WAJIR SOUTH SUB COUNTY , KENYA th th 7 to 17 October 2013 Caroline Njeri KIMERE ACKNOWLEDGEMENTS Special thanks are expressed to; • European Commission Humanitarian Office (ECHO) and Department For International Development (DFID) for the continued financial support to Save the Children Nutrition program and for funding this survey. • Coverage Monitoring Network (CMN) for the support provided through remote technical support by the RECO Inés ZUZA SANTACILIA. This survey would not have been possible without training provided initially and the support received through email during the data collection and analysis. • The Save the Children International (SCI) team in Wajir South, Wajir East and Nairobi. In particular, the Nutrition Specialist (Irene Soi) for her support in coordinating the SQUEAC survey at the field level. Thanks to the Health and Nutrition Programme Manager (Rahab Kimani) for her collaboration and support. We thank the Nutrition Coordinators (Lynette Dinga and Adan Abdille), Nutrition Officer (Daniel Wanyoike), data clerk (Farah Adan) and the enumerators for their tireless efforts to ensure that the survey was conducted professionally and timely. • The Ministry of Health (MoH) for their support and commitment especially the County Nutrition Coordinator (Nuria Ibrahim Abdi) and all the health workers who participated in the survey • The Survey team (enumerators and drivers) for their tireless efforts to ensure that the survey was conducted professionally and on time. • Community members who willingly participated in the survey and provided the information needed. • This study would not have been possible without the hard work and commitment of everyone involved. 2 EXECUTIVE SUMMARY Wajir South Sub-County is one of the 4 sub-counties in Wajir County in North Eastern Province (NEP) of Kenya. Save the Children has been implementing programmes in Wajir South district since July 2009.. Save the Children has partnered with Ministry of Health (MOH) in Wajir South and Habaswein districts to provide health and nutrition services. Save the Children is supporting 38 locations/settlements (23 outreach sites and 16 health facilities) to integrate management of acute malnutrition (IMAM), provide quality preventive and curative health services, and water sanitation and hygiene (WASH). Currently, 38 Outpatient Therapeutic Programmes (OTP) sites are functioning in both Wajir South and Habaswein district. There is also one stabilization center. Save the Children has supported community-level volunteers who are engaged in screening and mobilizing children under 5 and pregnant and lactating women. They detect cases of some diseases (including malnutrition) and refer them to the outreach sites and health facilities for management. Regarding the nutritional situation, data from SMART survey conducted in May 2013 shows the following: Global Acute Malnutrition and Severe Acute Malnutrition (SAM) rates were 10.5 % (7.9 - 13.5 95% C.I.) and 1.6 % (0.8 -3.1 95% C.I.) respectively. Resume of coverage assessment The coverage assessment was conducted to evaluate access and coverage of the Community based Management of Acute Malnutrition programme for children ages 6 to 59 months with SAM. It conducted between September 6th and 17th October 2013 and it was the fourth Coverage survey to be conducted in Wajir South Sub County. It was conducted at the end of the Haggai dry season. 2013 (October) Year 2010 (April) 2011 (April) 2011 (December) Assessment SQUEAC SQUEAC SQUEAC SQUEAC Coverage Point: 61.1% Point: 50.0% Point: 54.0% Point: 42.6% results (95% CI: 43.2-77.1) (95% CI: 29.4-70.7) (95% CI: 39.1-68.8) (95 CI 29.2%-57.0%) The SQUEAC methodology used consisted of 3 stages, applying the principles of triangulation (by source and method) and sampling to redundancy. The table below presents the main barriers on which the program must act to improve coverage as well as the boosters to the programme coverage. 3 Barriers Boosters Long Distance to HFs/Outreaches Good inter-linkage between community and (by CHWs follow up) Shortage of Staff at and high Staff turn over Awareness of OTP and MUAC by caretakers and the community RUTF shared, seen as food and sold in the Good mobilization (Acceptance of program) shops Nomadism/Migration Good integration at in services provided (Allows SAM Screening) Lack of ownership of management of Referrals from CHWs malnutrition by MOH Collaboration and referral from TBA Recommendations 1. Improve on community sensitization 2. Deliberate incorporation of varied sources of referrals (Sheikhs, Traditional healers) 3. Advocacy on Importance of RUTF and on availability of essential drugs 4. Come up with ways to address the chronic staff shortage in the district 5. Improve on the data quality 6. Strengthen joint planning and coordination with MOH and other partners 4 CONTENTS 1. INTRODUCTION ........................................................................................................................................................................................................... 7 1.1 CONTEXT ........................................................................................................................................................................................................... 7 1.1.1 Overview of the area .......................................................................................................................................................................................... 7 1.1.2 Nutritional situation............................................................................................................................................................................................ 8 1.1.3 Health access in Wajir South district................................................................................................................................................................... 9 1.1.4Nutrition services ................................................................................................................................................................................................. 9 1.2 SAVE THE CHILDREN IN DISTRICT .................................................................................................................................................................... 10 1.3RESULTS OF PREVIOUS SQUEACS IN WAJIR SOUTH ........................................................................................................................................ 11 2. OBJECTIVES ................................................................................................................................................................................................................ 12 2.1MAIN OBJECTIVE ........................................................................................................................................................................................................ 12 2.2SPECIFIC OBJECTIVES ................................................................................................................................................................................................. 12 3. METHODOLOGY ....................................................................................................................................................................................................... 13 3.1GENERAL OVERVIEW ................................................................................................................................................................................................. 13 3.2STAGES....................................................................................................................................................................................................................... 14 Stage 1: Identification of potential areas of high and low coverage and access barriers .......................................................................................... 14 Stage 2: Confirms the location of areas of high and low coverage ............................................................................................................................ 15 Stage 3: Wide area survey conducted to estimate overall coverage. ........................................................................................................................ 16 3.3ORGANIZATION OF THE EVALUATION ....................................................................................................................................................................... 18 3.3.1 CMN technical support ..................................................................................................................................................................................... 18 3.3.2 Team training, logistic organization and evaluation development ................................................................................................................... 19 3.4LIMITATIONS .............................................................................................................................................................................................................. 19 4. RESULTS ........................................................................................................................................................................................................................... 20 4.1STAGE 1 ....................................................................................................................................................................................................................