south HC and Bandiradey HC supported by SDRO

CISP: CISP works for Health and Nutrition programs in Ceeldheer and of Mudug and Galgadud Regions since 1993, currently CSP running TB, HIV centers and SHF (Emergency Health for 9month May to Jan2018 for 7 MCHs and 2 General Hospital in both Districts),

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

challenges lack of nutrition program in the 7 MCHs in Elder and Harardere, lack of SC in Harardere and Elder SC supported under EPI/Nutrition project is in gap since July.

Mercy USA: Mercy USA implementing Integrated Health and Nutrition Programme in Mudug and Galgadud, Mercy UAS currently running 10 Health centers and 13 PHUs with Target Beneficiaries 71,008 for a period of current PCA –July2017-feb 2018.

Mercy USA also have sub- Field Level Agreements with WFP for TSF programs on MCHN /BSFP in both Galgadud and Mudug the program period is April– August 2017 and targeted 64,588 community members, inclusive of 37,634 children <20,219 pregnant and lactating women (Health and Nutrition) and 79,416 community members directly and indirectly.

The current grant/FLA expires on 31st August 2017; however Mercy USA is in the process of proposal submission and most probably we will have an extension by the end of this month.

ADESO: Adeso implementing Cash Assistance Project for Somalia coastal communities (CAPS)in Mudug Mudug-Hobyo & Jarriban with period Sept 16th 2016 to July 15, 2017 with target beneficiaries 4490 Some completed, other ongoing (500), Amount of transfers is cash assistance for 1,470 HHs x $50/86 for 6 months, CFW work; 525 HHs x $120 for 1 month with 4 Months UCT, Skilled foremen; 21 x $ 144 for 2 months in both Hobyo and jariban districts.

ADESO is also implementing Drought Emergency Assistance Project for rural, pastoral and urban poor communities in Somalia (DEAP) for a period 12 months from April 2017 in Hobyo, the project rehabilitated water source for 4 Shallow wells, 3 Boreholes, Water trucking for 600HH, Distribution of Hygiene kit for 600HH in .

CDP: is implementing WASH emergency response preparedness of prepositioning of WASH supplies at regional supply hub and standby contingency for temporary water supply and hygiene education for Galgadud -Mudug regions at Adado and Galkacyo towns with UNICEF.

CPD is also Implementing SHF funded WASH and food security in Adado, Abudwak and parts of Harardhere. Also DHK funded WASH and Food Security interventions in Adado.

HDRO: Is implementing TSFP and BSFP Nutrition Programs in

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

Deh Relief: Deh Relief is implementing Health and Nutrition programs in Galkayo, Hobyo, Xarardheere and Ceelbuur districts of Galmudug.

For Nutrition, Deh is currently in agreement with Unicef expiring on 30th September 2018, this OTP project is running in Xarardheere and Ceelbuur districts of Mudug and Galgadud, 2 Fixed OTPs and 4 Mobile. It’s designed to support over 25000 U5 and PLW beneficiaries in a period of 2 years. Another OTP program supported by SHF in Hobyo and Xarardheere districts of Mudug, 1 fixed OTP and 4 mobile; this is 9 months program with 5200 U5 and PLWs and will expire on 15th December 2017. Deh also running TSFP/BSFP/MCHN program supported by WFP in Hobyo and Xarardheere districts of Mudg; 4 TSFPs, 2 BSFPs and 1 MCHN.

For Health, there is one program supported by SHF currently running in Galkayo and Hobyo districts of Mudug region; this program will expire on 20th November 2017 and is designed to help over 17000 beneficiaries in the target areas.

Since supplies of both Health and OTPs are received from UNICEF, the only challenge that is faced by the organization is the delay of the supplies and sometimes shortage of some items in the supply.

Other Discussion was SHF in Galmudug Stage:

SHF fund and distribution among partners, locations and priorities was one the discussed hotspots and will see the messaged as annex to the report.

Response for ICCG Intervention in Galmudug

We appreciate the hard work done by UNOCHA and Clusters in Somalia and Galmudug in particular.

Our coordination meeting was overwhelmed by complaint and Questions raised by the partners about how the SHF Galmudug is based on and what criteria has been used, line ministries also been asked what role do they have in the ongoing interventions and planned ones funded by SHF. Is the Galmudug Line Ministries responsibilities to submit the agencies those are workings in the state, and the kind of their interventions they are currently doing in the state and type of intervention needed to be complemented e.g Agency X is running Health and Nutrition in location Y and need WASH and food security to complement the integrated interventions.

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA

In addition, the following criteria needs to be followed:

• Government leadership of the process • Having a proposal in the 2017 SHF/HRP at target location (Galmudug state) • Cluster activeness and participation in meetings • Send monthly reports to the HMIS MoH • Be part of the 4W Matrix • Expertise and areas of presence interventions e.g having an office in the region and managing other projects previously along the one being requested. • Budget suitability vis-a-vis the proposal • Value for money • Technical Proposal-Integration component

For any agency to receive any funding and just in relation to SHF you will ask for the ministry's guidance and leadership on how all the allocations for the region is being done

Following after the discussion in Adaado meeting with will all implementing agencies we have seen and heard the discussions around this issues and would like to suggest:

As MOH Galmudug we are suggesting the following priorities:

1. Areas which are affected by the drought to be put in priority. 2. The agency selected must have a base in that area and fulfill all the criteria mentioned above. 3. It is impossible and not acceptable to be selected any agency which doesn’t have any base in the area. 4. MOH has the legitimate to identify agencies which are operating in Galmudug state and will not endorse any agency which are not operating in that area within the state of Galmudug. 5. MOH also suggest the compilation of the projects e.g.: (Health and nutrition must be integrated with WASH, livelihood and education).

Action points

Action point Timeline Responsible

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA 1. Provide permission letter and signing 2 weeks MoH,IPs MoU between Health, nutrition and WASH partners Operating in Galmudug and MoH-Galmudug

2. Call for massive interventions and scale ASAP MoH- up to prevent further deterioration of GMS,FMoH,UNICEF,WHO,WFP, the condition before Deyr Clusters And the IPs.

3. Estimation districts catchment August MoH-GMS ,IPs population in order to provides EPI supplies of standalone Nutrition implementing partners

4. Urgent cascade training of Health ASAP MoH-GMS,FMoH,UNICEF Facility staff mainly CTCs and CTU

5. Allocation, gap identifications, IP State MoHs ,FMoH, and selection and Priority implementation Clusters From now on related to SHF Fund or any other fund related to Health System to Galmudug should be consultative process led by the Ministry of Health :Annex is attached of criteria

6. Private company/HPs should be August MoH, Private sectors integrated the sectors for regulation and accountability with effective coordination led by the Ministry

7. AWD/cholera Case definition, MoH-GMS declaration and verification should be led by the ministry.

8. Urgent activation of Galmudug state ASAP MoH-GMS,FMoH,WHO,UNICEF level Subnational Clusters(Health, Nutrition and WASH)

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA END

MINISTRY OF HEALTH, GALMUDUG STATE ADADO, SOMALIA