SUMMARY REPORT OF A JOINTSEMI-QUANTITATIVE EVALUATION OF ACCESS AND COVERAGE (SQUEAC) SURVEY FOR NUTRITION PROGRAMMES, IN GABILEY AND BURAO DISTRICTS (SOMALILAND), BOSSASO DISTRICT (PUNTLAND), BELET XAAWA AND LUUQ DISTRICTS (SOUTH CENTRAL, SOMALIA). October – November 2017 Survey Funded by: Report compiled by consultants: Anthony Kanja and Kevin Mutegi CONTENTS CONTENTS ........................................................................................................................................ii LIST OF TABLES ................................................................................................................................ iii LIST OF FIGURES ............................................................................................................................... v ACKNOWLEDGEMENTS ................................................................................................................... ix ACRONYMS ...................................................................................................................................... x EXECUTIVE SUMMARY .................................................................................................................... xi Table 2-16 Recommendations for 2017 SQUEAC ..................................................................... xvii 1 INTRODUCTION ....................................................................................................................... 1 1.1 Survey Background ........................................................................................................... 1 1.2 Purpose of the study ........................................................................................................ 1 1.3 Justification for the survey ............................................................................................... 2 1.4 Objectives of the survey ................................................................................................... 2 1.5 Methodology .................................................................................................................... 2 2 GABILEY & BURAO DISTRICTS (SOMALILAND) COVERAGE INVESTIGATION ........................... 3 2.1 INTRODUCTION ................................................................................................................ 3 2.1.1 Nutrition programs in Gabiley .................................................................................. 4 2.1.2 Nutrition programs in Burao ..................................................................................... 4 2.2 INVESTIGATION PROCESS ................................................................................................. 5 2.2.1 Survey Team & training............................................................................................. 5 2.2.2 Data Quality Management........................................................................................ 5 2.2.3 Challenges ................................................................................................................. 6 2.3 FINDINGS .......................................................................................................................... 6 2.3.1 STAGE 1: ROUTINE PROGRAM DATA AND QUALITATIVE DATA ANALYSIS ............... 6 2.3.2 STAGE 2: HYPOTHESIS TESTING ............................................................................. 28 2.3.3 STAGE 3: WIDE AREA SURVEY ................................................................................. 32 2.4 DISCUSSION .................................................................................................................... 64 2.5 RECOMMENDATIONS ..................................................................................................... 67 2.5.1 Review of uptake of Gabiley District Year 2016 SQUEAC recommendations ........ 67 2.5.2 Gabiley District Year 2017 SQUEAC recommendations .......................................... 70 2.5.3 Burao District Year 2017 SQUEAC recommendations ............................................ 73 3 BOSSASO DISTRICT (PUNTLAND) COVERAGE INVESTIGATION.............................................. 77 3.1 INTRODUCTION .............................................................................................................. 77 3.1.1 Nutrition and Health Interventions in Bossaso District .......................................... 77 3.2 FINDINGS ........................................................................................................................ 79 3.2.1 STAGE 1: ROUTINE PROGRAM DATA AND QUALITATIVE DATA ANALYSIS ............. 79 3.2.2 STAGE 2: HYPOTHESIS FORMULATION AND TESTING ............................................ 99 3.2.3 STAGE 3: WIDE AREA SURVEY ............................................................................... 105 3.3 CONCLUSION ................................................................................................................ 115 3.4 RECOMMENDATIONS ................................................................................................... 116 3.4.1 Bossaso SQUEAC 2017 Recommendations ........................................................... 116 4 BELET XAAWA AND LUUQ DISTRICTS (JUBALAND) COVERAGE INVESTIGATION ................ 117 4.1 INTRODUCTION ............................................................................................................ 117 Consolidated Report of a Joint Semi-Quantitative Evaluation of Access and Coverage (SQUEAC) Survey in Somaliland, Puntland and Jubaland states in Federal Republic of Somalia, October-November 2017 Page ii 4.1.1 Nutrition programs in Belet Xaawa& Luuq ........................................................... 117 4.1.2 Objectives of the survey ....................................................................................... 119 4.2 INVESTIGATION PROCESS ............................................................................................. 120 4.2.1 Survey Team & training......................................................................................... 120 4.2.2 Challenges ............................................................................................................. 120 4.3 FINDINGS & DISCUSSIONS ............................................................................................ 120 4.3.1 STAGE 1: QUANTITATIVE AND QUALITATIVE DATA ANALYSIS ............................. 120 4.3.2 STAGE 2: HYPOTHESIS FORMULATION AND TESTING ......................................... 146 4.3.3 STAGE 3: WIDE AREA SURVEY ............................................................................... 149 4.4 CONCLUSION ................................................................................................................ 158 4.5 RECOMMENDATIONS ................................................................................................... 160 4.5.1 Review of uptake of LUUQ 2016 SQUEAC recommendations. ............................. 160 4.5.2 Luuq SQUEAC 2017 Recommendations ................................................................ 162 4.5.3 Belet Xaawa SQUEAC 2017 Recommendations .................................................... 164 5 APPENDICES ......................................................................................................................... 165 LIST OF TABLES Table 0-1 Coverage estimates with 95% Confidence Limits .......................................................... xii Table 0-2 Key Boosters and Barriers in Gabiley Survey ............................................................... xiii Table 0-3 Key Boosters and Barriers in Burao Survey ................................................................. xiv Table 0-4 Key Boosters and Barriers in Bossaso Survey ............................................................... xv Table 0-5 Key Boosters and Barriers in Belet Xaawa Survey ........................................................ xv Table 0-6 Key Boosters and Barriers in Luuq Survey .................................................................... xvi Table 0-7 Summary Recommendations for 2017 SQUEAC .............. 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Table 0-8 Pending issues from 2016 SQUEAC Recommendations in Luuq district ..................... xxi Table 0-9 Pending issues from 2016 SQUEAC Recommendations in Gabiley district ................xxii Table 2-1 Boosters, Barriers, Sources and Method in Gabiley District ........................................ 14 Table 2-2 Key for Interpreting BBQ Sources and Methods in Gabiley District ............................ 15 Table 2-3 Boosters, Barriers, Sources and Method in Burao district ............................................ 26 Table 2-4 Key for interpreting BBQ Sources and Methods in Burao district ............................... 27 Table 2-5 Synthesis of boosters and barriers in Gabiley District .................................................. 33 Table 2-6: Summary Prior mode for Gabiley District Assessment ................................................ 35 Table 2-7: Village sample size in Gabiley District ........................................................................... 37 Table 2-8 MCHN program coverage in Gabiley District ............................................................... 43 Table 2-9 ANC Visits during Pregnancy in Gabiley District .......................................................... 45 Table 2-10 Synthesis of boosters and barriers in Burao District Assessment .............................